Grant Number:	5R01CA174768-05 Interpret this number
Primary Investigator:	Miller, David
Organization:	University Of Michigan At Ann Arbor
Project Title:	Understanding Optimal Delivery Systems for Cancer Care
Fiscal Year:	2018

DESCRIPTION (provided by applicant): The quality and cost of cancer care vary widely across hospitals and health systems. A large body of research indicates that hospitals with better outcomes tend to have large case volumes and a defined focus on cancer care. These and other data have prompted many to advocate for specialized cancer hospitals-so-called "focused factories"-as the best delivery system for achieving more efficient cancer care. However, reforms in the Affordable Care Act, including Accountable Care Organizations (ACO), are moving care away from this model. Although proponents argue that ACOs will improve efficiency by encouraging previously unaligned hospitals and physicians to evolve toward integrated delivery systems, others worry that the intended benefits will not accrue for patients with complex cancer diagnoses, and that ACOs will discourage referrals to hospitals with the greatest cancer expertise. To explore this issue, we propose a study that evaluates comprehensively the relationship between care delivery models and the quality, outcomes, and cost of cancer care in the United States. In the first aim, we will examine the impact of care delivery models on the quality of cancer care. Using national Medicare claims and linked SEER-Medicare data, we will identify cohorts of patients with breast, lung, prostate, and pancreatic cancer. We will then compare the quality of cancer care provided in different care delivery models based on levels of adherence with guideline recommendations and/or nationally-endorsed quality measures. We posit that cancer-focused hospitals will often have higher levels of adherence, due in part to their greater concentration of disease-specific expertise. In the second aim, we will assess the association between care delivery models and outcomes, including operative mortality, complications, hospitalizations, and long-term survival. We hypothesize that patients treated in cancer-focused hospitals will have better mortality outcomes, while greater delivery system integration will correlate with fewer hospitalizations following initial cancer therapy. In the third aim, we will examine cancer-related expenditures for these patient cohorts as they vary over time after diagnosis. We will also assess payments related to different clinical services including surgical procedures, systemic therapy, end-of-life care, and non-cancer-related treatments. We expect that cancer-focused hospitals will achieve savings around episodes of surgical care, and that patients treated in more integrated delivery systems will have lower longitudinal costs for their cancer care. Results from this study will prove invaluable to CMS policymakers and other stakeholders as they debate whether delivery system reforms deemed good for healthcare in general are also good for patients with cancer.




Variation in prostate cancer treatment and spending among Medicare shared savings program accountable care organizations.
Authors: Modi P.K. , Kaufman S.R. , Borza T. , Yan P. , Miller D.C. , Skolarus T.A. , Hollingsworth J.M. , Norton E.C. , Shahinian V.B. , Hollenbeck B.K. .
Source: Cancer, 2018-06-15 00:00:00.0; , .
EPub date: 2018-06-15 00:00:00.0.
PMID: 29905943
Related Citations

Impact of Accountable Care Organizations on Diagnostic Testing for Prostate Cancer.
Authors: Luckenbaugh A.N. , Hollenbeck B.K. , Kaufman S.R. , Yan P. , Herrel L.A. , Skolarus T.A. , Norton E.C. , Schroeck F.R. , Jacobs B.L. , Miller D.C. , et al. .
Source: Urology, 2018-04-06 00:00:00.0; , .
EPub date: 2018-04-06 00:00:00.0.
PMID: 29630957
Related Citations

Association Between Hospital Participation in Medicare Shared Savings Program Accountable Care Organizations and Readmission Following Major Surgery.
Authors: Borza T. , Oerline M.K. , Skolarus T.A. , Norton E.C. , Dimick J.B. , Jacobs B.L. , Herrel L.A. , Ellimoottil C. , Hollingsworth J.M. , Ryan A.M. , et al. .
Source: Annals Of Surgery, 2018-03-19 00:00:00.0; , .
EPub date: 2018-03-19 00:00:00.0.
PMID: 29557880
Related Citations

System-Level Health-Care Integration and the Costs of Cancer Care Across the Disease Continuum.
Authors: Kaye D.R. , Min H.S. , Norton E.C. , Ye Z. , Li J. , Dupree J.M. , Ellimoottil C. , Miller D.C. , Herrel L.A. .
Source: Journal Of Oncology Practice, 2018-02-13 00:00:00.0; , p. JOP2017027730.
EPub date: 2018-02-13 00:00:00.0.
PMID: 29443647
Related Citations

Episode-based Payment Variation for Urologic Cancer Surgery.
Authors: Ellimoottil C. , Li J. , Ye Z. , Dupree J.M. , Min H.S. , Kaye D. , Herrel L.A. , Miller D.C. .
Source: Urology, 2018 Jan; 111, p. 78-85.
EPub date: 2017-10-16 00:00:00.0.
PMID: 29051001
Related Citations

Association of Delivery System Integration and Outcomes for Major Cancer Surgery.
Authors: Li J. , Ye Z. , Dupree J.M. , Hollenbeck B.K. , Min H.S. , Kaye D. , Herrel L.A. , Miller D.C. , Ellimoottil C. .
Source: Annals Of Surgical Oncology, 2017-12-29 00:00:00.0; , .
EPub date: 2017-12-29 00:00:00.0.
PMID: 29285642
Related Citations

Use of Routine Home Health Care and Deviations From an Uncomplicated Recovery Pathway after Radical Prostatectomy.
Authors: Kaye D.R. , Syrjamaki J. , Ellimootil C. , Schervish E.W. , Solomon M.H. , Linsell S. , Montie J.E. , Miller D.C. , Dupree J.M. , Michigan Urological Surgery Improvement Collaborative , et al. .
Source: Urology, 2017-11-16 00:00:00.0; , .
EPub date: 2017-11-16 00:00:00.0.
PMID: 29155190
Related Citations

Association Between Patient Satisfaction and Short-Term Outcomes After Major Cancer Surgery.
Authors: Kaye D.R. , Richardson C.R. , Ye Z. , Herrel L.A. , Ellimoottil C. , Miller D.C. .
Source: Annals Of Surgical Oncology, 2017 Nov; 24(12), p. 3486-3493.
EPub date: 2017-08-17 00:00:00.0.
PMID: 28819930
Related Citations

Accountable care organizations and prostate cancer care.
Authors: Hollenbeck B.K. , Kaufman S.R. , Borza T. , Yan P. , Herrel L.A. , Miller D.C. , Luckenbaugh A.N. , Skolarus T.A. , Shahinian V.B. .
Source: Urology Practice, 2017 Nov; 4(6), p. 454-461.
EPub date: 2016-11-10 00:00:00.0.
PMID: 29170755
Related Citations

Early effect of Medicare Shared Savings Program accountable care organization participation on prostate cancer care.
Authors: Borza T. , Kaufman S.R. , Yan P. , Herrel L.A. , Luckenbaugh A.N. , Miller D.C. , Skolarus T.A. , Jacobs B.L. , Hollingsworth J.M. , Norton E.C. , et al. .
Source: Cancer, 2017-10-20 00:00:00.0; , .
EPub date: 2017-10-20 00:00:00.0.
PMID: 29053177
Related Citations

Alternative payment models and urology.
Authors: Kaye D.R. , Miller D.C. , Ellimoottil C. .
Source: Current Opinion In Urology, 2017 Jul; 27(4), p. 360-365.
PMID: 28441271
Related Citations

Understanding the relationship between the Centers for Medicare and Medicaid Services' Hospital Compare star rating, surgical case volume, and short-term outcomes after major cancer surgery.
Authors: Kaye D.R. , Norton E.C. , Ellimoottil C. , Ye Z. , Dupree J.M. , Herrel L.A. , Miller D.C. .
Source: Cancer, 2017-06-30 00:00:00.0; , .
EPub date: 2017-06-30 00:00:00.0.
PMID: 28665483
Related Citations

Primary Care Focus And Utilization In The Medicare Shared Savings Program Accountable Care Organizations
Authors: Herrel L.A. , Ayanian J.Z. , Hawken S.R. , Miller D.C. .
Source: Bmc Health Services Research, 2017-02-15 00:00:00.0; 17(1), p. 139.
PMID: 28202052
Related Citations

Health Care Integration and Quality among Men with Prostate Cancer.
Authors: Herrel L.A. , Kaufman S.R. , Yan P. , Miller D.C. , Schroeck F.R. , Skolarus T.A. , Shahinian V.B. , Hollenbeck B.K. .
Source: The Journal Of Urology, 2017 Jan; 197(1), p. 55-60.
PMID: 27423758
Related Citations

Implications Of The Definition Of An Episode Of Care Used In The Comprehensive Care For Joint Replacement Model
Authors: Ellimoottil C. , Ryan A.M. , Hou H. , Dupree J.M. , Hallstrom B. , Miller D.C. .
Source: Jama Surgery, 2017-01-01 00:00:00.0; 152(1), p. 49-54.
PMID: 27682525
Related Citations

Sharp Decline In Prostate Cancer Treatment Among Men In The General Population, But Not Among Diagnosed Men.
Authors: Borza T. , Kaufman S.R. , Shahinian V.B. , Yan P. , Miller D.C. , Skolarus T.A. , Hollenbeck B.K. .
Source: Health Affairs (project Hope), 2017-01-01 00:00:00.0; 36(1), p. 108-115.
PMID: 28069853
Related Citations

Trends In Inpatient Urological Surgery Practice Patterns
Authors: Hawken S.R. , Herrel L.A. , Ellimoottil C. , Ye Z. , Clemens J.Q. , Miller D.C. .
Source: Urology Practice, 2016 Nov; 3(6), p. 499-504.
PMID: 27819017
Related Citations

Early impact of Medicare accountable care organizations on cancer surgery outcomes.
Authors: Herrel L.A. , Norton E.C. , Hawken S.R. , Ye Z. , Hollenbeck B.K. , Miller D.C. .
Source: Cancer, 2016-09-01 00:00:00.0; 122(17), p. 2739-46.
EPub date: 2016-09-01 00:00:00.0.
PMID: 27218198
Related Citations

Medicare's New Bundled Payment For Joint Replacement May Penalize Hospitals That Treat Medically Complex Patients
Authors: Ellimoottil C. , Ryan A.M. , Hou H. , Dupree J. , Hallstrom B. , Miller D.C. .
Source: Health Affairs (project Hope), 2016-09-01 00:00:00.0; 35(9), p. 1651-7.
PMID: 27605647
Related Citations

Implications Of Evolving Delivery System Reforms For Prostate Cancer Care
Authors: Hollenbeck B.K. , Bierlein M.J. , Kaufman S.R. , Herrel L. , Skolarus T.A. , Miller D.C. , Shahinian V.B. .
Source: The American Journal Of Managed Care, 2016 Sep; 22(9), p. 569-75.
PMID: 27662220
Related Citations

Understanding pre-enrollment surgical outcomes for hospitals participating in Medicare Accountable Care Organizations.
Authors: Hawken S.R. , Herrel L.A. , Ellimoottil C. , Montgomery Z.A. , Ye Z. , Miller D.C. .
Source: American Journal Of Surgery, 2016 Jun; 211(6), p. 998-1004.
PMID: 26518163
Related Citations

Adding A Spending Metric To Medicare's Value-Based Purchasing Program Rewarded Low-Quality Hospitals.
Authors: Das A. , Norton E.C. , Miller D.C. , Ryan A.M. , Birkmeyer J.D. , Chen L.M. .
Source: Health Affairs (project Hope), 2016-05-01 00:00:00.0; 35(5), p. 898-906.
PMID: 27140997
Related Citations

Urologist Participation in Medicare Shared Savings Program Accountable Care Organizations (ACOs).
Authors: Hawken S.R. , Herrel L.A. , Ellimoottil C. , Ye Z. , Hollenbeck B.K. , Miller D.C. .
Source: Urology, 2016 Apr; 90, p. 76-80.
PMID: 26809069
Related Citations

Surgery and Medicare Shared Savings Program Accountable Care Organizations.
Authors: Hawken S.R. , Ryan A.M. , Miller D.C. .
Source: Jama Surgery, 2016 Jan; 151(1), p. 5-6.
PMID: 26509237
Related Citations

Association of Postdischarge Spending and Performance on New Episode-Based Spending Measure.
Authors: Das A. , Norton E.C. , Miller D.C. , Chen L.M. .
Source: Jama Internal Medicine, 2016 Jan; 176(1), p. 117-9.
PMID: 26595375
Related Citations

Utilization and Outcomes of Inpatient Urological Care at Safety Net Hospitals.
Authors: Herrel L.A. , Ye Z. , Miller D.C. .
Source: The Journal Of Urology, 2015 Nov; 194(5), p. 1380-5.
PMID: 25936866
Related Citations

Clinical predictors and recommendations for staging computed tomography scan among men with prostate cancer.
Authors: Risko R. , Merdan S. , Womble P.R. , Barnett C. , Ye Z. , Linsell S.M. , Montie J.E. , Miller D.C. , Denton B.T. .
Source: Urology, 2014 Dec; 84(6), p. 1329-34.
PMID: 25288575
Related Citations

Toward better use of bone scans among men with early-stage prostate cancer.
Authors: Merdan S. , Womble P.R. , Miller D.C. , Barnett C. , Ye Z. , Linsell S.M. , Montie J.E. , Denton B.T. .
Source: Urology, 2014 Oct; 84(4), p. 793-8.
PMID: 25096341
Related Citations