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November 2018

Engaging Patients in Value-Based Cancer Care: A Missed Opportunity

Author Affiliations
  • 1Department of Medicine, Division of Medical Oncology, Duke Cancer Institute, Durham, North Carolina
  • 2Duke-Margolis Center for Health Policy, Durham, North Carolina
  • 3Department of Medicine, University of Chicago Medicine, Chicago, Illinois
JAMA Oncol. 2018;4(11):1479-1480. doi:10.1001/jamaoncol.2018.2826

Health care payments, including patient premiums and co-payments, are based primarily on service volume and cost rather than value. Payment reforms are under way to close gaps in quality and efficiency with leadership from the Center for Medicare & Medicaid Innovation (CMMI). To date, these payment models have encouraged practitioners and health care organizations to provide more efficient and higher-quality care but have largely overlooked patients. However, patients with cancer face substantial cost sharing for treatments and would benefit from more opportunities to share in benefits of high-value practice. For example, imatinib has revolutionized treatment of chronic myelogenous leukemia, with most of those treated with imatinib alive 10 years after diagnosis.1 Despite the distinct survival value of this drug, even co-payments of approximately $50 per month are associated with a 70% increased risk of nonadherence—evidence of cancer care’s financial toxicity.2 Moreover, patients should be active participants in their health. Medicare cancer payment reform is an example of how a more patient-focused payment model could improve the success of payment reforms that encourage higher-value care.

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