Redesigning Advanced Cancer Care Delivery: Three Ways to Create Higher Value Cancer Care

In 2010, cancer care costs exceeded US$124 billion and are expected to increase to $173 billion by 2020. Preventable resource use at the end of life and payment models that reward chemotherapy delivery disproportionately more than provider-patient discussions contribute significantly to rising expenditures. Persistent deficits in value are also evidenced by associated physical and emotional toxicities that patients and caregivers experience.

Societal burden from shortfalls in cancer care demands greater evaluation of our delivery system and cost-saving or so-called disruptive innovations. In response to this challenge, we designed a three-solution composite to provide better health care with less spending for patients with advanced cancer. Our care-delivery innovation was built from human-centered design components that we sourced globally and nationally. We used a novel, mixed-methods health care delivery redesign methodology composed of the following: literature appraisal to review deficiencies in advanced cancer care, quick ethnography to identify so-called disgusters or frustrations encountered by stakeholders in advanced cancer care, adapted human-centered design methods, weekly solution refinement with input from stakeholder panels, and forecasted health care spending reductions after widespread adoption of the strategy (Data Supplement provides detailed methods).

We aimed to create a sustainable disruptive innovation—one that would deliver discrete, high-quality services at the lowest possible cost. Therefore, we minimized overuse of inefficient resources and underuse of beneficial services. We identified inflection points, or critical moments, in a patient's disease trajectory in which improved care could substantially reduce future health care spending. These inflection points, particularly at diagnosis of advanced cancer and after treatment failure, provide just-right timing to implement our strategy.

The final design solution was a three-part composite aimed at the following: provision of goal-concordant care, immediate relief, and home- and community-based care. Here, we describe our disruptive innovation.

Reference Information

Author: 

Manali Patel,
David Moore,
Arnold Milstein
Publisher: 
Journal of Oncology Practice.
Publication Date: 
July 2015