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Becker’s Healthcare Podcast
Dr. Theodoros Teknos, President and Scientific Director of the University Hospitals Seidman Cancer Center at University Hospitals Cleveland Medical Center and Deputy Director of the Case Comprehensive Cancer Center
00:18:56
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- [00:02]
Becker's Hospital Review Announcer
The most important healthcare decisions don't happen in isolation. They happen when leaders come together. Becker's 16th annual meeting brings together more than 3,500 hospital and health system executives this April in Chicago. With 800 speakers from Ascension, Cleveland Clinic, Common Spirit, and more, the conversations get real. Leaders will share how their scenario planning for policy shifts brief breaking through value based care barriers and building clinical teams that translate new ideas into real world care. Join top decision makers in the room April 13th through the 16th. For the agenda and event details, visit BeckersHospitalReview.com and click on the Events tab in the upper right.
- [00:47]
Mackenzie Bean
Well, hello everyone and welcome to the Beckers Healthcare Podcast. I'm Mackenzie Bean, Associate Vice President and Managing editor of Becker's Hospital Review. Today I am truly so thrilled to be joined by Dr. Ted Technos, who is the president and scientific director of the University Hospital's Sideman Cancer center at University Hospital's Cleveland Medical Center. He also serves as Deputy director of the Case comprehensive cancer center. Dr. Technos, welcome to the podcast today. Thank you so much for joining us.
- [01:19]
Dr. Ted Technos
Thank you so much for having me, Mackenzie.
- [01:22]
Mackenzie Bean
It's such a pleasure. I'm excited for our conversation today, but before we dive in, I was hoping I could turn it to you just to share a little bit more about your yourself and your background.
- [01:33]
Dr. Ted Technos
Sure. So I am trained as an otolaryngologist, head and neck surgeon. So I still practice head and neck cancer surgery as well as reconstructive surgery following head and neck cancer ablations. I've been at several institutions throughout my career and have been here at University Hospitals as president and scientific director of the cancer program since 2017.
- [02:04]
Mackenzie Bean
Wonderful. Well, excited to tap your rich perspective today. I want to start off by looking at health system's efforts to grow and differentiate their cancer programs. Where do you see the biggest strategic misalignments between those cancer center ambitions and then perhaps broader health system priorities? And how can leaders close those gaps?
- [02:27]
Dr. Ted Technos
Yeah, this is a, this is a very important question. And really the biggest misalignment between health systems and cancer programs isn't money. It's really language and time horizons. So cancer programs, you know, we talk in aspiration, you know, the, the latest treatments, finding new discoveries. So we're really about aspiration and hope, whereas our health systems really talk in execution. You know, the gap really closes when oncology strategy is framed not just as prestige and academic success, but also as one of the system's most powerful engines for sustaining growth and differentiation as well as value. So I think the mistake a lot of cancer leaders make is after they, you know, they chase relentlessly after academic prestige, which is really important. But I think as leaders, we also need to be able to just as equally be facile and talking about margin, access volumes, cost of care, and all of those things that really are aligned goals. But I think oftentimes get sort of at odds with each other. So I think the best way for cancer centered leaders to really interface and close that gap is to really translate a cancer center's ambition into system relevant outcomes. What do I mean by that? I mean that really, in addition to leading with prestige and excellence, cancer center leaders should also focus on the other metrics that are really important to the system. Reducing leakage of cancer patients to other systems, documenting our downstream revenues, what our cyto care cost differentials are, and then really differentiating ourselves with payers. Then strategy for cancer centers also really needs to center around where care happens. I think winning systems centralize only what really needs to be centralized. Things such as complex surgeries, bone marrow transplants, phase 1 clinical trials, and any of those other things that do not have to be centralized can be decentralized, such as infusion services, imaging to lower cost settings. I think that aligns the cancer center's growth with the system growth as well. Then I think finally we just need to align incentives between cancer center leaders and our system leaders. What that really means is that rather than being a separate siloed leader to lead the cancer program, cancer center leaders really need to be system executives. Their goals should be closely aligned with the system goals as well. And they should be accountable for each, both system leaders for cancer center goals and then cancer center leaders with system goals. I think that's the way that we can really close the gap between expectations of both different components of a healthcare.
- [05:45]
Mackenzie Bean
System that shared accountability. And that's so interesting what you said about the aspiration versus execution. It sounds like cancer center leaders really need to be adept at translating their own aspirations or clinical to discoveries or efforts really into the concrete terms of how is this going to also support system wide outcomes? I'm curious, is there a specific real world example you can point to of maybe a decision or an effort on the cancer side that you really had to translate for the system wide perspective?
- [06:24]
Dr. Ted Technos
Yeah, I think examples of this may be for us when we, we have a centralized academic medical center and a freestanding cancer hospital, one of just 13 in the nation, but then we also have 17 sites in the region. And I think what we did is look specifically at and as I mentioned, what actually has to be on the main campus, that's the highest cost place to deliver cancer care and what can we do in the region? So a lot of what we decided to do was actually focus our clinical trial efforts, our really complex surgery on the main campus. And then even if patients are evaluated on the main campus, if they can receive standard of care therapy closer to home, which is a lower cost setting, we allow patients to do that. So we not only meet patients needs where they are and where they're at close to home, but we also then free up capacity in the main hospital for us to do more complex care so that both, you know, achieves our goal to get the maximum access, but then also optimizes our ability to create revenue both on the main campus as well as off the main campus sites. And payers like it because they see that we are actually trying to defray costs and bend that cost curve by not necessarily requiring everybody to be at the highest cost setting.
- [07:57]
Mackenzie Bean
I appreciate that example. I think it's a, you know, very relevant discussion that so many organizations are having as they think about sort of the structure of their service lines or those specialties. Let's look ahead to this upcoming year. Now from your perspective, what shifts do you see coming and how academic cancer centers translate discovery into standard clinical care? Do you feel like hospitals or health systems are overestimating or perhaps underestimating the operational lift that will be required to do that?
- [08:34]
Dr. Ted Technos
Yeah, this is a great question. So I think, you know, discoveries and translation is coming at us fast and furious. So I think, you know, the biggest trends that we're facing in 2026 really are how do we integrate precision medicine and system biology into our clinical workflows? How do we, how do we in essence use all these technological accelerations such as artificial intelligence and digital twins to make decisions for our patients? And then how do we accelerate clinical trial accruals using some of these really remarkable machine learning algorithms? So, you know, there's no question that all of these require a tremendous amount of planning and operational expertise for cancer center leaders to be able to make them a reality. And I do think that there is an underestimation of what this will take to really implement into, into our workflows.
- [09:47]
Mackenzie Bean
Yeah, that's so interesting. I think it's going to be a helpful perspective for listeners as they're thinking about this at their own systems. You know, we're also seeing health systems, cancer centers operating in a difficult environment. There's capital workforce pressures. We're seeing Research dollars being taken away in some cases. How can health system executives strategically decide where to invest in cancer care over say, the next three to five years? And is there anywhere where you think restraint might be more important and valuable than expansion?
- [10:25]
Dr. Ted Technos
Yeah, this is a challenge that all of us face. You know, there are limiting, you know, limited resources and you know, with some of the governmental changes coming both in Medicaid, Medicare, all, you know, the average health system, about 2/3 of our patients in the cancer program are on, are government insured. So we really are in some, in some ways held captive to some of the CMS changes that are coming, you know, with regards to our reimbursements. But then also, as you mentioned, NIH dollars, you know, are harder and harder to come by. By last estimate, you know, only the top 4% of grants are being funded, even though the NIH budget was expanded. So it's really a tough environment. So I think as cancer center leaders, you know, we really need to focus on how we spend those dollars in a very, in a very strategic way. So I think the ways that a really effective cancer center leader can do that is to anchor their strategy under these constrained times, to really focus on value and cost effectiveness. So we need to prioritize investments that deliver high value for our patients and the system, rather than just acquiring the expensive leading edge technologies that provide us with marginal gains. So what we are focusing on is how do we implement evidence based interventions and clinical protocols so that we can standardize pathways, how do we develop value based models in cancer care and then how do we essentially evaluate these outcomes? You know, before we embark on a high cost therapy, we do very thorough cost benefit analyses to make sure that it's good for the patients and also good for the system. The other thing I think we really need to do in constrained times is really double down on early detection, screening and navigation. So we all know that if we detect cancers earlier, we find them at earlier stages, they have better outcomes and it costs the system less. So we have really invested significantly in our early cancer detection, whether it be mammography, lung cancer screening, other screening modalities, and implemented population based screening programs and predictive analytics. And we've really moved the needle, especially in our lung cancer care, to earlier stages with lower cost. And then the other part that I think is really important is we can't continue to build a bigger and bigger system. So we really have to partner under constrained capital with our networks, with local providers, so that we can expand our reach, you know, reach more patients without actually Having to do more brick and mortar acquisition. And then the last thing that I think is really important is we need to leverage technology. And whether that's AI and machine learning to help with triage, clinical decision support, or even reducing the administrative and cognitive burden for physicians is really important for us to be able to become more efficient and deliver care that is best for our patients. And then finally, I think we really have to use very robust data to determine which investments are going to be viable in a three to five year period rather than over a decade, which is what typically we as cancer center directors are looking at, especially as we acquire very expensive, high cost research platforms, equipment. So we really need to see that ROI in a shorter time horizon rather than a longer time horizon.
- [14:38]
Mackenzie Bean
So really we almost outlined like a, a five pronged approach of having a relentless focus on value for both patients and the system of standardizing care pathways, value based models, early detection, screening and navigation. Like you said, said, increasingly looking at partnerships with local providers, other networks, of course, continuing to lean on technology, and then that very robust data to help really determine what are the viable investments. Is that a fair summary?
- [15:10]
Dr. Ted Technos
Absolutely, yeah. I mean, I think more than ever, you know, it's going to require a lot of, you know, very thoughtful decision making and you know, in great stewardship of the, of the limited capital dollars that are out there.
- [15:26]
Mackenzie Bean
I think, you know, you hint on this a bit, but I'd love you to elaborate. As we look ahead, even perhaps beyond three to five years, what organizational capabilities do you think will most determine whether a health system's cancer strategy succeeds or stalls? Whether that's, you know, research, governance, data access and more. I'd love to hear your take on that.
- [15:49]
Dr. Ted Technos
Yeah, I mean, I think ultimately the systems that are going to succeed in the future are going to be the ones that really think of oncology as an enterprise wide portfolio and not just a simple service line. So those systems and ours is an example of this, where cancer is looked at as not delivered only on the main campus, but is a component of the entire system. So in general, cancer programs ultimately are about 25% of the revenue of the entire health system and over a third of the margin. So it really needs to be embedded in system strategy. So the key is the systems that succeed are going to have a very cohesive strategy across their entire portfolio. They're going to use a lot of data to make informed decisions. And most importantly, they really need to align the physicians because physicians really are the drivers in cancer care. So beyond just employing the physicians, we really need to engage them. We need to engage them in helping us devise our work workflows and helping us implement them in a much more robust way. And then we need to partner, we need to partner with regional practices, we need to partner with other health systems and joint ventures. You know, the systems that are not going to do well, I think in the future are the ones that expand facilities, do a lot of brick and mortar building faster than they expand their, you know, their workforce capabilities. Also the ones that don't have a cohesive structure going throughout the system and they have sort of little fiefdoms of cancer care delivered in their regional hospitals that compete with the main campus will fragment care. And then I think ultimately, you know, the systems that invest in, you know, really long term platforms of innovation that are frankly hit or miss sometimes are going to have a hard time in this new sort of model of care that's, that's coming based on, you know, the economic challenge that we see in cancer care and health system delivery.
- [18:18]
Mackenzie Bean
Well, Dr. Technos, this has truly been just such an enlightening discussion. I so appreciate you taking the time to join, join the podcast and share your insights about how you're thinking about, you know, growth, innovation, value to patients and more. So thank you again.
- [18:34]
Dr. Ted Technos
We really appreciate, is my pleasure. And I really appreciate that the opportunity. McKinley.
- [18:40]
Mackenzie Bean
Yeah. Always happy to have you. Thank you so much.
- [18:44]
Dr. Ted Technos
You're very welcome.