Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA
Karma L. Kreizenbeck, Catherine R. Fedorenko, Julia Rose Walker, Mikael Anne Greenwood-Hickman, Laura Panattoni, Sarah Barger, Keith D. Eaton, Janet Freeman-Daily, Diane Mapes, Margaret Leigh Pate, Courtney J. Preusse, Gary H. Lyman, Scott David Ramsey
Background: Moving cancer care towards a value framework requires patients, providers, and payers to weigh cost, quality, and outcomes in decision-making. Many efforts are underway to help providers and payers make value decisions, but little has been developed for patients. Our regional value in cancer care effort used a claims-registry database to develop quality and cost reports aiming to provide actionable data to all stakeholders. Methods: Reports were generated using cancer registry records for Western WA from 2007-2015 linked with claims from two regional commercial insurers. Patients were presented quality reports on regionally prioritized metrics and the 2012 ASCO Choosing Wisely guidelines on breast cancer surveillance and EOL care. Patients also reviewed cost reports for episodes of care (diagnosis, treatment, end-of-life (EOL)) and out-of-pocket (OOP) cost estimates. Feedback stemmed from 1) stakeholder meetings over a 2-year period, 2) working groups of patients, payers and providers, and 3) an annual regional meeting on value in cancer care. Results: In total, 13 patients provided feedback at one or more outreach event. See table. Conclusions: Reports from a claims-registry database may not support the information needs of patients for care decision-making or representing “value”. Patients desired understanding more about patients “like them” for decision-making.
Quality | Cost | |||
---|---|---|---|---|
Breast Surveillance | EoL | Episode of Care | OOP Estimate | |
Patient Feedback | Utilization may reflect poor care coordination post-active treatment; patient anxiety; & a questioning of underlying evidence for recommendations | Distinguish between palliative radiation & chemotherapy | Ongoing costs of care (survivorship or post-active treatment) are relevant | Cost at the health-level does not adequately capture total financial burden |
Guidelines do not account for patient preferences | Concept of EOL is less important than understanding of overall Goals of Care | Episodes of care/insurance plan years may not be useful construct for patients; individual patient yearly deductibles/copays more accurately capture patient cost | Need for more detailed data (i.e. in/out of network costs; targeted therapy vs. chemotherapy) |
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