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Contents:
  1. Accelerating the Delivery of Patient-Centered, High-Quality Cancer Care
  2. Accelerating the Delivery of Patient-Centered, High-Quality Cancer Care | Clinical Cancer Research
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  4. 1. Overview

Accelerating the Delivery of Patient-Centered, High-Quality Cancer Care

Thus, providers and manufacturers would view affordability as a mutual and immediate imperative. This approach involves using iterative deliberations among stakeholders to reach the overarching goal of achieving evidence-based use of high-value technologies and dissuading the use of low-value technologies in daily practice The collaboration was associated with positive outcomes such as radiation treatment-related cost savings and improved efficiency in the insurance appeal process However, the slow adoption of high-value treatments and de-adoption of low-value treatments tends to be a more common experience This finding contrasts with the rapid uptake of new technology in radiation oncology When the data are not yet available for newly evolving techniques, payers in particular can help to advance the science of evaluating new technologies.

Although federal agencies continue to allot funds to support such science, resources are limited However, the large—often massive—initial investment for new technologies that must be recouped by the institutions places practitioners in a development trap: developing evidence for comparative effectiveness with no reimbursement is difficult; however, the absence of evidence makes justifying reimbursement difficult.

What begins to be lost in this cyclical trap is the impetus to generate unbiased data to advance the value perspective on new and developing technologies. Can practitioners, institutions, and the scientific community partner with payers as stakeholders to accept a shared risk inherent in the venture to establish the value of new technologies? Such a venture requires generating best evidence in a setting of considerable pressure to avoid the inefficient use of health care dollars for treatments that might or might not be beneficial.

Insurance coverage with evidence development was one solution discussed in this section for overcoming the economic development trap. This strategy would provide an opportunity for practicing radiation oncologists to engage proactively and collaboratively with payers. Quite simply, coverage denial threatens accrual to the very studies required to provide the evidence for or against the use of new technologies. Consistent payer reimbursement for treatment as a part of an evaluative study would support evidence development and help to justify either appropriate adoption or de-adoption of a new therapy Clinicians and investigators engaging payers in the early stages of study design could help to enlist payer support Another developing solution to improve value is to increase price transparency 72 , Addressing this asymmetry could empower patients to seek high-value treatment choices.

Level 1 data on the price transparency approach are eagerly awaited. Increasingly, extrinsic payer and policy factors seek to create incentives or disincentives for practitioners as a solution to improve value in care eg, through quality benchmark incentives and pay-for-performance and usage management and coverage policies.

Accelerating the Delivery of Patient-Centered, High-Quality Cancer Care | Clinical Cancer Research

Moving from an encounter-based fee-for-service payment model to a value-based reimbursement model is still an evolutionary process. The main caution is to avoid unintended consequences of these forces—the possibility that structural changes could slow clinical care or impede access to beneficial treatments. The goal is to provide information and to share decision-making, with providers engaging in empowering patients to take an active role in the adoption or de-adoption of practices through their preferences.

Collectively, such approaches can signal to both market and practitioners a need for different and better innovations. Practitioners in the radiation oncology community can have several critical roles in promoting value, by supporting the ongoing need to generate evidence for the comparative value of radiation treatment options, empowering patients by promoting a patient-centered approach in evaluating treatment value, and partnering with other stakeholders to adopt or de-adopt treatments using a value-oriented framework.


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The increasing costs of health care—and, in radiation oncology, the increasing expense of ever-advancing technologies—have prompted a societal imperative to examine value. The authors are responsible for the content of the article, which does not necessarily represent the views of the National Academies of Sciences, Engineering, and Medicine. Supplementary material for this article can be found at www. Europe PMC requires Javascript to function effectively. Recent Activity. Leaders in the oncology community are sounding a clarion call to promote "value" in cancer care decisions.

Speakers presented on key themes, including the rationale for a value discussion on advanced technology use in radiation oncology, the generation of scientific evidence for value of advanced radiation technologies, the effect of both scientific evidence and "marketplace" or economic factors on the adoption of technologies, and newer approaches to improving value in the practice of radiation oncology.

Discussions of "value" have increased as a priority in the radiation oncology community. The snippet could not be located in the article text. This may be because the snippet appears in a figure legend, contains special characters or spans different sections of the article. Author manuscript; available in PMC Jul PMID: Grace L.

Chmura , MD, James J. Patricia A. Justin E. Steven J. James J. Jason A. Peter A. Michael L. Stephen B. James B.

Anthony L. Ralph R. Author information Copyright and License information Disclaimer. Reprint requests to: Grace L. Tel: ; gro. Copyright notice. See other articles in PMC that cite the published article. Associated Data Supplementary Materials Suppl1. Methods and Materials The workshop convened stakeholders, including oncologists, researchers, payers, policymakers, and patients.

Results Challenges to generating evidence for the value of advanced technologies include obtaining contemporary, prospective, randomized, and representative comparative effectiveness data. Value Proposition in Oncology: A New Discussion Surrounding Medical Device Technologies Choosing high-value cancer treatment involves identifying and selecting treatments that will provide the best possible clinical outcomes and minimize costs to payers, patients, and society 2 , 5 — Increasing Costs of New Technologies in Radiation Oncology We need a value discussion specific to radiation oncology in part because of its overall trajectory of treatment costs, considered an outlier relative to the cost trajectory for other specialties Open in a separate window.

Clinical Evidence, Evidentiary Gaps, and Future Horizons for Research In this section of the workshop, the participants examined clinical research questions and the approaches currently used to address the evidentiary gaps regarding the comparative effectiveness and value of 2 illustrative technologies, IMRT and proton therapy. Use of IMRT The uptake of IMRT has steadily increased during the past decade but has shown signs of reaching a plateau analogous to the end segment of the proposed S-shaped uptake curve for new technologies 14 , 30 Fig. S-shaped curve representing the uptake of new technologies.

Evidentiary gaps in comparative effectiveness research on advanced radiation oncology technologies Obtaining data on comparative effectiveness is critical for promoting the appropriate use of advanced radiation technologies. Future horizons in comparative effectiveness research The discussion in this future horizons section sought to discuss solutions to address evidentiary gaps. Marketplace Factors and Technology Adoption In reality, clinical considerations have not been the sole driver of technology usage.

Defining, Measuring, Promoting, and Improving Value The goal of this workshop section was to introduce paradigms, approaches, and newer solutions for promoting and improving value in radiation oncology. Defining value for radiation oncologists Value in health care has been traditionally conceptualized as outcomes divided by costs, quantified over the entire cycle of care 4. Measuring value Approaches to evaluate value in radiation oncology are evolving. Improving value However, the slow adoption of high-value treatments and de-adoption of low-value treatments tends to be a more common experience Supplementary Material Suppl1 Click here to view.

Suppl2 Click here to view. Footnotes Conflict of interest: none. References 1.

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Young RC. Value-based cancer care. N Engl J Med. American Society of Clinical Oncology Statement: A conceptual framework to assess the value of cancer treatment options.

1. Overview

J Clin Oncol. Institute of Medicine. Accessed June 16, Porter ME. What is value in health care? Radiation oncology: A perspective on health reform and value-based initiatives. J Oncol Pract. Trends in the cost and use of targeted cancer therapies for the privately insured non-elderly: to Delivering high-quality and affordable care throughout the cancer care continuum. Konski A. The war on cancer: Progress at what price?

Wallner PE, Konski A. The impact of technology on health care cost and policy development. Semin Radiat Oncol. US Food and Drug Administration. How to Study and Market Your Device. Grabowski H, Vernon J.