As many cut costs, City of Hope CEO focuses on value

With many health systems seeing more financial pressures, organizations are looking for ways to cut costs.

Robert Stone, CEO of City of Hope, understands the need for fiscal discipline. But he tells Chief Healthcare Executive® that cutting costs isn’t the only answer.

In Stone’s view, the focus needs to be on giving patients more value.

“I talk to too many organizations and frankly, too many policymakers. The answer is, cut costs, cut costs, cut costs,” Stone says. “There is an obligation to be efficient in your costs, infrastructure. … That's always been there. Maybe it's a little more intense now. But you're not going to cut your way to providing the best value for patients. You have to reexamine how you provide care.”

The goal of giving patients more value and more opportunities for care led to City of Hope’s acquisition of the Cancer Treatment Centers of America, which was finalized in 2022. City of Hope also opened a new hospital in Orange County, California in December.

Across the country, hospitals and health systems are facing the prospect of Medicaid cuts in the coming years. Millions of Americans are projected to lose coverage, and the Congressional Budget Office has forecast $1 trillion in reduced Medicaid spending over the next decade.

• Read more: Over 400 hospitals at risk of closing due to Medicaid cuts, report says

Stone acknowledges that there will be challenges with Medicaid cuts in the coming years.

“I don't want to leave you with the misimpression that we aren't focused on cost,” he says. “You can barely pick up a publication or bring one up online without reading about such-and-such health care system cutting costs and making labor decisions. I don't want you to leave with the impression that we don't focus on that, because we do. We have an obligation to be good stewards to our patients, good stewards to our donors.”

And Stone stresses the increased importance of fundraising.

“Philanthropy is a huge part of City of Hope,” he says. “We were founded by philanthropists. It funds so much for us today. It's really important.”

But as City of Hope looks ahead, Stone returns to the concept of getting more value for patients.

“First and foremost, for me, getting back to defining what value really is in the eyes of a patient, and then designing a system that doesn't start with: What's the cost and how do we back into what we can do for the patient? Let's start with what the patient needs, and then figure out how we provide the best costs and the best value add for those patients,” he says.

Stone says patients deserve better than a healthcare system that may or may not offer the best care, based on what the patient can afford.

“It's just wrong,” he says. “Nobody would design a system that way.”

And he notes that higher costs make it harder for cancer patients to get the treatment they need.

“Even small increases in co-pays make people defer treatment,” Stone says. “And in cancer, ‘wait’ is a four-letter word. Patients need to get in. Their best chance of survival is getting in early.”

So Stone circles back to patients battling cancer and what they need, and focusing on getting the right treatments at the right time.

“They define value by survival, by giving the life they had before diagnosis back to them by how they're treated, the support that they're given,” he says.

Outside of City of Hope, Stone says the health system wants to change the conversation about access to health care.

Stone says, “We have an obligation to engage in the public discussion and the public dialogue around, how do you create access? How do you pay for access?”

City of Hope joined coalitions in California and Illinois that led to the passage of legislation outlining patients’ “Bill of Rights” in terms of access to care.

Stone also pointed to the passage of the California Cancer Care Equity Act, which Gov. Gavin Newsom signed in 2022. The legislation specifies that patients with complex cancer have the right to a second opinion at an academic center that has access to the latest therapies.

“It's really putting the patient first and doing it, not just in your own organization, but doing it as a society,” he says. “We're going to have to, as a society, ask the questions of, what do we value most, and how are we going to put our dollars to the best effect?”