The Impact of a Changing Health Care Delivery System on the Quality of Oncology Care - Administrative Supplement

不断变化的医疗保健服务系统对肿瘤护理质量的影响 - 行政补充

• 批准号: 10832790
• 负责人: Nancy L Keating
• 金额: $ 12.27万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-12-15 至 2025-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10832790
• 关键词: Academy; Accounting; Administrative Supplement; American; American Society of Clinical Oncology; Antineoplastic Agents; Blue Cross; Blue Shield; Cancer Patient; Caring; Direct Costs; Disadvantaged; Drug Utilization; Ensure; Face; Fee-for-Service Plans; Health; Health Policy; Health Services Accessibility; Health system; Healthcare; Hospitals; Improve Access; Incentives; Insurance Carriers; Integrated Health Care Systems; Malignant Neoplasms; Marketing; Medicare; Medicine; Mentors; Modality; Names; Oncology; Oncolytic; Oral; Outcome; Ownership; Parents; Patient-Focused Outcomes; Patients; Pharmaceutical Preparations; Pharmacy facility; Policies; Policy Maker; Price; Principal Investigator; Provider; Quality of Care; Reporting; Research; Societies; System; Time; Trust; United States Federal Trade Commission; Vulnerable Populations; Work; cancer care; care delivery; chemotherapy; clinical practice; cost; evidence base; health care delivery; health economics; health plan; interest; longitudinal dataset; malignant mouth neoplasm; medical specialties; medication compliance; meetings; member; novel; parent grant; participant enrollment; pharmacy benefit; response; symposium; trend

Project Summary This application is being submitted in response to the Notice of Special Interest (NOSI) identified as NOT-CA-23-044. The cancer care delivery system that frequently provides care that is not patient-centered, evidence-based, or accessible to vulnerable populations. In recent years, there has also been increasing consolidation among providers, which could have important implications for the quality of cancer care. Under the parent R01, we are studying the implications of growing integration across providers for patients with cancer. One key outcome we have considered is the impact of integration on the delivery of oral oncolytics. Oral oncolytics are an increasingly important treatment modality, accounting for nearly half of chemotherapy spending among patients enrolled in Medicare Fee-for-Service and Part D in 2019. Nonetheless, patients face significant challenges in accessing these medicines including high rates of prescription abandonment, non-adherence, and early discontinuation. Integration between health plans and specialty pharmacies may also impact patients using oral oncolytics. Indeed, many health plans have acquired a specialty pharmacy. This includes Centene and AcariaHealth (2013), CVS and Aetna (2018), Cigna and Accredo Pharmacy (2018), and Anthem and Bioplus (2022). Similarly, UnitedHealthcare has long been integrated with Optum Specialty Pharmacy, but has also recently acquired Avella (2018) and Diplomat (2019). Humana has long been integrated with Humana Specialty Pharmacy. Yet, the implications for patients are unclear. On the one hand, plan-pharmacy integration may allow plans to better assure patients receive and are adhering to medications, especially when it may reduce other forms of avoidable costs. On the other hand, plan-pharmacy integration may harm patients if it reduces the pharmacy’s incentive to assure access, as utilization poses a direct cost to the parent company. We propose describing and studying the effects of health plan and specialty pharmacy integration in cancer care. We will first build a unique longitudinal dataset identifying the pharmacies owned by each health insurer carrier in each year between 2010 and 2021. We will then seek to accomplish the following aims: 1. Describe trends in the degree to which oral oncolytics are filled through health plan-integrated pharmacies 2. Evaluate the association between health plan-pharmacy integration and patient outcomes including time- to-fill and medication adherence for oral oncolytics This proposal is closely related to the parent R01 and policy in two ways. First, this project studies a novel form of integration that has gone understudied: integration between health plans and pharmacies. This form of integration is also highly relevant for anti-trust policy, as the Federal Trade Commission is interested in crafting policy related to integration between plans, pharmacy benefit managers, and pharmacies. Second, the project focuses on a key policy lever, namely health plan policy, that influences quality and access to care.

项目摘要 本申请是对特别利益通知(NOSI)的回应，该通知被确认为 不是-CA-23-044。癌症护理交付系统经常提供不以患者为中心的护理， 以证据为基础的，或易受伤害的人群可获得的。近年来，这一数字也在不断增加。 提供者之间的整合，这可能对癌症护理的质量产生重要影响。 在母公司R01下，我们正在研究跨提供商日益增长的集成对以下方面的影响 癌症患者。我们考虑的一个关键结果是整合对口语教学的影响 肿瘤学。口腔肿瘤溶解剂是一种日益重要的治疗方式，占近一半 2019年参加联邦医疗保险按服务收费和D部分的患者的化疗支出。 尽管如此，患者在获得这些药物方面面临着巨大的挑战，包括高比率 处方药放弃、不遵守和提前停药。 健康计划和专业药房之间的整合也可能影响使用口服药物的患者 肿瘤学。事实上，许多健康计划都收购了一家专业药店。这包括Centene和 AcariaHealth(2013)，CVS和Aetna(2018)，Cigna和Accredo Pharmacy(2018)，国歌和Bioplus (2022年)。同样，UnitedHealthcare长期以来一直与Optus Specialty Pharmacy整合，但也 最近收购了Avella(2018)和Diplomat(2019)。胡马纳早已与胡马纳融为一体。 专业药房。然而，这对患者的影响尚不清楚。一方面，计划-药房一体化 可能允许制定计划，更好地确保患者接受并坚持药物治疗，特别是在可能的情况下 减少其他形式的可避免成本。另一方面，如果计划-药房整合可能会损害患者的利益 降低药房确保访问的动机，因为使用会给母公司带来直接成本。 我们建议描述和研究健康计划和专科药房整合在 癌症护理。我们将首先构建一个唯一的纵向数据集，以确定每个健康中心拥有的药店 2010至2021年间每年的保险承运人数量。然后，我们将努力实现以下目标： 1.描述通过健康计划综合药店提供口腔肿瘤溶解药物的程度的趋势 2.评估健康计划-药房整合与患者结果之间的关联，包括时间- 口腔肿瘤溶解患者的充填与用药依从性 这项建议在两个方面与母公司R01和政策密切相关。首先，这个项目研究了一个 未被研究的新的整合形式：健康计划和药房之间的整合。这 整合的形式也与反垄断政策高度相关，正如联邦贸易委员会感兴趣的那样 制定与计划、药房福利经理和药房之间整合相关的政策。第二， 该项目侧重于影响质量和获得护理的一个关键政策杠杆，即健康计划政策。