Missed Signals in Cancer Care: Strategies to Address Quality Measure Gaps

When it comes to designing accountable care models, the dramatically varied needs and preferences of patients with cancer can confound quality measurement, especially when compounded by increasingly targeted diagnostics and treatments, and higher-cost approaches to care.

Within the U.S. health care system, the shift from volume-based fee-for-service (FFS) to value-based payment is intended to encourage high-quality, patient-centered care and provide flexibility and resources for providers to continually improve care. Measurement is essential for promoting quality improvement and balancing financial incentives, but gaps in measurement can result in missed opportunities to improve patient outcomes and health system performance.

For many conditions, quality measurement is fairly straightforward. But for cancer, the factors that go into measuring quality of care get complicated quickly. That’s why the National Pharmaceutical Council recently partnered with Discern Health, the Duke-Margolis Center for Health Policy, and the American Society of Clinical Oncology (ASCO) to analyze gaps in accountable care measure sets for 10 types of cancer and identify solutions for filling the gaps.

The research team identified important gaps. Some types of cancers are simply underrepresented and are missing measures even where the level of evidence associated with clinical guideline recommendations is strong. Many cancer-specific process measures fail to measure signals of good care, like mutational or biomarker testing, appropriate imaging in diagnosis, and monitoring of treatment effectiveness or post-treatment surveillance.

The most actionable gaps were found in opportunities for cross-cutting measurement. While accountable care models use some cross-cutting measures, such as those that assess provider efforts to quantify pain, screen for depression, and reduce ER use, others are consistently missing:

• Access to different types of care: including palliative and hospice care, clinical trials, genetic testing and counseling, nutritional counseling, and psychosocial distress screening and treatment
• Standardized care planning and coordination: such as patient understanding of clinical findings, and shared decision-making across the full continuum of care, from diagnosis to treatment to survivorship planning and beyond
• Monitoring and addressing safety events: including those associated with the use of systemic therapy and radiation therapy
• Assessment of patient-reported outcomes: especially for pain control and global patient and caregiver satisfaction

The research partners engaged with a roundtable of experts to identify ways patient advocates, providers, payers, employers/purchasers, policy makers, and measurement experts can collaborate to close oncology measure gaps. The full study, published in the Journal of Managed Care & Specialty Pharmacy, presents recommendations from the roundtable, including guidance on incorporating patient-reported outcome performance measures (PRO-PMs) into measuring the quality of care.

This study builds on NPC’s “Mind the Gap” white paper, peer-reviewed publication, and conference from 2014, which explored the challenges and solutions to addressing health care quality measure gaps. In that study, researchers identified numerous measure gaps related to delivery of specialty care for high-impact conditions and proposed strategies for closing those gaps and improving accountable care measurement. To read more about gaps in measures and the steps program implementers can take to improve accountable care measurement, check out resources from NPC’s “Mind the Gap” paper and conference.