Policy Priority: Quality & Value

Quality

NCCN supports the use of evidence-based, nationally recognized, guidelines to ensure people with cancer receive quality care while reducing cost and clinical burden. Recently the NCCN Quality & Outcomes Committee reviewed the existing quality landscape and identified contemporary, relevant, cancer quality and outcomes measures by both evaluating current validated measures and proposing new measure concepts to fill crucial gaps. This work is a resource for quality measurement in oncology. In order to use quality measures to improve care and outcomes for people with cancer, NCCN affirms that:

Nationally-recognized, continuously-updated clinical practice guidelines are a key tool for quality programs to protect patient access to the highest standard of care;
Quality measurement must be informed by a variety of key stakeholder perspectives including patients, providers, payers, and health information technology vendors to ensure representative and meaningful measurement; and
Quality measurement must be easily available through a variety of interoperable digital platforms to ensure minimal administrative burden and ease of integration into clinical workflow.
In addition to the aforementioned statements, NCCN supports the alignment of similar, effective, measures in the quality space when and where possible.

Investment in Specialty Services

Studies have shown that academic cancer centers provide superior care for patients with rare, complex, or advanced cancers. Academic cancer centers provide comprehensive specialty care that is uniquely distinct from care in traditional physician office settings. Additionally, recent studies have shown academic cancer centers to have superior outcomes even in cancers considered common or high-volume. In order to ensure that people with cancer receive treatment at appropriate facilities, NCCN affirms that:

Payment reductions to off-campus accepted hospital based providers inadvertently penalize providers for providing high quality, comprehensive services that are typically available and provided at hospital-based facilities. Proposals to significantly decrease resources within the academic cancer center clinical system will likely result in significant barriers to patient access to comprehensive high-quality cancer care. This is particularly concerning for patients with complex, rare, or advanced cancers.
Cancer care is a field marked by multidisciplinary care and constant innovation, requiring adequate reimbursement to protect technological and scientific advancements in care delivery.

Advancing Value-Based Models of Care in Oncology

In pursuit of reduced healthcare costs and improved quality of care, the United States healthcare infrastructure is transitioning from a traditional fee-for-services (FFS) reimbursement model to value-based reimbursement. Value-based models seek to encourage cost-effective, high-quality care in a complex treatment environment. NCCN supports the advancement of value-based models in oncology to ensure people with cancer have access to the highest quality of care and health systems benefit from the most efficient use of resources possible. In order to manage costs while preserving optimal care, NCCN supports value-based models that:

Incentivize clinician payment based on quality and value of care over quantity of services;
Adopt provisions requiring participating providers and vendors to adhere to nationally recognized, continuously updated, professional society guidelines in treatment decisions;
Remain voluntary to ensure only practices with appropriate infrastructure and enthusiasm are included in the model;
Provide selected practices and suppliers with adequate time to reallocate resources to meet model demands;
Provide timely and actionable feedback to guide improvement;
Consider provider and patient burden when installing administrative processes; and
Provide mechanisms such as novel therapy adjustments paired with required adherence to nationally recognized guidelines, ensuring that innovative, potentially curative, therapies are not dis-incentivized when clinically appropriate.

NCCN strongly encourages the adoption of value models in oncology that adhere to the aforementioned principles to advance high-value cancer care.