Public and private payers play a substantial role in measuring and incentivizing health care quality. This includes developing value-based payment (VBP) programs that hold health care entities accountable for delivering “high-value” care. Incorporating patient voices into the definitions of value for these programs can help make sure that the U.S. health care system is paying for things that are important to patients. But, beyond the mandate to make health care more “patient centered,” there are benefits to payers to amplifying patient voices, especially in oncology. Achieving these benefits means addressing barriers to implementing patient-reported measures (PRMs) in oncology VBP programs.
The National Pharmaceutical Council called on payers to integrate patient input in VBP via a new article published in the Journal of Managed Care & Specialty Pharmacy (JMCP). The viewpoint article was developed in partnership with Discern Health, along with co-authors Dr. Mark McClellan, director, Duke-Margolis Center for Health Policy, and Dr. Ethan Basch, director, Cancer Outcomes Research Program, UNC Lineberger Comprehensive Cancer Center.
“Improving patient-reported measures in oncology: a payer call to action” explores the current landscape of oncology PRMs, which are tools that capture patients’ voices related to their care experience and outcomes, and patient-reported performance measures (PR-PMs), which translate PRM responses into metrics that may be used to assess healthcare performance, compare entities, and measure changes over time. The article also identifies barriers to implementation and recommends actions payers can take to advance the use of these measures.
Including patient voices in VBP is particularly significant for oncology, considering the physical and psychological stress related to cancer diagnosis and treatment. This topic is important to payers because understanding patient perspectives supports identifying and paying for more effective interventions that are meaningful to patients. PRMs can also enable payers to observe patient trends, target population health management strategies, and help providers respond to symptoms earlier, improving clinical outcomes and reducing costs. Payers also use PR-PMs in VBP programs to encourage quality improvement or include them in value-based contracts with life sciences companies – tying payment for products to measure performance.
“The ultimate goal of value-based purchasing programs is to align incentives to promote better and more efficient outcomes for patients. Patient-reported measures can help payers incorporate what matters to patients into benefit design, which in turn impacts the treatment patients receive, especially in oncology,” said Kimberly Westrich, NPC vice president of health services research and study co-author. “This article offers actionable steps payers can take to advance the use of PR-PMs in VBP programs.”
The article leverages a multimethod research approach that included a literature review, landscape scan, stakeholder interviews and survey, and a multistakeholder roundtable.
Key findings include:
- Within a universe of over 800 available PR-PMs, 515 crosscutting measures are applicable to oncology; and only 18 oncology-specific PR-PMs were identified. Some of this small number are already used in VBP programs.
- Gaps in available oncology PRMs and PR-PMs include (but are not limited to) goal attainment, personalized medicine, socioeconomic status and survivorship.
- Barriers to implementing further PRMs and PR-PMs in VBP include:
- Existing PRMs and PR-PMs available for use in VBP may not be meaningful to patients and caregivers.
- PR-PMs selected for VBP use must be held to high methodological standards to ensure validity, reliability, and fitness for the purpose they serve.
- Patient burden and survey fatigue arises from ongoing encounters with multiple providers. This could be exacerbated by irrelevant and/or complex questions.
- Resource constraints and competing priorities increase the burden on providers from implementing PRMs and reporting PR-PMs. Program incentives may be insufficient to offset the needed investment.
- Recommendations for public and private payers include:
- Identifying or developing meaningful measures that fill gaps,
- Engaging patients throughout measure and program development and evaluation,
- Designing programs that include scientifically sound measures standardized to reduce patient and provider burden while supporting care, and
- Engaging providers using a stepwise approach that offers resources and incentives to support implementation.
“Both public and private payers have an opportunity to take a leadership role in development and implementation of meaningful patient-centered PRMs and PR-PMs,” says Theresa Schmidt, vice president at Discern and article co-author. “The trick will be creating enough measure alignment across programs to reduce provider and patient burden while generating the data needed to support and incentivize the delivery of personalized care to a diverse oncology population.”
See the full article in JMCP for more details on actionable steps to promote PRM implementation in oncology VBP programs.
The JMCP article builds on the research highlighted in the 2019 white paper by NPC and Discern Health, Improving Patient-reported Measures in Oncology, which also was co-authored by McClellan and Basch. For additional information on oncology measurement from NPC and Discern, check out: Improving Oncology Quality Measurement in Accountable Care.