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View Diary: Monday Night Cancer Club: "The Fix for Cancer Care" (73 comments)

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  •  The shift from fee for service (10+ / 0-)

    to bundled care pertains to the whole of health care, not simply cancer care.  The entire health care world is afire with this discussion; it's mostly about medicare reform, but major health care organizations are busy re-organizing the way they deliver care in order to take advantage of these new incentives (which are a big part of the ACA).

    it seems even cancer care is to be considered in this large reorganization of the delivery of care.

    Words can sometimes, in moments of grace, attain the quality of deeds. --Elie Wiesel

    by a gilas girl on Mon Mar 25, 2013 at 06:22:16 PM PDT

    •  Can you say more? Particularly (9+ / 0-)

      in reference to my skepticism that this will indeed be set up in a way to help patients, regardless of the chronic condition they might have?

      Some DKos series & groups worth your while: Black Kos, Native American Netroots, KosAbility, Monday Night Cancer Club. If you'd like to join the Motor City Kossacks, send me a Kosmail.

      by peregrine kate on Mon Mar 25, 2013 at 06:27:32 PM PDT

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      •  from where I sit (6+ / 0-)

        it is hard to tell at the moment if this set up really will help patients -- they always SAY that it is about providing better patient care.

        What I know about stems mostly from Medicare patients, which was the primary impetus for this change...at the moment the system is set up to be inefficient and expensive: providers are rewarded simply for high volume of services, which means there's an incentive to over test, prescribe the most expensive procedures, etc, rather than actually provide the care that the patient may need.  The idea is to restructure the entire delivery system so that a provider system (rather than an individual provider) would be responsible for the whole of the patient's care and that the reimbursement would come from the outcome, producing healthier patients would kick-in the greatest financial incentive for the provider system, and would also incentivize more wholistic (including preventative) care.

        That's the theory.  On paper it looks good, because there is a lot that's wrong with how our health care system is organized to provide care (which is, I think what Emanuel is writing about).   The real worry is if it incentivizes systems to simply avoid sick people altogether (which wouldn't directly apply in cancer care, obviously).  In the instances where I have seen this new organizing principle applied to the delivery of care for at risk populations (poor, indigent, non-english speaking patients in large urban health care systems) it does seem to have advantages over the older way of doing things, for one thing it is more "patient-centered", so that it focuses on providing the care that has been demonstrated to work for the conditions that the patients are presented with.  And it focuses on expanding the health care team to include heretofore not recognized members of the care team (like patient care assistants, social workers, etc. who know more about patients lives and circumstances and can coordinate care).  I'm less familiar with how it might apply or what specific changes this kind of re-orientation might fit for cancer patients.

        Sorry.  Still, the idea is to get away from high-end, expensive treatments that aren't backed by an evidence base and deliver more team-based, patient centric care that concentrates on well-established treatment plans that have an evidence base for success.

        That's the theory.  Who knows (yet) about the practice?  

        Words can sometimes, in moments of grace, attain the quality of deeds. --Elie Wiesel

        by a gilas girl on Mon Mar 25, 2013 at 07:44:28 PM PDT

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        •  Well that's a bit like the model that is practiced (5+ / 0-)

          in Europe, and other countries and it seems to work great.

          Tracy B Ann - technically that is my signature.

          by ZenTrainer on Mon Mar 25, 2013 at 07:54:46 PM PDT

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        •  Thanks for your detailed reply. (5+ / 0-)

          I can see the appeal on paper. And if in practice it produces more patient-centered care, that would certainly be good. That's a shortcoming of cancer care in my experience, and the stories I hear from most people I know who are also dealing with it in one form or another: we're still very much on our own. I can't think of one person I know with cancer who has an advocate or an interpreter of the system and the options that may be available. There's usually very little time included for dialogue or consideration of choices regarding treatment, let alone support for the other aspects of survival that make a big difference.

          Back in the day when I did some (modest) HIV-support work, the innovation was to have case managers be assigned to people to help coordinate care in the multiple dimensions needed. That was a good idea, and it did help people when it was implemented well.

          I'm not saying that most people with cancer need that level of wrap-around support; fortunately, many people with HIV also don't have the level of difficulty to deal with now that used to be common then. But...it would be better if we were closer to that end of the continuum. And I think that's true for anyone with a serious, chronic and/or life-threatening condition. As it is, it's sink or swim.

          Oh, and don't get me started about evidence-based treatment for cancer. One of the most dismaying realizations of this whole process was my comprehension at last that there is NO consensus among oncologists about the best way to treat my particular cancer and stage. That was a wake-up call indeed.

          Some DKos series & groups worth your while: Black Kos, Native American Netroots, KosAbility, Monday Night Cancer Club. If you'd like to join the Motor City Kossacks, send me a Kosmail.

          by peregrine kate on Mon Mar 25, 2013 at 07:56:08 PM PDT

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        •  It is very close to the Kaiser (0+ / 0-)

          system of care that I use currently.  

          What you have described Gilas Girl,  is how Kaiser has organized themselves in California. Everyone who is in their system receives care, no one is denied just because of their condition.  Kaiser participates regularly in treatment trails (especially with cancer patients). The doctors use their internal systems of administration to innovate within the organization and it is integrated into the whole medical community.  

          I may have mentioned before, that my Pulmonologist is working  with a team of doctors to integrate into their own cancer treatment practice the latest lung cancer research regarding genetic markers for Squamous Cell Carcinoma of the Lung. That originating research was just published last Sept. 2012, my Pulmonologist talked in depth with the lead researchers involved February, and they are working to integrate this discovery into the whole system of care already.  (pretty fast response for such a huge bureaucracy if you ask me).

          Life is not a problem to be solved but an adventure to be experienced.

          by DarkHawk98 on Wed Mar 27, 2013 at 04:35:10 PM PDT

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