Value-Based Care Delivery Model Outcomes Data Show Varying Quality Improvement

A systematic review of value-based health care delivery models in oncology care presented at the American Society of Clinical Oncology (ASCO) Annual Meeting found that reports of outcomes are often lacking and show varying degrees of quality improvement.

With the rising cost of health care—particularly cancer care—in the United States, stakeholders have placed increasing importance on optimizing value through new health care delivery models. These models (ie, clinical pathways, accountable care organizations, bundled payments, and patient-centered medical homes) are designed to maximize outcomes and minimize costs through fundamental changes in care delivery.

Emeline Aviki, MD, MBA, Memorial Sloan Kettering Cancer Center (New York, NY), and colleagues performed a systematic review to describe the landscape of value-based interventions in cancer care. Researchers identified 23 articles describing 22 unique value-based interventions through searches of PubMed/MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Clinical Trials since passage of the Affordable Care Act.

The Effective Public Health Practice Project Quality Assessment Tool was utilized to evaluate the quality of studies reporting results.

Among the 23 articles, Dr Aviki and colleagues noted that 12 were published in peer-reviewed literature and 13 reported outcomes and were assessed for quality. All of these outcomes were considered moderate (n = 6) or weak (n = 7) quality.

The 22 value-based interventions included bundled payments (n = 6), accountable care organizations (n = 4), patient-centered medical homes (n = 9), and other interventions (n = 3). Researchers acknowledged that most interventions were conducted in community settings (76%) and performed through commercial payer contracts (87%), including all of the bundled payments and cancer-specific accountable care organizations.

Among the 12 interventions with outcomes reported, the majority (n = 7) improved value, some had no impact on value (n = 4), and one reduced value, though this effect was not significant after 2-3 years.

“Despite promising early signs, the efficacy of these interventions in cancer remains unclear,” Dr Aviki and colleagues concluded. “Moving forward, rigorous evaluations and increased outcome reporting will enable continued innovation to achieve the highest value of care for patients with cancer.”

—Zachary Bessette