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As a concept, everyone believes that a patient should be at the center of care, supported by shared decision-making. Patients and their clinicians review the best available evidence, review the options, look at costs and benefits, and together decide how to proceed.1 In reality, in a shift from fee for service to bundled health care payments that are now expanding to include oncology services, how will those processes play out in the years to come, given the inherent existential nature of issues raised by having advanced cancer, even as treatments continue to advance for some metastatic disease? And will difficult, emotional conversations about when to move from curative cancer therapy goals to palliative therapy or even hospice care become even more fraught when the specter of capitated fees is lingering in the background?
With drug costs for cancer now surpassing any other disease state, could physicians be incentivized to discontinue futile care—and who defines futile care?
No one knows yet how this will play out, but these topics and more were voiced in a wide-ranging presentation and discussion this spring during an Institute for Value-Based Medicine® session on oncology value-based care in Scottsdale, Arizona, held by The American Journal of Managed Care® in partnership with Banner|Aetna.