Behind the Scenes of One of the Region’s Providers of Cancer Care
David M. Waterhouse, MD, MPH, OHC chairman of clinical research with a patient.
Photography by Brian Ambs
It is one of the largest independent oncology practices in the country, bucking the trend of healthcare consolidation for three decades, while literally writing the book on the standards of cancer care and boasting one of the most vigorous clinical trial and research menus in the region.
However, unless you are a cancer patient or in the medical community, Oncology Hematology Care, Inc., might not be familiar.
“We are probably one of the best-kept secrets in Cincinnati, “ says David Waterhouse, MD, chairman of the Department of Clinical Research at OHC. “Our research effort is as large as any university and bigger than most in this region. At any given time we have open or pending 55-75 clinical trials. They are across the spectrum of cancer therapy.”
It’s not just the breadth of clinical trials that sets the practice apart. OHC’s concept of pioneering an oncology medical home program, combined with state-of-the-art treatments and technologies, has earned it a reputation for patient-centered care that goes beyond the norm.
The group, founded 30 years ago by oncologist Richard Levy, has grown from a small practice to nearly 60 physicians supported by 24 nurse practitioners and 450 employees at 17 locations in the region. OHC treats nearly every form of adult cancer and blood disorder.
OHC Leadership team: E. Randolph Broun, MD, president and chairman of the board (left) Richard J. Schiano, chief executive officer (right)
Talk to doctors, nurses and administrators at OHC and one thing becomes clear: They all cite the group’s independence – not being owned by a large hospital system – as the key to success.
“We don’t have a massive infrastructure that gets in the way of how we do things,” says Richard Schiano, who assumed the CEO job in January after coming to OHC in 2011 following 25 years at Procter & Gamble where he was director of North American Healthcare Customer Business Development.
“When you are in a large health system, there is more bureaucracy, more government red tape and more legal red tape. We have people close to the patients who, for example, understand the protocols to enroll someone in a trial. We can be more nimble than a large system in our ability to do that.”
OHC has been the exception to the trend toward consolidation in the healthcare industry during the last decade as hospital systems gobble up physician practices. The Affordable Care Act has made that an even more economically viable model, spurring on the economies of scale and, presumably, providing healthcare savings that consolidation can offer. However, some observers wonder what consolidation is doing to patient choice and access to the best treatment.
“We believe once you are bought by a hospital, patient choice gets limited,” says E. Randolph Broun, MD, OHC president and board chairman, who also maintains his practice specializing in bone marrow transplants. “A patient can be put under the economically driven constraints of a hospital system as to their policies about referring a patient outside their system.”
In the case of OHC, independence does not mean small. It is one of the largest independent oncology groups in the country and its doctors have wide-reaching impact and influence at almost all of the hospital systems in Greater Cincinnati.
“It would actually be difficult for us to be acquired by a hospital system,” Schiano says, “because we have doctors in all the hospital systems. In fact, our doctors are directors at various departments at hospitals.”
For example, Broun manages the bone marrow transport unit at Jewish Hospital; another physician is director of breast cancer education at another hospital.
The benefits of independence are perhaps best illustrated by the OHC Phase 1 (first in humans) clinical trial program, which may be the largest in the country at an independent group.
“In the traditional university setting, where most trials take place, decision-making, often by committee, can be very slow,” says Waterhouse. He explained that the pharmaceutical industry began a push to enlist more community doctors in trials over a decade ago to supplement the sometimes protracted university process.
“We were on the ground floor for that development and were involved in trials for a great many new drugs that have come to market,” Waterhouse says. “Of 13 drugs approved in 2014, we had a hand in eight of them. For our patients, that means they can get access to tomorrow’s mega drugs without having to travel for treatment to other cities. In fact, people comes to us from out of town all the time to participate in our trials.”
For example, the practice has been involved in one of the most exciting cancer therapies in years, the PD-1 inhibitors, a way to turn on the immune system to fight cancer. The inhibitor breakthroughs often make for stories on the nightly news. “We have been on the ground floor of that effort and we will be presenting a paper in June on this,” Waterhouse says.
The OHC clinical trial involvement has been spurred by Waterhouse, an advocate for the idea that a clinical trial is the best bet for a patient from the start. He notes trials are no longer the “Hail Mary” attempt to use a patient as a guinea pig, especially in cancer treatment. Waterhouse says trials now reflect how cancer fighting has radically changed. These days, treatment is targeted to the specific molecular structure of a cancer cell, even those malignancies unique to an individual patient.
“Every time I see a new patient, the first step I do is to see if there is a research opportunity. I think it should be part of our DNA to try to offer it to every patient. With our targeted therapies, there are brand new drugs being developed all the time with far more potential than their toxic ancestors.”
Independence also means flexibility since the group has agreements with most area hospital systems. “It gives us the opportunity pick the best facilities available to us for the patient,” says David Kirlin, MD, chief medical officer for OHC. “Some hospitals have newer, up-to-date equipment, some have the best surgical physicians for a particular type of care. We can more appropriately guide the patient.”
OHC’s streamlined approach also permits it to develop an industry-leading concept of the oncology medical home. Under the program, a patient is assigned to one of OHC’s 38 nurse navigators who act as a medical concierge for all issues related to the patient’s care, coordinating health needs and communicating with other providers. They also coordinate with family care providers and can bring in OHC on-staff financial navigators to help with insurance coverage and possible grants.
“The nurse navigator meets with the patient after the diagnosis and goes over the treatment plan and talks the patient through the experience,” says Ronda Bowman, RN, chief operating officer. “That nurse is there with them throughout the treatment. Our goal is to eliminate the fragmentation of healthcare that has frustrated patients and families. It provides better communications with other physicians, with the family and the patient. It is more cost-effective. It is a method of merging the healthcare team with the patient team, which includes the caregivers.”
Obviously the medical home concept makes for a more holistic, comprehensive approach to cancer treatment and would appear to be a common-sense approach that any cancer patient might expect in treatment. The problem is that most cancer treatment services don’t have such a well-defined medical home program. In fact, OHC is one of 10 community oncology practices invited to be involved in a pilot program to establish national standards leading to a certification process for the oncology medical home through the American Society of Clinical Oncology.
As another patient-friendly move, OHC has established Saturday hours at its Kenwood location, which Kirlin says has been a cost saving. Often a call from a cancer patient late on a Friday has meant a costly emergency room visit over the weekend since the physician’s office is not open until Monday. Kirlin says that hospital trip is often eliminated with the Saturday hours.
From a marketing perspective, Schiano acknowledges OHC is at a disadvantage since it does not get institutionalized referrals that come with being part of a hospital system. OHC relies more heavily on reputation and word-of-mouth. Schiano is drawing on some traditional retail and consumer marketing techniques to reinforce the group’s referrals from doctors and patients. For example, OHC is one the few in the healthcare industry to use Net Promoter, the management tool that gauges the loyalty of a firm’s customer relations. Schiano says the healthcare business world has been slow to adopt such traditional consumer satisfaction research tools. That has been changing partly because the ACA requires healthcare systems to produce more patient satisfaction data and might be financially rewarded or penalized based on those numbers.
Schiano says Net Promoter allows OHC to ensure they are delivering the best patient satisfaction and also to enlist those patients to help to spread the word through social media and other means. He said it also identifies unhappy consumers. “We contact them and find out why. We always want to be better and provide the absolute best patient experience. If we do, patients and their families will reward us by telling their friends,” Schiano says. “I believe we are the only independent practice using Net Promoter in the U.S. I learned in consumer marketing that it’s not about delivering the sale, it’s about delivering the experience for the customer and that is certainly true in healthcare.”
In the meantime, OHC seems to be positioned to grow its independence. “We are approached by other independent oncology groups who want to remain independent. In some cases that means they want to join us,” says Broun. “We recently welcomed in four oncologists from Springfield (Ohio) whose practice was in danger of being bought out by a local hospital system. We are doing a similar thing in Lima and have been asked to look into a practice in Cleveland.”
The bottom line for OHC physicians is that it is an exciting time to be in cancer care, especially when they have the freedom an independent practice provides to aggressively pursue cutting-edge treatments, which in turn leads to a good outcome for patients.
“Today a cancer diagnosis is no longer a death sentence,” Kirlin says. “When I started cancer treatment, it was machine gun therapy. Now it’s specific. We can hit the cancer and not everything else. Diseases I had no treatment for can be cured. In my first 20 years I probably got a new drug every six months. Now it’s every three to six weeks.
For location information call 1.800.710.4674 or visit www.ohcare.com.