Value-based care: Insights from a survey of patients with cancer in the United States.

Abstract

72 Background: Value-based care (VBC) and value-based payment (VBP) models, such as Medicare’s Enhancing Oncology Model (EOM), are increasingly used within cancer care to measure quality and promote cost containment. However, there is limited literature on the perspectives of patients living with cancer on VBC and aspects of quality in care. Methods: This cross-sectional survey aimed to understand patient insights on VBC in cancer care. It was conducted by the Patient Advocate Foundation (PAF) from October-November 2025. The survey was distributed to eligible invitees aged 19 years or older from across the United States (US). Invitees were people living with a chronic health condition and who had previously signed up to receive survey invitations from PAF. Data presented here are from the subset of respondents with cancer, analyzed using descriptive statistics and two-tailed significance testing. Results: There were 830 respondents in the cancer subset. The majority were female (63%), White (70%), aged over 56 years old (77%), had a total household income of less than $48,000 USD (57%), had not completed a college-level education (55%), and were insured by only Medicare (60%). Overall, respondents reported limited awareness of and familiarity with VBC, with 70% having never heard of it before. This was consistent across cancer risk level, care setting, gender, age, race, education, insurance, and geographic setting. Further, only 9% recalled their providers having discussed VBC with them. Almost half of respondents (48%) were concerned about VBC, with 44% unsure, and 8% excited. Respondents trusted their providers but remained concerned that cost incentives may decrease the quality of care. The most common metric of quality prioritized by respondents was efficacy, whereas metrics of quality typically used in oncology VBP models were considered less important by respondents (Table). Additionally, when asked to rank the top 3 important considerations for treatment recommendations, efficacy was again the top priority (89%), but costs to patients (32%) and costs to insurance companies (9%) were the fifth and sixth ranked priorities. Conclusions: This robust survey demonstrates that the current quality metrics of VBP models used in cancer care, such as the EOM, and the priorities of financially underserved patients living with cancer in the US are misaligned. The preferences and priorities of patients living with cancer are a critical consideration for the meaningful design and delivery of patient-centered VBP models. Top four metrics of quality Percentage of respondents ranking items as a top 5 priority (%) Efficacy 75 Safety/tolerability 55 Quality of life 53 Access to innovative treatments 52 Bottom four metrics of quality Fewer hospital/emergency room visits 15 Resources for health-related social needs 11 Resources for mental health 11 Use of electronic health records and patient-reported outcomes 10