250 Doctors. 100 Clinics. One Question: Does AI Actually Help the Patient?

Doug Flora: Welcome back everybody. We're here again, episode three of our series with our esteemed guests and some of them are old, favorites of yours and some of them are new. We're going to introduce one today, one of my dear friends and, in my opinion, probably one of the most innovative physicians I've worked with. So he inspires me, but also makes me feel guilty that I'm not moving fast enough. So as you have seen from our first couple episodes, I hope you've tuned in.

We started with trust and authenticity and Emily, and then we moved on to the architect. We had Jeff Honeycutt. You won't have seen this yet by the time you taped this, but really talked about infrastructure and nuts and bolts. And where we brought in Doctor. Gordan is a unique place.

And I think he's one of the rare people who has vision at scale. Doctor. Gordan probably doesn't need to introduce to this community oncology audience, but he has built a juggernaut as the managing partner, president of Florida Cancer Specialist. I think it's the largest physician owned practice. Was?

Lucio Gordan: Well, second to Texas Oncology. Okay, We're competing as brothers.

Doug Flora: That's right. Yes. Well, we'll have Deborah on here too. We'll say all the good things about your place too.

Lucio Gordan: Of course.

Doug Flora: But you guys have been able to innovate at incredible scale. And so we wanted you to come early in our series to try and help people allay their fears because you've executed at high levels. To folks who've been new or tuned in here, my partner, Krem Sanjay Juneja, the Onk Doc, who is probably doesn't need introduced anymore by anybody anywhere because, he's everywhere. And then you may or may not know Clint. Clint Taylor is a seasoned executive, with decades of experience on the industry side.

And we really felt it's important for you all as you are navigating vendors and applications to understand their perspectives. What we're trying to work towards is how do we all work together and put the patients in the center of every discussion. So excited to be here. Sandhya, you want to kick us off with Doctor. Gordan and let's get started.

Sanjay Juneja: I lost sleep about even how to start it just because there's so many questions I have. I'm very excited to have you. I'd really like to start related to this concept of informatics. I had somebody press me. I'm starting a master's in informatics this summer.

And they were like, well, is even the role of informatics anymore with the way that these interfaces and clawed, etcetera, potentially store data, etcetera? To which I was very appalled at that question, because obviously informatics isn't going anywhere. And you started it, the division in New York Cancer Practice. I think, as I understand it, realizing that there is just a tremendous amount of data that can truly change outcomes at an accelerated pace, the real world stuff, exactly how we're supposed to do as physicians, right? Evidence based stuff.

Can you walk us through that moment that you realized how important informatics would be kind of prospectively, and how you see that even changing or evolving as this whole AI era is upon us?

Lucio Gordan: Yeah, that's a great point. So I had the fortune of understanding data and informatics when I was nine. I started coding at nine in language that you probably don't even remember anymore, basic COBOL. So I coded from age of nine to age of 19, and then I went to medical school at that point and finished medical school at 23 and moved to The United States. So data has been part of my life.

Organizing multiple parameters, multiple data points that we have in medicine is critical. The infrastructure of what we have in medicine, patient care, research, precision medicine, AI, radiology, pathology, it's so complex that if you are not very prescriptive about putting everything on the right grid, a dynamic grid of individual data points, we'll fail. I learned and hired prior people than myself to run our shop on the data side, and they obviously understood the mission. We started this evolution of FCS when I joined seventeen years ago and I became president eight years ago. It has been a very nice, fast paced progression based on quality, rigor, and perseverance.

You have to really have a solid foundation and an understanding. But while it sounds very complicated, now Florida cancer is too big and they can do whatever, it's not true. We started small. We identified problems for the patients, how we can help the clinic, how we can get patients better treatment, better access, better outcomes. And then we just were very prescriptive in getting our mission across the spectrum.

Doug Flora: This is going be a critical point. One of the threads that we're going to pull on the entire talk today is, and I've seen your practice and I know your partners, and I was in a very similar practice for fifteen years of my career at oncology hematology care, now called OHC. And I know how hard it is when you're trying to assemble the plane in the air. But the thing that strikes me about Florida Cancer Specialists, you have been the beating heart of that place for as long as I can remember, audience needs to understand that scale does not dilute mission. They are every bit as dedicated to their patients individually as Emily is, right?

And all of us in our smaller practices, what the scale has afforded them is the ability to experiment, to innovate. And I know you're transitioning soon. We'll get to that, to a national innovative position. But for our audience, this is really, really a critical point that we will come back to. The physician has

Clynt Taylor: to own this, has to

Doug Flora: own it. We didn't own it when it was epic or when the EMRs were released and onco every electronic medical record fell short of what we thought we wanted because we weren't at the table. And so part of our conversations with leaders like yourself are to remind people that AI governance in oncology is not an IT function. It can't be. We're just not allowed to do that because if we do that, we lose the thread that every tool has to impact our patients.

So when you and I make decisions, I know this because we've been friends for a while, his questions for the IT team are, does this tool actually help the patient in the chair? Right? And Emily mentioned this beautifully. She said it so articulately about putting the patient in the center of every discussion. How do you keep that at 300 places?

Like, how do you make that culture the expectation and the rule, not the exception?

Lucio Gordan: Yeah. You know, we suffer from the headwind of the disincentive of scale. So, we have to be very formal and disciplined to overcome that so we can get the idea and the process across all the 100 plus practices we have and 600 providers, we see about one point one million patients a year there. So, without a very methodical approach, which sometimes is head scratching for our partners and the culture of the place, it becomes difficult. To your first question, Sanjay, it's a cultural shift that we push very hard through FCS, our partners, every single person is equally important there.

The mission is the patient. That has allowed us to be successful in what we do. But there's much work I have.

Doug Flora: It's inspiring. I was just there at his center or with his docs maybe a

Clynt Taylor: week ago, 2A1, they came up and like, We're ready for this. We need it.

Doug Flora: But that means that you've done the change management. You've done the heavy lifting to prepare them for this tsunami of information being thrown at them. We'll bring in Clint. He's a professional at building, right? And here we have Lucio, who to me is like the general contractor.

You've actually shipped product. He's delivered on this thing rather than talking about how do we deliver on things. When you beat these doctors, I know your heart has to beat a little bit more excitedly because this is the partner you guys are looking for to say, Lean in, help us help you, let's figure this out together as a strategic partner, not as a vendor buyer. We talked about the last couple of episodes. Talk a little bit about your perspectives.

When you see these innovative practices, everyone wants to meet them. How do you fashion your messaging to your industry friends who are on here to say, I'm worthy. I'm I'm actually going to be a partner, not just trying to make a sale?

Clynt Taylor: No. It's a really good it's a really good question and a challenging question because it's like for a lot of people, they they wanna get this meeting with Lucio, and then they get there and realize, Wow, I haven't thought through enough of the complexities of these organizations, because they really are It's simple in the sense that you see a patient, but I happen to know a little bit about your organization, and we were speaking about this a little bit earlier. One of the things I think was kind of interesting I want to come back to is when you talked to them about data and your answer was how to use data for better care, which I think is pretty interesting. We often hear about people who want to monetize their data. They want to sell their data.

They want to get, how do I get money from my data? But you didn't answer it that way. I thought it was really insightful in the sense that you're looking at how do we use the data that we have as an asset to improve processes. To your point, those are the kinds of things that characterize a practice and the way practices think about data and AI and applications because they're thinking everybody has a perspective. You have to understand that to really know how to approach these larger groups.

We've talked. It's culture too. So, every one of his office has a slightly different culture.

Doug Flora: The physicians, some are early adopters, some are dragging their feet hard, and will subconsciously undermine progress because it challenges their paradigm. Not just doctors, workers who fear they may be replaced. Quick follow on

Clynt Taylor: to this. To what extent do the oncologists within the practice know and appreciate the work that's being done on the data side and what goes on there? Does it pull through? Does it translate?

Sanjay Juneja: That's a good question.

Lucio Gordan: We make an effort to make this very transparent, and that's part of the fabric of FCS. Everything has to be crystal clear, data driven, ROI, and physicians have to have an understanding what we're trying to do. We have, for instance, AI subgroups. We have maybe eight physicians and our very smart data scientists that sit on the committees as we evaluate three, four ambient solutions, three, four coding, billing, and clinical trial matching, etcetera. And then once there's a solution, we bring to the board, myself and the informatics department, and then the board is aware of it.

And then we disseminate this information either state of the practice or communication via email or others text message. So, there shouldn't be any type of confusion about what we're trying to do. Not easy. It requires a lot of intent and intentionality. So, that's something we're proud of.

Clynt Taylor: Yeah.

Sanjay Juneja: What was hard for me to wrap my head around is I literally can't get a consensus on what fast food place we're going to with my three children, right? That in itself is a problem. And I've heard- That's a harder problem. That's a hard problem. But then, you then you talk about an institution and a lot of institutional leaders like, I can't get my urologist to talk to the med oncs to refer for, you know, neoadjuvant therapy or derm or whatever this case may be.

We spent a lot of time in our first two episodes, you know, talking about one, the change management, kind of setting the field before the change actually happens. And we said a lot of what you choose to go with first is kind of get your team together, figure out what the friction is, and where people's passions are, then go pursue it. There has to be, obviously, volumes, there are thousands of clinicians where some are enthusiastic and some are not enthusiastic, not just indifferent, but unenthusiastic or against it. What are some of the ground truth buckets that help dictate you all's decisions on this greater good? Is it quality control measures?

It sounds like patient care is an ultimate ace of spades. Like, if it's going to help patient care, else takes a second seat. But what are some of the other considerations you make knowing that some people will have some friction towards whatever this new implementation is?

Lucio Gordan: Yeah, so I learned this from my dad who is a retired nephrologist. Always take care of your patients and their families, and the results will come automatically. So I try to transform that in our practice. So again, at the end of the mission, first in the end is patient care, right? And I think all of us physicians, have the call for medicine and nurse practitioners, PAs, we'll try to seek that truth.

And then the issue is the process, right? How to get there? How to organize ourselves? How to get the doctors who want to go to McDonald's over Arby's or whatever, fast food?

Doug Flora: I haven't had Arby's in a while. That sounds really good, And

Lucio Gordan: as we joined several physicians and practices over time, I was physician 47, I believe, and now we're 300 or so. We were amalgamated villages and I think myself and the board, we made a very big effort to put this kind of normalized, but it's still keeping some autonomy at a local level and clear communication to navigate towards solutions that would work for everybody. When I say everybody, it's about 90%, which is good. And I don't want to give the impression that we're perfect. We have much work to do at Florida Cancer Specialists and that's what keeps me awake at 04:30 in the morning every day.

But that being said, just you have to lead by example. You know, as I said, I had fortunate enough to be in the geek field since I was walking, which helped me quite a bit. And having the vision as a clinician and then as an executive put the three pillars together.

Sanjay Juneja: So that's interesting. You know, it sounds like you detailed things that are recommended or are going to be implemented, but you allow some laxity on basically snapping in or off particular, I guess, either point solutions or things that you're putting between your clinics as an option. So, is that wiggle room.

Lucio Gordan: Yeah. The laxity was not too ample, to be honest with you. But for instance, the physicians who don't want to use AmbientScribe, they can use voice recognition or even a good old fashioned transcriptionist recording. And we haven't penalized them economically enough for not using ambient AI or anything yet. But at the end of the day, if we prove that ambient AI gets you faster, more quality time with the patient and their families, have more time to think about the case, better outcomes, better ROI for the company, but especially for the patient.

It's a very linear, if not geometric good story. Once you organize your data, have the infrastructure, have the right partners, communicate well, and deploy the right products within the company.

Sanjay Juneja: I have to believe success breeds success and fosters trust. But were there any, at times, potentially a failure or something that didn't work out? How do you approach that? Because you're somebody that lives in innovation. And in this example of Amdia and Scribe, some of it is a leap of faith that you just believe that it's going to be able to, versus others that can opt to adopt something once it's been proven somewhere else at an FCS.

What helps you navigate or hedge against the risk of failure? And if it does happen, has it happened? How does that change the, I guess, the culture of the architecture? Yeah.

Lucio Gordan: So, a couple of rules, Rod. You must be curious at all times. You must be diligent about learning, and you can't be afraid of failure. And I have failed many times. Of course, if you're not failing, you're not trying hard enough.

That's a good old cliche, but it's true. Tried to push a pre AI telephone answering system two or three years ago, epic disaster. Nothing to do with epic, but just the epic disaster. We probably lost a good amount of money there. So, that was an example.

When I implemented next generation sequencing at FCS, the beginning was very difficult, a lot of headwinds. But I think as a leader and a group of leaders surrounding me and helping make me good decisions, I had quite a bit of cachet with the board and with the doctors that the mistakes were forgiven and we made imperfect decisions or we poorly evaluated the vendor partner, come clean. And so but I think I have many more victories than losses. So, I'm super excited with that and haven't been fired yet.

Doug Flora: There you go. Well, we'll talk about that too because Okay. I think the point is about taking I'll send this back to Clinics too. I think what you're hearing from clinician after clinician after clinician is we build trust first, right? And product is maybe the byproduct of that relationship because what they're doing is iterating at scale, but you also fire bullets before cannonballs, right?

You don't deploy at 300 sites at once. Deploy at four. You maybe engage your early adopters on the committees so that you can share decision making. You may take the heat if it doesn't go well, but I'd argue as an executive medical director, we're doing our best. We may vet things for nine months and with every piece of information, every fiber of our body, we're trying to do the right thing for the patient.

And the outcomes may not be a result of a poor decision. It may be that you made the decision a year before the technologies were ready. Correct. It may be that the change management was skipped because the product was so sexy and shiny that you're like, I got to roll this out. My docs are going to love this.

And I'm learning in my job that the things that I am enamored with, the rank and file oncologists, they're already overwhelmed. And so I have to approach it at a pace and tenure that they can deal with rather than one that I'm on roller skates all the time. And I have to apologize to that sometimes because I'm living in a different world than they are these days. As an administrator, I didn't see 28 patients yesterday. For Clinics, you're approaching companies as partners and you guys are developing these tools and we tell you, you have to do everything.

You have to do because we're being approached by 200 vendors. When you build a product and you hear that kind of feedback, does that slow you guys down? Because it might be you want to develop a point solution. We're telling you all day long on every episode, it's really hard to buy 200 solutions, but you have to make principal decisions about your strategic investments of resources just like we do. So we say, We want it all, but your budget doesn't satisfy that either.

How do you make those calls?

Clynt Taylor: Well, usually the customer is We've come to know each other through a pain point. So while we may talk about a broader system or a platform that can support lots of these types of applications, usually there's something that brought us together and focusing there is usually the smartest thing. Because I've been at this a long time, I've had my set of failures too. And trying to go too fast is one of the quickest ways to fail. And you're trying to do too much too fast, either because the organization isn't ready for it or you skip steps.

I think that's a big part of it is understanding the pace of the partner who you're working with and dialing in on what you're trying to achieve. Create path, follow the path, stay patient. We learn a lot from customers that we've implemented with. They've taught us a lot about how to think about these things. There are always those doctors who are going to be the last ones to adopt it.

Well, let them be the last ones to adopt it and find those ones that are saying, Look, we're excited about this, and work with them, make it really collaborative.

Lucio Gordan: Yeah, that's a great point. Something that I learned, I'm sure other practices do the same, but just in case they don't, whenever I'm implementing a new solution or something difficult, I will go to my most optimistic and resilient doctors in different locations. These guys and girls can take negative feedback and they can push it through. Because if I were to select a region by geography just because we're trying to and to get somebody who is a negative to start, that the sky is always dark, it's hard. And these are the folks who are to be percentile, 5% of adoption, and that's fine.

One day they'll be on board or not. But anyways

Clynt Taylor: No, that's a really good point. We had Jeff on a previous episode. He made the comment about starting something and when they first launched it, they were at 80 5% success. Some people would look at that and go, that's a failure. I can't live with 85%.

Of course, they stayed with it a little while and then it got way up into the nineties. But I think that you're right. Finding the right people that are willing to to say, 85% is a good start. Let's go and drive it to 95%.

Lucio Gordan: 85% in oncology is a great start.

Clynt Taylor: Yeah, That's true.

Doug Flora: It's a Hall of Fame batting average. Yeah. What about this? What we're trying to do, Sanjay and I together, as a rule now, is we're trying to drive smarter cancer care. We really are trying to accelerate the discussion, this responsible evolution to integrated practices because I I really I think the tools are ready for a lot of these things.

For what you have to do, though, they come to you. We both get pitches all day long every day. How are you as the receiver recipient of those pitches? What's going through your head? How do you start the process in your own head of, is this a real solution?

Is this vaporware? And it's just, I've already wasted my time taking this meeting.

Lucio Gordan: Right. Yeah. Great point. As you know, 50% of the AI solutions are dead in twelve months. And that's a real stat.

First of all, I'll pass this to the data science, the cybersecurity people, the compliance really quickly on the process. I'm getting old enough that the shiny stuff has to be super shiny for me to get excited about. There's an AI tool goes to data scientists, compliance, legal, physicians, the small group, and then they clean it up and then eventually comes to me, our CEO, our system managing partner, and then we present to the board. But we try to move quickly. It's not months.

It's days.

Doug Flora: I'm really curious about that because in my center, it may take months.

Lucio Gordan: Doctor. Yeah. No, of course, everything for me is for Monday next week already, I'm sure for all of you too. So, I get frustrated, but I don't think it should take more than six, eight weeks for us to get something moving through. Then of course, we have to implement it well.

That's probably another couple months starting at the sides of the rosy glasses folks and then moving to darker sides with all respect. But for instance, ambient solution, we took our time so not to rush into a solution too quickly. And I think our team studied really well and tried to perfect with the company for four months or so. But then within three months, we got almost 90%.

Clynt Taylor: Oh, that's good. So, it was pretty fast.

Lucio Gordan: That's pretty fast.

Doug Flora: Yeah. Next steps though, you have a modification of your career. I don't even know if it's super different, but it's even bigger, right? As if FCS wasn't large enough, you've decided now that you're going to be directing innovation for this small company called McKesson.

Sanjay Juneja: Yeah. Have you heard of a bunch people?

Doug Flora: Eight company, something like that? That's right. That's right. And and so at at that scale, you are gonna have the 30,000 foot, view 60,000 foot. Yeah.

Of the entire enterprise. We're speaking for the audience. We're at COA twenty twenty six in Orlando, and we've just heard about innovations all day, every day. Some of these things are mind blowing and some of them are ripe. They're ready to go.

As a director of innovation, you're now driving these things. You've been maybe been the pilot probably at FCS. Now you are really the architect of national innovation at a level that few of us will ever see. It's daunting. I can't think of anyone better suited for it.

My question will you talk about what you're most excited about, what this opportunity allows you to do that you couldn't do with just 600 providers, just 1,000 providers?

Lucio Gordan: Yeah. So for somebody who was thinking of retirement, right? Change into a bigger role. Yeah, so fortunate enough that Brian Tyler, Kirkhaminski, Jason Hammonds, Evan Womack chose to get me to this job. So, super excited.

My vision is to optimize technology, AI solutions, systems, workflows in four or five different pillars for McKesson, including research. We must do better insofar as clinical trial matching, clinical research accrual, precision medicines. That's something I've done for quite a while at FCS, almost ten years. And so there'll be lessons learned that can transfer to the whole network, cell and gene therapy, informatics in general, EMR data. So, it's going to be a tremendous and huge job.

I'm working on my already job description and plan for 2027 when I start officially, but I couldn't be more excited.

Doug Flora: Are you hiring? Of course, we hire me. I got a job I like, but

Lucio Gordan: yeah, there we go. Yes, we need a team. Of course, this is a team sport and glad that the three of us or four of us are sitting together here. I can go into specifics, but anywhere from having in the research side, large language models or the evolution of LLMs, reading clinical trial patient specifics and matching them, increasing our current accrual with or without the tools that we already have, Cell and gene therapy, patient identification, moving towards early lines of therapy, monitoring potential side effects and following how these patients do over time, and then eventually moving to predictive analysis of clinical outcomes so we can predict what's going to happen five hours or five days later with biomarkers or wearables or HRV temperature, those things we can measure. I need a full podcast just to tell you about what I'm thinking at some point.

Doug Flora: I think we can fix that. He's talking about heart rate variability. Mine is very, very high when he's around. Yeah,

Sanjay Juneja: now it feels that. I'm just so excited And to hear I mean, this is where we're headed. It's really, in some ways, just reinventing the way we think of medicine. You know, everyone has always said forever, you know, it's reactive and not proactive. But I would argue we were never able to be proactive like we can today.

I mean, there are things, there are phenotypic expressions of sepsis and pneumonitis and stuff that, if you think about it, we're waiting all the way until somebody is symptomatic and actually brings it up into a clinic and actually is noticed by the doctor. But there's all kinds of things and patterns that occur with temperature, with heart rate variability, respiratory drive, REM sleep, that can be investigated to truly be, even outside of proactive, of course, cancer free, etcetera. But in those settings where there's cancer and cancer treatments, really see ahead. I mean, it's almost seeing into the future is what a lot of this technology allows us to do. I will say one thing that truly keeps me up at night at 04:30 is my concern.

Doug Flora: You're just going to bed.

Clynt Taylor: Is my concern of

Sanjay Juneja: this polarity that potentially will occur for places like mine in Southern Louisiana, where we're already arguably, and many other communities, behind in interoperability, in data normalization, in so many different capacities, AI readiness, that those that are AI ready and then have all of these things in place are obviously taking off and really benefiting from this, which is amazing. Right. But it's like, what are just a couple of things that if you could wave a wand that you would really recommend centers truly lock down and take the time to do? Is it on the data side? It could be anywhere.

I'm just curious if you can think that far back, how can you ensure that this doesn't end up getting stratified for the people working here?

Lucio Gordan: Yeah, very astute observation as always, Sanjay. The disparities of technology can really augment at a warping speed because of AI and centers like ours and someplace else without the infrastructure to do so. As far as the network at US Oncology, of course, there's so many more people that are much smarter than I am that will help push a very cohesive plan the network from a small practice, mid and large. We'll try and be cognizant and sensitive with the team to find solutions that can fit three pillars. Other thing that we should talk about is to educate Doug and I were exchanging some texts and ideas, and all the physicians in community oncology, how to use AR, how to prompt, what to use, when, which is every day, several times a day, and get this as our second language after Portuguese here and English and Seventh language for you.

Yeah, right. Yeah, almost. So, would be I think we have to take this to the very basics on an individual level, get us very familiar with this new language. Doug always said, Spend fifteen, twenty, thirty minutes, he keeps increasing the number, every day with AI to try to get used to it. And we have to train the staff as well.

So with US Oncology, I think we'll hopefully deploy the same rigor of teaching to the nurses, the front staff, etcetera. And of course, with partners that can help us, I think we can deliver transformation. Cultural changes take time, but we don't have the time to wait because of patient outcomes goes down. It's kind of I always use the term moral obligation. I think we do have the technology today to make patients live longer and better with better quality.

So, why not? We got to push this.

Clynt Taylor: I have a slightly different question, a little bit more tactical perhaps, but I'm curious to know how you think about this. Throughout all of oncology, it's no different than any other part of healthcare, the EMR has been the technology that has driven so much. It's also the technology that has, in many ways, controlled the adoption of other innovations. I'm curious to know how you think, what role does the EMR have going forward? How do you see it changing or evolving?

What role is there for other companies that may not be in the EMR? Where do you see that?

Lucio Gordan: Yeah, that's a funny, well timely question. I'm writing an article called The Death of the EMR by 2030, and I don't know if I shared with you the manuscript I read or not.

Doug Flora: I think you did. I don't know if I've read it yet.

Lucio Gordan: Yeah, I'll share with the group.

Doug Flora: Don't always open your emails. Oh, good.

Lucio Gordan: Yeah. I said about five Very,

Doug Flora: very important.

Sanjay Juneja: Shall open them just for the record.

Lucio Gordan: Copilot, Lucio, don't open. So, anyways, the way I see the evolution of EMR is as follows. EMRs as they exist today, they should not exist anymore, right? So EMRs serve their purpose. At least we don't have the piles of charts and faxes coming through.

We still have faxes coming through, but we don't have that monstrosity that used to be our office. We couldn't open the door because charts were blocking it. So some evolution. EMR is not all horrible, and we all complain about EMR, but there has been some benefit for it. But the way I see the EMR will sit more like a repository of data.

And then hopefully we have end to end solutions that will do Indian scribing, chart summarization, cognitive assistance, coding and billing, and so many things that can go revenue cycle side, clinical trial matching. Hopefully, we can find something that's in the spectrum, our new company, put it all together. But I see the AMR as just a repository update at this point. Move much slower than we probably should.

Doug Flora: This is why I wanted to have him here because we have been building this arc and we're going to continue. There's a plan to deliver this sort of curation of thought over a dozen episodes or what. What I wanted people to see is your bias towards action. It's unique. It's a word I use all the time, three words.

I really believe that we have this equipoise around AI that it is so hard to get started. And it's not. It's really not. Lacan Ajayi will have on one of these days. He's Jeff Honeycutt's partner at Highlands.

He uses the analogy of Duolingo. Learn Italian before you go to Rome twelve minutes a day. And there's lots of things that are advertising. Work out. Just do nine minutes of this Pilates and you're going to look like this guy, which did not work for me, by the way.

You have had career where you've been able to reflect, decide, and execute at a level that I don't think many people can claim, and it's why you're moving to McKesson to do that at even a bigger scale. But how do we get that level of decisiveness and urgency to some of the people out there who don't have that yet. Maybe they're younger, maybe they haven't made their bones yet. I think what I go back to and what we asked Jeff about the last time, if you're approached by someone who doesn't have what FCS has.

Clynt Taylor: Sure.

Doug Flora: Five practices. And they don't have an IT committee. They barely have a data team. They have one EMR and really no help, maybe even a board that's very skeptical. What would you tell that person who's listening today how to get in the sandbox?

How do you get started when you don't have 300 offices? Because that's where we're dealing with as a community in this place. I'm very inspired by the doctors I've met, and almost to a one, they're like, What do I do? I'm now convinced it's time. Where do I start?

Lucio Gordan: Right. Yeah. So, I come from the principle that I think we can all agree that life is so freaking short that we got to move faster, right? At pace, as you say. And so, I have this sense of urgency that and I always have had, plus some OCD traits and others, that keeps me going.

So, to your question, a smaller practice, a further away center, they can pick up the phone and call one of us. I think all of us will be eager to talk and give advice, you know, break bread together, give some ideas, get them inspired. That's really important. The other way is to find solutions that others have piloted or tried. They can join your group, my group, whatever, So, we can get a suite of service automatically transferred to them.

Or they can find a partner that has the end to end solution that can work with them. So, are many ways. So, call a friend or make a friend and then call. So, I think there is nobody in this table and others that I know that would be unwilling to help.

Doug Flora: Yeah. We talked about it the last two episodes. I may bring it up a lot more, but the urgency with which we approach COVID and we saw how it could work. Right. And we lost it.

And so, tagline, You've seen this practice at the speed of innovation. That's exactly how you spent your career. And what we're trying to do is foment those conversations so that we can accelerate the responsible adoption of these tools. It's coming. You saw it outside.

You're going see it this afternoon. He has to leave for a session in fifteen minutes. We'll round that up. But when you are doing that and you've taken the lumps doing it, you still manage to earn the trust of the providers around you because they knew you were disciplined and you were diligent and you weren't just chasing shiny things. Correct.

You were trying to solve problems. Maybe speak to that. And when you have really seasoned veteran innovators in the room, he's a builder. And what are you looking for in partners? Not just FCS, but you as a as a architect of innovation when you're trying to pick partners, when you're trying to say, is this person credible?

Is this person legit? Is it a smokescreen? You know? Because I I deal with that probably, you know, I get more more pitches than anybody in the country. I mean, maybe Deborah.

Yeah. But but, because we're enthusiasts, we're early adopters, we get barrage because we're easy prey. What are you looking for when you meet someone like Clint and and his brethren to say, yeah, I I think I'd like to have a deeper discussion?

Sanjay Juneja: And can I add one question to that also? Right now, there's such a a need for a shared role between the vendor and and the the institution. Right? Like, both in the sense of their own, you know, auditing, their own governance. There there's a lot of shared even reiterating, you know, once it's been propped up to make sure it performs in the same way and get it from 85 to 93.

Do you also seeing that always to be the case? Or is that going to evolve to where it's mostly reliably assumed by the vendor? Or does it mostly have reliably assumed by the institution? Because that's not really scalable if you think about it. Not every vendor can have that relationship with everybody all the time.

So what is it morphing to? Yeah, the winners will. Correct. But that's another type of inequity then. That's what kind of worries me.

Lucio Gordan: Yeah, that's right. Difficult challenges, both of you ask. So, when I'm looking for, in a vendor or a preferred partner, somebody who would spend some time with an institution like ours listening to us, maybe spending time in a very small Florida rural clinic to our biggest office, spend time with the research people, understand how the flow than checking in, checking out, going to the lab. Kind of almost have to immerse yourself in different areas and stay in listening mode for as long as you can handle and hold. Once there's trust from both sides, then you start iterating, bringing your ideas, your innovation to the table.

But to your point, Sanjay, it's not every practice that cannot be in the country crisscrossing the whole world. But if you find solutions for big practices that have smaller offices like we do, Texas does, and so many others do. It can be translated and augmented to a few independent practices that are rural or inner city or with five physicians, 10 physicians, instead of 300. Of course, the partners, vendors should be cognizant about the differences and work at a much lower price point. Otherwise, you'll exacerbate the inequities.

I'm not asking for you to charge much more, but I think it's fair that we will help you. And if we're going to increase the value of community oncology and cancer care, hospital systems or not, we need to have solutions that reach everybody and are affordable by everybody.

Sanjay Juneja: Great point. It's almost like a tiered system, like a tiered strategy.

Lucio Gordan: Yeah. So, I usually, as I said before, I deploy my SWAT team such as Amy Meng, Franklin German, Tina Potts, and other 10 people who are equally important. And they will, if you survive them, then it means that it's scalable, compliant, legal, and reproducible elsewhere because these are bare experienced operators. So, a smaller practice, Sanjay, to your point, I don't think I would set up an IT committee because they can't. They cannot hire the quality of people that we have, being a Florida Cancer or any bigger company.

It's just too expensive. Be glad to have them cut and paste, right? And so why not?

Doug Flora: I think COA helps too. Yeah, absolutely. COA is great, and I'm incoming as president of ACCC, and this is our mission next year, is to educate our 50,000 members at 2,100 cancer centers to make sure that they have the nuts and the bolts. They have a sober but hopeful view. That's why I wanted to have you on early because I'm trying to generate an understanding of the lift that Jeff shared, the hope that you share because the ambition is worthy.

Because if we go back to the very point of the series, the interviews, Sanjay and I are proselytizing, evangelizing, is that lives will be saved. Yep. And suffering will be reduced at scale if we can figure this thing out. Yeah. And the majority of the tools that

Lucio Gordan: are about to come out in the next eighteen months, we must fix it.

Doug Flora: We must. We have to again.

Sanjay Juneja: And you know, one thing we haven't talked about yet is the accessibility to these tools that are DTC or direct to patient. Because I feel like we've been in this world where the lag, so to speak, potentially of an institution or community group is just incurred upon by the patients, meaning it is what it is, and you are not privy to certain technologies or tools if your institution doesn't. But now, there's, I think, over 300,000 health apps that can connect to your data and your labs and everything. I just noticed my WHOOP, they let me do this more tailored cardio panel, etcetera, but then automatically synced all my labs also from my primary care, and I was just able to trend it and everything. As this accessibility occurs, it's not inconceivable and a little concerning to think that you couldn't have things that are now even looking at your mammogram or potentially looking through your records, spotting these gaps that we're trying to close.

Have you put any thought into what that world looks like? Because I don't think there's any rules out there to, one, now all patients, I think, should have the right to their data and sharing it. But then also, it's getting to me, in my opinion, a little loose on what you're able to do with that, to now kind of be at odds with a potential tool, AI tool, that the physician doesn't even have to analyze these things. And I just hope that it doesn't fracture the trust component of the traditional oncologist or physician without the tech and tools compared to what AI could potentially enable somebody to have in their pocket.

Doug Flora: We've to do a tech and tools episode. It's coming. Nobody's ready.

Lucio Gordan: Yeah. I think the human touch, the connectivity will not go away, right? Human to patients, and pretty sure it will not. But you're totally right. When I was asked to write this article about the death of EMR 2030, I was thinking, Should I write 2030 or 2035?

Because 2035 is what you're saying, in my opinion, not EMR itself. But patients should have access to everything, in my opinion. It's their data, right? Mammogram, biomarkers, labs, CAT scans, staging, everything. And then they should be able to, within our company, ask FCS, what is the educational materials about this?

What are my options? And go prepared to speak with the physician and other providers when they connect. I think that should be the evolution, then adding wearables to that, that we're connecting, upload it back to the clinic, intervening to prevent hospitalization or bad outcomes. If you want to get geeky, chips for labs at real time, we have glucose sensors already, why not sodium potassium creatinine, CRP. Know, CRP will be a powerful measure to is like a more complex HIV like.

It will be a phenomenal time when we can get all this aligned.

Doug Flora: It's going to be fascinating. They're moving into the continuous temperature monitoring. Yeah. Cool. I love the prediction because I think what I want to ask as we wind up, we got maybe five, ten minutes left.

What if it all goes right?

Lucio Gordan: Yeah.

Doug Flora: You are gonna be in charge of millions of lives soon. Right. And and give the audience maybe some hope for what that might look like because I think there's a lot of fear and loathing. There's a lot of trepidation and hand wringing that we're gonna end up with Skynet instead of Siri. Actually, they're both not that great, but Skynet's certainly worse from the Terminator movies.

I don't think that's where we're headed. I think we're headed towards a more relative abundance, earlier diagnoses, cleaner pathology, better diagnostic tools and recognition. And then as we move into 2030s, the predictive ability of somebody who, if we can record their temperature at 02:27AM while they're sleeping, and that activates an agent to initiate action, I just see the power of the possible is so unmistakable to me that if we get it right, we reduce suffering at scale, which is what we say we care about.

Sanjay Juneja: I don't even know. Do you think there's an if on top of that, or is it just a matter of when?

Doug Flora: It's when, and that's why we're doing this, Right? Because we want it in two years, not twelve.

Sanjay Juneja: Yeah. Yes.

Lucio Gordan: I think it's for sure when two years is pushing, we have to really get the boundaries warped for us to get there more quickly. Totally agree with you. So how would this look like if everything goes well? This will be a patient that potentially we can monitor ctDNA baseline, and these patients don't have visible cancer, we diagnose before it's a true cancer, right? There'll be the extreme.

Can we wipe out cancer by 2050 or 2040 if everybody has a chip that's monitored ctDNA, that's tissue agnostic, and then we do imaging and find where it is and go from there. For the patients who have been diagnosed, is going to happen beforehand, these are the folks that with sensors, chips, continuous monitoring, I think the hospitalization rate will go down significantly. ER visits will be avoided. We can have more outpatient units following these patients for a longer period of time, eight to eight, seven to seven, so that they don't have to show up. And I think we will avoid suffering because we'll be preventing the natural history of disease from going forward as it has in the last few millions of years.

Anyways, it's fascinating. I'm so excited with that.

Doug Flora: You're driving it. So this is why I wanted you to frame the rest of our series because at this point, we've probably all read Emperor of All Maladies by now. Oh, yeah. And we've moved from blood and black bile and all of this stuff. This is that next natural evolution.

It's the next force multiplier. Knew that Archimedes term, if you gave me a long enough lever and put me in the right place, I can move the world, that's called McKesson. You have a long lever. And so I love that you're leading these initiatives because I think you can iterate quickly. You can be decisive.

You can surround yourself with smart people, but you also have the vision to execute. And that's where I want to have you as the general contractor. Sure. Know? Because we did the conscience with Emily, right?

The kindest doctor on the planet. And then we moved to the architect, and now we've got the contractor who's ready to ship product. And I'm pretty excited for what happens then because I can start to see that flywheel effect, the whole Jim Collins.

Clynt Taylor: Mhmm.

Doug Flora: You know? Because we're not pushing this thing hard with our back. You know? I'm seeing with Sanjay, and we talk about this a ton because we're very close friends and we text about this every day, the conversations are shifting. It's not if, it's when, and it's not always when, it's how.

When you show proof of the positive outcomes of these things, and when Jeff talks about how we pulled it off and Emily says, This saved my patients, and in my center, it's been wonderful. I mean, the things that we're now doing with the tools that are overeating mammography or lung nodule detection or capacity management of chemo suite, those are reducing suffering at scale. And we talk about our tagline again, that's what we're doing here when we have these conversations. The honesty and the importance. We are running out.

We got five minutes left and I got to land this plane, but

Sanjay Juneja: let me If I may, I just wanna say, though, one thing I literally learned, you know, by today from Lucio is people think of there's two types of people. The people that are bullish and innovators, you know, just like super bullish on something, and then you have your responsible, methodical, disciplined. But we started this podcast talking about how everything you have built was methodical and organized and disciplined, and yet you are also the innovator. And I think whether it's tech solutions, whether it's leadership, the best, I think, most disciplined and the safest it can be adoption of innovation at the highest rate takes both of those. And I think usually we sit on one side or the other, and that's what makes you so unique.

And that's why, I think that's why you've seen that around you.

Doug Flora: But it's also why it's Florida cancer specialists. Right? And so these aren't accidents and you see this in every corporation going back to Jim Collins, the good to grade or the built to last. The difference between a Kroger and an A and P was that level of thoughtful leadership, right? Where they had their hedgehog, they had their Venn diagram of what is my passion, what drives my economic engine, and what can I be the best one or two in the world at?

You've embraced that. So as a leader, it doesn't surprise me at all when I see Texas oncology winning. It doesn't surprise me at all when Honeycutt's doing great or when you are doing great or others because it's a disciplined version of leadership that says, I'm curious. Yep. I'm a lifelong learner.

Yeah. I'm gonna add bias towards action because I think you can't just sit and think about it and study. You've got to do something.

Lucio Gordan: Yep.

Doug Flora: And that's why I want to have him on. We're going to have more leaders like Lucio. Not exactly like him. My thing I want to ask, maybe of Clint, now that you've had a half day of just soaking in this stuff, and it's not unmitigated optimism, but there's some responsibility on companies like yours to sort of design this future because you have people who are willing to institute it. How do you leave when you have these conversations?

Are you exhausted? I mean, you've No, no. I've asked Lucio, he's had a lot of Doug in his life for the last week. We've been together an awful lot lately, it is exhausting, but you will recover. Your heart rate variability will come down.

Come down.

Sanjay Juneja: That's awesome.

Clynt Taylor: No, I

Lucio Gordan: think and I

Clynt Taylor: think as as as an innovator or or someone who's been, I'm I'm by this. Certainly, energized by these conversations. I I don't think of myself as the most talented person in the world, but when you say, look, success means going and spending time with the practice and understanding the workflow, I can do the work. Our teams can do the work, right? So those are the kinds of things that are super encouraging because it is our philosophy, and I think it should be all of our innovative philosophies to really listen, to really learn, don't stop listening.

I think that especially now, and I said this earlier, where as opposed to saying, look, I've got this product, we want to fit it in somewhere. It's totally different with the new technologies we have. Now you really have the ability to morph and modify that. It really fits to the workflows and to really solve problems. So that's what's exciting.

Lucio Gordan: Yeah, no, totally. I have met brilliant people inside the system there, and I am very comfortable with their view. It's a very progressive one, and we always get to start somewhere, like whatever EMR you are, but I am absolutely confident we'll get through it. And so, I'm excited. And the other thing you said, it's our job to inspire others, newer generations.

You're a young guy. Doug is an old guy like me. That is also the theme for our series.

Sanjay Juneja: Yes.

Lucio Gordan: But anyways, inspire the new generation of leaders to maintain methodical focus on the future and outcomes. We

Doug Flora: close these episodes every single time with a nuts and bolts practical thing for the people who are listening. It's kind of our call to action, it's perfect that you ended there. I'm going to read this. Sanjay Naira writing these for every single episode, and this is a take home.

Lucio Gordan: Okay.

Doug Flora: If this is your assignment. Ask yourself one question before your next leadership meeting. Who in our organization owns the connection between the data and the patients? Not who manages the EHR, not who runs the reports, but who is the clinical leader responsible for making sure that every tool, every algorithm, every data driven decision ultimately answers the question that we started with at the very beginning of this. Is this helping the person in the chair?

Right? And that's why you're winning is because there's a clinician at the wheel. You got engaged, you learned, you studied. If your center doesn't have that person, if you can't identify who that is in your organization, it is, you found your most important hire or look in the mirror. Right?

Lucio Gordan: A 100%.

Doug Flora: Thank you all for joining us. Episode three is in the books. Look forward to episode four. It's going to be bigger and better and somebody certainly more engaging and enjoyable than Doctor. Gordan.

Love y'all.

Lucio Gordan: Thank you.

Clynt Taylor: Thank you.

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