3 Value-Based Care Lessons for Oncologists

Michael Kolodziej, MD, gave a forceful keynote speech at the Patient-Centered Oncology Care meeting in Philadelphia last night. He said that his goal was to speak the truth, and then he painted oncology’s approach to value as fundamentally broken.

Kolodziej, the Chief Innovation Officer at ADVI Health, is a healthcare analytics veteran with years of experience addressing cancer costs. He previously worked at analytics firm Flatiron Health, and before that he ran an oncology program at Aetna.

The total cancer expenditure cost in the United States is projected to jump from $124 billion in 2010 to $157 billion in 2020, he said, and change will need to come from oncologists if they want to control those numbers.

“If we put our heads in the sand and make believe that money doesn’t matter, we’re idiots,” he declared. “We are going to have to make some hard choices.”

He offered 3 lessons that need to be considered to reverse those costly trends.

The first was that oncologists should stop complaining about treatment costs and start embracing pathways. “We can’t just say ‘I’m a doctor and I know best’,” he said.

He showed the results of a study his team did when he was at Aetna. In a 2-year pilot program of Medicare-aged patients, recommended pathways reduced costs by 18% compared with typical care. Oncologists are not responsible for the cost of therapies, but they are responsible for how and when they are used, he noted.

The second lesson was that end-of-life and palliative care is being executed poorly and needs to be re-evaluated. Allowing constant hospitalizations in late stages of terminal cancer drives up costs without necessarily reducing patient discomfort, Kolodziej said. The number of patients seeing 10 or more physicians in their last 6 months of life rose by more than 3% between 2003 and 2010.

“I took care of a lot of cancer patients, and none of them came to me in the office and said ‘Boy, I’d really like to spend some time in the ICU’,” he joked. He pointed to studies that showed substantial savings from the COME HOME program, which works to keep late-stage cancer patients out of hospitals while maintaining quality of life.

Fixing the hospitalization issue will not be easy, according to Koloziej, but it is possible. Standardization and lay navigators, he said, are a starting point.

The third and final lesson he gave was that such evaluations and adjustments need to start now. With MACRA bearing down on the healthcare system, the cost of patients within a given practice will determine how well that practice is reimbursed by Medicare. Some oncologists have thought that the total costs assessed would not include chemotherapy, but he said they did so mistakenly.

Kolodziej made the comparison to the automobile industry: there was a time when high gas prices dominated headlines just as expensive healthcare premiums do today. General Motors stopped making Hummers, he said, but oncologists are still selling highly inefficient care decisions.

“We come from a time where we had so few choices and we were willing to try anything. [That time] isn’t there anymore, and we need to be okay with that,” he said.