Bringing CAR-T into the community: ‘Healthcare is like politics – it’s local’

At Reuters Pharma USA 2024, Cindy Perettie, executive vice president of Kite, Gilead, and Jeff Patton, CEO of OneOncology and executive chairman of Tennessee Oncology, discussed this shifting model and how to improve patient access to these therapies.

Perettie began by acknowledging that despite CAR-T​ having a ‘very complex’ delivery model, it is critically important to bring it into communities, as this is where 80% of patients are seen.

“There are a lot of barriers that come with any kind of complex therapy. With CAR-T we need patients to be close to a center for 30 days. They may need to travel. They need a caregiver. That is why being able to access care in their community is so attractive," she said.

Patton agreed that CAR-T is going to be an ‘extensively used’ therapy as it is so effective and improving convenience is key.

However, he admitted that CAR-T is a brand new technology with no existing delivery system to plug into like a pill or an easily infused therapy, requiring a brand new approach.

Unfortunately, he explained, pioneering a new approach can be very challenging when dealing with ‘bureaucratic organizations’ and payers – who must all agree on contracting, regulation, logistics and more.

“Starting from scratch and creating a new delivery system is not easy in our overregulated and non-free market healthcare system,” he said.

Citing a recent partnership between Kite and Tennessee Oncology to expand access in the southern state, Patton continued that in order to make these partnerships more fruitful – ‘we must educate payers and health systems that this is coming and its going to be big’.

“Right now, I don't think they believe how big it's going to be and we kind of see the future faster than they do. So its education and approaching it from the bottom up, where you go into a local community like we did in Nashville and you find willing partners.

“When you have a dominant local healthcare provider that can see the future like Tennessee Oncology and One Oncology did, then you can bring folks to the table to educate them. We’re specialists and we know a lot about it – but for health systems, CAR-T will never be 50% of what they do.

“It’s threatening to payers because its expensive and they want to put their head in the sand and not deal with it.”

Currently, Tennessee Oncology has 32 clinics around the state able to deliver CAR-T, with further expansion planned.

“Once we develop expertise to deliver it in one site, then we'll democratize it across our own practices. That needs to be replicated across the country,” Patton added.

While new technologies are developed at centers of excellence, providers such as One Oncology are able to see more patients and potentially achieve better clinical outcomes.

“The more we do it, the more clinical proficiency we develop. In society and in healthcare a lot of people think of academic medical centers and immediately say – that’s where I’ll go. If you have something incredibly rare, that is where you should go. But if you have pneumonia that’s the worst place – as the guys out in the community treat lots more pneumonia,” Patton said.

“So we need to change our mindset. While very specialized care should be done in one center, as we learn to adopt that technology and see it replicated across the country – it’s better done in a community setting with better clinical outcomes.”

Moving the model from academic only to the community also requires navigating multiple stakeholders and hospitals who are accustomed to carrying our these therapies may be hesitant to work with outside organizations. 

Similarly, payers who are familiar with bone marrow transplants may not want to change their processes and pricing.

Therefore, it is an ‘entrepreneurial process’ which requires a lot of education – as you are creating a new delivery system, Patton adds.

Crucially, prioritising state-based care is particularly relevant within the U.S. healthcare ecosystem – in which private insurance can limit access to cutting-edge treatments​ like CAR-T.

“From what I have observed, a single payer system is more straightforward when implementing complex care. In the US, where we have a fragmented system, without that partnership, it is challenging to bring these important therapies forward.”

As Patton describes, ‘healthcare is like politics – it’s local’ and with the right partnerships, CAR-T has the potential to thrive in a community setting.