The Exec: Harlan Levine Sees Innovation as the Key to Equitable Cancer Care

City of Hope's president of health innovation and policy is focused on using new technology and strategies to give those living with cancer the care they need when and where they need it.

Editor’s note: This article appears in the July-September 2023 edition of HealthLeaders magazine.

For Harlan Levine, MD, healthcare innovation is all about access.

Consumers—especially those living with a chronic condition such as cancer—shouldn't be denied access to care just because they're poor, part of a minority or living somewhere where they can't stand in front of a doctor.

Levine is president of health innovation and policy at City of Hope, the California-based, National Cancer Institute-designated cancer research and treatment health system that last year acquired the Cancer Treatment Centers of America. And while the partnership creates a physical network of healthcare sites for research and treatment, it's the virtual connections that he's focused on.

"We have a chance to export specialty care into the community," he says. "Healthcare needs to be on a broader continuum, [where we can] define the best type of care and deliver it to the best site for care, which can be the home."

Levine, who worked for Anthem, Towers Watson, and UnitedHealth Group prior to joining City of Hope and serves on a number of advisory boards and working groups, divides innovation into three buckets: Treatment, including new advances in genomics; delivery, which encompasses digital therapeutics and remote patient monitoring; and access, which addresses social drivers of health and other barriers that keep those living with cancer from getting the care they need.

It's that third bucket that he focuses on with AccessHope, a company spun out of City of Hope that uses telemedicine to connect oncologists to specialists regardless of whether they're located. It's a spin on the 'center of excellence' approach, where instead of having specialists gathered in one location, those specialists are brought online to the oncologist (and, perhaps, the patient).

Harlan Levine, MD, president of health innovation and policy, City of Hope. Photo courtesy City of Hope.

"We have to really understand that cancer care is different," Levine says. There are many moving parts to the care regimen, ranging from chemotherapy to surgery to mental health to rehabilitation to health and wellness (including diet and exercise) to palliative care. Bringing all those resources together and asking patients and their support teams to travel multiple times a week isn't in the patient's best interests or representative of patient-centered care.

Giving the oncologist the virtual tools to collaborate with specialists not only improves the treatment process, he says, but also reduces strain on patients and their care teams.

"We don't sometimes look deeply enough and ask if the quality is there," Levine adds. "When you put the patient at the center of care and look at what it means to them, you get a different idea of what value-based care is supposed to mean."

And that's when innovation comes into play.

Levine has been particularly active in securing access to care for those who face barriers, be they racial, societal, geographic, or financial. He helped to secure the 2022 passage of the California Cancer Care Equity Act, which expanded access to specialized cancer care for residents on the state's Medicaid program who live with a complex cancer diagnosis.

“This is the first step in creating a more equitable cancer ecosystem that works better for patients and expands access to lifesaving, groundbreaking treatments for those from historically underserved communities," City of Hope CEO Robert Stone said following California Governor Gavin Newsom's signing of the bill into law.

Levine says it's vital to push for equal access to cancer treatment and care, particularly at a time when new technologies are making access to treatment more equitable.

He says the rapid pace of healthcare innovation over the past few years—due in part to the COVID-19 pandemic—is propelling the industry to redefine healthcare. Health systems are now using technology to push care out of the hospital and give providers more opportunities to connect with and monitor their patient's health journey.

"Healthcare has been built on antiquated technology platforms" that make innovation challenging, he says. "In many cases it's easier to create new programs than to build off of existing platforms."

This also changes how health systems plan new approaches to healthcare delivery. Levine says he's spending a lot of time and attention on employers, many of whom are looking for new and innovative ways to cover healthcare services for their employees—and make sure those employees are getting the best care.

"Employers have driven a lot of innovation in healthcare," he says. "They've driven many of the disease management programs that we've seen over the past 30 years."

With that in mind, City of Hope is expanding its care platform to create a network of community cancer care centers across the country, linked by one electronic health record platform. This recognizes the fact that while many services can be virtual, there is still a need for physical sites to handle in-person care and services. The community center concept also hit on the idea of taking care out of large, imposing hospitals and delivering it in more welcoming locations closer to where patients live.

As City of Hope moves forward, Levine sees a lot of work going into genomics, augmented intelligence and data analytics, so that diagnoses and treatments are more precise and targeted. More importantly, with a virtual platform that includes RPM and home-based care, patients can access the services they need on a schedule and in a place that suits them, rather than the provider.

"The challenge we're facing right now is in integrating the old and the new," he says, "to help create comprehensive cancer solutions that any patient can access."