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1583 Health Care Drive
Rock Hill, SC, 29732

Phone: 803-329-7772
Email: info@kashyappatel.com

Value-based Care (VBC)

Fulfilling triple aim of reduce costs, improve patient experience, and improve outcomes

The US healthcare system is currently in a state of crisis. The Bloomberg Health-Care Efficiency Index ranked the United States 50th among 55 countries in 2014, with only Jordan, Colombia, Azerbaijan, Brazil, and Russia performing worseand this is despite spending more than $9,400 per capita annually on healthcare, a figure representing 17.1 % of the gross domestic product. Reasons include a fragmented, relatively unorganized, and uncoordinated delivery system, with silos and redundancies contributing to inefficiency. In oncology specifically, despite improvements in survival rates in many types of cancer, recent reports from the Institute of Medicine concluded that cancer treatment in the United States lacks in consistent quality and is neither patient-centric nor well-coordinated.

Dr. Patel is at the forefront of the transition from Volume-to-Value. Four years prior to widespread awareness of the issue of increased cost of care, Dr. Patel initiated a transformation from volume-to-value at his practice with the intent of delivering more patient centric care for his patients. When awareness finally arrived at national level, his practice had already achieved the goals targeted by the new approach to medicine. By utilizing biosimilars, providing after-hours care to reduce patient hospitalizations, and by improving care coordination, Dr. Patel's practice was able to reduce spending at his practice in 2019 by $2,400,000 and reduce his patient's hospitalization by 24%.

When CMS introduced the Oncology Care Model pilot as an alternative form of reimbursement for oncology practices (OCM model), Dr. Patel's practice was among the first to be selected by CMMI to participate in the model. By Year 2, his practice was named the top performer nationwide among 200 participating oncology practices. CMS has subsequently selected Dr. Patel's practice as the model of success and has filmed numerous videos regarding the innovations he has utilized to teach other practice's how to run a successful value-based care practice.

In addition, due to the success of the practice in meeting OCM's guidelines, Dr. Patel was able to offer input to CMMI around the design of the follow-up to the OCM model, known as OCF. He is currently the national leader in implementation of value-based care models and has been published in numerous journals guiding other physicians to navigating the difficult journey from volume to value.

He is also a national leader in the transition towards use of biosimilars in cancer treatment. Biosimilars treatments cost significantly less than reference product treatment and can result in savings upwards of 30% to Medicare while retaining equivalent treatment results. However, due to financial and mental barriers, the uptake of biosimilars has been limited in the US vs. Europe where they are much more clearly embraced. Dr. Patel is utilizing his platform as President of COA and his leadership in the oncology space to drive up usage of biosimilars to reduce financial toxicity while ensuring quality treatment for cancer patients. With extensive expertise in value-based care, Dr. Patel has successfully led multiple oncology payment pilots in his practice and consulted on others across the state and nation. He consults and guides multiple payers (Humana, BCBSSC, Centene as well as other small payers and CMMI) on the critical elements of Alternative Payment Models. He led two very successful model at the CBCCA where their practice successfully met critical quality and financial goals and saved tens of millions of dollars to payers. He has consulted for and advised following payers on regular bases, including:

  • Palmetto GBA-the largest MAC contractor as a paid consultant and as longest serving CAC member
  • BCBSSC (Blue Cross Blue Shield of South Carolina); He currently serves as a consultant medical director; has created training programs for BCBSSC
  • He has been a board member for Centene from 2021-2022
  • He has been a CAC Member for the SC state Medicaid Committee for over 12 years
  • He has been a P/T committee member for the SC Medicaid Advisory committee
  • He has facilitated designing APM (BCBSSC OCM model) with Dr. Laura Long (CMO BCBSSC) and Rene Frick (BCBSSC)
  • Under his leadership, the CBCCA was the most successful practice in the country having achieved performance-based payment (PBP) throughout the duration of CMMI initiative of the Oncology Care Model
  • He works closely with both CMMI and commercial payers including Humana, BCBSSC (primarily to define healthcare equity related work and experience) in newer version VBC
Speaking engagement on
Valued-based Cancer Care
Publications on Valued-based
Cancer Care

Speaking

Value-based cancer care holds the promise to advancing whole-person, equitable cancer care. The current landscape of value-based care in oncology is evolving rapidly, and new ways of thinking about strategies and approaches for managing exposure and involvement with government and commercial-payer sponsored models requires deeper understanding of the fundamentals, economics and building blocks of both payment and care delivery models.

Learning Objectives and Outcomes

Session length: 45 - 60 minutes

  • Learning objective #1 MACRA: Medicare Access and CHIP Reauthorization Act of 2015
  • Learning objective #2 QPP (Quality Payment Program): Final rule defining physician payment
  • Learning objective #3 AAPM: Advanced Alternative Payment Model
  • Learning objective #4 MIPS: Merit Based Incentive Program
  • Learning objective #5 Implications for the pharma industry; how industry can partner with payers and providers to fulfil aims of transition to the VBC
  • Learning Objective #6: How industry can prepare and coach providers to address cost of care

Interested in hosting Dr. Patel as a speaker at your event?

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Publications

  • Theresa Dreyer; Kashyap Patel, et al. Editorials Oncology Care Model: A Herculean Effort With Fixable Fatal Flaws. DOI: 10.1200/OP.20.00852 JCO Oncology Practice 17, no. 4 (April 01, 2021) 173-176
  • Patel K et al, The role of biosimilars in value-based oncology care, Cancer Management and Research 2018:10 4591-4602
  • Patel K et al, Oncology Practice Transformation Helps Deliver Patient-centered Cancer Care in a Community Oncology Practice. AJMC, EBO. April 2018
  • Patel KB et al Roadmap to Success in the Oncology Care Model: Tapping into Human Potential via Sustained Engagement. AJMC, EBO, December 2018
  • Patel K et al. Road Map to Success in the OCM: From Team Building to Implementation, American Journal of Managed Care, EBO, April 2019
  • Patel M, and Patel K. Oncology Practice Management; The Oncology Care Model: Aligning Financial incentives to improve outcomes. December 2016, Vol 6, No 12 - Oncology Medical Home
  • Patel K & Patel M. Oncology Practice Management; Journey from Volume to Value. Oncology Practice Management.2016;6:9:8-12
  • Patel K (interview and commentary) Treatment-Free Remission Test Offers "Paradigm-Shifting" Value in CML, Journal of Clinical Pathways, October 2018
  • Lozano R & Patel K. Unlocking the Potential of Biosimilars in Community Oncology. Cancer Therapy Advisor, April 2019
  • Kevin T, Patel K et al, The Cost Savings of Biosimilars Can Help Increase Patient Access and Lift the Financial Burden of Health Care Systems. Seminars in Arthritis & Rheumatism (2021), doi: https://doi.org/10.1016/j.semarthrit.2021.11.009
  • Patel K. Two-Sided Risk in the Oncology Care Model, AJMC, April 2019
  • Mary K. Nesline, Tyler Knight, S Colman; and Kayshap Patel, MD. Economic Burden of Checkpoint Inhibitor Immunotherapy for the Treatment of Non-Small Cell Lung Cancer in US Clinical Practice. Clinical Therapeutics
  • Patel K, Clinton N. Patient Centered Oncology Care (PCOC) as a roadmap to success in Alternate Payment Model (APM). Presented at the ASCO Quality Care Symposium. 2018, Phoenix
  • Whitney Rhodes, Kashyap Patel. Real-world use of bevacizumab-awwb, a bevacizumab biosimilar, in US patients with metastatic colorectal cancer. Future Oncology Volume 17, Issue 36Dec 2021Pages5003-5189
  • Dr Kashyap Patel on Pressing Topics in Cancer Care Delivery to Be Discussed at PCOC 2020

    Sep 08, 2020 - AJMC

  • Oncology Practice Transformation Helps Deliver Patient-Centered Cancer Care in a Community Oncology Practice

    Apr 17, 2018 - AJMC

  • Dr Kashyap Patel: Biosimilars and Value

    Dec 08, 2017 - AJMC

  • Dr Kashyap Patel Discusses Implementing the Oncology Care Model

    Sep 04, 2017 - AJMC

  • Dr Kashyap Patel Discusses Challenges of OCM Implementation

    Oct 25, 2016 - AJMC

  • Carolina Blood and Cancer Care Associates' Patient-Centered Transformation

    NCQA

  • Oncology Care Model: A Herculean Effort With Fixable Fatal Flaws

    Oncology Practice

  • Value-Based Care Perspectives

Value-based Care

Value-based Care

Patient Centered Cancer Care

Patient Centered Cancer Care

Diversity, Equity, and Inclusivity in Health Care

Diversity, Equity, and Inclusivity in Health Care

Precision Medicine

Precision Medicine

End of life care

End of life care

Health Care Policy and Legislation

Health Care Policy and Legislation

Leadership in Business of Medicine

Leadership in Business of Medicine