Quality Measures in Oncology

“When we ask people to deliver quality metrics and show what they have done, can we bring that information back to them in a usable format? Can we as payers take it and use it to reward? Can we use it to help pharma companies? Can we use it to help our employer sponsors understand what their costs are? Can we take it back to patients and give them action plans based on it?” asked Ira M. Klein, MD, MBA, FACP, chief of staff, Office of the Chief Medical Officer at Aetna. The answers to these questions were the premise for Dr Klein’s presentation entitled Quality Measures in Oncology.

Dr Klein stated the measurement domains for quality metrics: (1) patient experience; (2) value and access; and (3) clinical process and outcome. Furthermore, he noted 6 key questions that help determine the strength of a quality measure¹:

1. How strong is the scientific evidence supporting the validity of this measure as a quality measure?

2. Are all individuals in the denominator equally eligible for inclusion in the numerator?

3. Is the measure result under control of those whom the measure evaluates?

4. How well do the measure specifications capture the event that is the subject of the measure?

5. Does the measure provide for fair comparisons of the performance of providers, facilities, health plans, or geographic areas?

6. Does the measure allow for adjustment of the measure to exclude patients with rare performancerelated characteristics when appropriate?

Measuring Efficacy and Costs

Table

Dr Klein noted that outcomes can be used to tabulate efficacy and costs of care, but he clarified that more expensive treatment should be given to some patients if it is deemed appropriate. For example, despite similar efficacy, the cost of treatment options for non-small lung cancer and colon cancer vary tremendously; however, some patients will require more expensive regimens (). While treatment will be tailored to the patient, Dr Klein cautioned that “Uniformity builds efficiency and that is what we want.” He also stated that drug shortages, use of generics, and the price of future treatment regimens will also come into play when deciding what is best for the patient with respect to cost and efficacy.

Adherence

The key to success with quality metrics is adherence. Not just patient adherence but adherence by the medical professionals to quality metrics and pathwaysbased oncology strategies. According to Dr Klein, adherence should:

• Enhance patient outcomes and costeffectiveness of care by applying evidence- based clinical pathways and aligning oncology drug pricing with guidelines. Proper use of guidelines can promote drug pricing to drive selection of the most cost-effective medications, minimize side effects and toxicities, and support clinically appropriate lines of therapy

• Provide community-based care that continues to enable independent quality of life

• Provide decision support and care coordination for patients and families to help them make informed choices regarding lines of therapy or access to palliative and hospice care

• Align physician and reimbursement policy with clinical guidelines

Clinical Decision Support

Figure

Adherence to quality metrics also requires a means for the data to be exchanged seamlessly with various parties. At Aetna, Dr Klein said they are planning to use Medicity as an informatics exchange program that allows all parties to have access to the data ().

Using a clinical decision support system, both providers and patients can greatly benefit.

Providers receive:

• A flexible clinical decision support platform that can be supported by

multiple payers

• Evidence-based guidelines

• Network steerage preferences

• Online access to eligibility data

• Precertification waivers

• Applications that can make work flow easier

Members receive:

• Clinical information

• Social media

• Preferred physicians listing

• Culturally consistent content

• Seamless connection to benefit information

• Support services

The end result is that physicians get an office “that is a happy office, an efficient office. Time is not wasted finding data…or getting approval for things that should be approved based on the information available,” stated Dr Klein. Similarly, patients get information that helps them understand their disease, guidance for getting referrals, and access to patient organizations.

Concluding Remarks

Dr Klein ended his presentation by stating that for a program to work, patients should always be in the center with all other parties in communication to ensure treatment that is both medically appropriate and cost-effective.

1. Agency of Healthcare Research and Quality. Validity of Clinical Quality Measures. http://www.qualitymeasures.ahrq.gov/tutorial/validity.aspx. Accessed November 24, 2012.

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