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- Hi, everyone. This is Elizabeth Caslow with the
- Becker's Payer Issues podcast.
- I'm excited today to be joined by David
- D'bono, oncology medical director at Carillon Health. Doctor
- D'bono, thank you so much for joining us
- today. Thank you. Appreciate the opportunity.
- Of course. And so before we jump into
- some of the questions here, I would love
- to hear a little bit more about your
- career at Carillon and also just your general
- health care background and what you currently do.
- Well,
- again, thank you so much for,
- for the time today.
- I trained
- at Indiana University, so I did all my
- internal medicine
- residency, oncology fellowship.
- During the time of my internal medicine residency,
- there was a lot of
- oncology research being done at Indiana University.
- And I got to know
- many of those investigators
- and and so made a decision to to
- go into oncology.
- And I practiced
- community oncology
- in a small community in Illinois, South Of
- Chicago for about thirteen years.
- And during that time also became interested
- in palliative care and supportive care. And and
- so for about seven years, I did palliative
- care
- in an oncology setting,
- here in Detroit, Michigan.
- And for the last nine years, I've been
- with Carolina and Elevance Health.
- And I guess I would say that
- my motivation
- has been,
- to
- try to optimize
- the way we support,
- our members,
- and patients
- who are undergoing cancer care.
- And so we do that in a variety
- of ways.
- Certainly,
- one of the ways is something that we'll
- be talking about today,
- with navigation,
- but are also trying to make key connections
- with our palliative care resources
- and behavioral health resources. So
- our team actually works
- one on one with oncology
- providers,
- and practices
- around the country,
- to optimize,
- not only the quality of care, but also
- trying
- to make these connections
- with some of these supportive care resources that
- we have in order to overall optimize,
- the care that our members are getting.
- So let's dive into that initiative you hinted
- at earlier. So we're gonna discuss Elvance's cancer
- care engagement initiative. So at a high level,
- can you break down this program,
- when it started, what drove it, who has
- access
- to it, and what it actually includes?
- Sure. So it
- it started with some conversations,
- back,
- in kinda 2018,
- 2019.
- There was growing evidence,
- that
- navigation
- in cancer care
- makes a difference.
- It makes a difference in care quality.
- It makes a difference in patient experience,
- and it improves,
- the things that are important to patients,
- such as
- staying at home, not having to be hospitalized,
- avoiding complications,
- being able to continue to be employed,
- if we can get the optimal supportive care
- for them. So we had a lot of
- conversations
- about the the data
- that was supporting
- this type of work
- and decided that,
- we should launch our own navigation program. At
- that time,
- most practices didn't have navigation.
- What you see now is that practices and
- cancer centers are starting to adopt,
- this type of work.
- But I think we were,
- pretty unique,
- in trying to get this done early,
- in the in the payer space.
- And
- our thought process,
- primarily really was to
- to understand that the care
- that our members are going through
- when they're diagnosed with cancer is complex,
- has a big impact on their families,
- and that navigating
- the entire experience is difficult.
- And we thought we could really make a
- difference in that regard.
- So which members have access to this initiative
- right now, or is there not really anyone
- left out of it right now?
- So our our large local
- groups,
- are part of the program.
- Our Medicare Advantage Plans are part of the
- program,
- and it is available,
- for employer
- funded plans,
- if that's a program that they're interested in,
- in buying up for.
- Got it. And so
- cancer care engagement has an eighty four percent
- engagement rate. So what has been the key
- to unlocking
- such a high rate, and how can other
- navigation programs, other clinical programs replicate those results?
- Well, I think it it speaks to,
- identifying
- the right patients.
- We do use,
- some analytic resources
- to identify what we believe are the highest
- risk patients
- and the highest need patients.
- So if you're
- if you're contacting,
- a group of patients,
- that are
- likely to be receptive to a navigation program,
- I think you're gonna have high engagement rates.
- The other
- key point, I think, with our program
- is that it is
- human directed, if you will.
- You're not getting a call from,
- you know, an automated bot.
- And so
- so when we when we get somebody on
- the phone or through our digital apps, etcetera,
- knowing that,
- they are speaking to
- a oncology certified navigator,
- someone who,
- understands the space,
- who has a very comprehensive
- way of evaluating the situation,
- I think patients respond to that.
- Families respond to that. And so I think
- the
- the idea of,
- making a simple connection,
- making a human connection
- really contributes to the idea that
- patients are interested.
- They find the program to be helpful,
- and they remain engaged.
- So cancer care engagement has been associated with
- a seven percent reduction
- in avoidable inpatient admissions for Medicare Advantage members
- and fifteen percent for commercially insured. So why
- do you think there is variation with those,
- between those types of plans?
- And also, are you looking to
- get any more concrete data on ROI
- when it comes,
- to the solution?
- So your first question, I think, is a
- good one. And I think it it's
- it zero in zeros in on
- the differences in populations that we serve.
- When we think about a commercial population
- in the oncology
- space,
- we are
- primarily talking about
- younger patients
- who may have families.
- They may be,
- have full time employment.
- And
- so it's a different population than, let's say,
- a Medicare population
- who are intrinsically
- older,
- maybe retired,
- may have more comorbidities,
- and
- so I think the populations are different.
- But I would say that the difference in,
- the inpatient admission rates are
- are not large. So I think the
- the fact that we're impacting
- inpatient admission rates for both populations
- is probably the take home message,
- and I think we do that in a
- number of ways.
- Number one,
- our
- navigators
- are specifically trained
- to connect
- with oncology
- practices
- when there are significant issues identified.
- So,
- and they'll do this on a three way
- call. They'll they'll keep the the member on
- the call while they're contacting the practice.
- So when the navigator is concerned about a
- particular symptom,
- or,
- concerns about not being able to get to
- an appointment,
- they make that connection with the practice,
- and try to solve that problem on the
- spot. And I think that impacts,
- things like,
- inpatient admission rates,
- and,
- those kinds of
- issues that, again, I think are
- not only important
- to overall quality, but I think specifically important
- to patients.
- So I think this the the provider
- partnership is an important part of the program.
- With regards to ROI,
- that continues to be a work in progress
- as far as calculations.
- And
- though I don't have anything to share publicly
- right now,
- I would say that,
- what we are seeing is positive,
- and it's certainly something that we're interested in.
- But I think what we're seeing kind of
- it over the program evaluation,
- if you will,
- is that
- impacting
- engagement rates. So having a high engagement rate,
- impacting
- important
- outcome measures
- is likely to deliver
- an ROI.
- All things are sort of lining up that
- way.
- So I think
- the execution of the program, the design of
- the program,
- I think, is
- is
- making a complex journey for the member,
- easier.
- It is definitely
- impacting
- outcomes,
- and I think the
- the overall value of the program will follow.
- So I know earlier, you were talking about
- how your team had been mulling over this
- idea since a little bit before 2020.
- Can you talk about some of the
- early learnings from this program?
- What have you had to adapt?
- What's changed?
- How have you adjusted to accommodate members?
- Yeah. So good question because I think any
- any program like this is going to evolve.
- And
- I think some of the key learnings
- was,
- number one,
- we have to continue to refine,
- our ability to find the right member at
- the right time,
- in their cancer journey.
- So adopting
- our predictive analytics
- to identify patients, I think, is is, an
- ongoing process that we continue to monitor.
- The idea of
- making provider connections,
- as a
- inherent part of the program,
- came from feedback from practices.
- So our team
- now I'm talking not about our navigator
- team, but our provider enablement team, you know,
- speaks to this program whenever we meet with
- oncology practices.
- And feedback we got was
- this looks like a great program.
- However,
- we need to know
- if one of our patients is being navigated
- in your program.
- We are interested in knowing
- when your navigators
- identify problems,
- and that directly led to,
- enhancing provider partnerships,
- in the program.
- So I think that was a a a
- really key learning.
- And then thirdly,
- as the program,
- has developed and grown,
- we felt like
- we have a number of oncology
- clinical resources
- at Carillon.
- We're talking about physicians,
- physician assistants,
- oncology nurses, oncology pharm d's.
- And we felt like
- the navigation program, the CCE program,
- could benefit
- from the expertise of the clinicians within our
- organizations.
- So we have developed an advisory board,
- where
- the oncology clinicians have an opportunity,
- to provide
- feedback to the navigation team,
- provide them
- updates on what's going on in the medical
- literature with regards to navigation
- or other important issues.
- And what we have found is this has
- led to,
- specific educational
- opportunities for,
- our navigators,
- as well as their leadership,
- and it's also led to specific
- changes
- in a program.
- One thing that we are concentrating on now
- as a result,
- is how can we optimize
- the support of
- the caregiver
- of the
- the member with cancer.
- And so this was a a direct
- result of discussions that we had,
- within this oncology clinician advisory board.
- So
- I think
- a lot goes into the background of programs
- like this.
- We recognize that cancer care is complicated.
- Members need navigation
- to get, through their journey.
- And if I had to sort of summarize
- the ideas here, I would say that
- what we've really tried to do
- is to take advantage of all the resources
- that we have available,
- to really optimize this program over time.
- What are you looking to next when it
- comes to cancer care at Elevance?
- Well, cancer care,
- is a big, you know, it's a big
- field.
- And
- I think when you read the headlines about
- cancer care, you primarily read about new drugs.
- You know, a national meeting occurs.
- A new drug is,
- presented as a new drug as a new
- a new optimal care for particular patient,
- patient population.
- I'm just giving you an example. There was
- a new drug for pancreas cancer that was
- presented
- at our June meetings this year, and that
- made a lot of headlines.
- Our work
- and our team's work
- is concentrating
- on
- taking advantage
- of all the knowledge that has been developed
- over the last thirty years or so
- and how we better support
- members with cancer.
- So we've talked about navigation today,
- which has proven to be a successful program.
- We believe it
- simplifies the experience for for members.
- It optimizes provider partnerships
- and, ultimately, I think, delivers outcomes that are
- important,
- to our members.
- There are other types of supportive measures
- that we can continue to optimize.
- We have
- considerable
- palliative care resources
- at Carillon,
- And we believe
- formally
- connecting
- palliative care and oncology,
- is extraordinarily
- important.
- And if you go to a big hospital
- right now,
- in a big city, an academic center,
- there's up there's
- plenty of resources
- in palliative care.
- But most of the care that patients are
- getting in this country
- are outside of academic
- medical centers,
- and palliative care resources are scarce.
- We believe we can,
- help connect
- practices that don't have a lot of access
- to palliative care
- to care on resources in this regard.
- The same thing is true about behavioral health
- in oncology.
- There's a
- a a large literature
- on the importance of optimizing mental
- health, behavioral health,
- in members who have cancer.
- We have considerable
- resource in behavior behavioral health,
- and making a formal connection,
- we believe has
- great possibilities,
- and we're just
- starting those conversations.
- And then lastly, physical activity,
- in oncology patients who
- have undergone particularly curative intent treatment,
- is a is a growing part of oncology,
- and we believe we can do more to
- support
- that realm.
- And so, again, having some initial conversations
- on how we can
- optimize these connections.
- And I would say the theme here is
- that
- there are ways to support members with cancer
- outside of the drugs that they receive.
- And
- to optimize these types of supportive
- measures
- requires
- strong
- partnerships,
- whether it's internal resources and palliative care or
- behavioral health,
- external resources and exercise,
- or just simply
- partnering with oncology providers and finding out
- what they need.
- That, I think,
- is going to unlock,
- considerable
- opportunity
- for quality improvement,
- as well as patient
- experience improvement,
- in the years to come.
- As we wrap up, I know we have
- a few minutes left.
- Do you have any final thoughts
- for,
- industry leaders either in the payer space or
- at their services
- subsidiaries?
- Yes. Well, first of all, again, thanks so
- much for
- for inviting us
- and to give us this opportunity
- to,
- to explain sort of what we are doing
- in
- in the cancer care,
- models that we are developing.
- I think the key message here,
- is that
- cancer care in 2026
- is vastly different than it was
- even fifteen years ago, but certainly twenty five
- or thirty years ago.
- And in many ways,
- that experience of the member is vastly improved.
- Our drugs are better. Our knowledge is better.
- Our hospitals are better.
- But the experience
- is increasingly
- complicated.
- It can be fragmented at times.
- The needs of members change over time.
- So the the navigation
- needs
- of a member who's first diagnosed
- and is working full time and has small
- children
- is very different
- in that same patient
- ten years later
- who might be
- developing recurrent cancer or develop or has developed
- a toxicity,
- from the treatments that they got ten years
- ago.
- So the the needs of members change over
- time,
- and you absolutely
- have to be able,
- to, number one,
- identify those members
- to be able
- to determine
- what are their key needs,
- and then have the resources,
- to be able to
- figure out ways,
- to meet those needs.
- It's going to require partnerships,
- with,
- community resources,
- with the local oncology practices,
- with
- other cancer supportive care organizations,
- within the patient's community,
- or within our internal resources.
- Making that cancer journey
- simpler
- for members as well as their families
- to make it
- understandable,
- to avoid complications,
- to avoid toxicities,
- and maximize
- the quality of life for that member.
- It takes work.
- It takes commitment. It takes a program that
- is sustainable
- over time for that member.
- So my advice is
- to whether you're an employer, whether you're,
- an organ a local community organization, whether you're
- in the payer space,
- is
- commit,
- to a program that
- you have resources for,
- that where your skill sets lie,
- and jump in and
- and
- commit to making a difference.
- Not every organization is gonna be able to
- to do all things, including our own.
- However,
- we can each have a part,
- in making the member experience
- with cancer
- easier,
- simpler,
- and
- maximizing the quality of life
- for the member and the family.
- There's a lot of information out there.
- There are a lot of organizations
- doing this work,
- and
- I think,
- at the end of the day,
- we have to figure out ways
- to support the whole person,
- to partner
- with the care team that the member has,
- and
- to ultimately make a complex
- experience
- simpler,
- less fragmented,
- and,
- overall, a better quality experience
- for the member and their family.
- Doctor Debona, thank you so much for joining
- us today.
- Thank you. I appreciate the opportunity.
- Of course. And to our listeners, if you'd
- like to hear more podcasts from Becker's Health
- Care, you can visit beckershospitalreview.com.
- Thank you.