ABSTRACT
Oncology is a complex clinical specialty often requiring the close interaction of teams of different medical specialists for a successful outcome. The field is rapidly evolving scientifically, with successive discoveries of oncologic driver mutations soon followed by therapeutic agents able to interrupt the neoplastic process. Unfortunately, objective quality measurement demonstrates that many patients are not receiving optimal care, from diagnostic accuracy, therapeutic, or end-of-life perspectives. Quality measurement, reporting, and payment programs have the potential to focus attention on these care gaps and drive improvement. The federal government, as the largest single payer of health care services in the United States, has a compelling national interest to ensure that the medical care of Americans is at the highest level achievable. Accordingly, quality reporting and payment programs have been established in federal health care payment programs to drive improvements in care. This article reviews the science of quality measurement, documented gaps in oncology care, and ways to use new information technologies to decrease clinician burden associated with quality reporting. The article reviews how a measure is developed and incorporated into a Centers for Medicare & Medicaid Services (CMS) program. It also summarizes federal programs relevant to oncology care and the individual measures used in these programs. CMS looks forward to working jointly with the oncology community to drive continuous improvements in care.
ABSTRACT
Accountable Communities for Health (ACHs) are collaborative partnerships spanning health, public health, and social services that seek to improve the health of individuals and communities by addressing social determinants of health such as housing, food security, employment, and transportation. ACHs require funding not only for programs and services but also for core infrastructure functions. We conducted a legal and policy review to identify potential funding streams specifically for ACH infrastructure activities. We found multiple and credible options at the federal and state levels and in the public health, health insurance, and philanthropic and private sectors. Such options could support ACH infrastructure directly or through reimbursement for administrative costs associated with programmatic work. Yet we also found that there is no dedicated or explicit source of funding for these critical functions. For sustainable and long-term ACH support, policy makers and program administrators should clarify and define ACH infrastructure functions and, where appropriate, explicitly recognize supporting these functions as an allowable use of funds and facilitate their coordination across program funding streams.