Stephen M. Schleicher, MD, MBA: Hi, I am Steven Schleicher, practicing oncologist at Tennessee Oncology and one of the co-chairs for the conference this year.
OBR: What is being done to address challenges in cancer care for rural patients?
Dr. Schleicher: Tennessee Oncology’s mission – and all of community oncology’s mission – is bringing care to where patients live. That is the mission of community oncology. With that, access is a huge thing. I would argue that one of the biggest predictors of outcomes in cancer care is the zip code where that patient is. That’s due to several things, but one of them is true access to the comprehensive care.
Let’s talk about Tennessee Oncology, just because that’s my home institution. Part of it is just the landscape of our clinics. We have 35 clinics across the state, of which many are in rural and underserved areas. That alone allows the patient to often drive 15 minutes, park in a parking lot, walk inside, and automatically be there, versus driving an hour and a half dealing with Nashville traffic and navigating a large kind of ecosystem.
So that’s [number] one for access. [Second], telemedicine has changed how we think about access to care. Tennessee Oncology just received a $1.5 million grant from Tennessee’s Department of Health to help convert some of our clinics into telemedicine hubs. So a patient who may not have internet or a smartphone at home can come into one of our clinics and suddenly get access to all of our supportive services, palliative care, genetics, integrative oncology, nutrition, and others. So that’s one.
And then third, which has been a big issue kind of on the policy level, is the ability for us to mail oral oncolytic drugs to patients’ homes. For a lot of patients, especially those elderly who can’t drive per se, that is a huge patient-centered effort. Due to a Medicare FAQ during the pandemic, suddenly it is considered a Stark [law] violation to mail medications to patients’ homes. And the patient now, him or herself, has to come pick it up from the clinic itself.
Clearly, that doesn’t actually have any Stark [law] implications. The decision has been made for the patient to have that medication. Mailing it versus the patient picking [it] up shouldn’t really [make] a difference there. I’ll say Tennesee Oncology, and one of my colleagues, Samyukta Mullangi, MD, MBA, has written a lot about this. Lalan Wilfong, MD, has done the same thing at Texas Oncology. We were able to help to start getting some legislation to fix this through parts of the House [of Representatives], and the Community Oncology Alliance (COA) has been extremely helpful with that as well.
OBR: Can you describe the legislation aimed at fixing the Stark law concerns?
Dr. Schleicher: Yeah, so we have two efforts, both at the federal level. COA has been very involved in trying to help fix it, and now legislatively. How do we have a fix to this? The outcome of that is not yet known, but COA has been very helpful and Representative Diana Harshbarger and Senator Marsha Blackburn have been very integral to helping us get that message across to the rest of Congress. Then even at the state level, some things can help make the process more efficient. If a patient does not pick up the medicine but it’s still under our chain of custody, can we use that medicine somewhere else versus having to just throw it away? We’ve had legislative actions federally and at the state level.
Operationally, [we’re] trying to make this [cause] as little burden as possible for patients. How do we orchestrate a clinic visit with picking up the medicine so it’s not an extra trip for these patients who may be driving 20 minutes – or the really rural patients who still drive an hour to get to our rural clinic – or those who cannot drive and family members have to drive them. Operational issues and legislative issues [are at work], all just to make this patient-centered.
OBR: What are some of the other critical topics you’re planning to address in 2024?
Dr. Schleicher: One of the big things that Tennessee Oncology is doing is that we’ve launched this purely outpatient CAR-T program that is really controlled by the practice with hospital partners versus going through the hospital. [We’re] doing this all outpatient in a community oncology clinic. There was a great session yesterday with leadership from Tennessee Oncology, Texas Oncology, and the US Oncology Network discussing this.
I think as community oncology continues to strive to bring the most cutting-edge treatments where patients live, this is part of that mission. We’ve spent two years-plus planning this with the right stakeholders. We need a hospital partner, even if we’re going to kind of control this process. [We need] the right kind of clinical expertise within our group. We’ve hired some amazing physicians, pharmacists, and operators to help us with this. [We need] manufacturer involvement and then payer involvement. How do we finally kind of launch this? It’s going to happen very soon at Tennessee Oncology, and [we’re] excited to share those updates next year at the COA conference.
OBR: Can you describe the McKay Institute?
Dr. Schleicher: The McKay Institute was really the vision of my president and chief strategy officer, Natalie Dickson, MD. It looks at several things. Nashville is one of the healthcare services and healthcare innovation hubs, with startups and venture capital focused on healthcare delivery innovation. And Tennessee Oncology happens to sit in the middle of this. I think there’s an increasing number of amazing fellows and young physicians around the country who are interested in innovation and value-based care and things like that. Up until now, if you’re a fellow interested in that, your options are “Do I do academics and do research or do I do private practice or join a hospital or just leave medicine altogether to join a startup?” There’s no kind of hybrid. We were finding some amazing fellows around the country interested in being involved with this stuff, but there was no path.
To Dr. Dickson’s credit, she’s created a path now. One great example is Dr. Mullangi. [Her background] is very unique. [She went to] Harvard Med School and Harvard Business School. She worked a little bit at a company called Aledade, which is a very innovative accountable care organization. She has written extensively on policy issues for Harvard Business Review, been in the New England Journal of Medicine. She wanted to actually build something, not just do research. So we created a path for her to do so.
Partnering with an amazing company called Thyme Care, we’ve created a path where she’s at Tennessee Oncology in clinic three days a week and then spends two days a week as medical director of oncology at Thyme Care. So she’s getting to actually take what she learns in our clinic and apply it to an innovative company trying to change cancer care.
There will be an announcement soon; [we’re] actually partnering with startups themselves. Tennessee Oncology, we’re an innovative company, we have 35 clinics, some [are] urban with a robust kind of infrastructure, some [are] very small, one physician group is an hour and a half outside of Nashville. It is a great learning ground to test innovation and how [things] work for all patients. As companies come to us, instead of them becoming a vendor, [we] would rather make them a partner and build things together. The McKay Institute almost allows somewhat of a “venture studio” mechanism to actually co-build companies together, using our clinical expertise and infrastructure in testing things to improve care for our patients with a company that may be starting with an amazing idea and has capital to build this. And we get to work together on that.
Those are really two of the main cores of the McKay Institute. One final third kind of tenet is collaborating with other institutions on care delivery research. [We’ve worked with] the University of Pennsylvania and their Penn Center for Cancer Care Innovation led by Justin Bekelman, MD, and Ravi Parikh, MD, MPP, a close colleague. We’ve actually worked together and formalized the relationship to study care delivery together. We have a really interesting palliative care study that we did together that will be an oral abstract at the American Society of Clinical Oncology (ASCO) Annual Meeting. We can’t wait to share that with the rest of the country. The McKay Institute brings all those together.
This transcript has been lightly edited for clarity.
