A conversation with Mike Kolodziej MD and Marc Samuels, ADVI CEO on leading in a time of healthcare transformation

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Wednesday, 4 October 2017

Marc: What drew you to medicine and eventually to consulting?
Mike: I was attracted to oncology because of the intellectual challenges. And then, I fell in love with it because I like taking care of patients. I like getting to know the families. I like the interpersonal aspect of oncology care. And I felt like I could do a pretty good job of it. I had a very busy private practice. I also did a lot of administrative work as the medical director at U.S. Oncology around evidence-based treatment, trying to extract value from our electronic medical record and working on care-delivery models. So, I had that sort of focus, and I’ve carried that sort of focus around evidence-based treatment, using data to inform optimal care delivery, and then executing care-delivery reform to Aetna, Flatiron, and now to ADVI.

I understand very well the challenges that practices have around, for example, implementing advanced care planning programs, or taking risk, or focusing on quality improvement, guideline and pathway adherence. It is clear that practices need help. One totally unexplored area is how lifescience organizations can assist practices not only with lifesaving treatment but because they are enormous sources of clinical acumen and collective data – all to put towards increasing quality, lowering total and episodic costs, and creating value.

Marc: Let’s talk about what you’re did at Aetna and Flatiron. ADVI worked with you on implementing the Oncology Medical Home and OCM pilot. And your proton beam and diagnostic work. We spoke with Flatiron about 340b and getting more involved in policy.
Mike: I am proud of what we built at Aetna. The goal of the oncology medical home program is to use the lessons that we’ve learned from the primary care medical home program about team-based care, evidence-based care, enhanced access, and shared decision making, and to operationalize them in the cancer space. Given the ecosphere is moving from volume to value we wanted to reward providers who execute this enhanced care delivery model. I hope to put the same tools to work at ADVI working with providers and lifescience organizations.

The logic goes something like this: If you follow evidence-based care and make value-based clinical decisions, produce products with strong clinical utility and with an eye towards total cost of care, it’s just going to turn out that you will have better outcomes, keep people out of the ER and the hospital, and save money. So, practices should receive some money back and lifescience organizations should be able to charge a premium price related to the value they bring.

Marc: It’s interesting how CMS and CMMI have become kind of a disruptive force.
Mike: They are currently the greatest catalyst right now for change in oncology. It’s really amazing. United is close behind with their focus on guidelines and compendia adherence as a simple, elegant way to lower total and episodic cost – and its working. Patrick Conway’s departure may slow the pace of change; good for North Carolina bad for the nation. ADVI has been working with several organizations on CMS and private payer models focused on indication and combination pricing and value-based outcomes. We hope to move these efforts across the goal line with CMMI and with private payers and I am excited to be a part of this change.

Marc: What does a Chief Innovation Officer Do?
Mike: Buy and bill made it possible for learned practices to develop an efficient chemotherapy delivery model with enhanced revenue to put towards building out clinical services. The model can be adapted to provide for bundled payment, indication based pricing, and combination pricing. I relish working with providers and lifescience organizations to enhance their offerings so they are seen as catalysts and not impediment to meaningful oncology reform. The rapidity of innovation is going to mandate novel payment solutions. ADVI has been providing winning strategies to secure premium reimbursement, unfettered coverage, or high valued codes. They have been telling companies how to beat the competition above brand and at brand level. They have been missing the analytic heft to put behind their stellar record and the ability to operationalize for the same clients the recommendations they make. With my addition and working with Natalie Reid from Kaiser and CMMI, Marci Mutti from GSK, and Paul Martino from Anthem we have the team that can provide a seamless end-to-end offering. Clients don’t have to look elsewhere; and they already know how hard ADVI works. It’s a win-win.

Marc: What are you most excited about now that you’re at ADVI?
Mike: I think we really are at a time when oncologists, cancer care providers, lifescience organizations, and payers are starting to sing from the same hymnal. I think the dialogue about cost and value is a healthy one. I am most excited to continue the work I have been doing all my life but in a way and with support to bring everyone to the same table. I can be most effective given my experience working in both the provider and payer worlds helping providers practice, using tools, platforms, and products of meaningful use and value, and with a shared focus on cost, quality and value.

All my best,
Marc Samuels
CEO, ADVI
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