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Evidence-Based Oncology June 2016
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A Discussion on Oncology Quality Tools: Filling in the Gaps

Surabhi Dangi-Garimella, PhD
Improving the healthcare services that an organization provides can be challenging unless one gathers information on the service, collates it, improves on it, and implements the changes in the field. A panel of experts invited by Evidence-Based Oncology discussed processes that help identify the most valuable metrics and the importance of making them relevant for use in the clinic.
We are in the transition phase with interoperability, said Bosserman. “Projects like CancerLinQ2 that are now linking up multiple different electronic records and different data sets and CMS sets and SEER data sets—they can begin to feed all that information on a specific patient back to the practitioners.” Hoping for a bigger role for the federal government, Bosserman added that just submitting information to meet compliance requirements may not be the best practice for clinics to follow. “We need to start moving from these volume-control measures to value-based compliance measures,” she said.

As a payer, Malin provided a very different perspective. The challenge she experiences with the diversity of clinical practices that Anthem’s members are enrolled in extends beyond data silos. “Not all of our oncologists and physicians use EHRs, so extracting member data faces the biggest challenge right there, which can then increase the burden on those practices if we try to gather that data from them,” she said. To circumvent the issue, Anthem is using data from its prior-authorization and clinical pathways program, the Cancer Care Quality Program. “We can use that data, which we then get across all practices and members, in order to look at the quality of care being provided,” Malin explained.

Although Anthem has been working with EHR vendors to create an interactive system with a 2-way data transfer, problems arise when some practices have very sophisticated EHRs that link to their billing system and have in-built quality measures, while others are a solo practice that is completely paper-based. “Thinking of it from a health plan perspective, I have to come up with a solution that bridges all of those practice settings,” Malin said.

Bosserman is quite confident about the potential of CancerLinQ in promoting the quality of cancer care. “I think that platform under the SAP group is going international and will be a foundation of a system that can help us going forward on a larger level. It’s an evolution,” she said. NQF is interested in knowing how ASCO is planning to leverage the data that they gather via CancerLinQ. Will it be used “to populate measures that are already existing or to, perhaps, gain a better understanding of measures?” Goldwater asked. He believes that the platform could have a tremendous impact if it can help develop a new measure or provide updates on an existing measure.

Bosserman said that CancerLinQ has already had a significant impact on data accuracy. In her mind, the bigger challenge is with “structuring the processes in the clinics or the apps to collect the discrete data in both systems of identified data accuracy and data entry blanks.”

Standardizing Oncology Quality Measures
How does a health plan finalize its reporting requirements of oncology clinics and practices? Does Anthem, for example, follow CMS’ data-reporting requirements?

“What we have been focusing on, and reports that we’re going to be providing to practices sometime [in June 2016], include adherence to our pathways, [emergency department] utilization, hospitalizations during treatment, and access to hospice and other end-of-life care,” Malin said. She added that these measures are a part of the Oncology Care Model (OCM)3 and have been advocated by the Community Oncology Alliance and other groups. For Anthem, “Developing a smaller set of meaningful measures that can be implemented across their entire network is a substantial challenge.” Malin said that Anthem has tried to develop measures that can help practices compare the quality of care they deliver with other practices that treat Anthem members. Whereas these measures may not match up with the requirements of the Physician Quality Reporting System, she said they are in synch with the OCM.

As for the administrative burden of all the reporting on physician practices, Malin said that America’s Health Insurance Plans) (AHIP, has a working group that has tried to short-list measures across commercial plans and CMS, and some of these measures are a part of the OCM. “Figuring out the most efficient, and least burdensome, way for [physicians] to report data is a big challenge,” Malin said. Commending the rigor and the standards used by NQF in evaluating these measures, she said, “Measures that really get used for pay-for-performance and accountability, most eventually end up being reviewed by NQF.”

Gaps in Care Measurement
The presence of an exhaustive list of measures is not necessarily an indicator of a flawless system, as data gaps may still exist. Malin agreed, identifying several different gaps:
  • Quality measures may be too general to differentiate between high and low-quality care
  • There remains a need for cross-cutting aggregate measures, especially in cancer, with so many different tumor types and subtypes
  • Succinct measures are necessary, but rare cancers cannot be left out.
Goldwater said that NQF leads the Measure Application Partnership,4 a product of the Affordable Care Act, which brings together leading experts in oncology from numerous sectors: payers, providers, and consumers, to discuss measure gaps that need to be filled. These recommendations are, in turn, forwarded to CMS. He said that NQF has, over the years, identified gaps in palliative and end-of-life care in oncology. Additionally, there is a lack of information that can help understand where the disparities in cancer care lie, “to effectively then know what sort of treatments are necessary, what sort of preventions or screenings are needed, and where to emphasize efforts.”

Bosserman expressed her faith in the potential of the 2-way EHR system that Malin discussed, which will help doctors keep track of alternate care that their patients seek. “We don’t always get that real time in the practice unless you put some system in place that asks the patients, measures it and somehow keeps track of it,” Bosserman said. She believes that such gaps in information can be filled via a partnership between providers and payers. “The exciting thing is that the conversations between providers and health plans have really opened up. Dr Malin is one of the leaders in the field, and others at Aetna and United have really begun to reach out and try to partner with practices to start finding more solutions.” EBO

  1. website. Accessed May 31, 2016.
  2. Caffrey M. ASCO announces partner for groundbreaking CancerLinQ platform. The American Journal of Managed Care website. Published January 21, 2015. Accessed May 31, 2016.
  3. Dangi-Garimella S. Experts discuss Medicare’s new Oncology Care Model. Am J Manag Care. 2015;21(SP8):SP288.
  4. Cassel CK. Making measurement meaningful. Am J Manag Care. 2015;21(5):332b-c.
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