Oncology Care Regardless of Prognosis

The cost of cancer care is high and rising. 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.
 
CERC’s cancer 2.0 team focused on redesigning oncology care through three mutually reinforcing elements. These elements include:
 
  1. After an oncologist and patient jointly select a treatment option, subsequent visits for commonly used treatments are guided by clinical pathways software grounded in peer reviewed outcomes research.

  2. For patients for whom a software supported standardized clinical pathway is available, subsequent visits for treatment are primarily conducted by nurse practitioners or physician assistants supported by oncologists. Oncologists re-allocate their time to off-pathway patient.

  3. Oncologists participate in a multi-site oncology clinical improvement collaborative that continuously assesses and refines standardized clinical pathways.

Projects and Outcomes

Net Percent reduction in total annual American health care spending: 0.89%

Net annual savings $32 billion / Total annual American health care spending in 2018 $3.6 trillion

Publications and News

CERC Design Fellowship