System-Level Health-Care Integration and the Costs of Cancer Care Across the Disease Continuum.

Journal Article (Journal Article)

PURPOSE: Policy reforms in the Affordable Care Act encourage health care integration to improve quality and lower costs. We examined the association between system-level integration and longitudinal costs of cancer care. METHODS: We used linked SEER-Medicare data to identify patients age 66 to 99 years diagnosed with prostate, bladder, esophageal, pancreatic, lung, liver, kidney, colorectal, breast, or ovarian cancer from 2007 to 2012. We attributed each patient to one or more phases of care (ie, initial, continuing, and end of life) according to time from diagnosis until death or end of study interval. For each phase, we aggregated all claims with the primary cancer diagnosis and identified patients treated in an integrated delivery network (IDN), as defined by the Becker Hospital Review list of the top 100 most integrated health delivery systems. We then determined if care provided in an IDN was associated with decreased payments across cancers and for each individual cancer by phase and across phases. RESULTS: We identified 428,300 patients diagnosed with one of 10 common cancers. Overall, there were no differences in phase-based payments between IDNs and non-IDNs. Average adjusted annual payments by phase for IDN versus non-IDNs were as follows: initial, $14,194 versus $14,421, respectively ( P = .672); continuing, $2,051 versus $2,099 ( P = .566); and end of life, $16,257 versus $16,232 ( P = .948). However, in select cancers, we observed lower payments in IDNs. For bladder cancer, payments at the end of life were lower for IDNs ($11,041 v $12,331; P = .008). Of the four cancers with the lowest 5-year survival rates (ie, pancreatic, lung, esophageal, and liver), average expenditures during the initial and continuing-care phases were lower for patients with liver cancer treated in IDNs. CONCLUSION: For patients with one of 10 common malignancies, treatment in an IDN generally is not associated with lower costs during any phase of cancer care.

Full Text

Duke Authors

Cited Authors

  • Kaye, DR; Min, HS; Norton, EC; Ye, Z; Li, J; Dupree, JM; Ellimoottil, C; Miller, DC; Herrel, LA

Published Date

  • March 2018

Published In

Volume / Issue

  • 14 / 3

Start / End Page

  • e149 - e157

PubMed ID

  • 29443647

Pubmed Central ID

  • PMC5847466

Electronic International Standard Serial Number (EISSN)

  • 1935-469X

Digital Object Identifier (DOI)

  • 10.1200/JOP.2017.027730


  • eng

Conference Location

  • United States