Healthcare Delivery
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Value at ASCO

It has been about 10 years since I last attended ASCO.  My first impression this year was size.  If you took all the meeting space and laid it out end-to-end on a horizontal plane it would cover a larger area than my home town.  My second impression was how much has changed for health services research (HSR).  A decade ago I stood by my poster in the outer reaches of a dreary hall for 90 minutes.  Fewer than 10 people even strolled past the group of HSR posters.

This year the Guest Speaker at the Opening Session was Michael Porter from Harvard Business School.  Dr. Porter is trained as an economist and his work has focused on competitive strategy.  His talk was titled “Value-Based Health Care Delivery.”  He started by saying that there have been minimal improvements in patient outcomes despite attempting to influence care through guidelines, prior authorization, co-pays, and care coordination.  Dr. Porter then proposed that the way forward is “value,” which he defined as the “health outcomes that matter to patients” divided by the “costs of delivering those outcomes.”  He enumerated six changes that need to occur for value to drive genuine system improvement:

  1. integrated practice units that allow physicians, PA, APN, nurse, allied health care professionals, psychosocial care, and any other people involved in care to truly coordinate their efforts
  2. measurement of outcomes and costs for every patient over their entire course of care
  3. bundled payments
  4. integrated multi-site systems, which I understood to mean co-location of the practice units
  5. expanded geographic reach in areas of excellence
  6. improved health information technology

Dr. Porter spent most of his time systematically going through these six changes, explaining them and providing evidence of their benefit.  Dr. Porter exhorted those in the audience to take the lead in moving down this path.

After being momentarily caught up in Dr. Porter’s enthusiasm and optimism, my usual pragmatism returned.  Integrating practice units and sites would require a major cultural change.  We struggle to define and measure even the most basic patient-reported outcomes.  Decent cost data are hard to come by.  True improvements in health information technology will require agreement on common features, interoperability, and other factors that may be hard to achieve in a competitive marketplace.

I walked away from the presentation feeling encouraged that ASCO was willing to give such prominence to improving cancer care delivery.  I was left with two questions, which I pose to all of you:

  • What, if any, is the role of research in bringing Dr. Porter’s vision into reality?
  • What, if any, is the role of NCI in promoting such research?
Ann M. Geiger, MPH, PhD; Acting Associate Director

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