There’s been a massive gap in oncology where people who have been responsible for a dramatic increase in the standard of care have lacked a solid understanding of the business, payment and policy constructs required to deliver it. Dr. Stephen Schleicher has spent the early part of his career working to fill that gap.

Dr. Schleicher entered medical school with an interest in oncology, anchored by an appreciation for the psychological toll cancer can have on a person, their family and caregivers that he gained from parents who were both psychologists. During his internal medicine residency at Brigham and Women’s Hospital, Dr. Schleicher also worked at McKinsey and earned his MBA at Harvard Business School as part of a fully-funded fellowship. Through this combined experience, he started to develop a niche in the oncology space where clinical, business and policy decisions intersect, at a time when value-based care was just starting to gain momentum.

After a fellowship at Memorial Sloan Kettering Cancer Center, Dr. Schleicher joined Tennessee Oncology, one of the nation’s largest community-based cancer care practices, and shortly after became medical director of value-based care at OneOncology, a large community oncology network founded by Tennessee Oncology that spans multiple states. He subsequently returned his focus to Tennessee Oncology where he served as chief medical officer for two years and still practices as a breast cancer medical oncologist. Dr. Schleicher is also a board member and executive committee member at the Community Oncology Alliance.

To set the stage for a Healthcare is Hard series focused on Oncology, Dr. Schleicher talked to Keith Figlioli about both the clinical and business trends influencing cancer care. Topics they discussed include:

• Community providers vs. health systems. For Dr. Schleicher, the ultimate goal is to give cancer patients the personal feel of a community clinic with the resources – including access to precision medicine and clinical trials – that have historically only existed at academic medical centers. While Dr. Schleicher firmly believes that nearly all cancer care should be delivered outside the hospital, he recognizes the expertise for certain conditions – like rare sarcomas – that only exists at academic medical centers and discussed the dynamics of “coopetition” that exists between health systems and community providers in markets across the country.
• Oncology’s cost center. Drugs already account for a significant portion of spending on oncology care, and with dozens of new FDA approvals for cancer therapies each year – some with extremely high costs – this trend will continue. But there are many other variables contributing to the large percentage of spending that goes towards drugs, including the shift from infusions to more oral medication. Dr. Schleicher explains how reliance on oral medication introduces PBMs and specialty pharmacies into the equation, which can add cost and complexity, and sometimes slow the speed of critical care.
• The value based care dilemma. Dr. Schleicher talked about how successful The CMS Oncology Care Model (OCM) was at optimizing care for Tennessee Oncology’s patients. He says hospitalizations and ER visits went from 20%-30% of costs before OCM to less than 10% now. The remaining 90% of costs now goes towards drugs – even when used appropriately following pathways. The dilemma is that there isn’t too much more room for cost improvement in care delivery. Dr. Schleicher discussed how payers need a better understanding of how to incentivize providers around costs they can control, while allowing for expensive therapies if they’re the right drug at the right time to improve costs and outcomes in the long run.

To hear Stephen and Keith discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.