Wednesday, February 21, 2024

A Different AI: "" Talks About Value-Based Care in Oncology

Header:  In a few seconds, an alternative, open-access AI (Perplexity) generates several short essays about the outlook for value-based oncology.


A few weeks ago, this blog highlighted a new article by two oncologists, Klein & Kolodziej, here.  Their new article is a look-back and look-forward relative to their ten-year-old forecast for value based care and value based payment in oncology.


Fast forward.  This week, I've had several sessions playing with the free level of   In the example below, I asked it three questions about value based care in oncology.  1) What's a general overview; 2) What's the main barriers, and 3) What's the five year outlook?   

In each case, Perplexity combines very rapid internet research and a strong general knowledge database (as in "regular" AI like Chat GPT).  

Perplexity also extensively footnotes its reports.   One of the big concerns of 2023, that AI's would not give sources and would make things up, is largely left in the rear view mirror, when you use Perplexity.   

Except for the text in red, everything below was written in a few seconds by Perplexity.   Some of it is sharp; some of it is harmless general prose.   It would certainly jump-start someone who had to think about this topic and didn't have a starting place.


Unfortunately, I couldn't get the Perplexity report to word-wrap correctly on this blog, so to read the report with the important web links, I'll need to send you either to Plexplexity (in open access mode) or to Google Doc, below.




All the text below, except that in red, were generated in a few seconds by Perplexity. To click on links, use the cloud based document resources above, not the passage below.


Part 1 - 

Overview of a Report on Value-Based Oncology

To write a comprehensive report on value-based oncology care, focusing on patient outcomes, cost-effectiveness, provider incentives, and challenges, it's essential to integrate findings from recent studies and analyses. Here's a structured approach to crafting your report:


Begin with an overview of value-based care in oncology, emphasizing the shift from volume-based to value-based models. Highlight the global need for affordable, accessible cancer care that produces optimal patient outcomes1.

Patient Outcomes

Discuss how value-based care aims to improve patient outcomes by focusing on the quality rather than the quantity of care. Mention the lack of standardization in measuring long-term patient outcomes and the need for universal clinical and patient-reported outcome measures (PROMs)1. Also, address the challenges in implementing these measures, especially in less developed countries1.


Examine the financial aspects of value-based care, including the rising cost of cancer care and the financial toxicity associated with it2. Discuss strategies to improve cost-effectiveness, such as using composite tools to assess the value of drugs and increasing cost communication between patients and oncologists2. Highlight the importance of frameworks like the ASCO Value Framework and the ESMO Magnitude of Clinical Benefit Scale in assessing the value of clinical interventions2.

Provider Incentives

Explore how reimbursement incentives influence physician practice in oncology. Mention that value-based reimbursement policies may align physician incentives with patient needs more effectively3. However, also note the skepticism among physicians regarding the impact of financial incentives on their practice3.


Identify the primary challenges in implementing value-based care models, such as navigating the payer landscape, identifying cost-reduction opportunities4, and accounting for patient and disease complexity5. Highlight specific examples where value-based models like the Oncology Care Model failed to account for these complexities, leading to financial losses5.


Conclude by emphasizing the potential of value-based care in oncology to align healthcare delivery with patient needs, improve outcomes, and manage costs. However, also acknowledge the significant challenges that need to be addressed, including standardizing outcome measures, ensuring cost-effectiveness, aligning provider incentives, and overcoming implementation barriers.

Throughout the report, use examples from the provided studies to illustrate both successful implementations and areas where value-based care models have fallen short. This balanced approach will provide a comprehensive view of the current state of value-based oncology care, its potential benefits, and the obstacles that must be overcome.

Part 2 - 

What are the key challenges to implementing value-based care in oncology?

The main challenges and hurdles that have impeded the development of value-based oncology payments include:

  1. Lack of Standardization in Measuring Performance: It is difficult to measure performance from clinic to clinic, cancer site to cancer site, or physician to physician. This lack of standardization makes it challenging to define value in cancer care3.
  2. Difficulty in Defining Value in Cancer Care: There is no unanimous agreement on what "value" means in cancer care, making it challenging to establish value-based payment models3.
  3. Application of Quality Measures: The main challenge of value-based cancer care for payers and providers is the application of quality measures. There is a big push to use pathways and guidelines in the entire oncology arena, but putting these pathways into place is a challenge3.
  4. Problems with Benchmarks: It's hard to get into a value-based care contract if there is no historical data to show how a provider performs. Additionally, benchmarks can be problematic if something changes in the regular treatment of a disease4.
  5. Reporting Burden: The amount of data that needs to be reported to take part in value-based care programs is substantial, and it can be challenging to capture all the necessary data4.
  6. Difficulty in Defining "Value": It is difficult to define value-based care in any area, particularly in cancer care. There are challenges in defining the value of a life and determining the point of diminishing returns for certain therapies3.
  7. Financial Toxicity for Patients: The financial fallout of a cancer diagnosis can play a significant role in patients' outcomes, leading to severe financial toxicity for many patients5.

These challenges have contributed to the complexity and slow progress of implementing effective value-based oncology payment models. Overcoming these hurdles will be essential for the successful development and implementation of value-based care in oncology.

Part 3 - 
What is the 5 year outlook? 
You are chief commercial officer, for biotech, precision oncology, and genomics.

The five-year outlook for value-based care in oncology presents a landscape of both potential growth and persistent challenges. Specialists are expected to accelerate the adoption of value-based care models, leading to increased effectiveness and scalability, particularly in fields like nephrology and oncology2. However, the transition to value-based care in oncology is not without its hurdles. 

The Oncology Care Model (OCM), a major attempt to introduce value-based care into oncology, faced difficulties, with the successor model, Oncology Care First, now in doubt5. The OCM demonstrated challenges in managing the cost of new and expensive cancer therapies, impacting the ability to achieve cost savings5. Despite these obstacles, the potential for growth in value-based care remains significant, with the landscape evolving to address issues of quality, outcomes, and cost management2.

In the next five years, the value-based care market could reach a valuation of $1 trillion, driven by increased adoption and enhanced capabilities across providers, employers, and other healthcare stakeholders2. The continued traction in the value-based care market is expected to lead to improved quality of care and outcomes while providing benefits for patients, clinicians, and investors2. However, it's crucial to address the challenges related to cost management, equity issues, and the development of effective payment models to ensure the success of value-based care in oncology5.

In summary, the five-year outlook for value-based care in oncology presents a landscape of potential growth and continued challenges. While the adoption of value-based care models is expected to accelerate, addressing issues related to cost management and equity will be crucial for its long-term success. The evolving landscape of value-based care in oncology holds significant potential for improving patient outcomes and delivering benefits across the healthcare ecosystem.

click to enlarge

Separately, Perplexity discusses a 7-page letter that stakeholders sent to CMS in 2021 opposing a radiation oncology value based purchasing proposal, here.

 (More on Perplexity).  (Here too.)