Understanding Integration in Oncology Care and Association with Quality and Outcomes

This Program Project seeks to understand features of care integration in oncology that are associated with higher-quality care delivery and better outcomes for individuals with cancer. Mergers and acquisitions (a form of structural integration) among care delivery organizations have increased substantially in the past decade, particularly in oncology. Yet, such ownership changes are only one form of structural integration; structural features such as co-location, referral networks, and geographic reach also influence care delivery. Moreover, other forms of integration, including functional, normative, interpersonal, and process integration, are also important for organizations to provide integrated care. Structural integration via ownership changes is unlikely to lead directly to better care delivery on its own. Learning how organizations engage in various forms of integration is critical to understanding how different types of integration influence care. In this Program Project, we propose a novel research effort with four interrelated Projects reflecting different types of organizations that deliver cancer care. The organizations include health systems, independent oncology practices, post-acute care and hospice entities, and specialty pharmacies. Project teams will collect primary data from case studies and surveys and use Medicare administrative data to explore the following aims: Aim 1. Using case studies, adapt an existing conceptual framework and describe key forms of care integration beyond structure (i.e., functional, normative, interpersonal, process) for oncology care that are most relevant for integrated patient care experiences across settings and across the cancer continuum. Identify mechanisms through which forms of integration may produce integrated patient care and better care overall and for population subgroups, such as patients in rural areas and low-income areas. Aim 2. Measure and compare oncology care integration across settings and assess how these key forms of integration are associated with one another. Assess how structural features, practice factors (e.g., proportion of patients in rural areas), and market factors relate to non-structural forms of integration (functional, normative, interpersonal and process). Aim 3. Assess the association of key forms of integration with utilization, spending, and high-quality care within and across care settings, including health care systems, independent oncology practices, post-acute care and hospice, and specialty pharmacies, and assess mechanisms through which care integration improves or worsens care and outcomes overall and for subgroups, such as patients living in rural areas or living in low income areas. Defining and assessing how health care organizations integrate oncology care for patients with cancer and understanding how integration is associated with key outcomes of cancer treatment will inform policies and practices that can drive improvement in patient outcomes and patient, clinician, and staff experiences.