Change is coming – be informed

Verrilli-Diana_2_

ICON members will have an unprecedented opportunity to engage with value-based care pioneer, Diana Verrilli, at events around the country this March.

In the ongoing quest to curb the rising costs of cancer treatment without sacrificing patient outcomes, Diana Verrilli is a true pioneer. And now, SA oncologists will have an unprecedented opportunity to pick her brains.

Verrilli, a recognised expert in value-based care with more than 25 years’ experience in the healthcare industry, has been invited by ICON to engage with oncologists in South Africa on the merits of this model and the transitional journey involved. She will be speaking at three specially-organised events in Cape Town, Johannesburg and Durban on 27, 28 and 29 March.

Verrilli is vice president of Payer and Revenue Cycle Services at the US-based McKesson Specialty Health, a shareholder of the US Oncology Network, that champions those working on the front lines of healthcare by helping them deliver better care at lower costs. Her focus is on the development and execution of the company’s managed care and practice management solutions for its national network of affiliated community oncologists.

“Value-based care, promotes a move away from the fee-for-service model towards alternative reimbursement, and is something that ICON has been advocating for a long time,” says Dr Ernst Marais, Chief Operating Officer of ISIMO Health.

“The principle of value-based care is that you pay for where you add the most value, and insurance companies are willing to pay more for measured outcomes. A shift to this kind of reimbursement has been shown to deliver benefits to all stakeholders in the sector including and most importantly – patients.”

Dr Marais says that the ICON team encountered the work of Diana Verrilli on a recent trip to the US as guests of US Oncology, which is the largest oncology network in the US, spanning some 400 sites of care with a membership of around 1400 oncology physicians.

“Because of the strong synergies between what we are trying to achieve and what she has already helped to drive in that environment – we thought it was a perfect opportunity to invite her to share her knowledge with us,” he says.

Dr Verrilli will engage with SA oncologists on their role in contributing to discussions around value-based treatment and why it is important for them to be part of that process so treatment is not dictated by the people who pay for the service.

“It is imperative that the way patients are treated remains in the hands of the oncologists,” says Dr Marais. “With the rising cost of healthcare it is essential to find ways to make medical funds go further, especially for when South Africa transitions to a National Health Insurance Plan.”

While in the US, Dr Marais attended a US Oncology Pathway Symposium in Denver and visited Texas Oncology in Austin.

“Aside from learning a lot, it was very encouraging to observe that the processes we have within ICON are very similar to what they do in the US albeit on a much smaller scale,” comments Dr Marais. US Oncology is approximately ten times the size of ICON.

US Oncology consists of numerous practices that maintain their autonomy within the network. As an organisation, US Oncology offers both shared services and managed care services. Shared Services include administrative and financial services, IT infrastructure and software support. All clinical staff are employed and managed by the clinical practices themselves

With regard to managed care services, US Oncology interacts with the insurance companies on behalf of the practices, discussing treatment pathways and funding models, all in the framework of value-based care.

A recent study by Texas oncology, has demonstrated conclusively the impact of this approach showing that pathway compliance can contribute to as much as a 20 to 30% saving on costs, without compromising health outcomes of study patients. Key metrics in the study included fewer emergency visits and in-patient admissions, decreased in-patient days, a reduction in cancer-related use costs, and an increase in on-pathway adherence.

“What is key to note is that insurers will now pay oncologists more for people to be treated on pathway,” says Dr Marais. “Doctors are reimbursed more because they follow evidence-based medicine that is shown to deliver the best results and eliminate wasteful expenditure.

A highlight of the ICON team’s visit was the opportunity to attend a pathway debate.

“There were about 20 oncologists in the room discussing specific immunotherapies on the market,” says Dr Marais. “There were some very high-level but amicable debates and it was fascinating to see how they exchanged views on the merits of certain medicines. Specialists from all over the country video-conferenced in on the debate to talk through what should and shouldn’t be on pathway.”

“We left with a renewed sense that ICON is on the right path – armed with new knowledge and insights to share with the network to make oncology in South Africa a frontrunner in the field of innovative and cost-effective value-based treatment practices.”

 

To book your spot at one of the talks with Diane Verrilli please contact chris.salmon@isimo.co.za

 

Leave a Reply

Your email address will not be published. Required fields are marked *