Expanding Program Tackles Emerging Area of Health Care Research

MD Anderson News Release 01/14/13

Thomas W. Feeley, M.D., has been appointed head of The University of Texas MD Anderson Cancer Center's Institute for Cancer Care Innovation, a program he helped organize in 2008 to explore a new dimension of health care research.

Feeley, who remains head of the Division of Anesthesiology and Critical Care, has been at the forefront of MD Anderson's launch into the growing field of study known as the "science of improvement" or value-based research. The focus of MD Anderson's work in this area is to define, measure and, most importantly, improve the value of its care, and share results with other health care providers.

The Institute for Cancer Care Innovation explores a range of projects that span cancer economics, patient safety, quality improvement, information technology, education and outreach. Hundreds of MD Anderson employees from clinical, financial and operational areas collaborate on these projects, many of which are identified by front-line patient care providers, asking a simple question through observation: "How can we deliver this care better, and can we provide it at a reduced cost?

"Patients, as well as insurance companies and government payers, want to know how MD Anderson provides precisely what is needed to properly treat cancer and how that quality care is balanced with what the institution charges and what it costs," said Feeley. "With preparations under way now for the new accountability, transparency, reimbursement and measurement mandates of the Affordable Care Act, this research will be even more vital, and more institutions will be taking a look at the value they offer patients," said Feeley.

The program has its origins in work with Harvard Business School's Professor Michael Porter, who has championed the principles of value-based health care as the cornerstone for reforming health care delivery. It was Porter and his colleagues who defined "value" in health care as the balance of outcomes with the costs to deliver care.

One example of the collaboration between Harvard and MD Anderson was a pilot project in the Head and Neck Center where a team applied Porter's theories in a clinical setting. The team established these outcome measures for a population of head and neck patients: survival, time to go through treatment and return to work, the ability to swallow and speak and a number of other long- and short-term complications. The team worked with the Institute for Cancer Care Innovation to pull and compile the measurement data from patient charts and developed a definition of quality care for the established population of patients.

The pilot project is presented by MD Anderson faculty to the Harvard Business School classes throughout the year, and the concept has expanded to other patient populations and clinics.

In addition, MD Anderson was one of the first health care institutions in the nation to work with Harvard Professor Robert S. Kaplan, who developed a method for measuring the true costs of cancer care known as time-driven activity-based costing. While this method is frequently used in a number of industries, few health care organizations have employed the model that identifies the units of time it takes to perform a service and the cost per unit of time, then multiplies it by the quantity of the service. The tool provides realistic cost information that can be used in the equation to determine value.

In addition, the Institute for Cancer Care Innovation has undertaken projects that examine what kind of outcomes information patients prefer when seeking care and develop strategies to better engage patients in their care by accessing their shared electronic medical records.

Supporting and guiding the institute is an external advisory board chaired by Kenneth I. Shine, M.D., executive vice chancellor for Health Affairs for The University of Texas System. Shine pioneered national quality and patient safety initiatives as president of the Institute of Medicine before joining The University of Texas System.

"At the root of value-based research is the patient, just as with all of our programs at MD Anderson," said Feeley. "As this research matures and grows, this information can lead to more savvy patients and consumers because they will know that our approach to care is money well spent. Plus, they will ask more questions about their care, and we welcome that dialogue."

Feeley and key collaborators in the Institute for Cancer Care Innovation have published five major journal articles and consult frequently with health care providers who want to start quality-based research programs.

Trained as an anesthesiologist, Feeley came to MD Anderson in 1997 to lead the Division of Anesthesiology and Critical Care. He is a member of the Institute of Medicine's Committee on Improving the Quality of Cancer Care: Addressing the Challenges of an Aging Population. Feeley and colleagues were awarded the 2012 Edgar C. Hayhow Award from the American College of Healthcare Executives for an article defining value in healthcare with cancer as a model.