Prior authorizations: This time-consuming practice requires doctors to contact their patient’s insurance company to get permission to do a test or procedure. If the insurance company refuses, the physician must appeal and re-appeal. This process takes a tremendous amount of time and energy for the physician and their support staff. At SCCA, we are changing the model. We recently worked with a large commercial payor to eliminate prior authorizations for all imaging requests for patients covered by that insurer except for positron emission tomography (PET) and PET/computerized tomography (CT) scans. Our Quality and Contracting team conducted an extensive study and found that the financial risks that the payor would potentially incur by agreeing to eliminate prior authorizations would be minimal. The study found that the denial rate was already very low and that the scans were medically appropriate, resulting in a lot of wasted time securing prior authorizations for necessary procedures. This is the type of systemic change that benefits physicians, payors, and most importantly, our patients.
Dr. Nancy E. Davidson is the executive director and president of Seattle Cancer Care Alliance (SCCA), senior vice president of the Clinical Research Division at Fred Hutchinson Cancer Research Center and head of the Division of Medical Oncology at the University of Washington School of Medicine. Dr. Davidson’s research focuses on biology of breast cancer and how it affects breast cancer treatments. In addition to her translational cancer research, Dr. Davidson regularly sees and treats patients at SCCA’s Breast Cancer Specialty Clinic.
Thank you so much for doing this with us Dr. Davidson! Can you tell us a story about what brought you to this specific career path?
Thank you for allowing me the opportunity to share with your readers why I’m so passionate about serving patients and curing cancer. It was a summer job that provided the initial spark that ignited my career. I was a medical student and found a research job at the National Cancer Institute near my parents’ home so I could further explore my interest in cancer ― and supplement my lean student bank account.
What I found, though, captured my imagination ― there were new cell models of breast cancer that created a tangible link between lab and clinic, allowing researchers to develop potential new treatments in the lab that could then be brought to patients. This was an exciting time, a time when we could truly begin to see the relationship between biology that was being studied in the laboratory and how it was going to ultimately translate into care for people. And I can tell you, my passion for lab work that can directly impact patients’ lives has not diminished in the years since.
Can you share the most interesting story that happened to you since you began leading your company?
Growing SCCA’s footprint both regionally and nationally has been the priority since I took this leadership position. And a central part of SCCA’s mission is to ensure people have access to the best cancer treatments as close to their community and loved ones as possible. Therefore, I have had the great pleasure to have been a part of ensuring geographic growth of this amazing organization. In 2019, SCCA opened two new geographic locations to provide patients across the region. And just today, we announced an agreement with Overlake Medical Center & Clinics to will bring cutting-edge cancer care to their Bellevue hospital.
Across all these efforts, one goal remains constant, which is to bring the highest level of care and the most advanced treatments available, including:
– A nationally recognized treatment program. SCCA has been ranked among the top 10 cancer centers in the United States for over 13 years, and #1 in Washington for over 10 years, through U.S. News and World Report hospital rankings.
– Washington’s only NCI-Designated cancer center. This coveted distinction is only awarded to hospitals with an established track record of excellence in advancing the treatment of cancer.
– A national leader in survival outcomes. According to the National Cancer Data Base (NCDB) Survival Reports data, SCCA patients have higher five-year survival rates for almost every cancer type compared to patients treated at other medical centers.
And when I hear positive stories from patients who have been able to reduce their time spent driving to clinic and improve their quality of life, it shows that we are doing the right thing. It also tells us that it’s imperative that we, and other health care organizations, should be looking for alternatives for the way care is delivered through the lens of always putting the patients’ needs first.
What makes your company stand out? Can you share a story?
There are so many things that help make Seattle Cancer Care Alliance stand out, but the most important is our drive to stay at the forefront of the fight against cancer. That cannot be achieved without innovation, one of SCCA’s core values. We are uniquely structured as an alliance — our members are Fred Hutchinson Cancer Research Center, University of Washington Medicine and Seattle Children’s Hospital — and it’s the combined strength of these three institutions that helps us translate scientific discovery into the prevention, treatment and cure of cancer.
Can you share with our readers about the innovations that you are bringing to and/or see in the healthcare industry? How do you envision that this might disrupt the status quo? Which “pain point” is this trying to address?
At SCCA, the truest form of innovation is centered around how we deliver care to our patients. We are rethinking how the healthcare system can best serve its community and patients. That is why at SCCA we are redesigning our clinics — literally changing how they are constructed — to be patient-centered. SCCA’s new “universal room” model that we have introduced in some of our clinics is an example. This concept combines a comfortable and private space with a committed care team that provides personalized, seamless care to support healing. In other words, all the services a patient needs will come to them in one exam room, not the other way around. There are, of course, certain specialized and technical services that don’t always fit into the model, but overall I think you’ll see healthcare move toward a more human-centered design approach that focuses on the patient experience.
What are your “5 Things I Wish Someone Told Me Before I Started” and why.
I don’t think there were any surprises when I started my job here in Seattle. But here are five enduring lessons that I have kept in the forefront of my thinking as a cancer specialist.
Cancer research and care are team sports, and the patient is at the center of the team. Each patient is unique and deserves a personalized approach.
The many diseases that we call cancer are extremely complex. And complex diseases require a large team of experts to provide the best possible outcomes. Though I am trained as a cancer treatment specialist, I increasingly recognize that prevention is a critical pillar to reduce the burden of cancer. The single most important thing we could do today to prevent so many types of cancers (as well as other health problems like heart and lung disease) is to eliminate smoking. I am passionate about the importance of research because everything I know about how to help a patient today is based on results from laboratory and clinical research from yesterday, and tomorrow’s treatments will come from the research that we are doing today.
There is no better opportunity for young people today than to take up a career in biomedical research or health care. The scientific progress is phenomenal and the ability to play a role in using that knowledge to improve the well-being of people is a true privilege.
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?
This is a very important question yet one that is difficult to answer. As someone who has dedicated their professional life to helping cure cancer and deliver the best possible care for patients, it is disheartening to find the United States in this position.
I believe one of the main contributing factors has a lot to do with inequitable access to healthcare coverage. In 2017, The Commonwealth Fund analyzed the wealthiest nations and found that, in the United States, 44 percent of low-income Americans have trouble gaining access to coverage compared with 26 percent of high-income Americans. I believe that all Americans deserve access to healthcare, and I will continue to advocate on behalf of all patients. This is incredibly important for our patients because they need comprehensive coverage that includes cancer prevention and screening services, which are available to ensure they are diagnosed early when both outcomes and cost are better for the patient.
Another contributing factor is the price of healthcare in this country. The cost of healthcare is a leading concern for many Americans, and it is a significant driver to our national debt. According to the Peter G. Peterson Foundation, not only are costs higher, but we also have some of the poorest patient outcomes for a first-world country. When you add these factors together, you’re looking at a system that threatens the health of our overall economy.
You are a “healthcare insider”. 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.
To address healthcare industry needs holistically, we need to look at large system change in terms of economic, policy and environmental factors. For cancer care providers specifically, we can and should partner with commercial, real estate and government partners to find innovative ways to drive systemic change.
Prior authorizations: This time-consuming practice requires doctors to contact their patient’s insurance company to get permission to do a test or procedure. If the insurance company refuses, the physician must appeal and re-appeal. This process takes a tremendous amount of time and energy for the physician and their support staff.
At SCCA, we are changing the model. We recently worked with a large commercial payor to eliminate prior authorizations for all imaging requests for patients covered by that insurer except for positron emission tomography (PET) and PET/computerized tomography (CT) scans. Our Quality and Contracting team conducted an extensive study and found that the financial risks that the payor would potentially incur by agreeing to eliminate prior authorizations would be minimal. The study found that the denial rate was already very low and that the scans were medically appropriate, resulting in a lot of wasted time securing prior authorizations for necessary procedures. This is the type of systemic change that benefits physicians, payors, and most importantly, our patients.
Price transparency: At a national level, there are discussions about making healthcare costs more transparent. It is important that the whole health system figure out the best way to provide patients with meaningful and informative data, not only about cost but also about quality and outcomes. It’s really a conversation about value that is going to reshape the health system.
Workforce policies: The national nursing shortage is an issue the entire health system is grappling with. Efforts to increase training programs or to streamline the credentialing process for nurses who are moving from another state will help improve our capacity to address that shortage.
Telehealth: As telehealth services become more widespread, with more clinicians trained to provide this type of care and more payers reimbursing for these services, providers will be able to reach more patients who need our care. This is particularly true for rural communities in the Northwest, but also patients for whom travel is a barrier. SCCA has been involved in a Washington State Telehealth Collaborative advising on policy development. Telehealth will be another critical tool in our efforts to share our expertise with patients across the Northwest.
Thank you! It’s great to suggest changes, but what specific steps would need to be taken to implement your ideas? What can individuals, corporations, communities and leaders do to help?
We need to approach these changes holistically. It’s important for organizations to partner on these matters because change cannot be made unless we all work together — healthcare organizations, local/state and federal government agencies, large corporations, etc.
However, most importantly, we need to put patients first. At SCCA, our care programs are developed with a singular focus — the patient. They are always top of mind, especially when we think about changing the way we approach patient care. When we put patients first, we often find that not only do their outcomes improve but also our overall relationship with patients and their families.
I believe that our patient-centered approach can and should be replicated in other sectors. The relationship between an organization and the people they serve benefits all who are involved.
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
I am a fan of books that bring the importance of science to the lay public — books like “The Immortal Life of Henrietta Lacks” and “The Emperor of all Maladies.” I also turn to biographies about great leaders in other domains, like “Team of Rivals” about Lincoln’s masterful work with his Cabinet during the Civil War — these lessons are just as important in health care and cancer research.
How can our readers follow you on social media?
SCCA website: www.seattlecca.org/providers/nancy-e-davidson
And please follow SCCA’s social media accounts: