A pathway to value in cancer care

At Fred Hutchinson Cancer Research Center in Seattle, I am a daily witness to advances in cancer science, and I have grown increasingly comfortable speaking about the prospects for not just better treatments, but cures.

I also think it is time to step up the discussion on a closely related topic: how to provide value in cancer care to the people who count most — our patients.

That is why Fred Hutch is home to the Hutchinson Institute for Cancer Outcomes Research, or HICOR, and its team of top health care economists. They measure value in cancer care as a function of both quality and cost, and they share their assessments with all who have a stake in improving the quality and affordability of treatments and cures.

Importantly, they base their studies on data collected right here in Washington state, from the providers and insurers who deliver care to cancer patients in our communities.

HICOR has just released the latest results of a five-year effort to develop tools to measure cost and quality of care, covering more than 70 percent of cancer patients across the state. As the potential of HICOR’s approach becomes more widely understood, I believe it will be a model for the rest of the nation.

Their new Community Cancer Care Report is innovative and refreshingly transparent. It is the first publicly accessible document showing cancer clinic–level quality data linked to cost. It includes those covered by Medicare and the state’s largest commercial insurers. This comprehensive pooling of so much specific, statewide data is unique to HICOR and a tribute to the trust they have forged among stakeholders.

The report focuses on more than 25 cancer clinics, large and small, identified by name. Responding to the call for more transparency about health care costs, the report provides insights that before now were simply not available publicly. This cooperative effort brought together patient advocates, physicians, the state’s largest insurers and the operators of the cancer care clinics. It is bound to make some of these stakeholders uncomfortable at times, but I laud these participants for their willingness to work together.

... This is precisely the kind of tool needed to gain traction in the effort to meet the enormous challenge of making quality care available to all, at prices we all can afford.

HICOR is using good data and good science to give all the stakeholders in cancer care a clear set of metrics that shows how each clinic compares against statewide averages on measures of cost and quality. The genius of this approach is that it can serve as a tool or a guide. Participants in this endeavor can use it to learn where their efforts to improve quality and control costs are working most efficiently, and where they are not.

Reassuringly, this guide shows outstanding quality overall — meeting well-recognized standards of care — while providing unprecedented transparency about costs. If you were to spend some time with this document, a very interesting picture emerges. It shows how in some areas of care — such as appropriate use of advanced imaging following breast, colon or lung cancer treatment — there is remarkably little divergence in costs or in hitting quality measure targets throughout the state.

On the other hand, in the category of end-of-life care, the report found a 62 percent difference in quality metrics between highest- and lowest-performing clinics. That is a wide variation. The report also showed a clear association between higher quality and lower costs in this particular area. This is valuable information, uncovering the unexpected; good things can come from that.

By establishing common metrics developed in collaboration with peers, and by providing access to information previously not available, the report pinpoints areas that need improvement. For instance, more than half of cancer patients visit emergency rooms or require hospitalization during their first six months of chemotherapy treatment. We can learn from clinics that have strategies to improve that.

For many, this report may seem complicated and geeky. Yet in the hands of informed health care providers, economists, insurers and patient advocates, this is precisely the kind of tool needed to gain traction in the effort to meet the enormous challenge of making quality care available to all, at prices we all can afford.

Were the rest of the country to take our lead, and be willing to take this deep dive into the metrics of quality and cost, it will clarify our understanding of value in cancer care. We can all live better with the results.