Oncology Care

Fellowship Year 2015-2016

Background

The cost of cancer care is high and rising. National expenditures for cancer were $125 billion in 2010 and are estimated to rise to as high as $206 billion in 2020. This spending is divided among multiple different cost categories (chemotherapy, inpatient, surgery, radiation oncology, imaging, and others). Spending is also divided equally over the 3 phases of cancer care (initial phase, continuing phase, and end-of-life phase), meaning intervention across multiple cost categories and multiple phases is also required to achieve large-scale cost reduction. Physician choice of therapies is a principal cost driver, with up to 3-fold variation in the use of costly drugs, tests, and procedures without any associated clinical benefit to patients.

The current adult cancer care model—in which highly trained physicians craft discrete solutions for each patient—is also poorly suited to increasing treatment complexity, increasing cancer prevalence, looming physician shortages, and rapidly shifting payment models that require health systems to bear financial consequences of unwarranted clinical variation. Facing these challenges, our team sought to identify a higher-value method of delivering cancer care to lower spending and improve outcomes for patients with cancer.

Lowering the Cost of Clinical Excellence in Oncology

CERC’s cancer 2.0 team focused on redesigning oncology care through 3 mutually reinforcing elements. These elements include the following: 1) the use of pathways software to select high- value tests and treatments for patients at the point of care; 2) the use of a physician innovation collaborative to ensure pathways-consistent care across the care cycle, engage in regular meetings to assess the performance of the pathways, and assure continuing clinician engagement; and 3) the use of lower-cost nurse practitioners and physician assistants to deliver care for the approximately 60 percent of cancer patients whose care plans are formulaic and predictable.

Estimated Savings

Conservative forecasts show that the cancer 2.0 model could result in a net reduction in per- capita spending for cancer care by 21% net of implementation costs. If scaled nationally, this would be equivalent to approximately $32 billion in 2015.

Authors

Ian Goldstein MD, MPH, Julie Kuznetsov, MBA, Adam Miner, PsyD, Doug Blayney, MD, Sierra Matula, MD, Terry Platchek, MD, Arnie Milstein, MD, MPH, Manali Patel MD, 2016.