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Aligning financial incentives to promote rational use of active surveillance for prostate cancer

调整财政激励措施以促进前列腺癌主动监测的合理使用

基本信息

批准号：
10416477
负责人：
BRENT K. HOLLENBECK
金额：
$ 57.84万
依托单位：
UNIVERSITY OF MICHIGAN AT ANN ARBOR
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-04-01 至 2027-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10416477
关键词：
Achievement Address Adverse effects Androgens Biopsy Blue Cross Blue Shield Caring Characteristics Clinical Communities Cost Savings Data Development Diagnosis Disease Disincentive Ensure Goals Growth Healthcare Image Incentives Intensity-Modulated Radiotherapy Intervention Interview Lead Life Expectancy Literature Magnetic Resonance Imaging Malignant Neoplasms Malignant neoplasm of prostate Measures Medicare Methods Michigan Modality Modeling Monitor Morbidity - disease rate Movement Natural History Operative Surgical Procedures Patient-Focused Outcomes Patients Pattern Performance Physicians Policies Practice Management Privatization Provider Radiation therapy Registries Remunerations Review Literature Risk Savings Sexual Dysfunction Structure Symptoms System Testing Time Uncertainty Urologic Surgical Procedures Urologist Urology Variant aggressive therapy base bundled payment care costs cost curative treatments deprivation disorder risk financial incentive genomic signature health care delivery implementation measures improved interest meetings men mortality mortality risk overtreatment payment population health prevent prostate cancer risk provider behavior response surveillance strategy tumor tumor progression urinary

项目摘要

Project Summary This project aims to address inherent financial disincentives for active surveillance for prostate cancer. Many men with favorable-risk disease will not benefit from aggressive intervention. The uncertainty surrounding who and how to treat has led to wide variation in treatment patterns, in part driven by nonclinical factors such as financial incentives. The strategy of surveillance, which avoids or delays aggressive treatment for men with favorable-risk tumors, has been shown to reduce treatment associated morbidity and spending, without compromising survival. As such, it is well aligned with the current national interest in improving the value of health care delivery. Yet studies demonstrate surveillance is underutilized and its implementation varies widely. There are several factors contributing to this, but one plausible contribution is the financial incentives for providers embedded within the delivery system that favor aggressive interventions, as their reimbursement is immediate and can be several-fold greater than for surveillance-related activities. Recent payment reforms encourage a movement to alternative payment models (APMs), intended to improve the value of health care. An APM in this context could provide additional payment to providers for performing surveillance, while tying reimbursement to achievement of quality targets that ensure its appropriate performance and lowering total payer costs. The objective of this proposal is to develop APMs to promote rational use of surveillance, with the following aims: 1) To understand urologist response to payment incentives for active surveillance; 2) To develop robust quality performance measures for implementation of active surveillance; and, 3) To develop and simulate the financial impact of alternative payment models for favorable-risk prostate cancer on payers and providers. Ultimately, APMs will align financial incentives for payers and providers, reduce unwarranted variation in implementation, and shift more men to appropriate use of surveillance thereby improving population health among men with favorable-risk prostate cancer.

项目摘要该项目旨在解决对前列腺癌积极监测的固有财政抑制因素。许多患有高危疾病的男性不会从积极的干预中受益。围绕着谁的不确定性以及如何治疗导致了治疗模式的广泛变化，部分原因是非临床因素，财政奖励。监测策略，避免或延迟对男性的积极治疗，已证明，低风险肿瘤可降低治疗相关的发病率和支出，危及生存因此，它与当前国家在提高价值方面的利益是一致的。提供保健服务。然而，研究表明，监测没有得到充分利用，其实施情况差异很大。有几个因素促成了这一点，但一个合理的贡献是财政激励，提供者嵌入在有利于积极干预的交付系统中，因为他们的报销是直接影响，可能比与监测有关的活动大几倍。最近的支付改革鼓励转向替代支付模式（APM），旨在提高医疗保健的价值。在这种情况下，APM可以为提供者提供额外的监控费用，同时捆绑对实现质量目标的补偿，以确保其适当的性能和降低总付款人费用。本提案的目的是开发杀伤人员地雷，以促进合理使用监视，以下目的：1）了解泌尿科医生对主动监测的支付激励的反应; 2）制定强有力的质量绩效措施，以实施积极的监督;以及，3）制定并模拟可负担风险前列腺癌的替代支付模式对支付者的财务影响和供应商。最终，APM将使支付者和提供者的财务激励措施保持一致，在执行中的变化，并使更多的男子适当使用监测，从而改善男性前列腺癌患者的健康状况。