PFP Breast Cancer Program

Like many other countries around the world, Taiwan has been experiencing ever-rising health care costs, but without necessarily seeing commensurate improvement in quality measures. To address this unsustainable trend, KF-SYSCC has been dedicated to rethinking health care delivery and initiating reform. Here at our hospital, we believe that it is possible to improve patient outcomes through standard high-quality care, and thereby reduce costs through averted recurrence and complications. Our experience thus far has been promising and we hope to serve as a model for other health care institutions to look to.

In the early years of our hospital, during the early 1990s, we began experimenting with multidisciplinary, team-based breast cancer care. We hypothesized that this model would help facilitate cohesive care and eliminate the pitfalls that arise from doctors making decisions in isolation. As early treatment decisions in cancer care can affect later options, it seemed more effective to work as an integrated team, rather than as an assembly line of doctors. In this way, the full scope of each patient's care would be well-understood and an optimal treatment plan could be established. Within a couple years, we expanded this type of care delivery to our programs for colorectal and head and neck cancers.

Just as the delivery model should focus on quality, we believed the corresponding provider reimbursement plan should also prioritize and provide incentive for high-quality care. When Taiwan's National Health Insurance took effect in 1995, we hoped to collaborate with the Department of Health to instate a new payment plan for breast cancer care, one that rewarded performance based on a set of quality indicators. A multidisciplinary team of specialists from our hospital had established 15 indicators related to process and outcome, drawn from medical practices and research from the US and Europe. It was not until 2001 that our proposal was adopted, but we nevertheless tracked our adherence to these indicators in the intervening years. We continued delivering care with our eyes fixed on how health care should be structured.

After a series of discussions, in 2001 the Bureau of National Health Insurance (BNHI) officially launched a pilot pay-for-performance (P4P) program for breast cancer care. As an alternative to the fee-for-service model, this voluntary program reimburses providers with stage-specific capitated payments and awards bonus payments based on year-end survival rates. Participants must serve at least 100 breast cancer patients per year and monitor adherence to the established set of 15 quality indicators. They are also required to form a multidisciplinary team that meets on a regular basis and updates its practice guidelines.

Our hospital has been participating in the pilot program since its inception and remains a strong proponent of aligning payment with quality measures. Much of health care has become profit-oriented and we wish to see a return to patient-oriented focus. We are confident that this new reimbursement model is a change in the right direction, as we have consistently seen better outcomes for our patients than national averages. Our efforts have been featured in a 2009 Harvard Business School case study, led by Professor Michael E. Porter, and we view this honor as a clarion call to keep pressing forward along this path. It is our hope that through our experience and example, we may help advance the field of health care and strengthen the fight against cancer.

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