Advancing Cancer Care: Unlocking Effective Value-Based Care Models

Value-based care is frequently discussed in oncology and general healthcare, recognized for its potential to tackle significant challenges like reducing costs and improving patient engagement. Despite its promising framework, the real-world application in oncology still encounters numerous obstacles.

Cancer, once commonly associated with older demographics, now affects the working-age population, with a notable rise in diagnoses among individuals aged 20 to 64—often described as the ‘prime working years’. This demographic shift highlights the critical need for refining cancer care strategies to better accommodate and serve this younger population.

Understanding Value-Based Care in Oncology

At its core, value-based care in oncology emphasizes preventive services and long-term health outcomes. It’s also coupled with a payment model where clinicians are rewarded for the amount of value they deliver. Unlike traditional fee-for-service arrangements, where providers are compensated for individual units of care, value-based care aligns incentives with patient outcomes and cost containment efforts.

Despite the intentions behind value-based care, disparities between individual patient experiences and outcomes still exist. Stories of patients navigating fragmented care systems, struggling to access timely referrals or being prematurely discharged from hospitals. These challenges underscore the need for a reevaluation of how value-based care is practiced in oncology.

Leveraging Value-Based Practices

To bridge the gap between theory and practice, healthcare organizations can leverage a range of value-based practices tailored to the unique needs of cancer patients. From utilization management to care navigation and coordination, these practices aim to enhance care quality while containing costs. Standardizing end-of-life care, shifting care settings, and empowering patients through behavior change are critical components of a comprehensive value-based care approach.

Utilization management 

This involves substituting one type of service or product for another that costs less or is bundled more economically. This could help the patient achieve equal (or even better) results at a more affordable price point. 

Care navigation

Cancer care is such a complex journey from the perspective of the patient. It can be overwhelming having to wrap your head around appointments and the various healthcare providers involved. Care navigators are essentially shepherds who guide patients through each step of their treatment — ensuring they understand their diagnosis, the intricacies of their care plan, and helping them access necessary resources. 

Care coordination

Care coordination involves keeping in touch with how the patient is doing outside of the acute care settings, and digital devices are great for facilitating this. You can be alerted of issues (like blood pressure monitoring) much earlier in their progression and nip them in the bud before they become more serious. 

Increasing standardization of end-of-life care

A significant portion of cancer patients will face non-curative outcomes where symptom management becomes important. But at the moment, there’s too much variation between the services delivered. This creates a situation where patients fall through the gaps in terms of how well they’re cared for at this stage. Increasing evidence-based and standardized palliative care not only helps with patient experience, but also reduces cost. 

Substitution of care premises

Historically, oncology drugs have required patient monitoring. But now, if a patient has tolerated a few cycles of treatment, there’s the opportunity to shift care away from high-cost settings (like hospitals) to more cost-effective environments (such as home-based care or outpatient clinics). This can help to reduce the cost of treatment while delivering care in a more comfortable environment for the patient. 

Empowering patients through behavior change

In most complex healthcare encounters (cancer being one) patients who are newly diagnosed often enter this journey as passive recipients of medical care from healthcare professionals. For example, <5% of patients in oncology outpatient settings track symptoms or seek help from professionals to improve exercise during active treatment — both are proven to improve cancer care and cost outcomes. 

Behavior change (previously coined Participatory Health) as a value-based proposition is an often underrepresented term. Research demonstrates that patients with more active participation in their healthcare achieve better outcomes. 

With current technological advancements, it’s much easier for patients to participate actively in their care. 

They can get a better understanding of the disease, and be more in tune with what’s going on with their body. During medical appointments, they can convey the most relevant information to their doctor and partner with them in solving issues. This ultimately helps to improve health outcomes.

Such behaviors only come naturally to a small percentage of patients. So there needs to be more ways to facilitate these self-management behavior changes for the majority. This is what we seek to do at Osara Health which empowers cancer patients through personalized health coaching, education, and community.

When in Doubt, Circle Back to Delivering Value

As healthcare organizations navigate the complexities of value-based cancer care, the fundamental principle remains unchanged: patients are at the heart of our endeavor. Delivering value in oncology requires a holistic approach that considers patients’ diverse needs and experiences. By embracing the variety of value-based practices available, healthcare organizations can enhance the quality of cancer care while fostering a patient-centered approach that prioritizes individual well-being.