Preparing for Value-Based Payment: A Stepwise Approach for Cancer Centers.

Area of Science:

• Oncology
• Health Services Research
• Health Economics

Background:

• Many cancer centers lack data on population cost of care, hindering value-based payment (VBP) adoption.
• Smilow Cancer Hospital identified significant opportunities to improve care value and manage costs.

Purpose of the Study:

• To outline a stepwise approach for cancer centers to pursue value-based care.
• To identify key drivers of high costs within cancer patient episodes of care.
• To implement strategic interventions to enhance value and reduce unnecessary healthcare utilization.

Main Methods:

• Evaluated patterns of emergency department (ED) utilization and hospital admissions for cancer patients.
• Utilized Medicare Limited Data Set to quantify total cost of care across 6-month episodes.
• Implemented targeted interventions including urgent care, care management, and palliative care referrals.

Main Results:

• 50% of ED visits could have been managed with urgent care services.
• Patients with multiple ED visits or who died during an episode incurred twice the cost.
• Interventions aimed to reduce ED utilization, prevent admissions, and clarify goals of care.

Conclusions:

• A systematic approach addressing institutional barriers and analyzing cost drivers is crucial for VBP.
• Targeted investments in urgent care, care management, and palliative care can improve value.
• Internal metrics are essential for monitoring intervention success and provider performance.