Interview: Nathan Walcker

Preventive care

Elements such as screenings and mammograms to get in front of disease progression is ‘mission critical’

Nathan Walcker

CEO – Florida Cancer Specialists & Research Institute

What were some of the biggest takeaways from 2020? We serve cancer patients in nearly 100 locations across the state of Florida. If we’re not open or have staffing problems, that has direct downstream implications on patient care. In 2020, we saw, across our network of cancer specialists, roughly the same number of patients on a year-over-year basis. Given cancer incidence rates and demographic growth in Florida, the fact the volumes are flat, and in many cases down for providers, shines a bright light on the importance of preventative care. Doing things such as screenings and annual mammograms to ensure we’re getting in front of the disease progression is mission critical. FCS adopted telehealth and made a sharp pivot to how we operate fundamentally, soup to nuts, across our business. Systematic, repeatable processes ensure that every person coming into our clinics is safe and feels comfortable doing so. We then took that shift and operationalized it at scale for all our patients to continue having a rewarding experience in 2021.

How is Medicare’s oncology care model making a difference? The oncology care model is essentially a demonstration project, or pilot, from CMS. The Centers of Medicaid and Medicare Innovation (CMMI) ultimately is tasked with supporting what has been happening across healthcare for the past several years, marching toward value and quality, moving away from volume to a value-driven model. It boils down to demonstrating not just real return on dollars spent providing care, but also advancing quality for patients and efficiency for the system. At FCS we are fortunate to participate in the oncology care model and many other value-based arrangements. We perform well given that we’ve made the right and the smart investments infrastructure-wise to help support the patient. We have a care management team and a fully dedicated support infrastructure squarely focused on our patients and their extended care teams.

What are you watching out for in terms of legislation? Late last year, the Trump administration brought forth an approach to drug pricing called Most Favored Nation. Had that been enacted, community oncology practices across the country would have gone out of business overnight. Whether this carries forward into the Biden administration is something that we’re watching closely. We’re focused on making sure that our state legislators, senators and people on the Hill who are representing the great state of Florida know how big of an issue this is; and that they’re doing the right thing to make sure that patients continue to have a choice for convenient, high-quality care close to home.

David Pizzo

Market President – Florida Blue

We are becoming a lot more locally focused. We have had more offices, employees and engagement centers around the state than other insurers but throughout 2020, we have further concentrated on a hyper-local approach. We are looking at our customer base demographics, county by county if not neighborhood by neighborhood, to see how we can better serve the community and deliver against our mission of helping people and communities achieve better health. We have been developing a new working model within the company to do so, which includes staffing up. There are a significant number of nonprofits we can work with to reach the desired local depth for our services. This hyper-local approach and mindset is going to take us not only toward a significant culture change, but also into the future in a big way.

( ) The coronavirus laid bare some of the inadequacies of the longer-term care for the elderly, as well. Elderly rights groups such as the AARP are proposing programs that they are hoping the legislature will adopt that will bring such care into the 21st century but there has yet to be any substantial movement from lawmakers.

Additionally, the pandemic caused a renewed interest in mental health, as legislators on both sides of the aisle feared an uptick in mental health and addiction problems. Florida already is the state that ranks last in the country for per capita mental health funding. Unfortunately, the measures proposed, such as more accurately accounting for citizens’ dissatisfaction with mental health offerings, were widely considered insufficient. That said, the suicide rate in the country has been on the decline in spite of the pandemic.

Insurance An integral element in healthcare is the insurance market, and here too in Florida, the industry has not been without its problems. As mentioned, there is a 12.1% uninsured rate, slightly more than the national average. Using the federally run exchange, Florida has the highest enrollment on it than any state in the country, 17% of all enrollees in 2021. In terms of lower income residents, Florida has a Medicaid coverage gap, in large part due to the state government’s refusal to accept federal funding, and, as a result, people below the poverty line are not automatically eligible.

Florida also has a very high rate of people who receive medical insurance through their employers. States in such situations faced a precipitous disaster when the pandemic struck, the economy cratered and millions of jobs were lost virtually overnight. Such is the rate of job-based insurance that an unemployment rate of 10% translates to 646,000 people losing their coverage, and 25% can lead to almost 2 million without coverage. In Tampa, there was an especially high risk of job-based insurance loss, as the city ranked 11th in the country for jobs at a high risk of being deemed unessential and so affected by the pandemic (such as hospitality and retail). While the Florida economy recovered relatively painlessly from the initial shock of the pandemic, it still laid bare some major instabilities in the state’s insurance market.

Thankfully, on the whole, the Tampa Bay region is fairly healthy. In fact, it is slightly healthier than the national median. This is based on a number of metrics, including life expectancy, smoking rate and obesity levels. In terms of public health crises, besides the obvious once-in-acentury pandemic, the opioid crisis continues to be a scourge on the land with deaths from Fentanyl having risen exponentially over the last decade. Added to this issue is the lack of access to care for lower-income residents that has been mentioned already.

Vaccination campaign If the pandemic was the largest public health story of