Waste contributes to substantial unnecessary cost to the US health care system. Low-value services are one category of waste and examples abound in cancer care. These include cancer screening in populations unlikely to benefit, overtreatment of low-risk cancers, and aggressive and unwanted care near the end of life. Fee-for-service is the most common model for paying health care providers and incentivizes use of low-value cancer services. This is because fee-for-service encourages providers to deliver more care regardless of the value of care. Further contributing to the problem of low-value cancer care, providers are increasingly organizing in ways that reduce the value of health care. For example, prices for health care services are higher in markets where providers are in large, monopolistic groups. New policies encourage alternative ways to pay for health care that may realign incentives around quality, and as a result, improve value. One example is the Oncology Care Model (OCM), which is a bundled care method for paying for cancer care. A critical aspect of this model is that it shares in savings with providers who reduce the cost of care for administering chemotherapy. Using several national and regional data resources and employing hierarchical regression methods for causal inference, the purpose of this work is to evaluate the association between competition and use of low-value cancer care and the modifying influence of the OCM. Understanding how competition and the OCM interact to influence the use of low-value cancer services will help to determine which policies and programs make cancer care more efficient and cost less. It will also provide timely assessment of recent health care policies which influence market forces and cancer care delivery. The overall goal of the integrated career development plan is to prepare the candidate to become an expert in understanding and leveraging financial drivers of variation in cancer care delivery in order to improve value and outcomes. The training and research will be conducted at an institution with a strong record of providing excellent support and rich training and educational resources. The candidate's department is committed to the success of this early career clinician-scientist, providing any additional resources necessary to complete the proposed career development and research aims, and ensuring ongoing protected research time. The career development aims focus on critical training in health economics and industrial organization, health policy evaluation, advanced statistical techniques and health system leadership.
These aims will be overseen by a complementary and multidisciplinary mentoring team of experienced researchers and experts in these fields.
/ RELEVANCE TO PUBLIC HEALTH Cancer care is increasingly expensive with substantial spending wasted on low-value care. This project seeks to understand the financial drivers that contribute to use of low-value cancer services. This will help to determine which policies and programs make cancer care more efficient and cost less.