Purpose

There is a need 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.  Public health policy initiatives such as the 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 (ACS 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 Cancer Action Network's framework for reform.

Scientific Scope

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) to capture both demographic and outcome data, establish robust databases, and create registries or methods for data standardization across large data sources

Grant Mechanism and Eligibility

This RFA will use the Research Scholar Grants (RSG) mechanism. See the Research Scholar Grants section of All Grant Policies and All Grant Instructions for detailed descriptions of the ACS's priority focus on health equity research in the Clinical and Cancer Control Research Grants Program and budget instructions.

Eligibility: You ARE eligible to submit a proposal if you:

• Are a faculty at a US academic institution or eligible non-profit
• Are a full-time independent investigator at any career stage

Grant Term and Budget

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.

Grant awards of 2-3 years have maximum direct costs of $200K per year, with 20% allowable indirect costs; awards of 4 years have maximum direct costs of $165K per year, with 20% allowable indirect costs.

Multi-level health equity-focused applications may propose a project period of up to 5 years and $200K per year, plus 20% allowable indirect costs. Both intervention and non-intervention research is acceptable. If the study is primarily data focused, mixed methods should be utilized to collect both primary data and secondary collection, or both qualitative and quantitative data.

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:
    https://www.phdmc.org/program-documents/healthy-lifestyles/dche/64-achieving-health-equity/file
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 https://mrc.ukri.org/documents/pdf/natural-experiments-guidance
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 https://www.fightcancer.org/what-we-do/access-health-care
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

 Additional Questions:

For questions about this mechanism please contact Chanda Felton, Manager of the Diversity in Research Training Program, at chanda.felton@cancer.org.

Note: Grant application materials become available early January and July, and applications are due April 1 and October 15.