When it comes to incorporating patient input into the performance measures that underpin accountable care, how far have we come and what gaps still need to be closed, especially in oncology? A new study from the National Pharmaceutical Council (NPC) and Discern Health sheds new light on progress in making value-based reimbursement mechanisms, like accountable care, patient-centered. NPC and Discern Health collaborated with Dr. Mark McClellan, Director, Duke-Margolis Center for Health Policy, and Dr. Ethan Basch, Director, Cancer Outcomes Research Program, UNC Lineberger Comprehensive Cancer Center.
In the study, “Improving Patient-reported Measures in Oncology,” researchers examined available patient-reported measures (PRMs), tools to capture patient-reported care experiences and outcomes, and patient-reported performance measures (PR-PMs), which translate those experiences and outcomes into metrics. Researchers developed a three-pronged framework to assess the PRM and PR-PM landscape:
- Measure populations: identification of both oncology-specific and cross-cutting measures relevant to oncology
- Phases of care: assessment of the applicability of existing measures to each of three phases of care (population at risk, evaluation and initial management, and follow-up/survivorship)
- Domains: classification of measures into at least one of 14 facets domains related to either quality of life or experience of care
The research team identified gaps both by phases of care and by domain. Results from this landscape scan, along with stakeholder and expert interviews, informed a roundtable meeting. Recommended high priority domains for PR-PM implementation in value-based payment programs include care coordination, access to care, and symptoms/symptom burden. Roundtable participants noted that PR-PMs used in accountability programs should be held to a high standard for validity and reliability because of their potential to influence provider behavior and payment.
Report authors recommended five core strategies, with specific action steps for policymakers and measure developers, to improve patient-reported measures for oncology accountable care:
- Involve patients and caregivers throughout all aspects of the measures life cycle to ensure measures capture value
- Fill care phase and domain gaps in PRMs and PR-PMs
- Address methodological challenges
- Reduce provider and patient burden by standardizing and aligning use of PRMs and PR-PMs
- Support providers in PRM and PR-PM implementation
“We envision a future in which payment is tied to PR-PMs that are both meaningful to patients and reliably representative of provider performance,” said Kimberly Westrich, MA, NPC Vice President of Health Services Research and study co-author. “This research builds on our previous work on improving quality measurement in accountable care, elevating the voice of the patient.”