Improving cancer care through expert virtual reviews

Tatjana Kolevska, MD

Cancer is one of the most difficult diagnoses a person can face. As a physician and the medical director of the Kaiser Permanente National Excellence in Cancer Care Program, I’ve seen firsthand how powerful it can be when patients — and their doctors — have access to timely second opinions from subspecialists. In complex or rare cases, that added expertise can change the course of treatment and save lives.

That’s why I’m proud of the way our Cancer Expert Review Program is transforming care. This virtual forum connects Permanente oncologists with cancer subspecialists across the country, so no matter where a patient lives, their treating physician can quickly consult with experts and access innovative treatment options. Over the past year, this program has expanded to all 8 Permanente Medical Groups, reaching patients from Hawaii to Mid-Atlantic states.

Related virtual review cancer care podcast: Virtual oncology: Expert cancer care from anywhere

Behind this innovation is a commitment to improving patient care and providing physicians with the support they need to deliver the best care possible — both key principles of Kaiser Permanente’s value-based model of care. This pioneering approach can also serve as a model for efforts across the U.S. health system to reduce delays and improve outcomes.

Innovation and collaboration yield impressive results

Past cancer care innovations from Kaiser Permanente identified the best evidence-based treatment pathways for most cancers. But getting input from experts for rare or complex cancers isn’t always easy, especially in cases where there’s only a handful of subspecialists in the entire country who focus on one specific type of cancer.

Our Cancer Expert Review Program meets that challenge head-on. It gives every Permanente oncologist a way to quickly consult with experts in 11 cancer subspecialties, all through the electronic health record system. Physicians submit a request, and subspecialists review the case and respond with personalized recommendations for treatment and diagnosis.

Since the program’s rollout last year, physicians have requested more than 1,500 consultations — more than double the number included in recently published results in NEJM Catalyst. At the time of publication, nearly 700 consults had been completed, with more than 80% delivered within 2 business days, exceeding initial performance goals. Physicians overwhelmingly reported that the expert reviews influenced patient care, and in more than a third of cases, led to a change in diagnosis or treatment.

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Just as powerful is how much the Cancer Expert Review Program is improving the physician experience. Doctors report broad satisfaction, indicating that the program is easy to use and reduces the administrative burden.

The secret to success

Virtual, collaborative review programs like this represent the future of cancer care. There are several key factors that have made Kaiser Permanente’s implementation a success and that other physician leaders can consider when designing similar services:

• Strong leadership support. Clear buy-in and commitment from senior leadership and physicians helps drive systemwide adoption.
• Physician-driven design. It’s vital that doctors play a meaningful role in developing programs intended to support their clinical practice. Engaging a team of physician leaders, oncologists, subspecialists, and others enables intentional design and broad success.
• Building off proven innovations. Leveraging existing, successful innovations in cancer care can provide a strong foundation and help with developing and deploying a new program at scale. It also helps build physician trust.
• Designed for access and equity. Reaching as many patients as possible was priority number one, so the system was designed to be both broadly available and highly individualized. Wider patient outreach leads to greater impact on patient health overall.

Innovation in cancer care doesn’t come from technology alone. When we listen to doctors, empower collaboration, and build tools and systems that make care more precise and accessible, we create a future where more patients can get the care they need, where they need it, no matter how rare or complex their cancer might be.

Tatjana Kolevska, MD, is the medical director for the Kaiser Permanente National Excellence in Cancer Care Program and chair of the Kaiser Permanente Northern California Oncology and Hematology program.

Related content: Dr. Kolevska also joined host Alex McDonald, MD, on a recent episode of PermanenteDocs Chat to discuss the Cancer Expert Review Program in more depth — including how AI and integrated care are enhancing outcomes for patients and experience for physicians.