Changes to care delivery and payment models need to happen in order to improve a cancer care delivery system that is in crisis, found a new Institute of Medicine report.
The cancer care delivery system is beset with escalating costs, an increasingly aging population, a shrinking workforce and complex treatments for a difficult disease stretching healthcare resources, said the IOM.
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“Rising costs are making cancer care less affordable for patients and their families and are creating disparities in patients’ access to high-quality cancer care,” said the report, “Delivering high-quality cancer care: charting a new course for a system in crisis,” released Tuesday.
The cost of treating cancer is increasing faster than many other clinical sectors, soaring from $72 billion in 2004 to $125 billion in 2010, and forecast to reach $173 billion by 2020.
To make cancer care more affordable, the IOM committee of experts has recommended using quality measurement and new payment models to reward the cancer care team for providing high-quality and patient-centered care and eliminating ineffective interventions that have contributed to increasing costs in the fee-for-service environment.
Payers are experimenting with a variety of models, such as bundled payments, oncology patient-centered medical homes and accountable care organizations. These models can be applied to reward providers for using palliative care throughout treatment, advance care planning, timely hospice services and evidence-based practice guidelines and shared decision-making with the patient, the report said.
“If evaluations of specific payment models demonstrate increased quality and affordability, the Centers for Medicare & Medicaid Services and other payers should rapidly transition from traditional fee-for-service reimbursements to new payment models,” the report recommended.
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The IOM report said that changes were needed across the board in cancer care. “Most clinicians caring for cancer patients are trying to provide optimal care, but they’re finding it increasingly difficult because of a range of barriers,” said Patricia Ganz, MD, chair of the committee that wrote the report and a University of California, Los Angeles medical professor, in a news release.
Among committee recommendations are to:
• Fortify the training of clinicians and other healthcare professionals so they have the skills and competencies to care for cancer patients in a coordinated, team-based approach. Adequate training will help to respond to workforce shortages and growth of senior population, which accounts for most cancer diagnoses.
• Promote a learning health system for cancer care to analyze data of cancer patient outcomes in a variety of care settings and evidence-based cancer care treatments. Professional organizations and the Health and Human Services Department should develop a learning healthcare system, and payers should use incentives to encourage physicians to participate.
• Establish tools and pilots to help convert evidence into routine daily practice. Quality measures are needed as a standard way to evaluate the quality of cancer care that is delivered. These measures have potential to drive performance improvement, engage patients and influence physician behavior and reimbursement.
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