Jul 9, 2019
Subscribe through iTunes and Google Play.
Dr. Joanna Yang and Dr. Robert Daly join ASCO CEO Dr. Clifford A. Hudis to discuss the Health Policy Leadership Development Program (HP-LDP). As former fellows, Drs. Yang and Daly provide insight as to how the program has made them better advocates for their patients.
TRANSCRIPT
Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.
Clifford Hudis: Welcome to this ASCO in Action
podcast. This is ASCO's monthly podcast series, where we explore
policy and practice issues that impact oncologists, the entire
cancer care delivery team, and the individuals we care for, people
with cancer.
My name is Clifford Hudis. And I'm the CEO of ASCO as well as the
host of the ASCO in Action podcast series. For today's podcast, I
am delighted to be joined by not one, but two of ASCO's rising
leaders, Dr. Robert Daly and Dr. Joanna Yang.
Both Dr. Daly and Dr. Yang are recent participants in ASCO's Health
Policy Leadership Development Program, formerly known as the Health
Policy Fellowship Program. This is a professional development
program designed to build health policy and advocacy leadership
expertise among our members.
It's a one-year program where fellows get practical experience
working with our policy and advocacy staff and council to craft
policy positions and statements, along with other educational
sessions on communication, leadership, and advocacy. Starting this
year, participants will be able to participate as well in ASCO's
Leadership Development Program, which offers mid-career oncologists
the opportunity to improve their leadership skills and gain
valuable training to set them up to be future leaders in
oncology.
Dr. Daly and Dr. Yang, welcome, and thank you for joining me
today.
Joanna Yang: Thank you so much for the opportunity.
Robert Daly: Yes, thank you so much for having us.
CH: So Dr. Yang, I'm going to start with you. You were an ASCO Health Policy Fellow in 2017-2018. And I want to kick off our discussion by talking about what brought you to the program. Why were you interested in developing special expertise in policy work?
JY: Sure. So I've always been interested in
health policy. And I had the opportunity to study health policy and
health economics during undergrad. But of course, studying health
policy is very different than creating or influencing health
policy.
When I started residency, I saw many ways in which health policy on
a national level or even state level affected the patients I was
caring for. And I felt compelled to do more. But the issue is that
there is never any clear way for me to get involved or even to
learn how I could learn how to shape health policy.
And that's why the ASCO program is so great. I feel like it came at
exactly the right time. I was looking for a way to learn more to
develop the skills I needed to influence health policy.
And ASCO came out with this structured and immersive experience
where I could take the things that I had studied in school, and
also the things that I'd seen in practice, and use them to actually
have an impact on the patients I take care of.
CH: So Dr. Daly, you as well were one of our inaugural Fellows. What prompted your interest in applying for the program, especially given I think you were the first year?
RD: Yes.
CH: Right, so you took a leap off of the ledge there and said, I'll go first.
RD: Yeah, I'm similar to Dr. Yang. I had a
real interest in cancer care delivery research during my fellowship
at the University of Chicago. And I was lucky enough to be mentored
by Funmi Olopade and Dr. Blase Polite. And Dr. Polite was really
fundamental and helped developing the ASCO Health Policy
Fellowship.
And so I really saw this as an opportunity to augment that training
but really gain skills in leadership, advocacy, and health policy,
areas that I hadn't had exposure to in the past. So this seemed
like the perfect program for me at that point in my career.
CH: I have to say parenthetically that I'm
jealous of both of you, because while I was personally drawn,
especially in later years in my career to the policy and advocacy
aspects of work with ASCO-- and it truly is the reason that I moved
from my traditional academic career to this role as CEO at ASCO-- I
never, of course, had the opportunity to be trained and to learn
how to do this professionally as you two have.
So I am in awe of your accomplishments, as well as the
opportunities that are going to continue to unfold in front of you
because of this. So given that, and given that this is really the
beginning, we hope, of a career with impact, we should talk a
little bit about what you actually did.
The program, as I mentioned earlier, lasts for a year. And during
that time, Fellows worked very closely with our policy staff on a
mentor project. So I'll start again with Dr. Yang. Can you talk
about the project you worked, what it entailed, what you learned,
and where this is going?
JY: Sure. So I worked on a two-part project
with Alex Chen, who was my co-fellow during the past year. And as
you hinted at, the work is actually still ongoing.
So the first part was we looked at whether a bundled payment model
could work in oncology. And this really culminated in a white paper
for us.
But the second part of the project, which built on the first part,
was really the most fascinating. In the second part, it was really
asking, if not bundled payments, then what?
And we actually built on some of the work that Dr. Daly did that
he'll probably describe in a little bit. But we actually worked on
designing a pathway-based alternative payment model.
And of course, going into this, I had no experience designing
alternative payment models at all. But the beauty of the program is
that from the very beginning, Deb Kamin, said, we will not be
having you do any work that is not necessary. So all the work that
you do is important to ASCO, is important to our patients.
And that was really true for our project. So we were able to work
with the ASCO staff, and our mentors, Ray Page, and Linda
Bosserman, and a whole team of experts to create an alternative
payment model that we thought would allow oncologists to prescribe
the right drug at the right time, without being penalized by the
high drug costs.
CH: So I guess, based on that, we really should
have started with you, Dr. Daly. But your mentor project was
centered around clinical pathways. And I understand that ends up
being the foundation for the alternative payment model that Dr.
Yang just described.
So can you talk a little bit about that process, what you did as an
inaugural fellow in this and what you learned as you went through
the work?
RD: Absolutely. So I was lucky enough to be able
to serve on the ASCO Task Force on Pathways. So that was an
incredible experience for me because I really got to interact with
leaders on this issue, including Robin Zon and Ray Page, who are
very active in cancer care policy, both at the state level in
Indiana and Texas, but also on a national level.
So to be able to gain their mentorship that early on in the
fellowship was really a great asset for me. And we were looking at,
how do we write the criteria for what constitutes a high-quality
pathway?
So I really got to see, from soup to nuts, how do you write a
policy statement? How do you solicit input from those important
stakeholders? So the stakeholders in this case were fundamentally
the patients, but also providers, ASCO's Government Relations
Committee and State Affiliate Counsel, ASCO's board, the vendors--
get all of their input together to create a policy statement that
can really influence change.
And then lastly, I played the part of representing ASCO and in
discussions with the pathway vendors about these criteria for
high-quality pathways. So I learned about the important role ASCO
can have on influencing the development of products and services
that impact patient care, but also the impact ASCO can have on
legislation.
So in California, Connecticut, and other states, they started to
look at policy around pathways, policies around implementing the
criteria that ASCO had developed, so that those pathways that were
being used in their state were high quality. So it really showed me
the reach of ASCO and the impact of ASCO on patients and
providers.
CH: That is amazing because it really is a reminder-- and
I'm going to come back to this idea-- about how much impact one
person and one project can ultimately have. And I think that in
these sometimes cynical times, people forget that.
I alluded to this before about my own engagement with ASCO was
accelerated by my experience as an advocate on Capitol Hill--
again, an amateur to your professionalism. So I wonder if you would
reflect on your experience during the fellowship program.
I understand you were both frequently called on to join in advocacy
meetings on Capitol Hill. And this is with federal agencies, as
well as, I assume, with representatives, senators, and their staff.
Did either of you have any experience doing this before ASCO took
it to Capitol Hill?
RD: I had never had any experience doing advocacy
meetings. So it was really-- the fellowship really helped me learn
how to do that and how to do that effectively.
CH: What was the first meeting like?
RD: My first meeting was here in Manhattan.
It was at the office of Senator Gillibrand. And I was accompanied
by Heather Hilton, who is an ASCO advocate and someone who's served
on the Government Relations Committee.
And I was really nervous. I didn't know what to expect. But we met
with one of her health policy staffers and really had an engaging
discussion about an ASCO advocacy issue where we really felt heard.
We were able to share patients' stories and also deliver data that
ASCO had collected to help support our view.
So it was really an exciting experience for me. And then I got to
replicate that experience on Capitol Hill, meeting with
congressional representatives from New York in their offices, but
then also, as you said, going to government agencies, which was a
different experience as well.
So I really got to see a broad perspective of how you can advocate
for policy issues for ASCO.
CH: Dr. Yang, how would you describe your
initial advocacy meetings for someone who hasn't participated
before? What does it feel like to walk into that first meeting and
begin that first discussion?
JY: Sure. I've done that for my friends before.
I've described these meetings. And they always say, it's really not
at all what they expected. And I think that Dr. Daly's description
is exactly right.
So you go with your group-- usually it's by state-- to the member's
office. And then depending on how much room there is and how many
meetings are being held that day, your meeting is either going to
be in a conference room in the member's office or even, more
frequently, in the hall or any room that's available.
And the member is not always there, but one of their staffers is,
or sometimes multiple staffers, who are always really young but
super, super, super knowledgeable about the issue. Basically, you
go around, and you introduce yourselves and then describe the
issues that you're here to discuss.
And it's interesting because ASCO always does a great job of making
you exceedingly well-prepared with the facts. But the truth is that
most members and most staffers are most interested in hearing the
patients' stories, which is why it's so important that oncologists
come to the Hill to have these meetings.
I think that no matter how well you try to prepare, ultimately, it
really just comes down to engaging with the staffer and finding
some area of common ground. And cancer is so common that most of
the time in these meetings, I find that staffers or members will
say, I have a family member or friend or some other loved one who
has cancer. And it's really great that you guys are here.
CH: My own experience-- I mean, I'm here to talk
to you. And the listeners want to hear from you. But I just can't
help but share.
When I got involved in this before you all were, the key issue that
we were confronting was the decade-long flat-- in dollars-- flat
funding of the NIH and the NCI. And my first trips to Capitol Hill
consisted of virtually beating on doors and explaining why this was
a mistake for the country and for our people, and getting what felt
like the cold shoulder.
Over and over again, the same arguments seemed to fall on deaf
ears. But-- and this is an important "but"-- what I have learned is
that repeatedly making rational, evidence-based, and appealing
anecdotal arguments, just as you describe, can ultimately move the
needle. And it does.
And so my personal cynicism with regard to politics and making a
difference has gone down, not up, with aging. And I think listeners
should think about this.
You will never go to a congressional office and change a mind in
one quick phone call. But when dozens and hundreds of people do it
repeatedly over months and years, we actually do have the chance to
positively influence policy and legislative actions and regulations
in the United States.
And you should forgive me for waxing so poetic. You should be proud
that you've committed to doing this early. And I hope you start to
see the rewards.
So I'm sorry to carry on about my own experience here. But it
really is part of what has helped motivate all the staff to get
behind this program and launch it and support it.
Looking back, I'll turn back to you Dr. Daly. You're a couple of
years removed now from the program. Can you identify one or several
key learnings from your time as an ASCO Policy Fellow that have
stuck with you, that you find yourself coming back to in your daily
life?
RD: Yeah, I mean, I think what you've just said,
Dr. Hudis, about how you can really have an impact is something
that I learned during this fellowship. It wasn't something that I
had been aware of in the past, because I had never done advocacy
work before in the past.
So I think what this fellowship really trained me to do is to be an
effective advocate. And that is something that I can use in a
multitude of different areas as an oncologist.
So combining the patient stories that we talked about that are so
visceral and so needed when you're trying to get through to those
legislators or policymakers that you're trying to reach-- but also
backing that up with data, and I think ASCO really equipped us well
as advocates to have the data, as well as the personal stories, to
influence change.
So using tools like CancerLinQ to be able to look at broader data
sets and say, we know this is impacting our patients. We can see
that. And now we need to think of a solution for change.
And I think being involved in helping to create some of those
solutions was also really valuable for me. So with the pathways,
creating the policy paper, but also serving on committees during
that fellowship year on MACRA and other issues, like opioid
legislation, that were really affecting our patients, and seeing
how ASCO is effecting change in those areas, was something that
will stay with me throughout my career.
CH: And how about you, Dr. Yang? Do you see any
practical day-to-day impact, for example, in your work with
patients from your time in the fellowship?
JY: Yeah, absolutely. I think because I spent most
of the past year thinking about high drug costs, both for
chemotherapies, immunotherapies, and supportive drugs, I'm much
more thoughtful about the costs that are passed on to our patients.
And that can actually be really significant.
And one of the things that I do much more often is I ask about cost
to my patients when I prescribe medications. And that I really
attribute directly to work that I was doing with ASCO.
The other thing is that working with patients actually often gives
me ideas. So I'll see patterns emerging. And I'll think, we really
need to work on a policy that addresses this.
And the great thing about the Health Policy Fellowship is that you
remain involved with ASCO. So when I see these issues, I'm able to
take them back to ASCO and to the committees.
CH: Well, speaking of the committees, after you
and all of our Fellows complete the one-year program, you were
automatically added to one of ASCO's relevant committees. And I
think you're both members of the Clinical Practice Committee.
I'm curious-- I'll start with you, Dr. Daly-- has your time as a
Health Policy Fellow helped you in your work on the CPC, and
how?
RD: I think, absolutely. It's made me more fluent
in the issues that the CPC is confronting, the sort of things like
the Oncology Care Model, rural cancer care. I now have a foundation
where I'm able to contribute in a way on that committee that I
never could have before or without the Health Policy
Fellowship.
CH: Yeah, I think it's often the case that sometimes-- or
I shouldn't say often-- I think sometimes it's the case that people
get onto committees and really do have a steep learning curve. It
seems like maybe this could have accelerated your start on the
committee. Is that your experience, Dr. Yang?
JY: Yeah, I think so. I think that the Health
Policy Fellowship, that first year is a really steep learning
curve. But it does, as Dr. Daly said, provide a great foundation to
just be aware of all of the issues that affect cancer doctors and
cancer patients.
CH: So I'm going to go to a little bit of a speed
round, if you will, and ask you both to think about the other
members of our community who have not had the opportunity to do
this and might not ever have thought about it.
Dr. Yang, finishing the program last summer of course-- so it's
fresher, I think, for you-- why do you think it would be important
for oncologists to be aware of and engaged in policy discussions,
rather than nose to the grindstone, thinking about their clinical
and research responsibilities on a daily basis?
JY: Mainly, I really think that the reason for
oncologists to be involved in this is that regardless if you are
thinking about it or not, health policy affects you. And it affects
oncologists. It affects how they practice. It affects how they are
able to care for their patients and the type of care that they're
able to provide.
And if oncologists aren't involved, their voice is going to be
lost. And oftentimes, they're the most important voice for their
patients.
CH: And Bobby, what would you say to the old version of
me, the cynic, who says, this is a waste of time-- I'm not getting
involved?
RD: Well, I do think it really makes your
career more exciting to be involved in health policy issues. It
really broadens your view of how you think about patients and how
you think about cancer care, and makes coming to work every day, I
think, more exciting because you have this other lens that you're
looking at issues with.
CH: And looking back more specifically, and not
intending to turn this into a sales job for the Policy Fellowship--
we only have two slots a year-- but I wonder what each of you would
say to young colleagues thinking about this. What's the best reason
to get involved in the Health Policy Fellowship at ASCO? I'll start
with you, Dr. Yang.
JY: I think that if you're interested in quality
of care, the costs of care, access to care, then this fellowship is
the right fellowship for you. And I think that being interested in
those things doesn't necessarily provide you with the skill set you
need to actually do meaningful work in that realm.
And I think that the fellowship program really does provide you
with tangible skills that you can then use to write policy briefs,
to hold meetings, to be an advocate, all of which are really,
really, really important.
CH: Dr. Daly, is there anything you can add to that?
Or does that pretty much sum it up?
RD: I think that's absolutely right. I would just
add the mentorship of the fellowship is really incredible, so
getting to interact with the ASCO leaders, like Robin Zon, or Ray
Page, or Blase Polite, but also the ASCO staff as well, who are
incredible in the policy area, like Deb Kamin.
I think I learned so much from being in their presence for a year
and just absorbing all of their knowledge that they had, an
experience they had. And when I was at the annual meeting just a
couple of weeks ago, it was just such a fun pleasure to be there
and see all of them and know that those relationships are something
that will be with me throughout my career. And they really
influenced me.
CH: Wow. I think that's great. And I am so proud of both
of you and all the participants in these and the other development
programs that we offer.
I will share with you that from the perspective of the board of
directors, these programs really represent the crown jewel,
something that the board members take the light in. And you should
be proud to have contributed the way you have.
So Dr. Daly, Dr. Yang, I want to thank you again for joining me
today for this ASCO in Action podcast.
RD: Thank you so much for having us.
JY: Thank you.
And for all of our listeners, if you want to learn more about
ASCO's Health Policy Leadership Development Program, please visit
us at asco.org and search for "policy leadership." The application
period for the 2020-2021 year is now open, and it will be open
through the end of September. So there is time to get those
applications in.
And with that, until next time, I want to thank everyone for
listening to this ASCO in Action podcast.