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St. Luke's MSTI's Spirit of Innovation

By Dr. David C. Pate, News and Community
July 25, 2013

Innovation is critical to our success in transforming health care, and one of our leaders in innovation is St. Luke’s Mountain States Tumor Institute (MSTI), our distinguished community cancer program. MSTI is the only three-time winner of the Association of Community Cancer Centers’ Innovator Award, and so I have asked my blog editor, Roya Camp, to interview the folks at MSTI to see how they did it. Here is Roya’s report:

What’s behind St. Luke’s track record as the only three-time winner of the Association of Community Cancer Centers’ Innovator Awards?

Highly committed people with a passion for improvement – and a very strong desire to see cancer shrink away to nothing.

The ACCC honors member programs that have exhibited forward-thinking strategic planning and developed pioneering programs and replicable models. St. Luke’s Mountain States Tumor Institute is the only such program in the country to have won for the three years the award, sponsored by GE Healthcare, has been given.

“We are undefeated, so to speak,” said Robert Mancini, the oncology pharmacist who has had a hand, directly or indirectly, in all three awards.

As it is with so many St. Luke’s employees one way or another, medical care is personal for him. His father had cancer when Mancini was in his third year of pharmacy school. His dad subsequently recovered and by then, Mancini was interested in oncology. 

The impassioned work he and his MSTI colleagues are doing is putting St. Luke’s squarely on the map.

This year, the association recognized the work of MSTI Genetic Counselor Jennifer Eichmeyer and quality improvement projects that improved patient access and identification for genetic counseling.

Here’s more about all of MSTI’s award-winning efforts:

Genetic counseling

Eichmeyer worked in other areas of genetic counseling before settling into her current oncology activities. The ability to make a significant impact in the lives of entire families and generations of families has made it very meaningful work.

 “Part of the reason I picked cancer genetics is, here is a place that we can make a difference,” she said. “The majority of my patients are eager and interested and engaged. There’s fear, obviously, but they feel empowered by proactive care.

“I feel like I can make a much bigger impact, so that’s very rewarding.”

Eichmeyer and the St. Luke’s team conducted a three-month tele-health pilot project with the MSTI Fruitland clinic whereby patients could receive genetic counseling locally via video conferencing with the team in Boise.

Wait times for appointments dropped from 23 days to 16 days and access to services doubled, from eight hours per month to 16 hours per month, with the availability of immediate-needs appointments.

She also reviewed all new patient oncology charts on a weekly basis, focusing on pathology, age, and family history, to identify patients who would benefit from genetic counseling. Notified physicians then discussed genetic counseling with identified patients and approved genetic counseling referrals.

Baseline data in 2010 indicated 58 percent of applicable patients were offered the service. Jennifer’s chart review effort increased this total to 70 percent.

Eichmeyer, one of three full-time genetic counselors who work with St. Luke’s patients in Nampa, Meridian, Fruitland, Twin Falls, and Boise, has seen oncology patients as young as 19.

The team works with about 65 patients a month, talking about the basics of genetics, heredity, and family history. Most of Eichmeyer’s patients are adults, and most are worried about their children, grandchildren, and siblings when it comes to the breast, ovarian, colon, uterine, bone, and brain cancers the MSTI genetic counselors encounter.

Genetic testing is also available to family members, and the St. Luke’s genetic counselors have seen entire families at a time.

St. Luke’s physicians have been supportive of her efforts from the start, Eichmeyer said, and the St. Luke’s alignment and integration work have been a big boost.

“I think the biggest benefit for physicians is that they have better access to us,” she said. “Most of the smaller private practices have no or limited access to genetic counseling at all.”

St. Luke’s electronic health records also have supported the genetic counselors’ work, Eichmeyer said, noting she could not do chart review program without them. Electronic records also have facilitated appointments and helped to make the process easier for patients with complicated needs, treatment schedules, and appointment calendars.

“It’s made a world of difference,” she said.

MSTI’s award-winning genetics program, one of 10 recipients of ACCC recognition this year, now is attracting attention from cancer centers nationwide.

 “I think we’re right on par, if not slightly ahead,” she said. “For a small community, that’s pretty impressive.”

Oncology clinic:

In 2012, MSTI was one of the eight cancer centers honored with the Innovator Award. That time, it was our multidisciplinary supportive oncology clinic and integrated medication therapy management that garnered attention.

Of St. Luke’s approach, the ACCC said, “This model supportive care clinic improved access to early palliative care in patients with advanced cancer and includes a pharmacist who works side by side with the nurse practitioner to implement medication therapy management and medication reconciliation.”

The clinic serves as concurrent care for patients with advanced disease in the outpatient setting. Clinicians refer patients needing additional support, and patients and their families meet with members of the clinic team, including registered nurses, pharmacists, social workers, registered dietitians, and other practitioners as needed. Team members then work to develop individualized plans of care for each patient.

Particularly effective has been the integrated medication therapy management component. Patients are asked to bring in all of their medications to ensure against drug interactions, side effects, and duplications in therapy, and to assess for accuracy of records and documentation. Satisfaction surveys have shown that time spent with the pharmacists through this feature is immensely valuable for our patients.

Through funding from the National Cancer Institute Community Cancer Centers Networks Program, St. Luke’s has been able to expand the clinics across our MSTI sites.

Watch the short video about our award-winning supportive oncology approach.

Oral chemotherapy

In 2011, MSTI was recognized for our pharmacist-led oral chemotherapy program.

Mancini, who applied for the ACCC award, and the MSTI team knew from the research that many aspects of oral chemotherapy, from costs to adherence to side effects, were challenging for patients.

 “With oral chemotherapy, there’s a huge financial piece,” he said.

The team, which included pharmacists, pharmacy technicians, and patient financial advocates, worked out a system of controlled dispensing for these very costly medications. The approach was thorough and involved patient education, collaboration with physicians, counseling of new patients, and phone follow-up. MSTI financial advocates also worked more closely with patients to help them manage medication financing.

The controlled dispensing has meant that fewer medications are wasted and patient adherence has improved.

With some of the medications costing as much as $400 per pill, and some patients’ treatments costing as much as $12,000 per month, the improvements have been of immense value to our patients, their families, payers, and the community, which absorbs care costs when other payers can’t.

As with the other award-winning innovations, the program hit St. Luke’s Triple Aim target, particularly in the areas of better care and lower costs.

The program is financially stable and improves access to care, patient safety, and employee satisfaction, Mancini observes. Physicians and nurses surveyed have expressed satisfaction that there’s better oversight of how the medications are administered, and the approach has meant nurses spend less time following up on med use and more time on patient care.

“You can’t often find a program that improves all four parameters,” he said. “These are expensive medications that we’re using. We’re reducing costs to the patient because we’re ensuring that the medications are paid for, and we’re reducing waste.

“What we’ve proven is that the oral chemo program improves access to the medication for the patients,” Mancini said.  “We want to make sure that everything we’re doing helps patients.”

As with our genetic counseling work, this St. Luke’s innovation is attracting an increasing amount of national attention from other cancer centers. Mancini is routinely contacted for information and details about what the MSTI group has done, pharmaceutical representatives commonly refer other oncology pharmacists and clinics to him for advice, and the American Society of Health Systems Pharmacists has recognized our approach to oral chemotherapy.

He knew he was on to something when, early into his career with St. Luke’s, he was asked to present at a conference. The response to his report?

“Wow, you guys are really ahead of the game.”

A spirit of innovation

Mancini said he was attracted to St. Luke’s due in part to a culture that encourages initiative and group collaboration. And pharmacists who complete residencies with St. Luke’s have carried that spirit, and some of St. Luke’s best practices, out with them to other centers, multiplying the benefit.

“When I first looked at St. Luke’s, I had a pretty broad exposure to what pharmacy innovation is, innovative pharmacy care,” he said. “I saw that St. Luke’s was on par, if not ahead, of many California institutions.

 “It’s not individuals per se making things happen,” he said. “It’s working as a group. And the managers that I’ve worked with have always been supportive.”

More innovators should make their great efforts known, he believes. And with the ongoing changes in health care and healthcare delivery, there’s all sorts of opportunity for bright ideas in areas such as survivorship, navigation, pediatrics, and hematologic malignancies program.  

“When people look around, we often say, this is just something we do,” Mancini said. “We don’t recognize the benefits. We need to put them out there, to gain more recognition for St. Luke’s.”

About The Author

David C. Pate, M.D., J.D., is president and CEO of St. Luke's Health System, based in Boise, Idaho. Dr. Pate joined the System in 2009. He received his medical degree from Baylor College of Medicine in Houston and his law degree from the University of Houston Law Center.