Outcome measures for oncology alternative payment models: practical considerations and recommendations
- This paper focuses on synthesizing existing research on quality measures in oncology, particularly outcome-based quality measures which are underutilized.
- A set of "core outcome measures" is proposed for future oncology alternative payment models (APM).
- The study design includes a literature review, content analysis, and quality measure synthesis and categorization.
- Research involved analyzing 7 oncology quality assessment frameworks with 142 quality metrics, using the Centers for Medicare and Medicaid Services APM toolkit.
- 34 outcome-based oncology quality measures are identified, classified into five domains:
- Clinical care (e.g., hospital and emergency department visits, treatment effectiveness, and mortality)
- Safety (e.g., infections and hospital adverse events)
- Care coordination (for hospital and hospice care)
- Patient and caregiver experience
- Population health and prevention
- Both general and indication-specific outcome measures should be considered in oncology APMs.
- Challenges such as risk adjustment and data quality assurance need to be addressed when utilizing outcome-based measures.
- Rigorous quality assessment will enhance oncology care, and the success of oncology APMs depends on relevant quality measures for patients, providers, and payers.
Several alternative payment models (APMs) are being piloted to address affordability, equity and quality-of-care challenges in oncology care. Of these arrangements, the Oncology Care Model (OCM), developed by the Centers for Medicare and Medicaid Innovation (CMMI), is among the most extensive, covering about 200,000 chemotherapy episodes annually. The OCM relies on multiple quality measures to determine the level of payment for each provider, with the goal of incentivizing higher-quality care in a cost-effective manner. The OCM’s payment design is described in Box 1.
Despite innovations in the payment landscape, limited consensus exists about what constitutes indispensable quality measures in oncology. The absence of such consensus may not only limit the development of better payment models, which increasingly link payment to quality of care, but may also result in a lack of agreement on how value should be defined (and demonstrated) in an era of innovative, ever more expensive cancer therapies. In 2017, a national expert roundtable recommended that policy makers “prioritize and develop effective cross-cutting measures that assess clinical and patient-reported outcomes, including shared decision making, care planning, and symptom control” and highlighted an “overreliance on condition-specific process measures.”1 Disease-specific quality measures have been developed, but there is a lack of consensus on what quality measures ought to be utilized across multiple cancers, especially when measuring clinical outcomes.2 As oncology APMs evolve, there are practical considerations in the design and implementation of outcomebased measures.
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