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Method for Identifying High-Value Oncology Care Across Health Care Systems

May 13, 2021

Researchers developed a model to identify high-value oncology care in episodes of initial, survivorship, and relapse care (JCO Oncol Pract. 2021 Mar;OP2000462. doi:10.1200/OP.20.00462).

“To estimate the value of cancer care and to compare value among episodes of care, a transparent, reproducible, and standardized cost computation methodology is needed,” explained Douglas Blayney, MD, Stanford Cancer Institute, Stanford University school of medicine, CA, and colleagues.

“Charges, claims, and reimbursements are related to cost but are nontransparent and proprietary,” they continued.

Dr Blayney and colleagues developed a method to measure the cost of different phases of care: initial treatment with curative intent, surveillance and survivorship care, and relapse and end-of-life care.

Clinical data from the Stanford electronic health record, the California State cancer registry, and the Social Security Death Index were used to analyze the care of patients with breast cancer. Common Procedural Terminology codes were mapped to the corresponding cost conversion factor and date in the CMS Medicare fee schedule. Cost of care per day (CCPD) were computed for each patient to account for varying duration of episodes of care.

The median CCPD was $29.45 for initial treatment, $2.45 for surveillance and survivorship care, and $13.80 for relapse care. There were no differences in CCPD between hormone receptor-positive or HER2-negative, HER2-positive, and triple-negative breast cancers.

In addition, patients with relapsed disease within the most expensive CCPD group has significantly shorter survival.

“We developed a method to identify high-value oncology care—cost of care per patient per day—in episodes of initial, survivorship, and relapse care. The methodology can help identify positive deviants (who have developed best practices) delivering high-value care,” concluded Dr Blayney and colleagues.

“Merging our data with claims data from third-party payers can increase the accuracy and validity of the CCPD,” they added.—Janelle Bradley

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