Shopping for High-Quality, Affordable Oncology Care

My grandmother always told me, “Buy the best you can afford.” Contained in this simple advice, something we all have likely heard in one form or another, are a couple of key concepts worth extracting as they pertain to the oncology industry: the words “buy” and “best.”

The first word, “buy,” infers that a dec­ision has been made to purchase something, likely after shopping. But how does one shop for healthcare, for an oncologist, or for an oncology practice? Various websites (eg, healthgrades.com, Medicare’s Physician Compare, and payers’ Find a Provider option) provide some guidance, but they do not provide filters so that healthcare consumers can search for an oncologist or practice based on the search criteria that are most important to them.

The second word, “best,” is another challenge for the healthcare consumer. The word indicates quality, something proven, and the work of a known craftsman or artist. I have had the privilege of working with some of the best oncologists in the nation, so I support the notion of an oncologist as an artist who, with creativity, orders a personalized treatment plan for each patient. Although the treatment is chosen and administered with great care, how does a patient evaluate the quality or how “best” the treatment and patient experience are?

A student of clinical trials, I believe that one of the most relevant measures of the best care is the clinical success of the chosen treatment (ie, the clinical outcome). “No evidence of disease” being the ultimate goal, a range of clinical outcomes could factor into the decision that determines best care. In addition, the best care is likely proven over a period of time and should be determined by patients who are qualified to judge the quality of the treatment.

We are individuals and more than the sum of our treatment outcome; we are mothers, fathers, sisters, brothers, friends, and colleagues with important lives that deserve as little life-threatening disruption as possible. In addition to clinical outcome, it is also important to consider the overall patient when determining best care. The emotional, financial, and spiritual impact of care on the patient’s life, even accounting for variances in patients’ coping skills, must be evaluated to deem what care is best. In order to make this decision, we must ask patients what they have to say about their care. But where is there a collection of patient data that systematically measures the effect of cancer treatment on patients’ emotions, finances, or spirit?

The Patient Care Monitor, formerly known as the Cancer Care Monitor,1,2 gathered thousands of patient-reported reviews through a tablet computer in oncology waiting rooms across the United States. Included in the review was a validated set of questions targeted at emotional distress. The results, which were presented to oncologists, brought a variety of responses, from compartmentalizing a patient’s emotional distress and referring out to a therapist or support group, to hiring clinical psychologists on staff to more holistically approach the range of care. Other initiatives around patient-reported outcomes exist but are still the exception to everyday workflows at many oncology practices.

In oncology, professional organizations striving to improve care have designed, launched, and measured droves of quality improvement programs over the years. Physicians participating in quality improvement programs (while struggling to see more patients per day) have their day compromised by the droning impersonal data entry into a paper form or web portal. Though the quality programs are crafted by well-meaning healthcare organizations, pathway providers, and payers, the physician needs technological assistance to comply with the data collection requirements.

With so many organizations striving to define quality, let us encourage like-minded, quality-focused groups to come together and agree on 10 metrics. Perhaps we all gather around these metrics to collect, understand, and use the results to make real improvements in quality. As an industry, we then move to the next 10 metrics, and then the next, all moving together successfully around the same definition of quality, and making widespread, meaningful improvements in patient care and physician reimbursement for the achievements. The fractured approach of so many different definitions (and data-gathering requirements) of quality is stymieing any progress we could be making together if we all paddled in the same direction.

Expanding on the concept of best quality, the cost of the best care can be catastrophic to patients and their families. The financial impact of cancer, even for those with quality insurance, has been described as life-changing. Patients struggle with decisions on how to spend their hard-earned income or savings. Financial counselors at practices are unfortunately tasked with asking a patient to choose between potentially life-saving treatment and college tuition for a child. They somehow are able to have these difficult discussions in an encouraging and optimistic manner, and each day brave patients and their selfless families make difficult decisions. How is this collective experience shared with other patients? Where are these data captured, collected, evaluated, and served back to society for consideration?

This brings us to a third concept in my grandmother’s maxim, “Buy the best you can afford.” The term “afford” affects people differently, but in the frame of healthcare, it translates into the ability to stretch to a point that otherwise reasonable people would find financially uncomfortable. For this measure, there should be understandable, quantifiable, and transparent sources that provide data on the impact of this financial component—the ability to afford care. A tool that quantifies cost would allow patients to determine the oncology care that is the best they can physically and emotionally afford.

Could the answer be a safe, vetted, unbiased zone of online value-based oncology data, complete with outcome measurements matched with data on financial burdens to the patient and society? As we struggle in our industry, it is not helpful to complain without offering solutions. Consider the power of oncology practices, technology partners, payers, and patients banding together in a politically neutral way to identify first steps. Let’s start with technology that allows healthcare consumers to shop and select providers, define quality, and finally understand the finances of affordability.

The end goal seems lofty, but if we approach this systematically by solving 1 important concept at a time, by the end of the first year, I believe we will see otherwise disparate parties all pointed in the same direction (at least conceptually) and committed to advancing the accessibility, quality, and affordability of our oncology system. We should all be part of the solution. Let’s get started.

References
1. Fortner B, Okon T, Schwartzberg L, et al. The Cancer Care Monitor: psychometric content evaluation and pilot testing of a computer administered system for screening and quality of life in adult cancer patients.
J Pain Symptom Manage. 2003;26:1077-1092.
2. Abernethy AP, Zafar SY, Uronis H, et al. Validation of the Patient Care Monitor (version 2.0): a review of system assessment instrument for cancer patients.
J Pain Symptom Manage. 2010;40:545-558.

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