Tracking How Health Care System Changes Are Impacting Cancer Care

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 A major goal of the Affordable Care Act is to get people access to higher quality health care at lower cost. One way the health care law aims to achieve this goal is by giving financial incentives to health care providers – primary care doctors, specialists, and hospitals, among others – to form what are called accountable care organizations (ACOs). ACOs are a model for health care providers to coordinate care and control costs for their patients. New research funded by the American Cancer Society is studying how well the ACO concept is working for cancer prevention and care.

The intent of ACOs is to better coordinate care to ensure that patients get the right care at the right time to help reduce duplicate services and avoid medical errors.

The concept of ACOs is still fairly new, though, and their effectiveness is not yet clear. Additionally, how these organizations will affect cancer care in particular remains an unanswered question.

“Despite the transformative potential of the ACO model to both reduce health care spending and improve the quality of health care, little is known about the impact of this new type of health care payment model on the appropriateness of cancer diagnosis, treatment, and survivorship,” says Matthew J. Resnick, M.D., a urologic oncologist and health services researcher at the Vanderbilt Ingram Cancer Center.

Resnick, with the help of a $726,000 research grant from the American Cancer Society that starts July 2015, is going to investigate whether the integration of health care through accountable care organizations helps or changes, including possibly in negative ways, cancer diagnosis, treatment, and survivorship. Resnick says there may be potential “unintended consequences” of the ACO model. “It is critical that we ensure that cancer patients get appropriate care, not necessarily more or less care,” says Resnick.

Focusing First on Effect of ACOs on Cancer Screening

Resnick’s initial research is going to look at Medicare ACOs, which are ACOs formed specifically for providers serving patients who are covered by Medicare, the government-funded health insurance program for people age 65 and older. “When an ACO succeeds both in delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program,” according to the Centers for Medicare and Medicaid Services.

Resnick will analyze whether the financial and quality incentives associated with Medicare ACOs positively or negatively impact patients in terms of giving them appropriate cancer screening tests. One of the measures the government uses to assess the quality of care that an ACO is providing is cancer screening rates.

Resnick wants to determine if primary care doctors who are part of ACOs are now more likely to recommend to their patients appropriate cancer screening tests. The question, says Resnick, is, “are primary care physicians offering cancer screening recommendations to patients who are more likely to benefit and less likely to be harmed by the tests?” When it comes to colorectal cancer screening for example, Resnick wants to know: “Are doctors targeting colorectal cancer screening at 55- to 60-year-old patients and withholding screening from those in the 85-year-old range, who may be dealing with many other illnesses and less likely to benefit from early cancer diagnosis?”

“We don’t know the answer to that question yet,” he says. While Resnick says that so far it does look like cancer screening rates overall are increasing among ACOs, researchers have not yet evaluated the appropriateness of screening practices.

Resnick will spend the next few years tracking and studying Medicare claims data for a select group of patients to try to determine whether those getting care from a provider who is part of an ACO are more likely to comply with guidelines for the early detection of cancer, including the American Cancer Society’s guidelines.

“My goal is to make sure that the current ACO system is arranged such that the patients get the care they need and that the system results in better screening, namely undertaking screening the right patients and withholding screening in the wrong patients,” says Resnick.

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