By Dr. Fumiko Chino

Costs of Care, in partnership with the ABIM Foundation, would like to welcome Dr. Fumiko Chino as the 2018-2019 Teaching Value in Healthcare Learning Network Fellow. Fumiko is the second annual fellow of The Learning Network, which began in 2014 and serves to bring together educators and health systems leaders from across the country to advance stewardship in training and practice of value-based healthcare.

 Fumiko graduated medical school at Duke University Medical School in 2014 and is currently serving as Chief Resident in the Radiation Oncology at the Duke Cancer Institute. She became interested in high value care and the unique burden of out of pocket costs on cancer patients after enduring enormous expenses herself while navigating the treatment course of her late husband. She has worked with her team at Duke to help define and pilot work studying financial toxicity – the subjective and objective effects of treatment-related costs on cancer patients and their families.

A message from Fumiko:

It is an honor and a privilege to take the mantle of Learning Network Fellow from Dr Arjun Gupta. The phenomenal work that Arjun has put into the Learning Network and his tireless efforts to build a community of providers who are passionate and dedicated to high value care is inspiring. By championing innovation and fostering insight into how we define value, Arjun and the Costs of Care team have put the goal of providing optimal, evidence-based care to our patients at the center of everything they do.

My personal path to medicine and to the topic of high value care was unconventional at best. In another time and world, I was a happily engaged graphic designer working at an entertainment company. My life derailed spectacularly when my fiancé, soon husband, was diagnosed with cancer at 27. Outside the tragedy of his diagnosis and his physical symptom burden, the financial burden of his cancer treatment was excruciating. We know now through research that financial toxicity affects quality of life, satisfaction with care, and can even increase mortality. After his death, this experience with the high cost of care started me on the path to medical school and ultimately to the research that I do today on patient reported outcomes.

My research on financial toxicity has shown that high costs can decrease medication adherence and willingness to pay for care. It has also highlighted that over half of cancer patients are underinsured and rapidly depleting their savings. Examining the limits of insurance coverage is particularly relevant to the ongoing health care reform debate. In separate work, our team was able to show the scope of insurance coverage benefits after Medicaid Expansion under the Affordable Care Act for the poorest cancer patients. My current focus is in assessing health care disparities at the end of life. Palliative care has the dual benefit to both increase goal concordant care and decrease futile care; it is, by definition, high value care. Yet, too often, the patients who would benefit the most from palliative care services are referred too late to truly benefit.

The Learning Network Fellowship avails me the opportunity to have an open dialogue with key leaders in the field of value and surrounds me with like minded providers who are devoted to improving patient and health systems outcomes. My focus on both patient and provider education through a shared-decision model is pertinent to providers of all specialties and training. The promise of modern medicine is to provide personalized treatment that is affordable and equitable; to fulfil this promise we must work doggedly to remove obstacles to open and honest communication. Through education efforts via the Learning Network Fellowship, I’m excited to move forward towards that goal.

Fumiko Chino, MD is a cancer researcher at the Duke Cancer Institute with a focus on health care disparities and patient reported outcomes including financial toxicity, insurance disparities and utilization of radiation resources as well as end-of-life care. She is passionate about optimizing cancer treatment processes and costs to improve the overall patient experience and decrease disparities in high quality, high value care.   She is also the incoming Costs of Care Learning Fellow.

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