How to Evaluate the Quality and Cost of Cancer Care? Teamwork
Physically, emotionally, and financially, cancer is tough on patients and their families. Half of newly diagnosed cancer patients are over age 65, making Medicare the single largest payer of oncology care in the United States. Through its oncology care model (OCM), the Centers for Medicare & Medicaid Services Center for Innovation (CMMI) is looking for ways to reduce the financial costs to Medicare while reducing burdens for beneficiaries and their families by enhancing:
- Patient navigation and education,
- Care coordination among providers,
- Adherence to nationally recognized clinical guidelines, and
- End of life care.
Abt is in our fourth year leading an evaluation of OCM. We’re trying to determine if the model reduces costs to Medicare, and improves the cancer patient’s experience.
To properly evaluate OCM, we use a variety of data to assess a broad range of outcomes: patient care experiences, clinician perceptions, utilization and cost of health services, and clinical outcomes. Abt has the expertise to cover several of these areas, but it takes integrated, comprehensive partnerships for an evaluation of this scope, which must address such diverse program outcomes while keeping all of the pieces moving. That’s why we assembled a team of partners with the big data, economic, and clinical expertise to evaluate this complex program.
To start, we needed data, and lots of it. GDIT manages CMMI’s big data warehouse, which is used for program implementation and evaluations. GDIT’s experience and deep understanding of Medicare administrative data, gives them the insight to extract and assemble the necessary data from claims, Medicare beneficiary eligibility files, provider service files, and other related sources. They create beneficiary-, episode-, and provider-level files every quarter, which our team uses for evaluation analyses.
Of course, one of the vital metrics for determining the success of OCM is whether it changes utilization patterns and reduces Medicare costs. The Lewin Group is leading the cost and use analysis. They’re answering questions such as “Did the use of services change under OCM?” “Did Medicare save money?” “Where in the process did savings (or losses) occur?”
To understand the clinical impacts of OCM, we invited Dr. Nancy Keating and her colleagues from Harvard Medical School’s Department of Health Policy to join our team, along with Dr. Gabriel Brooks, a medical oncologist from Dartmouth. They’re determining if clinicians are adhering to national clinical guidelines, whether treatment patterns are changing to emphasize high-value care, and whether there are any deleterious consequences.
In addition to managing this team, Abt is surveying cancer patients and family members about their care experiences, surveying clinicians about their perspectives and experiences, and conducting dozens of in-depth case studies to understand how care delivery is changing. We’re also using our expertise in hospice and palliative care to measure improvements in care at the end of life.
Changing cancer care delivery to foster coordination and efficiency takes time, and the data thus far reflect the earliest years of OCM. Our team is still analyzing data and measuring OCM’s impact. We look forward to sharing a full report—the fruit of our collective labors—reflecting the first two years of OCM later this year.