A shift toward patient-centric healthcare is a natural evolution as consumers gain greater access to information and take on bigger roles in managing care decisions and dollars. Consumers today are more compelled than ever to serve as active participants in their healthcare, demanding from us more personalized experiences and better outcomes.
Patient-centric, value-based care has become an inevitable solution. It enables patients, providers, and payers to engage in meaningful ways, and empowers us by providing clearly defined pathways to well-established, evidence-based treatments with proven effectiveness.
Why Shift to a Patient-Centric Model?
A patient-centric model offers benefits across the board, cutting the growing costs and complexities of health care, and connecting stakeholders so that we can better focus on our shared objective: successful outcomes that positively impact patient health.
Here’s a closer look at the benefits we stand to gain by shifting to evidence-based, patient-centric care, and how technology can help:
Patient-centric care curbs the rising cost of healthcare
In the United States, medical care spending has grown at a rate faster than the gross domestic product, yet it is estimated that more than $900 billion is wasted each year – much of it on unnecessary or ineffective treatments.
The skyrocketing cost of health care is not surprising considering that the average annual cost of a drug to treat cancer was $150,000 in 2017. Today, there is a flood of new drugs, including more than 1,100 new cancer therapies—many immunologically or biologically targeted—imminent or pending FDA approval. They are expected to be more expensive than their predecessors. According to a study released in JAMA, the rising prices are industry-wide, leading to patients paying more for health care than ever before.
Treatment plans based on evidence-based standards and therapies can help reduce costs by expediently guiding us to the right treatment decisions, eliminating variability in care, and ensuring that the care is accessible to all who need it. It will also align evidence-based care with payers’ plans to assure payers that their members are receiving the best possible care, and to facilitate authorization and reimbursement.
Evidence-based care eases complexity
Our field’s ever-changing landscape, the volume of new drugs at our disposal and the escalating complexity of care are factors contributing to ineffective treatments and wasted spending. The science of medicine has advanced far beyond what an individual practitioner can process, track and know without advanced systems support.
As genomic, proteomic, and metabolomic mechanisms of disease are better understood, treatment options will continue to increase, adding to the complexity of care decisions, especially for physicians dealing with unusual diseases or presentations. Modalities of care options are growing too, offering new surgical techniques, radiation modalities and novel devices such as tumor-treatment fields for care consideration. It is expected that there will be more than 10,000 decision data points for physicians to consider when prescribing treatment, per patient, by 2020.
Patient-centric, evidence-based care will consider all factors and provide guidelines and up-to-date, evidence-based standards and clinical trials to enable us to make the most informed, appropriate decision for each patient.
Evidence-Based, Patient-Centric Care Benefits All Stakeholders
Selecting an evidence-based treatment that offers the best outcome at a more effective cost than a competing therapy creates value-based care that benefits all parties:
- Gives patients peace of mind that they are receiving the most appropriate treatment.
- Encourages accountability.
- Motivates patients to comply with treatment decisions.
- Ultimately, improves care and outcomes, and reduces costs.
- Harnesses research and data, and provides access to the most up-to-date, proven regiments.
- Streamlines workflow and decision making.
- Helps providers engage and motivate patients.
- Enables prompt payment from payers.
- Protects their members and their bottom lines by aligning plans with evidence-based guidelines to help them feel confident that they are providing the best possible outcome for patients.
- Streamlines workflow to more quickly approve treatments.
Patient-Centric Medicine Can Co-Exist With Evidence-Based Care
The era of personalized medicine is upon us with consumer-facing genetic and pharmacogenomic tests available at the neighborhood drug store. Patients understand the potential value of these tests to affect the treatment plans they receive and expect this data to be analyzed as part of a decision-making process.
Payers must adopt a flexible position to intake this data through positive coverage determinations, or risk using outdated actuarial risk tables to estimate costs. For example, if a genomic test can avoid the use of a potentially toxic or ineffective medication for a particular individual that would otherwise be considered evidence-based and effective in the larger population, likely covered by existing medical policy, then this test would be beneficial. This means that payers must look beyond population-based policy decisions and adopt a true patient-centric vision.
Patient-Centric Care Needs Systems Support
There is no denying the benefits of delivering the best possible care at the best possible cost, but it’s easier said than done. Physicians need technology for the support it can provide.
Software systems support can be leveraged to harness data to reveal patient-centric solutions with evidence-based outcomes—helping us avoid expensive trial and error treatments— and better align our processes with payers so that patients get the best possible, pre-authorized treatment as quickly as possible.
Effective systems support will also:
- Eliminate inappropriate treatment (system failure) through the application of nationally-accepted treatment standards at the moment of clinical prescribing.
- Obtain physician collaboration through a comprehensive set of evidence-based treatment regimens that allow physicians to practice medicine.
- Offer access to high-quality clinical trials, including systematized intelligence to distinguish between routine costs of care and experimental costs to help meet State and health law coverage mandates.
- Promote speedy authorization and treatment coverage by ensuring that compliance takes place at the front-end as opposed to back-end review after treatment has begun.
Related content: Patients Need Personalized, Not Generic Health Advice
Technology has driven the evolution of patient-centric cancer care by demanding transparency and providing access to information that enables patients, providers, and payers to become true partners in healthcare decisions. The partnership forged by patient-centric care models will continue to transform care by reducing costs and complexities as well as improving outcomes.
To learn more about the inevitable shift to a patient-centric, value-based approach to health care, and how a solution like NantHealth’s Eviti® Connect can help guide decisions to get each patient the best possible treatment— pre-authorized and accepted by his or her health plan— as quickly as possible, listen to NantHealth’s webinar presentation The Evolution of Value-Based Care: A Shift to Patient-Centric Care.
Sandeep Reddy, MD
Sandeep “Bobby” Reddy, MD, Chief Medical Officer at NantHealth, Clinical Associate Professor Geffen/UCLA School of MedicineDr. Bobby Reddy joined NantHealth in December of 2016 as Senior Executive Director of Medical Affairs and currently serves as Chief Medical Officer. Dr. Reddy oversees educational initiatives, outreach, clinical development programs, and clinical trials for GPS, NantHealth’s proprietary revolutionary pan-omic cancer analytic platform. Prior to this, Dr. Reddy was Chief Medical Officer at Caris Life Sciences. His executive and medical oversight have produced over 100 abstracts at major medical conferences and over 30 peer-reviewed publications since 2014. Previously, Dr. Reddy was Chief-of-Staff at Los Alamitos Medical Center and actively practicing clinical hematology and oncology. Simultaneously he has held an adjunct faculty position at the Geffen/UCLA School of Medicine as a clinical instructor at Harbor-UCLA Medical Center, where he was awarded the distinguished teaching award for clinical faculty in 2006. He is a member of the Los Angeles Biomedical Institute, ASCO, IASLC, and current SWOG investigator. His medical training includes fellowship training in hematology and medical oncology and therapeutics research at the City of Hope and Internal Medicine residency at Harbor-UCLA Medical Center. Dr. Reddy received his MD from the Geffen/UCLA School of Medicine after receiving his BS in biomedical sciences at the University of California, Riverside.