Aligning financial incentives to promote rational use of active surveillance for prostate cancer

调整财政激励措施以促进前列腺癌主动监测的合理使用

基本信息

批准号：
10416477
负责人：
BRENT K. HOLLENBECK
金额：
$ 57.84万
依托单位：
UNIVERSITY OF MICHIGAN AT ANN ARBOR
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-04-01 至 2027-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10416477
关键词：
Achievement Address Adverse effects Androgens Biopsy Blue Cross Blue Shield Caring Characteristics Clinical Communities Cost Savings Data Development Diagnosis Disease Disincentive Ensure Goals Growth Healthcare Image Incentives Intensity-Modulated Radiotherapy Intervention Interview Lead Life Expectancy Literature Magnetic Resonance Imaging Malignant Neoplasms Malignant neoplasm of prostate Measures Medicare Methods Michigan Modality Modeling Monitor Morbidity - disease rate Movement Natural History Operative Surgical Procedures Patient-Focused Outcomes Patients Pattern Performance Physicians Policies Practice Management Privatization Provider Radiation therapy Registries Remunerations Review Literature Risk Savings Sexual Dysfunction Structure Symptoms System Testing Time Uncertainty Urologic Surgical Procedures Urologist Urology Variant aggressive therapy base bundled payment care costs cost curative treatments deprivation disorder risk financial incentive genomic signature health care delivery implementation measures improved interest meetings men mortality mortality risk overtreatment payment population health prevent prostate cancer risk provider behavior response surveillance strategy tumor tumor progression urinary

项目摘要

Project Summary This project aims to address inherent financial disincentives for active surveillance for prostate cancer. Many men with favorable-risk disease will not benefit from aggressive intervention. The uncertainty surrounding who and how to treat has led to wide variation in treatment patterns, in part driven by nonclinical factors such as financial incentives. The strategy of surveillance, which avoids or delays aggressive treatment for men with favorable-risk tumors, has been shown to reduce treatment associated morbidity and spending, without compromising survival. As such, it is well aligned with the current national interest in improving the value of health care delivery. Yet studies demonstrate surveillance is underutilized and its implementation varies widely. There are several factors contributing to this, but one plausible contribution is the financial incentives for providers embedded within the delivery system that favor aggressive interventions, as their reimbursement is immediate and can be several-fold greater than for surveillance-related activities. Recent payment reforms encourage a movement to alternative payment models (APMs), intended to improve the value of health care. An APM in this context could provide additional payment to providers for performing surveillance, while tying reimbursement to achievement of quality targets that ensure its appropriate performance and lowering total payer costs. The objective of this proposal is to develop APMs to promote rational use of surveillance, with the following aims: 1) To understand urologist response to payment incentives for active surveillance; 2) To develop robust quality performance measures for implementation of active surveillance; and, 3) To develop and simulate the financial impact of alternative payment models for favorable-risk prostate cancer on payers and providers. Ultimately, APMs will align financial incentives for payers and providers, reduce unwarranted variation in implementation, and shift more men to appropriate use of surveillance thereby improving population health among men with favorable-risk prostate cancer.

项目摘要该项目旨在解决针对前列腺癌积极监视的固有的财务障碍。许多有利风险疾病的男性不会受益于积极的干预措施。周围谁的不确定性以及如何治疗导致治疗模式的广泛差异，部分是由非临床因素驱动的经济激励措施。监视策略避免或延迟了对男性的积极待遇有利风险的肿瘤已被证明可以减少与治疗相关的发病率和支出，而无需损害生存。因此，它与当前的国家利益相吻合，以提高医疗保健提供。然而，研究表明，监视不足，其实施差异很大。有几个因素是为此造成的，但是一个合理的贡献是经济激励措施嵌入在交付系统中的提供商有利于积极的干预措施，因为他们的报销是直接的，并且可能比与监视有关的活动大几倍。最近的付款改革鼓励采取替代支付模型（APM）的运动，旨在提高医疗保健的价值。在这种情况下，APM可以为提供者提供额外的付款，以进行监视，同时偿还实现质量目标，以确保其适当的性能并降低总数付款人费用。该提案的目的是开发APM，以促进监视的合理使用，并与以下目的：1）了解泌尿科医生对积极监视的付款激励措施的反应； 2）到制定强大的质量绩效指标来实施主动监视； 3）并模拟有利风险前列腺癌的替代支付模型对付款人的财务影响和提供者。最终，APM将对付款人和提供商的财务激励措施保持一致，减少不必要的实施的变化，并将更多的人转移到适当使用监视，从而改善有利风险前列腺癌的男性人口健康。