CareEdge: a patient-centered approach to cancer diagnosis and treatment planning (transcript)

This is the transcript of my recent podcast interview with Cancer Treatment Centers of America CEO, Steve Bonner.David Williams: This is David Williams, co-founder of MedPharma Partners and author of the Health Business blog.  I’m speaking today with Steve Bonner.  He is CEO of Cancer Treatment Centers of America (CTCA).  Steve, thanks for being with me today.Steve Bonner:            You’re welcome David.  I’m glad to be here.Williams:            What is CTCA, and what is the Patient Empowered Care Model?Bonner:            Cancer Treatment Centers of America is a rapidly growing network of very sophisticated cancer-focused centers that are licensed as hospitals. We are located in four states and under construction in a fifth.  We focus exclusively on cancer and specialize in later stage and complex forms. We have very sophisticated technology and talent and a lot of experience with cancer.The Patient Empowerment Model of Care is the genetic foundation of CTCA.  We were created by an international merchant banker whose mother got cancer. When she died he concluded that he couldn’t find a place that really was interested in understanding what she needed and wanted.He ran into a lot of bureaucracy.  So from the very beginning we have worked very hard to understand the patient and recognize the importance of giving patients as much control as possible over the process.Williams:            I know a key process issue is related to the initial diagnostic work. Can you describe the issues that patients typically face when they’re in the diagnostic phase?Bonner:            There’s a real irony at the very beginning of the cancer experience for most patients in America.  There are four things that they want once they know they’ve got cancer.  Number one, they want to know as much as they can possibly know about their cancer; where it is and how far it’s progressed in their body.  Number two, they want to know what options are available to them to treat the cancer.  Number three, they want to know what it’s going to cost them.  And number four, they want to know how quickly they can get into care.The way the market works today is that the patient typically gets that initial diagnosis from a family physician who is not a cancer expert. They then get a referral to an oncologist and have to call and make an appointment and wait some period of time to get in. Tests are taken, and they have to wait for the tests to come back. Most often they’ll get another referral to get more precise tests so they have another wait time/turnaround time. So it’s generally weeks and it can be months before patients get into effective care. That builds stress in their minds over that timeframe.  It also obviously gives the cancer a change to progress even further without having an effective treatment.Williams:            What is your company doing to address some of those issues?Bonner:            Our latest innovation is called CareEdge. It is a combination of services and prices that addresses this diagnostic phase.  If someone is interested in CareEdge, they’ll get four specific components to the process.  Number one, we’ll give them a complete listing of the diagnostic services that they’ll get. We believe they’re very comprehensive and very complete.  Number two, they get our guarantee that we will complete the diagnostic process in no more than five days.  Number three, they get a guaranteed price for the diagnostic work.  And number four, they get a complete personalized written care plan that suggests what they should consider implementing in terms of moving to care.  They can either have us implement that care plan at CTCA or they can take it to another provider and move right into the care phase built on that plan.Williams:            When you say that you have a comprehensive set of services, what would be the things that would comprise that suite?Bonner:            It’s grounded in this very holistic and integrative style of care that we have.  They would go through all of the conventional consultations.  They would start with a consultation with an oncologist.  They would be examined with all of the conventional radiology exams including MRIs and other precise diagnostic techniques.  They would also spend individual consultation time with a radiation oncologist if that’s appropriate, a medical oncologist to look at chemotherapy, with a surgical oncologist if surgery seems to be indicated.They spend one-on-one time with an oncology trained nutritionist because nutrition is so important to the cancer treatment process.  They would see a naturopathic doctor who is certified in oncology, with a mind, body, medicine trained expert.  They would have time with spiritual support people who work only in an oncology setting.  They also will have time with exercise physiologists to talk about how important exercise is to the immune system and to the treatment process.  They may talk to an acupuncturist and they may also get some exposure to things like humor therapy, laughter therapy, Reiki, yoga --all these things that can also be helpful to the process.It’s a very comprehensive experience that’s conducted over the three to five day period that I’ve described.Williams:            As you were describing those four different components, one of the ones that is not exactly service oriented is about the guaranteed price.  Can you talk about how that fits into an environment where presumably the vast majority of your clients are insured?Bonner:            This is, as you’ve indicated, a brand new approach.  We’ve secret shopped both ourselves and also all of our competitors to see if there’s anything like this.  We can’t find anything like this. The insurance companies are very intrigued by it, but they’re not quite sure what to do with it or how to do it. So we’re in that process.We had one patient come through the process who was actually a member of an HMO. We typically would not be accessible by HMO members, who would be restricted to the HMO network that they’re a part of. But she was at an advanced stage of cancer, she was a very knowledgeable and willful person and she wanted to come to CTCA.  She talked with her employer and with the HMO and they actually agreed to allow her to come for the fixed price. She paid part of the cost and the HMO paid the other part of the cost.We had two other patients who were approved. We have one-off arrangements with insurance companies to accommodate this and to test the idea and the value of a fixed price offering for evaluation.Williams:            It sounds like you have the option for people to go back to where they came from to implement their care plan.  Is that practical? Or when someone gets back from your controlled, service oriented environment are they just back to square one? Will the doctors just want to do their own tests and make their own treatment plan or is it actually a realistic option to more seamlessly integrate back in?Bonner:            We think it’s realistic and we do provide all of the records and all the diagnostics.  All that is patient owned data in our opinion, so they can legitimately go back to somebody. You can’t quite plug and play, but it’s pretty close to that.  They’re certainly going to run into some attitudinal complications.  People may, as you say, want to tighten up or go deeper or rerun some things, but we believe that it’s fully actionable.We also offer to collaborate with caregivers at home for all of our patients --not just in CareEdge.  So we can be talking to physicians who helped the patient before they came for the diagnostics or we can talk to them afterwards.  We encourage the patients to authorize us to get all the records that exist from prior to the time they came to us.  So from our point of view it can be very open, very collaborative and very actionable. But it comes down to all the vagaries of individual reactions back in the communities at home.Williams:            You mentioned you’re in four specific geographic locations and that you’re opening in a fifth.  Can you tell me what the fifth is and also about how you think about what geographic locations to serve and what we might see coming down the road after the fifth one?Bonner:            We’re in Illinois, Arizona, Oklahoma and Pennsylvania now.  We began construction on the next one in Georgia a month ago and we’ll be open there next summer.We also have a clinical practice up in Seattle, Washington.  Our plans are to go to a sixth hospital.  We’re looking at locations in the Pacific Northwest.  We’re also thinking about something else in the Northeast because of the concentration of the population.  But our current plan is to build out six of these and to have a pretty broad presence geographically around the country.Then we’re thinking about the next phase of distribution of our services, which might be less comprehensive centers surrounding these regional hospitals. We’d be in many more towns around the country to bring the less sophisticated treatment closer to home and then create a very easy way for people to move from those local CTCA facilities into the regional centers.Williams:            I’m going to take you away from talking about company specific things and ask you more about policy.There’s clearly starting to be a lot of discussion about costs and cancer treatment.  This is from a public that really doesn’t want to talk about any kind of limits, and that shouts “rationing” as there’s talk about cost control.On the other hand it’s becoming clear that Medicare is bankrupting the country and a number of pharmaceutical companies have realized that there is a lot of money to be made in the cancer treatment business. So there are a lot of expensive treatments on the market and more in development. Some of these treatments have marginal efficacy, at least on average.So I’m curious about how you see the cost debate evolving and what kind of a role CTCA might play in its niche.Bonner:            The larger context from our point of view is that the health care industry in the United States is on a quest to become much higher quality at a more reasonable cost than it’s been in the past and also to allow itself to become much more accessible.Our view is that if all you do is squeeze costs then you’re never really going to get there.  What we’re trying to drive is a conversation about the combination of quality, cost and value.  We want to help transform this market from one that is cost focused where people are constrained in their choices and pushed into closed networks in which there isn’t enough competition on quality or on price.There is a disconnect between what people really value and what they’re willing to pay for and the services they’re entitled to get in an environment as personal as health care.  That pushes people to allow the government or insurance companies to make some of the most personal decisions in their lives and it destines all of us to a much less efficient market.We’re working and trying to put much better information out there about the quality of what we do.  With CareEdge we start with this list of exactly what we’re going to do, the services we’re going to provide, the time we’re going to commit to in terms of delivering it and also the price.If you go on our website you’ll see our publication of our length of life and quality of life outcomes. We’re trying to help people find the best combination of quality, price and value.  There are many obvious and some pretty subtle opportunities to take cost out of the process, but it’s not coming just from saying whatever you’re doing today you have to do it at a 30 percent lower cost.Williams:            How are costs affecting treatment decisions today?  You talked about HMOs where people are in closed networks, which might affect where they’re going to go.  Are people making their own decisions, even those that have good insurance, that are based on costs when they have life-threatening illnesses like cancer?  What do you see coming from what Medicare is doing today?  Is cost being taken into account?Bonner:            We see almost an explosion of consumer involvement and engagement in health care in our little space in oncology here.  We’re now hosting over 8 million unique visitors a year on our website and these are all people who are looking for information on cancer, looking for options on cancer. Many of them come into our process and learn more. That’s how many of them come to us for care, bringing a whole plethora of different insurance situations behind them.  We have some in-network relationships, some out-of-network and some HMOs. We wind up in these one-on-one conversations about how a combination of care and price is going to be handled.There is certainly a price sensitivity here, but as I think you’re suggesting, when you get to life and death issues, price tends not to drive the decision.  It becomes a part of the decision and we see people studying that, but all of our patients decide to come to us on their own.  We don’t get referrals from anyone, so in the sense of taking control and in the sense of consumer shopping for different alternatives, that is the life that every one of our patients lives.  More of them are finding a way to come to CTCA.  The challenge is for the insurance company or the government to figure out a way to allow that to happen.Williams:            Let me change topics on you once again and ask you a final question. You’ve been named recently as one of the hundred most influential people in health care along with some big names people might recognize such as Barack Obama.  What did it take to get on the list?  Why do you think you’re there?Bonner:            That’s a great question and I’m trying to find that out.  One of our outward focused and in touch management fellows sent me an e-mail telling me that I was on the list, but I’m trying to figure that out.I will tell you that we’ve been working to be active participants in the national dialogue on heath care and we’re more active in Washington than we’ve been.Obviously we’re trying to refine our approach to health care and to tell the story that we think that our model belongs in the dialogue, so we’re trying to make that much more visible.I’ve been working with a lot of different organizations to do that.  I’m on the board of the National Foundation of Legislators.  We’re participating in the Leapfrog Group and we’re founding members for the Center for Health Transformation.We’re just trying to make this story available and my best guess is that somehow that found its way into the process of Modern Healthcare and here we are.Williams:            I’ve been speaking today with Steve Bonner.  He’s CEO of Cancer Treatment Centers of America.  Steve, thank you very much for your time.Bonner:            You’re very welcome David.  I really enjoyed the conversation.