This episode provides a critical look at the disparities in cancer care across the United States, the role of accurate diagnoses, and the potential of community-based oncologists in reducing costs and improving outcomes.
My guest, Mark Stadler sheds light on AccessHope's proactive approach to identifying patients in need and working with large employers to provide optimal care. My discussion with Mark also highlights the crucial role of innovation in healthcare service delivery and the potential of technology in creating more effective solutions for healthcare access.
Host David E. Williams is president of healthcare strategy consulting firm Health Business Group. Produced by Dafna Williams.
This episode provides a critical look at the disparities in cancer care across the United States, the role of accurate diagnoses, and the potential of community-based oncologists in reducing costs and improving outcomes.
My guest, Mark Stadler sheds light on AccessHope's proactive approach to identifying patients in need and working with large employers to provide optimal care. My discussion with Mark also highlights the crucial role of innovation in healthcare service delivery and the potential of technology in creating more effective solutions for healthcare access.
Host David E. Williams is president of healthcare strategy consulting firm Health Business Group. Produced by Dafna Williams.
0:00:10 - David Williams
Cancer is scary and it's also expensive. In fact, it's the number one cost concern among big employers. But while cancer treatments have improved and death rates have dropped, disparities and outcomes have widened. A key driver is access to comprehensive cancer centers, as Hope, a spin-off of leading cancer center City of Hope, is democratizing cancer care by widening access to first-rate resources. Hi everyone, I'm David Williams, president of Strategy Consulting Firm Health Business Group and host of the Health Biz podcast, a weekly show where I interview top health care leaders about their lives and careers. My guest today is Mark Stadler, ceo of AccessHope. If you like this show, please leave a review and subscribe Mark. Welcome to the Health Biz podcast. Thanks, david, nice to be here. Appreciate it. Let's talk a little bit. Wind the clock back a little bit. Talk about your background, your upbringing. You know what was your childhood like, any childhood, influences that have stuck with you throughout your career.
0:01:12 - Mark Stadler
Oh my, my childhood was idyllic. I grew up in Redondo Beach, California. I'm the sixth of eight children. I have five older brothers and two younger sisters, and we spent a lot of our time back in those days. California was, you know, much slower, much quieter. We spent our days on the beach and up in the local mountains and in the deserts. It was really quite an idyllic life. Redondo Beach is the home of the Beach Boys, so it was really something to grow up there.
0:01:46 - David Williams
That about spells it out. You know Now, were your parents looking for a daughter at some point, like, were you a disappointment, in that sense Were they, but they continued on. I mean, you didn't, they didn't give up, that's for sure.
0:01:56 - Mark Stadler
Well, they saved the best for last. In terms of the boys and I remind my older brothers of that I have very unusual family in that my oldest brother is 23 years older than I am and my youngest sister is nine years younger than I am, and it's the same parents Nice, so you can do the math and they stayed together for a long time. But, yes, they were consistently and constantly trying for that girl and she came along a year after me.
And yeah, yeah. So they got their wish there. So they were great people. My dad was an entrepreneur and owned his own trucking company and always wanted all the boys to work there, and I was the first one that said I want to go to college and went off to college and went and did my own thing. My brothers all went to work for the family business, so that sounds good.
0:02:45 - David Williams
Yes, an interesting dynamic with the larger family. Sometimes people say, you know, it's like great for the kids and tough for the parents and I talked to we have four and I talked to people sometimes who you know. They come from a big family and then they have a small one themselves, or sometimes it's the other way around. I haven't had so many that it's like consistent from one generation to the next. So yeah, I don't know what to say about that.
0:03:04 - Mark Stadler
Well, I have four children of my own. My mother told me as the fourth one was coming. She said don't try to compete with me. And I said, mom, that's not what it's all about. But today we have four children and 10 grandchildren. So, yeah, so I love big families. They're a lot of fun.
0:03:21 - David Williams
Now, what did you do in terms of education when you went off to school? What you know, what was the path and what was that like? And it sounds like you didn't have that many. You were the trailblazer, I was.
0:03:30 - Mark Stadler
I went to Loyola University of Los Angeles it says sometimes it says Loyola Marymount because that's the only thing left on the drop downs. But yeah, I was in the last graduating class of Loyola University when it was Loyola University and Marymount College Love the experience. It was a really great transformational experience for me to be at Loyola and I went into the group health insurance business right out of school, which was a new area really, and certainly self-insuring business insurance for large employers. So it was just. It was eye-opening and life-changing for me to enter this industry.
0:04:12 - David Williams
Very interesting. Yeah, I saw the stints with Great West and Allstate and then before moving along to Mercer as well.
0:04:20 - Mark Stadler
Yeah, I actually started with Great West right out of college and returned to them 20 years later and in between spent some time at Allstate and then about 17 years at Mercer, which was also life-changing, and really working with very prominent employers and, you know, working with some of the brightest people in the industry. It was a wonderful experience.
0:04:41 - David Williams
Tell me about.
0:04:42 - Mark Stadler
HealthSmart. What was that about? Healthsmart was a company that was doing a roll-up of independent third-party administration businesses. Today, Healthsmart is a part of UnitedHealthcare. Actually, they were recently acquired and rolled up into the UMR division of UnitedHealthcare. I've always liked businesses that were either you know you had to turn them around, you had to grow them, you had to figure out how to do new things with them, and HealthSmart very definitely fell within that. That bailiwick, if you will, of really trying to transform the self-funded business for mid-sized employers Got it. And how about Bridge Health? Bridge Health was a company that was involved. It still is. It's now a part of Transcarent. But Bridge Health was a company that was involved with guiding people into high-quality surgical solutions when they had a choice, so these were all scheduled surgeries. That was a company that, to a certain extent, needed a little bit of a turnaround and repositioning to get it to its growth stage and moving along and ultimately, as I said, it is now a part of Transcarent.
0:05:52 - David Williams
So you know it's an interesting area because people talk about. Sometimes you know when you need consumer-driven care and you hear about that and then within healthcare there are a limited number, but there are still a number of places where you really can make that choice. You've got the time and you actually have a choice. You've got the insurance that can do that and that's where it's helpful. Sometimes people, I feel, get a little ideological about how you know well you need to make it more of a consumer business. It just depends it can't be completely a consumer business. So it sounds like Bridge Health focused on the areas where it could be more so.
0:06:24 - Mark Stadler
It did, and you know a large portion of our population are in rural or secondary markets where you might not have the highest quality of surgical solutions or you have really good solutions but better options are available and Bridge Health made those things, for example, for people who lived in Alaska, bringing them down into the lower 48. Sometimes it was more. It was also an issue of both cost and quality that you could get the surgery done at a much more appropriate cost and the employers made it worth the employees' while to go down into the lower 48 to have the surgeries done. That's just one example.
0:07:01 - David Williams
It's nice when you can have. It's not a trade-off between cost and quality, but you could actually improve both, so it sounds worthwhile.
0:07:07 - Mark Stadler
Exactly.
0:07:08 - David Williams
Yes, it was. It was, so it sounds like you know great background to set you up for Access, hope and all the things that you're doing there. You know we were corresponding before this podcast and you were pointing out that cancer care is number one of on the cost concerns for employers, and that's despite the fact that it's not as though there's I mean, we hear about maybe different pockets and new things happening with cancer, but generally speaking, it's not as though that there's been a surge just in the number of cancers. Why is this on the top of employers' lists of cost concerns?
0:07:44 - Mark Stadler
Well, so oncology services today do consume, on average, about 12% of an employer's health care budget. We see some customers that are they're in the 20% range. Depends on the demographics of their group. Could be also the industry in which they're in. There are some industries that have higher incidence of cancer, like the airline industry and things like that where people have greater exposure. So there's a couple of things going on. One, there is a higher incidence and it's growing rapidly, and there are emerging subspecialties of cancer that are driving significant costs because they are new cancers that are being you know, they're being discovered. Today, when you look at cancers, about 1% of our population will get a new cancer diagnosis in a year. About 20% of that population will get a cancer. Of that, 1% will get a diagnosis. That's going to drive about 80% of total cancer costs within an employer's sponsored health plan.
0:08:51 - David Williams
Now you mentioned, mark, that that is. You know it's going to vary by employer. You've got your average amount, but then you've got some higher ones, and it does it have to do with the demographics of the employees, or is it actually something about the work environment as well? I wasn't sure what you were getting at with an airline example.
0:09:08 - Mark Stadler
Some of it can be environmental. So, for example, you just look at at the airline industry. You have people working outdoors on ramps. They have high sun exposure. You have people that are working in aircraft. That has higher radio radioactive exposure and other things, and so you we do tend to see some higher incidence of cancer in those in those work groups. You look at fire departments and other things like that that, because of exposure to certain elements, you may see higher incidence of cancer, regional differences in the incidence of cancer as well. The other thing that's driving this is a lot of the cost changes in cancer is medical knowledge. In the past it used to change about every three to five years. You'd get some new advancements, particularly in the oncology area. Today there are new advancements every 50 to 70 days. In certain areas of cancer New treatments are found because of what we've learned through molecular and DNA testing and the advancements in science. Today it's changing the pathway and those pathways are all leading to a cure. That is driving a lot of this as well.
0:10:29 - David Williams
And you were anticipating my next question in a way, because one reason the cost could be rising is that there's more you can do with the cancer now, so it's become more treatable. And I would say in the same way, if I'm going to spend more, I'm going to get something more for it, like a cure or long-term remission. That would be great, and maybe this is related. But there's these socio-economic disparities and outcomes seem to be rising and I'm just going to guess that that has to do with if you've got something that's changing rapidly, then those that can keep up with the change are going to do well, and there's going to be a separation of those folks from those that are going to, let's say, to physicians that are still practicing whatever they learned in medical school or the last time they had a chance to go to a CME.
0:11:16 - Mark Stadler
Yeah, you know there's a distinction in how cancer is being cared for across the country. There are 50 or so what are called NCI level cancer centers in the country. These NCI designated centers and academic centers are where about 90% of the research is happening around new and emerging cancers, new treatments, how to give more precise diagnosis of a cancer, which is really important. To get that precise diagnosis early in the cancer journey, your opportunity for survival is much greater. That's all happening in these NCI centers. As I said, about 90% of the research is done there, but only about 20% of the care is actually delivered through these big NCI centers. 80 to 85% of care is delivered in community-based oncology centers where those doctors, as you just said, they're very experienced oncologists but they may see some of these rare cancers or these new and emerging cancers once or twice a year or even in a career.
They also may not be able to keep up on the changes in treatment protocol of what is appropriate treatment for cancers today, because they just can't keep up with all of the new and emerging research. It's really important to be able to deliver that type of information to them so they can appropriately treat the patient, get them diagnosed correctly and to avoid what we call misadventures in cancer. When you do that, you're also pulling waste out of the system. Correct diagnosis leads to incorrect treatment, which means you then have to restart, and all of that was for naught. It's very expensive, not to mention the humanistic impact of that on the person who's going through the journey and the disappointment of knowing that they have to change treatment protocol and essentially restart.
0:13:21 - David Williams
A lot of times I hear arguments from an academic medical center. I'm going beyond cancer now and thinking more broadly that this is where the research is done. We have the most advanced approach Then. Yet the community hospitals will say, well, it's more convenient. Also, the outcomes might be better because we're not dealing with having to teach people or more focused Particularly. I'm thinking about something maybe a little more routine, like colonoscopy or other procedure. People may do as well or better, and it's less expensive. How do you think about? You've given me a good reason why a comprehensive cancer center could be less expensive, which is if you do the right thing first, you don't have to repeat it and do something else. Are there measurable differences in outcomes compared with average care at a comprehensive cancer center? How should we think about that?
0:14:12 - Mark Stadler
Recent studies would indicate that the outcomes are 20% better if you're in an NCI or one of these large research centers having your care delivered.
What we've tried to do at AccessHope and what we are doing is delivering that knowledge from that NCI center out to the community based oncologist, not putting the patient in the middle where they have to negotiate with their local doctor, but where we bring that directly to their local doctor in a peer-to-peer consultation with them to accurately diagnose and get the person on the right path the first time. Similarly, delivering that level of expertise, the appropriate level of expertise, to where it's needed most and when it's needed most. Many cancer patients can't travel and that's one of the challenges that they have in getting to one of these NCI centers. It could be geographically too far away or their immune system could be compromised in such a way that they can't travel, or the diagnosis is stage three or stage four and time is of the essence to get the diagnosis done quickly. So by exporting it, you're solving for a lot of those problems that are part of the geographical disparity in cancer care and you try to narrow that gap.
0:15:41 - David Williams
So, on a pragmatic basis, is this done you know, one patient at a time, or is it sort of a systemic approach where you would work, you know, with a given regional center? Like how does it come? Like, let's say, if I were in a place that doesn't have access but I know I want to be able to get this level and I go to my, you know, I just have to pick the right regional one. Or when I get there you could work with my physician there, my oncologist.
0:16:09 - Mark Stadler
What we do is we work through large employers who are sponsoring health plans, who are looking at the disparity in care and the of that's happening in their population and they've said we want to make sure that, when it comes to cancer, that our people are getting the very best that's possible. And we identify patients through that employer and reach out to their doctor directly on their behalf and on behalf of the employer's plan. And it's a it's a revolutionary approach. It's not something that a member that when I say member, it's a patient that somebody who's who's in this health plan has to opt in to do. They can if they would like to, but we're proactively reaching out and identifying situations and reaching out on their behalf to their doctor to assist them and let the doctor keeping the doctor in complete control of the case. 88% of the time when we're, when we're communicating with a doctor, they're adopting our recommendations. The 12% that might not. It might be because it's too late stage, there was, there was nothing else that could be done, but we know that we're making significant impact and the and the response we get from the local oncologist is thank you. How can I get this for all of my patients Got it Because they they are all one of the unique things and real wonderful thing about oncologists they're on a mission for a cure, they want to get that patient through.
That's their goal. That there's no, there's no profit in the end of a life, and they're really looking for the value that they can deliver in getting that person through their cancer journey successfully. And so are the employers. Employers also know that the right treatment might be more expensive, but it's the right treatment and if you get it done quickly and you avoid that, you know that misadventure I was talking about yeah, it actually pays for itself, and so cost is not the, not the driver of this.
It's really quality, that that that employers are looking for, that the employers that are hiring us, the other thing that they're trying to look at it in that they, that when we reach out to people, we do that without, without knowledge of their socioeconomic, their racial anything, and we are helping to deliver an employer's what they call their DE and I strategies, their diversity, equity and inclusion strategies, to make sure that there is health equity across their plan. And we see time and time again where we're reaching into underserved zip codes around the United States and your zip code does have a strong correlation to your success on a cancer journey. So when we can reach to that doctor in Tupelo, mississippi, or Hayes, kansas, that are way, far out away from these centers, and bring NCI level care to a, to a patient in that community, it's life changing. It really is life changing and it's very motivating. What motivates our team?
0:19:16 - David Williams
So I've heard about some second opinion services that also serve the employer market. A lot of the diagnoses probably are cancer, but they're not as focused as you are. I heard one element where you're saying maybe oncologists are particularly. You don't have an issue of, you know you stay out of my lane they're interested, maybe more interested than, let's just say, orthopedist or cardiologist, and is that the sort of? Is that the case? How would you contrast yourself with a? There's that element of it, but are you different? Like is second opinion? Is that the wrong way to think about it?
0:19:51 - Mark Stadler
Well, second opinion.
I would certainly encourage anybody to always get a second opinion on any type of medical care, because there are multiple ways to look at a diagnosis or you know a treatment plan, and it's your health.
But when it comes to cancer, what you don't want to have happen is you I call it the monkey in the middle.
You don't want to give a second opinion to the patient and leave them alone to go talk to their doctor, and you also don't want to create mistrust with the patient of the person that they're putting their life in, you know, in the hands of a local oncologist and to put a precision review with an, with a true NCI specialist.
These are the doctors that might actually be working on the clinical trials and looking at the emerging capabilities and treatment protocols for that specific subspecialty of cancer and putting them in touch with that local oncologist. It empowers the oncologist and the oncologist is not is not in a position where they're losing their patient, which they don't want to do, and they want to be able to treat that patient and appropriately treat them, and we're giving them everything they need to do. Sometimes a second opinion is it's a second opinion and it ends up in a file somewhere that no one really addresses, and we wanted to make sure that what we were doing was really adding value and changing the course of treatment and the outcome for people who are on a cancer journey.
0:21:21 - David Williams
I sometimes hear about it, related to managed care, even, let's say, medicare Advantage, that you have a certain percentage of your panel. If you're a physician, that has a certain way that you're treating them because of, maybe, in that case, your financial requirements, and then it changes your whole practice. Do you see an impact on? You know who had mentioned that local oncologists may say, hey, I wish you could have this for all the patients, but is there some sort of a broader effect that you have, even if you're not obviously getting the whole panel of the patients? Does that oncologist get better of the local oncologist? Do they practice differently?
0:21:57 - Mark Stadler
I think they do. I think they also establish relationships with the NCI center to be able to connect with them on future cases and other things like that. I think they. I think it's very empowering to them. Yes.
You know one of the things that also can happen in some of these other you mentioned Medicare Advantage and other situations. Some people are enrolled in plans that have very narrow networks. They have fewer options An NCI center, chances are, are not in one of those options and so they are relying exclusively on the opinions and the treatment protocols that are developed by that network to be able to offer an NCI guideline. For folks in those it can be again life changing.
0:22:47 - David Williams
Got it. So sounds like you're making good progress and I'm curious you know where. Where do you go from here. Is it just kind of getting the word out to more employers and building what you're doing, what you know, what's on your roadmap?
0:22:58 - Mark Stadler
Yeah. So today we're working with More than 35 of the Fortune 500 companies in the country have contracted with us and we're very flattered by that. We're continuing to to work with other large self-insured employers. We're also now working through large health plans where they are offering our services to their customers as part of a cancer offering. So that's a that's a big movement for us. We're working with Union welfare plans where there are labor negotiated benefits. They have a real keen interest in improving cancer care for their members. And then we're also just now entering the Medicare Advantage market with with a pilot next year To to see what we can do and impacting the lives for people on Medicare Advantage. The incidence of cancer in a Medicare population because of age is about double what it is for an under 65 population, and our mission is to deliver this life-changing information out to oncologists. And we're also to perpetuate the original mission of City of Hope, who founded us, which is to democratize cancer care.
0:24:10 - David Williams
Makes sense. I think that long term, you'd have to be working with an older population, considering that's where most of the cancer actually is exactly, yeah, so last question the last question I have for you, mark, is about sort of turning back to whether there's, you know, any good books that you've read lately, anything that you might recommend.
0:24:29 - Mark Stadler
Well, I'm reading two books, one at one. I'm reading for the second time. It's called the Empire of the Summer Moon because the movies coming out and that's not a commercial for the movie, but it's a fascinating story of the life of a Major Indian tribe in Oklahoma and it's, I think, something we can all learn from. And I'm also reading a really great book. It's called the American Nations a history of 11 rival regional cultures of North America.
0:24:56 - David Williams
Wow.
0:24:57 - Mark Stadler
And when you read it it really helps you understand why the left coast is different than the east coast and many of that still survives today. There's cultural norms in parts of and I live in. I grew up in, Redondo Beach. Today I live in Dallas, Texas, which is, you know, a very interesting cultural shift for me and it but it really helps you understand why some regional areas of the country are different. So it's it's fascinating book.
0:25:25 - David Williams
That sounds really good. Well, mark Stadler, ceo of AccessHope, thank you for joining me today on the health biz podcast. Thanks, david. I really appreciate being here. You've been listening to the health biz podcast with me, david Williams, president of health business group. I conduct in-depth interviews with leaders in health care, business and policy. If you like what you hear, go ahead and subscribe on your favorite service. While you're at it, go ahead and subscribe on your second and third favorite services as well. There's more good stuff to come and you won't want to miss an episode. If your organization is seeking strategy consulting services in health care, check out our website, healthbusinessgroupcom.