2024 World Conference on Lung Cancer (WCLC) - ePosters-EP.04D.01 Claims-Based Yield Metric for Lung Cancer Screening

Pdf Summary

This study examines a claims-based performance metric for lung cancer screening (LCS), which is critical given lung cancer's status as the leading cause of cancer mortality and the lack of existing payer performance metrics for screening. Despite the proven potential of LCS to reduce mortality, a significant gap exists in screening among eligible populations, partly due to the absence of HEDIS/Star quality metrics for health plans. This study introduces a yield rate metric defined by the proportion of incident lung cancer cases identified following an LCS, providing a practical and consistent measure across different payers.<br /><br />Using databases covering approximately 29 million lives, the researchers analyzed incident lung cancer cases within Medicare Advantage (MA) and Medicare fee-for-service (FFS) populations. Incident cases that had undergone LCS within the prior six months were included in the yield rate calculation. The results showed a consistent yield rate of about 5%, although FFS displayed a slightly higher rate than MA. Specifically, various MA plans demonstrated yield rates between 4.7% and 5.5%, while FFS populations showed rates ranging from 6.1% to 8.2%.<br /><br />The study concludes that a simple claims-based yield metric for LCS is feasible and produces relatively consistent results across different payer types. It emphasizes the need for further research to refine implementation parameters, ideal and target yield rates, and factors like minimum population sample sizes and feasible follow-up periods for stable results. By establishing such a metric, the screening rates for lung cancer could potentially increase, similar to what is observed for other screenable cancers when performance metrics are tied to revenue incentives.

Asset Subtitle

Josh Reinstein

Meta Tag

Speaker Josh Reinstein

Topic Screening and Early Detection

Keywords

lung cancer screening

claims-based performance metric

HEDIS/Star quality metrics

yield rate metric

Medicare Advantage

Medicare fee-for-service

cancer mortality

screening gap

payer performance

incident lung cancer cases