Legal Issues Around Structuring Value-Based Contracts

The November 12 session of the Association for Value-Based Cancer Care (AVBCC) 10th Annual Summit explored the future of value-based contracts (VBCs) and featured perspectives on common legal issues surrounding these contracts.

Jonathan Levitt, Esq, Co-Founding Partner of Frier Levitt, LLC, began the discussion with a look ahead at VBCs in the context of a potential new presidential administration. Due to the current climate, Wall Street believes the new administration will be great for pharmacy benefit managers (PBMs) and healthcare companies.

Ted Okon, MBA, Executive Director of Community Oncology Alliance, believes PBMs do not want VBCs, whereas stakeholders want to see value-based care on the provider side, commercial side, and drug side.

Antonio Ciaccia, Chief Strategy Officer of 3 Axis Advisors, disagreed, saying that PBMs want VBCs, and they already have these contracts. He asserted that PBMs are using their current contracts to create value for themselves, and not necessarily for the purchase of oncology treatments.

When asked about clinical integrated networks, Sibel Blau, MD, President and CEO of Quality Cancer Care Alliance Network and Medical Director of the Oncology Division at Northwest Medical Specialties, said that even the biggest institutions can’t be immune to all the requirements, costs, and infrastructure.

“When we talk about value-based care, not only is it good for the practice, but at the end of the day, you have to have provider buy-in,” noted Kathy Oubre, MS, Chief Operations Officer at Pontchartrain Cancer Center, who offered the perspective from a smaller practice.

Daniel Frier, Esq, Co-Founding Partner of Frier Levitt, LLC, believes physician-based groups need to take control over the contracts instead of waiting for the payer, which, in most cases, is the insurance company, to come up with value-based models.

Other hot topics during this session included self-funded plans, 340B entities, accessing data, and vertically integrated networks.

There’s still time to register for the AVBCC Summit! Don’t miss out on the timely and insightful 40-plus webcasts featuring top experts from every area of oncology care.

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