McClellan Mark B, Thoumi Andrea I
The Brookings Institution, Washington, DC
The Brookings Institution, Washington, DC.
J Oncol Pract. 2015 May;11(3):223-30. doi: 10.1200/JOP.2015.004655. Epub 2015 Apr 21.
Cancer care is transforming, moving toward increasingly personalized treatment with the potential to save and improve many more lives. Many oncologists and policymakers view current fee-for-service payments as an obstacle to providing more efficient, high-quality cancer care. However, payment reforms create new uncertainties for oncologists and may be challenging to implement. In this article, we illustrate how accountable care payment reforms that directly align payments with quality and cost measures are being implemented and the opportunities and challenges they present. These payment models provide more flexibility to oncologists and other providers to give patients the personalized care they need, along with more accountability for demonstrating quality improvements and overall cost or cost growth reductions. Such payment reforms increase the importance of person-level quality and cost measures as well as data analysis to improve measured performance. We describe key features of quality and cost measures needed to support accountable care payment reforms in oncology. Finally, we propose policy recommendations to move incrementally but fundamentally to payment systems that support higher-value care in oncology.
癌症护理正在发生变革，朝着日益个性化的治疗方向发展，有望挽救和改善更多生命。许多肿瘤学家和政策制定者认为，当前的按服务收费支付方式是提供更高效、高质量癌症护理的障碍。然而，支付改革给肿瘤学家带来了新的不确定性，实施起来可能具有挑战性。在本文中，我们阐述了直接将支付与质量和成本指标挂钩的责任医疗支付改革是如何实施的，以及它们带来的机遇和挑战。这些支付模式为肿瘤学家和其他医疗服务提供者提供了更大的灵活性，以便为患者提供所需的个性化护理，同时在证明质量改进以及总体成本或成本增长降低方面承担更多责任。此类支付改革增加了个人层面质量和成本指标以及数据分析对于改善所衡量绩效的重要性。我们描述了支持肿瘤学责任医疗支付改革所需的质量和成本指标的关键特征。最后，我们提出政策建议，以逐步但从根本上转向支持肿瘤学高价值护理的支付系统。
