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A seismic shift is occurring in how physicians calculate the value of cancer care. For decades, the merits of a given intervention were often measured primarily using overall survival gains, with even a few months of arrested cancer progression lauded as a major advance. Although some trials still tout such gains as the gold standard, researchers and policy makers are increasingly looking to expand the list of variables—many of them focused on quality of life and other functional outcomes—that need to be included when measuring the true value of cancer treatment.
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November 2015ENTtoday spoke with head and neck surgeons and other experts who are at the forefront of such efforts. Whether it’s a groundbreaking switch away from fee-for-service medicine to a bundled care model aimed at reducing waste while maintaining quality, or healthcare policy statements encouraging physicians to emphasize quality of life and other patient-focused, longer-term endpoints, the physicians behind these initiatives are changing the national dialogue about how we should define—and deliver—value for patients who have a wide variety of malignancies.
The timing of such efforts is not accidental. Recent projections of the cost of cancer care in the United States are staggering. By the year 2020, it is estimated that cancer treatments will cost more than $200 billion annually, according to data from the National Cancer Institute, with head and neck cancers expected to account for nearly $2 billion of that projected spending.
Unbundling the Waste in Cancer Care
The United States’ predominant fee-for-service payment model—in which providers are paid for every office visit, test, and treatment—is often cited as the chief culprit in soaring healthcare spending. That’s partly why an alternative system is being piloted at the University of Texas MD Anderson Cancer Center in Houston.
The pilot, a collaboration between MD Anderson’s Head and Neck Center and UnitedHealthcare (UHC), uses bundled payments as the basis for reimbursement. Under the bundled payment system, providers are paid for a defined episode of care with a single negotiated fee. Proponents say this approach incentivizes the elimination of wasteful tests and procedures and instead challenges physicians to provide care that is laser-focused on achieving the highest quality clinical care at the lowest cost.
MD Anderson appreciated the value of such an approach after seeing it in action in an earlier pilot of breast, colon, and lung cancer that slashed the cost of care by a third while improving key clinical outcomes (J Oncol Practice. 2014;10:322-326).