A Cancer Center Puts the New Approach to Work

Heidi W. Albright; Thomas W. Feeley

Article | Harvard Business Review | September 2011

A Cancer Center Puts the New Approach to Work: Pilot

by Heidi W. Albright and Thomas W. Feeley

Abstract

The University of Texas MD Anderson Cancer Center is a National Cancer Institute–designated Comprehensive Cancer Center, located in Houston, Texas. Seeing more than 30,000 new patients every year, MD Anderson accounts for approximately 20% of cancer care within the Houston region and 1% of cancer care nationally. MD Anderson is a medical condition–focused center that provides integrated, interdisciplinary care across the care cycle.
In collaboration with Michael Porter, we embarked on a major effort to expand clinical outcome measurement, beginning with a study of 2,468 patients in the Head and Neck Center, in 2008. We created the Institute for Cancer Care Excellence in December 2008 to support this effort. In 2010, with Robert Kaplan, we launched a pilot project, also within the Head and Neck Center, to assess the feasibility of applying modern cost accounting to health care delivery.

Keywords: health care; health care quality; measurement; Costing; Accounting; Health; Quality; Health Industry; North and Central America;

Format: Print

Citation:

Albright, Heidi W., and Thomas W. Feeley. "A Cancer Center Puts the New Approach to Work: Pilot." R1109B. Harvard Business Review 89, no. 9 (September 2011): 15–16. (This article is a sidebar description of a pilot of time-driven activity-based costing in the HBR article "How to Solve the Cost Crisis in Health Care" by Robert S. Kaplan and Michael E. Porter.)

As the diffusion of value-based health care efforts accelerates globally, the need for interoperable information technology systems that support value-based care is essential. Such systems are needed to facilitate dramatic improvements in patient outcomes and efficiency and, importantly, to end an era in which health IT has entrenched the status quo, perpetuated silos, and blocked reimbursement reform. A value-enabling IT platform must organize data around conditions and must enable integrated practice units to integrate care both within and across health systems. In addition, the electronic health record should be the sole source of costing information so that accurate costs for every encounter can be tracked, aggregated, shared, and used for improvement. This is the next generation of health care IT.

Article | Journal of Medical Systems | January 2020

Using Time-Driven Activity-Based Costing to Demonstrate Value in Perioperative Care: Recommendations and Review from the Society for Perioperative Assessment and Quality Improvement

O. Allin, RD Urman, AF Edwards, JD Blitz, KJ Pfeifer, TW Feeley and AM Bader

A shift in health care payment models from volume toward value-based incentives will require deliberate input into systems development from both perioperative clinicians and administrators to ensure appropriate recognition of the value of all services provided—particularly ones that are not reimbursable in current fee-for-service payment models. Time-driven activity-based costing (TDABC) methodology identifies cost drivers and reduces inaccurate costing based on siloed budgets. Inaccurate costing also results from the fact that current costing methods use charges and there has been tremendous cost shifting throughout health care. High cost, high variability processes can be identified for process improvement. As payment models inevitably evolve towards value-based metrics, it will be critical to knowledgably participate in the coordination of these changes. This document provides eight practical recommendations from the Society for Perioperative Assessment and Quality Improvement (SPAQI) aimed at outlining the principles of TDABC, creating process maps for patient workflows, understanding payment structures, establishing physician alignment across service lines to create integrated practice units to facilitate development of evidence-based pathways for specific patient risk groups, establishing consistent care delivery, minimizing variability between physicians and departments, utilizing data analytics and information technology tools to track progress and obtain actionable data, and using TDABC to create costing transparency.

Keywords: value-based health care; outcomes; Time-Driven Activity-Based Costing; Health Care and Treatment; Cost Management; Value; Activity Based Costing and Management;

Citation:

Allin, O., RD Urman, AF Edwards, JD Blitz, KJ Pfeifer, TW Feeley, and AM Bader. "Using Time-Driven Activity-Based Costing to Demonstrate Value in Perioperative Care: Recommendations and Review from the Society for Perioperative Assessment and Quality Improvement." Journal of Medical Systems 44, no. 1 (January 2020). View Details

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Since its establishment in 2005, Hamburg’s Martini Klinik had single mindedly focused on prostate cancer care with a commitment to measure long-term health outcomes for every patient. A wholly owned subsidiary of the University Hospital Hamburg, Martini Klinik was a “hospital in a hospital” in close proximity to other medical departments and services. By 2019, Martini Klinik had become the largest prostate cancer treatment program in the world with 8,000 outpatient cases and more than 2,500 surgical cases annually. Patients came from all over Germany and from around the world. A new and expanded facility was under construction to have the capacity to manage more patients with prostate cancer.

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A Cancer Center Puts the New Approach to Work: Pilot

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