Q&A With COTA’s C.K. Wang on Addressing Disparities in Oncology | Healthcare Innovation

Miami Cancer Institute, part of Baptist Health South Florida, is working with real-world data and analytics company COTA Inc. to better understand how certain patient demographics, such as Zip code, race/ethnicity, or other socio-economic factors, might contribute to disparities in patient outcomes.

In a recent interview with Healthcare Innovation, C.K. Wang, M.D., chief medical officer at COTA, described the company’s Real-World Analytics platform and its work with 11-hospital Baptist Health South Florida and other health systems to address disparities.

Wang described how COTA was founded about 10 years ago by a group of doctors and data scientists who were seeking to answer questions about their patient populations that they couldn’t through traditional sources of data. “These were questions that pertain to how patients are being cared for, as well as their associated responses and outcomes to therapies,” he said. “The use case was to help providers better understand the variability and potentially even deviation from established standards of care, and to also arm them with insight into their practice patterns so that they can have a more educated and better-informed discussion with payers.”

Over the past few years, COTA has worked to abstract many of Baptist Health’s records in breast cancer, lung cancer, colorectal cancer, prostate cancer, and most recently, ovarian cancer, so that they can better understand their cancer population in those diseases. Armed with those records that are fully abstracted, they could ask many different types of questions of the data. The first questions were whether the clinicians are following evidence-based standards of care.  

COTA’s platform was used by physicians to better understand BRCA testing patterns at Miami Cancer Institute between 2018 and 2019. This analysis led the Cancer Institute to implement blanket BRCA mutation testing for all patients with newly diagnosed metastatic breast cancer in an effort to identify all patients — and by extension their family members — who could be at increased risk of harboring the mutation. 

COTA also has developed analytics partnerships with MedStar Health and University of Chicago Medicine aimed at driving equity in care across all cancer patients. 

Baptist is focused on better understanding its minority patient population. “We collect a patient’s race/ethnicity and Zip code,” Wang said. “You can tell a lot about a patient’s socio-economic status and even access to healthcare from Zip codes. We can see when patients are being diagnosed with certain cancers and when they actually start therapy. You can start teasing out whether or not certain populations of their patients have a longer gap to therapy start. In many cancers, time is critical, and if you delay therapy starts, for whatever reason, that patient population may have worse outcomes.”

Once a health system identifies patterns of disparity, it has an obligation to work to close those gaps. “Baptist has made a very strong commitment to tackling this issue,” Wang said. “We know that when it comes to accessing care, especially specialized care, like cancer care, the fact is that if you have a center closer to the patient, they’re more likely to access the care and be compliant. Miami Cancer Institute has created a Division of Healthcare Equity to better understand the issues.”

“With our expanded partnership, we’ll be collaborating with COTA on research that analyzes the impact a patient’s demographics may have on the stage of their cancer diagnosis,” said Leonard Kalman, M.D., executive deputy director and chief medical officer at Miami Cancer Institute, in a statement. “Delayed cancer diagnosis for a patient frequently leads to poorer outcomes. Our hope is that this collaborative research will identify the patients who are most at-risk for delayed diagnosis so we can increase education and expand access to routine cancer screenings and treatment for these populations.”

I asked Wang what first steps health systems should take if they want to address similar issues but haven’t done so yet.

“Data is a key,” he said. “I think they’ve taken a huge leap forward by acknowledging that there may be issues. Just like any problem, the biggest step is to admit that there’s a problem. After that, I go back to what everyone in science and medicine is taught —  you have to validate your suspicions to make sure that they are true, because without data, it’s really hard to measure change or improvement. You need that baseline. Next you have to make sure they have the right foundations within the institution to retrieve and provide that data in a meaningful way or partner with a company that can help them do that. After that, you have to have the commitment, just as Baptist has made the commitment, to recognizing that having that insight isn’t good enough. It is about executing changes based upon the findings of that data. Otherwise, all that effort would have been wasted.”