New Study Outlines Gaps, Offers Strategies to Improve Oncology Quality Measures

(Washington, DC, January 30, 2017) – Gaps in the quality measures used by accountable care programs to assess cancer care may obscure problems in care delivery and lead to missed opportunities for improvement of patient outcomes, according to a new study published in the Journal of Managed Care & Specialty Pharmacy.

Quality measures are a key element of accountable care payment models. Measures can help providers identify improvement opportunities, track effectiveness of improvements over time, and get rewarded for maintaining high-quality care while lowering costs. The study, “Improving Oncology Quality Measurement in Accountable Care: Filling Gaps in Cross-Cutting Measures,” was conducted by experts at the National Pharmaceutical Council (NPC), Discern Health, the Duke-Margolis Center for Health Policy and the American Society of Clinical Oncology (ASCO).

The research team analyzed gaps in accountable care measure sets across 10 high-priority types of cancer. The cancers, which included breast, chronic myelogenous leukemia, colon, kidney, melanoma, non-Hodgkin lymphoma, non-small cell lung, ovarian, pancreatic and prostate cancer were selected based on factors such as prevalence, cost impact and disparities in care for vulnerable patients.

“We focused on cancer because of the complexity of the treatment landscape. Diagnostics and treatments are increasingly targeted to genotypes. Patient needs and preferences are incredibly varied,” said NPC Vice President for Health Services Research Kimberly Westrich, one of the study’s authors. “That makes it critically important to ensure performance incentives for care balance that complex interplay of factors.”

There is a gulf between the rapidly changing care environment, which is increasingly focused on personalized medicine, and the measures that have been used to assess quality. To analyze measure gaps, Discern Health first assessed existing quality measures against clinical practice guidelines developed by the National Comprehensive Cancer Network (NCCN) and other oncology specialty societies. The measure review included those that are part of existing accountable care measure sets, such as the Oncology Care Model (OCM). This analysis identified significant measure gaps across all 10 cancer types, including areas where available measures are not being used in accountable care measure sets and new measures need to be developed.

The oncology measure gap analysis, including initial recommendations for improving accountable care measure sets, was then presented and considered during a roundtable discussion among experts in cancer care, including patient advocates, providers, payers, employers/purchasers, policy makers, and quality organization representatives.

The group’s primary recommendation to improve oncology measures was to shift emphasis from condition-specific processes of care, such as stage-specific therapies, and instead prioritize development and use of more meaningful cross-cutting measures. The roundtable participants recommended that cross-cutting measures focus on patient-reported outcomes (PROs), clinical outcomes, safety, evaluation and management, and structural measures. 

“The roundtable participants prioritized cross-cutting measures because they recognized that using broader measures can address several important measurement challenges,” noted study co-author Discern Health Partner Tom Valuck, MD, JD. “With clinical evidence in oncology evolving so quickly, increased personalization of cancer care, and a growing measure reporting burden for providers, over-reliance on process measures for specific conditions results in measurement that is less meaningful and more burdensome.”

In addition to the development and use of cross-cutting measures, roundtable participants made the following recommendations:

Leverage clinical pathways: Clinical pathways, which help manage patient care based on clinical practice guidelines to improve quality of care, can drive appropriate testing and treatment, but roundtable participants noted that benchmark targets for use of clinical pathways should be less than 100 percent, since strict adherence to pathways is not appropriate for all patients.

Layer measures at varying levels: Once sets are defined, payers and providers can use measures at the provider-level for clinicians who want condition-specific process measures to guide appropriate care; at the system-level, where cross-cutting measures can give management a broader view of system performance; and at the external accountability level, where cross-cutting measures can be used to roll up outcomes—including patient-reported outcomes—for the cancer population.

“The oncology community’s understanding of cancer has become vastly more sophisticated and complex in recent years. Treatment options, fortunately, continue to increase at a rapid pace and current measures simply aren’t adequate to reliably improve patient outcomes and increase value,” said co-author Mark McClellan, MD, PhD, Director of the Duke-Margolis Center for Health Policy. “This study provides clear direction on how to overcome barriers to better measures and ensure that value-based payment incentives work the way they’re intended.”

 Roundtable participants filled out their recommendations by advising next steps for stakeholders, including:

• Building on the best available measures as identified by the Core Quality Measure Collaborative (CQMC), a group led by America’s Health Insurance Plans (AHIP) and the Centers for Medicare & Medicaid Services to promote measure alignment and collection of core performance measures across public and private sector payers
• Continuing to fund and develop cross-cutting measures, and leverage processes to create efficiency
• Funding from the Agency for Healthcare Research and Quality (AHRQ) and the Patient-Centered Outcomes Research Institute (PCORI) to support measurement science and advances in developing patient-reported outcome measures

“The roundtable’s recommendations are an important roadmap for developing quality measures that will lead to better care for people with cancer,” said Vice President and Medical Director, CancerLinQ, ASCO, and study co-author Robert Miller, MD, FACP, FASCO. “In that process, we can’t underestimate the importance of integrating patient-reported outcomes measures and assessing the patient’s understanding of the goals of care. Engaged patients are key to lowering overall costs, promoting safety, and improving outcomes overall.”

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

About the National Pharmaceutical Council
The National Pharmaceutical Council is a health policy research organization dedicated to the advancement of good evidence and science, and to fostering an environment in the United States that supports medical innovation. Founded in 1953 and supported by the nation's major research-based pharmaceutical companies, NPC focuses on research development, information dissemination, and education on the critical issues of evidence, innovation, and the value of medicines for patients. For more information, visit www.npcnow.org and follow NPC on Twitter @npcnow.

About Discern Health

Discern Health is a consulting firm that works with clients across the private and public sectors to improve health and health care. Its focus is enhancing the value of health care services through quality-based payment and delivery. Discern advises clients on quality strategies, including the use of measures to promote system transformation and demonstrate the value of products and services.

About The Duke-Margolis Center for Health Policy

The Robert J. Margolis, MD, Center for Health Policy at Duke University is directed by Mark McClellan, MD, PhD, and brings together expertise from the Washington, DC policy community, Duke University and Duke Health to address the most pressing issues in health policy. The Center’s mission is to improve health and the value of health care by developing and implementing evidence-based policy solutions locally, nationally, and globally. For more information, visit healthpolicy.duke.edu.

About The American Society of Clinical Oncology

Founded in 1964, the American Society of Clinical Oncology, Inc. (ASCO®) is committed to making a world of difference in cancer care. As the world’s leading organization of its kind, ASCO represents more than 40,000 oncology professionals who care for people living with cancer. Through research, education, and promotion of the highest-quality patient care, ASCO works to conquer cancer and create a world where cancer is prevented or cured, and every survivor is healthy. ASCO is supported by its affiliate organization, the Conquer Cancer Foundation. Learn more at www.ASCO.org, explore patient education resources at www.Cancer.net, and follow on Facebook, Twitter, LinkedIn and YouTube.