Study Recommends Measures to Fill Quality Gaps in Oncology Care

A collaborative study by the National Pharmaceutical Council, Discern Health, the Duke-Margolis Center for Health Policy, and the American Society of Clinical Oncology (ASCO), identified gaps in existing quality measures used by accountable care programs that could result in missed opportunities to improve patient outcomes.

Discern Health analyzed gaps in accountable care measure sets for 10 cancer conditions: breast, chronic myelogenous leukemia, colon, kidney, melanoma, non-Hodgkin lymphoma (NHL), non-small cell lung (NSCLC), ovarian, pancreatic, and prostate cancer. These cancer types were selected based on several factors, including:

• Impact of cost and mortality
• Expensive diagnostic procedures
• Disparities

The authors identified measure gaps based on discrepancies between recommendations by the National Comprehensive Cancer Network treatment guidelines and the existing quality measures used by oncology-focused accountable care programs and those developed by professional organizations such as the National Quality Forum, ASCO, American College of Surgeons, and American Society for Radiation Oncology.

Their initial gap analysis flagged the following in measures used by the accountable care programs:

1. Imbalance. Disproportionate representation of certain high-prevalence cancers (such as breast, colorectal, and prostate) and an underrepresentation of measures for other priority conditions (eg, NHL, NSCLC).
2. Condition-specific gaps. Gaps for appropriate mutational and biomarker testing, appropriate imaging for diagnosis and monitoring treatment efficacy, surveillance following treatment, adherence to hormonal therapies, and initiation of stage-specific radiation therapy.
3. Access to multidisciplinary care. Despite the use of cost-cutting measures, gaps were identified, especially access to multidisciplinary care. Some of the areas that were identified included: Hospice and palliative care Clinical trials Genetic testing and counseling Nutritional counseling

These results were subsequently presented to a panel of experts in cancer care, which included patient advocates, providers, payers, employers/purchasers, policy makers, and quality organization representatives. After reviewing the data, the experts recommended the following:

1. Development of more meaningful cross-cutting measures, rather than stage-specific therapies, focused on patient-reported outcomes, clinical outcomes, safety, evaluation and management, and structural measures.
2. Leverage clinical pathways for guidance, but personalize use based on patient needs.
3. Layer measures at varying levels: provider level, system level, and external accountability level.

Based on their analysis, the participants laid out a few recommendations to organizations—including the Core Quality Measure Collaborative (a group led by America’s Health Insurance Plans and CMS), the Agency for Healthcare Research and Quality, and the Patient-Centered Outcomes Research Institute—to promote measure alignment and funding to develop these cross-cutting quality measures.

You can access the full study and recommendations here.