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KEY CONCEPTS

  • As the demand to curb costs and improve the quality of cancer care increases, cancer care delivery should align with patients' value and preference.

  • Value assessment is of paramount importance to the delivery of value-based cancer care effectively and efficiently.

  • There are evolving value-based practices specific to the fields of medical, radiation, and surgical oncology.

  • To serve the need for value assessment in today's health care environment, there is ongoing development of various value frameworks.

  • Management science and health economics and outcomes research both contribute to value assessment frameworks.

  • Our ability to effectively communicate value will facilitate shared decision making among all stakeholders involved in value-based health care.

OVERVIEW OF VALUE-BASED HEALTHCARE

As projections indicate that healthcare spending will account for nearly one-fifth of the Gross Domestic Product in the United States in 2021, the rate at which healthcare costs are growing will limit our country's growth and possibly even bankrupt the nation.1 Cancer care in particular is of great concern because of its relatively high costs to deliver treatment. Furthermore, cancer care costs are expected to grow 40% from 2010 to a projected $175 billion in 2020.2

The rising cost of cancer care impacts many stakeholders including patients and their families, providers, payers, and manufacturers. If the costs of cancer care continue to rise unchecked, it will be become unaffordable for many Americans—a concern raised by an Institute of Medicine (now National Academies of Sciences, Engineering, and Medicine) consensus study in 2013.3 Financial hardship, or financial toxicity, describes the impact of direct and indirect healthcare costs that lead to significant financial burden for patients and their caregivers, resulting in increased psychosocial distress, worse outcomes, and poorer quality of life (QOL).4,5 In addition, as specialized cancer care continues to become more centralized, one well-recognized disadvantage is the limited access to high-quality care in patients with low socioeconomic status.6–8 Barriers to access treatment may impact patient-centric outcomes.

Moreover, there is now widespread recognition that high-cost care does not necessarily translate into high-quality care or improved outcomes. The per capita healthcare spending in the United States far exceeds that in other developed countries, yet when juxtaposed against life expectancies, it is clear there is a great deal of wasted expense in our healthcare system.9

As the demand to curb costs and improve quality increases, there is a societal consensus that healthcare should be more greatly assessed on value. Thus, the United States healthcare system is now in the midst of transitioning to a value-incentivized system.10 As policymakers and those covering the costs (insurers and patients) seek ways to assure the best use of limited resources, they are turning to business leaders, physicians, and health economists for a better understanding—and definition—of value. There is a growing understanding that true healthcare reform will require major strategic and organizational changes in the way healthcare ...

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