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: 10374837
• 负责人: Bruce E. Landon
• 金额: $ 40万
• 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 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10374837
• 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.

在个性化医学的革命和针对新的生物疗法的爆炸渠道 改善癌症的结局，同时减少治疗的副作用，癌症护理的成本 全国是增长最快的医疗保健费用领域之一。控制升级成本的努力 护理要么可以使用更多的一般付款改革来鼓励提供者改变其整体方法 在特定的临床区域（例如肿瘤学）明确护理或针对针对性。医疗保险责任护理 组织（ACO）计划代表着全国最重要的努力，以测试全球的影响 付款模型不集中在特定的临床领域。相反，在癌症护理领域，CMS 于2016年启动肿瘤护理模型（OCM），这是一种有针对性的捆绑付款方式 参与实践对6个月的发作负责，这是由收到的 化学疗法。这两种方法都为提供商系统自定义治疗提供了灵活性 方法同时还提供了强大的激励措施，以减少过度使用昂贵和/或低价值医疗保健 不受良好证据支持的服务。但是，没有任何关于任何一个的数据 提高癌症护理递送价值或两者比较有效性的方法 方法。迄今为止，超过500名参与者与Medicare签约参加了先驱 或Medicare共享储蓄（MSSP）ACO计划和近200个肿瘤学实践开始参与 OCM于2016年7月。在先前的工作中，我们发现ACO计划的第一年节省了约1％的总体 通过使用较便宜的护理环境和服务利用降低，费用是 在第二年内更大。这项研究的总体目的是确定非目标的付款改革是否 诸如Medicare 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验证，但 从历史上看，没有使用的方法与OCM的有针对性方法进行比较。我们的建议有 评估（1）ACO对总体支出对癌症相关服务的影响的三个具体目标，（2） ACO对低价值非现实服务的使用和脱落的影响以及高价值的使用 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。我们提出的工作将为全球和有针对性的影响提供细微的理解 关于癌症患者支出和使用服务的付款改革。作为新的，更昂贵的毒品 并开发了治疗方法，医疗保健组织将需要制定策略以确保 仅当其净福利证明高成本合理的情况下，就会使用这种昂贵的治疗方法。科学前提 我们的建议是提供重要的证据，以比较这两种改善价值的方法以指导 寻求提高癌症护理服务价值的政策制定者。

项目成果

Opportunities for Savings in Risk Arrangements for Oncologic Care.

• DOI: 10.1001/jamahealthforum.2023.3124
• 发表时间: 2023-09-01
• 期刊: JAMA HEALTH FORUM
• 作者: Landon, Bruce E;Lam, Miranda B;Landrum, Mary Beth;McWilliams, J Michael;Meneades, Laurie;Wright, Alexi A;Keating, Nancy L
• 通讯作者: Keating, Nancy L