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Becker’s Healthcare Podcast
Scaling Preventative Cancer Care with Data, Technology and Human Touch
00:20:17
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- [00:00]
A
Hi, everyone. This is Lucas Voss with Becker's Healthcare. So great to have you. Thanks for joining us. An exciting conversation today from vision to impact, HCA Healthcare's approach to preventative cancer care at scale. And I'm very excited to be joined by Dr. Dax Kirbogoff, Senior vice president, HCA Healthcare. Sarah Cannon, Cancer Network. Dr. Kirbagoff, thank you for being here today. It's great to have you.
- [00:28]
B
It is my pleasure. Look forward to the conversation.
- [00:31]
A
Absolutely. To start us off, could you introduce yourself and just a little bit about your work in healthcare?
- [00:37]
B
Absolutely. Well, my name is Dax Kurbigov. I'm a medical oncologist by training. But for more than a decade now, I've taken increasing roles in building cancer programs. And as we all know, delivering good cancer care starts at the level of risk identification and prevention. I'm privileged to serve as HCA Healthcare Sarah Cannon, Cancer Network's senior vice president. In that role, I have the privilege of working with physicians, nurses, genetic counselors, our operators, healthcare administrators, IT leaders, really, to develop ecosystems by which we can improve the level of care delivered to patients in the communities that we serve. So it's really a wonderful environment.
- [01:31]
A
Yeah, it's fantastic that you mentioned ecosystem, because I feel like that's a good way to describe healthcare in itself. And in this ecosystem, we often talk a lot about fragmentation and silos, et cetera. And oncology is certainly no different. Really. It struggles sometimes to move beyond those fragmented screenings and siloed risk assessments. What does a more coordinated approach to high risk patient identification look like for you? And why is that shift in paying attention to it so important long term?
- [02:07]
B
Yeah, it's a great question. And you know, you started by hitting the nail on the head. It really takes a village in healthcare. Right. We have so many dependencies across inpatient, outpatient screening centers, primary care. How do you pull it all together? And really, that's been the issue that we've tried to tackle, particularly around risk identification. And through risk identification, ultimately patient empowerment. Right. If you don't know that you're at risk, you don't know what questions to ask around how to mitigate that risk. And so that's really been the focus. I think there are a couple of pieces that we probably need to start with as assumptions, and one is just the vast majority of patients get their cancer care in community settings, more than 85%. And that number goes up to above 95% in terms of where patients do their cancer screening activities. Then the slightly sobering statistic is it's well, less than 10% of the individuals who are out there that, that have a personal or family history suggestive of a predisposition to cancer that actually know that they have a predisposition to cancer. And so really, you know, for. For us, you know, there. There is a moral imperative around doing a better job of identifying those at risk, communicating to them what that means, educating them and, and then connecting them with the right providers, whoever those providers might be, to understand what options might be available for earlier detection or to reduce their risk of cancer. So that's the why, right? Like, we've just got to do a better job of communicating and empowering folks. For us, that's really translated into a strategy that leverages, you know, technology, standardized processes and roles that we've now clearly defined in the organization to allow our providers our human capital, if you will, to perform at highest license. And I want to underscore, technology is never the only answer. It's always an enabler for us. Our partnership with Ambri Genetics, and particularly around their Ambri Care platform, has really been a. A potent enabler that has helped us to connect the dots between all of those different settings, such that we can engage patients in a patient centric way, gather the information that's really required to understand an individual's risk, then proactively, while they're already in the healthcare environment, offer them education and potentially genetic testing. If you do that right, if you make it convenient and you provide that education in a consistent way. What we've seen is tremendous uptake, tremendous compliance on the part of patients to answer the questions. And I'll say one other piece. What's always struck me as interesting is our patients frequently reflect on. They've been asked these questions before, but nobody's ever done anything with it. And they've always assumed that if there was something to be done, that that would be communicated to them. So really, a huge piece of this effort has been closing that loop. Right. Making sure that we act and we inform when there is something to act around and that we get those patients downstream to the people that can really guide them through important healthcare decisions.
- [06:11]
A
Yeah, I think that's such an important point because oftentimes we look at these tools and these processes, et cetera, from an organizational perspective, but at the end of the day, it also impacts the patient directly and patient outcomes. And I just wanted to ask if you could elaborate a little bit on that patient experience too. Have you had that experience in conversation with folks? Are they realizing this? Can you share a Patient experience that really illustrates this.
- [06:37]
B
Absolutely. And maybe that's the most gratifying piece of this, is when you do get to connect patients whose lives have been changed in meaningful way. For us, we started in our mammography centers. We started with a population of individuals, women who are coming in for their breast cancer screening. A population that's obviously by virtue of the fact that they're showing up for a mammography, that they're motivated around preventative care, wellness based care care. A story that stands out is that of one of our patients, Christina. Christina is like a lot of other women out there, right. She's 54, she's adherent, she's pursuing appropriate preventative care, she's showing up for her mammogram. What made her a little bit unusual was that she had a pretty strong family history of breast cancer. And in fact, her mother had passed away at age 45. Right. Like, there's a red flag right there. And here's a 54 year old woman with that family history who hasn't really had that family history acted on. So she came into one of our centers under our protocols, before she ever came into our center. She's engaged around a digital platform, a digital engagement, around providing some family and personal history. It turns out that while her mammogram that day was perfectly normal, and I mean perfectly normal, importantly, through that platform, through that engagement strategy, we recognized that based on her family history, she was appropriate for genetic counseling. And sometimes the magic of this is not making it hard for patients, not asking them to make another appointment or come back and see somebody else, but rather while they're there and thinking about it, to create the opportunity for them to receive education and if they are ready and comfortable for it, to offer point of care, genetic testing, and all of that happened for Christina. What was not surprising, perhaps on the basis of her family history, was that she ended up having a deleterious mutation, a mutation that predisposed her to breast cancer and other cancers. What was a surprise was that after a lot of education, time spent with providers, genetic counselors, members of our preventative care team, and breast surgeon, she elected to have prophylactic bilateral mastectomy. She underwent that procedure, and despite the fact, as I mentioned earlier, that her mammogram was stone cold normal, she was found to have breast cancer. I mean, thank goodness it was an early stage breast cancer. It was not visible on her mammogram. And so, you know, the sense of gratitude, the willingness to share her story so that other people become increasingly Aware of not just the importance of getting your mammogram every year, but really asking questions about your risk and whether there are options to mitigate that risk. That was a success story. I mean, that is what we live for.
- [10:01]
A
Yeah, absolutely. Thank you so much for sharing that. Because I think again, it illustrates sometimes it gets very theoretical and you talk about these hypotheticals. And a story like this really brings things to life and really shows the impact of all of this and everything that you're doing, which is fantastic. I want to come back to the organizational piece to this again. For some organizations, implementing some things is tough. You talked about your partnership with Embry. What are some of the barriers you faced in rolling out a system wide high risk program to really improve this? And what are some of the strategies and partnerships that helped overcome this at scale?
- [10:38]
B
Sure, great question. And complicated as you can imagine. I mean, I think the first thing, of course, is that there are a million good ideas about how we can improve care for patients, reduce the burden of cancer on society. And getting one idea or one initiative executed really requires us to scrutinize what's the most impactful intersection of good care and good business. It really started with understanding that we had a unique opportunity to touch literally millions of lives out there in a way that was sustainable for the business, that improved care, improved outcomes for us. The other piece, of course, is that fragmentation that you talked about earlier is a huge barrier. How do we connect our imaging centers to our primary care docs, to our hospital teams, to our nurse navigators, et cetera? And so that's where that IT platform was really so critical. And maybe the last barrier is just one, that is the human condition. All of our teams in all of our hospitals, at all of our centers are doing their very best to deliver best in class care. And so when you come in and you pitch a new idea or workflow change, there's an inherent resistance. I think for us, the success factor was starting by bringing together our providers from multiple geographies, literally from coast to coast, some of our thought leaders, to say, do we know that we're delivering the best care, particularly in this preventative space? Do we know that we're doing that well? What data do we have that. That corroborates that? And the answer was, more often than not, that data wasn't there. And we thought we were doing a good job and people were certainly working hard. But. But we involved our clinicians, our genetic counselors from day one to guide the build of this program. And then secondarily we gave them flexibility. We built a program and our technology platform through AMBRI was flexible enough that we could take into account the local nuances that make it hard to do a one size fits all. So we created specific processes that, that could be flexed with the same endpoint. And then ultimately, super important, we promised everyone data that we would conclusively be able to answer the question, reflect their performance back, and give them the evidence to say, you're really doing a great job at this, or you have an opportunity to improve. And that partnership, as you mentioned earlier, it's a team, it's a team sport. That part partnership really created the conditions by which we could scale deploy these programs rapidly across very, very different patient populations and geographies.
- [13:47]
A
Yeah, I think you mentioned two important points there, which is flexibility and then also the human, the human factor. Right. That always needs to be taken into account because again, there's built in flexibility there. We're not rigid. It's not one size fits all, which is key. And then of course, the data, I think that that's really key, having that data, looking at the data. And I'm wondering, once you have that data, what were some of the things that you were looking at from a performance metrics standpoint to really say, okay, this is having success, we can move on this, we can move forward with this. What were some of those metrics?
- [14:21]
B
Yeah, you know, really important because you need to know, you need to know before you start what's going to be important to capture. And, you know, the first thing for us was can we engage, can we engage patients before they ever show up for their mammogram? Will they respond to that? Can they, can they complete a risk questionnaire? Can we construct a risk questionnaire that's simple, convenient, clear enough that they can complete it with a high degree of accuracy? And, you know, while nothing is perfect, I'd say, you know, the most important metric for us out of the gate was will people respond to this? And I'm really pleased that what we found is that in excess of 85% of our patients complete their risk questionnaires either before they come in for their mammogram or within a few minutes of showing up for their test, which tells us that the patient appetite and willingness to be proactive about their health care is there. So I think that's a really important start for us. I think there are others that become equally critical. And at the end of the day, for me and for our partners, it's really about what are the end results And I think what we found to date is that beyond just patients engaging, they're following up downstream. And so we've identified almost 15,000 patients now that are appropriate for conversations around alternate or intensified screening strategies. We're approaching 1,000 individuals now who have had identified mutations, who can be informed and educated around health care decisions. And though this program really started within our mammo centers, it's now expanded to primary care communities. We are also expanding the program to other portals for cancer screening for the same reason that's incredibly important, because the data is telling us that when we do this, even when we do this on a women focused population, almost half of the time the implications of risk assessment and testing identify non breast cancer related interventions that could be considered. And so we don't want to be myopic here, but those metrics and being able to reflect that back to our providers, to our operations teams are absolutely critical in providing the evidence that we're doing a good job not just engaging patients, but getting them through all of the critical downstream pieces that ultimately translate into. We did something different because we had this, this, this important knowledge.
- [17:24]
A
Yeah, outcome based results and outcome based data, which is, which is really key. Well, Dr. Korbakov, I want to close us out here with sort of a look into the future, into the crystal ball a little bit. How do you see programs like yours, obviously, but also others around the country, whatever you're seeing in the industry evolving over the next five years, three to five years. And what are you excited about as we head into the future?
- [17:51]
B
Yeah, so many things. I mean, again, the opportunities to leverage technology to augment the capabilities of our outstanding staff, to be able to engage patients in whatever manner they prefer to be engaged, really allows us to touch more individuals and in important ways. I think we're going to continue to see expansion of programs like this one across many different healthcare settings. You know, the dream is universal risk assessment regardless, regardless of the portal of entry and being able to support patients through that journey. I think risk assessment itself is changing. Right. It's no longer going to be confined to personal family history. It's no longer going to be, quite frankly, compliant, confined to genetic testing. But risk based assessment through radiomics is going to be another factor that we have to integrate in precision medicine, personalized decisions. The other piece that I find tremendously exciting about the future is as we do a better and better job of identifying those who are at risk, we're also going to find more and more people who are, who are at risk for cancers that we don't traditionally have a good screening strategy for. And if the answer is early detection or prevention, what I think we can look forward to are novel technologies, blood based cancer screening, if you will, that offer promise as strategies to detect cancers early that we cannot screen for today. So I our power to intervene in a positive way on behalf of our patients really excites me as part of that future promise, that future state.
- [19:48]
A
Yeah, there's a lot happening. I feel like if we have this discussion in three months, there's going to be more to talk about. Dr. Kerbakov, thank you so much for your insights and your time today. This was fantastic.
- [19:59]
B
Absolutely, my pleasure. Thank you.
- [20:01]
A
Great to have you. And we also want to thank our podcast sponsor, Embry Genetics. You can tune into more podcasts from Baker's Healthcare by visiting our podcast page@beckershospitalreview.com.