Addressing Social Determinants of Health Through Value-Based Oncology Care: Yale Podnos, MD, MPH, FACS

At a recent Institute for Value-Based Medicine® event, Yale Podnos, MD, MPH, FACS, chief medical officer at The Oncology Institute, discussed the growing importance of addressing social determinants of health (SDOH) in oncology care and how value-based care models can help reduce disparities. He highlighted practical strategies for screening patients in day-to-day practice, emphasized the role of trust and language accessibility in improving clinical trial enrollment, and explored innovative ways to reduce financial toxicity and ensure equitable access to evidence-based cancer care. Podnos also reflected on the differences between community-based and academic approaches to oncology and the potential for shared best practices across care models.

This transcript was lightly edited; captions were auto-generated.

Transcript

How are SDOH currently being screened in oncology care, and what strategies can help make this screening actionable in day-to-day practice?

From a day-to-day perspective, I mean, you really just have to ask people. A lot of those social determinants of health sometimes can be very hidden, so it's really incumbent upon the practice—from the physicians down to the front office staff, everybody—to be really involved in it. Just ask. You have to engage your patients. You have to build those kinds of trust and relationships with them so that you feel comfortable asking and they feel comfortable answering.

What barriers exist to clinical trial enrollment among communities affected by SDOH, and what approaches can improve representation and participation in these trials?

Unfortunately, historically, there have been some communities that have not been well served by clinical trials. All of us know about them well, so it's really overcoming those trust issues. There are a few things that we can do. First of all, at The Oncology Institute, we are in the neighborhoods. We’re very community focused, and part of that also means that people who work in our offices tend to be from those neighborhoods. You might know somebody who knows somebody in the office, and so I think there's a trust there. Also, quite frankly, a lot of the people that work in our offices look like the people that they serve, because they're from those communities. I think that engenders a lot of trust.

The other big issue historically is language. Non-English speakers have not enrolled well, because a lot of the consents and instructions are only in English. I think as we've gotten further along over the past 5 years, there's been a real push for inclusion of people with different languages, so now there are consent forms in all sorts of different languages, and clinical research coordinators that speak different languages. That casts a wider net and brings people into clinical research.

What are some innovative ways to reduce patient financial responsibility and improve equitable access to cancer care?

I think that's one of the things we do at The Oncology Institute really well, because we have an alternative model. Value-based care really should serve those people who historically didn’t get as good care because they didn’t have PPOs or whatever. I think there are real opportunities within value-based care, whether it’s capitation or just being good stewards of the limited resources that we have and only giving people things that are really effective for them at the right times, in the right doses, for the right duration. That certainly goes a long way toward helping the financial toxicity that patients so often see.

A lot of it is to continue to evolve our pathways and guidelines that are evidence-based, like the NCCN or ASCO guidelines, because those ensure that the science is there first and foremost. By treating patients on those pathways, they have the opportunity to get great care that’s got evidence behind it.

What are you looking forward to discussing in the IVBM panel?

On the panels today, there were a couple of things, because there are different ways of achieving all these goals. On my panel in particular, I was very fortunate to have somebody from my organization, The Oncology Institute, which is a value-based care organization. Then, on the other hand, City of Hope, which is a wonderful institution where I trained, but as an academic tertiary care center probably approaches things very differently. I’m really interested in teasing out between those 2 some of the differences and maybe some of the best practices or commonalities.