When everyone is required to pay the same out-of-pocket amount for oncology services for which benefits depend on patient characteristics and clinical indication, there is enormous potential for both under- and overutilization. Unlike most current health plan designs, the value-based insurance design (V-BID) explicitly acknowledges and responds to patient heterogeneity across the entire continuum of cancer care. By adding “clinical nuance” to benefit design, V-BID encourages the use of services when the clinical benefits exceed the cost, and likewise discourages the use of services when the benefits do not justify the expenditure. This manuscript further describes the concept of V-BID, creates a framework for its development in oncology, and outlines how this concept aligns with ongoing research, care delivery, and payment reform initiatives.
Search Results
Jonas A. de Souza, Mark J. Ratain, and A. Mark Fendrick
Allysen Kaminski, Jyoti Aggarwal, and Gboyega Adeboyeje
inadequate reimbursement mechanisms, a lack of data supporting the tests’ clinical utility, limited adoption of genomic testing in patient care pathways and guidelines, and inadequate resources in clinical settings. Reimbursement concerns are related to the
Katy Winckworth-Prejsnar, James McCanney, Alyssa A. Schatz, Warren Smedley, Leonidas C. Platanias, Cecil M. Benitez, Lee N. Newcomer, C. Lyn Fitzgerald, and Robert W. Carlson
bills. The first, the Cancer Care Planning and Coordination Act, 10 would create a reimbursement mechanism in Medicare FFS for care planning and coordination services for beneficiaries with cancer. The second, the Patient Navigation Assistance Act, 11
Leigh Gallo, Ronald S. Walters, Jeff Allen, Jenny Ahlstrom, Clay Alspach, Yelak Biru, Alyssa Schatz, Kara Martin, and Robert W. Carlson
electronic health information is valuable to patients. Patient access to their health data will greatly benefit their well-being and improve cancer care. VI. Congress and payers should promote policies and reimbursement mechanisms that support
Thomas W. LeBlanc and Amy P. Abernethy
barriers remain. The lack of an established reimbursement mechanism for outpatient palliative care, for example, can make starting a clinic difficult even when it is clearly needed. Third, being a young field, palliative medicine has a relatively limited
James McCanney, Katy Winckworth-Prejsnar, Alyssa A. Schatz, Elizabeth A. Nardi, Andrea J. Dwyer, Christopher Lieu, Yelak Biru, and Robert W. Carlson
through active education and research that we can provide high-quality, patient-centered survivorship care for all. Moving forward, there is a need for comprehensive coordinated care across the healthcare system posttreatment, adequate reimbursement
provider Promote policies and reimbursement mechanisms that support interoperability and encourage the aggregation of patient data that will promote shared decision-making and increase understanding between patients, providers, and payers Maintain and
Ndiya Ogba, Nicole M. Arwood, Nancy L. Bartlett, Mara Bloom, Patrick Brown, Christine Brown, Elizabeth Lihua Budde, Robert Carlson, Stephanie Farnia, Terry J. Fry, Morgan Garber, Rebecca A. Gardner, Lauren Gurschick, Patricia Kropf, Jeff J. Reitan, Craig Sauter, Bijal Shah, Elizabeth J. Shpall, and Steven T. Rosen
-cell therapy. Separate from the reimbursement mechanism, CMS recently began a national coverage analysis for CAR T-cell therapy that will be in process until May 2019. Considering the demography of patients with cancer and that patients on Medicare can
