Chronic diseases are a tremendous burden to both patients and the health care system. Preventive strategies are available for many chronic diseases; these strategies include reducing risk factors, detecting and treating disease at an early stage, and managing the disease to slow or stop its progression. Hand in hand with prevention is maintaining ongoing and direct communications with patients about preventive strategies and potential symptoms or warning signs to look for—whether the patient is getting a routine exam or managing a chronic illness. The features in this issue explore preventive care for melanoma and the significance of the patient voice in value-based care discussions and models.
Today, melanoma is the fifth most common cancer among men and women. The incidence of melanoma affecting individuals aged 15 to 39 years has increased significantly. Sunscreen is a relatively cost-effective preventive tool that may reduce the incidence of melanoma, however, it can be cost prohibitive for lower socioeconomic populations. New York State (NYS) Medicaid, the primary insurer for the underserved in NYS, does not provide coverage for sunscreen. Dawn Queen, MD, and colleagues developed a model testing the hypothesis that NYS Medicaid coverage of sunscreen for pediatric beneficiaries is a cost-effective strategy for decreasing the burden of melanoma (page 51). They conducted a cost-effectiveness analysis using a health state transition Markov model based on data from the published literature. Outcomes measured included health costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio.
In 2016, the Center for Medicare and Medicaid Innovation launched the Oncology Care Model (OCM), announcing practice enrollment at then-Vice-President Biden’s Cancer Moonshot Summit. Given President Biden’s historical focus on cancer and strong association with Affordable Care Act reforms, some may think the new administration is likely to pursue innovative payment models for oncology. Theresa Schmidt, MA, and colleagues draw upon prior research on the integration of patient-reported performance measures (PR-PM) in oncology value-based payment programs, including the OCM (page 60). Authors explore recommendations for the Centers for Medicare & Medicaid Services to look beyond prior oncology value-based payment models. Recommendations include: (1) involving patients and caregivers during development and implementation; (2) selecting or developing patient-reported measures and PR-PMs to fill gaps in measuring shared decision-making, health-related quality of life, and goal-concordant care; (3) reducing reporting burden through the use of validated, standardized measures; and (4) providing implementation support.
Finally, Pharma Insight’s column coauthors Elizabeth Oyekan, PharmD, FCSHP, CPHQ, and Andrew Cournoyer, RPh, MBA, focus on three complex drivers contributing to increased health care spending, touching upon specialty drug trends and alternative prescription drug payment models, but they note that real change will come from a more holistic understanding of the health care system (page 47).