Grant Number:	1R37CA307515-01A1 Interpret this number
Primary Investigator:	Hu, Xin
Organization:	Emory University
Project Title:	UNCOVER-PC: Uniting Novel Concepts of Value to Enhance Reform in Palliative Care
Fiscal Year:	2026

Abstract More than 600,000 people with cancer die in the US annually. Many experience avoidable suffering and poor quality of life (QoL) due to inadequate symptom management. Early outpatient specialty palliative care (PC) has demonstrated benefits on QoL and end-of-life (EOL) outcomes in clinical trials as early as 2010, leading national guidelines to recommend initiation early after advanced cancer diagnosis. However, real-world delivery of outpatient specialty PC varies widely across different modalities, including timing, visit frequency, duration, and delivery approach, which creates uncertainty about what constitutes the most effective modality and which patient subgroups derive the greatest benefit. Compounding this challenge is persistently low uptake: in 2019, only 10% of patients received specialty PC within 3 months of an advanced cancer diagnosis. This underuse reflects patient- and provider-level barriers and systemic misalignment between reimbursement structures and the proven value of specialty PC. To address these systemic challenges and inform the design and evaluation of VBID strategies, we will conduct a patient-centered value assessment to inform value-based insurance design (VBID) models for outpatient specialty PC. Our value assessment framework incorporates novel value elements, including (1) family spillover effects that PC support improves QoL and reduces caregiving burden for caregivers, (2) heterogeneity of PC benefits across modalities and patient sociodemographic and clinical characteristics, (3) severity-adjusted valuation that allows a higher willingnessto-pay for PC with more severe illness, and (4) insurance value through covering direct medical costs of health care interventions to provide physical and financial risk protection for individuals. We will focus on Medicare beneficiaries with advanced breast, colorectal, and lung cancers, integrating data sources from populationbased cancer registries, Medicare claims, national surveys, and randomized controlled trials to evaluate the health and economic impacts of different PC modalities. Aim 1 will use a retrospective cohort analysis to assess associations between various PC modalities and health outcomes including EOL care and costs, and identify patient subgroups that derive the highest benefit from different PC modalities. Aim 2 will develop a discrete-time state-transition microsimulation model to estimate long-term societal costs and cost-effectiveness of various PC modalities, including both costs and QoL for patients and families. In Aim 3, we will simulate alternative VBID payment strategies to modify patient cost-sharing and provider reimbursements. We will project their impact on PC utilization and health and economic outcomes. By identifying which PC modality, for whom, and under what payment structures outpatient specialty PC delivers the most value, this study will generate evidence to advance efficient and effective outpatient specialty PC delivery and improve health outcomes for patients with advanced cancers and their families.





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