Oncologists see value-based care as beneficial, but rising prescription drug costs are challenging alternative payment model success, a new survey shows.
Approximately 57 percent of community oncologists in value-based care models identified prescription drug costs as their top challenge with alternative payment model success, a recent survey uncovered.
The survey of 530 community oncologists conducted by Integra Connect also showed 93 percent cited rising prescription drug costs as a major issue impacting the overall wellbeing of their practices outside of value-based care.
“With clinical outcomes rightly considered non-negotiable, this data shows that community oncology is seeking new frameworks for understanding the comprehensive value of novel therapies and other high-cost treatments,” Jeffrey Scott, MD, Chief Medical Officer of Integra Connect, stated in a press release.
“It is not an effort they believe that they can – or want to – undertake alone. While oncologists say pharma is not at the table today, they’re expressing the need for new data and insights that only manufacturers can provide. In addition, they foresee the need for closer payer cooperation in order for future generations of value-based reimbursement models to be successful.”
Value-based care is changing how most community oncologists prescribe drugs, including expensive novel therapies.
The survey showed that 87 percent of respondents are thinking differently about drug choices in light of value-based care. In contrast to their prescribing patterns under fee-for-service, the oncologists in value-based care models are now:
- Accelerating efforts to implement precision medicine (30 percent)
- Considering the impact of a therapy’s cost (26 percent)
- Increasing the use of care pathways (17 percent)
- Advancing efforts to predict quality (13 percent)
Thirty-eight percent of respondents also reported swapping drugs for lower-cost therapies when efficacy and toxicity remained the same. Another 38 percent said they are looking to get a deeper understanding of drug value and not just cost to ensure therapies will improve a patient’s outcomes.
Community oncologists said thinking about drug choice and value are necessary to keep cancer episode costs below financial targets in value-based care models. The majority of respondents (54 percent) are participating in Medicare’s Oncology Care Model, a bundled payment program that pays oncologists a fixed amount for chemotherapy administration and ties payment to patient outcomes.
Meanwhile, CMS also requires the oncologists to participate in the Merit-Based Incentive Payment System. MIPS adjusts a provider’s Medicare reimbursement based on their performance in four MIPS categories, which includes costs.
To succeed in the value-based care models, community oncologists said they need more information from pharmaceutical companies to understand drug costs and value. Respondents said they need the following to make more informed decisions about cancer treatments:
- Better data about care quality and outcomes (29 percent)
- Better data about treatment costs (25 percent)
- Increased use of care pathways (13 percent)
- Improved access to appropriate clinical trials (12 percent)
- Increased access to patient-reported outcomes (12 percent)
- Better data about patient experience with treatments (9 percent)
Community oncologists are primarily seeking additional data from pharmaceutical companies. However, the drug manufacturers have not been open to sharing more information with oncologists, the survey indicated.
About 64 percent of respondents said pharmaceutical companies have not been helpful with supporting oncologists who want to understand drug value. Another 25 percent said the companies have been somewhat helpful but only when providers requested additional data.
Conversely, seven percent of respondents received adequate help with understanding drug value and four percent felt pharmaceutical companies are collaborative partners.
Additionally, community oncologists are calling on payers to help them optimize prescribing patterns for value-based care. About 40 percent of respondents said a value-based reimbursement schedule would be the most helpful tool to incentivize oncologists to prescribe novel therapies.
While community oncologists are facing drug cost challenges with implementing value-based care, the providers are still optimistic about the benefits of the new models.
The providers are overwhelmingly interested in joining other alternative payment models. Almost one-half of the respondents (48 percent) are actively seeking participation in models other than the Oncology Care Model, while 39 percent are already in another model and 38 percent are planning to explore other options.
Date: March 22, 2019