Exploring the perception of value in cancer care: A comparison of patients, providers, and payers.

60 Background: As the healthcare system moves towards value-based models, defining "value" is crucial. In the context of cancer care, there are multiple metrics essential to the aggregate of “value”, however their relative importance to the various stakeholders in value-based care are unknown. This study assesses the priorities of key stakeholders in value-based cancer care. Methods: A survey was administered to international cancer patients through online support groups and to healthcare providers and payers within a large regional health system. Respondents ranked the relative importance of treatment costs, longevity, treatment experience, functional and emotional well-being, and longevity (survival). Agreement among groups was analyzed using Kendall's coefficient of concordance (W). The priorities of each group were compared among stakeholders. Results: A total of 1,103 respondents including 782 patients, 216 healthcare providers, and 105 payers/policymakers participated. The majority of respondents were female (70%), white (89%), and had completed a four-year degree (63%). The patient cohort represented six continents and 20 cancer types. The most common cancer site was the pancreas (35%), followed by the esophagus (11%), bile duct (10%), and peritoneal surface malignancy (9%). Among providers, 29% were physicians, 21% nurses, 11% advanced practice providers, and 39% other providers. Among payers, 24% were administrators and 24% held were business analysts. Patients prioritized longevity and functional independence (W=39%, p<0.001), while providers prioritized patient emotional well-being over functional independence and experience (W=35%, p<0.001). Payers prioritized emotional well-being and patient longevity (W=26%, p<0.001). The overall ratings for each value metric among the three groups differed significantly (all p < 0.05). All groups ranked treatment costs as least important. Rankings were consistent across gender, education level, and time spent with patients within the cohorts. Conclusions: With general consistencies amongst the views of stakeholders, there are remains significant discordances in the perception of value. While the highest priority across stakeholder groups differed, costs of treatment consistently ranked as the least important value domain. These findings have important implications for the development of value-based cancer care models that account for the diverse perspectives of key stakeholders. Further research is needed to develop a generalizable measure of healthcare value.