The financial stats of healthcare are all too familiar – the 18% of GDP, $3 trillion spend, and the $11k per capita cost are frightening to consider. We are on an unsustainable financial trajectory, as those numbers are projected to increase. The costs for cancer care, which include both medical services and drugs, are no different. In 2015, national costs for cancer care were estimated to be $190 billion and just 5 years later, in 2020, the costs ballooned to $209 billion. The 10 percent increase is primarily attributed to the aging and growth of the U.S. population.

As oncology practices transition to value-based care, they are challenged to take on more holistic responsibility for their patient. Fortunately, there are many examples of practices participating in CMS’ Oncology Care Model (OCM) that have made impactful workflow changes to achieve cost and quality improvements. The OCM was the first cancer-specific alternative payment model for Medicare recipients as well as Medicare's first APM for outpatient specialty medicine. Despite several practices succeeding in the OCM, many have not. At this point, the overall results of the APM have been underwhelming. Since the OCM was originally implemented in 2016, the program has led to a $155 million net loss to Medicare. While originally set to expire this summer, to be replaced by Oncology Care First (OCF), the date was pushed back by a year. CMMI can apply lessons learned when launching the OCF, and Texas Oncology is where they can find oncology care that is thriving in the race to value.

Our guest this week is Debra Patt, M.D., PH.D., MBA, a practicing oncologist and breast cancer specialist in Austin, Texas. Dr. Pratt serves as the Executive Vice President for Public Policy, Payer Relations, and Strategic Initiatives at Texas Oncology, a network of 210 sites of service and 490 doctors, serving half of the cancer patients in Texas. In this role she advocates for effective cancer policy at the state and federal level, and advises on strategy for various initiatives, such as telemedicine, optimizing growth and development of advanced practice providers, development of service lines, informatics initiatives and contracting. Her research is in clinical decision support, predictive analytics, telemedicine, health economics and outcomes, tools for patient symptom management and quality improvement. As an expert in healthcare policy, she has testified before Congress to protect access to care for Medicare beneficiaries. She is the editor-in-chief of the Journal of Clinical Oncology- Clinical Cancer Informatics.

Episode Bookmarks:

01:45 Background information on Dr. Debra Patt and her work in Value-Based Oncology Care

05:00 The Country’s Financial Burden of Cancer Care – Why we need to transition from Volume to Value

07:00 The need to anchor our expectations for value differently based on the aging of the population and the advancement of treatment

08:15 Investments inpatient care and drug research is more like a “mortgage” instead of paying “rent”

09:00 How cancer care is bankrupting patients due to out-of-pocket burden

09:25 Many forms of cancer are now being treating like an acute illness instead of a chronic disease akin to HTN or diabetes

09:45 The societal and economic benefits of people living longer upon the initial diagnosis of cancer due to advances in care

10:10 Referencing the book, “The Great American Drug Deal: A New Prescription for Innovative and Affordable Medicines”

10:40 Other investments, outside of new innovations in drugs and therapeutics, that are still needed in value-based oncology care

12:00 The Oncology Care Model (or OCM) -- the first cancer-specific alternative payment model for Medicare recipients

12:45 The underwhelming results of OCM,