The Challenges of Value-Based Care and Why it’s Worth it with Barry Russo
In this episode of Real World Talk, Nick Ritter talks to Barry Russo, CEO of The Center for Cancer and Blood Disorders.
They discuss the benefits and challenges of value-based care (VBC), an approach that takes into account every aspect of a patient’s health instead of focusing on just one issue, like cancer.
[00:22] Introduction — Nick Ritter introduces Barry Russo, CEO of The Center for Cancer and Blood Disorders.
[01:48] Value-based care — Russo explains that VBC has evolved into working on a patient’s entire medical experience (and the cost of that) rather than simply focusing on treating their cancer.
[03:24] How to do VBC — To do VBC, the Center had to set up an infrastructure to follow each patient and monitor their needs. For example, using clinical pathways that standardize processes, risk assessment tools, and electronic care to improve communication.
[08:04] VBC benefits — Russo believes that a VBC approach offers a better standard of care to patients. Every aspect of their health is tracked, including issues outside oncology, and the Center communicates more effectively with other specialists.
[10:44] Data challenge — One of the biggest challenges of VBC is getting data fast enough to make real-time decisions, especially on the payer side.
[12:00] It takes a village — Another challenge of VBC is maintaining effective communication between the many experts the approach requires, who aren’t involved when the focus is only on oncology. For example, dieticians, social workers, physiotherapists and cardiologists.
[14:12] VBC will become the standard — Given that VBC is likely to become the standard approach to healthcare one day, it’s better to implement it now and work through the various obstacles than get left behind.
[17:04] RWD for VBC — Russo appreciates real world data because in many cases, cancer treatments are so established that there are no new clinical trials studying them. And the results go beyond the theoretical.
[20:31] VBC for cancer — VBC oncology programs differ from those in other areas of medicine because the patient is under their care for longer. Patients are likely to experience non-oncological health issues during this time, which the oncology team is still responsible for managing.
[24:37] Cancer is missed under COVID — The COVID-19 pandemic has seen drastic reductions in the rates of screenings for various cancers, which means cancers aren’t being caught at the early stages, leading to a worrying rise in late-stage cases that are harder to treat (and more complex for VBC systems.)
[26:57] Protective measures — The Center has introduced multiple precautions to keep patients safe at their clinics, including a touch-free COVID screening process before entry, UV filtration systems, limited telemedicine, and improved electronic communications.
[33:19] The post-COVID clinic — Russo says the Center will likely keep some of the COVID measures even when the pandemic is over. For example, touch-free temperature checks, the UV filtration system, and more consistent electronic communication with patients.
Value-based care monitors every aspect of a patient’s experience. Where oncology clinics typically focus only on treating cancer, value-based care encompasses every aspect of a patient’s health. Risk assessment tools and a clinical pathway model help the Center’s oncologists constantly check in with patients and standardize medical decisions. Each clinic has a triage site to help manage patients’ symptoms and toxicities, which are sometimes deprioritized under other approaches.
It takes a village to do value-based care. Looking at every health issue a patient is experiencing means connecting with other specialists, including physiotherapists, dieticians, social workers and genetic counselors. Since cancer care tends to be long term, it’s more likely that cancer patients will also experience other health problems while under the care of their oncologists, compared to patients with acute conditions. This is one complication of value-based care in oncology.
Oncologists value the insights real world data offers. Many of the cancer treatments used today have been around for a long time, so there aren’t many new studies into them. Real world data provides an updated look at these treatments. In addition, real world data can look into outcomes that oncologists are really interested in but drug companies often don’t study, such as a patient’s quality of life and the long-term impacts of different medications.