Our goal of optimal care for the individual patient is firmly aligned with the value proposition of care. Plus, our member institutions, users of our guidelines and services, payers, and business collaborators are all calling for us to provide value-driven care.
—Robert W. Carlson, MD
The National Comprehensive Cancer Network (NCCN) recently appointed nationally regarded breast cancer expert Robert W. Carlson, MD, as its new CEO. Previously, Dr. Carlson was Professor of Medicine in the Division of Oncology and Medical Informatics, Stanford University Medical Center; he first joined the Stanford faculty in 1983. The ASCO Post spoke with Dr. Carlson about his new role at NCCN, which commenced on January 2, 2013.
Making the Move
What are your thoughts about leaving Stanford?
I’ve been at Stanford for 40 of the past 42 years, so I have many significant attachments to this wonderful institution that fosters creativity and discovery in a robust atmosphere of diversity. The hardest part of leaving, of course, is separating from richly productive relationships I’ve developed over the years with colleagues, staff, students, and especially with my patients.
What persuaded your decision to accept the CEO position at NCCN?
Simply put, the draw to NCCN is very strong. The organization’s ongoing ability and potential to improve the lives of cancer patients globally continues to mature, and I want to be a part of that crucially important process.
Evolution of NCCN
How has the NCCN changed in terms of its vision?
I wasn’t in the room when NCCN was founded, but I was just outside the door, one of the early participants. When NCCN was first organized in the mid-1990s, it was really in response to the increasing influence of HMOs and the threat they represented to the ability of academic medical institutions to care for cancer patients. I think NCCN’s founding leadership envisioned the organization’s goal was based largely on its ability to negotiate contracts with payers and, in turn, respond to the threats posed by the increased leverage of HMOs.
However, the payers were concerned that academic cancer centers were simply providing too much expensive care. NCCN responded by creating clinical practice guidelines so the payers would have a clear understanding of the value of care they were paying for. Over the years, NCCN guidelines have become the gold standard in the United States, viewed as optimal cancer care.
In fact, the guidelines are now used, in part, as defining what payers should cover. So the core product of NCCN has been inverted over the years, changing from one designed to justify treatment delivered, to one that is used to establish what payers should cover, from the community setting to academic institutions.
These are fiscally challenging times. Are you confident that NCCN will be able to maintain and grow its large portfolio of services?
There’s no question that we are living in challenging times, and it will take creativity and flexibility to accomplish our goals. But I believe we are well positioned to continue providing a wide array of cutting-edge services for the cancer community. Of course, maintaining the fiscal health of an organization of our size, reach, and ambitions requires a dedication to maintaining fiscal health.
Please give the readers a snapshot of the NCCN’s ongoing work.
We will continue our annual guideline conference in Florida, the Journal of the National Comprehensive Cancer Network (JNCCN) is flourishing with a rapidly increasing impact factor, and we have our ongoing CME programs that provide educational opportunities to the oncology community—these are well-established, vibrant programs that we plan to continue.
But we are a dynamic organization that is constantly seeking ways to improve our ability to serve the oncology community. For instance, in 2012, the NCCN website has had more than 4 million downloads of our guidelines alone. We also have more than 1.5 million unique users of our website’s products. We’re developing tools to facilitate faster and more seamless provider access to the guidelines within the context of electronic medical records (EMRs), which enables their use in real-time patient care. We are also collaborating with several pharmaceutical companies on initiatives to support translational research led by our member institutions.
Further, the organization is strengthening its relationships with payers by seeking to improve the quality of information we provide. This will maximize the efficiencies among payers, providers, and patients, and at the same time minimize health-care waste in the system.
Role of JNCCN
You mentioned that JNCCN is flourishing, what part does the journal play in the overall picture?
The JNCCN is a terrific educational product that allows us to publish the guidelines for wide dissemination. Importantly, the journal focuses on specific areas in the guidelines where new information or ongoing controversies can be addressed. This gives us the ability to expand the manuscript portions of the guidelines for the interested reader.
Moreover, our Editor-in-Chief, Harold Burstein, MD, PhD, has done a wonderful job of expanding the journal’s editorial reach and content, giving the publication an international presence.
Cost and Value of Care
Cost and value of cancer care is under growing scrutiny, as CEO is this something that you feel NCCN will spend more energy on?
We absolutely need to emphasize our attention to cost as it relates to value. First off, providing optimal cancer services is usually the most cost-effective and value-driven way to treat patients. Our goal of optimal care for the individual patient is firmly aligned with the value proposition of care. Plus, our member institutions, users of our guidelines and services, payers, and business collaborators are all calling for us to provide value-driven care.
The challenge, of course, is determining a cost-effective, value-based way to deliver care across a wide spectrum of interested parties, starting with payers, patients, and providers, all of whom might have a different take on what constitutes value. Then we need to address different regional and economic issues within that larger picture.
These are major challenges, but I believe that NCCN will find innovative ways to address the cost-and-value–driven equation. For instance, NCCN has entered into an extensive collaboration with a Washington, DC–based not-for-profit organization called the National Business Group on Health, which represents more than 350 of the nation’s Fortune 500 employers. We’re working with them to build model cancer-benefit templates that will not only be used by the group’s employers, but also by other companies.
Remarkably, the resources that we’ve developed through this collaboration have been downloaded more than 72,000 times. It’s clear that our constituencies are insisting that NCCN must address the issue of cost and value, and we are rising to that call.
Is there any single challenge you see as you prepare to assume the role of CEO?
The major challenge for NCCN is undoubtedly how we manage growth, and there are a series of dimensions that define growth. I do expect NCCN to add more member institutions—how many and how rapidly is still an emerging discussion. We should see growth in the coverage and accessibility for our guidelines by EMR implementation and collaborations. The organization also needs to grow its outreach and presence in the health-care policy arena.
To handle this growth will require establishing priorities and at the same time remaining in close contact with our members and those in the community setting. It’s important to note that as we move forward into new and exciting challenges, we need to work with other professional organizations so we can all benefit from the creative energy of a collective power base. ■
Disclosure: Dr. Carlson reported no potential conflicts of interest.