Late-Stage Cancer Care Model

Fellowship Class 2011-2012

Background

The annual cost of cancer care was $124.5 billion in the United States in 2011 and is expected to increase to $157.7 billion by 2020 — a rate that outpaces the projected growth of overall medical expenditures. Much of these expenditures are expected to occur for late-stage cancers, which are cancers with very poor prognoses due to type or stage.

Safely reducing per capita spending for late-stage cancer care

CERC’s care redesign team found three addressable failure points in current methods to treat late-stage cancer, summarized in the table below. Team members address these failure points via a new care model with three core elements: (1) help patients and their caregivers better formulate their goals for care and select treatment options that will better meet their goals; (2) offer immediate treatment of pain and other symptoms associated with late-stage cancer at home through a 24/7 call center staffed by nurses specializing in cancer care using symptom treatment algorithms and pre-placed emergency medication packets in patients’ homes; and (3) provide chemotherapy mostly in the patient’s home, or in safe, economical sites closer to patients’ homes.

Estimated savings

A conservative estimate of net savings from national implementation of the CERC model is $37 billion dollars in direct US health care spending per year. In June of 2016, a CERC research fellow team estimated that incremental savings from three additional elements of a more cost-effective cancer care model would lower spending for cancer care by an additional $27 billion annually. Though the team had deducted $5 billion from the estimated $32 billion savings that they estimated for these three additional elements, to be conservative in estimating the combined impact of all six care elements, their estimate of an additional $27 billion in savings was arbitrarily reduced by two-thirds to estimate a combined savings from all six new care model elements to $46 billion or 1.9% of annual estimated health care spending (equal to 2.4 trillion dollars).

Authors

Manali Patel, MD, Graham Abra, MD, David Moore, PhD, Terry Platchek, MD, Donna Zulman, MD, MS, Arnold Milstein, MD, MPH, 2012