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Evolving Healthcare Beyond the Conventional Walls of the Delivery System

Laura Joszt
Healthcare does not necessarily need to be disrupted, but it does need to evolve and utilize technology so that cancer care can move beyond the conventional walls of the healthcare delivery system, said Susan Dentzer, visiting fellow at the Duke-Margolis Center for Health Policy, during her keynote speech at the Quality Cancer Care Alliance’s Leadership Summit.
The word “disruption” is getting thrown around a lot in healthcare as rising costs are forcing providers, payers, policy makers, and more to find new ways to deliver care at lower costs. However, Susan Dentzer, visiting fellow at the Duke-Margolis Center for Health Policy, doesn’t like using that word.

People in healthcare who think they are going to get disrupted feel threatened by the idea, but patients might not also like the idea of their care being disrupted.

“…I don’t think it’s the number 1 phrase patients want to hear,” she said. “When I think about all the people I know who’ve had cancer and had close relatives have cancer, die of cancer, etc, if they had heard, ‘it’s going to be disrupted,’ that would not be their immediate thought of what was good.”

During her keynote speech at the Quality Cancer Care Alliance’s Leadership Summit, held September 5-6 in Grand Rapids, Michigan, Dentzer instead focused on the evolution of healthcare as it moves outside the conventional walls of care. “Evolution,” she believes, is a word that everyone can agree is more acceptable and less scary or frightening to patients.

In her previous role as the president and chief executive officer of the Network for Excellence in Health Innovation, Dentzer helped to work on a roadmap for reinventing the US healthcare system, called Health Care Without Walls. Some of the big questions the roadmap asks and seeks to address are:
  • Why does the United States still largely operate as a sick care system?
  • Why is the system so dependent on people going to it, instead of the system going to people?
  • Why isn’t the healthcare that doesn’t rely on laying on of hands delivered virtually?
“What can we do to take the part [of healthcare delivery] that is about exchanging information and move that to a more virtual context than we have done traditionally in healthcare?” Dentzer asked.

There are a wide variety of patients who could benefit from virtual care. Some of the patient profiles Dentzer outlined included an elderly woman with a cognitive impairment and a heart condition who is living on her own and wants to continue living in her home but cannot drive anymore, or a pregnant woman with a high risk of premature delivery who is working at a low-wage job and cannot take a day off work to go see her obstetrician.

The main hypothetical character profile and situation that the group created was Dave, a man in his 40s who lives on Kodiak Island in Alaska. He’s a relatively healthy person, but he develops a hacking cough that persists for months and when he finally goes to get care, the doctor detects a lump and thinks Dave might have lung cancer, but the doctor isn’t sure.

In the current situation, Dave would research lung cancer, find out he probably has non–small cell lung cancer, and determine he has to get to a major cancer center in New York for state-of-the-art treatment. Now he has to figure out how to consult with the clinicians there. Does he need to book an appointment, fly across the country, and stay overnight in a hotel? After he obtains advice on a treatment plan, then what? Does he move to New York during treatment?

In an ideal scenario, Dave could get his tumor tissue sequenced locally and the digital images sent to the cancer center in New York, he could get a telehealth consultation, his targeted therapy can be e-prescribed and then dispensed from a specialty pharmacy in Seattle, and finally his therapy can be delivered by drone to a critical access hospital on Kodiak Island.

While all of that is technically possible, this scenario would never happen.

“The system is not in any way organized around the patient or what the patient desires,” Dentzer said. But there might be a future where this can happen.



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