In this episode, guests Tommy Axford and Dr. Natalya Gertsik from Private Health Management (PHM), talk about clinical trials and cancer care. They discuss why employers struggle with cancer-related costs and how clinical trials can be both medically beneficial and cost-effective.
The conversation centers on the unique challenges cancer presents as a complex set of diseases rather than a single condition with standard solutions. Dr. Gertsik highlights a story about "Peter," who was given three months to live but achieved complete remission through a clinical trial identified by PHM.
As Peter recounts, "It has now been a dozen years that I have been in remission from what was an original death sentence."
The discussion explores barriers to clinical trial access, including the vast number of trials available and various patient, provider, and institutional challenges. With specialty oncology medications averaging $65,000, clinical trials sponsored by pharmaceutical companies can offer significant cost savings for employers.
As Dr. Gertsik notes, "Most of the benefits employers are putting in place work for 95 percent of their population, but they don't work as well for the sickest and most expensive 5%."
Key Takeaways:
- Cancer's complexity requires sophisticated solutions beyond traditional benefits
- Clinical trials can provide cutting-edge treatments while reducing employer costs
- Major access barriers include provider time constraints and complex qualification criteria
- Solutions need to focus on the 5% of employees who represent the highest healthcare costs
- Employers need partners who can address all cancer types comprehensively
Stay in Touch!
- Connect with Tommy Axford and Dr. Natalya Gertsik on LinkedIn
- Visit Private Health Management (PHM)
- Download PHM’s report on clinical trials and cancer
- Learn more about the Springbuk Activate Partner Marketplace and get other related resources
- Get the complete 2024 Employee Health Trends report and other related resources
- Connect with our co-hosts Brittany Hardaway and David Pittman
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Episode Transcript
[00:00:00] Brittany: Welcome back to Healthcare on the Rocks, Employee Benefits with a Twist. I'm Brittany Hardaway, Director of Strategic Partnerships at Springbuk. Today we are diving into a crucial topic, clinical trials and cancer care. This segment is a part of our continued conversation about cancer, one of the costliest conditions for employees, as highlighted in Springbuk's Annual Employee Health Trends Report, which if you haven't downloaded a copy yet, you can get it at springbuk.com/EHT24
[00:00:37] David: And I'm David Pittman, the Vice President of Marketing here at Springbuk. Joining us on this important topic today are two guests who are no strangers to this topic or even to our podcast. Tommy Axford, the Senior VP of Business Development and Strategic Partnerships at PHM and Dr. Natalya Gertsik, who is the Vice President of Partnerships there.
So welcome back, Tommy and Natalya.
[00:00:59] Natalya: Thank you.
[00:01:00] Tommy: Thanks, David.
[00:01:01] Brittany: Why don't we start with you, Tommy? For those who don't know you, can you tell us a little bit about your background and your specific role at PHM?
[00:01:10] Tommy: Yeah, sure, Brittany. I have, good, bad, or otherwise, I have been in healthcare consulting for a little bit over 20 years. A lot of that time was spent, really crunching numbers as a healthcare actuary. a lot of the work that you do at Springbuk and certainly that we do at, Private Health Management is near and dear to my heart.
At PHM, I have the privilege of really running a lot of our commercial functions. So sales, account management, and marketing, so really have good visibility to our go-to-market strategy, how we're positioning our services, and quite frankly, what our clients need and expect from us and the work that we do.
[00:01:51] David: Okay, thank you. And Natalya, how about you? Tell us a little bit about your background and what you do.
Yeah, thanks for having us on the podcast again. I lead partnerships at PHM, and I'm on Tommy's commercial team. Prior to joining PHM, I was a management consultant at McKinsey for a couple of years, primarily in the healthcare space, and have a PhD in biochemistry from Weill Cornell. Alright, let's get into it. As Brittany said at the beginning, in Springbuk's annual Employee Health Trends Report, cancer continues to be one of the cost drivers, one of the top cost drivers for employers. So why do you think employers are struggling to contain costs for this condition?
[00:02:33] Tommy: Yeah, David, I think it really stems from the notion that cancer is not just one disease and by its very nature is incredibly complex. And so deploying a solution or a strategy to manage a disease like cancer, given its complexity, is hard, is complex. And so I think, employers really struggled with, what are the levers that I can pull to really make an impact, to put a dent in cancer, also knowing that the, consequences of whatever they do are, really incredibly consequential, and can be life altering for their members.
And so I think, if you think about other conditions out there in the market where there are proven, known solutions, let's take diabetes or MSK as an example, there are some basic steps, some basic levers that employers can pull that generally are proven and will have a universal impact on that specific condition.
Cancer is not one of those. So it really does require, a high degree of sophistication, and a solution that really can match the complexity of the disease that cancer is. So I think employers really struggle, continue to struggle with what is that silver bullet, what can I do? What should I be doing to help my people and to better, manage the cost that is associated with cancer?
[00:04:03] Brittany: Okay, Natalya, you and your colleagues at PHM recently released a white paper dedicated to the topic of clinical trials in cancer care. Why are these trials so important in the world of oncology?
[00:04:20] Natalya: I can answer this, with a bullet point list, but I'm going to go ahead and answer it with a story that I think really brings to light the importance of clinical trials and of the work that we at PHM do.
A patient of ours, I'll refer to him as Peter, was diagnosed with stage 2 esophageal cancer and had chemoradiation and surgery. But his disease recurred only 5 months later. Over the next 3 years, he experienced progressive metastasis to his liver and lungs, despite trying numerous local and systemic treatments which were causing debilitating side effects with minimal benefits.
At that point, they thought they had tried everything, and Peter's oncologist at the center of excellence where he was being treated told him to get his affairs in order with three months to live. Peter refused to accept this and came to PHM. We sequenced his tumor and found three distinct mutations in something known as the Notch 1 gene, which is not commonly associated with esophageal cancer.
This was surprising to us, and some evidence suggested that one or more of these mutations could be driver mutations. We quickly got Peter in front of several leading experts who studied mutations like these, and they had opposing views, as leading experts often do.
One expert suggested trying immunotherapy first, while the other favored enrolling Peter on a clinical trial that PHM had identified, and this trial was targeting these notch mutations. PHM now had the difficult task of helping Peter decide which route he should take, and we did what we always do, which is consult the scientific and medical literature.
Our analysis suggested that the clinical trial offered the better treatment opportunity. And I'm very happy to report it was the right decision. The tumor disappeared within a year.
And I just want to read a quote from Peter, who said, "It has now been a dozen years that I have been in remission from what was an original death sentence. My much loved brother, along with Private Health Management, are credited with saving my life. A dozen years ago. When I was in the hospital, Private Health had the conviction to send my tumor tissue out for DNA testing, which would be key to saving my life. When conventional chemo and radiation failed, PHM took my DNA marker results and searched for an appropriate clinical trial to target my tumor.
"We found a trial, and I began weekly injections. Within about a year, I experienced a 100 percent complete response to the trial drug. Over the last 12 years, I have had about 25 scans which have shown the miraculous results of being cancer-free."
So this is an astounding case, and not every situation will be like this one, but I use it as an example here because clinical trials are important as they enable members to access new drugs and interventions that can literally save their lives.
And clinical trials are also important for employers and plan sponsors because they are a lever for managing costs within the health plan as they are covered by the trial sponsor and can offset the costs of specialty drugs.
[00:07:51] Brittany: That is really a compelling story. so like many tests and trials, I imagine there are some barriers that prevent patients from accessing these clinical trials. what are some of those barriers and how can we overcome them?
[00:08:07] Natalya: As important as clinical trials are to patient outcomes and to medical advancement, there are very significant access challenges that prevent folks from participating. We know patients aren't being enrolled in the right trials at the right time, and they aren't staying on those trials.
In fact, 85 percent of trials are failing to recruit or retain enough participants. There are many different reasons for this, and the categories of these barriers really fall into a couple of different buckets. The trials themselves, the design of the trials themselves, the provider behavior, patient behavior, and as well as institutional resourcing.
So I'll just give you a quick overview of what some of those are. So on the side of the trials themselves, it's an extremely complex landscape to navigate. there are like, 60,000 trials or more than 60,000 trials in total, 20,000 of them are in cancer. So that's the universe you start with when you're looking for a clinical trial, right? It can be daunting.
In addition, trials have very specific and lengthy inclusion and exclusion criteria, which means that patients have to meet many requirements to qualify for a clinical trial. So it's not enough to just have the desire to enroll on the trial, you actually have to meet the trial's standards.
So this can mean you can't have any of a long list of comorbidities, or that you must have a molecular biomarker to qualify, or that you must be treatment naive. So for a patient to determine on their own, whether they qualify for a trial is nearly impossible, and they rely on their oncologist as a primary source of information both for whether a clinical trial even exists for my condition, as well as whether I'm a good fit for that clinical trial.
This is problematic, and the reason it's problematic to rely on your oncologist or your provider for clinical trial identification and enrollment is because they are not set up for success there. They don't have enough time to navigate patients through clinical trial selection. They're also not incentivized to do In fact, there are some disincentives and misincentives there that actually, don't set providers up for success in this space. Providers don't know about trials happening at other facilities. I may be a provider and I know of a couple trials in my own institution, but I don't even know the ones that are being run in a different institution across the street, even if those trials may be a better fit for my patients.
In addition to that, providers often don't refer to clinical trials even within their own institution. And that's because of how time consuming it is to enroll a patient on a clinical trial and the misincentives that exist there. So providers are inundated. We know that in the past 20 years the number of investigational treatments targeting cancer has quadrupled, right?
So there's all these different clinical trials to choose from and all this research that would need to get done to identify clinical trial for a patient. And medical knowledge is expanding exponentially. And, physicians at the same time are tasked with lifelong learning. And so even if they really are interested in learning about new trials and treatments, they're also overwhelmed by it and don't have the time for it.
And so in short, we can't expect physicians to navigate trials on behalf of patients because our healthcare system hasn't set them up to do And at PHM, we do this work. And in that way, we serve as an extension of the treating provider and expand the provider's ability to care for their patients, including by bringing the right clinical trials to the table and then, once the trial is selected, facilitating the enrollment process for the patient.
That's on the provider side. There are also barriers on the patient side. There are financial barriers, right? Patients often have to travel to these sites, they may have to pay for lodging, they may be skeptical of trials, they don't want to be a guinea pig. They may not have all the information they need to make an informed decision, right? Who's educating these patients.
And also trials may delay therapy. So a patient has to be well enough clinically to tolerate that. And then of course there are, issues on the institutional side. They may be short staffed, clinical trial coordinators are in high demand and they may not have the resources they need to recruit enough patients.
And then of course certain institutions are running up certain types of trials. So this is why we look at it in an institution-agnostic manner, right? We don't want to be, confined by the fact that, Institution A is running only vaccine trials while Institution B is running mostly, ADC, trials.
We want to be able to look across, across the country and evaluate trials that would be the right fit for the member.
[00:12:35] Tommy: And I'll just, let me jump in real quick, Natalya, because I actually want to put an exclamation point on a question that you guys asked earlier around why employers struggle to manage a condition like cancer. And if you think about what Natalya just described, that is just one aspect of how we might go about treating and supporting a cancer patient. One aspect.
And we think about all the nuances, the logistical burden, the complexities associated with just that one aspect. it shouldn't be surprising to us that employers still struggle with, getting their arms around the right solutions, the right strategies, and the right ways to really make a dent and have a profound impact on cancer.
Thanks for sharing that detail, Natalya. I think it just emphasizes, emphasizes that point.
[00:13:28] Natalya: That's a good one, Tommy, and Natalya did talk a lot about the patients' and the providers' side of it, for the employers, what role do clinical trials play in helping them reduce their costs?
[00:13:41] Tommy: obviously, we have a strong point of view that they have a very important role to play. I think most employers don't necessarily think about clinical trials as part of their healthcare strategy, predominantly for two reasons. One, a lot of these trials are not yet FDA approved and by design are not going to necessarily be sort of buttoned up or packaged within their SPD or their plan design inherently, right? That said, if you think about what Natalya just described and a couple of points she made earlier, these trials are being, sponsored by pharmaceutical companies who are paying for the treatments.
So this can be a very cost-effective way to give cutting edge access to the very latest and best therapeutic options for members within a population.
So, David, based on a report that you guys issued, your EHT report, the average specialty oncology medication is somewhere around $65,000. if you think about our ability to source and find just a couple of clinical trials for members who would otherwise be prescribed those very expensive therapies, it doesn't take a lot to have a pretty meaningful impact on cost by accessing these trials, particularly when we overlay that with the outcome that Natalya described for Peter, where that is not only a better cost outcome, but certainly a way better clinical outcome, and in that case, actually life-saving, as we think about that.
So I think it's important for employers to start to really rationalize and think about how do we embed clinical trials into our strategy? May not necessarily be part of our plan design inherently, but do we have the right partners within our ecosystem who can actually help our members navigate to these very, important therapeutic options that should absolutely be part of the regiment, the options, the scenarios that we present? And that we support the members of it.
[00:15:39] Brittany: So, Tommy, how would you say that PHM ensures that clinical trials are accessible to a diverse patient population?
[00:15:50] Tommy: if you think about, the knowledge that's required, to access a clinical trial, if you think about some of the concepts that Natalya talked about around institutions having limited access to, information about available clinical trials.
So when you think about individuals who are in various, geographies, have, different socioeconomic backgrounds, you can see where, there are going to inherently be challenges getting diversity into clinical trials because by definition, individuals who, are of better means, who are in, cities and, urban areas where they have access to some of these high quality academic institutions are going to be better positioned to get into these trials.
And so this is where we come in. Our ability to come alongside of a member and their treating provider in those local communities, serving and supporting individuals who may not otherwise have any clue or access to resources or information that would help them navigate, enroll, and consider these trials is where we really shine.
It's a really important part of work that we do inherently embedded in our delivery model, which is helping all individuals, regardless of where they work, live, and play, access these very, important resources, when we think about something like clinical trials. And if I was to be honest, Brittany, I wouldn't just stop with clinical trials. It's really helping them access the very best care possible when they have a complicated diagnosis on cancer..
[00:17:22] David: Tommy, Natalya, you've been giving us some incredible information here from this report that you produced. So I'm sure people will want to download this and read it for themselves. Where can they find that?
[00:17:35] Tommy: David. so we will drop a link, to directly to the white paper, and as part of this podcast. In addition to that, I would encourage you to go to our website, privatehealth.com and click on the Insights link at the top where you can find access to this white paper, along with a whole host of other educational resources, around topics, focused on cancer, case studies that we've delivered, et cetera.
[00:17:58] David: That's great. I know we've done work with you previously on cancer reports. They're always amazing and very deep and thoughtful. So thank you for that. We will include that link in our show notes, as you said. Okay. Before we wrap up, Natalya, Tommy, anything else that you would like to, like our listeners to know?
[00:18:20] Natalya: I'll just say that most of the benefits employers are putting in place work for 95 percent of their population, but they don't work as well for the sickest and most expensive 5%. at PHM, we encourage employers to think differently when it comes to addressing those 5%, particularly cancer, because it really requires an entirely different level of support.
[00:18:46] Brittany: Cancer is not one disease, as Tommy pointed out, it is hundreds, and it's important for employers to identify a partner who can comprehensively address all cancer types. And we've developed a model over the past 17 years that can really move the needle on serious and complex cases, and particularly cancer by activating precision oncology for patients and bringing the best of what, medicine has to offer to patients with serious and complex conditions. You bring up a good point, Natalya. I know that typically, just in history of analytics, a very small percentage of the population make up like 80 percent of the employer's spend. So it is definitely important for them to focus on that 5%, as you mentioned. with that said, thank you both for joining us today.
It has definitely been a pleasure speaking with you and learning more about your clinical trials.
[00:19:42] Tommy: Thanks for having us, Brittany. Always a pleasure to join the Springbuk team to talk about, what is, maybe not exciting, but very important topic of addressing cancer within an employer workforce.
[00:19:56] Natalya: Thank you for having us.
[00:19:57] David: And I would say it is exciting. It's, it's interesting. It's, certainly thought provoking and important, as you said. So thanks for sharing that with us. And thank you to all of our listeners for tuning in once again to Healthcare on the Rocks: Employee Benefits with a Twist. Don't forget to subscribe, leave us a review, a rating, tell us that you love us, send gifts.
It is my birthday month, so I'm accepting gifts all month long. And remember, we will see you next time. Until then, stay well and stay informed.
