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Grant Details

Grant Number: 5R01CA269367-02 Interpret this number
Primary Investigator: Shahinian, Vahakn
Organization: University Of Michigan At Ann Arbor
Project Title: Aligning Financial Incentives to Promote Rational Use of Active Surveillance for Prostate Cancer
Fiscal Year: 2023


Abstract

Project Summary 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.



Publications

The 340B Program and oral specialty drugs for advanced prostate cancer.
Authors: Faraj K.S. , Kaufman S.R. , Oerline M. , Herrel L.A. , Maganty A. , Caram M.E.V. , Shahinian V.B. , Hollenbeck B.K. .
Source: Cancer, 2024-02-23; , .
EPub date: 2024-02-23.
PMID: 38395607
Related Citations

Urologist practice divestment from radiation vault ownership and treatment patterns for prostate cancer.
Authors: Faraj K.S. , Kaufman S.R. , Herrel L.A. , Maganty A. , Oerline M.K. , Caram M.E.V. , Shahinian V.B. , Hollenbeck B.K. .
Source: Cancer, 2023-12-26; , .
EPub date: 2023-12-26.
PMID: 38146764
Related Citations

The immediate effects of private equity acquisition of urology practices on the management of newly diagnosed prostate cancer.
Authors: Faraj K.S. , Kaufman S.R. , Herrel L.A. , Maganty A. , Oerline M. , Caram M.E.V. , Shahinian V.B. , Hollenbeck B.K. .
Source: Cancer medicine, 2023 Dec; 12(24), p. 22325-22332.
EPub date: 2023-12-15.
PMID: 38100144
Related Citations

Acquisition of Urology Practices by Private Equity Firms and Performance in the Merit-based Incentive Payment System.
Authors: Faraj K.S. , Kaufman S.R. , Herrel L.A. , Maganty A. , Oerline M. , Caram M.E.V. , Shahinian V.B. , Hollenbeck B.K. .
Source: Urology practice, 2023 Nov; 10(6), p. 597-603.
EPub date: 2023-10-19.
PMID: 37856709
Related Citations

Association between urology practice use of multiparametric MRI and genomic testing and treatment of men with newly diagnosed prostate cancer.
Authors: Faraj K.S. , Kaufman S.R. , Herrel L.A. , Oerline M.K. , Maganty A. , Shahinian V.B. , Hollenbeck B.K. .
Source: Urologic oncology, 2023 Oct; 41(10), p. 430.e17-430.e23.
EPub date: 2023-08-12.
PMID: 37580226
Related Citations

New technology in prostate cancer and financial toxicity.
Authors: Maganty A. , Hollenbeck B.K. .
Source: Urologic oncology, 2023 Sep; 41(9), p. 376-379.
EPub date: 2023-05-10.
PMID: 37173237
Related Citations

Health care delivery system contributions to management of newly diagnosed prostate cancer.
Authors: Krampe N. , Kaufman S.R. , Oerline M.K. , Hill D. , Caram M.E.V. , Shahinian V.B. , Hollenbeck B.K. , Maganty A. .
Source: Cancer medicine, 2023 Aug; 12(16), p. 17346-17355.
EPub date: 2023-07-20.
PMID: 37475511
Related Citations

Effects of In-office Dispensing by Single-specialty Urology Practices on Management of Advanced Prostate Cancer.
Authors: Lai L.Y. , Kaufman S.R. , Oerline M. , Caram M.E.V. , Maganty A. , Shahinian V.B. , Hollenbeck B.K. .
Source: Urology practice, 2023 May; 10(3), p. 230-235.
EPub date: 2023-01-30.
PMID: 37103497
Related Citations




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