Download Novel Ways to Bend Cancer Spending Trend

Disrupting Cancer Care:
Novel Ways to Bend Cancer Spending Trend
Manali I. Patel, MD MSPH
Instructor of Medicine, Hematology/Oncology
Stanford University School of Medicine
Overview
• Cancer Care Expenditures
– Compared to Healthcare, Gross Domestic Product
– Drivers of cancer expenditures
• Innovations in care delivery
– Value Options and the “Triple Aim”
– Clinical Excellence Research Center
– Pilot test partners
– Next steps
Annual Percent Increase
GDP, Healthcare, Cancer costs
Cancer (Medical)
18%
GDP
US Health Care
9%
3%
1990
National Cancer Institute 2012
2011
Expenditures Borne by Society
• 1: 10 spend > $18,000.00 out of pocket on care
• 1/3 patients used up savings for cancer care
• 2.65x as likely to file bankruptcy
Ramsey 2013; Bach P 2013; Garber 2012
Value to Customers
Value Improvement Options
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Time
Adapted from W.E. Deming
Value to Customers
Value Improvement Options
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+
Time
Adapted from W.E. Deming
Value to Customers
Value Improvement Options
=
+
+
+
Time
Adapted from W.E. Deming
The “Triple Aim”
Population
Health
Experience
of Care
Better Health
Better Care
Per Capita
Cost
Lower Cost
Berwick D Health Affairs 2008
Clinical Excellence Research Center
Better Health, Less Spending
Clinical Excellence Research Center:
A Care Model Accelerator
CERC Design Process
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•
•
•
Unreasonable value improvement targets
Knowledgeable inventors, trans-disciplinary
Diverse panel of subject matter experts
Exposure
– “Design disciplines”
– Relevant emerging science/technology
• Partnerships
– Target-set, test, demonstrate and spread
Payer
Pilot Partners
Design-thinking in Cancer?
120
100
80
Knowledge of transdisciplinary Approaches
60
Knowledge of Design-thinking
Agree with transdisciplinary approaches
40
20
0
Patients
Academic Providers
Community
Providers
Payer Executives Healthcare Delivery
System Executives
Patel MI 2013 Transdisciplinary Approaches to Improving Cancer Care, JOP, In Press;
Design-Thinking:
Through the Patient’s Journey
Design-Thinking:
Un-Met Needs
Patient
Caregiver
Provider
Staff
Payer
Wait times
Respect
Comfort
Anxiety
Goals
Burn-out
Communication
Distractions
Space
Anxiety
Timeliness
Quality care
Administrative
Communication
Follow-up plans
Wait times
Scheduling
Authorizations
Follow-up plans
Comfort
Claims
Data
Costs
Satisfaction
Scheduling
Design-Thinking: Opportunities
Wait Times
Communication
Support
Inform, engage patients
and caregivers
Comfortable environment
Improve workflow,
fewer tasks, delegation,
“Lean” clinics
Engage families and patient
Websites and videos
Educational activities
Design-Thinking: Solution Validation
Design-Thinking: Concept
CERC Design Product:
Advanced Cancer Care
• Respect patient and family goals
– 1:1 Care Guides
• Immediately relieve symptoms
– Protocol-driven symptom control
• Optimize care at and near home
– Appointments, chemotherapy closer to home
•
~30% Net Reduction in Annual US Spending
Patel MI 2014
Next Steps
• Other pilot test sites
– Similar model of co-design
– Demonstration/Evaluation
– Spread
• Translate research into practice and policy
Summary
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•
•
•
•
•
Rapid growth of health expenditures
Expenditures largely borne by society
Addressing targets bends spending trends
Satisfaction and clinical outcomes important
Value improvement options are needed
Can innovative care delivery models succeed?