Innovation at the Nexus of Value, Quality, and Technology
by Amanda Patton, Manager, ACCC Communications
An expert panel—representing the payer, private practice, hospital-based cancer program, academic medicine, and the patient advocacy perspectives—discussed Innovation: Value, Quality, and Technology on Thursday, Oct. 3, at the ACCC National Oncology Conference in Boston, Mass. Echoing keynote speaker Whitney Johnson’s theme of disruption and innovation, panelists identified major disruptors to the status quo and multiple constraints challenging oncology care delivery.
Disruption is not limited to oncology. “It’s our entire medical system,” said panelist Roy Beveridge, MD, Senior Vice President and Chief Medical Officer, Humana, Inc. “It’s a brave new world and the next five years will be very exciting.”
Specific disruptions cited by panelists included changing relationships between primary care providers and specialists, hospitals and payers, and providers and payers. Added to this are overarching uncertainties about reimbursement, how (or if) the sustainable growth rate (SGR) fix will be achieved, and the impact of the newly created health insurance exchanges on oncology providers and the patients they serve.
Panelist Al Benson, MD, FACP, Professor of Medicine, Northwestern University’s Feinberg School of Medicine, sees constraints ahead in three main areas: patients having to deal with fragmentation of services, workforces shortages, and technology-driven challenges. “Technology is really overwhelming, and I wonder how a general medical oncologist is going to adjust to these massive changes. With more diagnostic tools, it’s not only how we’re going to afford them, but how to integrate the technology into healthcare structures so patients can move through the system more efficiently.”
Nancy Davenport-Ennis, CEO of the Patient Advocate Foundation (PAF), shared the patient advocate perspective. “Disruption for patients begins the day their name and cancer is said in the same sentence,” she said. For her organization, a major challenge has been the accelerated growth of uninsured patients over the past year. Thirty-eight percent of patients served by PAF in 2012 were uninsured, she said.
Panelists also discussed the evolving provider-payer relationship. Quality care does not have to be expensive care, panelists agreed.
Partnering with a payer, a provider can demonstrate quality metrics and use of pathways, commented panelist Kim Woofter, RN, OCN, Chief Operating Officer, Michiana Hematology Oncology. Through participation in Health Information Exchanges (HIEs) practices can integrate with other providers to streamline patient enrollment in clinical trials, as well as partner with hospitals to reduce hospital re-admission.
Panel moderator Cliff Goodman, PhD, the Lewin Group, asked panelists to share innovations they’ve developed in response to these challenges.
Given the fragmentation of the current delivery system, Norma Ferdinand, Senior Vice President, Lancaster General Health, said her heath system is responding by supporting a culture of innovation and learning. The health system recently opened a new cancer center to centralize services with a patient-centered, rather than physician-centered design. The system is also participating an accountable care organization, among other initiatives.
Kim Woofter said her practice has taken ownership of care coordination in the period immediately after hospital discharge. A large triage staff handles the 48 hours post-discharge, following up with patients to ensure they have needed medications and resources. “We can affect return admission by interacting with that patient within the first 48 hours after discharge,” she said. Participation in a Health Information Exchange (HIE) is also facilitating the practice’s ability to demonstrate quality to payers.
Davenport-Ennis described a range of services PAF is providing including 24/7 patient portals, online easy-to-use tools for consumers, and more.
A key takeawy from the discussion: Innovation at the nexus of value, quality, and technology requires a patient-centered, data-driven, learning organization.