PENTA as a model for advanced integrated cancer management in low-resource settings.

Abstract

e13783 Background: Cancer models are reactive, fragmented, and volume-based care, in which the lack of coordination between different layers of care, along with clinical and quality variability, technological pressure, and dominant positions, result in high levels of inefficiency and waste, affecting economic sustainability and hence effective access. This is prohibitive for low-resource settings. Modern healthcare system models in this scenarios should focus on solve this problems. Comprehensive cancer management needs a reorientation towards value- and efficiency-generating architectures.Usual redesigns have focused on direct cost containment through intensified audits or new contracting and payment modalities between stakeholders. However, the real impact of these strategies is marginal, increasing sectoral mistrust and failing to meet the quintuple aim. PENTA is a comprehensive cancer management framework to optimize cancer patient care, with emphasis on clinical governance, data guidance, and clinical-administrative alignment. This is an operational model for stakeholders in low-resource settings. PENTA model has been successfully implemented in health insurance companies in Colombia and in private insurance branch in Peru. Methods: PENTA has been applied since 2020. We employed a work methodology based on the Agile-2 matrix, which allows for fluidity and lower resource consumption. This methodology is hybrid and its execution begins with an initial diagnosis of the process within the partner company. This diagnosis includes prioritizing interventions from each of the axes, but understanding that this is a systemic project that includes 5 fundamental axes. This axes must be worked on simultaneously and interdependently to achieve the greatest value. Axes are: 1. Smart Risk Management, 2. Advanced Clinical Gobernance, 3. Value Audit, 4. Technology Management and 5. Value-based Contracting Focus on managing inefficiencies and waste (optimization model), PENTA can generate early results across various dimensions such as clinical variability and technology costs. Structuring and using a cross-cutting data architecture is fundamental to the model's development into a data control tower. Results: Implementation of a data control tower for cancer cohorts , development of joint clinical pathways (insurer-payer) for prioritized diseases, clinical practice agreements with hierarchical positions on high-cost medications, implementation of mini health technology assessments (HTAs), and generation of new prospective payment modalities based on performance adjustment. The estimated savings generated are $1.5 million for the phase 2 in Colombia and $800,000 for the phase 1 in Peru. Conclusions: PENTA is an agile framework for cancer management that can be sucessfully adapted to low-resource settings.