How Can We Improve Oncology Quality Measurement in Accountable Care?

As our health care system shifts from a focus on volume to a focus on value, accountable care programs can help health care stakeholders drive toward more effective treatment plans. Quality measurement, tied to financial incentives, is one of many approaches accountable care programs are using to promote system-wide improvement. Measures can help payers to reward better care, providers to take action to improve care, and patients to make informed decisions about their care.

Quality measurement in oncology is particularly challenging because care often includes targeted diagnostics and therapeutics that are indicated based on individualized patient preferences and tumor markers. Yet, most oncology quality measures are based on processes rather than patient outcomes or preferences, creating a potential disconnect.

To determine whether or where there are gaps in oncology quality measurement, which can lead to missed opportunities to spot problems or improve care, the National Pharmaceutical Council (NPC) and Discern Health analyzed the current oncology quality measure landscape for 10 high-priority cancers. The analysis, published as a white paper, “Improving Oncology Quality Measurement in Accountable Care,” also examines cross-cutting measures that assess clinical processes and outcomes across more than one condition, including multiple types of cancer. The white paper’s detailed measure gap analysis identified a number of important findings that can be used to improve cancer care:

• Accountable care measure sets for cancer typically include important cross-cutting measures for pain quantification and treatment planning, depression screening, inpatient and outpatient utilization rates, and radiation dose limits and use of radiation for palliative care.
• Despite a historical focus on development of process-related quality measures for cancer care, few measures exist or are in use beyond the breast, colorectal, and prostate cancer clinical areas.
• Numerous measure gaps for cancer-specific treatment processes exist, particularly for appropriate mutational and biomarker testing, imaging utilization, initiation and adherence to therapies, and initiation of radiation therapy.
• Other high-priority cross-cutting measure gaps remain, particularly for patient-reported outcome performance measures (PRO-PMs), stage- and tumor-specific data collection, survival and disease recurrence, and adherence to appropriate clinical pathways.

With that information, the study authors convened a roundtable discussion with health care stakeholders, including patients, providers and payers, to evaluate gaps the authors identified to improve quality measures and measure sets. Based on the measure gap analysis and roundtable review, the white paper authors developed six key areas in oncology measure development that can be strengthened, along with a set of short-term action steps to begin closing any gaps. The suggestions detailed in the white paper, along with a companion paper released in the Journal of Managed Care & Specialty Pharmacy in January, can help provide next steps to ensure patients get the right therapies for them.

The white paper and JMCP study exploring oncology measure gaps are a follow-on from prior NPC-supported work, the “Mind the Gap” white paper, peer-reviewed publication, and conference that explored challenges and solutions for closing gaps in health care quality measures.

NPC and Discern Health are hosting a webinar on April 26 from 1 p.m.-2:30 p.m. Eastern Time to discuss gaps in oncology quality measures and the white paper. The panel will be moderated by NPC Vice President of Health Services Research Kimberly Westrich, and will feature study authors Tom Valuck of Discern Health, Mark McClellan of the Duke-Margolis Center for Health Policy, and Robert S. Miller of the American Society of Clinical Oncology, as well as roundtable participant Alan Balch of the Patient Advocate Foundation. Registration is available via NPC’s website.