Oderda Gary, Brixner Diana, Biskupiak Joseph, Harnett James, Chen Chieh-I, Quek Ruben G W
College of Pharmacy, University of Utah, Salt Lake City.
Regeneron Pharmaceuticals, Tarrytown, NY.
J Manag Care Spec Pharm. 2024 Aug;30(8):825-833. doi: 10.18553/jmcp.2024.30.8.825.
There is limited knowledge of how US managed care professionals view and prioritize quality metrics/performance measures, care models, alternative payment models, and clinical pathways in oncology settings.
To characterize payor perspectives on, and the use of, oncology clinical pathways and performance measures in their reimbursement/access decision-making process.
A survey was implemented via SurveyMonkey software and distributed electronically to a national sample of the Academy of Managed Care Pharmacy (AMCP) Market Insights Panel members from July 11 through August 5, 2022. The survey was created by a steering committee based on literature reviews of the current and future oncology care landscapes. The survey consisted of 47 questions, including those to establish respondents' position, responsibilities, and demographics. The results are presented as descriptive statistics for 7 key questions that covered the perceptions and use of quality metrics/performance measures, alternative payment models, and oncology care pathways as prioritized by the steering committee.
Among the 695 AMCP panel members who were sent the survey, 73 responded (response rate 10.5%), 54 were eligible to continue, and 31 completed the entire questionnaire; the low response rate may limit generalizability of the survey results. Specific oncology clinical and economic measures of performance were currently used (70%-88%) but generally received less endorsement for future use (39%-49%) except for chemotherapy during end of life, which was considered for future use by 80% of respondents but was only currently used by 31%. Benchmarking was the primary reason for the use of performance measures; only 27% used these to inform value-based agreements. Real-world data tracked by respondents' institutions primarily focused on managed care and pharmacy utilization (39%-85%), with patient-reported and clinical outcomes tracked by only 17%-34%. Almost one-third (31%) did not use clinical oncology pathways, and among those who did, fewer than half (48%) reported that their organization tracks whether treatment decisions agree with the oncology care pathways, and only 26% reported feedback to oncology providers on how often their treatment decisions agree with the pathways. When considering alternative payment models, patient-related components received lower rankings in importance than clinical relevance, actionability, and costs.
Variation among payors regarding current trends in oncology care management, including on the importance of patient-centric outcomes and the use of oncology clinical pathways, suggests the need to focus on value-based health care and greater uptake of oncology clinical pathways.
对于美国管理式医疗专业人员如何看待肿瘤学环境中的质量指标/绩效衡量标准、护理模式、替代支付模式和临床路径并对其进行优先级排序，人们了解有限。
描述支付方在肿瘤学临床路径和绩效衡量标准用于报销/准入决策过程中的观点及使用情况。
2022年7月11日至8月5日，通过SurveyMonkey软件进行了一项调查，并以电子方式分发给美国管理式医疗药师学会（AMCP）市场洞察小组全国样本的成员。该调查由一个指导委员会根据对当前和未来肿瘤学护理格局的文献综述创建。调查包括47个问题，包括用于确定受访者职位、职责和人口统计学信息的问题。结果以描述性统计数据呈现，涉及指导委员会确定为优先事项的7个关键问题，涵盖质量指标/绩效衡量标准、替代支付模式和肿瘤学护理路径的认知和使用情况。
在收到调查的695名AMCP小组成员中，73人回复（回复率10.5%），54人有资格继续参与，31人完成了完整问卷；低回复率可能会限制调查结果的普遍性。目前正在使用特定的肿瘤学临床和经济绩效衡量标准（70%-88%），但除临终化疗外，这些标准在未来使用方面通常获得的认可较少（39%-49%），80%的受访者考虑在未来使用临终化疗，而目前只有31%的人使用。基准化是使用绩效衡量标准的主要原因；只有27%的人将这些标准用于基于价值的协议。受访者所在机构跟踪的真实世界数据主要集中在管理式医疗和药房利用情况（39%-85%），只有17%-34%的机构跟踪患者报告的结果和临床结局。近三分之一（31%）的人未使用肿瘤学临床路径，在使用的人中，不到一半（48%）报告其组织跟踪治疗决策是否符合肿瘤学护理路径，只有26%的人报告向肿瘤学提供者反馈其治疗决策与路径的符合频率。在考虑替代支付模式时，与患者相关的因素在重要性方面的排名低于临床相关性、可操作性和成本。
支付方在肿瘤学护理管理当前趋势方面存在差异，包括以患者为中心的结局的重要性以及肿瘤学临床路径的使用，这表明需要关注基于价值的医疗保健并更多地采用肿瘤学临床路径。
