How MedTech can transition to value-based cancer care

The migration to a value-based care system requires more than just changing how payors reimburse clinicians. It also requires a fundamental shift in the way we define value-based care.  Medical device companies will need to rethink their approach to product development by delivering multi-disciplinary, bundled solutions with intelligent devices and artificial-intelligence (AI) tools that help clinicians improve the quality of cancer care while lowering costs and enhancing the patient experience. AI and digital tools could enable capturing outcomes data and the impact of care longitudinally.

To paraphrase both Albert Einstein and Sir Isaac Newton, for every action there is a reaction. How are the actions of clinicians using medical technology impacting patient outcomes? The outcome is what really matters, and it’s possibly the future of medical technology (MedTech) in a value-based healthcare system.

Redefining value-based care

How is value defined? It depends on the patient and what they value (e.g., survival, return to work), the disease/injury for which they are being treated, and their environment. Porter and Teisberg define value as outcomes that matter to patients divided by the cost to deliver care.^[i]

The National Comprehensive Cancer Network, in an article on Medscape.com, described starting its quest to add value to its guidelines by looking up the definition of value[ii]. What they discovered is there are numerous definitions of value depending on the source, but there was one consistent theme that they built into their value system: flexibility.

MedTech can be flexible and adapt. In an NCCN Policy Report (D’Amico et al., 2020) on quality measurement in cancer care, the authors note that technology offers potential solutions to improving care, “particularly when goals and specific needs align across patients, physicians, practices, payers, and policies.  This has been demonstrated through rapid implementation of technology to support the early oncology value-based re-imbursement models, such as MIPS (Merit-Based Incentive Payments) and OCM (Oncology Care Models).”

Advancing medical technology to bring value to patient care

Medical technology should be viewed as an investment that improves how patients are diagnosed and treated for cancer, ultimately improve their outcomes and bring value to their care. Take for example less invasive, procedures that lower cost by reducing a patient’s hospital stay and deliver a societal benefit by decreasing time off of work. Advancements in imaging – specifically magnetic resonance imaging (MRI) and positron emissions tomography (PET) – are also enabling more personalized care, particularly in patients with slow-growing cancer who can undergo active surveillance, as well as those with metastatic castration-resistant prostate cancer (mCRPC) where tumor-targeting Theranostics using emerging radioligand therapies (¹⁷⁷Lu), or tumor-directed targeted alpha therapy with radiotracers (²²⁵Ac) are showing promising results.

Technology can be used for disease prevention and early intervention as well as to identify patients who are more likely to have an adverse reaction or poor prognosis after treatment for a disease, such as those who are more prone to develop heart failure or cardiomyopathy after chemotherapy or radiation therapy. Conversely, using technology to enhance the patient experience by increasing access, bundling diagnosis and treatment in one clinic, or personalizing the patient care pathway so it meets their family/environment needs might create value for the patient. The common theme across each example is that the patient becomes a partner in their care – one who understands both the value and the risks.

“Health innovators need to meet a growing burden of proof that their products and services address health outcomes that matter to patients. By championing internationally standardized measurement of health outcomes, companies can demonstrate their contribution to improved health and be best positioned for regulatory, pricing and value-based contracting conversations down the line,” states Jennifer Bright, President of the International Consortium of Health Outcomes Measurement (ICHOM).

COCIR, the non-profit European Trade Association representing the medical imaging, radiotherapy and health IT industries, notes that value-based care requires patient-centric approaches that measures both the cost of the intervention and the quality of the outcomes. Balancing quality and value requires defining patient groups and measurable parameters, determining the appropriate care pathway and basing care decisions on results.

“Overcoming resistance to change, promoting a culture of transparency and accountability, and engaging healthcare professionals in the implementation process are key factors for success,” says Dr. Mathias Goyen, Chief Medical Officer EMEA at GE HealthCare. “Value-Based Health Care (VBHC) presents significant opportunities for Europe to improve healthcare delivery. By focusing on patient outcomes, VBHC promotes personalized and tailored care, enhancing patient experiences and satisfaction. It encourages shared decision-making, empowering patients to actively participate in their healthcare journey.”

Delivering MedTech equipment and solutions to support value-based care.

Should medical technology company shift their focus to value – defined as a balance between cost, quality of care and patient outcomes – versus traditionally being focused on quantity (which historically was good for MedTech’s bottom line), what is the role of medical equipment manufacturers in a value-based cancer care system? How can these companies contribute to a new paradigm and enable profitable provider models, while also remaining profitable?

An area of opportunity is to invest in solutions that enable earlier diagnoses or disease prevention. To build sustainability in healthcare systems, particularly those with aging populations, providers need to focus more on prevention-based patient services rather than chronic disease management. One suggestion, particularly in the pharmaceutical industry, is that suppliers align their prices with patient outcomes.^[iii]

While this approach could be difficult to emulate in the medical technology industry, due to the plethora of devices that may be used during a cancer patient’s care journey (particularly an urgent or life-threatening event), developing technologies that help prevent disease, or help clinicians diagnose disease at its earliest stage, rather than treat disease is at the foundation of value-based cancer care.

MedTech can pursue solutions that address affordability and access to care. The goal of many healthcare organizations and health systems is to actually keep patients out of the hospital and move care from siloed academic centers to community-based centers or even to the patient’s own home (hospital@home). Industry leaders, such as GE HealthCare offers solutions for providers and their patients. A patient-centric, breast care diagnostic consultation and assessment often in just one appointment with the One-Stop Clinic™ for Breast, where the creation of rapid diagnostic clinics is designed to improve earlier cancer diagnoses. Another advancement in MedTech, includes in-home monitoring devices that transmit data wirelessly and can help patients avoid repeat trips to physician offices or clinics, helping to lower the cost of their care. In models, such as hospital@home, there are opportunities for medical equipment companies to partner with healthcare organizations – a shared risk approach – and be incubators of ideas and solutions with their customers.

In device development, MedTech can examine how a device can help clinicians be more efficient or deliver fewer complications.  In MRI, there is a concerted effort across nearly all vendors to reduce scan times through acceleration techniques and by adopting AI or deep-learning to enhance resolution  David Campbell, Partner at Oliver Wyman, adds that these companies will also need to “think ‘beyond the device’ and look for ways they can improve outcomes and cut overall costs.” 

Bringing additional value to the future of cancer care

The successful model for MedTech in a value-based cancer care system must include technologies and devices that improve patient outcomes and experiences, as well as help to lower the cost of care.

Information and analytics are another area of opportunity to connect value-based care. Digitalization has evolved to provide better insights and can lead to more personalized care. Intelligent devices can help aggregate patient data to analyze trends on device performance and monitor their effectiveness, while potentially aligning this data with patient outcomes. Decision support systems embedded into the electronic clinical applications that most physicians use in their daily routine can help guide care pathways with a cost-value-outcome approach. Medical equipment companies must look to participate in more effective and efficient delivery health systems, either alone or through partnerships.

Last, follow the evidence, and bring that evidence back into information technology and decision support systems to further inform care pathways and treatment decisions. It’s that continual feedback loop of gathering real-world evidence on patient outcomes to align it with what patients need and physicians want that will add value to care. And is it possible that radiology – with its hand on the pulse of device innovation that delivers the information other clinicians need to make informed and valuable clinical decisions – should be the driving force behind value-based care?

 

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