In the United States, approximately 14 million people have had cancer and more than 1.6 million new cases are diagnosed each year. However, more than a decade after the Institute of Medicine (IOM) first studied the quality of cancer care, the barriers to achieving excellent care for all cancer patients remain daunting. Care often is not patient-centered, many patients do not receive palliative care to manage their symptoms and side effects from treatment, and decisions about care often are not based on the latest scientific evidence. The cost of cancer care also is rising faster than many sectors of medicine--having increased to $125 billion in 2010 from $72 billion in 2004--and is projected to reach $173 billion by 2020. Rising costs are making cancer care less affordable for patients and their families and are creating disparities in patients' access to high-quality cancer care. There also are growing shortages of health professionals skilled in providing cancer care, and the number of adults age 65 and older--the group most susceptible to cancer--is expected to double by 2030, contributing to a 45 percent increase in the number of people developing cancer. The current care delivery system is poorly prepared to address the care needs of this population, which are complex due to altered physiology, functional and cognitive impairment, multiple coexisting diseases, increased side effects from treatment, and greater need for social support. Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis presents a conceptual framework for improving the quality of cancer care. This study proposes improvements to six interconnected components of care: (1) engaged patients; (2) an adequately staffed, trained, and coordinated workforce; (3) evidence-based care; (4) learning health care information technology (IT); (5) translation of evidence into clinical practice, quality measurement and performance improvement; and (6) accessible and affordable care. This report recommends changes across the board in these areas to improve the quality of care. Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis provides information for cancer care teams, patients and their families, researchers, quality metrics developers, and payers, as well as HHS, other federal agencies, and industry to reevaluate their current roles and responsibilities in cancer care and work together to develop a higher quality care delivery system. By working toward this shared goal, the cancer care community can improve the quality of life and outcomes for people facing a cancer diagnosis.

/pdf/delivering-high-quality-cancer-care-charting-a-new-course-2u1fq5ml3k.pdf

Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis

OBJECTIVES: To summarize evidence regarding the health outcomes associated with polypharmacy, defined as number of prescribed medications, in older community-dwelling persons. DESIGN: Systematic review of MEDLINE (OvidSP 1946 to May, Week 3, 2014). SETTING: Community. PARTICIPANTS: Observational studies examining health outcomes according to number of prescription medications taken. MEASUREMENTS: Association between number of medications and health outcomes. Because of the importance of comorbidity as a potential confounder of the relationship between polypharmacy and health outcomes, articles were assessed regarding the quality of their adjustment for confounding. RESULTS: Of the 50 studies identified, the majority that were rated good in terms of their adjustment for comorbidity demonstrated relationships between polypharmacy and a range of outcomes, including falls, fall outcomes, fall risk factors, adverse drug events, hospitalization, mortality, and measures of function and cognition. However, a number of these studies failed to demonstrate associations, as did a substantial proportion of studies rated fair or poor. CONCLUSION: Data are mixed regarding the relationship between polypharmacy, considered in terms of number of medications, and adverse outcomes in community-dwelling older persons. Because of the challenge of confounding, randomized controlled trials of medication discontinuation may provide more-definitive evidence regarding this relationship than observational studies can provide. Language: en

/pdf/health-outcomes-associated-with-polypharmacy-in-community-1sc96j9bdh.pdf

Health Outcomes Associated with Polypharmacy in Community-Dwelling Older Adults: A Systematic Review

Objective
Up to 32% of older patients take less medication than prescribed to avoid costs, yet a comprehensive assessment of risk factors for cost-related nonadherence (CRN) is not available. This review examined the empirical literature to identify patient-, medication-, and provider-level factors that influence the relationship between medication adherence and medication costs.

/pdf/patients-at-risk-for-cost-related-medication-nonadherence-a-39xradvzw2.pdf

Patients At-Risk for Cost-Related Medication Nonadherence: A Review of the Literature

The Most Common Barriers to Glaucoma Medication Adherence: A Cross-Sectional Survey

Using the most recent data on health spending published by the Organization for Economic Cooperation and Development (OECD), we explore reasons why U.S. health spending towers over that of other countries with much older populations. Prominent among the reasons are higher U.S. per capita gross domestic product (GDP) as well as a highly complex and fragmented payment system that weakens the demand side of the health sector and entails high administrative costs. We examine the economic burden that health spending places on the U.S. economy. We comment on attempts by U.S. policy-makers to increase the prices foreign health systems pay for U.S. prescription drugs.

http://dzcowan.com/Tech%20Attachments/HS%206000/HealthCare%20Spending%20in%20International%20Context%20HS6000R3.pdf

U.S. Health Care Spending In An International Context

Beginning in 2006 the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) will offer pharmacy benefits to forty-two million Medicare beneficiaries nationwide. In a 2003 n...

Prescription Drug Coverage And Seniors: Findings From A 2003 National Survey

This study projects how much Medicare beneficiaries who sign up for the standard Part D drug benefit in 2006 will pay in quarterly out-of-pocket payments through 2008. In the first year we estimate that about 38 percent of enrollees will hit the benefit’s no-coverage zone, known as the “doughnut hole,” and that 14 percent will exceed the catastrophic threshold. Because drug spending is highly persistent over time, beneficiaries who experience the biggest gaps in coverage are likely to do so year after year, with potentially serious financial consequences.

Riding The Rollercoaster: The Ups And Downs In Out-Of-Pocket Spending Under The Standard Medicare Drug Benefit

The proposed Part E, Medicare Extra, outlined in this paper adds a comprehensive benefit option to Medicare, eliminating the need for beneficiaries to purchase a private drug plan and Med...

Medicare extra: a comprehensive benefit option for Medicare beneficiaries.

American Health Care: Why So Costly? Testimony for the Senate Appropriations Subcommittee

Copies of this report are available from The Commonwealth Fund by calling its toll-free publications line at 1-888-777-2744 and ordering publication number 677. The report can also be found on the Fund's website at www.cmwf.org. president of The Commonwealth Fund, is a nationally recognized economist, with a distinguished career in public policy and research. Before joining the Fund, she served as chairman of the Department of Health Policy and Management at The Johns Hopkins Bloomberg School of Public Health, where she also held an appointment as professor of economics. She served as deputy assistant secretary for health policy in the Department of Health and Human Services from 1977 to 1980, and was the first woman to head a U.S. Public Health Service agency. A native of Oklahoma, she received her doctoral degree in economics from Rice University, which recognized her achievements with a Distinguished Alumna Award in 1991. Ms. Davis has published a number of significant books, monographs, and articles on health and social policy issues, including the director of The Commonwealth Fund's Program on Medicare's Future, is a leading expert on Medicare with more than 30 years of health services research and policy experience. Ms. Cooper worked in the federal agency responsible for Medicare beginning with its enactment in 1965 and was later director of its Office of Strategic Planning, for which she was responsible for research and long-range policy development in Medicare and Medicaid. She has also served in the Department of Defense's Office of Health Affairs and on the Advisory Council on Social Security. Ms. Cooper has published a number of monographs and articles on a range of health policy issues, including national health expenditures, the economic cost of illness, competition in Medicare, the effectiveness of interdisciplinary teams, and the Ticket to Work Program. The Federal Employees Health Benefits Program (FEHBP) works well in providing decent, affordable health coverage for the 8.5 million people it serves, including the president, members of Congress, federal employees, retirees, and their families. The most tangible real-world example of " managed competition, " FEHBP is a system of competing private health plans in which the government contributes a relatively fixed amount toward the employee's coverage and employees pay a premium based on the cost of the individual plan they choose. Largely because of its ability to constrain cost growth reasonably well with limited government intervention, the program has been proposed by some …

The Federal Employee Health Benefits Program: A Model for Workers, Not Medicare

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