National Comprehensive Cancer Network guideline compliance in an oncology value-based care program serving Medicare members.

Abstract

e23219 Background: Value-based care (VBC) focuses on improving patient health outcomes while reducing the overall cost of healthcare. The National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology (NCCN Guidelines) provide evidence-based and consensus-driven recommendations for the management of cancer. These guidelines aim to ensure that patients receive the most effective preventive, diagnostic, treatment, and supportive services to achieve optimal outcomes. They are considered the standard for clinical direction and policy in cancer care and are regularly updated. The NCCN Guidelines are designed to assist healthcare professionals, patients, and their families in making informed decisions and improving patient care and outcomes. 1 While studies have shown that compliance to NCCN guidelines improves survival, little information exists regarding the impact of compliance in VBC arrangements. This study aimed to evaluate compliance to NCCN regimen guidelines in Medicare members being treated for cancer under a VBC arrangement. Methods: This is a cohort study of individuals receiving care, in a single state, enrolled in a VBC contract within a large national insurer from January 18, 2024 to October 28, 2024. Medicare members with bladder, colon, lung, breast, hepatocellular, rectal, pancreatic, kidney, biliary tract and prostate cancer with at least one oncology claim within the measurement time period were included. NCCN compliance was a quality measure of the VBC, was defined using pharmacy and medical claims and deemed as concordant if the entire prescribed treatment regimen matched an NCCN recommended regimen (Level 1 and 2a); members not receiving an NCCN recommended regimen were deemed to be non-concordant. Results: This study included 332 patients, the mean [SD] age was 73.7 [6.9] years with 183 [55.1%] members identified as female. Avg Age Female [73.7] while Male was [73.8]. The total population captured through the automated prior authorization platform yielded 95.7% NCCN compliance. Conclusions: In this study, individuals receiving chemotherapy participating in a shared savings VBC demonstrated 95.7% compliance to NCCN guidelines. Embedding NCCN regimen compliance into VBC quality measures, coupled with online, real-time compliance assistance helps drive optimal NCCN compliance rates in Medicare patients and, in turn, improve clinical outcomes for patients. References #1: https://www.nccn.org/guidelines/guidelines-process/about-nccn-clinical-practice-guidelines#:~:text = The%20NCCN%20Guidelines%C2%AE%20are,in%20any%20area%20of%20medicine .