||1R01CA269367-01 Interpret this number
||University Of Michigan At Ann Arbor
||Aligning Financial Incentives to Promote Rational Use of Active Surveillance for Prostate Cancer
This project aims to address inherent financial disincentives for active surveillance for prostate cancer. Many
men with favorable-risk disease will not benefit from aggressive intervention. The uncertainty surrounding who
and how to treat has led to wide variation in treatment patterns, in part driven by nonclinical factors such as
financial incentives. The strategy of surveillance, which avoids or delays aggressive treatment for men with
favorable-risk tumors, has been shown to reduce treatment associated morbidity and spending, without
compromising survival. As such, it is well aligned with the current national interest in improving the value of
health care delivery. Yet studies demonstrate surveillance is underutilized and its implementation varies widely.
There are several factors contributing to this, but one plausible contribution is the financial incentives for
providers embedded within the delivery system that favor aggressive interventions, as their reimbursement is
immediate and can be several-fold greater than for surveillance-related activities. Recent payment reforms
encourage a movement to alternative payment models (APMs), intended to improve the value of health care.
An APM in this context could provide additional payment to providers for performing surveillance, while tying
reimbursement to achievement of quality targets that ensure its appropriate performance and lowering total
payer costs. The objective of this proposal is to develop APMs to promote rational use of surveillance, with the
following aims: 1) To understand urologist response to payment incentives for active surveillance; 2) To
develop robust quality performance measures for implementation of active surveillance; and, 3) To develop
and simulate the financial impact of alternative payment models for favorable-risk prostate cancer on payers
and providers. Ultimately, APMs will align financial incentives for payers and providers, reduce unwarranted
variation in implementation, and shift more men to appropriate use of surveillance thereby improving
population health among men with favorable-risk prostate cancer.