As the U.S. cancer survival rate continues to grow, health systems are grappling with how to scale the wraparound services that support patients before, during and after treatment.
Matthew Gonzales, MD, is associate vice president and chief medical and operations officer for the Institute for Human Caring at Renton, Wash.-based Providence. He spoke to Becker’s about the barriers health systems face when integrating supportive cancer care services and the business case for investing in them.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What barriers are preventing health system leaders from integrating and scaling supportive care services for cancer patients?
Dr. Matthew Gonzales: My sense when I talk nationally to healthcare leaders or policymakers, is no one thinks cancer care is where we’re getting everything right. Yes, we are extending life. Yes, we are helping people live longer, but I don’t know that we all think that we’re always helping patients and their caretakers. Everyone recognizes that, as much as we want to get there, there are still large operational challenges to making that a reality. One of the fundamental pieces is the lack of reimbursement for these services makes it really challenging. We all want to do the right thing, but we can’t do the right thing and not get covered for the cost of caring for people in the ways that they deserve to be cared for.
Q: One of the interesting things about Providence is its seven-state footprint and how strategies and initiatives get built across state lines. What lessons have you learned about embedding these services into routine workflows that might be replicable or important for other leaders to learn from?
MG: While we have made strides, we’re also still learning. When you look across the country, about 15% of people get the supportive care services that they perceive that they need.
Where we do offer these services, they are perceived to be helpful to patients. We also really see a decrease in healthcare expenditures when we’re providing this type of care, which makes total sense. If we’re having a team that’s specifically focused on ensuring that a patient’s symptoms are met when they’re going through chemotherapy, they’re less likely to show up in an emergency room. All of the costs that are generated from that for both the health system, the insurer and for the patient are shared savings to everybody.
We not only see that patients perceive it as helpful, but there’s good data to suggest that we avoid costs that don’t need to happen.
Q: How do you make the business case for health system executives that investing in these services is worthwhile?
MG: It’s a challenging business case to make, but it is makeable, and that’s partly why we’ve been involved with the Together for Supportive Care Coalition — because we think we can do more together and learn from other places.
What we’ve learned from the collaboration is that supportive cancer care reduces emergency revisits by 25% and reduces inpatient costs by 56%. Those are pretty striking numbers. When you think about the fact that only 15% are getting this kind of care, the savings that can be generated are pretty substantial. Just increasing supportive cancer care by 10% — would impact probably 4.7 million lives and lead to total savings of $11.3 billion.
It’s not about getting less care; it’s about helping people ensure that the journey they’re on goes awry less often. They end up in the hospital less often because they’re supported proactively. This collaboration has clearly shown us that there is a dollar argument to be made for doing the right thing. The question is how we all come collectively together to recognize that and start looking at innovative reimbursement or funding models.
If you start talking about a 50% increase [in supportive cancer care], the estimated savings the coalition is projecting is around $22.3 billion. I’ve been accused of being too much of an optimist, but I think this is one of the places in healthcare where doing the right thing leads to increased savings for the healthcare system. It’s hard to argue against thinking collaboratively and creatively around how we redesign the system to meet patients’ needs.
Q: What do you think needs to change culturally or structurally in the industry for the mindset shift to occur where support services are seen as essential rather than adjunct?
MG: The true answer to that is listening to the people that we serve. Whoever you’ve known that has gone through this journey will tell you in large part that there are still gaps in the support that’s needed. Cancer stops the conversation. It affects an entire family. It is a real, huge challenge when you hear that word, because there’s so much suffering that comes from it.
It feels adjunct because our healthcare system is built around this model of: You have a disease and we’re going to focus on treating it. But we are in the mindset that adding more costs more. This is one of the areas in healthcare where that is not true. This is the opposite part of that equation where adding more actually leads to decreased costs, and that’s a unique area that we need to recognize within healthcare. There’s demonstrable evidence to suggest that doing the right thing here leads to savings and better outcomes down the road for patients and families.
Q: Where do you think leaders should prioritize investment first if they’re starting the journey of expanding supportive cancer care in a way that’s both meaningful for patients and sustainable for their organizations?
MG: Can you ask me that in a year? We’re working on answering that.
What I can say is that we and others are invested in doing this well, and because the gap is so large — talking about that 15% — it means we all have shared learnings to do. I am excited for Providence and for the Institute for Human Caring to be a part of this conversation, and I invite others to think about working with us on this journey. So many Americans are affected by this illness, and working together we can go further in helping them navigate that journey with as little disruption and trauma as possible.
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