JAMA Oncology essay: We need to redefine 'value' in health care

October 13, 2015 | by Tami Dennis

When it comes to health care – especially cancer care – our nation’s current  discussion of “value” needs to evolve, for the good of us all. That’s the take-home message in a powerful new essay published in the influential JAMA Oncology by City of Hope’s Joseph Alvarnas, M.D., director of value-based analytics.

“Owing to their generally higher costs, academic cancer centers (ACCs) may erroneously appear to compare unfavorably with community-based, nonacademic centers in terms of value,” posits the essay, co-written by City of Hope Chief Medical Officer Alexandra M. Levine, M.D., M.A.C.P., and Guy R. Majkowski of RAND Project Air Force.

In fact, the authors contend, nothing could be further from the truth.

Using their expertise in cancer care, and their knowledge of the health care system in general, the authors lay the groundwork  for a new way of looking at value – one based not just on costs but on real value, that is, the most appropriate care delivered at the most appropriate place and with the best outcomes, all at a sustainable cost.

Here is an excerpt from their essay “Moving Toward Economically Sustainable Value-Based Cancer Care in the Academic Setting

“Academic cancer centers are well suited to play multiple roles in this idealized system. Unfortunately, unchecked market forces undermine this ideal. The financial disincentives for managed care organizations and payers are significant and often preclude these entities from consistently referring patients to ACCs. The misalignment of economic incentives and most effective care is best illustrated by the progressive narrowing of coverage networks, many of which do not include an ACC as an option for patients.”

Then the authors -- also thought leaders on this important topic – offer their prescription for change.

Alvarnas, Levine and Majkowski  urge academic cancer centers  to adopt an “innovation-based care model.” Such a model, they say, would help centers achieve economic sustainability and lead to an “eventual cure of cancer itself.”

They then tick off a series of necessary steps to get cancer care where it should be – starting with an unflinching analysis of outcomes, process, cost and risk.

“Providing optimal cancer care to patients is not a zero-sum game,” the authors write. “By rigorously understanding their value propositions, ACCs can unequivocally distinguish themselves from nonacademic community centers to the benefit of both.”

The authors conclude: “With a renewed focus on their distinct value propositions, ACCs can continue to distinguish themselves in ways that will provide the basis for a sustainable economic model capable of delivering the personalized medicine technologies that will eventually eradicate cancer.”

The eradication of cancer – that should be the national conversation. And City of Hope’s leaders are helping to shape it.

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