00:00:00:15 - 00:00:04:02 I’m Dr. Rob Winn and you're listening to Real Cancer Talk 00:00:04:02 - 00:00:07:02 from VCU Massey Comprehensive Cancer Center. 00:00:08:02 - 00:00:10:13 Hello and welcome to today's podcast. 00:00:10:13 - 00:00:13:21 I am Marcy Wright, the deputy director for the Alliance for Equity 00:00:13:21 - 00:00:16:21 in Cancer Care, also known as just the Alliance. 00:00:16:24 - 00:00:21:01 We're thrilled to bring you this special episode created in collaboration 00:00:21:01 - 00:00:25:03 with the Journal of Oncology, Navigation and Survivorship and the Alliance. 00:00:25:12 - 00:00:30:04 This episode is part of our ten piece series celebrating the latest achievements 00:00:30:10 - 00:00:33:10 and advancements in navigation within cancer care. 00:00:33:19 - 00:00:35:22 So what exactly is the Alliance? 00:00:35:22 - 00:00:38:23 We're a multi-site initiative working to advance 00:00:38:23 - 00:00:41:23 health equity by improving access to high quality, 00:00:42:02 - 00:00:46:06 culturally responsive care for patients from underserved communities. 00:00:46:13 - 00:00:49:24 With a $20 million commitment from the Merck Foundation. 00:00:50:07 - 00:00:53:02 Our program partners with community organizations 00:00:53:02 - 00:00:57:04 to better reach populations disproportionately impacted by cancer. 00:00:57:09 - 00:01:01:05 Joining our conversation today will be Doctor Robert Winn and Miss Sharon Gentry. 00:01:01:16 - 00:01:05:08 Doctor Winn is the director of the VCU Massey Comprehensive Cancer Center, 00:01:05:17 - 00:01:10:02 a National Cancer Institute designated facility that provides advance 00:01:10:02 - 00:01:14:06 care, groundbreaking research, education and community engagement. 00:01:14:24 - 00:01:19:12 He leads efforts to establish a 21st century model of equity in cancer science 00:01:19:12 - 00:01:20:22 and care, involving 00:01:20:22 - 00:01:24:14 community partnerships to address disparities locally and globally. 00:01:24:18 - 00:01:26:00 We welcome you, Doctor Winn. 00:01:27:04 - 00:01:29:15 Miss Sharon Gentry has over 40 years 00:01:29:15 - 00:01:33:04 in oncology nursing with 25 years in patient navigation. 00:01:33:12 - 00:01:36:22 She founded North Carolina's first and College of Navigation program 00:01:36:22 - 00:01:40:19 in Winston-Salem, connecting care systems and community resources. 00:01:41:02 - 00:01:43:20 She holds a nursing bachelor's from USC 00:01:43:20 - 00:01:46:20 Chapel Hill and a master's from USC Greensboro. 00:01:47:05 - 00:01:50:01 A member of the Academy of Oncology Nurse and Patient 00:01:50:01 - 00:01:54:23 Navigation since 2009, Sharon served as a program director 00:01:54:23 - 00:01:58:15 and is now editor in chief of Dance and Conquer. 00:01:58:20 - 00:02:01:18 Currently, she participates in local navigation 00:02:01:18 - 00:02:06:00 and nurses chapters and lectures nationally on oncology navigation. 00:02:06:05 - 00:02:08:15 Welcome, Miss Sharon Gentry. 00:02:08:15 - 00:02:12:02 Thank you very much for inviting me here to hear about this Alliance 00:02:12:02 - 00:02:14:03 for Equity in Cancer Care. 00:02:14:03 - 00:02:16:21 I have watched it develop over the years, 00:02:16:21 - 00:02:20:17 and when you see the numbers and the differences, 00:02:20:17 - 00:02:25:06 these programs are making it literally takes your breath away. 00:02:25:14 - 00:02:28:14 This is how navigation should be done. 00:02:28:21 - 00:02:32:00 It is replicable and it is sustainable. 00:02:32:00 - 00:02:34:11 And each different community. 00:02:34:11 - 00:02:39:17 So thank you for allowing me to shout out the great work that you're doing. 00:02:39:17 - 00:02:40:11 Miss Sharon, 00:02:40:11 - 00:02:43:11 I know you wouldn't say it, so I'm going to say it for you. 00:02:43:19 - 00:02:47:17 You know, you have been a champion for navigation 00:02:47:17 - 00:02:50:17 when most people thought it was just this cute little thing. 00:02:51:01 - 00:02:55:20 You, right from the beginning, recognized how important it was, forming 00:02:55:20 - 00:03:01:03 organizations, writing about it, aligning people, getting conferences together. 00:03:01:08 - 00:03:03:06 So. So, ma'am, I just want to let you know, 00:03:03:06 - 00:03:07:16 because I know you wouldn't say, any time I get to share a panel with you, 00:03:08:00 - 00:03:11:11 I know I'm in good stead because, all your work has been centered 00:03:11:11 - 00:03:15:12 on only one thing that is getting and making sure that everybody 00:03:15:12 - 00:03:17:13 has access in the best possible. 00:03:17:13 - 00:03:19:04 We know the importance of navigation. 00:03:20:07 - 00:03:21:00 I'll end with sort of 00:03:21:00 - 00:03:24:00 saying that that's part of the fun of the Alliance 00:03:24:02 - 00:03:28:10 is that, you know, we had all of us coming together supported certainly, 00:03:28:18 - 00:03:33:05 by, our industry, family with Merck. 00:03:33:09 - 00:03:37:01 But all of us came together and thinking about the different strategies 00:03:37:01 - 00:03:40:05 of navigation, of not only can we put in place 00:03:40:05 - 00:03:43:05 the best practices, but how can we learn from one another? 00:03:43:10 - 00:03:47:05 And I think that having this group together as an actual alliance 00:03:47:05 - 00:03:51:05 and having some amazing people like you and others, you know, at the home 00:03:51:05 - 00:03:52:09 we've been able to do, 00:03:52:09 - 00:03:55:20 I think, some good things and learned some good things about how navigation 00:03:55:20 - 00:03:59:23 isn't a one size fits all, but that it really is as precise. 00:03:59:23 - 00:04:03:07 The precision that's needed in this is as much as the precision needed, 00:04:03:07 - 00:04:05:09 and next gen sequencing, where we're actually trying 00:04:05:09 - 00:04:07:09 to find the next drug for the next person. 00:04:07:09 - 00:04:09:03 This is just about people in community. 00:04:09:03 - 00:04:12:22 So again, Doctor Wright, you know, again, you're not going to give yourself 00:04:12:22 - 00:04:15:02 a shout out. So I'm going to do it for you. 00:04:15:02 - 00:04:17:21 Thank you for being really, the steady hand and, 00:04:17:21 - 00:04:21:12 from an operational perspective and, and everyone else of making sure 00:04:21:12 - 00:04:25:00 that this alliance stays an alliance, and actually is productive 00:04:25:00 - 00:04:27:08 Thank you, Dr. Winn and thank you, Sharon. 00:04:27:08 - 00:04:28:18 So let's get started. 00:04:28:18 - 00:04:31:23 Sharon, what are you seeing nationally in this space, 00:04:32:09 - 00:04:35:18 and how is the work of the Alliance contributed to our goals 00:04:35:18 - 00:04:40:11 of ensuring the best outcomes for all patients through navigation? 00:04:42:06 - 00:04:44:10 I am seeing many different 00:04:44:10 - 00:04:49:20 techniques, procedures, pathways for oncology, patient navigation. 00:04:49:20 - 00:04:53:08 Right now, but it key, it goes back to the community. 00:04:53:09 - 00:04:58:13 What does the community need to make sure that patient navigation 00:04:58:13 - 00:05:03:09 is meeting the needs, whether it’s accessibility, education, 00:05:03:18 - 00:05:07:09 pulling the community leaders together saying we can do this better. 00:05:07:21 - 00:05:13:11 So when I look at the Alliance for Equity in Cancer Care, again, it comes back that 00:05:13:11 - 00:05:17:17 what you're doing is detailed in such a way 00:05:17:17 - 00:05:21:10 that it can be replicated in other communities. 00:05:21:10 - 00:05:23:01 We are all too busy. 00:05:23:01 - 00:05:26:01 We are all too short staffed to reinvent the wheel. 00:05:26:10 - 00:05:30:10 So I feel like the Alliance is putting that wheel out there for us. 00:05:30:10 - 00:05:33:14 You're showing the process as you use, you’re naming the people 00:05:33:14 - 00:05:38:07 that come together at the table, and you're doing that in a way 00:05:38:07 - 00:05:41:21 that you can say at the end of the process that the alliance that's doing 00:05:42:02 - 00:05:45:15 this is sustainable because we've made a difference in X. 00:05:45:22 - 00:05:51:09 Your metrics are astounding, and I want to share that with the whole world. 00:05:51:16 - 00:05:54:13 So that's why I'm so excited that we're doing this series 00:05:54:13 - 00:05:57:05 in the Journal of Oncology Navigation Survivorship. 00:05:57:05 - 00:06:00:23 So each of your program can step up and be highlighted. 00:06:00:23 - 00:06:04:17 And hopefully the readership can identify with something in that program. 00:06:05:05 - 00:06:08:19 Doctor Winn, there are a lot of initiatives around 00:06:08:19 - 00:06:10:03 patient navigation. 00:06:10:03 - 00:06:13:18 But the alliance is unique in its collaborative approach 00:06:13:18 - 00:06:15:12 within the community. 00:06:15:12 - 00:06:17:22 Why do you think the Alliance's community 00:06:17:22 - 00:06:21:11 rooted approach is so critical for its success? 00:06:23:07 - 00:06:24:22 You know, 00:06:24:22 - 00:06:27:24 I was thinking about this and, you know, 00:06:27:24 - 00:06:33:06 we just had a recent experience where we were able to witness, 00:06:33:06 - 00:06:37:01 with my own eyes, the importance of this alliance and the 00:06:38:15 - 00:06:42:03 courage, innovation, and just truth. 00:06:42:03 - 00:06:46:02 What I'm going to say, just grit of getting it done. 00:06:47:04 - 00:06:48:02 Imagine. 00:06:48:02 - 00:06:51:07 And you, Marcy, Doctor Wright, were right there when we 00:06:51:16 - 00:06:54:16 heard the testimony of a married couple 00:06:54:16 - 00:06:57:16 that have been around for married for 60, almost 60 years. 00:06:57:21 - 00:06:58:22 Yeah. 00:06:58:22 - 00:07:01:24 In not just rural Montana, 00:07:01:24 - 00:07:04:24 but frontier country. 00:07:05:01 - 00:07:07:14 This program 00:07:07:14 - 00:07:11:13 not only sort of wanted to do what we have been doing, but a challenge 00:07:11:13 - 00:07:15:16 to sort of, ideas about what we could do to make it possible. 00:07:16:08 - 00:07:20:19 Hearing from a woman that said she got the diagnosis of cancer 00:07:20:19 - 00:07:22:21 and was certainly ready to give up, 00:07:22:21 - 00:07:25:12 and her husband, sitting right next to her, said he was, 00:07:25:12 - 00:07:26:19 you know, not ready to give her up. 00:07:26:19 - 00:07:28:23 But he knew that he had no other choice. 00:07:28:23 - 00:07:33:23 And so they were making plans because a drive from Bozeman to Dillon 00:07:34:13 - 00:07:37:13 was difficult, and during the winter, almost impossible. 00:07:37:24 - 00:07:40:07 And so, like many Montanans and like many of the people in 00:07:40:07 - 00:07:43:16 rural communities in frontier communities, they have to make the choice of saying, 00:07:44:01 - 00:07:47:00 you know, we're going to just choose to make peace with our maker. 00:07:48:06 - 00:07:48:18 Two years 00:07:48:18 - 00:07:51:18 later, they're there holding each other's hand 00:07:52:02 - 00:07:55:24 because this program was able to figure out how to take navigation, 00:07:55:24 - 00:08:00:20 not only getting a person to something, but occasionally bringing things to them. 00:08:01:21 - 00:08:04:21 You see navigation, I think, and part of the Alliance, 00:08:04:21 - 00:08:06:00 and I've learned this from 00:08:06:00 - 00:08:09:14 not only sharing and others, is just about exactly what you said. 00:08:09:24 - 00:08:12:04 Getting what we need to get 00:08:12:04 - 00:08:15:04 to the right communities and the right people at the right time 00:08:15:13 - 00:08:18:15 so that they can have access to being healthy and a chance of being healthy. 00:08:19:17 - 00:08:22:08 I think what I loved about this is that we've done everything 00:08:22:08 - 00:08:25:08 from frontier country to rural 00:08:25:09 - 00:08:28:01 to urban underserved. 00:08:28:01 - 00:08:31:02 You know, high, high, densely populated areas like in new Jersey. 00:08:31:13 - 00:08:34:02 And what there is one commonality. 00:08:34:02 - 00:08:36:02 And what you're getting at, Doctor Wright, 00:08:36:02 - 00:08:39:21 is that bottom line is for this to work, you have to have a plan. 00:08:40:20 - 00:08:42:09 You do have to have resources. 00:08:42:09 - 00:08:43:18 It certainly has to be organized. 00:08:43:18 - 00:08:45:01 It's not just by goodwill, 00:08:45:01 - 00:08:49:08 but when you put those together with actually focused people, things get done. 00:08:49:09 - 00:08:52:09 So that's what I've been the proudest about. 00:08:52:11 - 00:08:55:11 It's clear that while the geography may be different, 00:08:55:17 - 00:08:58:17 the challenges of our patients are always pretty much the same. 00:08:58:22 - 00:09:02:22 And it is having access to the best possible care that they can get 00:09:03:05 - 00:09:05:22 and having a chance at hope so 00:09:05:22 - 00:09:07:21 that, you know, that's what I've learned. 00:09:07:21 - 00:09:11:08 So we know that the cancer journey isn't just medical. 00:09:11:09 - 00:09:17:06 It includes the social drivers of health that impact care access and outcomes. 00:09:17:14 - 00:09:22:19 I want to take a moment just so quickly highlight some of our partners, Dr. 00:09:22:19 - 00:09:27:11 Winn’s kind of already talked about our Conquer Cancer and the ASCO Foundation 00:09:27:17 - 00:09:31:20 and the amazing work that they're doing in Dillon, Montana 00:09:32:01 - 00:09:36:13 We've spared more than $100,000 in just travel costs. 00:09:36:20 - 00:09:40:21 An additional $15,000 have been provided to these patients 00:09:41:02 - 00:09:44:03 and associated social services and costs. 00:09:44:23 - 00:09:48:03 The Kentucky Markey Cancer Center, 00:09:48:03 - 00:09:50:12 they've launched this amazing patient app. 00:09:50:15 - 00:09:55:07 So it's right there in these patients hands from Hazard to Lexington. 00:09:55:09 - 00:09:58:15 Patients can receive their navigation services 00:09:58:19 - 00:10:01:22 in the ease of their hand through an app on their cell phone. 00:10:02:06 - 00:10:07:15 We're also partnering with NCCN, who's adopted this health equity report card 00:10:07:19 - 00:10:11:16 so that it can now be used in a community oncology setting. 00:10:11:21 - 00:10:16:24 This is huge for adapting these changes right there within the community. 00:10:17:10 - 00:10:20:11 Another partner is Robert Wood Johnson. 00:10:20:17 - 00:10:26:20 The Barnabas Health, they've transformed its navigation program on its head. 00:10:27:03 - 00:10:29:11 They're intervening early in the cancer 00:10:29:11 - 00:10:32:19 care journey, starting at the emergency department. 00:10:33:00 - 00:10:35:19 And even before diagnosis. 00:10:35:19 - 00:10:41:01 Mary Bird, Mary Bird Cancer Center, in Baton Rouge, Louisiana, 00:10:41:04 - 00:10:46:21 has expanded its patient navigation program by over 174% 00:10:47:02 - 00:10:50:02 in response to its demonstrated success. 00:10:50:10 - 00:10:55:14 Boston Medical Center, created in that institutionally funded navigator role 00:10:55:21 - 00:10:59:00 after demonstrating the value of navigation. 00:10:59:22 - 00:11:03:00 Case Western, they've increased the enrollment 00:11:03:00 - 00:11:08:01 in their partners program by more than 20% since January, 00:11:08:13 - 00:11:13:12 and MSK or Memorial Sloan Kettering Cancer Center has expanded 00:11:13:15 - 00:11:17:13 its Integrated Cancer Care access network, also known as ICAN, 00:11:17:19 - 00:11:20:22 to improve access and within patient navigation. 00:11:21:02 - 00:11:24:06 So through our partners, we're really starting 00:11:24:06 - 00:11:28:04 to see some of the difference, some in the impact that the Alliance 00:11:28:04 - 00:11:32:06 has made across, you know, the entire United States. 00:11:32:06 - 00:11:33:15 As I just described, 00:11:33:15 - 00:11:37:22 all of these programs are dealing with navigation in its own special way. 00:11:38:03 - 00:11:41:18 And within the Alliance, we've decided that we're not focusing on the person, 00:11:41:21 - 00:11:44:00 but we're focusing on the process. 00:11:44:00 - 00:11:47:18 So, Doctor Winn, how do you think that the Alliance is using this 00:11:47:18 - 00:11:51:18 as a way to be able to really transform the landscape of navigation? 00:11:52:01 - 00:11:52:24 Yeah. No, absolutely. 00:11:52:24 - 00:11:57:02 And I want to pick up on something that, Sharon said this is and, 00:11:57:05 - 00:12:01:14 you know, people think of outreach, engagement and navigation as just acts. 00:12:02:15 - 00:12:04:10 There's a science too. 00:12:04:10 - 00:12:08:21 There's a history to it, dating all the way back, to the 90s. 00:12:08:21 - 00:12:12:05 And, you know, you know, with luminaries like, you know, 00:12:12:05 - 00:12:15:10 Friedman and everybody else, we know that. 00:12:15:15 - 00:12:19:08 But what we've learned from each other is that I think and Sharon, 00:12:19:08 - 00:12:20:06 I think he said it best. 00:12:20:06 - 00:12:23:07 It's it's resources, it's operation. 00:12:23:08 - 00:12:25:22 It's actually understanding the science that goes with it. 00:12:25:22 - 00:12:28:21 It's understanding the details and the data. 00:12:28:21 - 00:12:31:23 It's getting a little bit more sophisticated and using tools. 00:12:31:23 - 00:12:33:10 Right. Because that's all the AI is. 00:12:33:10 - 00:12:36:10 And figuring out how we can deliver the best intervention 00:12:36:12 - 00:12:39:12 and how we can get it to people the best possible way. 00:12:40:15 - 00:12:43:14 What I've learned is that they were had you asked me 00:12:43:14 - 00:12:46:24 before the great experiment was done with the Alliance. 00:12:47:04 - 00:12:50:20 I would have said, yeah, it's probably easy to get it in 00:12:50:20 - 00:12:54:15 highly densely populated urban areas, but, we probably won't be 00:12:54:15 - 00:12:56:10 when it comes to rural. Yeah. 00:12:56:10 - 00:12:58:05 And when it comes to frontier, no wait, 00:12:59:08 - 00:13:01:10 we've just proven all of that. 00:13:01:10 - 00:13:03:19 It turns out that, like, that old commercial you used to say 00:13:03:19 - 00:13:07:14 with the Marines back in the day, a few good folk with a few good folk 00:13:08:02 - 00:13:11:10 that are very thoughtful, with detailed plans and the right 00:13:11:10 - 00:13:16:14 resources and information and data, we can come up with processes 00:13:16:20 - 00:13:20:09 that are not just without soul, but that are full of soul. 00:13:20:24 - 00:13:25:20 And so when you bring the humanity together with the with the stringency of 00:13:26:00 - 00:13:29:02 and detail that's actually needed to pull off 00:13:29:02 - 00:13:33:04 and operate these programs by evaluating our processes. 00:13:33:18 - 00:13:36:08 What you have is an outcome that I think is undeniable. 00:13:36:08 - 00:13:39:08 In fact, to be honest with you, I, I'm going to tell you 00:13:39:08 - 00:13:42:21 before we share jumps on this that I, you know, I'm going to say 00:13:42:21 - 00:13:46:20 that the 36% fewer Americans dying from cancer in large part 00:13:46:21 - 00:13:50:04 isn't just because we came up with new molecules that became medicine. 00:13:50:10 - 00:13:53:13 It's because we were able to get people to those medicines. 00:13:53:13 - 00:13:56:20 And that actually stems from not the actual medicine itself, 00:13:57:23 - 00:13:58:18 but from 00:13:58:18 - 00:14:02:09 navigation, which is a core component that runs throughout it all. 00:14:02:10 - 00:14:05:11 So I don't know, Sharon, if you you know, if you agree. 00:14:06:16 - 00:14:08:04 Oh, I agree wholeheartedly. 00:14:08:04 - 00:14:10:05 I absolutely agree wholeheartedly. 00:14:10:05 - 00:14:13:05 You hit on every key concept that was there. 00:14:13:10 - 00:14:15:21 And it's all about the community. 00:14:15:21 - 00:14:20:02 We know that there are enough cancer patients to go around. 00:14:20:02 - 00:14:22:15 So this is not a competition. 00:14:22:15 - 00:14:26:15 This is how we can make sure when those people come through the door, 00:14:26:15 - 00:14:31:04 no matter where they are, frontier, rural city, wherever they are, 00:14:31:05 - 00:14:35:14 they're going to get the same standard of care as they come through that door. 00:14:36:03 - 00:14:40:01 And that's exactly what navigation process does. 00:14:40:01 - 00:14:42:22 It evens the playing field. 00:14:42:22 - 00:14:48:01 And by you sharing what you're doing, there is no excuse for people out there, 00:14:48:01 - 00:14:51:11 no matter where they live, to say, I can't do this. 00:14:51:21 - 00:14:53:08 Yes, you can. 00:14:53:08 - 00:14:56:13 Look at these numbers, look at this process. 00:14:56:13 - 00:14:58:21 It is driven by a team. 00:14:58:21 - 00:15:04:18 And every one of the grants that you have, it is a team focus. 00:15:04:18 - 00:15:07:18 And it's not someone working in their silo. 00:15:07:19 - 00:15:09:04 They are working together. 00:15:09:04 - 00:15:12:12 I've always thought navigation pulled things together. 00:15:12:12 - 00:15:14:01 It was that seamless thread. 00:15:14:01 - 00:15:17:09 They go to the health care system that makes it look like the patient, 00:15:17:09 - 00:15:19:09 that we're a seamless thread and we know we're not. 00:15:19:09 - 00:15:21:16 We all have to work to improve our processes 00:15:21:16 - 00:15:24:07 and get along with the department beside us. 00:15:24:07 - 00:15:27:09 But we always, always keep this, that center. 00:15:27:09 - 00:15:29:06 Focus on that patient. 00:15:29:06 - 00:15:30:23 Let's get that patient through. 00:15:30:23 - 00:15:33:22 And then you're pulling that family with them 00:15:33:22 - 00:15:35:24 because that family has got opinions. 00:15:35:24 - 00:15:37:15 They've heard myths. 00:15:37:15 - 00:15:39:17 We've got to get them through here too. 00:15:39:17 - 00:15:45:09 And when you leave with a better educated patient and a better educated family, 00:15:45:09 - 00:15:49:03 those strong networks in the community hear about it 00:15:49:18 - 00:15:52:18 and those people become spokespersons for you. 00:15:52:18 - 00:15:56:11 So I'm excited to see this whole process come together in the way that you've 00:15:56:11 - 00:15:57:22 done each of these grants. 00:16:00:19 - 00:16:02:15 We know that early access leads 00:16:02:15 - 00:16:06:19 to better outcomes, and the cancer journey isn't just medical. 00:16:07:06 - 00:16:11:03 The Alliance is heavily focused on addressing and social drivers of health. 00:16:11:13 - 00:16:14:08 How can others incorporate these factors 00:16:14:08 - 00:16:17:08 into their patient centered care models as well? 00:16:17:19 - 00:16:20:09 let's talk about these social determinants of health. 00:16:20:09 - 00:16:22:03 They're very different where I live. 00:16:22:03 - 00:16:23:23 They're very different where you live. 00:16:23:23 - 00:16:26:02 So here's the key point. 00:16:26:02 - 00:16:27:22 Do you know what they are. 00:16:27:22 - 00:16:31:15 And I always think this goes back to the studies that have been done 00:16:32:06 - 00:16:35:02 over time in oncology care. 00:16:35:02 - 00:16:38:02 The patient sees things one way. 00:16:38:08 - 00:16:41:09 And the health care providers see them another way. 00:16:41:17 - 00:16:44:22 So we've got to use that patient voice 00:16:45:12 - 00:16:48:12 when we are starting navigation programs. 00:16:48:16 - 00:16:53:07 Each navigator and the whole process of navigation 00:16:53:12 - 00:16:56:15 is told to walk in those patient's shoes, 00:16:56:24 - 00:17:01:15 see it through their eyes, hear it through what they're hearing. 00:17:01:23 - 00:17:04:13 And that way you can pick up what are the main 00:17:04:13 - 00:17:07:13 social determinants of health that are impeding their care. 00:17:08:03 - 00:17:11:13 We may think it's transportation, but sometimes you may be fooled, 00:17:11:24 - 00:17:14:14 especially when we have a lot of those little church ladies 00:17:14:14 - 00:17:18:21 that say, yes, I can take that person to treatment or wait. 00:17:18:22 - 00:17:21:22 You know, you just have to listen to what they do. 00:17:22:00 - 00:17:26:07 So yes, social determinants of health are very evident 00:17:26:07 - 00:17:29:13 in each one of the processes that you do here. 00:17:30:09 - 00:17:34:24 And you do have to restructure around what they are. 00:17:35:08 - 00:17:38:12 It's not always going to be we always did it this way. 00:17:38:18 - 00:17:40:11 No. Take that off the table. 00:17:40:11 - 00:17:41:24 Let's come together. 00:17:41:24 - 00:17:45:04 How can we do it better and more efficiently? 00:17:47:06 - 00:17:48:08 I'm so glad you said that. 00:17:48:08 - 00:17:50:15 Because I was thinking to myself, as you were saying that. 00:17:50:15 - 00:17:53:15 And, as always, spot on 00:17:53:24 - 00:17:57:12 that one of the things that I think most people are surprised by 00:17:57:12 - 00:18:02:00 is that they will say, well, I get rural by navigation is difficult there. 00:18:02:02 - 00:18:05:11 And why we, you know the travel time is 3.5 hours, 00:18:06:22 - 00:18:09:16 not recognizing that in some urban areas 00:18:09:16 - 00:18:14:21 try to get from, say, for example, the South, you know, places in Chicago 00:18:15:04 - 00:18:19:03 to one of the main academic hospitals, maybe only eight miles, 00:18:19:03 - 00:18:23:17 but could take you up to 2 to 3 hours to get to, to get to and to get back. 00:18:24:01 - 00:18:27:12 What I learned from this program is that it's sometimes, 00:18:27:12 - 00:18:31:24 you know, I've learned this a, this, scientific term. 00:18:31:24 - 00:18:33:21 I had to go back to high school, actually, to, 00:18:33:21 - 00:18:37:08 to recall it, this context of distance versus displacement. 00:18:37:22 - 00:18:40:18 And sometimes we talk about the distance traveled. 00:18:40:18 - 00:18:42:00 But, you know, the reality is 00:18:42:00 - 00:18:45:24 if the distance travel is like a circle, you can still wind up in the same spot. 00:18:47:02 - 00:18:48:14 You didn't move right. 00:18:48:14 - 00:18:52:14 So you moved, you covered distance, but there wasn't any displacement. 00:18:53:02 - 00:18:54:13 As I'm starting to think about 00:18:54:13 - 00:18:58:03 the language in the framework of how we are getting to our patients. 00:18:58:10 - 00:19:03:10 I think that using this alliance as an example, we were able to discuss, 00:19:03:16 - 00:19:07:16 like right there, challenges in both urban, frontier, and rural settings. 00:19:08:02 - 00:19:11:00 So the distance is one thing, but how do you tackle the distance 00:19:11:00 - 00:19:11:14 in one area, 00:19:11:14 - 00:19:15:14 might be better if we had volunteer planes, which I wish we had more retired, 00:19:15:20 - 00:19:20:04 you know, people who are actually were flying and, 00:19:20:09 - 00:19:22:01 you know, could do these little things 00:19:22:01 - 00:19:26:09 all the way from that to how do you just not just give someone a subway pass. 00:19:26:11 - 00:19:29:11 How do you functionally get someone to get from point A to B? 00:19:29:12 - 00:19:30:19 I think that the conversations 00:19:30:19 - 00:19:33:19 are starting to get a little bit deeper, but I think what you said was 00:19:33:19 - 00:19:36:21 how do you look at the individual patient and get them what they need? 00:19:37:12 - 00:19:38:22 Agree 100%. 00:19:38:22 - 00:19:40:14 You're teaching them how to fish. 00:19:40:14 - 00:19:42:04 You're not giving them fish. 00:19:42:04 - 00:19:44:01 We're not giving them fish. 00:19:44:01 - 00:19:46:05 I learned that from you the very first time we were together. 00:19:47:09 - 00:19:49:16 Haha. 00:19:49:16 - 00:19:52:19 So, we always heard Doctor 00:19:52:19 - 00:19:55:22 Winn say the alliance's approach is community informed. 00:19:56:03 - 00:19:58:05 It’s not a one size fits all. 00:19:58:05 - 00:20:02:12 And the overarching goal is to create better access to cancer care. 00:20:02:17 - 00:20:05:14 And you guys kind of touched on this a little bit already, 00:20:05:14 - 00:20:10:03 but can we discuss a little bit more about how creating these earlier, 00:20:10:08 - 00:20:14:22 access in these early opportunities will be leading to better outcomes, 00:20:15:01 - 00:20:19:09 specifically timely diagnosis and treatment and the role that navigation 00:20:19:09 - 00:20:23:15 can play and improving, improving that area of cancer care. 00:20:23:21 - 00:20:26:05 So, Doctor Wright, you just hit on it, right? 00:20:26:05 - 00:20:29:14 We know that even though we have more men come out, 00:20:29:21 - 00:20:32:21 more miracle medicines than ever, 00:20:33:04 - 00:20:35:22 but with cancer, timing matters. 00:20:35:22 - 00:20:38:16 If we can get you your care early, 00:20:39:18 - 00:20:42:14 it turns out that you have a better survival rate. 00:20:42:14 - 00:20:48:02 What navigation does is it tries to narrow the disparity field. 00:20:48:09 - 00:20:51:16 But what good solid navigation can do is it 00:20:51:16 - 00:20:54:16 can not only identify that your avenue, but it can get you through. 00:20:54:16 - 00:20:57:19 Actually, once you get into a health system, you still need to be navigated. 00:20:57:20 - 00:21:01:00 This is why I keep telling people just because you got to the front door, 00:21:01:03 - 00:21:01:24 doesn't mean that 00:21:01:24 - 00:21:05:12 you know how to get through the 16 and 32 different rooms that you have to make. 00:21:05:22 - 00:21:08:22 This is where navigation cuts down that time 00:21:09:03 - 00:21:13:02 makes it much more efficient and I think does save lives. 00:21:13:04 - 00:21:17:05 By the way, good navigation also just doesn't want you get your treatment, 00:21:17:05 - 00:21:20:08 just leave you, you know, leave you and just say, hey, bye bye. 00:21:20:08 - 00:21:21:02 Your treatment's over. 00:21:21:02 - 00:21:22:21 Good navigation continues to understand 00:21:22:21 - 00:21:25:21 that wellness matters and that survivorship actually. 00:21:25:24 - 00:21:29:18 And by the way when you say how do we actually how do you do this early. 00:21:30:01 - 00:21:32:21 Great navigation, which I think Sharon and others have actually 00:21:32:21 - 00:21:35:21 also advocated isn't always in a health system. 00:21:36:00 - 00:21:37:16 It's around prevention. 00:21:37:16 - 00:21:41:03 It's around behavioral changes that can have interventions in your community. 00:21:41:03 - 00:21:44:14 So good navigation just isn't an activity. 00:21:44:21 - 00:21:49:12 It really is a whole framework for me that I've actually come to pick up 00:21:49:12 - 00:21:53:14 that it's nursing, navigation, community activators, I mean all nine. 00:21:53:17 - 00:21:56:16 But working together is a team that says that 00:21:56:16 - 00:22:00:11 if once you're notified of getting cancer, how do we get you to the door? 00:22:00:17 - 00:22:02:11 Right? That's one part of navigation. 00:22:02:11 - 00:22:04:23 But how do we get you through the door 00:22:04:23 - 00:22:07:24 is another really sophisticated level of navigation. 00:22:08:07 - 00:22:09:10 All of those pieces, 00:22:09:10 - 00:22:12:11 when done right, will allow you to get to your diagnosis quicker. 00:22:12:19 - 00:22:14:05 Your therapy faster. 00:22:14:05 - 00:22:14:19 And actually, 00:22:14:19 - 00:22:18:10 once you're done with your therapy to get to what I actually really do 00:22:18:10 - 00:22:23:19 believe is another goal of navigation, it keeps you whole and well, by again, 00:22:23:19 - 00:22:27:04 continuing to figure out what is it that you need to be healthy. 00:22:28:12 - 00:22:30:16 I agree 100% 00:22:30:16 - 00:22:35:24 and what we know that navigators do the navigation process, when performed 00:22:35:24 - 00:22:41:14 well by trained navigators, is that trust in the health care system. 00:22:42:07 - 00:22:44:18 How many of us live around cultures 00:22:44:18 - 00:22:48:04 or live around communities where they don't trust the hospital? 00:22:48:17 - 00:22:51:08 They don't trust what's going on. 00:22:51:08 - 00:22:54:05 But yet you've got someone in the community that says, 00:22:54:05 - 00:22:57:22 let me listen to you, and what you need to understand. 00:22:58:12 - 00:23:02:05 And we often use people within their own community to talk to them 00:23:02:05 - 00:23:06:06 and to work with them and say, this is what we can do. 00:23:06:16 - 00:23:08:12 So it's a chain of trust. 00:23:08:12 - 00:23:12:12 As you pass this patient along from the community to the treatment 00:23:12:21 - 00:23:14:14 to survivorship. 00:23:14:14 - 00:23:18:16 And that's what, that where navigation makes a huge difference. 00:23:18:22 - 00:23:20:15 It's just not one person. 00:23:20:15 - 00:23:21:17 It's a team of persons. 00:23:21:17 - 00:23:25:06 And I could not agree more that the community 00:23:25:06 - 00:23:28:13 is a central part of everything we do. 00:23:29:04 - 00:23:33:05 So I'm going to switch gears a little bit and talk about the alliance 00:23:33:05 - 00:23:36:06 and the work of navigation in a national model. 00:23:36:10 - 00:23:39:23 How do you think we can continue to scale this at a national level 00:23:40:04 - 00:23:43:16 and get more people to see the importance of navigation? 00:23:44:06 - 00:23:47:06 Now, you know, I'm going to want to hear from Sharon on this one. 00:23:47:13 - 00:23:52:01 Okay, I've got this one, because I will tell you that by attending 00:23:52:01 - 00:23:56:24 your Alliance meetings, I was like, oh my goodness, this is a pearl. 00:23:56:24 - 00:23:59:24 This is a hidden pearl, and we need to get it out there. 00:24:00:08 - 00:24:04:06 So that's why I'm so appreciative that each one of your programmers is going 00:24:04:06 - 00:24:09:00 to step up and published in the Journal of Oncology Navigation and Survivorship. 00:24:09:18 - 00:24:12:00 It's great that you're getting it out there 00:24:12:00 - 00:24:16:13 in your own alliance world, but we need to take it beyond your walls. 00:24:16:20 - 00:24:19:20 We need to get it out there where people can read about it. 00:24:20:00 - 00:24:23:21 And you're so easy to access when people may have a question, 00:24:23:21 - 00:24:24:23 they may call you Marcy. 00:24:24:23 - 00:24:29:06 They may call up the Perkins Cancer Center, they may call whoever. 00:24:29:13 - 00:24:33:02 But your group is willing to talk with other people 00:24:33:10 - 00:24:37:01 as they go forward and say, yes, this is how we did it. 00:24:37:13 - 00:24:42:06 If I heard of your process and I wanted to put it in place in my rural area, 00:24:42:21 - 00:24:47:10 it may not work, but if I can go head to head with somebody on your team 00:24:47:10 - 00:24:52:16 and say, tell me what worked and tell me what barriers that you ran into 00:24:52:21 - 00:24:56:05 and what did you do to overcome those barriers? 00:24:56:13 - 00:25:00:10 It prevents me from having to jump through that hoop and learn on my own. 00:25:00:10 - 00:25:02:08 I'm going to learn from you. 00:25:02:08 - 00:25:06:04 And so by your willingness to share, you're telling the world 00:25:06:04 - 00:25:09:05 that this can be done in any community 00:25:09:11 - 00:25:12:11 and by many different processes. 00:25:12:13 - 00:25:14:04 Absolutely. Absolutely. 00:25:14:04 - 00:25:15:14 Couldn't agree more. 00:25:15:14 - 00:25:17:13 I was about to ask you, Marcy, what did you think? 00:25:17:13 - 00:25:19:20 I mean, you you you the one seeing us all. 00:25:19:20 - 00:25:21:15 You know, what do you think? 00:25:21:15 - 00:25:24:07 Being the deputy director for the Alliance has truthfully opened 00:25:24:07 - 00:25:29:04 my eyes to the role that navigation can play across all the landscapes. 00:25:29:06 - 00:25:34:02 We, like you alluded to, we spent some time recently in Montana, 00:25:34:02 - 00:25:39:23 in Dillon, Montana, and it was really exciting to be able to see how something, 00:25:39:23 - 00:25:44:03 as one would think, as simple as just offering an infusion suite, 00:25:44:10 - 00:25:47:19 two infusion suites in this small town 00:25:48:01 - 00:25:51:01 could lead to such enormous change. 00:25:51:02 - 00:25:55:07 And so when you see that, it just invigorates you to say, you know what? 00:25:55:07 - 00:25:56:22 We can do this across. 00:25:56:22 - 00:26:00:12 We can take this model into different rural towns. 00:26:00:12 - 00:26:03:12 I grew up or my parents grew up in a small town in South 00:26:03:12 - 00:26:06:21 Carolina, outside of the big city. 00:26:07:00 - 00:26:10:11 They didn't always have access to some of these resources. 00:26:10:11 - 00:26:14:21 And so some of my passion for this work is driven from that to say, hey, 00:26:15:00 - 00:26:16:07 this is an opportunity 00:26:16:07 - 00:26:20:06 to be able to expand some of the things that we're doing in these rural towns. 00:26:20:10 - 00:26:23:08 And so some towns that look like where my parents grew up. 00:26:23:08 - 00:26:26:13 So I'm really, you know, excited about these opportunities. 00:26:26:13 - 00:26:30:17 When we think about leveraging some of these local and community resources, 00:26:30:21 - 00:26:34:02 of course, I immediately think about the university in Kentucky 00:26:34:04 - 00:26:38:13 and how they partnered with some of their, their local communities 00:26:38:13 - 00:26:41:20 to be able to go right in that app and link their patients 00:26:41:20 - 00:26:45:03 to resources that are right in their community. 00:26:45:15 - 00:26:48:23 They can go through that app and be linked up with a service 00:26:48:23 - 00:26:51:23 that they need to address some of their social drivers. 00:26:52:00 - 00:26:54:22 I think about the work that Mary Bird Perkins is doing 00:26:54:22 - 00:26:58:06 and their navigation program, and how they're linking up 00:26:58:06 - 00:27:02:01 their navigators with their patients and kind of holding their hand 00:27:02:05 - 00:27:05:20 from the start to the finish of their cancer journey, 00:27:06:01 - 00:27:09:10 And when you think about the work that's being done and how folks are leveraging 00:27:09:14 - 00:27:12:14 not just their community, but their local resources 00:27:12:14 - 00:27:16:16 and their regional resources to expand this work, it's really, really exciting. 00:27:17:01 - 00:27:20:11 Doctor Winn, would you like to comment about some things that we can expect 00:27:20:11 - 00:27:23:24 to come down the line as far as support for navigation is concerned? 00:27:24:07 - 00:27:27:17 Yeah, I would I have to say that, you know, and you know, things, 00:27:29:02 - 00:27:32:02 you know, can be a little bit unstable. 00:27:32:12 - 00:27:34:03 But there are some truths. 00:27:34:03 - 00:27:39:03 And I think people recognize that while the push for AI is certainly 00:27:39:03 - 00:27:42:03 something that is laudable and should happen, 00:27:42:16 - 00:27:46:22 while the emphasis on, development of new drugs 00:27:47:10 - 00:27:51:05 has actually certainly had an impact, I mean, there's no doubt about it 00:27:51:17 - 00:27:53:01 that molecular targeted 00:27:53:01 - 00:27:57:02 therapy has changed the game, that immunotherapy has changed the game. 00:27:57:02 - 00:28:02:00 That better chemotherapy and, you know, more, tissue 00:28:02:00 - 00:28:05:15 sparing surgeries have all changed the game as well as imaging. 00:28:07:00 - 00:28:11:07 But what really has changed the game is the unheralded, 00:28:11:08 - 00:28:15:10 unheralded hero or heroine of this story, which is navigation. 00:28:16:09 - 00:28:20:13 What I remember that in all administrations, 00:28:20:13 - 00:28:23:17 including this one, there is a recognition 00:28:24:24 - 00:28:27:24 that navigation matters 00:28:28:03 - 00:28:31:03 and that when you try to uncouple 00:28:31:15 - 00:28:36:05 the reduction of 36% fewer Americans dying from cancer, 00:28:36:19 - 00:28:41:00 if even if you tried, it'd be almost impossible 00:28:41:09 - 00:28:44:06 to disentangle it from the fingerprints 00:28:44:06 - 00:28:47:06 and the actions of good solid navigation. 00:28:47:15 - 00:28:52:02 And so when I think about the national, you know, sort of look, 00:28:52:15 - 00:28:56:18 I think what has become more interesting is over the last 20 years, 00:28:57:05 - 00:29:01:16 it's become much more accepted as a fact, as opposed to 00:29:01:16 - 00:29:05:02 something that's still evolving and so waiting to see if it has value. 00:29:05:08 - 00:29:08:05 You know, if you would have told me about 20, 30 years ago, there were people 00:29:08:05 - 00:29:11:21 who were out there who knew this way before anybody else did, who actually, 00:29:11:21 - 00:29:15:08 almost within the first year were like, duh, navigation matters. 00:29:15:17 - 00:29:18:19 It took a little bit of time for the rest of the community 00:29:18:19 - 00:29:23:00 to actually understand that, because we were so enamored with drugs 00:29:23:09 - 00:29:27:17 and so enamored with new screening techniques and so enamored 00:29:27:17 - 00:29:30:17 with new imaging modalities, that we forgot 00:29:31:10 - 00:29:35:15 that navigation is central to the success of almost all of that, 00:29:36:20 - 00:29:38:12 independent of who you are. 00:29:38:12 - 00:29:41:23 And so what I would say on the national stage is that, 00:29:41:23 - 00:29:47:18 some people were fearing that we might actually see navigation get, less funded. 00:29:47:18 - 00:29:51:00 I'm going to say that what I've seen is that I think that, 00:29:51:00 - 00:29:54:08 but folks like Sharon and others raising our voices in unison 00:29:54:08 - 00:29:58:06 and with programs like the Alliance, it becomes the evidence, 00:29:58:22 - 00:30:03:06 the data that sort of says this is not just some sort of feelgood activities. 00:30:03:11 - 00:30:04:10 This is the impact. 00:30:04:10 - 00:30:09:06 So I actually think the future for navigation, and all of its various 00:30:09:06 - 00:30:12:13 forms of navigation, still sit on pretty solid ground. 00:30:12:13 - 00:30:16:13 Now, they may be overly optimistic, but I have to say that most of the things 00:30:16:13 - 00:30:20:20 I'm reading and most of which are tea leaves mostly, by the way, but, 00:30:21:06 - 00:30:25:07 as I'm reading those tea leaves from both the federal and the state, I don't think 00:30:25:07 - 00:30:28:07 that there has been this major, push 00:30:28:13 - 00:30:31:13 to rip and cut and gut navigation. 00:30:31:22 - 00:30:36:05 So I think as I look in the future, I'm cautiously optimistic 00:30:36:11 - 00:30:40:24 that people have gone from, you know, us proving the value to them, 00:30:40:24 - 00:30:43:09 knowing the value of good, solid navigation. 00:30:44:17 - 00:30:45:21 Sharon, where 00:30:45:21 - 00:30:50:12 do you feel like the, alliance aligns with the future of navigation? 00:30:51:04 - 00:30:54:12 I think the alliance is leading the future of navigation. 00:30:54:12 - 00:30:58:06 If you want me to be honest, I have a favorite saying. 00:30:58:06 - 00:31:02:14 And I share this with all the navigators you only know what you know. 00:31:03:01 - 00:31:06:02 And Marcy, from your conversation you just had and from Doctor 00:31:06:02 - 00:31:09:13 Winn's comments, think of all the education 00:31:10:00 - 00:31:13:15 that has been done at each one of your sites. 00:31:14:00 - 00:31:18:04 Navigators learn, the health care professionals learned, 00:31:18:11 - 00:31:19:24 the community learned. 00:31:19:24 - 00:31:24:15 It was all about educating each other on what can be done 00:31:25:01 - 00:31:27:23 to best make that patient needs. 00:31:27:23 - 00:31:32:20 And so I think that education is a strong foundation of navigation, 00:31:33:03 - 00:31:36:20 and you're willing to share that with many people as you go forward 00:31:36:20 - 00:31:42:10 and say, this is what we've done with every number that you give, 00:31:42:15 - 00:31:47:11 whether it's financial, whether it's save visits for travel 00:31:47:11 - 00:31:52:11 or save miles for travel, or getting a into someone's home 00:31:52:11 - 00:31:57:19 or even having a patient access care, there is value to every number. 00:31:58:02 - 00:32:01:18 So return on investment is screaming 00:32:01:18 - 00:32:05:17 from the work that you're saying, and it's teaching nurses. 00:32:05:17 - 00:32:08:02 It's teaching all types of navigators. 00:32:08:02 - 00:32:11:14 The patient navigator, the social worker that you do 00:32:11:15 - 00:32:16:00 make a difference and return on investment is part of your job. 00:32:16:09 - 00:32:21:04 You can make a difference, just not in financial numbers, but other numbers. 00:32:22:24 - 00:32:25:12 I think that one additional area 00:32:25:12 - 00:32:29:08 is the voice that we're putting towards the collaborative care model. 00:32:29:20 - 00:32:32:20 We're really through the alliance, pushing 00:32:32:20 - 00:32:37:09 this whole concept that it takes more than just the patient, 00:32:37:09 - 00:32:42:04 it takes more than just the family, it takes more than just the provider. 00:32:42:10 - 00:32:44:23 It takes us all. It takes the community. 00:32:44:23 - 00:32:50:14 And it is truly a collaborative care model that starts from the beginning 00:32:50:17 - 00:32:54:22 and ends at the end, with everyone being fully engaged, 00:32:55:03 - 00:32:58:21 informed and active in the decision making process. 00:32:59:04 - 00:33:03:18 Let's transition a little bit now to discussing some of the challenges. 00:33:03:18 - 00:33:04:00 You know, 00:33:04:00 - 00:33:07:03 when we're talking about the Alliance and we're talking about navigation, 00:33:07:03 - 00:33:09:06 we really focus on all of the great things, right? 00:33:09:06 - 00:33:12:09 You're saving money, you're saving miles, you're saving travel. 00:33:12:16 - 00:33:14:16 You, you know, have reached more people. 00:33:14:16 - 00:33:18:10 We've reduced, time, we've improved timeliness of care. 00:33:18:16 - 00:33:23:23 But that all comes with some challenges, some things that we know from our grantees 00:33:23:23 - 00:33:28:06 is that staffing or retention is definitely a challenge, 00:33:28:10 - 00:33:32:13 when it comes to, navigation and even this collaborative care model. 00:33:32:19 - 00:33:36:03 Additional challenges around institutional buy 00:33:36:03 - 00:33:38:17 in navigation isn’t free, right? 00:33:38:17 - 00:33:40:09 And so how does the 00:33:40:09 - 00:33:44:01 how do you get your institution to buy into some of these efforts? 00:33:44:09 - 00:33:47:04 biggest challenge is change. 00:33:47:04 - 00:33:49:20 You're asking either the community, 00:33:49:20 - 00:33:53:17 the health care system to change, but you're not doing it alone. 00:33:54:02 - 00:33:58:05 So you're including the voices or you're inviting different ones to the table. 00:33:58:18 - 00:34:02:22 And when I look at the change of I think what's going to be critical 00:34:02:22 - 00:34:03:20 in the future... 00:34:03:20 - 00:34:08:00 You've hit on a couple times here, is your emergency room care. 00:34:08:21 - 00:34:11:21 What drops people to the emergency room for care. 00:34:12:11 - 00:34:16:00 And my thoughts are that we might be the way 00:34:16:00 - 00:34:16:22 some of the health care 00:34:16:22 - 00:34:20:09 policies are going are going to drive more people to emergency room care, 00:34:21:00 - 00:34:23:20 and the reason I say that is I can remember as 00:34:23:20 - 00:34:27:20 I am going to consider myself an old navigator, as an old navigator, 00:34:27:20 - 00:34:29:14 before it was a popular term here 00:34:29:14 - 00:34:33:00 I sat down with the emergency room nurses and said, 00:34:33:13 - 00:34:36:02 if you have a patient that comes through the door 00:34:36:02 - 00:34:40:02 and needs this, call me, call our department. 00:34:40:02 - 00:34:45:06 So again, it becomes that I had to open my door to help them when they come. 00:34:45:15 - 00:34:49:03 And that way I took some of the load off of them by people 00:34:49:03 - 00:34:54:02 that come through the emergency room that truly needed navigation at that point, 00:34:54:08 - 00:34:58:19 for me to connect them in the system and to get the care they need. 00:34:59:00 - 00:35:01:02 So again, here comes education. 00:35:01:02 - 00:35:02:08 That's part of that thing. 00:35:02:08 - 00:35:06:02 We've got to educate people on what we're doing 00:35:06:08 - 00:35:09:14 and what we can do for the patient and help them and say, 00:35:09:14 - 00:35:13:16 I can take this part of load off of you and it's going to make a difference. 00:35:13:16 - 00:35:14:18 I think in the future. 00:35:16:05 - 00:35:17:21 You know, I 00:35:17:21 - 00:35:21:08 well, always I mean, I was yeah, that was spot on. 00:35:21:19 - 00:35:25:16 You know, the thing that I know for me is a challenge and remains 00:35:25:16 - 00:35:30:14 a frustration is the sense that sometimes health systems still believe 00:35:30:14 - 00:35:34:23 erroneously, by the way, that navigation is a nice thing to have, 00:35:34:23 - 00:35:38:00 but not necessarily for their bottom line even. 00:35:38:24 - 00:35:43:10 And trying to get people to understand 00:35:44:00 - 00:35:47:17 that if you have effective, efficient navigation, 00:35:47:17 - 00:35:48:23 not only are you able to increase 00:35:48:23 - 00:35:52:10 the volume of patients that you can sort of see in your system, 00:35:53:05 - 00:35:57:02 but you and not only do you save money and not only do you save lives, 00:35:57:02 - 00:36:00:02 but it's just good practical sense. 00:36:01:00 - 00:36:03:04 And yet there are still 00:36:03:04 - 00:36:06:04 some health systems out there 00:36:06:17 - 00:36:11:13 that actually focus on the new MRI, which is they should 00:36:12:05 - 00:36:16:22 the new surgical suite, which obviously they should, the new clinics, 00:36:17:01 - 00:36:20:04 which are definitely, and the workforce that goes with that clinic. 00:36:20:22 - 00:36:23:05 But I'm going to say to you that actually, 00:36:23:05 - 00:36:26:14 I think that a mistake that many health systems make 00:36:26:23 - 00:36:30:00 is not putting into that mix, at the very beginning, 00:36:30:15 - 00:36:33:15 effective strategies, 00:36:33:17 - 00:36:37:22 practices, protocols and procedures around navigation. 00:36:37:22 - 00:36:40:19 So I think if I look at one of the challenges in the future, it's 00:36:40:19 - 00:36:44:00 going to be, obvious resources, but that's an obvious one. 00:36:44:06 - 00:36:47:21 You know, that's like the, the, what who's the, the little show? 00:36:47:21 - 00:36:49:21 I think it was a movie by Broadway show cabaret, 00:36:49:21 - 00:36:51:10 where money makes the world around. 00:36:51:10 - 00:36:53:22 But you know, to be honest with you, resources are important. 00:36:53:22 - 00:36:58:07 So I'm not going to underplay, the importance of having resources, 00:36:58:14 - 00:37:03:06 but I am going to say resources, and with a very wise, 00:37:03:06 - 00:37:08:10 practical, pragmatic, forward thinking health system that integrates 00:37:09:00 - 00:37:12:23 navigation into its fabric as much as the next medicine. 00:37:13:08 - 00:37:17:21 I think that if we can get over those two humps, I think we would do a lot. 00:37:18:24 - 00:37:21:04 I agree 100%. 00:37:21:04 - 00:37:25:03 If you build it, are they going to come or do you need to someone 00:37:25:03 - 00:37:29:13 to make sure they can access and get to the MRI? 00:37:29:13 - 00:37:34:03 So new surgical suites, the new clinics, which yes, they are needed. 00:37:34:12 - 00:37:35:14 You build on that, 00:37:35:14 - 00:37:38:14 you better have a process of how are you going to direct people there. 00:37:39:00 - 00:37:41:23 You know, the funny part is that I always wanted to modify that. 00:37:41:23 - 00:37:45:15 You build it, they will come to our health system people and says you build it. 00:37:46:03 - 00:37:49:04 But the reason why people would come to those baseball games 00:37:49:13 - 00:37:52:17 is because people would tell them, you should come to the new stadium. 00:37:53:00 - 00:37:55:01 It just doesn't organically happen. 00:37:55:01 - 00:37:57:12 And so many people think you build a building. 00:37:57:12 - 00:38:00:08 Most of people run past the building, and go, What is that for? 00:38:00:08 - 00:38:02:16 So people still have to be told 00:38:02:16 - 00:38:05:21 and people have to be made to feel comfortable and excited. 00:38:06:03 - 00:38:10:03 And you cannot convince me that that's just not advertising, 00:38:10:03 - 00:38:13:07 that is evangelizing. We're navigators. 00:38:13:21 - 00:38:15:22 It is trust and word of mouth. 00:38:15:22 - 00:38:18:02 And that's what navigation is all about. 00:38:19:04 - 00:38:20:21 And I think there's data to back us up 00:38:20:21 - 00:38:22:19 that all the commercials in the world doesn't drive. 00:38:22:19 - 00:38:26:06 So. So it's funny to me that we're talking about this. 00:38:26:06 - 00:38:28:21 And yet some of the best and brightest 00:38:28:21 - 00:38:31:14 have not understood from our health systems 00:38:31:14 - 00:38:33:20 that this is an integral part, not a nice part, 00:38:33:20 - 00:38:37:04 an integral part of how do you make a successful health system? 00:38:37:10 - 00:38:37:24 Mostly. 00:38:37:24 - 00:38:40:18 And then how do we do right by our patients. 00:38:40:18 - 00:38:44:18 So you both talked about, you know, if we build it they will come. 00:38:45:13 - 00:38:47:02 How do we keep them there? 00:38:47:02 - 00:38:50:05 How do we build a sustainable model around that? 00:38:50:08 - 00:38:52:24 I quickly will just say, because I really am interested in 00:38:52:24 - 00:38:55:01 what Sharon’s thoughts are on this, but I would quickly say 00:38:55:01 - 00:38:59:20 that one of the important pieces on this that we can't forget is that the emerging 00:38:59:20 - 00:39:02:20 theme of public private partnerships, it's important. 00:39:03:02 - 00:39:05:22 You know, I was reminding a group, 00:39:05:22 - 00:39:08:12 last week that when we think of 00:39:08:12 - 00:39:11:15 public private partnerships, we think as if those are just new. 00:39:11:21 - 00:39:14:21 Remember that the aqueducts of Rome were 00:39:14:21 - 00:39:18:05 actually the best example of public and private partnerships, right? 00:39:18:15 - 00:39:21:15 The government sort of said to certain builders of aqueducts, 00:39:21:15 - 00:39:23:05 if you partner with us, 00:39:23:05 - 00:39:27:01 we'll make sure you share in the, in the, in the proceeds that come after, 00:39:27:01 - 00:39:29:09 so you can have sustainability for your business. 00:39:29:09 - 00:39:32:11 In fact, I think that as we start thinking about this, 00:39:33:00 - 00:39:37:19 certainly health systems, certainly industries, certainly foundations, 00:39:38:07 - 00:39:41:23 and certainly the government all working together as a team 00:39:42:10 - 00:39:46:02 will actually be the magic formula, because I think one of those alone 00:39:46:02 - 00:39:47:07 might be good. 00:39:47:07 - 00:39:51:04 But thinking about a sustainable model, I think a sustainable model comes 00:39:51:04 - 00:39:54:21 with partnerships, particularly in health care and particularly with navigation. 00:39:54:21 - 00:39:58:18 So if I had my my magic world, it would be, 00:39:58:19 - 00:40:03:12 an idea that we continue to push forward the ideal of what good, solid, 00:40:03:19 - 00:40:05:15 trustworthy, and trusting 00:40:05:15 - 00:40:09:12 public private partnerships look like to sustain navigation efforts. 00:40:10:13 - 00:40:11:14 You hit it on the head 00:40:11:14 - 00:40:14:14 because I was going all the way back to civilization. 00:40:14:15 - 00:40:17:07 And it is what is out there. 00:40:17:07 - 00:40:22:12 What is being said about the care that patients receive, where they go? 00:40:22:12 - 00:40:25:10 What's that word of mouth that makes a difference? 00:40:25:10 - 00:40:27:16 And that was even before we had the written word 00:40:27:16 - 00:40:31:00 or even they had all these cell phones and all the social media. 00:40:31:12 - 00:40:35:06 It was truly the word of mouth that can make or break a community. 00:40:35:18 - 00:40:38:11 And so when we were going forward 00:40:38:11 - 00:40:41:16 and we're building these private and public, 00:40:42:14 - 00:40:45:12 I guess acquaintances, as I go around to gather, 00:40:45:12 - 00:40:48:06 you've got to have that voice of that patient there. 00:40:48:06 - 00:40:50:11 You've got to ask them, what do they need? 00:40:50:11 - 00:40:53:02 Are we meeting your needs and what do they want? 00:40:53:02 - 00:40:57:18 So that's critical in anything that we do going forward at this point. 00:40:58:08 - 00:41:02:05 And as we close today, I just wanted to give you an opportunity 00:41:02:05 - 00:41:07:02 to, you know, to close out with anything that you wanted to say regarding 00:41:07:02 - 00:41:10:23 next steps with the Alliance, Doctor Winn or where you think we should go 00:41:10:23 - 00:41:11:22 next Sharon? 00:41:13:14 - 00:41:14:19 I think the biggest thing 00:41:14:19 - 00:41:18:09 I have is that, where I'm transitioning from, 00:41:18:14 - 00:41:21:17 does navigation have value to clearly its value? 00:41:21:17 - 00:41:25:11 Now we have to figure out how to make it, you know, how to sustain that value. 00:41:26:02 - 00:41:29:24 If I had to leave it with one word because I know we're coming close on time, 00:41:29:24 - 00:41:34:23 I would say I am cautiously optimistic and hopeful for the future of navigation, 00:41:35:07 - 00:41:38:21 because I am confident that and, 00:41:38:21 - 00:41:42:06 a well, well knowledged about the impact it will have. 00:41:42:09 - 00:41:44:05 So the impact is not the question. 00:41:44:05 - 00:41:47:17 It's whether we will have sustainable mechanisms to make sure and ensure 00:41:47:17 - 00:41:50:17 that everyone gets the best possible access to care. 00:41:51:12 - 00:41:55:08 And I'm going to say on that, but, we are now being recognized nationally 00:41:55:20 - 00:42:01:11 by CMS, by the CAC, that we do make a difference in the world of oncology care. 00:42:01:11 - 00:42:05:14 We are seeing other chronic diseases come on and trying navigation, 00:42:05:14 - 00:42:09:12 whether it be cardiac, whether it be HIV or whatever, they're also using 00:42:09:12 - 00:42:12:24 the navigation principles, that we're using. 00:42:13:14 - 00:42:17:19 So behind each one of those, again, is that key 00:42:17:19 - 00:42:21:15 word of metrics and metrics wasn’t always financial. 00:42:21:15 - 00:42:24:06 And you've showed it in every one of your aid programs. 00:42:24:06 - 00:42:29:10 And you showed it differently each time that it makes a difference. 00:42:29:10 - 00:42:30:24 Whatever you're measuring. 00:42:30:24 - 00:42:33:03 But things have to be measured. 00:42:33:03 - 00:42:35:17 We can't just say we do this process. 00:42:35:17 - 00:42:39:19 What are you doing with this process to make a difference? 00:42:39:19 - 00:42:42:19 Are you keeping people out of the emergency room? 00:42:42:22 - 00:42:46:15 Are you making sure that people get the care that they need? 00:42:47:00 - 00:42:50:19 So it's just all about metrics and what we can do to take that forward 00:42:50:19 - 00:42:54:24 and keep putting those out there in a national way, 00:42:55:11 - 00:42:56:03 and make sure 00:42:56:03 - 00:42:59:17 that navigation is represented on many of these government and private 00:42:59:24 - 00:43:01:00 organizations. 00:43:02:19 - 00:43:05:14 Well, thank you, Sharon, and the journal on, 00:43:05:14 - 00:43:09:01 the Journal of Oncology, Navigation and Survivorship 00:43:09:06 - 00:43:13:23 for giving us this platform to be able to, you know, get our word out 00:43:13:23 - 00:43:16:22 and what the Alliance is doing and the work of the Alliance. 00:43:16:22 - 00:43:20:09 We're looking forward to continuing to work with you as we roll out 00:43:20:09 - 00:43:24:11 the additional nine, pieces that will come out from this series. 00:43:25:05 - 00:43:26:14 Thank you guys for your time. 00:43:26:14 - 00:43:29:09 And this was phenomenal. 00:43:29:09 - 00:43:30:07 You know, thank you. 00:43:30:07 - 00:43:34:04 And as always, thank you for your steady hand and, 00:43:34:18 - 00:43:39:09 constant reminding, of the importance of the alliance and outcomes. 00:43:39:09 - 00:43:40:17 So thank you, Doctor Wright. 00:43:40:17 - 00:43:45:01 And as always, I just always enjoy, being in the presence of Sharon. 00:43:45:01 - 00:43:46:08 Thank you. 00:43:46:08 - 00:43:46:21 Thank you. 00:43:46:21 - 00:43:49:20 And I'm so excited for this Alliance for equity. 00:43:49:20 - 00:43:52:05 You are really steering people forward. 00:43:52:05 - 00:43:53:21 You're leading navigation. 00:43:53:21 - 00:43:55:12 So all I can say is keep it up.