'Value' in health care: What it means, what it doesn't mean

May 29, 2015 | by Nancy Brands Ward

Ranked by U.S. News & World Report as one of the elite places in the world to receive cancer care, City of Hope brings a mission-driven commitment to treating patients and their families through what may be the most intense experience of their lives.

Joseph Alvarnas, medical quality expert 'Value' in health care, especially cancer care, should be about individuals and outcomes, not one-size-fits-all treatment, says Joseph Alvarnas.

Now, as efforts to reduce costs escalate and definitions of what constitutes health care value and quality are rewritten, it’s never been more important to bring greater to transparency toward understanding what the institution does for patients, said Joseph Alvarnas, M.D., director of Medical Quality and associate clinical professor of the Department of Hematology & Hematopoietic Cell Transplantation at City of Hope.

Here, Alvarnas, who has been an outspoken proponent of the need to define true "value" in health care, puts into perspective City of Hope's unique system of care and how failing to understand its value can be a disservice to patients who need it.

City of Hope combines a range of services to provide comprehensive, leading-edge care for its patients. Could you describe that system of care?

We take a patient throughout the continuum of care that’s necessary to not only treat their disease but also to ultimately seek to restore them to a sense of wholeness. The care model has three levels: the best known care, a rapid track to innovative therapies and a person- and family-centered vision of what health care should be.

We offer not just the best known therapies, but also the best therapy for a particular person. For some people, that may be a research protocol. For others that may be not getting chemotherapy – it may be supportive care or palliative care.

What sets City of Hope apart from others in terms of providing state-of-the-art therapy?

There are a number of things that set City of Hope apart from other cancer centers. In part, it's a laser-like focus upon caring for patients. It is a medical staff that is uniquely qualified through their expertise, clinical skills and deep experience in taking care of this patient population. It is a deep-seated dedication to ensuring that our scientific and research efforts translate into meaningful new therapies for patients. It is a mission-driven focus on creating better and more effective treatments.

This quest for better cancer care is empowered by being grounded in a deep commitment and respect for our patients and their families. This is first and foremost a person-centered vision of excellence in care.

We are also uniquely committed to driving innovation in cancer care. We have a unique alignment of resources allowing us to leverage the best of what’s known and the most promising of what has yet to be fully described that most places can’t replicate.

Our Beckman Research Institute gives us basic science capabilities, and we have three manufacturing facilities where we can design cells, engineer stem cells and make small molecules. We have one of three Alpha Stem Cell clinics in California where new therapeutics are rapidly developed and given to patients. We have a research hospital where physicians, nurses and support staff are trained in caring for patients receiving a “first-in-human” medication. There are few places in the United States that can say that.

Here, our mission is: Study it, create it, get it to patients and move it forward to the national stage very quickly.

patient care and value "Value" in health care isn't about just about costs. It's about quality, the patient experience and outcomes.

Person-centered care is integral to the care model. What does it look like?

Our dedication is to tailor a care plan based on a person’s risk – whether that’s a genetic risk or disease stage – that integrates not only the very best of standard-of-care medicine but also includes innovative therapies targeted to attributes of that person’s immune system or disease.

It’s also anchored by a system of support from a deeply integrated health care team of physicians, nurse practitioners, nurses, social workers, members of the chaplaincy and other professionals to provide seamless care in a way that is both highly effective and very person-centric. It takes the idea of having cancer or a life-threatening disease and transforming it from the loneliest place in the universe to one where you are surrounded by people who genuinely care.

What should people consider when deciding where to get care?

When someone has cancer or other life-threatening disease, we’re embarking on a long-term relationship, so the best attribute of a doctor is whether they listen. That has to work.

If somebody feels they can’t talk to the physician openly or that their questions aren’t answered in a respectful way, they’re in the wrong place. And for people with rare or hard-to-treat diseases for which the state of the art changes rapidly, they should be careful to be cared for by someone who is an expert in the field and who does a lot of that care.

Is City of Hope for every cancer patient?

Not everybody with cancer has to come to a comprehensive cancer center like City of Hope. I talk about care-escalation schemes to determine which patients need to come here and which don’t. For certain cancers, including blood cancers like leukemia or lymphoma and certain refractory cancers [treatment-resistant cancers], there’s just no substitute for the level of expertise you get at a place like City of Hope. It’s often the difference between living and not living.

A key aim of health care reform is to increase access to care, but sometimes the result is the opposite. Why is that happening?

Healthcare quality The impact of the Affordable Care Act is, in many ways, still evolving.

Under the Affordable Care Act, we’ve seen a narrowing of health care networks as insurance companies try to keep the whole system viable and reduce costs. The problem is that cheaper care often doesn’t mean better care. One of the great tragedies is when a patient can’t be treated effectively because they’re stuck within their network. Cancer care is different; the stakes are high. Part of our challenge is to engage pay0rs so that they will understand the value and consistently pay for these services.

You’ve talked about the need for a broader national conversation about quality and value of health care in light of ongoing reform. What might that sound like?

As there’s this rush to make health care more efficient, payors don’t always understand what it is they’re paying for. This is where the issue of value becomes front and center.

Most of the metrics of success used by payors and the government center about the question: “Did you deliver yesterday’s therapy well?” That’s not what this institution is about, because yesterday’s therapy may be inadequate for the needs of the patients we see today.

None of the measures include the things we do particularly well – the things that make a profound difference for our patients and their families and their lives. We need very careful alignment of doing what we say we’re going to do, which is delivering innovative care, person-centered care, and making that transparent to payors, government and other stakeholders so that what we do is completely clear to them.


Learn more about becoming a patient or getting a second opinion by visiting our website or by calling800-826-HOPE (4673). You may also request a new patient appointment online. City of Hope staff will explain what's required for a consult at City of Hope and help you determine, before you come in, whether or not your insurance will pay for the appointment.

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