Dataset Information

The impact of provider payment reforms and associated care delivery models on cost and quality in cancer care: A systematic literature review.

ABSTRACT:

Objectives

To investigate the impact of provider payment reforms and associated care delivery models on cost and quality in cancer care.

Methods

Data sources/study setting: Review of English-language literature published in PubMed, Embase and Cochrane library (2007-2019). Study design: We performed a systematic literature review (SLR) to identify the impact of cancer care reforms. Primary endpoints were resource use, cost, quality of care, and clinical outcomes. Data collection/extraction methods: For each study, we extracted and categorized comparative data on the impact of policy reforms. Given the heterogeneity in patients, interventions and outcome measures, we did a qualitative synthesis rather than a meta-analysis.

Results

Of the 26 included studies, seven evaluations were in fact qualified as quasi experimental designs in retrospect. Alternative payment models were significantly associated with reduction in resource use and cost in cancer care. Across the seventeen studies reporting data on the implicit payment reforms through care coordination, the adoption of clinical pathways was found effective in reduction of unnecessary use of low value services and associated costs. The estimates of all measures in ACO models varied considerably across participating providers, and our review found a rather mixed impact on cancer care outcomes.

Conclusion

The findings suggest promising improvement in resource utilization and cost control after transition to prospective payment models, but, further primary research is needed to apply robust measures of performance and quality to better ensure that providers are delivering high-value care to their patients, while reducing the cost of care.

SUBMITTER: Nejati M

PROVIDER: S-EPMC6450626 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Publications

The impact of provider payment reforms and associated care delivery models on cost and quality in cancer care: A systematic literature review.

Nejati Mina M Razavi Moaven M Harirchi Iraj I Zendehdel Kazem K Nejati Parisa P

PloS one 20190405 4

<h4>Objectives</h4>To investigate the impact of provider payment reforms and associated care delivery models on cost and quality in cancer care.<h4>Methods</h4>Data sources/study setting: Review of English-language literature published in PubMed, Embase and Cochrane library (2007-2019). Study design: We performed a systematic literature review (SLR) to identify the impact of cancer care reforms. Primary endpoints were resource use, cost, quality of care, and clinical outcomes. Data collection/ex ...[more]

PMID: 30951536

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Project description:ObjectiveTo evaluate episode-based payments for upper respiratory tract infections (URI) and perinatal care in Arkansas's Medicaid population.Study settingUpper respiratory infection and perinatal episodes among Medicaid-covered individuals in Arkansas and comparison states from fiscal year (FY) 2011 to 2014.Study designCross-sectional observational analysis using a difference-in-difference design to examine outcomes associated with URI and perinatal episodes of care (EOC) from 2011 to 2014. Key dependent variables include antibiotic use, emergency department visits, physician visits, hospitalizations, readmission, and preventive screenings.Data collectionClaims data from the Medicaid Analytic Extract for Arkansas, Mississippi, and Missouri from 2010 to 2014 with supplemental county-level data from the Area Health Resource File (AHRF).Principal findingsThe URI EOC reduced the probability of antibiotic use (marginal effect [ME] = -1.8, 90% CI: -2.2, -1.4), physician visits (ME = 0.6, 90% CI: -0.8, -0.4), improved the probability of strep tests for children diagnosed with pharyngitis (ME = 9.4, 90% CI: 8.5, 10.3), but also increased the probability of an emergency department (ED) visit (ME = 0.1, 90% CI: 0.1, 0.2), relative to the comparison group. For perinatal EOCs, we found a reduced probability of an ED visit during pregnancy (ME = 0.1, 90% CI: -0.2, -0.0), an increased probability of screening for HIV (ME = 6.2, 90% CI: 4.0, 8.5), chlamydia (ME = 9.5, 90% CI: 7.2, 11.8), and group B strep-test (ME = 2.6, 90% CI: 0.5, 4.6), relative to the comparison group. Predelivery and postpartum hospitalizations also increased (ME = 1.2, 90% CI: 0.4, 2.0; ME = 0.4, 90% CI: 0.0, 0.8, respectively), relative to the comparison group.ConclusionUpper respiratory infection and perinatal EOCs for Arkansas Medicaid beneficiaries produced mixed results. Aligning shared savings with quality metrics and cost-thresholds may help achieve quality targets and disincentivize over utilization within the EOC, but may also have unintended consequences.

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Dataset Information

The impact of provider payment reforms and associated care delivery models on cost and quality in cancer care: A systematic literature review.

Objectives

Methods

Results

Conclusion

Publications

The impact of provider payment reforms and associated care delivery models on cost and quality in cancer care: A systematic literature review.

Similar Datasets

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