Purpose: A call for research that evaluates the impact of the many changes now occurring in the healthcare system with a particular focus on cancer prevention, control, and treatment. Efforts focusing on improving access to care may also impact inequities that contribute to health disparities. New health public policy initiatives such as the new federal and state marketplaces that have expanded insurance coverage, as well as Medicaid expansion in some states, create natural experiments ripe for evaluation. Research to be funded by this RFA should focus on the changes in national, state, and/or local policy and the response to these changes by healthcare systems, insurers, payers, communities, practices, and patients.

A clear understanding of these changes can help clinicians, health systems, public health and public policy professionals, patient and consumer advocates and providers to identify and guide needed improvements in cancer prevention and control and health care and health more broadly. Findings from this research may also inform advocacy and policy development by the American Cancer Society Cancer Action Network (ASC CAN) in the context of meaningful health care reform by assessing outcomes related to the structure of the health system on availability, administrative simplicity, adequacy, and affordability of coverage, referred to as the 4 A’s, which make up the Society and ACS CAN’s framework for reform.

We are keenly interested in supporting rapid learning research to study the effects of health policy changes on patients, providers, and health systems. This includes but is not limited to:
• Facilitators and barriers to care;
• Unintended consequences;
• Differential experiences and outcomes of patients seeking or receiving care;
• Best practice models for quality care; and,
• Economic Impact

Specific examples of potential research areas that may be applicable include the following, organized by the 4 A’s of meaningful healthcare reform:

1. Availability
• Investigate factors impacting equity in cancer prevention, diagnostic, treatment, and survivorship services across populations based on availability of health insurance coverage, type of coverage, affordability, and health care setting.

• Compare and contrast access and outcomes by state to provide new knowledge pertaining to how insurance coverage or lack of coverage (including lack of expanded Medicaid coverage) impacts cancer screening, diagnostic, treatment, or palliative care services.

• Evaluate the impact of expanding health insurance coverage for previously uninsured or underinsured persons.

2. Affordability
• Compare and contrast variations in health insurance benefit packages (including services, Rx formularies, and cost-sharing) on health care costs and the resulting impact on cancer prevention, diagnosis, treatment, and palliative and support care services.

• Examine how tobacco rating is impacting the affordability of and access to insurance coverage.

• Compare and contrast changes in health risk pool distribution and their impact on health care costs, health insurance enrollment and access pre- and post-implementation of the Affordable Care Act of 2010.

• Test methods to improve the efficiency of health insurance coverage and utilization.

• Compare and contrast models for improving high quality patient-centered care such as Patient Centered Medical Homes, Accountable Care Organizations, and patient and provider incentives to encourage guideline-concordant care.

3. Adequacy
• Compare and contrast the implementation of health insurance marketplaces to assess their impact to access to needed services and choice of providers, and on the adoption and completion of cancer screening, diagnostic, treatment, and palliative and supportive care services.

• Compare and contrast the transparency of key information (e.g., network providers, formularies, etc.) and the extent to which this information is provided in a consumer-friendly manner.

4. Administrative simplicity
• Assess the effectiveness of strategies to educate consumers about healthcare benefits and their impact on the adoption and completion of cancer screening, diagnostics and treatment services.

• Conduct dissemination and implementation research of evidence-based strategies supporting patients in overcoming administrative barriers related to health insurance to facilitate the adoption and completion of cancer screening, diagnostic, treatment or palliative and supportive care services.

Acceptable study designs: We encourage investigators to submit innovative proposals using an array of study designs which may include interventional or non-interventional research such as case control studies, cohort studies, clinical trials, comparative effectiveness research, dissemination and implementation research, cross-sectional studies, ecological, or mixed methods research. For example:

• Mixed-method studies utilizing secondary analysis and original data collection.

• Conduct primary data collection in the form of surveys, key informant interviews, focus groups or other methods to capture patient level experiences and their perceived solutions.

• Make creative use of primary and secondary data sources (such as CMS data)9 to capture both demographic and outcome data, establish robust data bases, and create registries or methods for data standardization across large data sources

Application Deadline: October 15 and April 1

Eligibility Requirements:

1. Applications may be submitted by not-for-profit institutions located within the United States, its territories and the Commonwealth of Puerto Rico.

2. United States citizens or permanent residents of the United States are eligible to apply.

3. Independent investigators at all stages of their career are eligible to apply. The usual ACS restriction to investigators within the first six years of their initial independent research appointment for the Research Scholar grant applicants does not apply to this RFA.

Mechanism: This RFA will use the Research Scholar Grant mechanism.

Length of Study: Awards may not exceed a period of 4 years, with one exception (see health equity below). It is anticipated that some studies will require no more than two years to complete.

Health equity focused applications may propose a project period of up to 5 years if the study involves mixed methods utilizing both primary data and secondary collection to obtain qualitative and quantitative data.*

Budget: This RFA will use the Research Scholar Grant mechanism budget instructions.*

*See the Research Scholar Grants Policies and Instructions for a detailed description of the Society’s priority focus on health equity research in the Cancer Control and Prevention Research Grants Program and budget instructions.

Award Period
Direct Cost Cap Per Year
Indirect Cost Cap Per Year
Less than 4 years $200,000 20%
4 years $165,000 20%
5 years $200,000 20%

 

References

1. Centers for Disease Control and Prevention (CDC). Healthy Communities Program. Retrieved from http://www.cdc.gov/healthycommunitiesprogram/overview/healthequity.htm

2. National Partnership for Action to End Health Disparities (2011). National Stakeholder Strategy for Achieving Health Equity. Rockville, MD: U.S. Department of Health & Human Services, Office of Minority Health. Retrieved from: http://minorityhealth.hhs.gov/npa/templates/content.aspx?lvl=1&lvlid=33&ID=286

3. Craig et al. using natural experiments to evaluate population health interventions. Medical Research Council (MRC) Population Health Sciences Research Network and the MRC Methodology Research Panel.2011.Medical Research Council UK, Polaris House, Swindon SN2 1FL, Retrieved from http://www.behaviourworksaustralia.org/wp-content/uploads/2012/10/NaturalExperimentsGuidance_MRC-guidance.pdf

4. Lipscomb et al. Comparing Cancer Care, Outcomes, and Costs Across Health Systems: Charting the Course .J Natl Cancer Inst Monogr 2013; 46:124–130

5. American Cancer Society Cancer Action Network (ACS CAN) Access to Care priorities, Retrieved from http://acscan.org/healthcare

6. Abernethy A. Rapid-Learning System for Cancer Care. J Clin Oncol .2010; 28(27): 4268-4274

7. Riley et al. Rapid, responsive, relevant (R3) research: a call for a rapid learning health research enterprise. Clinical and Translational Medicine.2013 ;( 2):1-6 Retrieved from http://www.clintransmed.com/content/2/1/10

8. US Department of Health and Human Services. About the law. Retrieved from http://www.hhs.gov/healthcare/rights/

9. Center for Medicare and Medicare Service and the Research Data Assistance Center (Resdac). Retrieved from http://www.cms.gov/Research-Statistics-Data-and-Systems/Research/ResearchGenInfo/ResearchDataAssistanceCenter.html