Jennifer Malin, MD, staff vice president, Clinical Strategy, Anthem, spoke about her health plan’s requirements on quality measures and whether they resonate what CMS requires providers to submit.
“What we have been focusing on and reports that we’re going to be providing to practices include adherence to our pathways as well as [emergency department] utilization and hospitalizations during treatment and access to hospice and other end-of-life care,” Dr Malin said. She added that these measures are a part of what CMS requires through the Oncology Care Model.
However, for Dr Malin, she sees challenges with developing a small set of more meaningful measures that can be used across their entire network. The crux is to derive maximum information without placing further burden on the practices. She said that Anthem has been working to find a “sweet spot of measures” to help practices compare themselves with other practices across the health plan’s network.
Dr Malin said that America’s Health Insurance Plans, or AHIP, has a work group that has brought together private payers and CMS, which “led to the short list of measures that's included in the current oncology care model.” The challenge, however, remains the lack of standardization across practices, with respect to the data systems used. She went on to add that with pay-for-performance and accountability, the National Quality Forum would ultimately ensure that a said measure is up to par—so that’s the least of her concerns.