‘We need to give anybody who wants to come to us that chance’

Dr. Pat Basu is coming up on his one-year anniversary as CEO of Cancer Treatment Centers of America. During that time, Basu has worked to expand its network with payers and forge partnerships with other providers. Basu’s career includes stints as an adviser to then-President Barack Obama, a Stanford University Medical Center physician and as senior vice president of Optum/United Health Group. He spoke with Modern Healthcare Managing Editor Matthew Weinstock.

MH: You’ve been in the role for almost a year now. Has anything surprised you about CTCA operations?

Basu: The areas of strength are threefold. Our patient outcomes: If you look at the morbidity and mortality versus the National Cancer Institute database and outcomes, we’re really good. And their symptom management: Those two go hand in hand. Because we manage patient symptoms so well, we have good adherence to therapy rates and really good outcomes.

The patient experience and journey is really powerful and phenomenal.

I have had so many patients come to me directly when I’m making rounds in the hospital, or speaking at a five-year survival celebration, and they say everything from, “They called me by my name. They put their hand on my shoulder. They knew I was here. I didn’t have to wait.”

All of those things that the normal healthcare system is known to be poor at. I’m

not trying to be coy. I’m a physician who worked in an insurance company, so I’m a dyed-in-the-wool healthcare professional as it is. I’ve seen both sides.

The third aspect is our powerful brand. Quantitatively, patients have heard of us. They trust us and they’ve considered getting care at a very high rate here. And then qualitatively, oftentimes I ask patients, “What made you come here?” Oftentimes it’s word of mouth.

Where does that leave us in terms of areas for improvement? One big category is partnerships.

Are there clinically affiliated networks? Are there joint venture partnerships? Are there joint accountable care organizations that we should be creating or talking about together?

It also just includes the modern economy. There are business vendors that might do certain things better. Upgrading to a better centralized scheduling pathway … there are companies to do that.

No. 2. When I first started, a lot of our patients were still coming to us out-of-network. As of the conclusion of my first year, we will be 95% to 98% in-network with all major payers.

Then a third area … just dealing with that crunch between changing payer environment and financing environments in conjunction with pharmaceutical costs.

When you’re in the business of oncology, you are inadvertently in on the business of pharmacy because you have to procure and prescribe those drugs. You’re always thinking about patient cost.

MH:

What role can you play in trying to help patients navigate the high cost of drug therapies?

Basu: We’re constantly working with our drug procurement vendors; we’re constantly working with manufacturers; we’re looking at value-based care payment alternatives with pharmaceutical companies.

We’re going deeper (in terms of) standardizing our pathways. Where it’s relevant, we’re switching to biosimilars. We’re looking at comparative effectiveness … all of those things help.

MH: How critical was it for you to address payer networks?

Basu: I’m a big believer in affordability and access. So you’re delivering great quality, you’re delivering great affordability, but why do anything that would restrict access? We’ve been very conscientious to say, “Let’s not have any access barriers. Let’s get all the commercial contracts that allow patients to come to us, and Medicare Advantage.”

There were examples of patients as recently as 2018 who wanted to come to us, but we’re unable to because we didn’t have a contract with (their insurer). When I looked at that data, I said, “This is unacceptable. We need to give anybody who wants to come to us that chance.”

MH: How much of that contracting is focused on riskbased arrangements?

Basu: In our traditional contracting, with about a third of those we already have some pretty significant

risk-based or value-based contracting. We also have an entirely dedicated, full-on value-based care (model). To differentiate the two … in the first bucket, it’s existing contracts and existing payers where we have some minor element of value or risk to it. In our second bucket, we’re looking to do special carveouts where we take significant, or in some cases, total risk for oncology. We have a few contracts where we’re in discussions to take north of somewhere between 80% and 100%.

MH: What are the keys to value-based oncology care?

Basu: If you look at oncology as a chronic disease … there are now 15 million Americans who have cancer as a past diagnosis. So they’re in survivorship, or as we like to call it, thrivership.

But there’s also 50 million Americans right now who are wondering if they should get tested. Their aunt had cancer, should they get this genetic test? The pre-acute, and the post-acute all need to be managed.

We’re helping manage intake and decisions around cancer-risk assessment. It’s programs to screen, programs to manage behavior and lifestyle changes to reduce their risk of cancer.

The second layer, which is more analogous to knee replacement, is basically a defined type of cancer— breast, lung, etc.—over a defined period. We work with payers or employers to take on risk.

“Value-based care can be good for patients. It can be good for providers. And it can be good for whoever’s the underwriting organization.”

MH: What kind of partnerships are you looking at?

Basu: A lot of it is meshing our brand and our trust with their local care delivery. We have a ubiquitous and powerful brand, but we are not on every street corner.

What these partnerships look like is a joint ability to serve that patient. And it can take a few forms. One is, we see that patient initially for high-level oncology care, and then they get follow-up care back home.

A second option can be that we co-manage that patient together in a way that is in our specialty that gives the same quality, gives the same service that they would want to get from us, just closer to home. And the third is more of an oncology management-services organization model. In that case, we’re helping manage their oncology service line so they can focus on general medicine.

MH:

Are there any other things you are exploring for CTCA?

Basu: We’ve pushed the envelope on our data and our precision medicine. We have one of the richest oncology datasets probably in the world. We think that we can serve patients with that information even though it’s not us delivering the direct care.

We have about 10 large life-sciences groups that we’re working with to bring better solutions to market. It’s just a phenomenal opportunity that represents some of the best of what we can do in oncology. If we all stay in our silos, we might find cures to cancer 20 years from now. By doing this, we can (accomplish that) much,

● much faster.