Association Between a National Insurer's Pay-for-Performance Program for Oncology and Changes in Prescribing of Evidence-Based Cancer Drugs and Spending
| Autor: | Ezra Fishman, Atul Gupta, Amol S. Navathe, Michael J. Fisch, Gosia Sylwestrzak, John Barron, Justin E. Bekelman, Ying Liu, David Joseph Debono |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Cancer Research Evidence-based practice Lung Neoplasms Cancer drugs MEDLINE Antineoplastic Agents Breast Neoplasms Pay for performance Medical Oncology 03 medical and health sciences 0302 clinical medicine medicine Humans 030212 general & internal medicine Practice Patterns Physicians' Association (psychology) Reimbursement Incentive Oncologists Evidence-Based Medicine Insurance Health Drug Prescribing business.industry Cancer Fee-for-Service Plans medicine.disease Blue Cross Blue Shield Insurance Plans United States Prescriptions Oncology 030220 oncology & carcinogenesis Family medicine Colonic Neoplasms Female business |
| Zdroj: | Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 38(34) |
| ISSN: | 1527-7755 |
| Popis: | 2016 Background: Efforts to standardize quality and control cost growth for cancer care have focused heavily on promoting evidence-based cancer drug prescribing. We evaluated the association between a national commercial insurer’s ongoing pay-for-performance (P4P) program for oncology and changes in prescribing of evidence-based cancer drugs and spending. Methods: Retrospective difference-in-differences quasi-experimental study utilizing administrative claims data from the insurer’s commercial health plans in 14 states covering 6.7% of US adults. We included patients 18 years of age or older with breast, colon, or lung cancer who were prescribed cancer drug regimens by 1,867 participating oncology physicians between 2013 and 2017. We leveraged the geographically staggered, time-varying rollout of the P4P program to simulate a stepped-wedge study design. Specifically, we estimated a patient-level model clustered by physician and used physician fixed-effects to examine pre- to post-intervention changes in evidence-based prescribing and spending for patients of participating physicians eligible earlier versus later in the period of P4P program rollout. We evaluated four categories of spending over a 6-month episode period: cancer drug spending; other (non-cancer drug) health care spending; total episode spending; and patient out-of-pocket spending. Results: The P4P program was associated with an increase in evidence-based regimen prescribing from 57.1% of patients in the pre-intervention periods to 62.2% in the post-intervention periods for a difference of +5.1 percentage points (pp) (95% CI 3.0 pp to 7.2 pp, P< 0.001). The P4P program was also associated with a differential $3,235 (95% CI $1,004 to $5,466, P= 0.005) increase in cancer drug spending, a differential $253 (95% CI $101 to $406, P= 0.001) increase in patient out-of-pocket spending, but no significant changes in other health care spending or total health care spending over the 6-month episode period. Conclusions: A national insurer’s oncology P4P program was associated with a 5.1 percentage point increase in prescribing of evidence-based cancer drug regimens. Our findings suggest that P4P programs may be effective in increasing evidence-based cancer drug prescribing at national scale -- enhancing cancer care quality. However, they may also increase out-of-pocket expenses and may not lead to savings in total health care spending during the 6-month episode. |
| Databáze: | OpenAIRE |
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