Comparing Targeted and Non-Targeted Approaches to Improving the Value of Cancer Care Services

比较提高癌症护理服务价值的靶向和非靶向方法

• 批准号: 9895590
• 负责人: Bruce E. Landon
• 金额: $ 37.18万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-01 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9895590
• 关键词: Comparing; Targeted; Non; Approaches; Improving

Amidst the revolution in personalized medicine and an exploding pipeline of new biologic treatments aimed at improving cancer outcomes while also decreasing the side effects of treatment, the cost of cancer care nationally is among the fastest growing segments of health care costs. Efforts to control escalating costs of care either can use more general payment reforms to encourage providers to change their overall approach to care or be targeted explicitly at specific clinical areas such as oncology. The Medicare Accountable Care Organization (ACO) programs represent the most important effort nationally to test the impact of a global payment model that is not focused on a particular clinical area. In contrast, in the area of cancer care, CMS launched in 2016 the Oncology Care Model (OCM), which is a targeted bundled payment approach that holds participating practices accountable for spending for a 6-month episode that is triggered by the receipt of chemotherapy. Both of these approaches provide flexibility for provider systems to customize treatment approaches while also providing strong incentives to reduce overuse of expensive and/or low value health care services that are not supported by good evidence. Yet, no data are available on the effectiveness of either approach for improving the value of cancer care delivery or of the comparative effectiveness of the two approaches. To date, over 500 participants have contracted with Medicare to participate in either the Pioneer or Medicare Shared Savings (MSSP) ACO programs and almost 200 oncology practices began participating in the OCM in July 2016. In previous work, we found that the first year of the ACO programs saved ~1% in overall costs through both use of less expensive care settings and decreased utilization of services, but savings were larger in year 2. The overall purpose of this research is to determine whether non-targeted payment reform policies such as those being used in the Medicare ACO program will be successful in promoting high value delivery of oncology services, including both abandonment of unproven therapies and adoption of proven, but historically underused ones, and to compare this with the targeted approach of the OCM. Our proposal has three specific aims that assess (1) the effects of ACOs on spending on cancer-related services overall, (2) the effects of ACOs on use and de-adoption of low value non-evidence-based services and use of high value services such as hospice and palliative care, and (3) comparison of these outcomes for ACO and OCM participants. Our proposed work will provide a nuanced understanding of the effect of global and targeted payment reforms on spending and the use of services for cancer patients. As new and ever more costly drugs and treatment approaches are developed, health care organizations will need to develop strategies to ensure that such costly treatments are used only when their net benefits justify the high cost. The scientific premise of our proposal is to provide important evidence comparing these two approaches to improving value to guide policy makers seeking to improve the value of cancer care services.

在个性化医疗的革命和新生物治疗的爆炸式增长中 改善癌症结果，同时减少治疗的副作用和癌症护理成本 在全国范围内，这是医疗保健费用增长最快的部分之一。努力控制不断上升的成本 护理机构可以使用更普遍的支付改革来鼓励提供者改变其总体方法 护理或明确针对肿瘤学等特定临床领域。医疗保险责任护理 组织 (ACO) 计划代表了全国范围内测试全球影响力的最重要努力。 不专注于特定临床领域的支付模式。相比之下，在癌症护理领域，CMS 2016年推出肿瘤护理模式（OCM），这是一种有针对性的捆绑支付方式， 参与实践负责 6 个月的支出，该支出是由收到的 化疗。这两种方法都为提供者系统提供了定制治疗的灵活性 方法，同时还提供强有力的激励措施，以减少过度使用昂贵和/或低价值的医疗保健 没有充分证据支持的服务。然而，没有任何数据表明这两种方法的有效性 提高癌症护理服务价值或两者比较有效性的方法 接近。迄今为止，已有超过 500 名参与者与 Medicare 签订了参与 Pioneer 计划的合同 或 Medicare 共享储蓄 (MSSP) ACO 计划和近 200 个肿瘤诊所开始参与 2016 年 7 月的 OCM。在之前的工作中，我们发现 ACO 计划的第一年总体节省了约 1% 通过使用较便宜的护理设施和减少服务利用率来降低成本，但节省的费用 第二年的规模更大。本研究的总体目的是确定非定向支付改革是否 医疗保险 ACO 计划中使用的政策将成功促进高价值 提供肿瘤学服务，包括放弃未经证实的疗法和采用经过证实的但 历史上未充分利用的方法，并将其与 OCM 的目标方法进行比较。我们的建议有 评估 (1) ACO 对癌症相关服务总体支出的影响的三个具体目标，(2) ACO 对低价值非证据服务的使用和取消采用以及高价值服务的使用的影响 临终关怀和姑息治疗等服务，以及 (3) ACO 和 OCM 的这些结果的比较 参与者。我们提出的工作将提供对全球和有针对性的影响的细致入微的了解 对癌症患者的支出和服务使用进行支付改革。作为新的且更加昂贵的药物 并制定治疗方法后，医疗保健组织将需要制定战略以确保 只有当其净效益证明高成本是合理的时，才会使用这种昂贵的治疗方法。科学前提是 我们的建议是提供重要的证据来比较这两种提高价值的方法，以指导 政策制定者寻求提高癌症护理服务的价值。