Is Oncology Care Ripe for Disruption?

In preparation for the ACCC 46th Annual Meeting & Cancer Center Business Summit in Washington, D.C. on March 4-6, we are talking with several featured speakers about the topics they plan to address at the summit. Susan Dentzer—a health policy expert and Senior Policy Fellow at The Duke-Margolis Center for Health Policy—will speak about "Disruptive Innovations That Could Change the Delivery of Cancer Care." Here she talks to us about the positive disruption she thinks should occur in oncology and the healthcare system in general.

ACCCBuzz: What is your definition of a “disruptive innovation”?

Susan Dentzer:It’s very trendy to talk about disruption these days, and whether you call it disruption, innovation, or evolution, healthcare does need to change. Other industries have undergone transformation in recent years, and consumers have benefited. One good example is Spotify, which was at the leading edge of a movement that completely transformed the music business. Because of Spotify and other innovators, most of us now listen to music by streaming it. Daniel Ek, Spotify’s co-founder and CEO, is now investing heavily in healthcare because he believes that the sector needs to evolve to meet current needs.

ACCCBuzz: How does healthcare need to change?

Susan Dentzer: A starting point is to think about what is inherent in different aspects of healthcare delivery. One aspect is the “laying on of hands,” which is required, for example, when someone is in an accident and needs trauma surgery, or needs some other invasive procedure. In these scenarios, the patient needs to be in the same place as a provider to receive care.

Another aspect is care that entails the exchange of information. This occurs when your doctor asks what your symptoms are, when your last mammogram or other screening exam was, or whether your medication is helping you feel better. Information exchange like this often takes place virtually in other aspects of our lives. Yet in our healthcare system, for the most part, information exchange happens much as it did throughout the 20^th century: only when a provider and patient are in the same location.

There are many reasons for this, including payment restrictions. With some exceptions, providers often cannot get paid unless the patient comes into their office. But the system itself is also resistant to change, and that’s wrong. Forcing patients to come to care, rather than taking it to them, isn’t convenient for patients, and it involves a lot of activity that does not have anything to do with healthcare (e.g., taking time off work, driving a long distance, looking for a parking spot). These activities are even more difficult for patients who are compromised in some way. It is largely unnecessary, but we insist that it is how things must happen. Our traditional, institutional model of care is not organized around the needs or desires of patients.

ACCCBuzz: How does this apply to cancer care?

Susan Dentzer: So much cancer care that is necessary is not getting done, and again, one reason is that we act as though patients and providers must always be in the same place. For example, palliative care does not necessarily require the laying on of hands; rather, it is about exchanging information, listening, determining a patient’s concerns, and meeting a variety of needs. There is no reason it needs to happen in the physical healthcare setting. Lots of hospitals simply don’t offer palliative care because they don’t have staff or don’t see the need. Now, tests are being done to determine how well palliative care can be provided remotely to patients, which could drastically extend the provision of this service into areas of the country that badly need it.

ACCCBuzz: What about clinical care?

Susan Dentzer: Increasingly, the same can be said for clinical care. The nature of cancer care is changing, from diagnosis through treatment. Many therapies are oral now, and some infusions can be home-based. This trend of moving care to homes is already happening in other countries and other specialties, such as in kidney dialysis. In Hong Kong, 90% of dialysis patients get dialysis at home now.

Some providers find these changes in healthcare delivery exciting and liberating. Others say, “You need to understand the essence of the healthcare I deliver to my patients … The personal connection is so important … You can’t underestimate the value of having a patient and doctor in same room.” At the same time, I’ve heard their patients talking about schlepping to the office when they don’t feel well, barely having time with their doctors, and spending half of their day in infusion centers where they sometimes feel they can barely get the attention of nurses. They ask, “Please explain the ‘magic’ of these in-person encounters to me. I would have appreciated home infusion of my chemotherapy. I would have been just as happy, if not more so, with a ‘visit’ with my doctor over my smart phone.”

ACCCBuzz: What else has to happen to enable this new care model?

Susan Dentzer: It will take a lot of pieces coming together. Payment models have to enable it. Regulations have to enable it. But all of that is doable; very few of our existing structures or practices are so essential that they should stand in the way of taking care directly to patients. We need to truly put the patient at the center of care, not just pay lip service to it.

A health policy expert and award-winning editor and journalist, Susan Dentzer is a Senior Policy Fellow at The Duke-Margolis Center for Health Policy. She has served as the president and chief executive officer of the Network for Excellence in Health Innovation; editor-in-chief of the policy journal Health Affairs; and an on-air Health Correspondent for the PBS NewsHour. She is the editor and lead author of the book, Health Care Without Walls: A Roadmap for Reinventing U.S. Health Care. She is a member of the National Academy of Medicine and the Council on Foreign Relations; a fellow at National Academy of Social Insurance and the Hastings Center; and a member of the Board on Population Health and Public Health Practice of the National Academies of Science, Engineering, and Medicine.