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- Becker's fourteenth annual CEO and CFO roundtable
- brings together more than 1,500
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- and nearly 400 speakers for four days built
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- Join us November second through the fifth in
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- upper right.
- Hello, and thank you so much for tuning
- in to the Becker's Oncology Leadership Podcast.
- I'm Elizabeth Gregersen, a reporter here at Becker's.
- And today, I am talking to Alicia Cruz,
- vice president of the Orlando Health Cancer Institute.
- Alicia, thank you so much for taking the
- time to speak with me today.
- No. Absolutely.
- Thank you for taking the time to talk
- to me. It's been an absolute pleasure getting
- to know you through Becker's Oncology.
- Aw. Thank you so much. I know. I'm
- always grateful to share your insights, so I'm
- excited that our podcast audience now gets to
- meet you. Before I dive into my questions,
- I'd love if you could share a bit
- about just your background and your role at
- Orlando Health for our listeners.
- Absolutely. So I've been in health care operations
- leadership for about twenty six years.
- I think I've done every specialty
- beyond ortho,
- and I'm gonna leave that alone other than
- ortho oncology.
- But about sixteen years ago,
- I ended up losing my brother to colon
- cancer and decided I needed to leave the
- Northeast,
- applied to a job in the Sunshine State,
- at the University of Miami to just get
- out of the Northeast gray. And
- within
- nine months, got kind of lured over
- to talk about a role at a can
- the cancer institute, so at Sylvester.
- And just
- absolutely took a dive, considered it a sign,
- and for the first time in health care,
- really fell in love with what I was
- doing.
- So I've been in oncology ever since.
- And, there's no looking back for me. This
- is my passion plus purpose role. I get
- to create for patients and their families
- in everything that we do.
- And now I also enjoy really building up
- leaders and building teams and doing startup programs.
- So it's become a true passion plus purpose
- career, and I plan to stay oncology for
- the long haul.
- Amazing. Thank you so much. And and as
- you kind of hint at some of the
- things you're most excited about that you're working
- on,
- at Orlando Health,
- are you able to narrow it down to
- maybe what your biggest priority is right now?
- Yes. Absolutely.
- As we've seen in throughout the state of
- Florida, and I'm assuming it's everywhere,
- a lot of population growth, which also means
- a lot of cancer diagnoses,
- early cancer diagnosed, late stage still
- in much
- earlier populations like younger populations. So for me,
- it's access,
- making sure that if someone is thinking
- that they have cancer or quickly
- getting to someone who is diagnosed, like, making
- sure they can get into the door and
- meet with an expert
- to alleviate that anxiety.
- You know, we keep getting bigger and bigger,
- but sometimes when you get larger and larger,
- you forget that that that critical time window
- of getting someone in,
- is the most important thing you can do.
- And if you can't do it, they will
- vote with their feet and go somewhere whether
- they have better quality, worse quality.
- They are not looking at scores. They're looking
- at how can I get in and who
- did my neighbor go and see and how
- quickly can I get into them,
- so they can alleviate that fear of what
- does this mean for me?
- So we are heavily focused on access right
- now and making sure that time window is
- the right window.
- And then in some of those diagnoses
- that, you know, you've been in the oncology
- space for a long time,
- we are not MD Anderson or Sloan Kettering
- where we only take a cancer diagnosis.
- We also have a lot of workup opportunities
- and a lot of referrals that may not
- to be or they might be high risk.
- So just making sure those are appropriately
- kind too. So just making sure
- that we're getting patients throughout the communities in
- which we serve in a timely essence, really
- taking care of their needs. So
- the other piece of that is access to
- clinical trials. Right? So in oncology today, if
- you don't have trials, you're really not offering
- the treatment you should be offering the way
- that we continue to evolve.
- So if you're doing
- tomorrow's treatments today, that means you're offering the
- robust clinical trial portfolio.
- And that's something we have hyper focused on
- as well, making sure that our patients don't
- have to go outside of their community, outside
- of their state
- to get the same access to the latest
- and greatest, the innovative,
- the Till therapy, the you know, any of
- the things
- that are not your typical standard of care
- at this point. So those are our big
- ones. So access and then, of course, clinical
- trial access and having a portfolio that matches
- our community.
- Absolutely. And I I think the way you,
- you phrased it with, you know, patients will
- vote with their feet and walk somewhere else,
- I think, is something, you know, leaders across
- all specialties can can relate to,
- specifically when it comes to, you know, oncology
- service lines and cancer centers.
- You mentioned kind of the growing patient population,
- clinical trials.
- So
- those might be incorporated in your answer to
- the question I'm about to ask you. But
- is there any kind of pressure that you
- feel
- cancer centers are facing right now that is
- not getting talked about enough?
- I don't know that it's not being talked
- about, but
- globally being shared,
- just in passing a few just seeing leaders
- and being on some exchanges.
- The drug shortages that are happening right now,
- the growing drug expense where some of your
- smaller
- we're lucky we're a large system.
- We've got that benefit of a very large
- supply chain to help us negotiate, you know,
- at a large scale
- and then also having that inventory.
- But I think it was earlier this week,
- we were on a leadership exchange, and some
- of the smaller programs are really struggling and
- having to
- stratify
- if we only have, say, 30 doses,
- what 30 patients are we gonna be able
- to give this to? How do you pick?
- Right? Because you have 60 patients.
- And those choices are very difficult.
- So I think people are feeling it and
- struggling, and,
- they're each struggling in their own arena right
- now. So I think that's always a hard
- one. And we're gonna see more of that
- as the drug expenses seem to continue to
- grow up.
- And, of course, everything we're doing right now,
- all the new developments,
- some of those drugs are very expensive. When
- you look at cellular therapy and gene therapy,
- they're not cheap. So making sure you have
- the team behind that
- so you don't get stuck with a huge
- expense. And, yes, you you gave someone life
- altering treatment, but then you also incurred an
- expense with no reimbursement. That is a scary
- dilemma in the wrong, like, environment.
- So I think around the drugs and expenses
- and where we're going, that's one complication and
- pressure.
- Then there's always this staffing challenge.
- It's just a very different
- working group at this point. You have a
- new generation of folks who
- they really do love that work life integration.
- And post COVID,
- when it's complicated,
- sometimes they'll just jump ship and go do
- something else.
- So keeping that team to support, you know,
- the physicians and APPs are not the ones
- that typically jump every one or two years.
- But building that really strong team around you
- to be able to deliver the care,
- that continues
- to be a challenge.
- Even in the systems where, you know, you
- have great benefits and you might pay competitively.
- If if there's the assumption or the feeling
- perception
- that it's complicated,
- then they can do the same thing working
- in a less complex
- specialty,
- we still lose them every day. So for
- the long haul, I think that's where we
- start to dive into the AI space. Right?
- When you have less of those experts who
- are staying to support the team,
- How do you how do you have the
- systems around that? So instead of just humans,
- you've got the tech to help with some
- of the workflow.
- Absolutely. And I'd love to kind of pick
- your brain about how you're navigating
- AI right now. You know, I know everyone
- kind of has a different mindset, different strategy.
- I think,
- overall, I've heard there's places where it's, you
- know, changing
- the game and then other times where maybe
- it's overhyped.
- Safety concerns, of course, are always the caveat
- everybody shares their opinion with, but I I'd
- love to to see how you are looking
- at AI right now.
- Yeah. Absolutely. I think for our system, overarching,
- Orlando Health has been at the cutting edge
- kind of they've been there and
- trying to make sure that we have the
- most
- innovation in every space.
- So that's been great for us because we've
- been able to
- turn on our AI lung incidental program,
- which then now can be turned on for
- other modalities.
- And what that did was identify patients that
- you would miss. You know, they showed up
- to the ED after a car crash.
- And it's something showed on a chest except,
- but no one was looking for an incidental.
- Right? So finding a lung cancer early, that's
- pretty incredible.
- We have AI turned on within our EMR
- to help, you know, the infusion capacity piece.
- It's huge. Where we used to think we
- were full because you had people manually trying
- to arrange a schedule. Well, you take that
- out and let the tech come in and
- all of a sudden,
- you 30% more volume without
- going into overtime, without stretching your nurses too
- much over lunch, all of the things.
- Huge impact there.
- Of course, there's 7,000
- solutions for every problem you have. So trying
- to find the right
- vendor or player or stakeholder to work with
- you within your EMR and within your system,
- it's not quick. So
- turning some of those on took a while,
- And you see some of the vendors, you
- know, now they're starting to absorb one another.
- So it gets a little complex. And for
- us, we never like to operate outside of
- our EMR too much because once you have
- to log in to something else,
- that's more clicks, that's more logins, that's more
- everything.
- So we're pretty straightforward
- with
- our IT governance and steering committees, and they
- also have an AI governance committee.
- So they really sets out the things that
- are not appropriate from a safety lens and
- what is doable from an IT lens for
- us. But when it's really important,
- say, for our specialty,
- we do have a chief informatics officer that's
- also a head and neck surgeon on our
- team. And so we
- together,
- we kind of vet out what will work,
- what won't work, and we've been able to
- be nimble by having all the right stakeholders
- there. We are blessed and that we have
- a strong oncology informatics team. So when we
- do finally get that green light, we can
- implement
- fairly quickly. Usually, it's that pre process that,
- you know, it has to go to supply
- chain, has to go to finance, has to
- go all around, get vetted out. But Yeah.
- I I really pride our organization on allowing
- us to use these tools because
- the the inbox management for the team messaging,
- you know, handling patient messages,
- that reduces their time. The things that they're
- finding for screenings and incidentals,
- that just identifies patients early. Puts it in
- a workable list. So it's pretty incredible what
- it can do. And then our system turned
- on, for us, Copilot, and now we have
- access to Claude and ChatGPT.
- So
- how that reduces even the administrator burden. Right?
- Mhmm. Nespar need this. Hey. What are the
- last 15 emails I've missed? Can you summarize
- who I need to get back to? And
- it's taking hours of days. So then you
- can spend it purposely rounding with your teams
- and finding out what do you need, what
- do you not need, what's broken. So I
- think it's completely shifting
- how we do our work as administrators too.
- Perfect. And I love all those concrete examples
- because I know our listeners love them as
- well of just how, you know, the technology
- is actually
- changing things
- in your day to day, you know, workflow
- and
- and broader, you know, when it comes to
- diagnostics and everything. So I'm excited to see
- what what comes next out of Orlando Health
- there.
- Yeah.
- Absolutely. Yeah.
- And I'm kind of phrasing this question to
- leaders as a forward looking
- leadership
- question. So
- when you look towards the next generation of
- oncology leaders
- who maybe are just joining the field or
- on their way up,
- is there a challenge that you think will
- be left in their hands that they're going
- to need to solve that maybe the field
- hasn't fully tackled yet or isn't taking seriously
- enough today
- that you see the future generation having to
- face?
- Yeah. It's gonna sound old school, but
- with all of the tech and how fast
- we are moving,
- really making sure we still keep that balance
- of a personal touch and the communication.
- It
- you know, you can send me 7,000,000 emails
- in a day, but if if I'm out
- there and I'm supposed to be rounding on
- teams and talking to them and sharing information,
- it's just the the speed of which we're
- getting all of this new info
- and how quickly you can
- not communicate important things to the entire group.
- So every time we have our town halls
- or med staff meetings or our pod meetings,
- you find out that you think you've communicated
- things well and everyone is up to speed,
- but there's so much information coming at everyone.
- You do have to have those intentional conversations.
- So it's I've said it a few times
- in the last two years. It's almost like
- back to basics. Don't forget
- that personal touch to find out what is
- working with your patients, what is working with
- your teams.
- And we find sometimes that, okay. Great. Now
- we have this new tool that helps us
- send more MyChart messages to patients. Some patients
- hate using MyChart and messaging.
- They would prefer you call them back, but
- instead they're getting a message and they have
- six more questions.
- So it's really not losing sight of
- how are we making sure we're communicating to
- everyone in the way they receive communication
- and not assuming.
- Yeah. It's kind of like don't let the
- pendulum swing all the way in the other
- direction.
- Kind of find that that happy middle ground.
- Exactly.
- And if anyone's listening to the podcast,
- I'm sure you know what my last question
- is gonna be. I always like to ask
- the oncology leaders what is giving them hope
- when they look towards the future of cancer
- care and what, you know, is giving them
- optimism about what oncology will look like in
- the next years.
- I'd love to hear your perspective.
- For me, I keep calling it the most
- exciting time to be in this space because,
- you know, you you hear people you talk
- and, like, I'm from a small town back
- in Illinois, and I go home and they're
- like, oh, yeah. You guys don't wanna cure
- cancer. You just wanna keep treating so you
- can make money. But they don't understand the
- science and what has been discovered and what
- is going on.
- And to I was telling my mom a
- few months ago, like, went to a Caris
- talk and, you know, you're treating two patients
- with the same treatment and they're not having
- the same results. Well, now you can do
- a liquid biopsy or
- different testing and find out, well, yeah, the
- one's not responding because it's a completely different
- cancer with a completely different genetic system and
- mutation that's impacting how they, you know, they
- receive treatment.
- And so being able to get precision medicine
- and get down to
- treating that person based on their genetic makeup
- and that biopsy is pretty phenomenal.
- And even watching what they've done in the
- melanoma space, watching terminal,
- stage four terminal melanoma patients
- suddenly having a chance of, like, they're completely
- eradicating their cancer.
- Just went through this with one of my
- best friends, my old neighbor in Miami,
- last year December telling me, oh my god.
- I have
- metastatic
- melanoma,
- and I think this is it.
- And
- two months ago, finding out that he's in
- remission, cancer free, and he was on a
- trial down in Miami, and
- that is what gives me hope about what
- we're doing and where we're headed, and it's
- just an exciting time to see that impact.
- Absolutely. And I think, you know, being able
- to
- to talk about your friends and and and
- have that connection of all these kind of
- broader innovations and the excitement about the future
- and and tying it back to, you know,
- your friend and and the patients that Orlando
- Health is serving is
- is such a great way to end the
- podcast. So I'm grateful,
- for you looping us in on that, and
- I hope your friend's doing well.
- But thank you so much. And that's why
- it's it's such a personal connection to the
- field and such an exciting time to help.
- So just honored to serve in the role.
- Absolutely. Well, thank you again, Alicia, for coming
- on the podcast and taking the time to
- share your insights with our audience.
- Truly a pleasure. Thank you for having
- me.