Toward Accountable Cancer Care
Year: 2013
Type: article
Abstract: Cancer accounts for over 500 000 deaths and nearly $ 125 billion in medical costs annually, second only to heart disease.While interventions arising from the Affordable Care Act aim to improve care quality and reduce cost growth for patients with heart disease, reforms directed toward cancer care have received comparatively little attention.Research and innovation have led to measurable improvements in survival and quality of life for patients with cancer.Treatment now often resembles the management of chronic disease, incorporating both acute in-patient and longitudinal outpatient care.However, the delivery of cancer care is inherently multispecialty and multisetting medical care that easily produces fragmentation, generating high costs and care variability.Achieving accountable cancer care will require tailored payment and delivery system reform.Surgical, medical, and radiation oncology cancer specialists "quarterback" complex, interdisciplinary cancer care and symptom management.Their roles change and evolve with treatment phase, and most specialists do not provide the full scope of primary care services.Primary care providers (PCPs) continue to manage the comorbid illnesses of cancer patients, and over half of PCPs counsel patients on cancer treatment decisions involving major procedures. 1 This unsteady balance of patient care does not fit neatly into current concepts of accountable care organizations or medical homes, which focus on primary and preventive care, or medical neighborhoods.Under the traditional fee-for-service system, cancer specialists are economically incentivized to deliver more care, be it surgeries, chemotherapies, or radiation fractions, rather than evidence-based care. 2 Fee-for-service payments also do not encourage better symptom management or care coordination among cancer specialists and between cancer specialists and PCPs.Uncoordinated cancer care results in overuse of unnecessary-and underuse of necessary-tests and treatments, avoidable hospitalizations, and gaps in the management of comorbid illness.Three principles of reform should drive accountable cancer care.First, accountable cancer care should align provider incentives toward patient-centered, coordinated care among cancer specialists and PCPs.It is imperative that accountable cancer care move beyond fee-
Source: JAMA Internal Medicine
Language: English
Subfield: Economics and Econometrics
Domain: Social Sciences
Open Access status: green
Funder: National Cancer Institute
OpenAlex ID: W2012204392