CWWeekly presents this feature as a way to put the spotlight on issues faced by executives in the clinical trials space. Staff Writer Ronald Rosenberg spoke with Jeff James, CEO of Wilmington Health in Wilmington, N.C.
Q: You discussed the topic “Making Clinical Trials a Care Option for Patients: Piloting an Infrastructure” at September’s Disruptive Innovations conference in Boston. How have your organization and similar health centers begun to implement that strategy for people with serious chronic conditions?
A: We have taken a look at it through the lens of our accountable care organization and are starting to identify populations differently—[not only] by their disease types but also by their eligibility for potential participation in various clinical trials. We are also looking for clinical trials that meet particular disease types.
We are also developing procedures to connect the visit information from the clinical trials to the primary care physician via our electronic medical record and developing strategy for transitioning patients out of clinical trials in a way that maintains their engagement in their own healthcare.
Q: Given the financial concerns of large healthcare organizations, is providing clinical trial care options a cost-savings or cost-shifting strategy? Please explain.
A: Actually it is both. So, our cost data indicates that there certainly is some cost-shifting to pharma. For example, some of the tests traditionally ordered by physicians are now being ordered for the patient within the clinical trial. Additionally, now some of the office visits are being taken up or facilitated by the research trial. So there is definitely some shifting of the costs to pharma.
However, what we are seeing is significant improvement in patients, not just from the therapeutic that may be under study but also in other areas that don’t have anything to do with the study. So what we’ve seen is: Patients that are involved in outpatient research projects have fewer admissions into the hospital. Now those costs are saved by the system because those admissions never happen. We can show that the cost for hospitalizations before they start trials is much higher than after they get involved in the trials.
So, the cost is shifted in some regards to pharma, but [there is] also some significant savings to the traditional healthcare system because there are fewer admissions and the comorbid conditions seem to get better.
Q: From your experience, what new approaches are needed to encourage physicians to talk to their patients so they might consider clinical trial participation? Also, what’s been your experience in convincing physicians to become Principal Investigators (PIs)?
A: In order to get a physician excited about sending their patients to clinical trials, the physician has to have confidence in the trial. They have to understand what the trial is all about, how it’s likely to benefit their patient, why it’s a better option than, perhaps, a traditional pathway. And there also has to be a feedback loop back to the physician, so the physician understands how the patient is performing in the trial.
The physician is recommending this. They are recommending it, often, instead of a more traditional approach. But nonetheless, it is still their patient. They want to know how that patient is progressing. So a regular feedback loop to the physician as well as significant education up front is important.
Statistics show that a very small percentage of folks participate in clinical trials—1 to 2%. However, 71% are likely to, if it were referred by their physicians. This is a really big area of opportunity for the industry. But it is going to take the physician understanding all of the benefits of clinical research, as well as having that feedback loop, and some of the work we are doing is going to help quite a bit, so they’ll understand how it can assist patients, as well as all of the savings to the system.
Convincing physicians to become PIs— that is really not a process. You really don’t convince them to become PIs. In my experience, some of them want to become PIs because it appeals to the scientist in them. It is a diversion from their normal routine and they like that diversity. And other physicians just want to practice medicine. It is really up to the doctor. There doesn’t seem to be any way to convince physicians that don’t already have a slant to it (becoming a PI).
So, you provide them with information about how becoming a PI is beneficial, and then just see if that is something they are interested in doing. It definitely takes a certain kind of physician to become a good PI. We have 160 providers at Wilmington Health, but maybe only a dozen to 18 PIs. They recognize it as a benefit to their patients and the diversity it provides.
This article was reprinted from Volume 19, Issue 44, of CWWeekly, a leading clinical research industry newsletter providing expanded analysis on breaking news, study leads, trial results and more. Subscribe »