society, we need to learn new framing, new approaches, and new ways of paying for the care that people need at the end of life. It can be done, and done within just a few years, if we set about the job now.
Reshaping the financing of end-of-life care for those with cancer requires attention to three elements: serviceable methods, adequate description and monitoring, and innovation with evaluation. Many organizations bear responsibility for addressing these needs, some of which are noted (in parentheses) in the discussion that follows.
Metrics for costs and effects (Agency for Healthcare Research and Quality [AHRQ], Health Care Financing Administration [HCFA], National Center for Health Statistics [NCHS], MedPAC, Department of Veterans Affairs [VA])
Benchmarks—what quality can real systems yield? (AHRQ, Health Resources and Services Administration [HRSA], HCFA, VA)
Developing models to correct for nongeneralizable populations (AHRQ, HCFA)
Efficient methods to monitor population experience with end-of-life care in cancer, measuring outcomes and processes (Centers for Disease Control and Prevention [CDC], AHRQ).
Efficient reporting and analysis of costs, in aggregate and to various payers (HCFA, MedPAC, AHRQ)
Exploration of the relationship between costs and life span, and development of language and methods to correct for varying life span in assessment of cost (National Institutes of Health [NIH], AHRQ, VA)
Developing surveillance methods to monitor trends and comparisons among populations by age, race, diagnosis, and geographic locality (CDC, states)
Describing service use (including hospice) by outcomes, variations, and comparisons across geographical areas (HCFA, AHRQ)
Assessing the costs and benefits of interventions in generalizable populations (NIH, AHRQ)