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Value-Based Care: Improving Outcomes, Reducing Costs for Texas Oncology Patients

April 05, 2019

At Texas Oncology, our priority is delivering high quality, effective care to patients by focusing on patients’ overall well-being – not just their disease. Understanding patient goals and values, educating patients on their disease and treatment, identifying and assisting with areas of distress, and discussing the cost of care, sometimes leading to “financial toxicity,” are important concerns. We have embraced value-based care to help ensure that patients get care that is clinically effective, aligns with their values while being mindful of cost.

This includes participating in value-based care programs from the Centers for Medicare and Medicaid Services (CMS) as well as with private insurers. Recently, CMS has rewarded Texas Oncology for meeting high, comprehensive standards for quality care, cost management, and reporting in two key programs, the Oncology Care Model (OCM) and the Merit-Based Incentive Payment System (MIPS). These programs were created in health care reform laws passed by Congress. MIPS was included in a 2015 Medicare bill; OCM was part of the Affordable Care Act signed into law in 2010.

Ultimately, value-based care means we are sharpening our focus on what will accomplish the best patient outcomes…”

“We’re proud that we’ve met the CMS criteria for these value-based care programs. It’s an affirmation of our commitment to delivering the highest quality care while effectively managing the cost of care,” said, Dr. Lalan Wilfong, vice president, Quality Programs at Texas Oncology. Cancer care can be costly.

Even patients with robust private or government health insurance benefits often incur significant out of pocket expenses. Value, in this context, means helping reduce costs using evidence- and research-based guidelines for administering care.

In practical terms, examples of how Texas Oncology delivers more value and improved care to patients include:

  • Helping patients better manage common treatment side effects and avoid emergency room visits
  • Making sure patients take medications on time and as directed, so that the medicines work better
  • Avoiding low value, high cost care, such as optimizing nausea medications to minimize this common side effect of chemotherapy

“Ultimately, value-based care means we are sharpening our focus on what will accomplish the best patient outcomes, and de-emphasizing a fee for service approach to care,” said Wilfong. “This helps our patients have a better overall journey while avoiding unnecessary costs.”

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