My journey revolutionizing oncology through patient-centered healthcare

As the leader of the oncology, genetics, and laboratory medicine programs at Carelon, I’m lucky to have a broad view of the current state and future potential of advancing oncology patient care. This view is informed by a blend of real-world research and business leadership experience in high-need clinical areas like cancer, HIV/AIDS, Alzheimer’s disease, and a career focused on fostering collaboration between diverse sets of healthcare stakeholders.

As a college student studying abroad in South Africa, I had the opportunity to witness the health impacts that remained when apartheid ended. Among the most devastating realities of that era was a nearly one-third population prevalence rate of HIV — much of which remained without formal diagnosis — resulting in limited and often disconnected opportunities for meaningful solutions.

After completing my master’s degree, I returned to South Africa as a project director with the United States Agency for International Development (USAID), leading research into the intersection of traditional and nontraditional medicine in HIV identification. This included work on how the health system could cooperate with traditional practitioners to increase awareness and acceptance of HIV to accurately diagnose, treat, and manage the disease. It was the first instance of what would become a throughline in my career: working collaboratively to find and take advantage of actionable moments to positively change the trajectory of people’s health.

Like HIV/AIDS in the late 1990s and early 2000s, oncology is an area bursting with unmet needs. It’s an area that highlights the art still present in the practice of medicine. While pharmaceutical research and treatment options increase, the delicate balance between hope and science requires a diligent, nuanced approach that rests on a firm foundation of evidence-driven innovation. We must elevate the behavioral, environmental, and psychosocial concerns of patients so they receive as much attention and support as their biomedical needs, including the delivery of hospice and palliative care in a way that respects patients’ humanity and centers their values and priorities.

Cooperation that centers on patients and prioritizes evidence

Achieving success within our healthcare system requires better collaboration among health plans, care providers, and patients. We need to continue to shift the perception of the plan–provider relationship toward one of partnership. This involves undoing the inaccurate stereotypes that health plans measure success solely by their ability to restrict or halt treatment, and that care providers are always inclined to choose the most expensive treatment options. Instead, we need to disrupt this model and place the patient’s needs at the center of our collective efforts. This requires a shared commitment to foster the continual growth of evidence-based care.

For example, Carelon’s Cancer Treatment Pathways program recommends specific treatments regarding clinical efficacy, safety, toxicity, and cost. The program provides powerful treatment guideposts that look specifically at the unique nature of each patient by incorporating genetic biomarkers, family and treatment history, and additional clinical information to develop a refined set of patient archetypes. Then, out of the pool of approved drugs indicated for a specific cancer type, they identify the two or three treatments that have the best chance for success for a particular patient. While these pathways are optional, they enjoy broad support and adoption within care provider practices, even when not mandated. This widespread acceptance stems from reliance on the best available clinical evidence, which is publicly accessible for use and review. By embracing this approach, we demonstrate our commitment to quality, open engagement, and a shared focus on meeting the distinct needs of each patient.

Equally important is member support and guidance from a team trained in the unique challenges of cancer diagnosis and treatment. Although physicians gain familiarity with treatments and patterns over time, each patient's journey is unique. Patients must interpret new medical information in real time, understand their options, consider future implications, and manage the demands of a life-altering diagnosis. Oncology-focused care navigators can provide education, guidance, and support that complements what patients receive from their clinical care team and personal circle of support. 

When a patient faces challenges such as not fully understanding aspects of their treatment plan, experiencing treatable side effects (like a rash or nausea), or encountering transportation difficulties in reaching appointments, our Cancer Care Engagement team  serves as valuable care management partners. Their role is pivotal in helping patients navigate toward optimal outcomes, empowering patients to be involved in their own care. These dedicated partners collaborate with patients’ care providers, sharing insights and actionable steps to drive a connected and coordinated care journey for the patients as well as an opportunity for awareness and growth with the care providers.

We want to be an amplifier for our care provider partners, augmenting and supporting their crucial roles in the positive outcomes for their patients and our members. Ideally, we want them to be able to tell their patients, “Call me immediately if you need X, Y, or Z. If you need A, B, or C, your health plan has a great resource, and here’s the number to call.” Our goal is to always reinforce the trust and strength within a patient–provider relationship, offering wraparound services that improve the patient experience and the efficacy of their treatment.

Building flexibility into integrated models

Each patient is unique. From employment to family support to the availability of healthcare resources, many factors influence how each person will approach and navigate cancer. As a leader within this space, our delivery models must be flexible enough to accommodate each patient.

Models that lack integration are often siloed and inflexible, offering a one-size-fits-all solution with no capacity for ebb and flow and little opportunity for broader connectivity or learning. Integrated models are better able to deliver resources to members in a connected way. Whether that’s incorporating mental health support, emphasizing the importance of timely palliative care, or connecting patients to options like clinical trials, these models can flex to provide support where it’s needed, while saving resources where they’re wasteful or redundant.

It’s rare for a cancer patient to only be managing their cancer diagnosis, with many managing a range of comorbidities. Prioritizing whole health means that even when cancer care is the primary focus, we cannot lose sight of patients’ other needs, like diabetes or cardiovascular disease. Similarly, a patient with breast cancer may be focused on ensuring her cancer treatment doesn’t limit her future fertility.

The social determinants of health — conditions in which people are born, live, learn, work, play, worship, and age — also have a significant impact on a patient’s ability to manage their cancer diagnosis and subsequent treatment.

All of these factors can impact treatment decisions and the support that’s needed. Deep experience within cancer treatment and management combined with flexible integration is the key to successfully personalizing care.

 

Embracing humility for the dynamic journey ahead

I continually remind myself that even the smartest people, with the best information and intentions, don’t always agree. While there are areas of hard-won consensus (e.g., the growth of strong, unified antismoking campaigns), there are still many areas in which the best minds can look at the exact same evidence and come to different conclusions. This realization is an invitation to humility.

Holding on to humility can be challenging when working toward a passion. The drive to achieve can push us past options that we need to consider even in the face of our own confidence. Humility aligns us with the journey — how we work with each other along the way — as opposed to a focus purely on the destination. Connectivity enables us to think about the patient, care provider, and even our own company in as many ways as possible. This ensures that we do not fall into the trap of assuming that each patient only has one concern, each care provider needs the same thing, or that one of our programs will provide an isolated solution. Each patient is unique and deserves to be treated accordingly.  

The cancer care landscape is changing at an astounding pace. The rapid influx of new treatments means that the cancer treatment paradigm in 5 to 10 years will differ significantly from today. Our challenging task is to wrap our decision-making around that change, adapting while keeping a strong and vital focus on the most important need. A key ingredient will be keeping all stakeholders working together within this bifurcated focus.

When I started in HIV 25 years ago, even the most rudimentary treatments like AZT weren’t yet available in South Africa and today’s prophylactic drugs like PrEP weren’t even on the drug development radar. Working in that environment, it was hard to imagine our current reality, in which HIV is not only preventable, but a manageable diagnosis in which we have real hope for a future cure.

Today, oncology is on that same path. We can’t always see the most hopeful vision of the future, but we are confident it’s on its way. Our task is to remain humble, collaborative, creative, and driven. And to focus on the progress we can make every day for the patients who deserve nothing less.