Quality and Value: Measuring and Utilizing Both in Your Practice

Anne C Chiang, MD, PhD, Yale School of Medicine (New Haven, CT), spoke first at the “Quality and Value: Measuring and Utilizing Both in Your Practice” session at the 2016 American Society of Clinical Oncology (ASCO) Annual Meeting (June 3-7; Chicago, IL).

She began by making an important distinction between cost and quality but stressed the importance of measuring former through programs such as the Quality Oncology Practice Initiative (QOPI).

QOPI is ASCO’s signature quality program, with over 185 measures available to providers for assessing various clinical practices. In the last 3 abstraction rounds of QOPI (Fall 2013, Spring 2014, and Spring 2015), almost 1000 practices submitted more than 32,000 charts. When the results of these charts were compared with data from 5 years ago (Fall 2009, Spring 2009, and Fall 2010), they demonstrated notable changes in demographics.

The mean number of oncology doctors increased from 6.7 to 7.8, employed physicians rose from 15.2% to 28.7%, and private independent practices dropped from 63.8% to 47.9%. Dr Chiang said she found this last statistic particularly interesting, as private independent practices used to be the norm, representing more than 80% of care, but that figure has continued to decline over the last few decades.

A deeper look also showed that patients had greater access to supportive services, including dieticians, financial counseling, and other similar services. In addition, electronic medical records were used by more than 90% of practices in the more recent dataset, indicating a significant shift within the industry.

In conclusion, Dr Chiang reemphasized her stance that the QOPI is about more than just managing cost; it is a first step towards creating a culture of quality, effective benchmarking, and appropriate tools for measuring cancer care. Currently, QOPI is also one of the tools that providers can use to comply with upcoming changes taking place under MACRA, which is set to change which practices are reimbursed, and ASCO will continue its work towards making it a more effective resource for enhancing the value of care delivered.

Lowell E Schnipper, MD, PhD, Beth Israel Deaconess Medical Center (Boston, MA) followed Dr Chiang’s presentation with a discussion of the ASCO Value Framework that he and his colleagues on the ASCO Value in Cancer Task Force developed to help inform treatment decision-making.

Dr Schnipper said that the development of new therapies for cancer care has produced promising results in recent years, going so far as to say that they have changed the entire landscape of care. However, he added that the costs of these new therapies have also risen in such a way that they have become unaffordable for middle-class families.

What the Value Framework is intended to do is take elements of care doctors already view as being important—clinical benefit, toxicity, cost—and make them part of the discussion at the point of care for patients. This is especially important for patients who may be less interested in survival and more interested in other factors such as quality of life.

However, Dr Schnipper did acknowledge that the framework in its current form is severely limited, mainly because it must be used manually, which can take time and may be difficult to explain to patients. The end goal of the framework, and what ASCO is currently working towards, is partnering with a software developer to turn the framework into an app that can provide data in real time at the point of care. He added that integrating the framework into clinical pathways could also be an effective way of ensuring that patient-provider conversations take place and providing better value-based outcomes.

To close the session, Steven L D’Amato, BCOP, RPH, discussed the current benefits and challenges associated with ASCO’s QOPI by using his own practice as an example.

In 2007, Mr D’Amato explained that his practice was one of the first that took steps toward QOPI certification. To achieve QOPI certification, institutions must exceed a quality score higher than 75%. In reaching that goal, Mr D’Amato’s practice faced two critical issues. The first was the fact that his institution was not utilizing a completely paperless electronic health records system. This slowed their ability to effectively track and measure outcomes. The second was an issue with ensuring adherence to oral medications. Both of these issues were identified after initial assessment with QOPI and solved after the implementation of appropriate programs in clinical care.

Still, Mr D’Amato added that his practice has probably not saved money through achieving QOPI certification. It took a dedicated staff just to analyze quality metric charts and identify ways to improve care practices; but he stressed that it has absolutely improved care delivery, which he viewed as an area of paramount importance.

Mr D’Amato concluded by illustrating the potential value of QOPI for all health care stakeholders, including payers, providers, and patients, all of which benefit from a health care system that delivers more value-based care.—Sean McGuire