With cancer care costs on the rise, attaining value-based care—curbing costs while maintaining or improving the quality of care—is becoming a high priority. Alternative payment models are increasingly holding practices accountable for the quality of care that they provide, as well as their use of resources, by requiring that practices report on various quality measures.
In an effort to establish consistency across health systems in how value is defined, the American Society of Clinical Oncology (ASCO) developed a core set of 10 value-based performance measures to combine clinical performance, the appropriate use of resources, and the measurement of patient outcomes and experiences.1
“ASCO undertook this effort in the belief that a common set of measures would allow and promote meaningful comparisons among health systems and providers, and across patient and disease populations,” stated Michael N. Neuss, MD, Chief Medical Officer, Vanderbilt-Ingram Cancer Center, Nashville, TN, and colleagues.
To develop the performance measures, ASCO convened a group of oncology providers, patient advocates, payers, medical professional organization representatives, and representatives from national quality measurement organizations, nearly all of whom had personal experience with cancer as a patient, a caregiver, or as a family member of a patient with cancer.
The ASCO group agreed that the proposed value-based measures should include 4 core elements:
- Process measures to assess appropriate active treatment based on recognized guidelines
- Patient experience measures that focus on patient satisfaction with care (eg, symptom relief)
- Measures to assess whether resources are used appropriately (eg, hospital and emergency department use)
- Measures to assess patient- and disease-related outcomes (eg, survival, duration of response).
10 Performance Measures
The group developed the following 10 performance measures and ranked them based on their importance:
- Appropriate use of antineoplastic therapy
- Reduced emergency department use
- Providers’ awareness of their patients’ care goals
- Reduced hospitalization use
- Successful care coordination by physicians
- Providers’ success in managing patients’ pain
- Hospice care utilization at the end of life
- Complete patient evaluation using evidence-based testing at diagnosis
- Multidisciplinary input at diagnosis and initial treatment
- Adequate radiation therapy use (eg, fractionation).
The first 5 measures included the appropriate use of antineoplastic therapy, the avoidance of excessive emergency department use, patient perception of providers’ awareness of their care goals, the avoidance of unnecessary hospitalization use, and responsibility for and successful coordination of care among physician providers.
The ultimate goal of drafting these value-based performance measures is to launch pilot projects that test these measures and to create a data source and reporting system to support the value measures, stated Dr Neuss and colleagues.
The pilot projects would collect valuable information (eg, patients’ symptoms, comorbidity measures) from providers, patients, and potentially third-party surveyors that is not typically found in administrative data sets. This information can be collected into an analytic platform that will test the feasibility of collecting and sharing meaningful value information with providers, patients, payers, and the public.
“We believe that, if designed in a way consistent with the framework we suggest, the project would provide a blueprint for enhancing quality of care, increasing value, reducing waste, and optimizing resource use,” stated Dr Neuss and colleagues.
- Neuss M, Rocque G, Zuckerman D, et al. Establishing a core set of performance measures to improve value in cancer care: ASCO Consensus Conference Recommendation Report. J Oncol Pract. 2017;13:135-140.