PETER YESAWICH: I'm with a company that owns a number of health care assets. And the one that we'll talk about today is Cancer Treatment Centers of America-- five operating hospitals around the country. And I came to that organization, actually, as a member of the national board about 20 years ago and then decided to actually invest some of my talent in the operating side of the business about eight years ago.
And along the way, what we've done is we've been very active in introducing true principles of hospitality in the delivery of care to patients. And I wanted to just share a couple of things with you, talk about food very briefly, and then make a big pivot. And I will tell you that food obviously takes on a different dimension in the oncology business, right, because of the fact that you have many patients that are going through chemotherapy. Their immune system is compromised as a result of that. It's not just an issue of the nutritional value and the comfort, but it's really the impact that has on the ability of the patient to make it through the treatment.
And I was really fascinated this morning listening to the inherent tension that exists in this room and I think exists in these businesses between the issue of comfort as it relates to food and the nutritional value as it relates to food. And it's interesting that some of you have kind of pivoted one way, and others-- whether it was hot dogs in Maine or if it was fillets in Phoenix, the idea is that there is a distinctive tension here.
And I will simply tell you that we experienced that years ago. I think we figured it out because we have a 97% patient satisfaction rating, and that's a remarkable number when you consider this is the cancer business. We're not fixing broken bones. It's a completely different environment that we operate in.
So what I want to share with you is the insight that we have learned from a number of pieces of proprietary work that we do. And I'm going to bring you into the tent quickly and show you a couple of things that I think might hopefully force you to think a little differently about some of the things you've heard this morning.
And we always are interested not just in what our patients tell us but, importantly, the patients that we could serve tell us. So I'm going to share with you some insights from a piece of work we've done now for many years where we've gone out in a national survey. And very quickly, for those of you that like data, it's a probability survey nationally of 1,000 cancer patients in this country that are quota sampled across the four stages of cancer-- 250 stage ones, so on for two, three, and four.
We've also then looked at a companion survey of 1,000 caregivers, because we want to get the perspective not just of the patients but also the perspective of those, certainly in oncology, the caregivers. I'm going to share with you a couple of things and what we've learned from all of this.
And the first question is, what are really the most important aspects of care for delivery? And you're going to see in a moment that the comfort dimensions of food are important, but they're not the most important. There are other things that are far more important.
You'd think, logically, the most important thing would be clinical excellence, right? If you ask somebody and you expected a rational answer and said, well, what's most important to you, they would say, getting well.
Well, as it turns out, you're going to see, interestingly enough, that's not necessarily the case. Because a lot of other things get in the way in the delivery of care, one of which we've talked about this morning.
But the thing that rises to the top is this issue, and that is the logistics of care delivery. If you think about that for a second, that's certainly true for a cancer patient. I would submit to you it's true for most patients, because what happens is they have to see multiple specialists in different locations at different times. They have to collect and deliver medical records.
They have to have consultations with people who are somehow going to contribute to their care. Maybe it's assisting with the fact that they've got kids at home, and they need to worry about care at home. Maybe it's the fact they've got financial issues. Certainly, there's not a patient that presents in our institution today that is not burdened by the idea of the cost of care.
Now, many times, they don't articulate that. They won't tell you that, because they're embarrassed about that. But the reality is that weighs very heavily on their minds. So as it turns out, it's this whole issue of the lack of care coordination.
Now, this is going to be difficult for some of you to see. But let me call out the colors, because I think that's the nature of this story. So over here, we have a piece of work where we look at 26 dimensions of care.
And I heard this term a couple of times this morning, too, and I would encourage you to think about this. And that's the difference between the expectation that people bring to the service delivery and the experience they actually have. So what we're going to do is we're going to measure the difference between the expectation and the experience. And the reason we do that is we want to see what the hierarchy looks like but, importantly, identify the greatest gaps between the experience and the expectation, because that then allows us to focus on some things that people tell us are very important, assuming we can fix them.
So if you scan this, in red, you're going to see dimensions that we define as dimensions of care and comfort management. By the way, the food dimension is a comfort dimension to us. So if you look at these things up here, the doctor is spending as much time as the patient needs. That's number two after getting timely information.
How many times have you had a loved one in the hospital? They've just had an MRI or a CAT scan or blood work, and they say, well, we'll have the results for you tomorrow. Tomorrow's not acceptable to someone who is in this urgent state of care delivery.
So let's go continue to look at some of these. The ease of scheduling appointments. That's in the blue, which down here, you'll see as logistics. I'm not going read all of these. But let's just go ahead and scan on the reds-- comfort and stress-free environment, involves the patient and caregivers fully, integrated team, individual to coordinate care.
Now, you'll notice, in blue, these are logistic issues-- timely information, scheduling appointments, all components on the same campus, helping with insurance and paperwork-- big deal for patients. Getting appointments in 24 hours-- don't want to wait. Down here, provides help with transportation.
OK. Then in the green, interestingly enough, these are all of the clinical dimensions. So if you take a look at these, things like pain management, access to clinical trials, survivorship programs, integrative services, genomic testing.
So what emerges here is a very interesting picture. And that is if you kind of put all of these dimensions in three buckets, what happens is the attributes that rise to the bucket that seems to dominate this are attributes as you see here that have to do with care and comfort. Interesting observation.
OK. So let me show you in this slide very quickly. Lots of data here, but I'll kind of pull out a couple of things that I think you'll find fascinating.
OK. So what we look at over here is we say, well, the top number on top of the distribution here is the relative importance of the dimension. I realize it may be hard to see, so I'll read this for you. This is care and comfort of an integrated care team. 81% of all of these patients say that is the number one thing that is a driver of import to them.
And then down here at the lower number is the actual percentage of patients that said, yes, that's exactly the experience that I had. So then we calculate the gap. You can see here it's the 25%, which is the difference between the upper number and the lower number.
And what I'm going to do is just highlight the one gap across all of the data where you see it's the largest. And you'll notice that it happens to be for the attribute that is the second most important, which is the availability of an individual to coordinate care.
So think about that revelation. So now, all of a sudden, you say, wow, there's an idea here. And that idea here is that if you were able to go ahead and provide patients with one individual who would serve as, in effect, really, a concierge-- someone who would coordinate the care, get the records, schedule the appointments, ensure timely results delivery, and so forth-- all of a sudden, what happens is that gap decreases. Patient satisfaction goes way up. And obviously, the critical requirement here is a mandatory as clinical excellence.
So with that, I thought-- do we have a few minutes for just a little video? Yeah. So the summary of all that is that we take that insight, and then what we do is we have identified groups of people in the organization who are, for all intents and purposes, patient concierges. Now, we don't call them that.
But what they do is they coordinate every aspect of care from the moment an appointment is confirmed for a patient all the way through the course of their treatment. They're going to make sure that they got picked up at the airport properly. They're going to make sure that if loved ones are coming with them, the accommodations are all set for them to go ahead and stay and so forth. They're going to make sure they collect and distribute the medical records to the appropriate clinicians. They do all of that.
So essentially, what we do is we strip all of the logistic challenges away from the patient to allow them to focus on the care. And it's remarkable the impact that has on their psychological outlook.
Now, this may be a little difficult to see. And I'm not going to run the whole thing. I'll just run a couple of minutes. But what we've tried to do is to-- hang on a second, wait just a second if you could-- is to try to kind of vicariously show somebody what it would be like to be in one of our hospitals.
And so this is a video that attempts to do that, and it's actually in the voice of the patient. So what we've done is we have a patient who actually kind of walks you through this. And this is on our website.
And it's actually shot in 360, so it's really interesting. And we won't demonstrate this now, but if you're so inclined, you can go to the web address and actually move the cursor. So as you're listening to the patient, as she's talking to you about when she got picked up at the airport and so on and so forth, all of the things that surrounded her in terms of the care delivery, that essentially destressed her.
But let's just watch maybe a minute or two. We won't move the cursor, so you won't see the 360. But you'll hopefully get the idea. So go ahead and hit that if you could.
- Cancer. It's a word none of us wants to hear, yet it has touched most of us in some way. At Cancer Treatment Centers of America, we believe cancer care isn't only about treating the cancer. It's about quality of life both during and after treatment.
Here, you will find a compassionate team of medical experts focused on the treatment of one disease-- cancer. Our goal is to provide treatment options to help our patients get back to living their lives. Meet Tara, one of our patients.
- Hi, I'm Tara [? Bye. ?] I'm a patient here at Cancer Treatment Centers of America. And I receive treatment for melanoma.
When I first came to Cancer Treatment Centers of America and I walked through the doors, the first thing I noticed was how welcoming of an environment it was. It wasn't like a hospital.
I remember during our first week here, when we met with our team, the way that they talked to you was as if they were talking with somebody that was part of their family. To come here and have treatment options, it's really amazing to know that you have that hope. Please join us on a tour so we can show you what Cancer Treatment Centers of America has to offer.
- On their first visit, patients meet with an intake doctor or an appropriate cancer specialist to review--
PETER YESAWICH: OK, we can go ahead and turn that off there. Yeah, if you were doing this on your laptop or at home, you could then take the cursor, and you could kind of move it around the room and see the patient consulting with the physician and so on and so forth.
Anyway, I guess my concluding thought for you is to say that, yes, the food is critically important. It's only a dimension of care. And that there are other dimensions of care that, at least in our business, we have determined, I think, in a pretty definitive manner that are more important and to understand what those are.
And hopefully, there's a clue in all of this for you. And that is this issue of coordination of care, which is a critical issue and, frankly, one that I think most health care providers do a very poor job on. And the reason for that is that the care is so fragmented.
And if you're able to go ahead and address that in a way that destresses the patient, there are tremendous benefits that accrue to the patient as a result not just in terms of the patient satisfaction scores that you get, but in terms of their ability to focus on the quality of the care they're receiving. And there are very, very significant psychological benefits associated with that as they kind of move through care.
So that's what I wanted to share with you. And hopefully, that pivot was helpful. And I'm happy to take a question if anybody has any questions.
SPEAKER: Yeah, we have about 10 minutes for questions.
PETER YESAWICH: Sure. Please, yeah.
AUDIENCE: I love that, and I love your video. It's very inspiring. My question is about this coordination of care, because it's very complicated as a caregiver. It's complicated when you go to another setting. So when you're assigned a concierge, did they then get the records on your behalf and source all that information for you?
PETER YESAWICH: Yes. They [? know ?] all of that.
AUDIENCE: And have you built a proprietary system to do that, or is that manually driven and manually executed?
PETER YESAWICH: Well, it's supported by, obviously, a lot of systems. I don't know that I would call them proprietary. I think the processes that we use are probably proprietary. Yeah.
But no, that's absolutely right. And that is that once the appointment is confirmed and that individual who is assigned to work with you is a patient, they're the ones that do all the work. All you need to do is to show up.
And we book the airline, and we buy 35,000 tickets on American Airlines each year. We book the flights. We pick you up at the airport. We have Marriott-quality guest rooms in the wings of our hospitals. So if you want to bring family with you, we make that available for $40 a night. I mean, it's a different way of thinking about care.
Now, it happens to be one that is very challenged in the current environment because of what's happening with the economics of care. But as a result, I mean, we're trying to find ways to continue to do that. But the idea is that, really, all you need to do is literally to show up as the patient, and all these other elements are taken care of for you.
AUDIENCE: So just a follow up question to that. So I understand how this works. Sometimes, you can't even get an appointment until your records are reviewed to determine which is the right specialist. So how do you address that?
PETER YESAWICH: We schedule first. And then we get the documentation, obviously, in anticipation of when that will occur. And if we need to make an adjustment, we will.
But one of the things that's very true, certainly, in oncology, and I suspect in a number of other disciplines reflected around the room, is the urgency that accompanies the request. As I like to say, we get a half a million calls a year from people who are calling about treatment. And no one calls us casually. They call because something just happened. Something just happened. Somebody just got a diagnosis or whatever it may be.
And as a result of that, the urgency that comes across the phone is palpable. And we've got about 100 people who do nothing but just answer the phone who are very highly trained. And they're the ones that actually start the conversation, get the information, create the record, and so forth. And at that point, it's followed all the way through.
But to your point, one of the things that we know is critical for patients, and we've all heard stories about this with any medical specialty, is they say, well, I want to go to a specialist, and I can't get an appointment for eight weeks. Eight weeks can be a critical period for a cancer patient, right?
So the idea is we have a corporate norm, but our typical time between when you have been confirmed for admission-- which means you've gone through the process, the insurance approval, and so forth-- and you're physically in the intake room with the physician is eight days. That's the corporate standard.
AUDIENCE: And then my last point, and this is something we don't yet talk about in this room, but hopefully, you can shed some light on it, is the alternative medicine programs that you've done, which have been--
PETER YESAWICH: Yeah. Yeah. Well, we believe in an integrative approach to care, which means it goes beyond the conventional therapy, surgery, chemotherapy, and radiation. And there is a lot of evidence-based science behind that, which is basically intended to do one thing, which is to minimize side effects. It doesn't necessarily contribute to a cure, so to speak. And even the clinicians will debate whether or not you can ever be cured.
But having said that, what it does is it allows you to minimize the things that typically accompany treatment-- nausea, fatigue, hair loss, all the kinds of things that typically occur when someone goes through this. So the idea is to use the integrative therapies that have been demonstrated to be effective for that if it's clinically indicated to help patients go through that process. And it's highly effective.
And there's always a controversy in medicine about the extent to which that type of clinical support really is providing this kind of efficacy. And we could debate that all day long. But the fact of the matter is that there are increasingly patients who demand that, because they come very enlightened.
It's amazing how enlightened they are. So they've done their homework. Maybe half of them have failed treatment someplace. And as a result of that, they've really studied their clinical condition. And they come, and they have a very enlightened dialogue, certainly, with our people.
AUDIENCE: Can I just say it's so powerful with this whole spirit and emphasis of coordination to have-- I love that part of it, because if you want to do it, it feels very disconnected. And to have a whole network of people supporting you in all those ways is very powerful.
PETER YESAWICH: Yeah, I agree. And it's of immense benefit to patients. Yes.
AUDIENCE: How many of the calls are you not able to accommodate?
PETER YESAWICH: The majority.
AUDIENCE: My mother was in your hospital. She had an amazing experience.
PETER YESAWICH: Really? Which one? Which hospital?
AUDIENCE: She's in Boca Raton.
PETER YESAWICH: OK. She probably went to our Atlanta hospital. Yeah.
AUDIENCE: It was a couple years ago.
PETER YESAWICH: Yeah. Yeah, the sad part is--
AUDIENCE: I remember when she was trying to get in.
PETER YESAWICH: Yeah.
AUDIENCE: She kind of needed to call someone to call someone to call someone.
PETER YESAWICH: It's very difficult to get in, yeah.
PETER YESAWICH: It's in single digits. Yeah. And it's not because we don't want to. It's because the big gorilla in the room is the insurance company, right? And I'm sure everybody's heard about this. So I mean, if you don't have the right insurance, unfortunately-- I'm certainly there. We accept Medicare patients. But if you don't have the right insurance, then unfortunately, you're not going to have benefits. And that's an issue.
And then other is the issue of you have to be willing to travel, and you have to be physically able to travel, because these are destination hospitals. And those three things would eliminate 2/3 of the people who would otherwise seek care. Yeah. Anything else I can answer for you? Yes.
AUDIENCE: What's the average length of stay?
PETER YESAWICH: 80% of cancer care is delivered on an outpatient basis. That'll be of interest to the group. So it was interesting. I heard the comment earlier about the patients are only in a hospital for a couple of days.
The reality is it's an outpatient business. And it's the ones principally that are in for surgical procedures, or maybe they have a regimen with radiation that are in for multiple days.
So the number of beds that we have in the hospitals is very small-- 30 beds, 40 beds. Even though it's a high volume, the reason is most of the patients are coming for outpatient care. Yeah.
AUDIENCE: Peter, just to comment more so-- and it follows up, too, from our advisory board meeting yesterday, I sat in on the strategy session. And as I look around this room and I think about the conversation we've had over the last 24 hours, the value of this organization really should be to be able to put this quilt together. Because if we fall short of that, then we're missing the opportunity collectively.
So the coordination, the concierge, the quality food service, all the stuff that we're here-- and if we as a group don't figure out a way to put all this together, we're not going to revolutionize the experience in health and hospitality. So I would put that out there as a challenge to all of us, because that's why I'm here. I'm here to do that work and to do it together. So it was just a comment.
SPEAKER: Excellent. And that's a really good point for us to actually break. So thank you all for coming.
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Peter Yesawich, SHA ‘72, MS ‘74, Ph.D. ‘76, Chief Brand Officer, Brown - Legacy Group, speaks about the cancer experience, the critical importance of care coordination (logistics and management), and current challenges for caregivers. The talk was part of the Healthy Futures Roundtable held on October 10th, 2018.