There is a need for hope and innovation in the delivery of value-based oncology care.  Cancer costs are on an alarming trajectory due to the aging and growth of our population. Oncology is currently the 3rd most expensive specialty, but it is growing 3X faster than the top 3 specialties. Unless we find a way to replicate and scale value-based oncology care, it will be soon be the #1 most expensive specialty!  Value-based transformation in oncology is especially needed due to the high variability in cancer costs from state-to-state, as we see a 2-3X cost differential multiple between regional markets, with no correlation between cost and quality.  Eliminating cancer care disparities would prevent 34% of all deaths and save $230 billion in direct medical costs and $1 trillion in indirect costs to society. Furthermore, we are seeing financial toxicity in cancer care that results in 1 in 4 patients declaring bankruptcy within 2 years of diagnosis. And on top of that, 1 in 3 Medicare patients are refusing to fill lifesaving prescriptions due to high out-of-pocket costs. This financial toxicity in cancer care is disproportionately impacting minority and low income communities, leading to increased mortality, decreased quality of life, and lower survival rates.

To find hope and innovation amidst these grim statistics, look no further than The Oncology Institute of Hope and Innovation (TOI). Their highly specialized, value-based cancer care practice delivers cutting-edge, evidence-based cancer care to a population of approximately 1.6 million patients.  Oncology patients undergoing value-based care at TOI experience 40% fewer inpatient admissions, 75% fewer ER admissions, with patient satisfaction scores that are 14% higher than traditional oncology care.  Joining us in the Race to Value this week is Brad Hively (CEO) and Dr. Daniel Virnich (President) from TOI – the largest oncology practices in the US.  They discuss the importance of patient-centered high-quality, outcomes-based cancer care; emerging value-based oncology payment models; patient engagement and care coordination; clinical care pathways; physician compensation methodology; the importance of physician leadership in value transformation; and how to replicate growth at scale when delivery value-based oncology care.

Episode Bookmarks:

01:30 Introduction to the Oncology Institute of Hope and Innovation (TOI), Brad Hively, and Dr. Dan Virnich

03:00 TOI is the first specialty value-based care company to go public (November 2021) and has become one of the largest oncology practices in the US

04:00 The unsustainable financial trajectory of American healthcare with annual costs of cancer care ballooning to $209 billion due to aging and growth of US population

06:00 “Oncology is the 3rd most expensive specialty in the senior population, but it is growing 3X faster than the top 3 specialties. It will soon be the #1 most expensive specialty.”

07:00 “From state-to-state, there can be a 2-3X multiple difference in oncology care costs, and there is no correlation between the cost and the quality.”

07:45 How do you replicate high value oncology markets across the country? (TOI is achieving 25% lower costs in oncology care.)

08:30 85%+ of oncology revenue comes from drugs (fee-for-service practices reimbursed at cost + 6% which creates a misalignment of financial incentives)

10:00 Medicare’s new value-based Enhancing Oncology Model (EOM) that is replacing the Oncology Care Model (OCM)

11:30 Brad explains why the voluntary Oncology Care Model has not generated as much savings as Medicare initially envisioned.

12:30 Brad discusses TOI’s participation outcomes in the OCM and how they are looking forward to EOM.

13:00 EOM will be slightly more limited (e.g. few cancer types included in the program, lower upfront care coordination payments).

14:00 The enhanced focus on health equity and patient navigation with the new EOM payment model.

Ver todos los episodios