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Dana-Farber Cancer Institute · September 2014 Dana-Farber Cancer Institute Purpose: Develop statements describing your center’s three or four most notable efforts to demonstrate

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Page 1: Dana-Farber Cancer Institute · September 2014 Dana-Farber Cancer Institute Purpose: Develop statements describing your center’s three or four most notable efforts to demonstrate

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

Page 2: Dana-Farber Cancer Institute · September 2014 Dana-Farber Cancer Institute Purpose: Develop statements describing your center’s three or four most notable efforts to demonstrate

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.