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Policy, Guidelines, and Disparities

Policy, Guidelines, and Disparities. Peter B. Bach, MD, MAPP Memorial Sloan-Kettering Cancer Center bachp@mskcc.org. Overview. The goal of practice guidelines is to: Improve the quality of care? Manage care? Save money? Monitor the quality of care? Reduce disparities?

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Policy, Guidelines, and Disparities

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  1. Policy, Guidelines, and Disparities Peter B. Bach, MD, MAPP Memorial Sloan-Kettering Cancer Center bachp@mskcc.org

  2. Overview • The goal of practice guidelines is to: • Improve the quality of care? • Manage care? • Save money? • Monitor the quality of care? • Reduce disparities? • Give academics (with weird skills) something to do?

  3. Improve care quality • Underlying assumption: care is sub-standard • Practice guidelines used broadly would raise average level • Have to assume that deviations from guidelines net harmful • As opposed to important personalization • Clinical decision support can have a guidelines background

  4. Clinical decision support

  5. Manage care (oncology example) • Pathways tell doctors which treatments to use in common conditions • Mostly payer contracts linked to pathways ask for 80% adherence

  6. Save money through competition

  7. Save money: Guidelines for Metastatic Non-Small Cell Lung Cancer

  8. Metastatic Non-Small Cell Lung Cancer

  9. Using episode payment

  10. Metastatic Hormone Refractory Prostate Cancer

  11. Anti-Androgens

  12. Monitor the quality of care

  13. Reduce disparities

  14. Give academics work

  15. Summary of Published Guidelines on LDCT Screening for Lung Cancer

  16. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm280536.htmhttp://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm280536.htm

  17. Then there’s the dissemination challenge

  18. Two Views of the Population Benefit Laurie Fenton Ambrose President and CEO Lung Cancer Alliance Straight Extrapolation from the NLST 80,000 avoided deaths/yr

  19. Dissemination Challenge • Available to anyone 50 years of age or older with a history of smoking or second hand smoke exposure • $199 for an individual, • $299 for a couple • Available to: “Patients…age 40 and over, typically with a history of smoking of at least 100 cigarettes in a lifetime.” • $399 • http://www.sequoiahospital.org/Medical_Services/Cancer_Care_and_Early_Detection/SDR2_M177128 “The findings were INDISPUTABLE, “low dose” Lung CT saves lives by 20%.”

  20. Thank you

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