Who Pays for Innovation?

Earlier this blog described the benefits of cancer rehabilitation, and the innovation of incorporating an early, risk-stratified assessment of each patient. The assessment goal is to identify the complexity of the patient’s needs and direct each patient to the appropriate pathway to receive effective and individualized short-term and long-term programs of care.

 Risk-Stratification Delivers Better Care at Lower Cost

A risk-stratification approach is followed in the UK, Australia, and Canada and it has been shown to provide better care for patients at significantly lower costs than in the US1. Moreover, risk-stratification can help solve the related problem of an increasing number of cancer survivors needing treatment coupled with declining numbers in the oncology workforce.2

While there is consensus around risk-stratification and its benefits, there is no consensus yet about how to get from here to there. Unfortunately, a lack of published data make it difficult to compare up-front investment costs to long-term savings. Providers are understandably reluctant to invest in change until more information is available describing patient-centered measures.

Happily, information available from the CMS Innovation Center (CMMI) experience with the Oncology Care Model (OCM) from 2016 supports the argument that whichever plan is adopted, savings result3. Providers can achieve these benefits by employing cancer rehabilitation therapists to identify and treat impairments as early as possible, before they can accumulate or worsen. For example, in 2012, Stout et al. documented that providers achieved a $20,000 savings per patient, on average, if lymphedema is treated early in the treatment trajectory compared to usual care, which is to wait until the end of treatment, if at all4. Similar savings are projected for other cancer diagnoses.3

Want to Save Money? Treat Impairments Early

CMS’s OCM specifically incentivizes providers to lower their costs through 12 quality measures, listed in order of the greatest savings. The top two are avoidable hospitalizations (including re-hospitalization episodes) and unnecessary ER visits. Pain management is ranked fourth.  Cancer rehabilitation is particularly effective for all of these measures. Continuing with the lymphedema example, addressing care early and helping survivors adhere to long-term self-care plans can help survivors avoid costly ER visits and avoidable hospitalizations over the balance of life. It is significant that cancer rehabilitation rarely uses prescription drugs to achieve results, and that improvements in function are linked to higher quality of life, faster return to work, and a reduction in lifetime cost of care.2

 Feasibility Studies are Needed, and Soon

Cancer rehabilitation will make strides forward when leaders see evidence that their services can improve the quality of care and pay for itself under a value-based system. Research has a crucial role to play.

References

1 Alfano, C., Jefford, M., Mahner, J. Birken, S., & Mayer, D. (2019). Building personalized cancer follow-up care pathways in the United States: Lessons learned from implementation in England, Northern Ireland, and Australia. ASCO Educational Book, ASCOpubs.org.

2. Pergolotti, M., Alfano, C., Cernich, A., Yarbroff, K. Manning, P., de Moor, J. … Mohile, S. (2019). A health services agenda to fully integrate cancer rehabilitation into oncology care. Cancer, Nov 2019. pp 3908-3916.

3. Michael Stubblefield MD March 26 webinar: Cancer Survivorship as a Model of Survivorship Care. https://youtu.be/95vDE0AhHvQ  (See also National Coalition of Cancer Survivorship website:https://www.canceradvocacy.org/.

4. Stout, N., Pfalzer, L., Springer, B., Levy, C. McGarvey, C., Danoff, J., Gerber, L. & Soballe. P. (2012). Breast cancer-related lymphedema: Comparing direct costs of a prospective surveillance model and a traditional model of care. Physical Therapy, 92(10).

Nancy Litterman Howe

Nancy Litterman Howe, M.S., C.E.S. is a cancer survivor and a 4th-year PhD student at Arizona State University, Edson College of Nursing and Health Innovation. As a 2020-2021 National Coalition of Cancer Survivorship (NCCS) Elevate Ambassador, Howe advocates for providing cancer rehabilitation services to people from the point of cancer diagnosis, through treatment, and for the balance of life. Howe lives in Phoenix, AZ. Email address: NancyLHowe@gmail.com

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