Envisioning the Future of Cancer Care

“We don’t need to new sights, we need new eyes,” said healthcare futurist Joe Flower, as he opened up the Association of Community Cancer Centers 45th Annual Meeting and Cancer Center Business Summit, being held March 20-22 in Washington, DC, with a vision of a healthcare system that provides better quality care at a lower cost that is more easily accessible for all stakeholders.

Healthcare is complex, and therefore, simple solutions won’t work, he said. And over the next 10 years, the healthcare industry will experience a turbulent time as a result of multiple factors, which range from new technologies to economic pressures.

The goal is to remove the current fee-for-service, opaque system and replace it with one that is more efficient and transparent. Those who lead the charge on this will be more attuned to the needs of the market and will excel at building and reshaping the business of care seriously and deeply around the needs of patients and their families, as well as the emerging big buyers of healthcare, he said.

Before painting a picture of how the healthcare system should, and could, look like in the future, Flower honed in on why these changes are being sought after. The central factor driving all the change that we’re seeing, and will continue to see, in healthcare is that it costs too much, he said. This year alone, the United States will spend an estimated $3.9 trillion on healthcare, approximately one third of which will be waste. And cancer care is the poster boy for the extraordinarily shocking cost of healthcare in the country, he said.

Looking at trends over time, Flower pointed out that US healthcare spending started to increase faster than that other countries in 1983-1984, when diagnosis related group (DRG) codes were implemented. While meant as a cost-cutting measure, what these DRG codes did in effect was “give the industry a manual for how they can make more money” by upcoding and using newer technology with a better ICD9 code even if the technology wasn’t more expensive, he said.

Flower then presented the audience with a table of elements, which included all the different facets he said are needed to facilitate this care delivery transformation we so often hear about.

“Community cancer centers are generally ahead of the rest of healthcare in these areas because of the nature of cancer care,” said Flower. “In the changed environment, you can look to community cancer centers’ relative skill in these areas as a competitive advantage.”

This new care delivery system begins with behaviors driving such an environment, notably trust, which includes both trust between the patient and their provider, as well as between the different members of the care team. He also mentioned the phrase commonly cited when envisioning the future of cancer care: patient-centered care, where the system is built around the patient’s needs. Other drivers include moving from acute treatment to chronic, longitudinal treatment, as well also population heath and community health strategies.

“We know your zip code is a far better predictor of your longevity than your genetic code,” said Flower.

Looking at the system built around these behaviors, team-based care and a standardization of protocols that end unneeded variation in care are crucial. Flower also underscored the importance of disintermediation of the entire health system so that physicians don’t have to go through health systems, payers, and employers in order to access their patients, and vice versa.

Employers have already started to play a more active role in their employees’ care, and this trend will continue in the coming decade, with employers looking to deal directly with physicians and penetrate through other intermediaries. Flower gave the examples of Haven, the well-known joint venture between Amazon, Berkshire Hathway, and JP Morgan, as well as Walmart’s continued efforts to get more involved in healthcare.

In order to sustain this environment, risk must be redistributed and moved away from fee-for service and treat-to-code and toward “transparent and competitive payment models” like bundled payment, said Flower. Different payment elements of this changed care delivery environment include spot auctions, where a patient can essentially shop around their area for a service, see how much they would pay, look at reviews of the provider, and make an appointment online. Flower compared it to booking a hotel or a seat on an airplane.

And lastly, complementing these abilities, technology will be able to fill gaps in the system. However, Flower emphasized, technology should never become a substitute for human contact. Instead, it should keep the patient directly hooked into the system and keep communication across the continuum. Recognizing that interoperability has not yet become a reality, Flower does see it becoming one in the coming decade.

Other elements include technologies like monitoring patches and smart drugs, which will be supported by blockchain, as well as elements the healthcare system has already started introducing into care delivery, such as artificial intelligence, big data, and personalized medicine that fits to a patient’s specific needs.