Latest / Becker’s Healthcare Podcast / Healthcare Upside / Down: Building Better Access to Cancer Care with Patient Centered Partnerships

Transcript

Healthcare Upside / Down: Building Better Access to Cancer Care with Patient Centered Partnerships · Becker’s Healthcare Podcast

0:00
Well, hello everybody, and welcome to Healthcare Upside
0:02
Down, a podcast by Becker's Healthcare and ECG
0:05
Management Consultants,
0:07
where we'll explore the upsides and the downsides
0:09
of healthcare and the industry's most current trends.
0:12
I'm Erica Spicer Mason, and I'm thrilled to
0:14
be joined by three guests today as we
0:16
walk through this conversation.
0:18
We have joining us, Doctor. Brian Druker, the
0:20
president of OHSU Knight Cancer Institute.
0:24
And then we also have two leaders from
0:25
ECG Management Consultants, Elizabeth
0:28
Lebau, the principal of the Oncology Service Practice,
0:32
and Jim Donahue,
0:33
partner of Payer Strategy and the contracting division.
0:37
So with that, Brian, Elizabeth, Jim, welcome to
0:39
the podcast. Thank you so much for making
0:41
time for this today.
0:42
Thank you. To be here. Yeah. Nice to
0:44
be here.
0:45
Oh, great to have you all with us.
0:47
And before we get into the meat of
0:49
our conversation today, I wanted to know if
0:51
each of you could share just a little
0:53
bit more about your background and the perspective
0:55
that you bring to this discussion on cancer
0:57
care access and delivery.
1:00
Brian, let's have you get us started. Yes.
1:02
Thank you, Erica. I'm Brian Drucker. I'm the
1:04
president of the Oregon Health and Science University
1:07
Knight Cancer Institute in Portland, Oregon.
1:10
About thirty years ago, I started my career
1:13
in Oregon as the lead academic developer of
1:16
Gleevec or imatinib for chronic myeloid leukemia,
1:19
and that drug transformed the life expectancy of
1:22
patients with chronic myeloid leukemia from three to
1:25
five years to now normal life expectancy
1:28
and really helped launch this new era of
1:31
precision oncology.
1:33
But my most important role aside from running
1:35
our cancer center
1:37
is I'm still a doctor and I still
1:39
see patients. So every day I'm dealing with
1:41
patients who need access,
1:43
who are fighting with insurance companies over denials,
1:47
are looking at the high cost of medications
1:49
and need financial assistance,
1:51
and have troubles navigating our complicated health care
1:54
system. So I'm right in the midst of
1:57
what's happening in health care
1:59
access and affordability.
2:02
Yeah. Brian, it's so great to have that
2:04
perspective of yours on this call today. So
2:06
thank you so much for sharing more about
2:08
you and,
2:09
a little bit more about your work and
2:10
your practice.
2:12
Jim, how about you next?
2:14
Sure.
2:15
So as you mentioned, I'm a partner in
2:17
our payer strategy and contracting practice. The
2:20
focus of my work is in
2:24
working primarily with academic medical centers that include,
2:29
advanced cancer programs, mostly NCI designated cancer centers,
2:33
as well as stand alone,
2:35
cancer programs
2:37
in developing their strategies
2:39
for their interactions with payers and,
2:42
government as well as,
2:44
commercial payers and in supporting the negotiations of
2:47
the contracts.
2:48
One of the things that occupies
2:50
a lot of my thought
2:52
is thinking about this not in a static
2:54
way, but in a longitudinal
2:56
way because cancer treatment,
2:58
as is true in all areas of health
3:00
care, but I think a particularly
3:02
acute for for cancer care is
3:05
the there's significant advancements
3:07
in
3:08
how
3:09
patients are best treated,
3:11
through all stages of the diagnostic stage and
3:14
as well as the treatment,
3:16
of their of their illness.
3:18
It's evolving very quickly. And so it's dangerous
3:20
if you simply look to the past as
3:22
an indication
3:23
of how you need to think about
3:26
what are the economics needed to support care.
3:28
You almost you really need to understand where
3:30
things are going, especially given the pace of
3:32
evolution.
3:33
And so that longitudinal
3:35
look
3:36
is something that's of particular
3:38
importance to me. And when I think about
3:39
what
3:40
value based care, it's a term that's used
3:42
a lot, is to me,
3:45
that's less about a capitation or whichever buzzword
3:48
you wanna use, but more about
3:50
making sure the economics
3:52
of how and where you're concentrating the revenue
3:55
and what you're paying for aligns,
3:58
as best as you can
4:00
with
4:01
the best way to treat a patient in
4:03
in all aspects of their care.
4:05
Oh, Jim. Well, it's great to learn more
4:07
about you and to have this perspective
4:09
of that longitudinal outlook that you're speaking to
4:12
and the economics of cancer care.
4:14
So thank you for being here. And, Elizabeth,
4:16
I know oncology service practice is right there
4:19
in your title, so I know you work
4:20
closely in this space, but would love to
4:22
learn a bit more about you as well.
4:24
Sure. So it's a pleasure to be here.
4:26
As you said, I'm a principal with ECG
4:29
Management Consultants, and I work with,
4:32
cancer centers all across the country,
4:34
develop helping to develop strategic plans and system
4:37
integration and partnerships and growth planning,
4:41
and really all struggle with the same thing
4:44
for reasons that we'll talk about in a
4:45
few minutes,
4:46
with having sufficient capacity to address
4:50
the the the patient need.
4:52
Before I was at ECG, I spent
4:54
several decades,
4:55
in academic medical centers in Boston
4:59
helping to expand access largely through
5:02
building new buildings, new partnerships, expansion to community
5:06
sites,
5:07
and really trying to,
5:09
trying to expand capacity.
5:11
And then, you know,
5:13
the other perspective that I bring is, is
5:16
deeply personal. I lost both my parents at
5:18
young ages to cancer and,
5:21
you know, watched as they accessed some of
5:23
the best,
5:25
cancer care in the country and the ways
5:27
in which that was really helpful to them
5:29
and the ways in which they really,
5:31
struggled with, with some aspects of it. So
5:34
I bring all of that to the discussion
5:36
today.
5:37
Yeah. Elizabeth, thank you so much for sharing
5:39
that. It's it's great to learn that you
5:41
have this background in the industry, but also
5:44
you're bringing that familial experience with you.
5:47
I know that that can be a real
5:49
a true motivator to do work that matters.
5:51
So thank you again for sharing.
5:53
And I'm excited to elaborate a little bit
5:55
more too on this concept of access. I
5:57
think that's a good place to start our
5:59
conversation because access, of course, can mean a
6:02
lot of different things.
6:03
You know, cancer care is becoming an increasing
6:05
area of focus for leaders.
6:07
We're seeing rising incidence among young younger patients,
6:10
growing costs, and those access barriers that each
6:13
of you have touched on already. So for
6:15
each of you, when we talk about expanding
6:16
access to best practices and diagnosing and treating
6:20
cancer,
6:21
What does that mean to you, and where
6:22
do you think the industry is falling short
6:24
here at the moment?
6:26
And, Brian, maybe you could get us started
6:27
with that since I I know you're seeing
6:29
this, on the ground level.
6:31
Yeah. So
6:33
thank you, Erica.
6:34
When I think about access and affordability and
6:38
all the hurdles that patients face, I just
6:40
wanna come back to and Elizabeth understands this
6:44
as I do because cancer is personal to
6:46
all of us.
6:47
But imagine getting that call and being told
6:50
you've got cancer.
6:52
And
6:53
that is a life changing phone call, and
6:56
your mind is gonna go numb as you
6:58
think about,
6:59
in my how long do I have? What
7:01
does this mean? What's gonna happen to my
7:03
family, my kids,
7:05
my job? All these things are racing through
7:07
your mind
7:08
when you think you might have been given
7:10
a death sentence.
7:12
And
7:13
we need to make this as easy as
7:15
possible for patients to navigate this complicated time
7:18
in their life by getting them into our
7:21
systems, getting them the care they need, but
7:23
also
7:24
ensuring that they get the best outcomes with
7:26
the best and latest technologies and treatment.
7:29
And to do that, we have to make
7:31
sure that not only is the care affordable,
7:34
but also that health care systems can reinvest
7:38
in these new technologies that are gonna lead
7:40
to better treatments and better outcomes and improve
7:43
access.
7:44
So it's this entire ecosystem we have to
7:46
think about,
7:47
but what I care deeply about is making
7:49
sure that the patient is the focus of
7:51
what what we're doing.
7:54
Absolutely.
7:55
Brian, appreciate
7:57
those initial perspectives. And I think what you
7:59
mentioned,
8:01
kind of bringing all myself in the audience
8:03
into that experience of when you get that
8:05
diagnosis,
8:06
the uncertainty of what happens next and how
8:09
unnerving it must be to not have clear
8:11
next steps.
8:12
Appreciate you sharing and highlighting that.
8:14
Jim, Elizabeth, would love to hear from you
8:16
on this as well.
8:17
So, yeah, I can I can go next?
8:19
You know, when I think about access, I
8:21
think about
8:23
the fact that the population is aging and
8:26
it's aging rapidly into the age when cancer
8:29
is typically diagnosed. And in addition to that,
8:32
incidence in younger people are rising. So the
8:35
need for cancer care is just exploding, and
8:38
it's rapidly outpacing
8:41
both a physician shortage and labor issues. So
8:44
we're we're at this place
8:45
where
8:46
there just isn't enough capacity
8:48
to to meet the need. And every
8:52
place that I work with is trying to
8:53
build faster and hire more and hope that
8:56
AI solves some of that. But at the
8:58
end of the day, cancer is an incredibly
9:01
complex
9:02
disease to treat with multiple specialties and multiple
9:06
stages. And
9:07
when
9:08
I think about
9:10
access, I think both about, you know, some
9:13
of the amazing scientific discoveries,
9:15
doctor Druker's Gleevec,
9:17
things like CAR T and other cell therapies,
9:20
but also not the things that are kind
9:22
of the, you know, Lamborghinis of cancer care
9:25
or the quantum physics of cancer care, but
9:27
some of the basic
9:28
ways in which the industry is falling short,
9:31
getting people in for routine colonoscopy and then
9:34
a follow-up,
9:36
with other imaging or in to see a
9:38
specialist.
9:39
And we're just I don't think it's any
9:42
particular
9:43
sector's fault or individual's fault, but we are,
9:46
as an industry,
9:48
falling short.
9:50
Yeah. The capacity challenges are are are so
9:52
important to raise here, Elizabeth.
9:54
Jim, anything you would add from your standpoint?
9:57
Yeah. And I kinda go back to that
9:59
definition I gave earlier for the way that
10:02
I think about what's value based care in
10:05
this, which is aligning the economics with where,
10:08
you know, with with the the care model
10:10
and its entirety that you'd want. And one
10:12
of the barriers I see, and I don't
10:14
put this just on the payers at all.
10:16
I think it's a it's a collective, but
10:18
I think the solution would need to involve
10:20
both sides would be
10:22
thinking about where we're investing our dollars,
10:25
on the things. I'm all for the Lamborghinis
10:29
as Elizabeth talked about. I mean, car t
10:30
is a it's amazing what's done there, and
10:32
that's
10:33
but, you know, when we think about the
10:35
opportunity, I think, to monumentally change things
10:38
of the things that we know that work
10:41
of diagnosing patients earlier. That's a matter of,
10:45
extending
10:46
the knowledge that we have,
10:48
out into a community setting, getting it out
10:51
to,
10:52
to places where people can be screened and
10:54
diagnosed,
10:56
and set on the proper treatment, you know,
10:58
course of treatment as soon as possible.
11:01
And to do that, we need to invest
11:03
in, you know, making this practical.
11:05
It's
11:06
that extension
11:07
involves hospitals themselves, the hospital setting itself, but
11:11
it also involves an extension of
11:14
the places that understand the pathways and extending
11:16
those out into community settings, which means necessarily
11:19
it's physician offices or it's, you know, whatever
11:22
other settings. And the economics of those
11:24
right now
11:25
are misaligned. And so
11:28
I I'd love to see the opportunity for
11:30
collaboration of investment in targeted ways and not
11:33
getting constrained by
11:35
the existing frameworks or parameters of contracts of
11:38
figuring out where we invest. I think it's
11:40
from a best clinical practice for getting economics
11:42
for a moment. I think it makes sense.
11:44
I would argue that it also makes sense
11:46
from an economic standpoint because the cost of
11:49
from, you know, there's humans at the core
11:51
of this, but the cost
11:53
of treating a patient who's diagnosed and set
11:55
in a course of treatment
11:57
earlier,
11:59
in the progression of the cancer
12:01
is less than
12:03
if it's later. As and, of course, the
12:05
outcomes and the human costs, etcetera, are obviously
12:08
at the at the center of this, and
12:10
those are more favorable if you diagnose it
12:12
earlier as well.
12:15
Jim, I appreciate what you're saying here, and
12:16
it really highlights that, I think, tension that
12:19
we're seeing in health care where systems are
12:21
under growing pressure to manage the costs of
12:25
treating something and diagnosing something as complex as
12:27
cancer.
12:28
But then also they're under a lot of
12:29
pressure to advance equitable and high quality cancer
12:32
care.
12:33
So I was going to ask next, you
12:35
know, what do you see as the most
12:36
significant opportunities to close gaps in access and
12:40
outcomes?
12:42
Is it something else? We'd love to give
12:44
a few get a few more thoughts from
12:45
you on this. Yeah. I'll I'll jump in
12:47
and just,
12:48
continue on with what Jim and Elizabeth have
12:51
mentioned.
12:52
Sure. And that's that we in many respects,
12:55
we need to think about how to transform
12:57
our our health care system to a truly
12:59
health care system where it is about diagnosis,
13:03
early diagnosis,
13:05
and prevention.
13:06
And if you think about colonoscopies,
13:09
think about the workforce that we would need,
13:12
the community health workers, the community educators,
13:15
and the the gastroenterologist
13:17
you need out in the communities to perform
13:19
the colonoscopies
13:20
for prevention,
13:21
but also a health care system
13:24
that
13:24
rewarded those behaviors and rewarded
13:27
that early diagnosis or screening.
13:30
And so we have to I think we
13:32
have to completely reimagine
13:34
how we're delivering care, but also think about
13:38
prevention with,
13:39
HPV vaccination.
13:41
Again, community health workers, education,
13:44
that's something that's actually pretty cheap and pretty
13:46
simple
13:47
that could prevent cancer.
13:50
So
13:51
there, if you thought about how would you
13:52
reimburse that, how would you get that out
13:54
to communities
13:55
and enhance the uptake of these life saving
13:59
preventative treatments,
14:01
that could be revolutionary
14:02
in terms of decreasing incidence.
14:05
I agree. It's interesting when you think about
14:07
reimbursement done. There's the reimbursement for, like,
14:11
there's there's a clear, like, framework for reimbursement
14:14
of you. If you've got the vaccine, you
14:16
can get a reimbursement. There's a code for
14:18
that and a reimbursement for that.
14:21
There's a reimbursement
14:22
clear mechanism for reimbursing,
14:25
you know, an MRI or, you know, pick
14:26
your your radiological diagnostic test or for a,
14:32
you know, a physician or a nurse practitioner.
14:34
As you start to get to
14:36
other folks who might extend out there, there's
14:38
not the there's not a real framework for
14:40
reimbursing for those other costs. Everything else that's
14:43
involved in reaching out to the patient and
14:46
communicating to them,
14:47
and and that's one of the I think
14:49
a gap that we've got right now. Because
14:51
to your point, it's there are some things
14:53
that are not expensive
14:55
on the based on the codes that we've
14:57
got, but the whole systems that you need
14:59
to develop to get those out to people,
15:01
there's not a framework to invest it. So
15:03
if you've got a health system that's doing
15:04
it,
15:05
they're doing it for you know,
15:07
it's consistent with their mission, but
15:10
we're budget constrained. And so it it inhibits
15:13
our ability to accelerate that. I would suggest
15:15
that. And doctor Trucker, you're so much closer
15:17
to it than I. I'd be interested in
15:19
your thoughts on on that.
15:22
Yeah. No. Again, and one of the things
15:23
that we're doing in our Tesman area is
15:26
we are investing in community cancer navigators and
15:30
community health care workers.
15:32
And a lot of that is focused around
15:35
things like HPV vaccination, just education in the
15:39
communities. Let's increase the uptake,
15:41
and we're paying for that out of our
15:43
budgets.
15:44
And it would be great if a health
15:46
care system was paying for that, but we
15:48
recognize the impact that has in our state
15:50
and for the people that live in our
15:52
state, so we're willing to do that.
15:54
But, again, I would much rather see that
15:56
this be reimbursed through a health care system,
15:59
than having to put in some philanthropic dollars
16:02
or other things, but we're willing to do
16:04
it because it's important to us.
16:07
Yeah. And I think that kind of leadership
16:08
is is critical. And one of the things
16:10
that I've just found such a pleasure in
16:13
in in getting to know Brian is that
16:16
he's constantly putting the patient at the center
16:19
of decision making.
16:21
And one of the examples of that, where
16:24
I think there is a misalignment in the
16:26
payment system today and yet huge opportunity for
16:29
a win win win for providers, payers, and
16:31
most importantly, the patients,
16:33
is in that early
16:35
diagnostic
16:37
space where
16:38
left to the system's devices,
16:42
someone might have
16:44
a bad outcome on a screening test or
16:46
they might have an incidental finding,
16:48
and then there's they're kinda lost. Right? They
16:51
might get an appointment to follow-up a couple
16:53
weeks later, and then someone might order a
16:55
test a few weeks,
16:56
you know,
16:57
scheduled a few weeks later. And then there
16:59
might be another
17:00
maybe they get the results on the portal
17:02
and they don't know what to do with
17:03
the results.
17:04
And
17:05
in my opinion, that's one of the places
17:07
where there's the most
17:09
suffering. Right? Because you might have cancer. You
17:11
might have this, you know, as as Brian
17:14
said earlier, this, oh my god. You know,
17:16
this is a life changing event. You might
17:18
not, but there's nothing really you can do
17:20
about it until you get through that.
17:22
And
17:23
as much as kind of protocolizing
17:26
and electronic health records and so forth might
17:29
help with that, at the end of the
17:30
day, it's a very human experience. What do
17:33
I do next? How do I get an
17:35
appointment? Who's the right specialist?
17:37
When can I get in? How will I
17:38
get the results?
17:40
And I think that there's no replacement for
17:43
a human being side by side. And that's
17:45
really as I've heard,
17:47
Brian talk, that is really, you know, your
17:50
vision, which I think is both, you know,
17:52
enormously,
17:53
enormously comforting to a terrified patient and family,
17:57
super helpful to the physicians who are trying
17:59
to manage all of this while they're seeing
18:01
an entire day's worth of patients.
18:04
And then as Jim said, from a payer
18:05
perspective, you know, let's get the patient in,
18:07
diagnose, figure out a treatment plan, and get
18:09
them started on treatment so it doesn't it
18:12
doesn't sit there.
18:14
Elizabeth, I really appreciate you highlighting that example.
18:18
It's so helpful. And, you know, I think
18:20
a lot of what you all are touching
18:21
on, which is
18:23
opportunities
18:23
to reshift
18:25
essentially the economics of cancer care, some of
18:27
the reimbursement
18:28
models,
18:29
keep while keeping the patient at the center.
18:31
I mean, those are those are big shifts
18:33
that, of course, require partnership and collaboration.
18:36
So I wanted to talk a little bit
18:38
more about actually operationalizing
18:40
some of these changes.
18:41
So as you as you all look ahead,
18:43
what types of collaboration, whether it's between payers,
18:46
providers, policymakers,
18:48
have the most potential to really reshape access
18:51
in this way? And what would it look
18:53
like if those partnerships
18:54
really worked in sync?
18:56
Maybe I'll I'll start if that's okay. And
18:59
I have small examples,
19:02
of them, but I'd love to see there'd
19:03
be more momentum for us. So I've seen
19:05
examples,
19:07
in
19:08
with institutions
19:09
that are are serving a a wide community,
19:12
academic institutions that include NCI designated cancer centers
19:16
that serve a broad community
19:18
that have,
19:20
invested in
19:22
in in in establishing freestanding clinics,
19:25
throughout the communities that they serve. But we
19:28
did it in a way that it wasn't
19:30
just about cancer because these were, programs that
19:32
incorporated
19:33
a a wide range of services, although cancer
19:36
was a very critical component of it,
19:38
is we
19:39
in the negotiations with the payers, we
19:43
intentionally
19:44
and we're it wasn't you know, we we
19:46
told them what we were trying to do
19:48
is shifting dollars to different places. We weren't
19:50
taking just a decrease. We were,
19:53
we shifted dollars. We reduced what you got
19:56
paid for drugs a bit, in the hospital
19:58
setting. We increased what the reimbursement
20:01
was in the physician setting, which made the
20:04
viability of the freestanding clinics,
20:06
more sustainable,
20:08
especially want those that are, you know, connected
20:11
to,
20:12
the care team. In this case, it was
20:14
epic, and so you had, you know, all
20:16
the the pathways and etcetera were,
20:19
were
20:20
supported through that system.
20:22
And so the patients were able to get
20:24
access to care
20:26
in a wider range of settings
20:29
while remaining
20:30
connected to their care teams. Because I think,
20:33
you know,
20:34
one of the things that I see is
20:35
a real tension that's problematic,
20:38
between providers and payers, particularly related to cancer
20:41
care,
20:42
is the payers are understandably
20:45
looking to control what they see as higher
20:47
cost. If they look at it in myopic
20:49
sense,
20:50
the cost of a of care that's provided
20:52
in a hospital setting is more expensive than
20:55
in a freestanding setting or in any other,
20:58
you know, ASC. But it's mostly, in this
21:00
case, gonna be,
21:02
freestanding settings.
21:03
And so often,
21:06
the efforts to try to redirect care to
21:09
less expensive settings
21:11
takes the form of
21:13
separating the patient from their care team. So
21:16
you'll have an institution
21:18
that
21:19
does not have an economic model that makes
21:22
the freestanding
21:23
settings sustainable.
21:24
And so they don't have those settings for
21:26
a lot of the care related to cancer.
21:28
And so the initiatives by the payers to
21:31
say that you have to get care at
21:33
a freestanding setting
21:34
is effectively saying,
21:36
you need to leave your care team for
21:38
a critical aspect of the treatment of your
21:40
cancer, which is really problematic. And I can
21:44
imagine from a, you know, from a personal
21:45
standpoint
21:46
would be terrifying. Right? And,
21:48
understandably,
21:50
I think,
21:52
the opportunities for collaboration would be,
21:55
in a more systematic way and not having
21:57
it be the exception,
21:58
finding models that are looking to
22:01
make the freestanding model sustainable
22:03
with the decisions of where the patient is
22:05
treated
22:06
being clinically driven as opposed to financially driven.
22:09
And, frankly, that requires collaboration on both sides
22:12
and a degree of trust that's,
22:15
been hard to engender. But,
22:17
you know, I do find that when you
22:19
make this very real,
22:21
it it changes the dialogue with the with,
22:23
you know, between providers and payers. If you
22:26
understand that there are patients in the middle
22:28
of it, if you bring that very much
22:30
into focus
22:32
And and that's this is a little bit
22:33
kumbaya. So I I you know, there's no
22:36
magic bullet in that. This is just gonna
22:38
take hard work. But I think I hope
22:40
if we can create more examples of that,
22:42
we create momentum
22:43
that allows for this to become more the
22:45
norm and have less
22:47
headwinds against it to move towards those models.
22:50
I would echo some of what Jim said,
22:52
and I would very much like to see
22:54
close relationships
22:55
between providers and payers. And
22:58
just relate,
22:59
a pivotal moment in my career was
23:02
I was giving a plenary talk at ASCO
23:05
and talking about the discovery of Gleevec and
23:08
the impact it's had on the field.
23:10
The talk right before mine was somebody from
23:13
Sloan Kettering, had previous been at Duke,
23:16
who was talking about setting up a navigation
23:19
program for cancer patients undergoing therapy
23:23
where they were monitoring them for early signs
23:26
of symptoms like fevers, fatigue,
23:29
and having a nurse reach out to these
23:31
patients if they saw kind of a blip
23:33
in what was going on so they could
23:35
keep them out of the emergency room, keep
23:37
them out of the hospital.
23:39
And not only did they save money by
23:41
doing that, they extended survival by three months.
23:46
So think about all the treatments that insurance
23:49
companies will pay for
23:51
that extend survival by three months in advanced
23:54
cancer,
23:55
And imagine you put that into
23:58
a system that could help hundreds of patients
24:00
for that same amount of money by keeping
24:02
them out of the hospital, saving costs,
24:05
and extending survival and improving quality of of
24:08
of their life.
24:10
And to me, that was pivotal and it's
24:11
okay. We need to focus more on, again,
24:14
patient centric,
24:15
but let's involve our payers in those discussions
24:18
and have them help to reimburse a system
24:21
that puts the patients at the center.
24:24
It's a really powerful example, Brian. Thank you.
24:27
Elizabeth, anything you would add here?
24:29
Yeah. I I would just add, I think
24:31
those are both those are those are great
24:33
examples. I think there's the opportunity to share
24:36
knowledge not only
24:38
in
24:39
clinical and research findings, but also in operational
24:41
findings. And I I just spent a little
24:43
bit of time with some folks from
24:46
Ohio State, Johns Hopkins,
24:48
Huntsman,
24:50
talking about
24:51
diagnostic
24:52
clinics,
24:54
which I'm really excited about because I think
24:56
it's a pretty low cost solution to a
24:58
complex
24:59
problem that's
25:01
today under reimbursed but really worth exploring. And
25:04
what those are are, you know, often started
25:07
with just a, patient navigator and an advanced,
25:11
advanced practitioner, nurse practitioner, or
25:14
a physician assistant with some medical direction,
25:18
oversight.
25:19
And it's a place where if people have,
25:22
a positive finding on a screening test or
25:24
an incidental finding in in imaging or just
25:26
a suspicion of cancer that needs to be
25:28
worked up,
25:30
that could be managed by the primary care
25:31
physician. But we all know that primary care
25:34
physicians are incredibly strapped
25:36
for time.
25:37
It could be managed by a specialist, but
25:39
it's not always clear which specialist is the
25:41
right one. And so
25:42
what these places have done is developed a
25:45
largely protocolized
25:46
approach to
25:48
diagnosing cancer
25:50
that is managed on a day to day
25:51
basis by the APP in conjunction with a
25:54
navigator who helps the patient,
25:57
get to the next step, get an appointment
25:59
with the right specialist,
26:00
get the right diagnostic testing,
26:03
waits for the results, stands side by side
26:06
with the patient, walking them through each step
26:08
of the process, answering their questions, hopefully easing
26:12
some of their anxiety,
26:13
at least by getting them to the right
26:15
next place, and then does a hand off
26:18
to,
26:19
if there is a diagnosis to the right
26:21
specialist. And when I think about my parents'
26:24
experience
26:27
undergoing cancer, I think the most painful time
26:30
throughout as difficult as it was, and they
26:32
both, you know, they both died from it.
26:34
They had bad outcomes. But even with that,
26:36
the most difficult time was that uncertainty and
26:39
that aloneness.
26:40
Right? What do I do next? I don't
26:41
even know who I should call, and I
26:43
gotta wait for a callback from the doctor.
26:45
And,
26:46
and and so this kind of thing is
26:48
very low cost. Right? It's it's really just
26:51
the labor and some system support.
26:53
And it's hugely helpful to patients getting the
26:56
diagnosis
26:57
faster
26:58
and hugely helpful getting the the the patient
27:00
to the right subspecialist.
27:02
Right? So if they if they have,
27:05
you know, us in my dad's case, a
27:07
gastroesophageal
27:08
cancer, they end up with a GI oncologist
27:11
and not, you know, some other
27:13
some other specialist, which would then just be
27:15
wasting everybody's time. So
27:17
I'm really excited about that. I think there's
27:19
a lot of opportunity there. I hope that
27:21
the payers see the value in it beyond,
27:23
you know, an NP visit.
27:26
But we're not quite there yet, but I
27:27
think there's a lot of a lot of
27:29
potential.
27:30
I would just echo that as well. The
27:32
uncertainty not knowing is way worse than than
27:35
actually knowing it. But I'd also
27:38
recognize that the Lamborghini
27:40
of early cancer detection's coming, and these are
27:42
the multicancer early detection blood tests.
27:46
And that's gonna put a whole new wrinkle
27:48
into
27:50
getting access to screening
27:52
out in the communities, but then increasing the
27:54
numbers of people that are gonna need to
27:56
be evaluated for potential cancer. And that's that's
28:00
coming and coming quickly.
28:03
Yeah. Brian, I appreciate that that forward look
28:06
there. We've definitely seen a lot more conversations
28:09
about the multi cancer early detection tests in
28:12
our own work here at Becker's. And,
28:14
I just wanna say I I've appreciated this
28:16
conversation so much and the insights from the
28:18
three of you. I think this is the
28:20
most human centered conversation on access that I've
28:23
had in a long time and, just wanna
28:25
say again how much I appreciate your time
28:26
and your expertise.
28:28
Before we wrap, are there any final thoughts
28:30
or takeaways that you'd like to leave with
28:31
our listeners?
28:33
I guess the one thought that I have
28:35
is that there's
28:36
there are so many things
28:38
that we know we could do
28:41
if we can figure out how to work
28:43
together. Like, we there are so many things
28:45
that we could do to advance the way
28:48
that
28:49
patients with cancer
28:51
are are treated from
28:53
from a clinical,
28:54
from
28:55
a a humane, you know, from a, you
28:57
know,
28:59
a a a human perspective
29:01
of what we know already that do not
29:03
require breakthroughs.
29:05
And I think our big challenge now is
29:07
figuring out how we
29:09
how do we take advantage of the things
29:11
we already know we can do. Reminds me
29:13
of a slogan, just do it.
29:18
Perfect. Elizabeth, anything else you wanted to add?
29:21
Yeah. I was just gonna say, I think
29:23
that, you know, I I I really agree
29:25
with with Jim on that. And I I
29:27
think that
29:29
the pace of everything is getting
29:31
so fast, and people are just trying to
29:33
get through their days in a way that's
29:35
really hard to slow down and look at
29:37
and say, does this make sense? And I
29:39
think that's really gonna be essential because I
29:42
think that when you're just trying faster and
29:44
faster to keep up with whatever it is,
29:46
getting the bills out the door, getting the
29:48
appointments made, getting the patients seen,
29:50
you miss so much of that opportunity that
29:52
really is right before us. And I really
29:55
appreciate conversations like this because I think that,
29:57
you know, perspective I bring, certainly the perspective
30:00
that Doctor. Druker brings and that Jim brings
30:02
are all so different. And yet, you know,
30:04
in twenty minutes, we've just identified a whole
30:06
set of things that if we could
30:08
really
30:10
focus on and make happen, I think there's
30:12
huge potential.
30:14
So well said. Elizabeth, thank you for closing
30:17
us out. And Brian, Jim, wanna thank you
30:19
again for joining as well. It's been great
30:21
learning from the three of you. We also
30:23
wanna thank our podcast sponsor for today, ECG
30:25
Management Consultants.
30:27
Listeners, be sure to tune into more podcasts
30:29
from Becker's by visiting our podcast page at
30:32
beckershospitalreview.com.