A Holistic, Scalable, Value-Based Care Pathway for Lung Cancer Patients
As a lung cancer team we had been operating as an IPU since March 2016 with the objective to increase survival and Quality of Life of our patients as well as reducing side effects. This translated in weekly multidisciplinary meetings to discuss patients. Although this was a good start, we lacked several of the major components of value-based healthcare. Our objective became to increase patient empowerment, involvement of GP’s and multidisciplinary team interactions, improving early supportive care and lowering costs for care team and payer without compromising on outcomes.
We set out to put the “ideal care pathway” on paper, being a combination of patient involvement, standardizing our operations while providing tailor-made care, further refining our multidisciplinary approach and systematically measuring outcomes that matter most to patients. For this last part, we chose the ICHOM standard set for lung cancer as the basis but added outcomes and QoL measurements during treatment on top of that.
This ideal “pathway on paper” was proving to be a project that would require lots of manpower not just to implement but also to keep it running, let alone continuously improve it. On top of that, a complex system that lives on paper has its shortcomings. Therefore it was decided to implement our vision with the Awell Health platform in the beginning of 2017.
2 months later the first pathway was implemented and integrated with our EMR. Since then, we have effectively implemented this vision in our clinical practice and now consider it our standard of care. The digital care pathway has helped us to empower our patients and transmural stakeholders (GPs), gain visibility on outcomes and make us more productive. As a multidisciplinary team consisting of physicians, nurses, social service, psychologists, palliative care specialists and spiritual workers the pathway has enabled us to support every aspect of the patient from clinical treatment to addressing issues around the end of life in a standardized, yet tailor-made way without requiring unreasonable efforts of our team members. As a result, we are starting to see the effects of the pathway on important outcomes such as E.R. admissions, where we see a strong trend towards a decrease for patients in our pathway. Further effects on outcomes and cost reductions are being researched at this moment.
Apart from the initial deployment at multiple sites in our hospital, we have been continuously improving all aspects of the pathway and have set up collaborations for benchmarking. Awell Health is offering our lung cancer pathway in its pathway library in order to turn this into a truly scalable solution outside of the walls of our hospital.
We are doing all of this without “hard” incentives such as bundled payments from our government or payers. The result of empowering the patient, improving outcomes and enabling transmural stakeholders such as the GP means less revenues for us as a hospital team. However, we are convinced that delivering superior value to our patients is the only correct path and will keep evolving our transmural, digital care pathway continuously to further improve outcomes in a scalable, sustainable way.