Community Cancer Care Report

Hutchinson Institute for Cancer Outcomes Research

Community Cancer Care Report

Public report shows clinic-level cancer care quality measures linked to cost 

The HICOR team is pleased to provide the first publicly accessible statewide report showing clinic-level quality measures linked to cost in cancer care. This report includes data for cancer patients covered by Washington state’s largest public and commercial insurance providers. The report is designed to facilitate discussions among clinicians providing cancer care, insurance plan administrators, and employer groups who purchase insurance. We also hope it will be a useful introduction to patients and their families — those who are most impacted by cancer care delivery. 

The results presented in this report draw from a patient-level database that links enrollment and claims records from commercial and public health insurance plans with clinical information from Washington state cancer registries, including approximately 70 percent of the cancer patients who received care in Washington state between 2014 and 2016. 

The report displays quality measures and associated costs across the spectrum of cancer care. The quality measures include recommended treatment immediately following diagnosis, emergency department and inpatient hospital admissions during treatment, appropriate use of surveillance testing for patients who have been treated with curative intent, and care for patients in the last 30 days of life. Where possible, we have aligned community input with recommendations and evidence-based guidelines from national organizations such as the National Comprehensive Cancer Network and the American Society of Clinical Oncology (ASCO), and quality initiatives such as the Quality Oncology Practice Initiative. 

Report shows opportunities for improvement in cancer care

The report identifies areas where we are performing well as a region. Nearly 86 percent of breast, colorectal and lung cancer patients in the population measured receive recommended treatments based on guidelines in a timely fashion. The report also identifies areas where there is room for improvement. Over half (52.0%) of cancer patients have an emergency department visit or require hospitalization during their first six months of chemotherapy treatment. At end of life, the use of hospice is variable and many patients spend time in the intensive care unit instead of at home or in lower-intensity settings. 

Mapping quality with cost data allows us to identify and learn from practices that deliver the highest quality and lowest cost care in the state. In some cases (for example, follow-up imaging after breast, lung and colorectal cancer treatment), quality is relatively uniform across cancer clinics but costs vary widely, suggesting that efficiencies can be gained without sacrificing quality. For other measures (for example, end of life care), there is a relatively strong relationship between higher quality and lower cost, suggesting that improvements in quality can also reduce expenditures. 

First step to improving cancer care

The Community Cancer Care Report reflects priority areas identified by community leaders who are involved in paying for, providing, and receiving cancer care. The information in this report is therefore a selective view of a very complex world. The metrics themselves are not intended to inform individual medical care decisions. Issues such as doctor-patient communication, respect for patient preferences and quality of life are also critical aspects of cancer care. We hope to address these issues in future reports. 

The metrics in this report were chosen because our community felt that they were both meaningful and actionable. We believe that public reporting is the first step toward improving and achieving health care’s triple aim for cancer care — better health, better care and lower costs — by spurring collaboration, research and innovation. 

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