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

项目摘要 该项目旨在解决前列腺癌主动监测的内在经济障碍。许多 患有有利风险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 如何治疗导致了治疗模式的广泛差异，部分原因是非临床因素，如 财政激励。监测的战略，避免或推迟对患有艾滋病的男性进行积极治疗 具有良好风险的肿瘤，已被证明可以减少与治疗相关的发病率和支出，而不是 危及生存。因此，它很好地符合当前国家利益，即提高 医疗保健服务。然而，研究表明，监督没有得到充分利用，其实施情况差异很大。 有几个因素导致了这一点，但一个看似合理的贡献是 嵌入在交付系统中的支持积极干预的提供商，因为他们的报销 与监视相关的活动相比，这一风险立即增加，并可能增加数倍。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可以向提供商提供额外的费用，以便在捆绑的同时执行监视 对质量目标的实现进行补偿，以确保其适当的表现并降低总成本 付款人费用。这项建议的目的是发展自动防盗系统，以促进合理使用监察，以及 以下目标：1)了解泌尿科医生对主动监测的付费激励的反应；2) 为实施主动监督制定强有力的质量绩效措施；以及，3)制定 并模拟有利风险前列腺癌替代支付模式对支付者的财务影响 和提供者。最终，APM将统一对付款人和提供商的财务激励，减少不必要的 在实施方面有所不同，并将更多的人转移到适当使用监视，从而改善 前列腺癌高危男性的人群健康状况。

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.