Cancer costs the U.S. an estimated $200 billion per
year, including more than $77 billion for medical care. Understanding the drivers of these costs and
their relationships to health care quality and patient outcomes is a critical
focus of the work of Dr. Mark C. Hornbrook.
Mark C. Hornbrook,
PhD, is a health economist and Chief Scientist at Kaiser Permanente's Center
for Health Research and a recognized expert in research focusing on the
determinants of medical care utilization, expenses, economic burden, health
outcomes, and comparative effectiveness. Dr. Hornbrook is a member of the Executive
Committee of the Cancer Research Network and co-leads the CRN Health Care
Quality and Cost scientific working group (with Drs. Jane Weeks and Debra
Ritzwoller).
Dr. Alyce Adams, Co-Lead,
Outreach and Collaborations Core for the CRN, recently sat down with Dr.
Hornbrook to discuss the importance of the CRN and how others can leverage these
unique resources to answer cutting-edge research questions.
Dr.
Adams: How did you get involved in the Cancer Research
Network?
Dr.
Hornbrook: I was actively involved in the creation of
the HMO Research Network as an investigator at the Kaiser Permanente Center for
Health Research. When the NCI issued the
RFA for the CRN, the HMORN Board decided to respond as a group to demonstrate
the CRN’s viability as a foundation for multi-site population-based research. Dr. Ed Wagner, Director of Group Health
Cooperative’s research center was designated as the overall PI for the CRN
proposal. While I had no prior cancer
research experience, I wanted to support Ed’s vision that the HMORN could serve
as an innovative platform for multi-center cancer research. I was particularly interested in the
development of the CRN from an informatics perspective and the potential a
distributed data model held to revolutionize cross-institutional research. My ultimate goal was to build the capacity of
the CRN to conduct research on determinants of utilization, outcomes, and costs
for cancer patients. I knew this work
would need high quality, comprehensive utilization and survival data, in other
words, the Virtual Data Warehouse.
My work
on the common data infrastructure and the Virtual Data Warehouse, the CRN,
along with the AHRQ-funded Centers for Education and Research on Therapeutics
(CERTs), generated the proof of concept that standardized distributed data
warehouses greatly facilitate multi-site research.
Dr.
Adams: In addition to your many active research
studies, you are also the Principal Investigator for Medical
Care Burden of Cancer: System and Data Issues study, a National Cancer
Institute funded study to develop a multi-site, multi-payer database to support
analyses on the determinants of cancer costs in fee-for-service and HMO
settings. What motivated you to conduct
the BURDEN study and what have been the key findings to date?
Dr.
Hornbrook: The BURDEN study started as a R01 that was independent
of the CRN. I wanted to examine the
determinants of the incremental medical care costs of cancer (above the
background level of medical care costs to meet all other care needs). The study was later brought in under the CRN so
that we could spread the use of the BURDEN methods to other research settings
and facilitate outside collaborations. When
we started the BURDEN study (2007), the only available datasets on expenditures
for cancer care were primarily the SEER Medicare data files, which excluded
managed care populations. The reason for
this exclusion was that while health plans provide claims data for the creation
of a CMS risk adjustment model to pay Medicare Advantage plans, data on charges
from HMOs were omitted. As a result, there
was no way to get cost data on managed care populations. BURDEN is the 1st resource to
provide managed care resource costs for adults with cancer. This facilitates analyses of patterns of
care, costs, and cost comparisons.
Dr.
Adams: How do you envision others leveraging the
power of the BURDEN dataset?
Dr.
Hornbrook: We encourage external investigators to
consider collaborating with our research team on using the BURDEN database to
facilitate their research project. We
have collaborated with investigators within and outside of the CRN to leverage
the power of the BURDEN dataset through small pilot projects and projects led
by CRN Scholars. The availability of common
master agreements as part of the CRN collaborative process facilitates this
kind of data sharing. It’s important to
be sure that Scholars and others do not face insurmountable data access issues or
challenges and can generate findings quickly for proposals and publications.
Dr.
Adams: Are there critical unanswered questions that
the BURDEN dataset is uniquely positioned to answer?
Dr.
Hornbrook: The BURDEN/SEER-Medicare datasetscan support investigations into the sources
of relative cost savings of HMOs versus FFS in cancer care; investigations of variations
in costs among HMO cancer patients; the reasons for high costs of end-of-life
care; investigations of the patterns of regression to the mean (the tendency
for extreme costs to return to near average levels upon repeated measurement) when
comparing FFS to HMO costs; examination of variations in treatment costs across
types of cancer; analyses of the effects of comorbidities following a new
cancer diagnosis; the quality of life consequences of cancer treatments for
cancer survivors; and what constitutes affordable cancer care.
Dr. Adams:
If someone is interested in learning more about the BURDEN dataset, what
is the best way for them to find out more?
Dr. Hornbrook:
They should contact me or my co-leads in the Health Care Quality &
Cost (HCQC) Scientific Working Group Drs. Debra Ritzwoller, PhD, Institute for
Health Research, Kaiser Permanente Colorado, or Jane C. Weeks, MD, MPH, Dana
Farber Cancer Institute via Joanna E. Bulkley, PhD, Joanna.E.Bulkley@kpchr.org.
An Additional
Note about Dr. Hornbrook:
Dr. Hornbrook’s work has produced
over 190 peer-reviewed journal articles and book chapters. He served as a
Commissioner on the Physician Payment Review Commission (PPRC), Congress of the
United States, from 1986 through 1990. During his tenure, the PPRC developed
the Medicare Fee Schedule and Volume Performance System reforms of the Medicare
Part B payment system. Dr. Hornbrook also served as a member of the National
Committee on Vital and Health Statistics, from 2008-2012, where the key policy
issues being addressed related to guidelines and incentives for installing
electronic medical record systems.
