Discern Health, Baltimore, MD.
National Pharmaceutical Council, Washington, DC.
J Manag Care Spec Pharm. 2021 Jan;27(1):118-126. doi: 10.18553/jmcp.2020.20313. Epub 2020 Oct 26.
Despite rising interest in integrating the patient voice in value-based payment (VBP) models for oncology, barriers persist to implementing patient-reported measures (PRMs), including patient-reported performance measures (PR-PMs). This article describes the landscape of oncology PRMs and PR-PMs, identifies implementation barriers, and recommends solutions for public and private payers to accelerate the appropriate use of PRMs in oncology VBP programs. Our research used a multimethod approach that included a literature review, landscape scan, stakeholder interviews and survey, and a multistakeholder roundtable. The literature review and landscape scan found that limited oncology-specific PR-PMs are available and some are already used in VBP programs. Diverse stakeholder perspectives provided insight into filling current gaps in measurement and removing implementation barriers, such as limited relevance of existing PRMs and PR-PMs for oncology; methodological challenges; patient burden and survey fatigue; and provider burden from resource constraints, competing priorities, and insufficient incentives. Key recommendations include: (a) identify or develop meaningful measures that fill gaps, engaging patients throughout measure and program development and evaluation; (b) design programs that include scientifically sound measures standardized to reduce patient and provider burden while supporting care; and (c) engage providers using a stepwise approach that offers resources and incentives to support implementation. DISCLOSURES: Funding for this project was provided by the National Pharmaceutical Council. Schmidt, Perkins, Riposo, and Patel are employees of Discern Health, a consulting firm with many clients, including government, life sciences, nonprofit, and provider organizations. Valuck is a partner at Discern Health. Westrich is an employee of the National Pharmaceutical Council, an industry-funded health policy research group that is not involved in lobbying or advocacy. Basch reports grants from National Cancer Institute and Patient-Centered Outcomes Research Institute; fees from serving as a consultant on research projects at Memorial Sloan Kettering Cancer Center, Dana-Farber Cancer Institute, and Research Triangle Institute/CMS; and fees from serving as a scientific advisor to CareVive Systems, Sivan Healthcare, Navigating Cancer, and AstraZeneca, outside the submitted work. McClellan reports fees from serving on the boards of Johnson & Johnson and Seer Bio and as an advisor to Cota outside the submitted work; and McClellan is an independent board member on the boards of Cigna and Alignment Healthcare, co-chair of the Guiding Committee for the Health Care Payment Learning and Action Network, and receives fees for serving as an advisor for MITRE, outside the submitted work.
尽管人们对将患者声音纳入肿瘤学价值为基础的支付(VBP)模式的兴趣日益增加,但在实施患者报告的衡量指标(PRMs)方面仍存在障碍,包括患者报告的绩效衡量指标(PR-PMs)。本文描述了肿瘤学 PRMs 和 PR-PMs 的现状,确定了实施障碍,并为公共和私人支付者提出了建议,以加速在肿瘤学 VBP 计划中适当使用 PRMs。我们的研究采用了一种多方法的方法,包括文献综述、景观扫描、利益相关者访谈和调查,以及多利益相关者圆桌会议。文献综述和景观扫描发现,现有的肿瘤学特定的 PR-PMs 有限,有些已经在 VBP 计划中使用。不同利益相关者的观点提供了对当前衡量标准差距和消除实施障碍的见解,例如现有 PRMs 和 PR-PMs 对肿瘤学的相关性有限;方法学挑战;患者负担和调查疲劳;以及资源限制、竞争优先事项和激励不足给提供者带来的负担。主要建议包括:(a)确定或开发有意义的衡量标准,通过在衡量标准和计划开发和评估过程中让患者参与来填补空白;(b)设计包括科学合理的衡量标准的计划,以减少患者和提供者的负担,同时支持护理;(c)采用逐步方法让提供者参与进来,提供资源和激励措施以支持实施。披露:本项目的资金由国家制药理事会提供。Schmidt、Perkins、Riposo 和 Patel 是 Discern Health 的员工,该咨询公司有许多客户,包括政府、生命科学、非营利组织和提供者组织。Valuck 是 Discern Health 的合伙人。Westrich 是国家制药理事会的员工,该理事会是一个行业资助的健康政策研究小组,不参与游说或宣传。Basch 报告说,他从国家癌症研究所和患者中心的成果研究所以及从 Memorial Sloan Kettering Cancer Center、Dana-Farber Cancer Institute 和 Research Triangle Institute/CMS 的研究项目中获得咨询费;并从 CareVive Systems、Sivan Healthcare、Navigating Cancer 和 AstraZeneca 担任科学顾问获得费用,这些都与提交的工作无关。McClellan 报告说,他从 Johnson & Johnson 和 Seer Bio 担任董事会成员以及从 Cota 担任顾问的费用都与提交的工作无关;并且 McClellan 是 Cigna 和 Alignment Healthcare 的独立董事会成员,是卫生保健支付学习和行动网络指导委员会的联合主席,并从为 MITRE 担任顾问获得费用,这些都与提交的工作无关。