Impact of Maryland s All-Payer Model on Racial and Socioeconomic Disparities in Prostate Cancer Management
Abstract
Scientific Objective and Rationale: Prostate cancer is the most common nonskin cancer and the second leading cause of cancer-related death in U.S. men. There are important disparities in appropriate treatment, postoperative outcomes, and access to care for prostate cancer. Specifically, Black men and men with low socioeconomic status (SES) have greater barriers to receiving appropriate intervention, experience higher rates of readmissions and complications, travel longer distances to seek care, and have a higher likelihood of facing delayed care, compared to other patients. Maryland’s All-Payer Model of 2014, a payment reform, was introduced to improve outcomes and optimize costs of hospital services by making hospitals accountable for the entire hospital revenues, readmissions, and complications. If Maryland hospitals meet payment and quality targets, they can keep their revenues and get additional bonuses from Medicare; if they fall short, they have to repay the difference between the payment target and their total revenues to Medicare and receive financial penalties (up to 50%) in the following year. These changes may have positive and negative effects on existing disparities in prostate cancer care. First, to constrain total revenues, Maryland hospitals may consider cheaper therapies (i.e., conservative treatment) to expensive interventions (i.e., curative treatments, including surgical or radiation therapies). This might be harmful for men with high-risk, localized prostate cancer, where curative treatments are appropriate, particularly for Black and low-SES men who already face substantial challenges to receiving curative treatment. Second, the Model may spur hospitals to select appropriate surgical candidates and improve their care practices to meet the payment and quality targets (i.e., readmissions and complications) for the sake of savings. This may enhance surgical outcomes for prostate cancer patients who undergo prostatectomy, particularly among Black men and SES disadvantaged patients who already face worse outcomes, reducing the existing disparities. Third, Maryland hospitals may just shift the high-cost and high-need patients from their facilities to achieve cost containment and quality targets. Therefore, Black men and men from low-SES strata may need to travel longer distances for prostate cancer care and be more likely to face delayed treatment. Ultimate Applicability of the Research: Alternative payment models like Maryland’s All-Payer Model, in which participating entities take on considerable financial risk to deliver high-quality care at lower cost, have been mainstream strategies of improving the value and efficiency of health care delivery since the passage of the Patient Protection and Affordable Care Act of 2010. This proposal will provide scientific evidence that will inform the further design of alternative payment reforms to include inequality/disparity-focused metrics, reducing racial and SES disparities for prostate cancer. This will benefit all men with prostate cancer in general and Black and low-SES men in particular. Such beneficial changes will ultimately advance prostate cancer care, which may generate positive spillover effects on other groups, such Service Members, Veterans, and military beneficiaries. Principal Investigator’s Career Goals in Prostate Cancer Research: My short-term career goal is to become an independent prostate cancer researcher who is dedicated to facilitating health equity and reducing disparities in prostate cancer. My long-term career goal is to emerge as a policy leader in the fields of health policy, health disparities, and cancer care. To realize these goals, I am seeking support in the form of an Early-Investigator Research Award. This award will afford me a great opportunity to devote 100% of my effort to purse formal coursework, mentorship, and project-based learning-activities preparing me for a long career of independent scientif
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Jan 04, 2024
- Source ID
- HT94252310141
Entities
People
- Meiling Ying
Organizations
- United States Army
- University of Michigan