Opportunities in Oncology (Part 1): The Intersection of Clinical Care, Business and Policy

There’s been a massive gap in oncology where people who have been
responsible for a dramatic increase in the standard of care have
lacked a solid understanding of the business, payment and policy
constructs required to deliver it. Dr. Stephen Schleicher has
spent the early part of his career working to fill that
gap.

Dr. Schleicher entered medical school with an interest in
oncology, anchored by an appreciation for the psychological toll
cancer can have on a person, their family and caregivers that he
gained from parents who were both psychologists. During his
internal medicine residency at Brigham and Women’s Hospital, Dr.
Schleicher also worked at McKinsey and earned his MBA at Harvard
Business School as part of a fully-funded fellowship. Through
this combined experience, he started to develop a niche in the
oncology space where clinical, business and policy decisions
intersect, at a time when value-based care was just starting to
gain momentum.

After a fellowship at Memorial Sloan Kettering Cancer Center, Dr.
Schleicher joined Tennessee Oncology, one of the nation’s largest
community-based cancer care practices, and shortly after became
medical director of value-based care at OneOncology, a large
community oncology network founded by Tennessee Oncology that
spans multiple states. He subsequently returned his focus to
Tennessee Oncology where he served as chief medical officer for
two years and still practices as a breast cancer medical
oncologist. Dr. Schleicher is also a board member and executive
committee member at the Community Oncology Alliance.

To set the stage for a Healthcare is Hard series focused on
Oncology, Dr. Schleicher talked to Keith Figlioli about both the
clinical and business trends influencing cancer care. Topics they
discussed include:



Community providers vs. health systems. For Dr.
Schleicher, the ultimate goal is to give cancer patients the
personal feel of a community clinic with the resources –
including access to precision medicine and clinical trials –
that have historically only existed at academic medical
centers. While Dr. Schleicher firmly believes that nearly all
cancer care should be delivered outside the hospital, he
recognizes the expertise for certain conditions – like rare
sarcomas – that only exists at academic medical centers and
discussed the dynamics of “coopetition” that exists between
health systems and community providers in markets across the
country.


Oncology’s cost center. Drugs already account for a
significant portion of spending on oncology care, and with
dozens of new FDA approvals for cancer therapies each year –
some with extremely high costs – this trend will continue. But
there are many other variables contributing to the large
percentage of spending that goes towards drugs, including the
shift from infusions to more oral medication. Dr. Schleicher
explains how reliance on oral medication introduces PBMs and
specialty pharmacies into the equation, which can add cost and
complexity, and sometimes slow the speed of critical care.


The value based care dilemma. Dr. Schleicher talked
about how successful The CMS Oncology Care Model (OCM) was at
optimizing care for Tennessee Oncology’s patients. He says
hospitalizations and ER visits went from 20%-30% of costs
before OCM to less than 10% now. The remaining 90% of costs now
goes towards drugs – even when used appropriately following
pathways. The dilemma is that there isn’t too much more room
for cost improvement in care delivery. Dr. Schleicher discussed
how payers need a better understanding of how to incentivize
providers around costs they can control, while allowing for
expensive therapies if they’re the right drug at the right time
to improve costs and outcomes in the long run.




To hear Stephen and Keith discuss these topics and more, listen
to this episode of Healthcare is Hard: A Podcast for Insiders.