About the Episode
Why is cancer care so expensive? How can we improve quality and patient experience? Join Health Tech Remedy hosts Dr. Trevor Royce and Dr. Timothy Showalter as they dive deep with Dr. Andrew Norden, Chief Medical Officer at OncoHealth, a leading digital health company focused exclusively on oncology.
In this episode, Dr. Norden shares OncoHealth's unique approach to tackling the complexities of cancer treatment costs and quality through innovative technology-enabled services and analytics. Learn about OncoHealth's journey from its origins in Utilization Management (UM) as Oncology Analytics to its current focus on four key pillars:
Clinical Decision Support & Prior Authorization: How OncoHealth aims to ensure appropriate care and root out high-cost, low-value treatments through a "kinder, gentler, more collaborative" approach.
Data Analytics & Real World Evidence (RWE): Leveraging data from their extensive network to generate crucial insights for research and practice.
Digital Health Platform (IRIS app): Providing patients with much-needed support for symptom management, navigation, and care gaps outside of clinic hours.
Value-Based Care & Cost Management: Positioning the company to help shift oncology away from fee-for-service towards outcomes-based models.
Dr. Norden also discusses his fascinating career path from academia to health tech leadership, including his time at IBM Watson Health, and why OncoHealth's mission resonated with him. He highlights the exciting potential of AI in streamlining prior authorization processes and reducing burden on providers.
Discover how OncoHealth is partnering with health systems like Geisinger to apply these technologies at scale and what the future holds for value-based care in oncology.
Whether you're a healthcare professional, administrator, patient advocate, or simply interested in the intersection of technology and cancer care, this episode offers valuable insights into the challenges and innovations shaping the future of oncology.
Transcript
Dr. Timothy Showalter:
[0:00] Hey, Trevor. It's just the two of us today, man. How you doing?
Dr. Trevor Royce:
[0:03] I'm sad. No Paul. This is very sad.
Dr. Timothy Showalter:
[0:05] We'll have to like make up what we can about like Minecraft or podcasts about dictators or something like that.
Dr. Trevor Royce:
[0:13] Can we drop the hammer without Paul? Is that, is that doable?
Dr. Timothy Showalter:
[0:16] I think we got to come up with something else without Paul. Let's get it on. That seems too old. How about let's kick it?
Dr. Trevor Royce:
[0:25] Welcome to Health Tech Remedy, the show where three physician leaders in health technology tell the stories of new and established companies and interview leaders from the industry. I'm Trevor Royce, radiation oncologist and researcher with experience in real-world evidence, informatics, and AI diagnostics.
Dr. Timothy Showalter:
[0:39] And I'm Tim Showalter, a radiation oncologist and prior medical device entrepreneur who is now focused on bringing AI advances to cancer patients. Missing in action today is our beloved all-star co-host and third amigo, Paul Gerard. Paul started off as a physical medicine and rehabilitation specialist before focusing on reimbursement policy, molecular diagnostics, and market access for AI products. Since he's not here, I'll also share on his behalf that he's pretty solid on skiing as a resident of Maine, as well as the landscape of competitive youth American Ninja Warrior events.
Dr. Trevor Royce:
[1:16] Amazing, amazing. You learn something new about Paul every day.
Dr. Timothy Showalter:
[1:19] And we'll continue to share every time he misses.
Dr. Trevor Royce:
[1:21] One of these. This week, we're talking about OncoHealth. I'm pretty excited about this. Tim, I think you've known the team over.
Dr. Timothy Showalter:
[1:27] There for quite some time. Yeah, that's right. I met Andrew Norden, their chief medical officer, back in like 2019. And they've got a really interesting story. I engaged with him when I was thinking about stepping into an industry role. I've been in academia for a while. And Andrew really shares a similar background. I think you'll relate to it as well. And I know before he was CMO at OncoHealth, he was chief medical officer at Coda Healthcare. And even before that, he goes back to a deputy chief health officer at IBM Watson.
Dr. Trevor Royce:
[2:00] I believe. So we'll hear more about that from him. Amazing. Some background on OncoHealth. It's pretty interesting. It's a digital health company. That focuses exclusively on oncology or cancer care, and they provide, quote, technology-enabled services and analytics. Their focus is to health plans, employers, providers, and patients, all with the goal of improving quality, efficiency, and experiences of cancer, cancer treatment, and the patient experience. And I think their scope and purview has changed. They've been around for a while, and we'll talk a little bit about that today. Their primary focus to start off, as I understand it, was utilization management, which we've already heard about in some of our other episodes. The idea of having systems in place to control the amount of healthcare consumed. That's, you know, fundamentally what utilization management is. Not to limit appropriate care, but rather to be thoughtful about the care that's delivered, how it's delivered, and minimize excessive care, inappropriate care. We could spend weeks talking about utilization management because there's a lot that comes along with that, and there are all sorts of different important perspectives with utilization management. So part of that conversation, again, will be with OncoHealth today, and it's a really important topic to discuss on this podcast. So they have what's called the Iris app, digital services for patients who are members of health plans that work with OncoHealth, and they've had some really big contracts with some very large health systems to help these products to patients in those healthcare networks. And as we heard from Tim.
Dr. Timothy Showalter:
[3:23] We'll be speaking with Andrew Norden later in great detail about this, who's the CMO at OncoHealth. They're super interesting. Obviously, we recently interviewed the CMO at Cohere Health. And, you know, so some connection with utilization management as well. But what's really interesting from OncoHealth is kind of a different founding story and a different way that the company's evolved. I think they're really kind of spreading out and focusing within oncology.
Dr. Trevor Royce:
[3:49] But building more digital products really across that space to engage all the stakeholders. Just to kind of dive into that a little bit. You know, there's lots of different aspects of utilization management.
Dr. Timothy Showalter:
[4:00] We've heard kind of more broadly and on the orthopedic side, and now we're diving a little bit more specific in oncology. Yeah. And what's interesting about it is, so they, before they were OncoHealth, they were called Oncology Analytics. And they were actually founded back in 2009 or thereabouts by a physician, an oncologist, Dr. Mark Fishman. And I think, you know, a big part of the vision was not just cost containment, but also ensuring uniformity and quality of care and really reducing some of the variation in care that folks are concerned about may affect quality outcomes. They're currently headquartered in Atlanta, Georgia, though I think they also have substantial Florida presence. And they're really broadly focused on building solutions for health plans, employers, providers, and patients. So I think they view that as sort of the virtual cycle. They offer a lot of technology-enabled services and real-world data analytics. There's a lot of thought leadership that you see from them, too. So I'm always seeing posts on LinkedIn with analysis about, you know, latest updates from conferences. They followed sort of an interesting growth story over the years, looking back through what I could piece together for press releases, and I think Andrew Norden was around for a lot of this, so maybe he can tell us more details, but I know back in 2020, they raised.
Dr. Timothy Showalter:
[5:23] Million series C funding round and that was led by like their capital. There were some existing investors like McKesson Ventures and Oak HCFT and the Blue Venture Fund and stated in their goal was to really expand their capabilities and lean into the real world data and analytics solutions for health plans. They did a rebrand from Oncology Analytics to OncoHealth in 2021. A big part of that was their vision for the future, for going beyond just sort of payer-focused analytics. And they updated their website, did all the renaming, and they really introduced more of a patient focus. I see from publications back in 2022, they had delivered on the significant growth.
Dr. Timothy Showalter:
[6:14] And they had a 43% year-over-year revenue increase that they reported in the beginning of 2022 and they had 1.2 million new members added to their digital platforms, and they grew their workforce substantially. So at least at that point, they were over 200 employees. They had a strategic investment announcement in 2022 from private equity, so Arsenal Capital Partners and McKesson Corporation, and the idea was to further enhance their oncology management solution. So I think this is all a bit about sort of broadening their reach and doubling down on oncology. And then there was a big announcement earlier this year, just last month, that OncoHealth appointed a new chief executive officer, John Mack, to lead the next phase of growth. Prior CEO Rick Dean, who's been in the sort of the payer world for.
Dr. Trevor Royce:
[7:10] Years and years, who served as CEO for seven years. So a lot of this time period for evolution, Rick was in the CEO position and really building out more data, more analytics, and the more patient-centric digital platform. So they've been around for a while and they've grown a lot clearly and had different leadership teams come into place. And maybe it's worth spending some time kind of reflecting on their products to date. And I think that'll reflect kind of really how they've grown from, you know, more purely on the data or utilization management side to all these other platforms. You know, in reading about OncoHealth, there are kind of four pillars that maybe we can touch on here. And Tim would welcome your kind of commentary on all of these. But maybe we'll start off with the first one, which is this idea of clinical decision support and prior authorization. I think we've spent a fair amount of time on this podcast already talking about prior authorization or utilization management and how it can act as a sort of gatekeeper for appropriate amounts of care. And maybe it's worth spending or reflecting a little bit on what is unique about oncology and why prior authorization is such a critical concept in the care delivery for oncology. I mean, right out of the gate, when we think of oncology and healthcare utilization, it's because it's so expensive. And that's because of these new drugs.
Dr. Timothy Showalter:
[8:27] Very sophisticated technologies and techniques, like as radiation oncologists, things like IMRT or stereotactic radiosurgery or cyber knife or whatever you want to call it. Because of those, the great costs of these interventions like medications or therapies in oncology, prior authorization kind of has an outsized role in oncology and as a strategy for utilization management. Even from the provider perspective, I mean, we're both in radiation oncology, and I think there's so much variation within the health system overall. And in some ways, it can be like a positive pressure to make sure that the docs are always doing the right thing, no matter if, you know, did they sleep well the night before or are they up with their infant or something. Make sure that everyone's, you know, given sort of the guideline recommended care.
Dr. Trevor Royce:
[9:13] The costs can vary from course to course so much that it's obviously worth it to payers and employers and patients that they're getting the right value as well. So this was like their OG service line, my understanding. I think this is really where they started. And then I think as you go through these pillars, it's like talking through the evolution of the company. A big piece of their clinical decision support prioritization is things like peer review, where you've got, you know, experts looking at treatment recommendations and so forth before approval, which is a very classic, you know, prior authorization type approach. A little different from what we heard earlier from Cohere. All right. So pillar number two, data analytics and real world evidence. And this is a topic that is near and dear to our hearts, Tim, with some prior professional experience in the area. But, you know, basically this is the idea of collecting all.
Dr. Timothy Showalter:
[10:05] This data that's used in the routine course of care, putting it in a usable format and having you know, all sorts of use cases from research to patterns of care questions to efficacy questions, using data collected as healthcare is delivered throughout the U.S. And so OncoHealth is clearly very well positioned to build these real world data sets, just given their extensive network and focus. Yeah, I mean, I think this is where like having a sort of a broad platform that touches all the stakeholders also provides a lot of data for them. And I certainly see on the analysis side that they're often presenting abstracts at meetings, sharing white papers or offering seminars. Industry. So I think this is where they really sort of shine and have built their strength within the oncology area. The next one, you know, the digital health platform for patients. I didn't see that one coming. I remember talking to Andrew about it years ago. Been interesting to sort of follow that development. This is what they call the IRIS platform. And I see it as like, you know, I'm still in the clinic and you are too. Like, you know, there certainly are challenges and potential care gaps along the way for patients who are receiving treatment, having access to.
Dr. Trevor Royce:
[11:22] Like nurses and social workers and getting guidance on nutrition and symptom management, all those sorts of like things that happen often outside of the clinic hours. And I think that's, you know, what they're really providing. So I can see how it adds value to patients and certainly for the payers who are trying to look for the best value for their covered lives. I could see some potential benefit from that. I'm curious to hear, you know, Andrew's take on what sort of impact and success they've had with that. Yeah. Yeah. And, you know, these kind of categories of product lines are integrated and, you know, I think they build upon each other. You know, you can envision how prior authorization could be informed by real-world evidence and like what types of treatment is actually being delivered. And then you can take the next step and think about how digital health platforms for patients could inform their real-world data sets, but also be a direct sort of effector in a patient care where you can help with symptom management or medication adherence or, you know, whatever support service you want to provide directly to the patients in your network, all from a digital lens. This clearly sort of fits together in this digital health world that OncoHealth has created. And then the last one is a value-based care and cost management. And it's kind of related to the first one with prior authorization. You know, this idea of.
Dr. Timothy Showalter:
[12:37] Value-based care has really taken hold in the U.S. and in oncology in particular over the last, you know, one or two decades. The stated goal to move away from a fee-for-service or pay for the health care delivered versus pay for the outcomes that are achieved with health care. And OncoHealth, with the tools we just talked about, is clearly well-positioned for value-based care and cost management, where they're collecting this data, they're appreciating the cost done, and they can focus on these high-quality care outcomes and presumably value-based metrics that they can collect and report on. They probably have some special potential opportunities to help people. You know, if I think about this business model. Obviously, there's a big role in utilization management. But if we compare it to Cohere Health, you can see they've sort of taken a different strategy. So, you know, Cohere struck me as like really all in on the technology as applied to key components of utilization management. And you can see how that technology stack can move from like certain parts of the process. But they're not in the cancer space, first of all. And then I think what OncoHealth has really done is they've gone deep on oncology.
Dr. Trevor Royce:
[13:43] And built a lot of synergy with respect to the data and their insights they can provide. And I wonder if they actually may be sort of uniquely positioned in the oncology space to help with value-based care models based on this. And you sort of see their thought leadership on LinkedIn and other venues about really applying their data analysis to carve out a space in this area. Interesting to hear more about what their experience might have been with, you know, integrated delivery networks or other entities, which assume some risk in these approach to get some insights about while you guys care. And it's nice to kind of talk about these abstractly and what they're trying to achieve, but most important is kind of how they actually get this into clinics and.
Dr. Timothy Showalter:
[14:27] And get into patients. And I think one thing that reflects that or those efforts is this deal they announced last year with Geisinger health plan or health system, which is kind of famous in the health technology world for being an innovative health system. And so, you know, it's not surprising to see that they took on this partnership with OncoHealth. But basically, I think they have over 500,000 members in the Geisinger health plan. And this partnership.
Dr. Trevor Royce:
[14:52] With OncoHealth presumably will be, take these technologies and really apply them directly to patients and in clinic at scale. And so that's why I think they're so well positioned to be leaders in health technology, you know, partnerships like this. That's one of the things I want to explore just in a few minutes when we get to spend some time with Dr. Andrew Norden, who, again, is the chief medical officer at OncoHealth. And he's been there like all throughout this period of transformation back to its OncoAnalytics days.
Dr. Timothy Showalter:
[15:21] And also, I think just personally, like us, Trevor, he spent a number of years in academia before stepping into an industry role. So interesting to hear his.
Dr. Andrew Norden:
[15:29] Like overall career arc and experience in.
Dr. Timothy Showalter:
[15:31] His words. I mean, when you take a platform like this.
Dr. Andrew Norden:
[15:35] Like what we've just described, and you apply it to 18 health plans across the US, 12 million members, a focus on value-based care, this can like really be an incubator for some of these alternative payment models that.
Dr. Timothy Showalter:
[15:48] We've been hearing about for, you know, the last decades, definitely in radiation oncology. It's a very lively discussion for alternative payment models. How can we shift, how we reimburse for services? It'll be really cool to see what they can achieve with that. All right. Well, listeners, stay tuned because next up has an interview with Andrew Norden.
Dr. Andrew Norden:
[16:07] So Andrew, great having you. Good to be with you guys. Thank you. Thanks for your time today. And where do we find you today? You find me seated in a Marriott lounge in South Florida, while my sons are enjoying some time in the nearby water park and golf course. Well, fantastic. Hopefully you get out there to join them pretty soon. Maybe we would start off with your journey. Take us back to finishing med school. How did your path evolve from clinical medicine into the leadership roles that you've taken on in real world data, oncology, and even utilization management? Yeah, well, I can tell you that looking back, my career path is certainly not one that I had mapped out as a medical student. And it's been somewhat of a wild ride.
Dr. Andrew Norden:
[17:01] I went to med school at Yale, and I went in believing with all certainty at that time in my life that I would become a neurosurgeon. And I remember, I think I shadowed a neurosurgeon like in my first weeks of medical school. And I probably made the mistake of going into an epilepsy surgery where they were removing a tiny little piece of cortex that had been deemed to be the seizure focus in this patient. And it was a 12-hour undertaking, extraordinarily tedious with control of all the tiny vessel bleeders, etc. Anyway, I was able to dismiss the notion of becoming a neurosurgeon there in my first few weeks.
Dr. Andrew Norden:
[17:51] And then I wrangled with different career paths and ultimately felt that the brain was just the most fascinating organ. And because I enjoy talking to patients and establishing longer-term relationships with them, I settled on neurology as a career path. I went to the Mass General Brigham program for neurology. But I trained in what was then the Partners Neurology residency program. And I don't know that I knew at the time that neuro-oncology was even a field, but I took care of a number of brain tumor patients during my residency and found that to just be like a fascinating combination of medicine and neurology, a really interesting scientific area, a great way to establish long-term relationships with people who really need help. And that led me to train in this, you know, extremely niche field of neuro-oncology. I did that training at Mass General and Dana-Farber.
Dr. Andrew Norden:
[18:49] I ended up taking a faculty job at Dana-Farber after my fellowship. That was sort of the first time I would say during my career journey where I was able to take a breath. I had been very linearly focused on, you know, finishing med school and training and getting into an academic career. It's hard to characterize exactly what I experienced, but it was something like, man, this is really sad. The patients don't do well. And, you know, I looked at my mentors and I had some really terrific ones who had been in the career for 20, 30 years.
Dr. Andrew Norden:
[19:32] Sort of watched a wave of therapies, you know, come with great promise and then go. And somehow they still maintained their hopefulness. And I just quickly sort of came to this view that I wasn't sure how hopeful I would be able to feel after 20, 30, 40 years of watching this. My entree into neuro-oncology came when anti-angiogenic therapy was brand new and there was great enthusiasm that drugs like bevacizumab were going to, you know, revolutionize the care of glioblastoma. And it was clear to me in those early days that that was not going to be the case. You know, there were short-term benefits. Some patients felt a lot better, but not for long. I started to think about, you know, rather early in this career as an attending, what could I do to have more of an impact?
Dr. Andrew Norden:
[20:23] And maybe to impact more than one patient at a time? And maybe to find some, you know, joy in my day, frankly. You're naive when you're young and you think, oh, the sadness won't bother me. But as I got into my attending career, started having children of my own, seeing young people die of terrible diseases, brain tumors. It just wasn't for me. So I had a relationship with the chief medical officer, Dana Farber, at the time, and he had begun to build a network of community-based cancer centers around Boston and in southern New Hampshire. And he needed some help managing that. And he took a chance on a guy who really had had no leadership training or management experience at the time. But that is what kind of kicked off a real change in my career. And I ended up initially taking on a 50 percent role with him, you know, serving as the medical director for Dana Farber's network, which was really fast growing. I learned an enormous.
Dr. Timothy Showalter:
[21:26] Amount in that time.
Dr. Andrew Norden:
[21:28] My 50 percent rather quickly spread to 80 percent. And then next thing I knew, I had been doing that job for five years, and I was seeing patients still a half day a week. What got me most jazzed in that role was the opportunity to implement.
Dr. Timothy Showalter:
[21:44] Cancer treatment pathways across the network. And I really enjoyed helping to roll out that program across Dana-Farber's network. And at a certain point.
Dr. Andrew Norden:
[21:57] I said, geez, it would be great if I had an opportunity to actually be involved, not just in implementing these pathways and other related systems, but in helping to develop them myself. And that was the moment when IBM Watson Health was a hot topic in health technology. We could talk more about that, though I usually reserve it for a conversation where alcohol is involved. It's a little early for that. Yeah. Yeah, it's only not even 10 a.m. yet, so you're probably right.
Dr. Timothy Showalter:
[22:29] But anyhow, I jumped from Dana-Farber to IBM Watson Health, where I was the first physician leader for oncology and genomics.
Dr. Andrew Norden:
[22:39] And that's what kicked off my health tech career. That's really interesting, because I always wondered sort of how, what happened for that first move away from being a healthcare administrator.
Dr. Andrew Norden:
[22:50] Or practice. But thinking back to that time, like that was the area of great promise at the moment. So it makes a lot of sense. It was a very hot and sexy area. IBM had remarkably powerful marketing messages, which I think history has proven were way ahead of, you know, reality, which is probably a key part of what led to the ultimate failure of that business. It was an exciting time. And it's particularly exciting, I would say, to see the way the world has kind of caught up. And now, you know, now I think AI has real promise in a way that probably wasn't quite ready then. Yeah. And just like for our listeners benefit, could you catch us up briefly on what were the next steps for you and how you ended up at OncoHealth? I spent a short time at IBM for reasons that I think are implicit in the comments I just made.
Dr. Andrew Norden:
[23:45] I connected with a company that was actually an IBM partner called Coda while I was at IBM that was trying to do things that I would say are similar to what Flatiron was doing which were to say we wanted to take EMR data and curate it and use highly curated high quality EMR data to generate insights that might be relevant for both practice leaders and pharmaceutical companies. I felt like there was tremendous potential for that technology at the time. And so Coda recruited me to join them as chief medical officer. I spent a number of years there building a data curation operation and helping both provider and pharma clients sort of use the data in a way that was impactful. One of the lessons of that company was that it's becoming, I would say, increasingly hard to access EMR data for commercial purposes, because with Flatiron's great success, providers were starting to perceive that their data had tremendous financial value. And so it was increasingly... At that time to persuade a practice to share data with you.
Dr. Trevor Royce:
[25:14] And OncoHealth came along and said, we have a really interesting proposition.
Dr. Andrew Norden:
[25:20] Which is that we see enormous amounts of data in the course of operating our core business, which is oncology, prior authorization, and utilization management. And they expressed a goal of using that prior authorization data to build a data business on top and I thought that that was a really unique concept that others hadn't really thought of at the time and that was the way that OncoHealth which was called Oncology Analytics at the time ultimately persuaded me to join them interestingly the data business never.
Dr. Andrew Norden:
[25:59] Materialized at OncoHealth, but it explains how, you know, a guy who spent the first half of his career at Dana-Farber on the provider side now finds himself as the physician leader for a utilization management company. And a particularly interesting and difficult moment in the history of utilization management. It would be great to hear a little bit more specifics about OncoHealth, about the problem you guys are solving for and how you do it, and it's specific to oncology as well. OncoHealth is a really interesting company. We're more than 15 years old. We were founded by a medical oncologist, a guy named Mark Fishman in South Florida, who was a solo medical oncology practitioner initially and then expanded his practice a bit. But it was a small operation.
Dr. Andrew Norden:
[26:50] And Mark was deeply frustrated with the perverse incentives that were and are inherent to oncology practice in the United States. For your listeners, what I mean is oncologists are paid a percentage of the price of the drugs that they incentivize.
Dr. Andrew Norden:
[27:11] Medical oncologist, that is. And so the more expensive the drug you infuse, the larger the number of absolute dollars that you make. And that made Mark pretty sick, particularly because he saw drugs with marginal benefits coming to market at very high price tags. That's obviously a huge problem to this day that we all, I think, understand well. So Mark was an innovative thinker and worked to develop all sorts of novel ways of controlling costs that he hoped he could interest the market in. He developed some novel fee schedules that were sort of intended to increase the margin on high-value drugs and reduce the margin on lower-value drugs. He developed, unrelated to the fee schedule, some incentive programs, and he did case reviews and started doing these services for Humana in South Florida. Humana was OncoHealth's sort of first customer. And interestingly, a lot of those things that Mark started doing almost as, you know, like on the side of his desk as he was building this company are things that we still do to this day. Ultimately, with Humana as that first customer.
Dr. Trevor Royce:
[28:35] The company grew quite a lot, particularly around utilization management, to the point that today we have more than 20 utilization management customers. What that means is.
Dr. Timothy Showalter:
[28:48] These are payers that.
Dr. Trevor Royce:
[28:49] Hire OncoHealth to do prior authorization reviews on their behalf.
Dr. Andrew Norden:
[28:55] Most of the business is medical oncology. The next largest line is radiation oncology. And then there's also some genetic and molecular testing. You know, contrary to what you might think, based on the news, prior authorization is very much not dead. And I can say that, you know, as a physician, I came to it with some degree of trepidation because of the way that oncologists and physicians in general look so negatively on it. And no doubt, you know, there have been abuses in this industry that shouldn't be. But it saves money. It saves real money. And it blocks bad care. That's not to say that there's huge amounts of bad care, but there's enough of it that, you know, we're talking about single digit percentages of the requests that OncoHealth receives that represent what most people would look at and say, this is bad care. And that bad care comes with a fabulously high price tag. So that's OncoHealth's core business is sort of rooting out that bad care. That's the way I think about it. I mean, you prevent bad care rooted out, but presumably you're also preventing some bad care that would happen.
Dr. Timothy Showalter:
[30:04] Without that system in place, as opposed to just rooting out the bad care that's going on. Like, there's probably some preventative layer there. You're teaching people in a sense, right? Exactly. Like, without the system in place there.
Dr. Andrew Norden:
[30:15] You would expect there to be more, probably. Yeah, no, Trevor, I believe that. I think that's right. We kind of call that the sentinel effect, which is when you know you're being observed, your behavior changes. And the truth is that we see that in the patterns of requests that we receive when we launch a new client. Often the case volume at the beginning is extraordinarily high and the denial rates are higher and higher than they will ultimately be. And I think that's because patterns of care evolve when people know that they're being watched. Now, you know, I feel obliged to sort of say the thing that, you know, some of your listeners might be thinking, which is, you know, we're representing one or two or maybe three payers that a particular practice interacts with. Our rules are not exactly the same as those of the payers that the other payers that a practice may interact with. And so I think the fact that the industry is sort of somewhat fragmented in that way makes it probably hard for providers to know exactly what to do all the time. But.
Dr. Andrew Norden:
[31:25] And, you know, there are certain best practices that I think are enforced across this industry and they're helpful. What have you guys built in terms of like innovation that you're most proud of? And what are you most excited about that's happening maybe this year or like trends in the field? In some ways, the thing I'm most proud of is that I've maintained Mark's legacy. And I really give Mark credit for this, of doing this in a kinder, gentler, more collaborative way than our competitors. There is a tendency in prior auth, because you have the power to say no, and because there is some incentive to generate savings for the payer, some companies in.
Dr. Timothy Showalter:
[32:04] This space enforce arbitrary rules. We have gone to great lengths.
Dr. Andrew Norden:
[32:08] To ensure that we employ smart, often still practicing medical oncologists and radiation oncologists, smart, well-trained oncology pharmacists who review the cases. We have an internal culture of trying to get to yes. We want to avoid denying care except when it's egregious or there's, you know, some real inflexibility on the part of the requesting physician that aligns with use of low value care. And so for me, I really have come to believe in what I'm saying, that we're looking for the examples of bad care or inexplicably high cost care and rooting it out. And we're doing that in a collaborative way without being jerks. I'm proud of that. I think one thing that we've seen is it's really hard to save money in oncology for all sorts of reasons. But I think we all know in our hearts that not all the care is is good and not all of the care is high value. You know, I believe we're genuinely looking for the bad stuff and rooting it out. And I'm proud that we're doing that in a different way.
Dr. Andrew Norden:
[33:25] That doesn't mean, you know, deny first, wait for the appeal. You know, like we're actually trying to do it the right way. And you've built real oncology expertise to like, I mean, throughout the organization. We have, Tim. I mean, and I tell my team when we have town halls how proud I am. Like, this is a.
Dr. Timothy Showalter:
[33:42] I mean, this is a very legitimate group of strong, you know, of strong, well-trained oncology folks who come from the best places. They're employed by us and they're working hard to do the right thing. The thing I'm most excited about in this space is AI, not just because it's a buzzword, but because AI is actually a very good use case for utilization management.
Dr. Andrew Norden:
[34:06] Because everything we do or almost everything we do is text-based and because AI can approve things quickly, I have strong concerns about companies that are sort of showing up on the scene saying that they're going to use AI to deny. That's I think crazy and should never be. But the truth is most docs are doing really good work and the downside with prior authorization is the burden that it places on them. Increasingly, and even over the next year, we will see that in our own shop and in the industry more broadly that AI is able to find the obvious yes, really, really fast. Increasingly, I'm hopeful that can happen at the point of care. So, you know, prior auth doesn't even have to be sort of a post-visit process like after the doctor visit, the way it operates today.
[34:55] But I think that that's real and we will increasingly see that be real and let our, you know, strong oncology team focus on the small portion of care that really shouldn't be and trying to educate, persuade these docs to change their approach.
Dr. Timothy Showalter:
[35:11] That's exciting because I'd say that Trevor and I share your enthusiasm about AI and it's going to be really interesting how OncoHealth deploys that in the prior authorization space as well. Well, I think we're up for time. So I just want to say thank you so much Andrew for, you know, stepping away from your vacation to spend some time with us. Really fascinating to hear your career story as well as your experiences at OncoHealth.
Dr. Andrew Norden:
[35:35] Guys, it's a pleasure and I wish you lots of great success with the podcast. Thanks for including me as a guest.
Dr. Timothy Showalter:
[35:41] Great. Thank you.
Dr. Trevor Royce:
[35:42] Thank you, Andrew.
