WCOE: Improving Quality for Patients by Delivering and Paying for Care Differently

In two America Tonight segments entitled, “Is America treating cancer the wrong way?” Michael Okwu of Al Jazeera America delves into the cost of cancer care and an experiment in delivering care differently to reduce costs and improve quality for patients. Okwu interviews Dr. Arnie Milstein, director of the Stanford Clinical Excellence Research Center (CERC) and Dr. Manali Patel, an oncologist who has designed and is testing a program for patients with advanced cancer. He also interviews two patients who have chosen different paths for their cancer treatment.

Dr. Patel’s program includes a health coach, who spends time with patients and families to ensure they understand the “big picture, helping them decide how cancer treatment fits in with how they want to spend the rest of their lives.” Patients also have access to a 24-hour hotline to address symptoms and side effects and avoid trips to the emergency room, and some patients have chemotherapy administered at home by a home health nurse.

Dr. Patel believes that with better information, up to 70 percent of patients with advanced cancer would choose less aggressive treatment options, and she predicts that the model could save $50 billion annually in reduced hospital visits and chemotherapy.

She shared her model with a number of hospitals and health systems but met with resistance because of lost revenue from chemotherapy drugs and administration. “‘Chemotherapy is how we keep our practice going,’” she recalled them saying. “‘Chemotherapy is how we keep our hospital running,’” she said. Okwu points out that two thirds of oncologists’ income comes from administering drugs.

“We need to change the way we pay for cancer care and almost every other type of care in this country,” Dr. Milstein said. “We need to gear it to what patients and their families are looking for, which is improved physical and mental well-being.”

At NCCS, we agree with Dr. Milstein, and we advocate for more rational methods of paying for cancer care that are not based on the quantity of care delivered and that reward shared decision-making and a cancer care planning process, including advance care planning.  Our current system does not incentivize the kind of care patients want – time with their care team to evaluate options and make appropriate decisions.

“It’s easier, sometimes, to say, ‘Oh, metastatic lung cancer. Let’s give you these two drugs or even three drugs,’ and very quickly have a treatment plan put into place with chemotherapy orders signed than it is to sit down with the patient and their families and go through this difficult conversation,” said Dr. Patel.

As patient advocates, our first priority to make sure patients have access to the best quality care and quality of life throughout their cancer experience, including at the end of life. Patients who fully understand their treatment options – including benefits, risks, side effects, quality of life, and cost – can make better decisions for their care. We understand that “more” is not necessarily better and that for some individuals with cancer, the decision to treat their symptoms rather than aggressively treat their advanced cancer, is the best one.

While we advocate for patients, we also have to be concerned about the sustainability of the cancer care system, so the potential for cost savings is also important. We believe that it is possible to improve quality for patients while better utilizing resources for the cancer care system as a whole.