From Alzheimer’s Research to Rural Care at Banner Health

00:00:19:07 - 00:00:44:25
Chris DeRienzo, M.D.
Hi, this is Dr. Chris DeRienzo, the chief physician executive of the American Hospital Association. Welcome back to Advancing Health. We've got a really interesting conversation today with a colleague of mine at Banner Health. Joining us on the podcast is Dr. Corey Casper. He's the senior vice president and chief research officer, the inaugural chief research officer at Banner Health and also a professor of medicine and clinical translational science.

00:00:44:25 - 00:01:02:21
Chris DeRienzo, M.D.
I had to try that one. I had to practice it a couple of times to get it right. Professor of medicine and clinical translational science at the University of Arizona. And we are very lucky to have him on the podcast today to talk about some of the interesting work they're doing to integrate research findings into a large community health system.

00:01:02:21 - 00:01:05:07
Chris DeRienzo, M.D.
Corey, thank you so much for being on the podcast.

00:01:05:13 - 00:01:10:14
Corey Casper, M.D.
What an incredible mouthful to begin with. But thank you for having me and I really look forward to our conversation.

00:01:10:19 - 00:01:28:21
Chris DeRienzo, M.D.
Well, you know, I think it would be helpful, for starters, to just help our listeners understand the arc that brought you out of what I might describe as a more traditional background in academic medicine into this unique partnership that Banner has with its academic partner at University of Arizona.

00:01:28:27 - 00:01:49:14
Corey Casper, M.D.
Yeah, thanks for asking that question. You know, there's a dirty secret, which is that every single healthcare worker working in the United States right now essentially has to come through an academic medical system to get to where they are. It's the way you become a health care worker. And so we all are very used to a very traditional academic medical system, and it works really well for lots of things.

00:01:49:15 - 00:02:23:27
Corey Casper, M.D.
I mean, it's incredibly the best in the world for training healthcare workers. It's exceptional at generating great research and often it's the source of amazing care. So when the model works well, it's incredible. I think what I was seeing in my career, after almost 25 years in a very traditional academic medical setting, is that there are increasing pressures and strains on that traditional model that make it more and more challenging to translate the incredible research that we're doing into teaching, and, more importantly, to every patient who needs to access care in this country.

00:02:23:28 - 00:02:38:13
Corey Casper, M.D.
You know, we're in such a golden age of research where research findings are accelerating and becoming so much more impactful, but getting them to every patient that needs them. And that's why I was so excited about the opportunity to join Banner as their first inaugural chief research officer.

00:02:38:14 - 00:02:52:07
Chris DeRienzo, M.D.
Let's build for a moment on what exactly does Banner look like? Many of our listeners might not be familiar with the reach of Banner as a health system, much less the nature of its partnership with your academic partner.

00:02:52:09 - 00:03:12:20
Corey Casper, M.D.
It's a great question. I wasn't familiar with all of the ins and outs of Banner either before joining about a year and a half ago. So Banner Health is an integrated healthcare delivery system, and we're one of the largest in the country. So we operate 33 hospitals, literally hundreds of clinics. We are the largest employer in the state of Arizona, employing over 65,000 individuals.

00:03:12:20 - 00:03:40:21
Corey Casper, M.D.
And we reinvest $1 billion a year back into our communities as a nonprofit healthcare delivery system. So it's a very large, very unique system that's run incredibly well. The way that we provide high quality care to so many people in so many areas, rural areas, urban areas, at our partner referral hospitals, you know, at our rural referral hospitals is through highly standardized, highly quality driven care.

00:03:40:24 - 00:04:05:09
Corey Casper, M.D.
You know, that is the hallmark of what we do at Banner, and that's all incredibly exciting. But what really attracted me as our chief research officer was kind of taking that next step. So, sure, we have 1.2 million patients under care. We have large health care system that is integrated with an insurance plan, as well as with ownership partly of Quest Labs in our region.

00:04:05:09 - 00:04:35:21
Corey Casper, M.D.
And so a truly integrated system of data that you could really begin to make some important observations using research about health outcomes and how to improve them. But what was really exciting too is some of the traditional partnerships that we've had for many years. So for over a decade, our academic partner has been the University of Arizona. So it's two colleges of medicine in Phoenix and Tucson are our partners in our delivery, and we oversee all of the clinical and translational research at the University of Arizona.

00:04:35:21 - 00:04:54:14
Corey Casper, M.D.
And we partner with them to deliver care and to train the next generation of healthcare workers. So it's an incredibly strong partnership. We're also, I think and I don't know this for sure, but I think we're one of the only, if not the only, large health care delivery system that's partnered with two NCI designated comprehensive cancer centers.

00:04:54:16 - 00:05:15:07
Corey Casper, M.D.
So the University of Arizona has a comprehensive cancer center in Tucson. And then we partner with MD Anderson in Houston to provide our cancer care in all regions other than Tucson. So it's an incredible embarrassment of riches that we have in terms of our partnerships. And that's really one of the things that hallmarks, you know, what makes us so successful.

00:05:15:09 - 00:05:48:04
Chris DeRienzo, M.D.
Well, let's build on those partnerships and to help our listeners understand, given the footprint that you've described, with a huge reach across 33 hospitals into the communities, but also this this fairly robust research pillar that you that you now lead. How are you bridging that gap from the discoveries that happen in labs, you know, at Banner. But all over the country, this bleeding edge of research with a community health system that is using your words, they're reaching 1.2 million patients a year.

00:05:48:04 - 00:05:55:03
Chris DeRienzo, M.D.
That is that is not a small gap. And my guess is the translational part of your title is exactly where that lives.

00:05:55:06 - 00:06:13:00
Corey Casper, M.D.
Yeah. Thanks so much. So there's three ways that I think we really try and address taking the research gains that we make and translating them to every single patient that we have. And I'll talk about these three ways and give you some examples because I think they're really quite exciting. So first and foremost our research is really focused or strategic.

00:06:13:00 - 00:06:37:18
Corey Casper, M.D.
So, you know, having been at the University of Washington, trained at the University of California, San Francisco, you know, went to medical school at Cornell, at New York Hospital. These are huge academic health systems that well, reputed and really do lots of things really well. I'm not saying that we don't, but for an organization that's primarily a healthcare delivery organization that also does some very good research, it's really important to focus.

00:06:37:18 - 00:06:57:04
Corey Casper, M.D.
So one of the first things that we really did was to think about where are those areas where we're making unique contributions and unique contributions within our region that really benefit our patients, but we can also learn from those patients. And so obviously, we operate our headquarters is in Phoenix, Arizona. We operate out of the southwest. Before coming to Phoenix

00:06:57:04 - 00:07:14:04
Corey Casper, M.D.
I often thought that, you know, Phoenix was sort of the home of some of the oldest people in the country, but that's actually not true. I learned that our median age is actually not that dissimilar from New York or other cities, but we do definitely have a bimodal distribution where we have many elderly people and many young people.

00:07:14:07 - 00:07:40:19
Corey Casper, M.D.
So a lot of our research is focused on diseases again in our patient population. So what are the diseases that are common that we focus on? We have a huge program in neurological diseases, especially memory and movement disorders because that's a huge problem in our region. As I mentioned, we have two large, you know, partnerships and a large research program in cancer because, you know, oncology is a critical portion of our part of the world. Cardiovascular disease,

00:07:40:19 - 00:08:04:22
Corey Casper, M.D.
so, you know, again, a disease that's often associated with aging, but structural heart disease, rhythm disorders and coronary heart disease. Fourth is our programs and orthopedics. Again, you know, our bones are what tend to fail us as we start to get older. And so we focus on how to keep them healthy and rehabilitate them when they're not. And then lastly, we have a very large program because of our breadth and transplantation.

00:08:04:22 - 00:08:22:21
Corey Casper, M.D.
And so how do we sort of make sure that these gains that we're making in transplantation are available to everyone? So first one way we just make sure that our research is getting to as many people as possible is we focus on the areas in our region and in those areas that we think can be applicable to the world.

00:08:22:25 - 00:08:43:18
Corey Casper, M.D.
The second way that we really do this is that we are laser focused, like our like, mission in the world right now is to think about the types of research that will change the practice of medicine. What we're really good at is protocolizing and standardizing the practice of medicine. So if we can define a best practice we can get that out there.

00:08:43:18 - 00:09:05:12
Corey Casper, M.D.
And so our research is laser focused on that. And I'll give you a couple of examples. So we have a preeminent Alzheimer's Institute, probably one of the best in the world. Scientists that are Alzheimer's Institute helped to develop one of the first blood tests to early detect Alzheimer's disease. We're very much, in part, developed and finalized or finished at Banner.

00:09:05:14 - 00:09:35:04
Corey Casper, M.D.
Terrific. Like wonderful that there's a blood test that's available. But what we then recognized is that still there's gaps in people's ability to get this test. So our researchers took it a step further. What if you could develop a device that would collect a small sample of blood at home and allow that blood to be shipped to a central laboratory where you can get a test for dementia that is as accurate right now as a spinal tap and as a, you know, MRIs that you used to need to get PET scans to diagnose Alzheimer's disease.

00:09:35:06 - 00:09:55:14
Corey Casper, M.D.
That test can now come to your home. So we've now allowed that test to go to people's homes in all sorts of rural parts of Arizona, and even a collaboration in rural parts in sub-Saharan Africa. So it's a great example of how we take technology, we develop new technology and make it fit for purpose. But more than that, we find a way to democratize it.

00:09:55:14 - 00:10:20:09
Corey Casper, M.D.
So we find a way to get that technology to every person who needs it. And I'll take that example one step further. We had a huge NIH grant to develop an imaging center where we actually developed some of the first ways PET scans to image people's brains, to look for dementia and other memory disorders. Fantastic. But very few people can travel to our quaternary care hospital, to our premier research clinic and get that test.

00:10:20:09 - 00:10:51:01
Corey Casper, M.D.
So what did we do? We worked with some other investigators in the Phoenix region from some of our collaborating institutions, and we came up with - it sounds crazy - but essentially behind a little RV, we were able to build this thing that kind of looks like a portable pizza oven, and it's a portable MRI machine. And this machine to rural communities throughout the southwest and offers people the ability to get scans, brain scans, to diagnose and to prevent deterioration in brain health.

00:10:51:01 - 00:11:00:15
Corey Casper, M.D.
So, again, a way that we're taking the research we've made at a sort of highly specialized referral center and making sure they're available to every person out there.

00:11:00:18 - 00:11:20:24
Chris DeRienzo, M.D.
And to me, these are examples that highlight exactly the connection we're trying to lift up. You know, there are only a handful of academic medical centers in America relative to the 6000, I think 51 at last count, total hospitals in the country. But I've seen this strength in community health systems of getting to execution. And in the communities they serve,

00:11:20:26 - 00:11:29:00
Chris DeRienzo, M.D.
what I'm hearing you describe is a model that really links the leading edge of research with the populations who can most need it.

00:11:29:01 - 00:11:30:08
Corey Casper, M.D.
That's exactly right.

00:11:30:09 - 00:11:33:26
Chris DeRienzo, M.D.
I want to make sure we get to your third. And so what's the third one?

00:11:34:02 - 00:11:55:25
Corey Casper, M.D.
Yeah. So the third thing that we're doing is we're trying to make sure that we can do this research as quickly and efficiently as possible. Now, why is that important? I mean, I'm sure, you know, with you doing the work that you do, you speak with a lot of people. And I'm sure you've heard a lot about all of the medical research now in the United States, funding cuts, changes in priorities, changes in the regulatory landscape.

00:11:55:26 - 00:12:18:07
Corey Casper, M.D.
It is not an easy road to navigate right now. But one thing that is really clear is that given all of those uncertainties and given the challenges, you need to have a laser like focus on the research that you do and you need to do it efficiently. What we've done is we've really established a new program to rapidly open clinical trials and have them available to our to our patients.

00:12:18:08 - 00:12:39:00
Corey Casper, M.D.
We are working towards a goal of getting new clinical trials open within 40 days of being approached by a sponsor. Like, that's incredible. Like, if we can do that, and we're making, you know, we've already reduced the time to activating a clinical trial at Banner fourfold. So we're making huge strides towards that. But it's such a simple example of something that we take for granted,

00:12:39:01 - 00:13:05:20
Corey Casper, M.D.
right? Like if, if our value proposition in the world as being a, you know, a health system with a strong academic partner and doing academic clinical research, if that's our value proposition, then we've got to get these studies to the patients who need them by doing them quickly and by doing them as distributably as possible. So right now, our research, we don't just do at our primary quaternary referral hospitals, we do them across our network.

00:13:05:20 - 00:13:22:14
Corey Casper, M.D.
So if you're in Northern Colorado and you're at one of our more rural sites, you have that same access that someone in downtown Phoenix has. And so to us, that's a model of research that we feel like truly will be able to bring the gains that we're making in medical research now to every patient and needs them.

00:13:22:16 - 00:13:45:06
Chris DeRienzo, M.D.
Corey, this has been a spectacular conversation. If I could read back what I'm hearing, I think your combination of focus, of depth and of reach is really what's driving this translation of research out into the 1.2 million patient community who you serve at Banner. Again, most folks on our podcast or listening to our podcast aren't going to be based in an AMC.

00:13:45:06 - 00:14:12:08
Chris DeRienzo, M.D.
So my last question for you. We've only got about a minute or two left, and I'd love to ask it of everybody who I get to interview for our show is if you had one thing that you would hope our listeners take away that they can bring back to possibly their rural hospital in Mississippi or in western Oregon and say, I want to help my home get better at translating this cutting edge research to reach my communities.

00:14:12:08 - 00:14:19:02
Chris DeRienzo, M.D.
What guidance would you give them? What first step should they take after they finish listening to our conversation?

00:14:19:04 - 00:14:43:24
Corey Casper, M.D.
Such a great question. I mean, I have an easy answer to that. I think we overcomplicate research, right? We think about it as a as a highly falutin academic exercise that is often frustrating and inaccessible to many. But research is simply the process of sitting at the bedside, recognizing a question that's important, and asking the question in a way that's answerable, measurable, and impactful.

00:14:43:26 - 00:15:08:10
Corey Casper, M.D.
If your eyes are open, if you see the problems that you're confronting at your health center, no matter how big or how small, single bed, clinic, hospital, tiny clinic, whatever it is, find a way to ask and answer those questions because it'll be to the benefit of your patients. And there's lots of people out there, whether they're at large academic medical centers or whether it community networks like ours that are there to partner with you.

00:15:08:10 - 00:15:22:13
Corey Casper, M.D.
So keep your eyes open. Look for those questions that present to us every day as clinicians. Ask those questions and find ways to answer them efficiently, impactfully. Because all of our patients and all the world will benefit from it.

00:15:22:15 - 00:15:28:28
Chris DeRienzo, M.D.
Corey, thank you so much for joining the podcast. Listeners, thank you for tuning in. This has been a lot of fun.

00:15:29:01 - 00:15:37:24
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.