Spotlight Episode: Oncology Side Effect Management in the Real World, With Dan Nardi From Reimagine Care

[00:00:00] [SPEAKER_03]: Spotlight Episode Oncology Side Effect Management in the Real World, Today I am speaking with Dan Nardi from Reimagine Care.

[00:00:20] [SPEAKER_02]: American Health Care entrepreneurs and executives you want to know.

[00:00:24] [SPEAKER_02]: Talking. We're ndlessly seeking value.

[00:00:29] [SPEAKER_03]: Right out of the gate here, I wanted to thank Reimagine Care for sponsoring this episode.

[00:00:34] [SPEAKER_03]: It's kind of a breath of fresh air, honestly, to have someone reach out not only with an interesting pitch for a show,

[00:00:39] [SPEAKER_03]: but also within offer to help out financially.

[00:00:42] [SPEAKER_03]: Pulling off a show like this one is not cheap and my eventory business partner Dave Durk,

[00:00:46] [SPEAKER_03]: and I are happy to find the vast majority of it.

[00:00:49] [SPEAKER_03]: But yeah, for rather fresh air and thanks much to the team over at Reimagine Care for their sponsorship.

[00:00:56] [SPEAKER_03]: My one disclaimer is that I have not personally vetted the solution,

[00:00:59] [SPEAKER_03]: but there is a weight paper available link in the show notes where you will also find some insights from Reimagine Care's work with Memorial Herman Health System.

[00:01:07] [SPEAKER_03]: So today, Real on the South Value listeners,

[00:01:11] [SPEAKER_03]: we are going to hear about doing at home cancer care.

[00:01:14] [SPEAKER_03]: Otherwise known as integrative cancer care.

[00:01:16] [SPEAKER_03]: Otherwise known as side effect management.

[00:01:18] [SPEAKER_03]: This is the same topic by the way that I ranted about being so important in episode 442.

[00:01:24] [SPEAKER_03]: In that last episode 442, Andreas Mang from Blackstone was talking about how the most common reason for read missions

[00:01:31] [SPEAKER_03]: is nausea after chemotherapy.

[00:01:34] [SPEAKER_03]: I mean, think about that.

[00:01:35] [SPEAKER_03]: A voidable with a capital A expensive for everybody and horrible for an already very, very ill person patient.

[00:01:44] [SPEAKER_03]: For the extent of the problem, again, please go back and listen to episode 442.

[00:01:49] [SPEAKER_03]: But today we're talking about how do you think about operationalizing the hey,

[00:01:54] [SPEAKER_03]: let's actually make sure cancer patients are proactively managed after they leave the four walls of the clinic.

[00:01:59] [SPEAKER_03]: Interestingly, helping patients get their questions answered and not show up needing emergency care or abandoning their treatment.

[00:02:07] [SPEAKER_03]: Also gets high marks with nurses and doctors, which makes sense who wants to show up in clinic every morning,

[00:02:14] [SPEAKER_03]: dealing with a patient portal full of messages and questions and too many patients hooked up to IVs in the ER.

[00:02:21] [SPEAKER_03]: I don't think the feedback of clinician teams, in other words, is insignificant because we need to protect our clinical teams.

[00:02:29] [SPEAKER_03]: So they have the bandwidth to protect their patients.

[00:02:32] [SPEAKER_03]: Dan Arty, my guest today is CEO over at Riemagine Care.

[00:02:35] [SPEAKER_03]: Earlier he headed up operations at Kerem Health, which I'm sure provided some great perspective.

[00:02:41] [SPEAKER_03]: Oh and one last point at the present time Riemagine Care's clients are mostly health systems who

[00:02:46] [SPEAKER_03]: white label this service.

[00:02:48] [SPEAKER_03]: My name is Stacey Richter and for once, this podcast is sponsored by somebody else besides the Ventria Health Group.

[00:02:55] [SPEAKER_03]: Dan, Arty, welcome to Relent in the South value.

[00:02:56] [SPEAKER_03]: Thank you for having me say a similar side of the beer.

[00:02:58] [SPEAKER_03]: This show is a little bit I would say of a companion show to episode 442 admittedly I went off about

[00:03:05] [SPEAKER_03]: the issue that I see with oncology care.

[00:03:10] [SPEAKER_03]: Tolerability is actually a point to be made as we're contemplating delivering oncology care.

[00:03:16] [SPEAKER_03]: We're really keeping track of what's going on with the patient and the side effects that these

[00:03:20] [SPEAKER_03]: are toxic.

[00:03:22] [SPEAKER_03]: The dose is the poison is really a thing.

[00:03:28] [SPEAKER_03]: So if we're thinking about that though, what actually are the problems here?

[00:03:34] [SPEAKER_03]: Why does it really matter if I just ask you to kind of crystallize that point?

[00:03:38] [SPEAKER_03]: Why does it really matter when we're thinking about oncology patients to be really paying attention

[00:03:43] [SPEAKER_03]: to what is going on with them and managing side effects and keeping track of their experience

[00:03:50] [SPEAKER_03]: in air quotes?

[00:03:52] [SPEAKER_00]: Well, I think most people would agree that the U.S. healthcare system is challenging and

[00:03:56] [SPEAKER_00]: enough to navigate for just the average person.

[00:03:59] [SPEAKER_00]: But on top of that, patients that are going through cancer treatment, it's to a whole different

[00:04:03] [SPEAKER_00]: level. The amount of complexity that gets layered into their treatments for patients that are

[00:04:09] [SPEAKER_00]: going through this is so many different challenges and hurdles that they're asked to clear

[00:04:14] [SPEAKER_00]: there's access to care. You have the vast majority of oncologists are basically an urban

[00:04:19] [SPEAKER_00]: setting. So any patients that are in more rural settings, be this a urban, like you're

[00:04:23] [SPEAKER_00]: having to travel along distances to get that specialist care.

[00:04:27] [SPEAKER_00]: And there's also the concept that cancer is not just one disease.

[00:04:31] [SPEAKER_00]: It's so many all tied into one. And so there's not one care pathway. There's not one plan.

[00:04:36] [SPEAKER_00]: There's not one treatment. There's so much variability and treatments have gotten so much

[00:04:41] [SPEAKER_00]: better which is helping patients live longer but they're with all these new meds that are being

[00:04:46] [SPEAKER_00]: released in the oral combined with other treatment pathways, just the complexity that

[00:04:51] [SPEAKER_00]: she counts on itself. And so we're asking patients going through their cancer to tackle a lot

[00:04:56] [SPEAKER_00]: and to be their own care coordinators in some cases. This brings a whole level of emotional

[00:05:01] [SPEAKER_00]: and it's psychological dress on top of them and their caregivers, their families.

[00:05:06] [SPEAKER_00]: And it's just it's a lot. So there's where I could go on for a long time but this is at the highest

[00:05:11] [SPEAKER_00]: level that's how that's how I think of it.

[00:05:13] [SPEAKER_03]: You mentioned four or five things there. If we're talking about access to care,

[00:05:18] [SPEAKER_03]: you know if someone is situated nearby a cancer center that's very different than somebody who's

[00:05:24] [SPEAKER_03]: literally hours away from one. There's just this inherent complexity as we're talking about

[00:05:29] [SPEAKER_03]: here and then the variability there in and just like the stress of having your life on

[00:05:34] [SPEAKER_03]: on the line it cannot be underestimated. But let me ask you this. If I'm just thinking about this

[00:05:39] [SPEAKER_03]: kind of this highest level, what really is the downside to letting patients navigate this

[00:05:44] [SPEAKER_03]: themselves? Is it just you know annoying in the moment and I am minimizing this intentionally here.

[00:05:49] [SPEAKER_03]: I'm exaggerating for purposes of clarity but is this like the patient it sucked for them in the

[00:05:55] [SPEAKER_03]: moment but at the end of the day it really doesn't matter or they're outcome issues and

[00:06:00] [SPEAKER_03]: or financial issues here that wind up compounding when patients don't navigate this well.

[00:06:06] [SPEAKER_00]: It's folks. I mean in the moment think about this if you're a patient and you've got

[00:06:11] [SPEAKER_00]: questions two in the morning you just had your most recent treatment yesterday and your now

[00:06:16] [SPEAKER_00]: uncontrollable pain vomiting whatever that might be you want to be able to get answers in the moment

[00:06:21] [SPEAKER_00]: and if you can't what are you going to do? Are you going to go to the emergency department and so

[00:06:26] [SPEAKER_00]: being able to support patients in the moment 24, 7, 365 with oncology trains,

[00:06:32] [SPEAKER_00]: care teams to be able to give them the answer to comfort, support them in the home that will then

[00:06:38] [SPEAKER_00]: read too not only like giving them a better experience in the moment but better outcomes and I'll

[00:06:43] [SPEAKER_00]: use an example here so you know the components of reimagined care that we have it's more

[00:06:48] [SPEAKER_00]: proactive. We're checking in with patients. We're obviously there for any reactive moments like

[00:06:52] [SPEAKER_00]: the one I just explained earlier in the morning but proactive we're checking in with patients. We're

[00:07:02] [SPEAKER_00]: they become like an eight or nine out of ten right that would require an ER and EED business so

[00:07:07] [SPEAKER_00]: if we can support them in those moments and catch these a little bit earlier we avoid those. There's

[00:07:12] [SPEAKER_00]: call savings for the entire healthcare system into better experience with the patient also very

[00:07:17] [SPEAKER_00]: likely that they're going to remain on their treatment continue taking their medication,

[00:07:21] [SPEAKER_00]: remain on that treatment that their oncologist has already prescribed to them which will then

[00:07:25] [SPEAKER_00]: lead to better outcomes for them throughout the rest of this treatment journey so there's it's

[00:07:30] [SPEAKER_00]: go back to your questions. Oh, right there's the immediate term like support we can give them

[00:07:34] [SPEAKER_00]: but then there's a lot of downstream outcomes that we're able to drive by supporting patients in

[00:07:39] [SPEAKER_03]: the moment. Yeah and in that earlier episode for 412 one of the things that what got brought up there is

[00:07:45] [SPEAKER_03]: the most common cause of re admissions is nausea from chemotherapy and re-emissions are bad.

[00:07:52] [SPEAKER_03]: They cost a lot you have a patient who's now back in the hospital for something as you said

[00:07:56] [SPEAKER_03]: that's totally avoidable and now their treatment is interrupted because they're literally lying

[00:08:03] [SPEAKER_03]: in a hospital bed getting an IV for rehydration so you know it's just pretty logical I guess.

[00:08:10] [SPEAKER_03]: And now I'll give a personal example. I had a friend of mine who's in the middle of chemotherapy

[00:08:13] [SPEAKER_03]: right now and she called me and said that she was allergic to her treatment so here she is saying

[00:08:19] [SPEAKER_03]: she's allergic to her treatment. I'm listening to what her allergies are. I'm like you had a really

[00:08:24] [SPEAKER_03]: bad side effect but like if she thinks she's allergic now she is halting the best practice med

[00:08:31] [SPEAKER_03]: for her condition as opposed to getting a dose adjustment so you definitely can see the patient

[00:08:38] [SPEAKER_03]: outcome side of this that patients have their questions answered and get their right answer

[00:08:43] [SPEAKER_03]: as opposed to Dr. Googling and her deciding she's allergic to her therapy at the same time

[00:08:48] [SPEAKER_03]: you can see that total cost of care could potentially diminish. With re-imagined care you've

[00:08:56] [SPEAKER_03]: said that you'd in our quotes do the hard stuff related to cancer treatment what is the

[00:09:00] [SPEAKER_03]: hard stuff like what is hard about what we're talking about there are a lot of companies

[00:09:06] [SPEAKER_00]: that are helping to improve the entire cancer treatment journey right from early upstreams

[00:09:14] [SPEAKER_00]: navigation second opinions early diagnosis you know Mexican that treatment obviously kind of the

[00:09:19] [SPEAKER_00]: middle part of this and then and survivorship but downstream palliative care I'm going to first say

[00:09:24] [SPEAKER_00]: all of this is important being able to help support patients through that entire spectrum

[00:09:29] [SPEAKER_00]: is very very important when we say that the re-imagined care is doing the hard stuff what

[00:09:34] [SPEAKER_00]: we're saying is like we're squarely in that treatment phase we partner with the oncologists with

[00:09:39] [SPEAKER_00]: health systems community practices to be an extension of their care for that 97 98% of the journey

[00:09:46] [SPEAKER_00]: that happens outside of the four walls we help meet the patients where they're at.

[00:09:51] [SPEAKER_03]: Yeah there's this term integrative oncology and we had Dr. Ethan Bosch who did a big study about

[00:09:58] [SPEAKER_03]: integrative oncology on the pod was 2017 it was quite a while ago but one of the things that he said

[00:10:04] [SPEAKER_03]: loud and clear was you can't really do integrative oncology well unless you're collecting

[00:10:09] [SPEAKER_03]: patient reported outcomes and you're measuring things and you really have a way that you're

[00:10:13] [SPEAKER_03]: touching base with patients when they're not in clinic so say that I am a patient I have just gone

[00:10:21] [SPEAKER_03]: and gotten my infusion it's now going to be two weeks say before the next one what are you guys

[00:10:27] [SPEAKER_03]: do because a lot of times patients will not reach out. We check in a couple of times each week

[00:10:33] [SPEAKER_00]: just like hey how are you feeling are you having any of these symptoms and then we're able to walk

[00:10:38] [SPEAKER_00]: through so we have an AI based virtual assistant we named Remi and so Remi is able to communicate

[00:10:45] [SPEAKER_00]: proactively checking in seeing how you're feeling and if you can either respond and work

[00:10:49] [SPEAKER_00]: through those pathways then or just knowing that Remi is available 24-7 that the employee had earlier

[00:10:56] [SPEAKER_00]: of two in the morning you may start interacting with Remi then and so whether it be calling

[00:11:02] [SPEAKER_00]: the number directly or interacting through the virtual assistant also we mentioned earlier E-Pros

[00:11:07] [SPEAKER_00]: so a patient reported outcomes we reached out once a week we're able to kind of aggregate that data

[00:11:12] [SPEAKER_00]: combined with the other symptom responses and the real-time patient data we're able to

[00:11:18] [SPEAKER_00]: aggregate all of that plus all of the historical data we know about you from the EMRs and the

[00:11:25] [SPEAKER_00]: prescriptions and treatment plans other data sources we're able to have this really full and rich

[00:11:30] [SPEAKER_00]: data set that allows us to surface this to our care team and eventually if needed

[00:11:37] [SPEAKER_00]: surface it back to the oncologist to help make the best possible decisions for you the patient

[00:11:43] [SPEAKER_00]: in the moment so it's like we're filling those gaps proactively and reactively

[00:11:48] [SPEAKER_00]: in between those two weeks you know spans between treatments. You're reaching out proactively

[00:11:53] [SPEAKER_03]: so patient goes home and they're getting is it a phone call is there an app that gives

[00:12:00] [SPEAKER_03]: notifications like how does this how does Remi talk to people we chose text as the lowest

[00:12:07] [SPEAKER_00]: period entry patients of all different ages demographics they're able to interact and

[00:12:12] [SPEAKER_00]: connect and ask questions and then we're able to surface that in transition at two one of our

[00:12:17] [SPEAKER_00]: care team members if those interactions responses kind of bubble up our team can take that

[00:12:23] [SPEAKER_00]: over in real time we can then transition it to a phone call we can transition it to a video of

[00:12:27] [SPEAKER_00]: is it we want to meet the patient where they're at in the moment that's how we've chosen to tackle

[00:12:32] [SPEAKER_03]: this AI is sending proactive texts can answer some basic questions if things start getting

[00:12:38] [SPEAKER_03]: dicey there's a person that starts stepping out because I'm assuming that how your measure

[00:12:43] [SPEAKER_03]: your performance is measured is like how many patients don't go to the ER how many patients

[00:12:48] [SPEAKER_03]: continue with their treatment and don't step out you know I'm sure there's maybe other outcome

[00:12:55] [SPEAKER_00]: measures yes avoidable ED visits is certainly one metric that we track and we just announced an

[00:13:01] [SPEAKER_00]: expansion of a moral hermine we're really excited about expanding across their entire population

[00:13:07] [SPEAKER_00]: one of the key metrics that we tracked during the initial phase of our implementation with them

[00:13:11] [SPEAKER_00]: was those avoidable ED visits we actually the goal was to be below 12 percent and we actually

[00:13:17] [SPEAKER_00]: do our program we're actually able to see it be close to 4 to 5 percent so a huge decrease not only

[00:13:23] [SPEAKER_00]: do we blow away the goal but well below industry average that is a big outcome there's a white paper

[00:13:29] [SPEAKER_00]: we put out last month we have side by side patient populations where we're just doing maybe phone

[00:13:35] [SPEAKER_00]: triage for one group but we're doing the full remedy integration and triage for another group

[00:13:41] [SPEAKER_00]: we are able to see it really great improvement of catch you symptoms of lower severity

[00:13:46] [SPEAKER_00]: for the the remedy engaged population this technology plus services combination

[00:13:53] [SPEAKER_00]: we send just avoid those issues bubbling up and meeting whether BE or ED visits whether just

[00:14:00] [SPEAKER_00]: need like more intensive responses from our team or you know escalations back to the existing

[00:14:07] [SPEAKER_00]: oncologists work excited to continue to track these and monitor these and bring in other outcomes as

[00:14:12] [SPEAKER_03]: so we will definitely link to that white paper in the show notes and I bet it's surprising

[00:14:19] [SPEAKER_03]: for clinical teams it's really difficult for the in clinic teams to even know how many of

[00:14:24] [SPEAKER_00]: their patients wind up in the ER I've heard yes and we all know that the health care

[00:14:28] [SPEAKER_00]: we end up with all these side-most data silos and all these other things and so yeah that happens

[00:14:33] [SPEAKER_00]: a lot because especially if you're going to see a patient had to drive in a couple of hours

[00:14:37] [SPEAKER_00]: to go to their oncologists but now they're home they're having an issue to go to a

[00:14:42] [SPEAKER_00]: their local emergency department it might be in a totally different health systems so they may not know

[00:14:47] [SPEAKER_00]: for weeks month or ever that that patient actually had that experience so you are hired by health

[00:14:53] [SPEAKER_03]: systems i.e. the whole white labeling for how do doctors and nurses feel about reimagine care

[00:15:01] [SPEAKER_00]: that's a great question I think we have mixed mix feelings depending on the time frame when we

[00:15:05] [SPEAKER_00]: initially start implementing having some these conversations the knee jerk reaction is to like oh

[00:15:11] [SPEAKER_00]: no you're going to take over my patient list should be here to disperse and immediately we'd be very

[00:15:15] [SPEAKER_00]: clearly work with them and say oh we're not we're here to help you be better and be in more places

[00:15:19] [SPEAKER_00]: at once from decisions like we're white labeling we're charting right in their EMR so it's a single

[00:15:25] [SPEAKER_00]: source of truth from a patient record we are there to truly be that extension for them and allow them

[00:15:31] [SPEAKER_00]: to see more patients be more effective for their entire population and so you know with the initial

[00:15:36] [SPEAKER_00]: phase that we had at Memorial Herman we saw we had one oncologist to start with us for a period of

[00:15:42] [SPEAKER_00]: time and we were measured whole bunch of different things and one of the key was it's actually

[00:15:46] [SPEAKER_00]: new patient volume so we were able to help support that provider in taking on 9% increase in their

[00:15:54] [SPEAKER_00]: new patient volume over their peers during that time and their previous benchmark and years

[00:15:59] [SPEAKER_00]: for their prior and so it's not only being able to see more patients with quality of life our

[00:16:04] [SPEAKER_00]: net promoter score on our provider side is amazing you know and we built this program more from

[00:16:09] [SPEAKER_00]: a patient perspective but to see the impact of having for riders is truly outstanding for us and

[00:16:15] [SPEAKER_00]: so we have quotes like you know I've now been able to have dinner with my family a couple times

[00:16:19] [SPEAKER_00]: this week for the first time since I started here or you know I've had the best sleep in my life

[00:16:24] [SPEAKER_00]: this is becoming an oncologist like that's not hyper really that's a real impact that we're having

[00:16:28] [SPEAKER_00]: for people providing care and so that really is what to keep us coming back obviously patients first

[00:16:35] [SPEAKER_00]: but the fact that we can have such an impact on such an important group in in healthcare system

[00:16:40] [SPEAKER_03]: is truly like changing so it sounds like at the beginning the maybe the responses you know you

[00:16:51] [SPEAKER_03]: say is we got this like what are you saying that I'm not taking care of my patients it sounds

[00:16:56] [SPEAKER_03]: like the conversation has gotten a lot more nuanced than that it's not a matter of is anybody

[00:17:02] [SPEAKER_03]: doing a good job or not doing a good job the nuance is how do I want my nurse suspending their

[00:17:08] [SPEAKER_03]: time how do I want my APP's to spend time because if there's somebody that can take care of

[00:17:12] [SPEAKER_03]: those phone calls at 2 o'clock in the morning so that I don't walk in every single day with

[00:17:16] [SPEAKER_03]: seven emergencies right ensuring that or purpose building for the needs of our patients so that

[00:17:23] [SPEAKER_03]: everybody can do their job as best as possible and nobody gets stuck in kind of this reactive

[00:17:28] [SPEAKER_03]: loop it sounds like more people are recognizing that operation on needs here absolutely and I think

[00:17:37] [SPEAKER_00]: healthcare for a long time has also had the weakened to it better than anyone else right you go

[00:17:42] [SPEAKER_00]: else this mail system everyone's like we can do it better and they have an entrepreneurial spirit

[00:17:47] [SPEAKER_00]: which is awesome but there is coming a time where we can't just keep doing the same we can't

[00:17:52] [SPEAKER_00]: just keep throwing bodies at it in solutions like ours technology enabled services and bringing

[00:17:57] [SPEAKER_00]: the right care teams at the right moments or patients this is where we can help augment that

[00:18:03] [SPEAKER_00]: and bring in this new version of cancer care that's what we're excited for and we've been

[00:18:09] [SPEAKER_00]: really great partners on the early stages of our journey and excited to be announcing

[00:18:14] [SPEAKER_00]: a handful of more partnerships in the next couple months that are I think will continue to show

[00:18:18] [SPEAKER_03]: the momentum that we're building. Dan Arty from Reimagined Care where can people go to get

[00:18:23] [SPEAKER_03]: more information about the work that you do? Yeah we can go to the website reimaginedcare.com

[00:18:30] [SPEAKER_00]: exactly how it sounds like I said our white papers out there will share the link to that you know

[00:18:36] [SPEAKER_00]: we're excited to have any support along the way so happy to connect with any organizations any

[00:18:41] [SPEAKER_03]: individuals that would like to help us in our journey. Thank you so much for being on the podcast today

[00:18:46] [SPEAKER_01]: Dan Arty thank you for having me appreciate it. Hi this is Tom Nash one of the RHV team members

[00:18:52] [SPEAKER_01]: you might recognize my voice from the podcast intro if you love this show and you want to show us your

[00:18:57] [SPEAKER_01]: support please follow us on your favorite podcast app sign up for the newsletter or maybe

[00:19:02] [SPEAKER_01]: making a small donation in the tip jar. Thanks so much for listening.