Achieving the triple aim in cancer care through a tri-part research collaboration.

Abstract

52 Background: Curbing rising cancer care costs require models that safely lower expenditures and improve experience and outcomes. We developed a care delivery model integrating lay health workers to address early goals of care and symptoms (JOP 2015). We then created a research-collaboration with a health plan (which paid for care and processed claims), a contracted oncology group (which implemented the model), and a university research center (which designed the intervention and conducted the evaluation) to test effects on patient satisfaction, utilization, and costs. Methods: All patients newly diagnosed with cancer, referred to the contracted oncology group, and who were beneficiaries of the health plan from 11/17/13 through 9/30/15 were enrolled. We analyzed descriptive statistics and pre-intervention and 5-month post-intervention surveys to assess satisfaction with care and decision-making. Results: There were a total of 412 patients with cancer enrolled over the study period. The mean age of enrollees was 76 years; 53% were women. The mean risk adjustment score was 2.5 (www.CMS.gov). Gastrointestinal malignancies were the highest proportion of cancer diagnoses (26%) followed by breast (23%) and genitourinary cancers (13%). Thirty-one percent of patients were diagnosed with stage IV disease; 22% with stage I; 18% with stages II and III; and 10% with unknown stage. Twenty-two percent of patients died during the study period. In comparison to pre-intervention surveys, there were statistically significant improvements in overall mental and emotional health (p < 0.05) and improvements in satisfaction with care and decision-making (p < 0.05). Conclusions: Research collaborations can help to rapidly implement and test novel strategies of care delivery. These collaborations are needed to align stakeholder priorities to improve cancer care and reduce healthcare spending. Our collaboration demonstrates the feasibility of an all-stakeholder approach to designing and implementing innovative high-value cancer care delivery strategies. Our early findings demonstrate improvements in patient emotional and mental health and satisfaction with care and decision-making.