|Dr. Paul Lange
|Dr. Daniel Lin
|Dr. Pete Nelson
|Dr. Paul Lange
|Dr. Daniel Lin
|Dr. Pete Nelson
In a healthcare world where breaking down traditional silos will be a key part of addressing the challenge of change that lies ahead, the hands-on philanthropy of a Seattle couple in their involvement with City of Hope has been the underpinning of two grants to provide training on the humanistic side of medicine.
The grants, both $1.5 million for five years, are from the National Cancer Institute to City of Hope, a nationally regarded cancer research and treatment facility in Duarte, east of Los Angeles, and are designed to train representatives from cancer centers around the country. By seeking involvement in the programs, the institutions have indicated they wish to change, and want to understand how to go about it.
Matt Loscalzo, executive director of the department of supportive care medicine at City of Hope, helped create the models for both the breaking-down-silos grant and one for a tablet-based program to train health professionals in how to screen cancer patients for issues that might affect their care.
He credits City of Hope's Sheri & Les Biller Patient and Family Resource Center, supported with both dollars and direct involvement by the couple who transplanted from Los Angeles to Seattle several years ago, with attracting the attention of NCI to the grant applications.
"We would not have gotten these grants, at a time when very few grants are being funded, without the philanthropic and institutional partnership that exists between CoH and the Billers, who are veryactively involved in the operations of the Center," Loscalzo said. "Most institutions say to philanthropists, 'we're pleased to get your money, now please leave us alone.' It doesn't happen that way with CoH and the Billers."
City of Hope bills the center, which in October is celebrating the fifth anniversary of its opening, as "the international model for compassionate care" and touts CoH itself as "one of the only institutions in the United States to offer this level of comprehensive support."
The grant that is likely most exciting to Loscalzo, whom I met at City of Hope two years ago in an introduction by Sheri Biller, is the one to train representative teams from other cancer-care institutions in the use of the tablet, a device named theSupportScreen. He pioneered the device that has become a vital part of the compassionate care that is the key to the Biller Center's success.
Loscalzo says the SupportScreen, a "primitive prototype" of which he brought to City of Hope when he came there from UC-San Diego in 2007, is used to identify physical symptoms, psychosocial problems, family concerns and triages the patient's concerns to the designated professionals or resources."
The SupportScreen prompts patients to answer various questions regarding their care and concerns and researchers have found that patients are frequently more likely to share fears and concernswhen prompted by a computer application rather than by face-to-face personal questions.
Although the Billers have moved to Seattle, where Les has become chairman of Sterling Bank, they remain closely involved with City of Hope, where Sheri is chair of the board.
The purpose of both grants is to, as Loscalzo puts it, "transform the humanistic side of medicine, a recognition that innovative approaches that are patient and family centered represent an idea whose time is coming, real soon. And the rest will come later."
While both grants are focused on cancer care, Loscalzo suggests "they are models for dealing with other chronic diseases."
Evidence of the interest the silos-breakdown concept is having with healthcare facilities around the country is that the next session, to be held in October at Mt Sinai Hospital in New York, which is City of Hope's partner in the grants, attracted more than 200 applicants for the 50 spots. City of Hope and Mt. Sinai will rotate in conducting the semi-annual programs.
The grants will entail training teams of health care professionals: physicians, nurses, social workers, psychologists, business administrators and chaplains who, when they return to their respective institutions, will be expected to begin a process of changing the cultures there.
The institutions that have sent representatives to the sessions have agreed in advance that they want agents of change trained in how to do that, and the programs involve regular followups with the attendees to track their progress and assist with challenges in leading the change process.
And the breadth and extent of interest by cancer centers around the country should be taken as a positive sign that they understand the need to change.
As dramatic changes in the healthcare system unfold, an emerging piece of those changes is the growing role being played by advocates who become in-person navigators of the system for patients and their families.
It's a healthcare innovation that won't mean the eventual end of one-on-one doctor-patient interactions, but proponents of the advocate role suggest it will lead to far larger percentage of physician visits in which a patient is accompanied by his or her "team."
Scott Forslund, director of strategic communications for Premera Blue Cross of Washington, suggests that "One benefit of a patient advocate model is that it may provide a fiduciary responsibility by allowing for focus on only the one patient that the advocate is serving."
Forslund adds that "The escalating cost of care and the complexity and fragmentation of the healthcare delivery system are hugely driving the need for better coordination of care and greater economic engagement by consumers and advocacy on their behalf."
It's that "advocacy on their behalf" that is driving the new trend on behalf of patients. And it is attracting a growing number of entrepreneurs who are parlaying their years of experience in the healthcare industry into new companies that they hope will grow as the field becomes more broadly known.
Three of those businesses, created by entrepreneurs who have picked different pieces of the advocacy picture, are in the Seattle area. One is a health advocacy company, another is focused on home healthcare and the third is seeking to create a personal heathcare guide for patients and their advocates.
Allied Health Advocates
Allied Health Advocates (AHA) is a health advocacy company focused on providing in-person assistance to patients and their families who are navigating the health care system, "whether facing a new diagnosis, an immediate health care issue or managing a chronic and complicated medical condition."
Robin Shapiro, president and COO of AHA, which she co-founded in 2008 with partner Beth Droppert, says the advocate industry is forming around the idea that patients want to get more engaged in the healthcare experience, but lack the background to be really involved.
"Patients don't understand the pressures on doctors, so we act as navigators and as a sounding board, bringing good communications to the process so doctors can be more efficient with patients," Shapiro says.
She admits it's a field too new for a lot of doctors "to even know about the role we play." But she adds that "the doctors we have worked with have been very supportive, cooperative and at times grateful that we work with the patient and the health care team."
Virginia Kenyon, whose Seattle-based Kenyon HomeCare Consulting provides consulting services for a variety of home health hospice and home care agencies, views the advocate role as "critical in this day and age of complex medications and procedures and the options now available to all of us."
At this point the advocate role is not covered by insurance or Medicare.
But Kenyon, who started her business in 1999, suggests that if insurance companies could see that the advocate role would reduce costs and improve health and care, they might be willing to pay for it.
"Right now they probably would view it as costing them more because the advocates would push for coverage that companies currently will deny," Kenyon added.
Kenyon recalls that early in her career as a nurse, in the 1970s, "nurses used to be required to advocate for their patients, which sometimes was very difficult because it could out you at odds with the physician."
She notes that a settlement in a recent federal suit against Medicare for its requirement that home healthcare agencies had to close cases of patients who weren't showing progress will also serve to reduce healthcare costs.
"Keeping people at home and keeping them stable, even if they are no longer making progress or improvement, will keep people at home and stable rather than being in the hospital," she said.
StrataLife Solutions LLC was founded two years ago by Trini Evans, who brings a 25- year healthcare background in nursing and home healthcare roles to her effort to launch her publication-focused business.
The Health Advocate Guide, the launch product for her business, is designed to be a personal medical communication system that is taken by the patient or a "team" member to each physician visit. The three-ring binder (which also has a patient's information on line), contains forms and legal documents, such as healthcare directive and durable power of attorney for healthcare, as well as pages to guide the collection and retention of doctor-visit records.
One of the pages in the guide advises patients on "gathering your team," suggesting that one team member would accompany the patient to doctor visits, thus serving as advocate to take notes, ask questions and ensure accuracy in dealings between patient and medical professional.
"It's designed to give a patient the ability to be a participant in their care, rather than an observer of it," she says.
Some involved in the healthcare industry suggest there is a latent pressure building for advocates who will help patients navigate the array of procedures for various diseases and conditions, balancing benefits with costs, and actually slowing, or bringing down, healthcare cost
Thus part of the effort to get control of the escalating costs of healthcare might find advocates, for example, helping a patient with a particular cancer weigh the relative benefits of an array of similar procedures to address the cancer that, in Seattle, can range in cost from $800 to $57,000, depending on where the procedure is done.