Segment 11: Confronting Gaps in Care Measurement

Although there are a lot of quality measures currently available, are there gaps that need to be filled? Jennifer Malin, MD, staff vice president, Clinical Strategy, Anthem, said that while there are a lot of quality measures, with ASCO taking a lead in developing these, gaps persist. “Some of the quality measures are maybe too general to really differentiate high quality and low quality care,” Malin said, adding that measures might be too general to end up being meaningful.

There’s also the possibility of measure fatigue, especially in cancer, with its many subtypes, with specific treatments for each. What would be ideal, Malin said, would be the development of cross-cutting measures, such as Anthem’s approach for pathways adherence, which helps measure if the most appropriate treatment is being delivered. “The issue is coming up with a succinct number of measures that are really meaningful. It’s hard to do that with 200, but at the same time you need measures that don’t leave rare cancers, where arguably it’s the biggest challenge in making sure people get appropriate care, out of the picture,” Malin added.

Jason C. Goldwater, MA, MPA, senior director, National Quality Forum (NQF), agreed with Malin that care gaps do exist, and explained how NQF is working to explore these breaks and workout ways to fill them up. NQF, Goldwater said, facilitates and leads the Measure Application Partnership, which “brings together a lot of national experts in the area of oncology, again, from numerous sectors from payers to providers to consumers and so forth that talk about the measure gaps and talk about the measures that are needed.” The resulting recommendations are then turned in to the CMS with the hope of being commissioned.

Goldwater specifically discussed gaps in palliative and end-of-life care and also being able to understand disparities in cancer care, driven by socioeconomic and other factors. This, he believes, can help direct efforts in the right direction. “I think that we're still evolving that area and still working through to understand what we can best do to fill those gaps whether they come through a CMS sponsored project or whether they come from an organization's own initiative to determine whether or not that gap can be identified and filled and filled in such a way that it would create a sustainable metric that would be able to be used and evolved over time,” Goldwater added.

Linda Bosserman, MD, assistant clinical professor and staff physician, City of Hope, is hopeful about Anthem’s efforts to provide patient outcomes data to the individual physician or clinic—whether they visited the emergency room or the hospital, the frequency of the visits, etc. this information, Bosserman said, is usually not available in real-time to the clinic, unless they have a system in place that queries the patient on it. “It's really going to take this larger partnership, partnership between the primary doctors. How are we looking at overall health outcomes at the primary care levels…the hospital, the emergency room, and then how do we tie in hospice and palliative care in more effective ways. There are a lot of gaps and huge opportunities,” Bosserman said. These conversations between providers and payers can push us toward solutions, she said.