Impact of the Accountable Care Model in Oncology

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Topic: Impact of the Accountable Care Model in Oncology

Accountable care organizations (ACOs) are apt to grow meaningfully as the Affordable Care Act takes full effect by 2014.  These organizations stand to fundamentally reshape the delivery of care due to a new set of priorities that may or may not be aligned with better patient outcomes.  While well intended, I see potential for these organizations to create rigid standards around the treatment of complex diseases, and in the process, compromise the important role of physician judgment.  In life threatening diseases such as cancer, insuring a close association between criteria deemed to be important by the ACOs and actual patient outcomes will be critical.  Alignment of clinical trial design to meet formulary requirements of ACOs may therefore challenge the biopharmaceutical industry and contract research organizations to think differently about development priorities for both on market and pipeline candidates with increased emphasis on non-clinical measures such as such as economic utility and patient satisfaction. Efficient collection of patient information will be key for ACOs to succeed; the figure below from the Centers for Medicare and Medicaid Services (CMS) illustrate ACOs in the context of a broader initiative to standardize electronic information in healthcare.

cms

Source:  Centers for Medicare and Medicaid Services (CMS)

While I appreciate the attractiveness of this healthcare delivery model, which rewards high quality and low cost outcomes versus patient throughput, I’m concerned about the abrupt realignment of economics within the chain of delivery of care and ultimately potential implications on patient outcomes.  Moreover, I worry that for budgetary purposes, important clinical measures might be compromised in clinical trial design for economic measures, which could have a negative effect on long term drug utilization considerations.  I therefore feel that in oncology, prior to implementation of wide-spread ACOs, small pilot programs should be designed around specific types of cancer to elucidate specific, disease specific pitfalls.

 

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One Response to “Impact of the Accountable Care Model in Oncology”

  1. jagoldbe Says:

    There are so many problems with the ACA that I do not even know where to begin. As an Emergency Physician, I have been following the impending changes and failing rollout with intense scrutiny. It’s failures to this point are leading me to seek a career outside of medicine because of its onerous regulations and inability to practice medicine the way my experience dictates. In the realm of oncology I anticipate, as you have, that the shift from medically appropriate care to financially driven and ‘customer satisfaction” oriented care will not only limit what oncologists are able to provide, but worsen outcomes of those patients who could benefit from intense treatment with expensive chemotherapeutic agents and modalities. While I believe that pilot programs to demonstrate the impending impacts (i.e. failures) of ACO’s and the ACA would be beneficial, there is no way the government would allow anything to shed a negative light on President Obama’s signature “achievement.” I would also doubt they could even coordinate such a program given the failure to implement the ACA after it passed 3(!) years ago.

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