The Future of Healthcare: “Administrative costs associated with healthcare delivery need to be brought down by embracing telemedicine” with Deepak “Dee” Khuntia, M.D. , SVP at Varian Medical Systems

Administrative costs associated with healthcare delivery need to be brought down by embracing telemedicine, and reshaping rules and regulations to offer more flexibility and access to information. For example, home dialysis could end up decreasing costs substantially versus in the hospital or outpatient clinic. Asa part of my interview series with leaders in healthcare, I […]

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Administrative costs associated with healthcare delivery need to be brought down by embracing telemedicine, and reshaping rules and regulations to offer more flexibility and access to information. For example, home dialysis could end up decreasing costs substantially versus in the hospital or outpatient clinic.

Asa part of my interview series with leaders in healthcare, I had the pleasure to interview Deepak “Dee” Khuntia, M.D.. Dr. Khuntia is the senior vice president and chief medical officer of Varian Medical Systems, where he is responsible for leading the company’s Medical Affairs program. He works closely with the Varian product, regulatory, business development, and innovation teams to provide clinical and scientific guidance in all areas of clinical risk and opportunities, safety reviews, adverse experience reporting, product life cycle reviews, clinical protocol design, mergers and acquisitions, and strategy. Khuntia’s career highlights include leading multiple national and international clinical trials designed to advance the standards of care in the treatment of brain, lung, head and neck, and prostate cancer. Khuntia has worked in the field of radiation oncology at Varian for six years, starting as vice president of medical affairs in 2013. Prior to Varian, Dr. Khuntia served as the director of research and education for a large private practice in the San Francisco Bay area. He also contributed to academia, practicing at the University of Wisconsin in Madison, where he served in many leadership roles, including residency program director and vice-chair of radiation oncology outreach. At one point, he was also course director for neoplastic diseases at the University of Wisconsin School of Medicine and Public Health. As an industry expert, Khuntia extends thought leadership credibility through his widely published clinical research, presentations and papers which cover a broad range of topics including radiotherapy, radiosurgery and imaging techniques in the treatment of cancer. Passionate about broad scale quality cancer care delivery, Khuntia has lectured worldwide helping to bridge the knowledge gap that exists with the recent surge of advanced radiation techniques. He holds an undergraduate and medical degree from the University of Illinois and completed his residency in radiation oncology at the Cleveland Clinic.

Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?

Ididn’t always want to be in medicine. In fact, I started out as an engineering major in undergrad because of my strengths in math and science. Within the first year however, I realized I didn’t enjoy it like I expected I would. Instead, I redirected my strengths in science by pursuing the medical field, where I could make a real and direct difference to improve the lives of patients.

I grew up in a small town, where access to leading healthcare was often limited, and I wanted to change that. First, I focused on rural medicine and primary care and studied it at the University of Illinois College of Medicine. During the end of medical school, I was exposed to health technology and became extremely interested in radiation oncology. I later went on to complete my radiation oncology residency at the Cleveland Clinic Foundation.

Within the field of radiation oncology, oncologists are able to help patients of all ages and backgrounds in a real and meaningful way during the most difficult times of their lives. Initially, my career was in academic medicine, where I led a variety of programs in research, education and administration at the University of Wisconsin. I then had a brief, full-time stint at a private practice in the Bay before joining Varian, where I still practice Radiation Oncology in a limited capacity.

I enjoyed my time as an academic, but I wanted to help people in a broader scale — and in a much faster way for seeing improved outcomes. With research at a university, one can change and improve the way diseases are treated, but this takes years and sometimes decades. Working in the industry, we have the power to utilize technology to influence the practice of medicine much faster and in a more direct way. My role at Varian fulfills this personal passion. I still see patients, but also have the distinct opportunity to help innovate and develop the tools and technology that will impact the masses.

Can you share the most interesting story that happened to you since you began leading your company?

As an oncologist, there are very few times in your career where you are in the driver’s seat with the ability to dramatically change the way that cancer is treated at scale. With Varian, I have the chance to do just that. Most recently, we have the privilege to work on the development of technologies that have the potential to change the way we treat cancer on a broad scale. One is related to Flash therapy, where we are able to deliver ultra-high dose rates of radiation. Varian’s proton platform has a powerful clinical accelerator that can be optimized to deliver the ultra-high dose rates necessary to produce the Flash biological impact. Preclinical research on the Varian Probeam has been encouraging as it has shown significantly reduced toxicities to healthy tissues while maintaining excellent tumor control in mouse models.

A second area that I am excited to work in involves the use of digital health to improve patient outcomes. We recently acquired a company called Noona Healthcare that focuses on patient quality of life. Tools like Noona have the ability to reduce ER visits, reduce calls to the clinic, and possibly improve survival. To be involved in these innovative advancements during my career is a momentous opportunity and continues to captivate me.

What do you think makes your company stand out? Can you share a story?

The day-to-day cadence and expectations of a job can cause you to inadvertently lose appreciation for the work at hand. At Varian, our customers are always reminding us how important our work is — a continuous reminder of the patient lives we’re able to impact. For instance, there was a healthcare provider that was visiting our offices from India when I first joined Varian. He was almost in tears when I met him. I asked him what was wrong and learned they were tears of gratitude. Nothing was wrong. Instead, he was honored to be at the Varian headquarters where machines are built to treat cancer. Thinking about the number of lives that are being saved because of the work being done on these few acres in Silicon Valley was incredibly moving to him — almost a spiritual experience. The encounter had a significant impact on me and to this day, gives me perspective regarding the impact Varian and my colleagues have in this world.

What advice would you give to other healthcare leaders to help their team to thrive?

A primary piece of advice to my fellow healthcare leaders is to always remember that there is no single solution. We have been successful at Varian by partnering with many different teams, both internally and externally. When an organization fails to look beyond its knowledge base and value system, solutions may be one-sided. Even with the best intentions, leaders may find themselves solving for problems that are not “real” problems. Collaboration is necessary to identify and solve for the issues that are most critical.

For example, clinical issues are very time consuming for physicians, who are now tasked to do things they were not required in the past. Nurses used to handle calling in prescriptions, but now the physician must provide an electronic paper trail and sign off on every prescription and change before a nurse can call it in. Current electronic medical record (EMR) systems are beneficial for billing, tracking encounters, analyzing inefficiencies in a health system’s infrastructure and eventually real-time clinical support, but they have added burden to physicians who are already short on time. Increasing efficiency at the clinic is great, but if it in turn increases burden on the physician, it will backfire as the physician is the busiest person at the clinic. It may reduce overall care team time spent on tasks from five minutes to two minutes, but if that ends up shifting time to the physician, the advancement will not improve efficiency.

Stakeholders that recognize the need for collaboration and exposure to multiple vantage points are more likely to thrive because they are able to break silos to partner and go beyond the company’s single view, pooling knowledge to truly understand where problems are that need to be solved. The biggest disruptions occur when two separate groups come together and share ideas.

Ok, thank you for that. Let’s jump to the main focus of our interview. According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?

  1. The high cost of healthcare is a huge barrier and a large reason why the U.S. healthcare system is ranked as the worst among high income nation. One main reason for this is the skyrocketing administrative costs. Doctor’s salaries have barely risen in years (and in some cases, actually have dropped), but the cost of administrative management has dramatically increased. Reasons for this increasing need for administrative management include rules and regulations like HIPAA that are policing how procedures must be implemented, defensive medical practices, where unnecessary and excessive testing is done due to fear of lawsuits, inefficiencies in patient record management, including the transfer of records, and the high cost of R&D.
  2. The lack of democratized access to healthcare is another challenge that the U.S. healthcare system faces, as the socioeconomic status of patients impacts their quality of care. Geographically, where the patient lives affects the care they receive. Other countries that have more centralized delivery of healthcare avoid some of these problems, but then don’t have quick access to the latest innovations. It is a complex issue that requires striking a balance between best practices and embracing new technologies.
  3. Finally, the rising cost of drugs in the healthcare system is getting worse and is likely pulling resources away from other areas we could invest our healthcare dollars. Currently, healthcare pharmacy costs are approaching (if not exceeding) the cost of paying healthcare providers…and it is on the rise. This is not sustainable.

You are a “healthcare insider”. If you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.

  1. Administrative costs associated with healthcare delivery need to be brought down by embracing telemedicine, and reshaping rules and regulations to offer more flexibility and access to information. For example, home dialysis could end up decreasing costs substantially versus in the hospital or outpatient clinic.
  2. The way in which patient information is shared is not effective and needs to be radically improved. When clinics, innovators like Varian and even the patients themselves have more seamless access to records and information, we can learn from existing patient outcomes and develop technologies accordingly. If vendors had access to clinical data on real patients, they could use the data to make better products.
  3. There is a critical need for more investment in research around major healthcare issues, including cancer. There have been cuts in cancer research, yet cancer continues to rank as a leading cause of death in America. In fact, 50 to 60 percent of cancer patients receive radiation therapy in the US, but very little is invested in research within this area of the field.
  4. Greater incentives need to be created that will allow more remote access for patient care and embrace telemedicine at a broader scale. I live in Silicon Valley and am able to service my patients regularly thanks to video calls on my iPad. Imagine doing this with patients living in small towns. The challenge is that the current payer system does not always support radiation oncologists’ participation in mobile technology for patient interactions. We need to advocate for change in order to have more flexibility to ultimately, democratize access.

Ok, its very nice to suggest changes, but what concrete steps would have to be done to actually manifest these changes? What can a) individuals, b) corporations, c) communities and d) leaders do to help?

We need to embrace telemedicine to help bring healthcare administrative costs down and democratize access. To help clinicians make better medical decisions, we need to better track patient symptoms. Patient Reported Outcomes (PROs) are vital to obtain a holistic view of the patient. Just because a tumor is gone does not mean the final outcome is successful. Perhaps the tumor is gone but the patient is in severe long-term pain, is experiencing blindness or faces other debilitating side effects. Looking beyond traditional outcomes by utilizing PROs will help improve experiences, and it is why PROs are becoming a more important end point for many of the clinical trials currently being conducted.

Outside of clinical trials it is challenging to capture PROs. In the past, patients were asked to fill out paper forms during clinic visits, but this was not as accurate, as patients don’t always remember day-to-day symptoms when asked to report everything since their last visit in one sitting. The key to access and accurate data sharing is mobile technology, which allows patients to easily enter their symptoms daily, and offers clinics a view of the entire puzzle, rather than just the piece they see during the patient’s appointment.

The power of mobile technology in the capture of meaningful PROs was a driving force behind Varian’s acquisition of Noona Healthcare last year. It is a powerful, proved tool that has validated PRO end points built into the software. The cloud-based architecture of Noona captures patient-reported outcomes in a manner that empowers clinicians to improve symptom management in oncology. Noona is simple and engaging for patients to use, regardless of their age. Today’s average user is 64, and the oldest user is 95. According to a study in the Journal of Clinical Oncology, the use of ePRO solutions like Noona result in fewer ER visits, clinic calls and hospitalizations, with a 20 to 35 percent improved survival rate. Noona is a revolutionary change in the information science division of healthcare and the goal is for ePRO tools like Noona to become the standardized way to care for patients.

Ultimately, patients can be the final say in what happens and they should demand more from their providers, more from their payers, and more from their government. The current reimbursement system, for example, does not drive value and best outcomes. Whether it’s a fee-for-service clinic or incentives to prescribe the more expensive drugs, both drive to less efficient health care delivery.

How would you define an “excellent healthcare provider”?

An excellent healthcare provider is one who treats the patient and not the disease. However, the very nature of today’s healthcare system has made this extremely challenging when doctors are faced with quotas to fill and have very limited time with patients. An excellent healthcare provider listens to the patient and is available to the patient, especially when treating cancer patients where quick medical attention is needed frequently. Additionally, being knowledgeable is essential to treat patients effectively. Going beyond standard treatments by staying abreast of the latest innovations, emerging trials and technology is another way to offer the very best care. Finally, bedside manner is a timeless quality that every excellent healthcare provider should possess. Communicating in a way that is comprehendible by the patient, while also showing empathy, is the way to build trust with the patient.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

“Learn to work harder on yourself than you do on your job. If you work hard on your job you can make a living, but if you work hard on yourself you’ll make a fortune.” — Jim Rohn

The team at Varian chooses to work here because they have an intrinsic passion to help heal people, and it doesn’t feel like work because the impact of our efforts goes far beyond a paycheck. Having seen, first-hand, the differences we have made to the lives of patients across the globe is truly priceless and what motivates me to get out of bed every day and do my very best.

Are you working on any exciting new projects now? How do you think that will help people?

Our Flash therapy work through the Varian FlashForward™ Consortium to study ultra-high dose rate cancer treatments with protons has been very exciting. Flash therapy is a non-invasive treatment using external beam radiation delivered in high doses, at ultra-high speeds (less than one second), and in one to three sessions. The initial preclinical and translational research on the value of ultra-high dose rate Flash therapy has been promising, and we continue to expand on our research here.

Specific to digital informatics, our Noona platform has the potential to disrupt the future of cancer treatments because it enables clinicians to gather and assess information on patient symptoms earlier. This in turn leads to better decisions sooner, with the ultimate opportunity for the potential to achieve better outcomes.

You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger.

We have an abundance of information on patients in healthcare, and how they respond to treatment. Unfortunately, today this information is not being utilized. Instead this data sits untouched in paper charts and EMRs. We need to build a movement that will allow easier, streamlined access to patient information in order to harness the data to design effective treatments and technology, all while bringing down healthcare costs and improving outcomes.

How can our readers follow you on social media?

Thank you so much for these insights! This was so inspiring!

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