In value-based payment models, cost-containment incentives must be counterbalanced by quality measures to ensure that patients are not denied access to appropriate yet potentially costly care. Quality measures are tools that quantify processes, outcomes, patient perceptions, and structures or systems that are associated with a spectrum of goals for health care. While many cancer quality measures exist, measures are needed that are more meaningful and actionable to support care improvement. Commentaries in this issue discuss quality measure development and contextualize performance data from performance period (PP) 4 results of the Oncology Care Model (OCM). Also featured is a Research Report of a pilot program using supportive care interventions to improve care quality and outcomes.
Commentaries in the Viewpoint section dive into the history, utility, and development of quality measures. Tom Valuck, MD, JD; David Blaisdell; and Theresa Schmidt, MA, PMP, CSPO, note that, taking the processes of guideline development and measure development sequentially, it could take more than 4 years before quality measures relevant to a given novel treatment are available to benchmark quality, support accurate payment based on performance, and steer quality improvement. They detail 3 strategies measure developers shoulder consider to ensure that payers and physicians can meaningfully evaluate and improve care. Reading their piece caused me to take a step back and contemplate, are we measuring the quality of the right things and at the right level? Are we even measuring quality at all? In my Counterpoint, I explore these questions and assert that quality measures should be developed and based on “real-world evidence,” as real-world data and evidence are major inputs into the “learning machine,” which is vital to survive the world of alternative payment models.
The Perspectives article in this issue examines OCM year-3 results, including performance data available to date and projected expected performance with respect to one-sided vs two-sided risk. Charles Saunders, MD, contends that the three most critical success factors for optimizing continued performance improvement are expected to be application of predictive analysis of end-of-life decisions and of care pathway effectiveness; investment in key technologies for care coordination and performance trend analyses; and risk mitigation strategies.
Finally, the Research Report in this issue details the integration of a multidisciplinary supportive care prehabilitation program for patients with esophageal cancer. Ashley E Glode, PharmD, BCOP, and colleagues conducted a pilot project, STRENGTH (Seeking To Reactivate Esophageal aNd Gastric Treatment Health), to implement supportive care interventions in the prehabilitation phase of neoadjuvant treatment. Patients experienced improvements across multiple outcomes. Authors plan to further optimize the program and assess its effects on patient quality of life.
