Fred Hutch releases report on cancer care in Washington state

SEATTLE – Fred Hutchinson Cancer Research Center has released a report on quality and cost of cancer care at Washington state clinics. The “Community Cancer Care in Washington State: Quality and Cost Report” is the result of a five-year initiative led by the Hutchinson Institute for Cancer Outcomes Research, or HICOR, a research group at Fred Hutch focused on health economics in cancer care. HICOR collaborated with more than 25 Washington cancer-care providers, public and private health insurers, patients, and researchers to develop the report.

“The report offers a depth and breadth of data that hasn’t existed before,” said HICOR Director Dr. Scott Ramsey, a cancer researcher and health care economist at Fred Hutch. “Although many oncology quality measures are tracked at the national level by organizations such as Medicare and the National Cancer Institute, they are not released to the public at this level of detail, and they are not linked to cost.”

The report is the first in the nation to publicly report clinic-level quality measures linked to cost in oncology. The report provides:

• A picture of how hospitals and clinics are performing and how they compare to the statewide average on selected indicators —information that is unavailable from any other source.
• Meaningful information to help care providers improve quality while addressing the rising costs of cancer care.

Publicly reporting clinic-level outcomes in a regional setting is important because most cancer patients are treated in community clinics. Clinics can see areas where they excel and other areas where there may be room for improvement. The report is not intended to provide side-by-side comparisons; rather, it’s about the sharing of information to improve care across the state.

“The reality is you can’t improve what you don’t know,” said HICOR Co-director Dr. Gary Lyman, oncologist at Fred Hutch. “Although it was five years in the making, we consider this report a starting point. As we move forward, it will serve as a tool to help cancer-care providers identify new opportunities to collaborate, share best practices and improve care, with a focus on increasing value and reducing cost.”

The project started at the first Value in Cancer Care Summit in 2014 when HICOR brought together representatives of regional clinics and payer groups to develop consensus on high-priority areas for performance measurement. HICOR developed the performance measures in collaboration with clinicians and administrators from hospitals and clinics delivering cancer care, health insurance administrators, patient partners, researchers, health care quality organizations, policymakers, and government leaders in Washington state. Interim regional-level quality and cost reports were discussed at subsequent annual meetings. This is the first public release of clinic-level findings.

The report looks at four clinical areas:

• Adherence to treatment recommendations for breast, colorectal, and lung cancer.
• Emergency department visits and inpatient hospitalizations during chemotherapy.
• Follow-up testing after treatment completion for breast, colon, and lung cancer.
• Appropriate provision of end-of-life care.

The data used for this report comes from a HICOR database that combines clinical information from cancer registries and health care use and cost information from health insurance claims. The Washington State Cancer Registry and the Western Washington Cancer Surveillance System collect comprehensive information on staging, initial treatment, and survival for persons diagnosed with cancer in Washington state. HICOR linked enrollment files from Medicare, Regence Blue Shield, Premera Blue Cross, and the Washington State Uniform Medical Plan with the cancer registries. HICOR’s analytics team developed the performance measures in collaboration with stakeholders and followed national best practices for public reporting.

Ramsey said the report’s focus on relationships between costs and care, along with its emphasis on transparency, can provide meaningful, actionable insights for all stakeholders. For example, care providers can better monitor and improve their own performance, payers can make more informed decisions on resources for a particular type of care or treatment, employers can more clearly assess health plans and treatment options for their employees and policymakers can be more informed when shaping the future of cancer care.

“Our overarching goals for this effort are straightforward,” Ramsey said. “We want to ensure that cancer patients in our state receive the highest quality care and that the data provided in this report support all parties in working together toward that common goal. The Community Cancer Care Report is an example of a collaborative effort to reach across differences for the betterment of patients.”

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