Michele Heisler

Understanding the effects of the Oncology Care Model on cancer care for dual eligible patients

Research Project Description
Lindsey A. Herrel, Andrew Michael Ryan, Michele Heisler, Brent K. Hollenbeck, John Z. Ayanian, Paula M. Lantz, David Christopher Miller

Candidate: Lindsey Herrel, MD, MS is a urologic oncologist and junior health services researcher focused on improving cancer care for vulnerable populations through health policy reform. Dr. Herrel's long-term career goal is to become an independent surgeon-scientist evaluating healthcare policies that impact vulnerable populations with cancer, with the ability to translate research findings through healthcare policy reform.

Research Context: Nearly 900,000 Medicare beneficiaries are diagnosed with cancer annually, with costs exceeding $34 billion. The Oncology Care Model, which is the first alternative payment model in cancer, incentivizes physicians to provide higher quality care at a lower cost. For dual eligible beneficiaries who qualify for Medicare due to elderly status and Medicaid due to low income, programs such as OCM that reward improvements in quality and reductions spending through care coordination, may offer a unique opportunity to improve cancer care for these vulnerable populations. However, this program may also lead to adverse selection and limited access if financial incentives are not properly aligned.

Specific Aims: 1) To better understand practice level variation in OCM participation for dual eligible beneficiaries. 2) To examine the effect of OCM participation on quality of cancer care and spending for duals. 3) To evaluate the impact of alternative payment strategies on cancer care for dual eligible beneficiaries.

Research Plan: Dr. Herrel will use Medicare claims and methodology consistent with current policy to characterize practices participating in OCM, in particular where duals are receiving cancer care. She will then use advanced econometric methods to evaluate the effect of the OCM policy on improving quality and reducing spending for duals. Finally, she will determine if current financial incentives are properly aligned with caring for duals and will assess if alternate payment strategies may provide greater motivation to care for duals.

Career Development Plan: In parallel with this research plan and under the guidance of well-established mentors, Dr. Herrel will develop expertise in: 1) health equity for vulnerable populations and dual eligible beneficiaries; 2) legislative and regulatory aspects of health policy; 3) advanced econometric analyses for policy evaluation and simulation.

National Cancer Institute

Funding Period: 7/1/2019 to 6/30/2024