Innovating Cancer Care to Improve Value: Health Care Innovation Awards Round Two

Craig Deligdish, MD

February 2014, Vol 5, No 1 - From the Editor


The Patient Protection and Af­fordable Care Act (ACA) has been a major topic in the news of late. In addition to providing better healthcare and allowing the uninsured to obtain affordable insurance coverage, the ACA has provided funding for outcomes research and healthcare innovation. Established by the ACA, the Patient-Centered Outcomes Research Institute (PCORI) to date has approved more than 275 awards, totaling more than $464 million, to fund patient-centered comparative clinical effectiveness research projects.1 In addition, the Center for Medicare & Medicaid Innovation (CMMI) has already awarded more than $1 billion in grants to more than 50 organizations for the projects that propose improving quality, reducing cost, and improving value in healthcare.1

PCORI was created to fund research that will allow providers to adopt and utilize evidence-based information, allowing patients and providers to make better healthcare decisions. In addition, PCORI has set up a National Patient-Centered Clinical Research Network to facilitate clinical comparative effectiveness research, and has invested more than $100 million in this effort.2

In May 2013, CMMI announced Round Two of the Health Care Innovation Awards.3 The purpose of Round Two is to test new payment and service delivery models to improve health and to lower costs through improved quality for Medicare, Medicaid, and Children’s Health Insurance Program enrollees. In Round One, the Innovation Center supported projects that transformed care through a variety of initiatives, also with a focus on improving quality and reducing cost.

Round Two proposals, however, looked to test models that focus on new payment and service delivery models, with a specific focus on populations with specialized needs, such as patients with cancer and those receiving high-cost physician-administered drugs, therapeutic services (eg, radiation therapy), and other outpatient services. The funds being provided are specifically targeted to approaches that transform financial and clinical models, focusing on high-cost subspecialties, such as oncology and cardiology. The grants also look to support models that test patient engagement and shared decision-making tools.

In this regard, more than 20 grants were submitted by organizations that focus on treating patients with cancer to include academic medical centers, provider collaboratives, large oncology practices, state governments, and others. Examples of grants that were submitted include proposals by Oncology Resource Networks, a clinically integrated network model representing oncologists in New York, Michigan, Pennsylvania, California, Florida, Montana, and Nevada. Recently, Oncology Resource Networks submitted 3 proposals, each of which proposed novel payment methodologies while transforming financial and clinical models for payers and providers. One of the models, “Transforming Cancer Care with Technology, Payment Engagement and Novel Payment Methodologies,” proposes equipping physicians with the electronic infrastructure and up-to-date information needed to deliver cost-effective, evidence-based oncology, radiation, and palliative cancer care. This approach is designed to move beyond data and infrastructure to provide financial incentives for providers who embrace the proposed models and technology.

The program rewards providers who implement a web-based decision support tool for chemotherapy and radiation therapy, and who adopt fee schedule adjustments for chemotherapy that incentivize cost-effective treatment. The use of an electronic portal allows efficient communication between providers and patients, and is designed to enhance patient engagement and shared decision-making. Practice enhancements that allow for the adoption of medical home concepts and accountable care contribute to a design that has been demonstrated to reduce the cost of care while improving outcomes. The model seeks to test how these approaches can result in better care coordination. The adoption of advanced illness programs and a shared-savings model allows physicians, patients, and payers to work together to encourage the use of cost-effective, evidence-based treatment that improves quality in a very vulnerable patient population.

Payers, including Florida’s Medicaid program, Blue Cross Blue Shield of California, Blue Cross Blue Shield of Michigan, Priority Health, WellPoint, Florida Blue, Empire BlueCross BlueShield, BlueCross BlueShield of Western New York, and oncology providers in community, hospital, and comprehensive cancer centers, agreed to partner in this collaborative proposal to test these programs in more than 10,000 patients.

Other models that were proposed by Oncology Resource Networks to CMMI include an integrated network model that suggests managing the costs of radiation therapy through episodes and bundled payments. Again, incentivizing patients and engaging patients, providers, and health plans were core components of this proposal. Requiring physicians to be accountable to evidence-based guidelines is an important feature of this proposal. A third proposal by Oncology Resource Networks described a model regarding high-cost drugs that resembled approaches taken in the Medicare Modernization Act, a law that resulted in the creation and implementation of Medicare Part D.

A recent article published in the New York Times examined some of the efforts by the Health Care Innovation Center to transform healthcare and examine new models that will potentially improve outcomes.4 The article focused to a large degree on medicine’s historical approach to proving concepts such as randomized clinical trials. PCORI and the Health Care Innovation Center have examined other approaches to include comparative effectiveness research and models that do not always include control groups. The article quoted a number of researchers who were critical of the approaches taken by the Innovation Center, whereas Patrick Conway, MD, MSc, the acting director of the center and Chief Medical Officer for the Centers for Medicare & Medicaid Services, defended the Health Care Innovation Center’s philosophy regarding its investments and the demonstration projects that have been funded by the center thus far.

Nearly all of the oncology professional organizations, including the American Society of Clinical Oncology (ASCO), Community Oncology Alliance, and the National Comprehensive Cancer Network, have taken positions on value-based cancer care. In 2007, ASCO established the Cost of Cancer Task Force, and more recently changed its name to the Value in Cancer Task Force, to address cost, quality, and value as they relate to cancer treatment.

It is frequently accepted that tremendous progress has been made in the treatment of cancer, yet there is also agreement that the costs are accelerating to a point where they are no longer sustainable for many patients and payers. The funding provided by CMMI as part of Round Two of the Health Care Innovation Awards will hopefully allow patients to continue to benefit from new and innovative treatments, and provide greater value and better outcomes for patients and payers.

References

  1. 1. Patient-Centered Outcomes Research Institute. PCORI offers $206 million in research support through latest funding announcements. February 5, 2014. www.pcori.org/2014/pcori-offers-206-million-in-research-support-through-latest-funding-announcements/. Accessed February 12, 2014.
  2. 2. Patient-Centered Outcomes Research Institute. PCORnet: The National Patient-Centered Clinical Research Network. www.pcori.org/funding-oppor tunities/pcornet-national-patient-centered-clinical-research-network/. Accessed February 12, 2014.
  3. 3. US Department of Health and Human Services. Health Care Innovation Awards. Catalog of Federal Domestic Assistance. Number 93610. www.cfda.gov/?s=program&mode=form&tab=step1&id=5cb9e 018d023ac884a 95a265aa11e623. Accessed February 12, 2014.
  4. 4. Kolata G. Method of study is criticized in group’s health policy tests. The New York Times. February 2, 2014. www.nytimes.com/2014/02/03/health/effort-to-test-health-policies-is-criticized-for-study-tactics.html?hpw&rref=us. Accessed February 10, 2014.