Many chronic conditions--such as certain cancers--lack the proper representation in Medicare pay-for-quality programs, according to a recent Avalere survey.
The analysis included 20 Medicare programs based on Avalere's Quality Measure Navigator that evaluated quality of care for both providers and health plans. High-impact conditions are defined by the relative cost, prevalence and disease burden, among other factors, of each chronic condition to the Medicare population.
Avalere determined that some diseases have more quality measures than others: Diabetes and chronic renal disease have 21 measures each, while prostate cancer and lung cancer each have only three measures. Though it is among cancers in the top 20 highest impact conditions, there are no quality measures for endometrial cancer, and Alzheimer's also lacks any quality measures.
"As Medicare and other payers move toward value-based payments for services and pharmaceuticals, we need more meaningful quality measures in oncology and selected other areas of medicine to ensure alignment," Avalere CEO Dan Mendelson said in the survey announcement.
Payers have made strides to overhaul the entire oncology reimbursement system. For instance, UnitedHealth started an episode payment pilot in 2009 for oncology services, and established more than 60 quality and cost measures to determine whether the bundled payment program was achieving its goals.
For more:
- here's the survey