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Disruptive change in healthcare delivery

Craig Bunnell, SF ’08, Chief Medical Officer at Dana-Farber Cancer Institute has been negotiating the steep hills and deep valleys of government-mandated healthcare since Massachusetts became the first state to institute health insurance reform in 2006. As healthcare providers now fear about the Affordable Care Act, the revamped system and its subsequent amendments in 2008, 2010, and 2012, disrupted the status quo, forcing organizations and individuals to rethink their positions in the marketplace.

Craig Bunnell, Dana Farber CMO and Sloan Fellow AlumAlthough Bunnell acknowledges that new health insurance realities have posed prodigious difficulties, he’s not interested in rolling back time. “Change is difficult,” Bunnell says, “but necessary. We have an ethical and economic imperative to repair this nation’s healthcare system. Yes, we felt the disruption of the Massachusetts healthcare law, but we also saw the impact. After the legislation was introduced, that percentage of uninsured in Massachusetts dropped to one to two percent—the percentage of uninsured across the rest of the country is somewhere around 14 %.” [The federal percentage has been steadily dropping under the new healthcare law.]

For Dana Farber, “disruption” meant a potential barrier for some patients. Because the hospital is one of the most prestigious cancer centers in the world, new low-budget health plans created by the legislation prohibited some patients from turning to Dana-Farber for care, limiting them to lower-cost options. That barrier to access threatened the Institute on myriad levels. “The revenue we derive from patient care also subsidizes a wide range of patient support services and helps to fund our research into new and better therapies.”

In fact, Bunnell says, the new health legislation forced Dana-Farber to revisit its mission. Should the hospital cut services that don’t pay for themselves, such as palliative and survivorship care? Should it eliminate expensive “extras” like social workers, psychologists, nutritionists, resource specialists, and patient navigators—services that Dana-Farber considers critical to those with cancer and therefore the organization’s mission?

Cancer research at Dana-Farber not driven by the bottom line

“Our ah-ha moment was that no, we did not want to cut that over-and-above level of service,” Bunnell reports. “In fact, we decided we would increase our level of service. We would attract patients because of the sheer quality of our care.” Bunnell says that every new patient who calls Dana-Farber can choose when they want to be seen—even the very next day. The focus, he says, is always on the patient, not the providers.

Dana-Farber, Bunnell also points out, is the only cancer hospital to offer genomic testing, free of charge, on the tumors of every new patient as part of a major research study funded by the Institute. As we move to start linking what we learn from genomic testing with our vast clinical experience, we are poised to make advances at an ever-accelerating rate—advances that were previously unimaginable.”

“What we learn from our research fuels our care which, in turn, fuels our research. If new healthcare legislation makes us rethink what we do and why we do it, it’s all good. We improve both our level of care and our bottom line.”

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