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September 2014
Dana-Farber Cancer Institute
Purpose: Develop statements describing your center’s three or four most notable efforts to demonstrate superior value and/or improve quality and reduce costs.
1. Getting the Diagnosis Right
Failure to establish the correct diagnosis can result in initiating the wrong treatment leading
to poor outcomes and greatly increasing the cost of care. A 2011 study of cases diagnosed
at outside institutions and subsequently analyzed at Dana-Farber/Brigham and Women’s
Cancer Center (DF/BWCC) identified a high incidence of serious misdiagnoses at outside
institutions. Among 335 sarcoma cases, the DF/BWCC diagnosis varied from the outside
institution in 24% of cases. In 16%, discordance was clinically significant, altering the
treatment approach (Raut et al. Connective Tissue Oncology Society presentation, Chicago,
2011).
2. Alternative Payment Methodologies for Bone Marrow Transplants
DFCI has the largest Bone Marrow Transplant (BMT) program in Massachusetts and is
widely recognized for its expertise and quality in performing BMTs. To promote and reward
high-value cancer care for this complex patient population, DFCI has pioneered a bundled
payment arrangement for hematopoietic stem cell transplants (HCST). Under this
arrangement, stem cell transplants are reimbursed based on case rate bundles. The HCST
payment model highlights our leadership in developing innovative arrangements that align
with our single disease focus and our ability to deliver superior patient outcomes through
value-driven cancer care.
3. Reductions in the Use of High Cost Services
By leveraging evidence-based strategies to eliminate utilization of such services when not
clinically indicated, DFCI has demonstrated cost savings and improved patient care. To date,
our work has focused primarily on reducing the use of biologic compounds, high-cost drugs,
and intensity-modulated radiation therapy (IMRT). In addition, the best-practice guidelines
derived from these projects have helped to shape health plan policies for relevant services
and have contributed to reductions in system-wide costs as the guidelines are applied
across payers and providers.
4. Palliative Care
DFCI’s palliative care service (PCS) leverages the unique expertise of its clinicians and
support staff to coordinate care for our sickest patients and has demonstrated success in
reducing hospital readmissions through effective discharge planning and care transition
management. The PCS provides approximately 2,000 pediatric visits and 13,000 adult visits
September 2014
per year, and in recent years, the readmission rate of the Palliative Care Unit has been
approximately 18% -- about 30% below that of the general oncology service. Discharged PC
oncology patients are 15% less likely than non-PC patients to be rehospitalized, which
contributes to reductions in the overall cost of care and improvements in patient outcomes.