Measuring value

There’s a new dimension of research under way at The University of Texas MD Anderson Cancer Center.

The institution has long been at the forefront of cancer patient care and research, and now it is raising the bar on measuring the quality of how that care is delivered. It’s related to what is known in some academic circles as patient-centered outcomes research, and it complements the ongoing clinical, basic and prevention research programs for which MD Anderson is best known. Ultimately, this field of research will have a crucial role in the institution’s future as new therapies, advances in understanding the cancer process and new strategies for reducing risk come to light.

Leading the Way

The Institute for Cancer Care Excellence is developing a model for the next generation of a health care delivery system for cancer. It’s a comprehensive program focused on creating evidence-based systems that deliver safe, timely, effective, equitable and patient-centered care at a reasonable cost. This new field of research parallels MD Anderson’s clinical and research programs and demonstrates the institution’s commitment to report clinical outcomes, enhance patient safety and improve quality.

The institute is led by Thomas W. Burke, M.D., executive vice president and physician-in-chief; Thomas W. Feeley, M.D., vice president for medical operations and head of the Division of Anesthesiology and Critical Care, and Ronald S. Walters, M.D., associate vice president for medical operations and informatics, and is supported by philanthropic funds. MD Anderson’s $1 billion Making Cancer History®: The Campaign to Transform Cancer Care has designated a goal of $25 million for the Institute for Cancer Care Excellence. The institute also is fueled by the involvement of clinical faculty and staff as well as nationally known collaborators such as Harvard Business School and Rice University.

“The Institute for Cancer Care Excellence applies traditional academic thinking to what’s important to patients, doctors and third-party payers now and in the future,” says Feeley. “We all will have some very tough choices ahead with our health care system, and we have to start developing the data and show that we provide value with our approach to cancer care or demonstrate how we can provide better value. Value reflects the difficult balance between outcomes and cost.”

Translating just what value is and defining outcomes, especially with a disease as complicated as cancer, is tough, says Feeley, but not insurmountable.

“As with everything at MD Anderson, we look at these questions from the perspective of our patients and what’s most important to them,” he says.

The Harvard Connection

Launched in 2009, the Institute for Cancer Care Excellence reflects one of the 10 points in a recent brief by John Mendelsohn, M.D., president of MD Anderson, outlining actions required to continue the progress against cancer. It was Mendelsohn’s early interest in this research that led MD Anderson to team up with Harvard Business School’s Michael E. Porter, Ph.D., a leading authority on competitive strategy and its application to health care, the environment and other social issues.

Porter’s book on value-based competition in health care pushed forward a national dialogue on the topic. He was first to define value in health care as the relationship between outcome and cost. With MD Anderson as a clinical “lab” to study Porter’s theories, the Cambridge-Houston team set out to answer the question of whether multidisciplinary care can improve value.

After teaming with Harvard Business School and other national collaborators, MD Anderson began asking its own questions related to value and, as with so many initiatives related to cancer, made the commitment to become a national leader.

Leveragingits unique position within one of the largest and premier cancer centers in the world, the Institute for Cancer Care Excellence corrals, coordinates and initiates projects that take advantage of not only the large patient population, but also clinical faculty looking for new efficiencies to help preserve the way they practice and administrative staff who want to safeguard the institution’s fiscal future and the margin that supports its mission.

The work of the Institute for Cancer Care Excellence also touches health care consumers who want the best quality and safest care. Developing meaningful and useful outcomes and patient safety data will allow patients and families the opportunity to select the best care by looking at detailed and substantive information on their particular diseases.

Health Care Reform Mandates

With the framework of health care reform in the United States now emerging, and its impact imminent, the work of the institute is even more vital, say its leaders.

Under health care reform, the Secretary of Health and Human Services must define outcomes by 2012 and cancer centers will be required to report those metrics by 2014, requirements that push health care institutions to be more transparent with consumers, says Burke. All institutions, including MD Anderson, must comply with these mandates to be paid for care extended to patients covered by Medicare and other private third-party payers.

“Because of the tremendous impact that this research will have on the consumer, as well as the clinical operations and business sides of MD Anderson, our efforts are integrated with those who negotiate our managed care contracts and Medicare, forecast our patient growth and plan long-range,” says Burke. “The work that we’re doing through the Institute for Cancer Care Excellence touches almost every aspect of our daily work. We must come together to bring about some of the changes this research will identify.”

Head and Neck Center Pilot Program

MD Anderson’s Head and Neck Center is an example of one clinic that has begun to develop measurements and establish outcomes and definitions of quality. Randal S. Weber, M.D., the Department of Head and Neck Surgery chair, and Ehab Hanna, M.D., medical director — both of whom have lectured at Harvard Business School with Burke and Walters — have set outcome measures for patients with head and neck cancer through a pilot project that looked at patient survival, disease, the time it took patients to go through treatment and return to work, and quality of life issues such as speaking and swallowing ability and other lingering short-term or long-term complications. They’ve worked with the Institute for Cancer Care Excellence to pull and compare data from patient charts.

Results of the pilot project were presented at Porter’s health care executive series at Harvard Business School. To date, some 1,500 people have accessed the study and discussed the value of the multidisciplinary care model. The results have led to more streamlined, automated processes for patients, faculty and staff.

Walters says it’s crucial that MD Anderson clinicians explore the value proposition of cancer care and get involved with the Institute for Cancer Care Excellence. In addition to the Head and Neck Center conducting its own research, there are projects under way for measuring clinical outcomes for breast, prostate, gynecologic and lung cancers, as well as sarcoma. Other clinics and supportive areas will begin projects in the near future.

“We need clinicians to be involved in the institute because it’s their work, their care, their patients,” says Walters. “All this data and information can lead to an informed patient who can make the right choice for value-based cancer care. We can be in a better position to protect our standard of care because we have the data to show that our approach is money well spent.”