Latest / Becker’s Payer Issues Podcast / Advancing Smarter, More Personalized Cancer Care with Dr. David Debono

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Advancing Smarter, More Personalized Cancer Care with Dr. David Debono · Becker’s Payer Issues Podcast

0:01
- The payer provider relationship has never been simple,
0:04
- but what's happening now is something different.
0:07
- Value based models are maturing unevenly,
0:10
- prior authorization
0:11
- reform is reshaping workflows on both sides, and
0:14
- affordability pressure is intensifying.
0:17
- The organizations that figure out how to collaborate
0:19
- genuinely, not just contractually,
0:21
- are the ones that will set the terms
0:23
- for what comes next.
0:24
- Becker's fifth annual fall payer issues round table
0:27
- brings together more than 500 executive level attendees
0:30
- and 70 plus speakers for two days of
0:32
- focused senior level conversation
0:35
- on benefit design, network strategy, transparency,
0:38
- and the financial and regulatory dynamics that are
0:41
- redefining how care gets paid for. Join us
0:44
- November second and third at the Swiss Hotel
0:46
- Chicago.
0:47
- For the agenda and event details, visit beckerspayer.com
0:51
- and click on the events tab in the
0:52
- upper right.
0:54
- Hi, everyone. This is Elizabeth Caslow with the
0:57
- Becker's Payer Issues podcast.
0:59
- I'm excited today to be joined by David
1:01
- D'bono, oncology medical director at Carillon Health. Doctor
1:04
- D'bono, thank you so much for joining us
1:06
- today. Thank you. Appreciate the opportunity.
1:09
- Of course. And so before we jump into
1:11
- some of the questions here, I would love
1:13
- to hear a little bit more about your
1:15
- career at Carillon and also just your general
1:17
- health care background and what you currently do.
1:21
- Well,
1:21
- again, thank you so much for,
1:24
- for the time today.
1:26
- I trained
1:28
- at Indiana University, so I did all my
1:30
- internal medicine
1:31
- residency, oncology fellowship.
1:34
- During the time of my internal medicine residency,
1:37
- there was a lot of
1:39
- oncology research being done at Indiana University.
1:43
- And I got to know
1:45
- many of those investigators
1:46
- and and so made a decision to to
1:49
- go into oncology.
1:51
- And I practiced
1:53
- community oncology
1:55
- in a small community in Illinois, South Of
1:58
- Chicago for about thirteen years.
2:01
- And during that time also became interested
2:04
- in palliative care and supportive care. And and
2:07
- so for about seven years, I did palliative
2:09
- care
2:10
- in an oncology setting,
2:13
- here in Detroit, Michigan.
2:15
- And for the last nine years, I've been
2:17
- with Carolina and Elevance Health.
2:20
- And I guess I would say that
2:23
- my motivation
2:24
- has been,
2:26
- to
2:27
- try to optimize
2:29
- the way we support,
2:31
- our members,
2:33
- and patients
2:34
- who are undergoing cancer care.
2:37
- And so we do that in a variety
2:38
- of ways.
2:39
- Certainly,
2:40
- one of the ways is something that we'll
2:42
- be talking about today,
2:44
- with navigation,
2:46
- but are also trying to make key connections
2:49
- with our palliative care resources
2:51
- and behavioral health resources. So
2:54
- our team actually works
2:56
- one on one with oncology
2:58
- providers,
3:00
- and practices
3:01
- around the country,
3:03
- to optimize,
3:05
- not only the quality of care, but also
3:07
- trying
3:08
- to make these connections
3:10
- with some of these supportive care resources that
3:13
- we have in order to overall optimize,
3:16
- the care that our members are getting.
3:19
- So let's dive into that initiative you hinted
3:21
- at earlier. So we're gonna discuss Elvance's cancer
3:24
- care engagement initiative. So at a high level,
3:28
- can you break down this program,
3:30
- when it started, what drove it, who has
3:32
- access
3:33
- to it, and what it actually includes?
3:37
- Sure. So it
3:38
- it started with some conversations,
3:41
- back,
3:43
- in kinda 2018,
3:45
- 2019.
3:47
- There was growing evidence,
3:50
- that
3:51
- navigation
3:52
- in cancer care
3:54
- makes a difference.
3:56
- It makes a difference in care quality.
3:59
- It makes a difference in patient experience,
4:03
- and it improves,
4:05
- the things that are important to patients,
4:08
- such as
4:09
- staying at home, not having to be hospitalized,
4:12
- avoiding complications,
4:15
- being able to continue to be employed,
4:19
- if we can get the optimal supportive care
4:22
- for them. So we had a lot of
4:24
- conversations
4:24
- about the the data
4:26
- that was supporting
4:28
- this type of work
4:30
- and decided that,
4:32
- we should launch our own navigation program. At
4:34
- that time,
4:36
- most practices didn't have navigation.
4:39
- What you see now is that practices and
4:42
- cancer centers are starting to adopt,
4:46
- this type of work.
4:47
- But I think we were,
4:49
- pretty unique,
4:50
- in trying to get this done early,
4:53
- in the in the payer space.
4:55
- And
4:56
- our thought process,
4:58
- primarily really was to
5:01
- to understand that the care
5:03
- that our members are going through
5:07
- when they're diagnosed with cancer is complex,
5:11
- has a big impact on their families,
5:14
- and that navigating
5:16
- the entire experience is difficult.
5:19
- And we thought we could really make a
5:20
- difference in that regard.
5:22
- So which members have access to this initiative
5:25
- right now, or is there not really anyone
5:28
- left out of it right now?
5:30
- So our our large local
5:33
- groups,
5:35
- are part of the program.
5:36
- Our Medicare Advantage Plans are part of the
5:39
- program,
5:40
- and it is available,
5:42
- for employer
5:44
- funded plans,
5:46
- if that's a program that they're interested in,
5:49
- in buying up for.
5:51
- Got it. And so
5:54
- cancer care engagement has an eighty four percent
5:56
- engagement rate. So what has been the key
5:59
- to unlocking
6:00
- such a high rate, and how can other
6:02
- navigation programs, other clinical programs replicate those results?
6:08
- Well, I think it it speaks to,
6:11
- identifying
6:12
- the right patients.
6:15
- We do use,
6:17
- some analytic resources
6:19
- to identify what we believe are the highest
6:22
- risk patients
6:23
- and the highest need patients.
6:26
- So if you're
6:28
- if you're contacting,
6:31
- a group of patients,
6:33
- that are
6:34
- likely to be receptive to a navigation program,
6:38
- I think you're gonna have high engagement rates.
6:41
- The other
6:42
- key point, I think, with our program
6:45
- is that it is
6:47
- human directed, if you will.
6:50
- You're not getting a call from,
6:53
- you know, an automated bot.
6:55
- And so
6:57
- so when we when we get somebody on
7:00
- the phone or through our digital apps, etcetera,
7:04
- knowing that,
7:06
- they are speaking to
7:08
- a oncology certified navigator,
7:10
- someone who,
7:12
- understands the space,
7:15
- who has a very comprehensive
7:17
- way of evaluating the situation,
7:20
- I think patients respond to that.
7:23
- Families respond to that. And so I think
7:26
- the
7:27
- the idea of,
7:30
- making a simple connection,
7:32
- making a human connection
7:35
- really contributes to the idea that
7:38
- patients are interested.
7:40
- They find the program to be helpful,
7:43
- and they remain engaged.
7:45
- So cancer care engagement has been associated with
7:48
- a seven percent reduction
7:50
- in avoidable inpatient admissions for Medicare Advantage members
7:54
- and fifteen percent for commercially insured. So why
7:57
- do you think there is variation with those,
8:00
- between those types of plans?
8:03
- And also, are you looking to
8:05
- get any more concrete data on ROI
8:08
- when it comes,
8:09
- to the solution?
8:11
- So your first question, I think, is a
8:13
- good one. And I think it it's
8:17
- it zero in zeros in on
8:19
- the differences in populations that we serve.
8:23
- When we think about a commercial population
8:26
- in the oncology
8:27
- space,
8:28
- we are
8:29
- primarily talking about
8:32
- younger patients
8:33
- who may have families.
8:35
- They may be,
8:37
- have full time employment.
8:40
- And
8:41
- so it's a different population than, let's say,
8:44
- a Medicare population
8:46
- who are intrinsically
8:48
- older,
8:50
- maybe retired,
8:51
- may have more comorbidities,
8:53
- and
8:54
- so I think the populations are different.
8:57
- But I would say that the difference in,
9:01
- the inpatient admission rates are
9:04
- are not large. So I think the
9:07
- the fact that we're impacting
9:09
- inpatient admission rates for both populations
9:12
- is probably the take home message,
9:15
- and I think we do that in a
9:17
- number of ways.
9:19
- Number one,
9:20
- our
9:21
- navigators
9:22
- are specifically trained
9:25
- to connect
9:26
- with oncology
9:28
- practices
9:29
- when there are significant issues identified.
9:33
- So,
9:34
- and they'll do this on a three way
9:36
- call. They'll they'll keep the the member on
9:39
- the call while they're contacting the practice.
9:43
- So when the navigator is concerned about a
9:45
- particular symptom,
9:47
- or,
9:48
- concerns about not being able to get to
9:52
- an appointment,
9:53
- they make that connection with the practice,
9:56
- and try to solve that problem on the
9:58
- spot. And I think that impacts,
10:01
- things like,
10:03
- inpatient admission rates,
10:05
- and,
10:07
- those kinds of
10:09
- issues that, again, I think are
10:11
- not only important
10:12
- to overall quality, but I think specifically important
10:15
- to patients.
10:17
- So I think this the the provider
10:20
- partnership is an important part of the program.
10:24
- With regards to ROI,
10:27
- that continues to be a work in progress
10:29
- as far as calculations.
10:31
- And
10:33
- though I don't have anything to share publicly
10:35
- right now,
10:37
- I would say that,
10:39
- what we are seeing is positive,
10:42
- and it's certainly something that we're interested in.
10:45
- But I think what we're seeing kind of
10:48
- it over the program evaluation,
10:50
- if you will,
10:52
- is that
10:54
- impacting
10:56
- engagement rates. So having a high engagement rate
11:00
- impacting
11:01
- important
11:02
- outcome measures
11:04
- is likely to deliver
11:07
- an ROI.
11:09
- All things are sort of lining up that
11:11
- way.
11:12
- So I think
11:13
- the execution of the program, the design of
11:17
- the program,
11:18
- I think, is
11:20
- is
11:21
- making a complex journey for the member,
11:25
- easier.
11:27
- It is definitely
11:28
- impacting
11:29
- outcomes,
11:31
- and I think the
11:32
- the overall value of the program will follow.
11:35
- So I know earlier, you were talking about
11:38
- how your team had been mulling over this
11:40
- idea since a little bit before 2020.
11:43
- Can you talk about some of the
11:45
- early learnings from this program?
11:48
- What have you had to adapt?
11:50
- What's changed?
11:52
- How have you adjusted to accommodate members?
11:55
- Yeah. So good question because I think any
11:58
- any program like this is going to evolve.
12:02
- And
12:03
- I think some of the key learnings
12:06
- was,
12:07
- number one,
12:08
- we have to continue to refine,
12:12
- our ability to find the right member at
12:14
- the right time,
12:16
- in their cancer journey.
12:18
- So adopting
12:19
- our predictive analytics
12:21
- to identify patients, I think, is is, an
12:24
- ongoing process that we continue to monitor.
12:28
- The idea of
12:30
- making provider connections,
12:34
- as a
12:36
- inherent part of the program,
12:39
- came from feedback from practices.
12:43
- So our team
12:44
- now I'm talking not about our navigator
12:47
- team, but our provider enablement team, you know,
12:51
- speaks to this program whenever we meet with
12:53
- oncology practices.
12:56
- And feedback we got was
12:59
- this looks like a great program.
13:02
- However,
13:03
- we need to know
13:06
- if one of our patients is being navigated
13:09
- in your program.
13:11
- We are interested in knowing
13:14
- when your navigators
13:15
- identify problems,
13:18
- and that directly led to,
13:21
- enhancing provider partnerships,
13:24
- in the program.
13:26
- So I think that was a a a
13:28
- really key learning.
13:31
- And then thirdly,
13:33
- as the program,
13:35
- has developed and grown,
13:37
- we felt like
13:39
- we have a number of oncology
13:41
- clinical resources
13:43
- at Carillon.
13:44
- We're talking about physicians,
13:46
- physician assistants,
13:48
- oncology nurses, oncology pharm d's.
13:52
- And we felt like
13:54
- the navigation program, the CCE program,
13:58
- could benefit
14:00
- from the expertise of the clinicians within our
14:03
- organizations.
14:05
- So we have developed an advisory board,
14:09
- where
14:10
- the oncology clinicians have an opportunity,
14:14
- to provide
14:15
- feedback to the navigation team,
14:19
- provide them
14:20
- updates on what's going on in the medical
14:22
- literature with regards to navigation
14:25
- or other important issues.
14:27
- And what we have found is this has
14:29
- led to,
14:31
- specific educational
14:33
- opportunities for,
14:34
- our navigators,
14:37
- as well as their leadership,
14:39
- and it's also led to specific
14:42
- changes
14:43
- in a program.
14:45
- One thing that we are concentrating on now
14:48
- as a result,
14:49
- is how can we optimize
14:52
- the support of
14:53
- the caregiver
14:55
- of the
14:56
- the member with cancer.
14:58
- And so this was a a direct
15:01
- result of discussions that we had,
15:03
- within this oncology clinician advisory board.
15:07
- So
15:08
- I think
15:09
- a lot goes into the background of programs
15:12
- like this.
15:13
- We recognize that cancer care is complicated.
15:18
- Members need navigation
15:20
- to get, through their journey.
15:24
- And if I had to sort of summarize
15:26
- the ideas here, I would say that
15:29
- what we've really tried to do
15:32
- is to take advantage of all the resources
15:34
- that we have available,
15:36
- to really optimize this program over time.
15:39
- What are you looking to next when it
15:42
- comes to cancer care at Elevance?
15:45
- Well, cancer care,
15:47
- is a big, you know, it's a big
15:49
- field.
15:50
- And
15:51
- I think when you read the headlines about
15:53
- cancer care, you primarily read about new drugs.
15:58
- You know, a national meeting occurs.
16:01
- A new drug is,
16:03
- presented as a new drug as a new
16:06
- a new optimal care for particular patient,
16:10
- patient population.
16:11
- I'm just giving you an example. There was
16:13
- a new drug for pancreas cancer that was
16:16
- presented
16:17
- at our June meetings this year, and that
16:20
- made a lot of headlines.
16:22
- Our work
16:24
- and our team's work
16:26
- is concentrating
16:28
- on
16:29
- taking advantage
16:31
- of all the knowledge that has been developed
16:33
- over the last thirty years or so
16:36
- and how we better support
16:38
- members with cancer.
16:40
- So we've talked about navigation today,
16:43
- which has proven to be a successful program.
16:48
- We believe it
16:49
- simplifies the experience for for members.
16:53
- It optimizes provider partnerships
16:56
- and, ultimately, I think, delivers outcomes that are
16:59
- important,
17:00
- to our members.
17:01
- There are other types of supportive measures
17:05
- that we can continue to optimize.
17:08
- We have
17:09
- considerable
17:10
- palliative care resources
17:12
- at Carillon,
17:14
- And we believe
17:16
- formally
17:17
- connecting
17:19
- palliative care and oncology,
17:21
- is extraordinarily
17:23
- important.
17:25
- And if you go to a big hospital
17:27
- right now,
17:28
- in a big city, an academic center,
17:31
- there's up there's
17:33
- plenty of resources
17:35
- in palliative care.
17:37
- But most of the care that patients are
17:39
- getting in this country
17:41
- are outside of academic
17:43
- medical centers,
17:44
- and palliative care resources are scarce.
17:48
- We believe we can,
17:50
- help connect
17:52
- practices that don't have a lot of access
17:55
- to palliative care
17:57
- to care on resources in this regard.
18:00
- The same thing is true about behavioral health
18:04
- in oncology.
18:06
- There's a
18:07
- a a large literature
18:09
- on the importance of optimizing mental
18:12
- health, behavioral health,
18:14
- in members who have cancer.
18:17
- We have considerable
18:18
- resource in behavior behavioral health,
18:22
- and making a formal connection,
18:25
- we believe has
18:27
- great possibilities,
18:29
- and we're just
18:31
- starting those conversations.
18:34
- And then lastly, physical activity,
18:37
- in oncology patients who
18:39
- have undergone particularly curative intent treatment,
18:43
- is a is a growing part of oncology,
18:47
- and we believe we can do more to
18:49
- support
18:51
- that realm.
18:52
- And so, again, having some initial conversations
18:56
- on how we can
18:58
- optimize these connections.
19:00
- And I would say the theme here is
19:04
- that
19:05
- there are ways to support members with cancer
19:10
- outside of the drugs that they receive.
19:13
- And
19:14
- to optimize these types of supportive
19:17
- measures
19:19
- requires
19:20
- strong
19:21
- partnerships,
19:23
- whether it's internal resources and palliative care or
19:26
- behavioral health,
19:28
- external resources and exercise,
19:31
- or just simply
19:33
- partnering with oncology providers and finding out
19:37
- what they need.
19:38
- That, I think,
19:40
- is going to unlock,
19:43
- considerable
19:45
- opportunity
19:46
- for quality improvement,
19:48
- as well as patient
19:50
- experience improvement,
19:52
- in the years to come.
19:54
- As we wrap up, I know we have
19:55
- a few minutes left.
19:57
- Do you have any final thoughts
19:59
- for,
20:00
- industry leaders either in the payer space or
20:04
- at their services
20:05
- subsidiaries?
20:07
- Yes. Well, first of all, again, thanks so
20:09
- much for
20:10
- for inviting us
20:12
- and to give us this opportunity
20:15
- to,
20:16
- to explain sort of what we are doing
20:18
- in
20:19
- in the cancer care,
20:21
- models that we are developing.
20:24
- I think the key message here,
20:27
- is that
20:29
- cancer care in 2026
20:33
- is vastly different than it was
20:36
- even fifteen years ago, but certainly twenty five
20:39
- or thirty years ago.
20:41
- And in many ways,
20:44
- that experience of the member is vastly improved.
20:49
- Our drugs are better. Our knowledge is better.
20:52
- Our hospitals are better.
20:55
- But the experience
20:56
- is increasingly
20:58
- complicated.
21:00
- It can be fragmented at times.
21:04
- The needs of members change over time.
21:07
- So the the navigation
21:09
- needs
21:10
- of a member who's first diagnosed
21:12
- and is working full time and has small
21:14
- children
21:16
- is very different
21:18
- in that same patient
21:20
- ten years later
21:21
- who might be
21:23
- developing recurrent cancer or develop or has developed
21:27
- a toxicity,
21:29
- from the treatments that they got ten years
21:31
- ago.
21:32
- So the the needs of members change over
21:35
- time,
21:36
- and you absolutely
21:37
- have to be able,
21:39
- to, number one,
21:41
- identify those members
21:45
- to be able
21:47
- to determine
21:49
- what are their key needs,
21:52
- and then have the resources,
21:55
- to be able to
21:58
- figure out ways,
21:59
- to meet those needs.
22:02
- It's going to require partnerships,
22:05
- with,
22:06
- community resources,
22:09
- with the local oncology practices,
22:12
- with
22:13
- other cancer supportive care organizations,
22:16
- within the patient's community,
22:18
- or within our internal resources.
22:22
- Making that cancer journey
22:25
- simpler
22:27
- for members as well as their families
22:31
- to make it
22:32
- understandable,
22:34
- to avoid complications,
22:36
- to avoid toxicities,
22:39
- and maximize
22:40
- the quality of life for that member.
22:44
- It takes work.
22:46
- It takes commitment. It takes a program that
22:49
- is sustainable
22:51
- over time for that member.
22:53
- So my advice is
22:56
- to whether you're an employer, whether you're,
23:00
- an organ a local community organization, whether you're
23:03
- in the payer space,
23:05
- is
23:06
- commit,
23:07
- to a program that
23:09
- you have resources for,
23:12
- that where your skill sets lie,
23:16
- and jump in and
23:18
- and
23:19
- commit to making a difference.
23:21
- Not every organization is gonna be able to
23:24
- to do all things, including our own.
23:27
- However,
23:29
- we can each have a part,
23:31
- in making the member experience
23:35
- with cancer
23:36
- easier,
23:39
- simpler,
23:41
- and
23:42
- maximizing the quality of life
23:45
- for the member and the family.
23:47
- There's a lot of information out there.
23:49
- There are a lot of organizations
23:51
- doing this work,
23:53
- and
23:54
- I think,
23:55
- at the end of the day,
23:57
- we have to figure out ways
23:59
- to support the whole person,
24:01
- to partner
24:04
- with the care team that the member has,
24:07
- and
24:08
- to ultimately make a complex
24:12
- experience
24:13
- simpler,
24:14
- less fragmented,
24:17
- and,
24:18
- overall, a better quality experience
24:21
- for the member and their family.
24:24
- Doctor Debona, thank you so much for joining
24:26
- us today.
24:27
- Thank you. I appreciate the opportunity.
24:30
- Of course. And to our listeners, if you'd
24:32
- like to hear more podcasts from Becker's Health
24:35
- Care, you can visit beckershospitalreview.com.
24:38
- Thank you.