Transcript Slide 1
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 = + + + Time Adapted from W.E. Deming Value to Customers Value Improvement Options = + + + 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 • • • • 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 • • • • • • 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?