Tennessee Oncology’s Richard L. Martin III, MD, MPH: “Equity Cannot Be Just Something We Do for a Single Day”

Tennessee Oncology, which serves patients throughout Tennessee and northwest Georgia, has named Richard L. Martin III, MD, MPH, to the newly created role of medical director for Health Equity and Community Engagement. Martin is also the new president of the Tennessee Oncology Practice Society, a state affiliate of the Association of Community Cancer Centers (ACCC). In an interview with Evidence-Based Oncology™ (EBO), Martin discussed his goals for his new role.

This interview has been lightly edited for clarity.

EBO: What are your goals and priorities in your new role as medical director for Health Equity and Community Engagement?

Martin: I am very excited about my new role. First, I want to acknowledge what a unique opportunity it is for a company to develop this role, which was the vision of Natalie Dickson, MD, our president and chief strategy officer.

Having this permanent role shows a structural intentionality to putting time, effort, and commitment to delivering on health equity. It’s also going to allow us to build capacity and longitudinal relationships with our partners. Some of the goals that I will have in this role, in alignment with our executives at Tennessee Oncology, are really best reported as domains—those being patient-centered care, where every patient can feel included; having the patients and community members as stakeholders; establishing health equity for all people—including our own employees—which means workforce culture, training, and hiring; establishing a research-to-practice pipeline; and then building out those internal medical partners, as well as community partners in order to start chipping away on social determinants of health.

EBO: As a hematologist/oncologist, what has been your experience with patients facing equity-related issues such as access to care? How will these lessons influence your work in your new role?

Martin: One of the first things that I’ve noticed is that a lot of people have an overemphasis on barriers that are outside of our control, which leads to futile thinking about being able to address accessibility. And I found in my experience working at Meharry Medical College and at National General Hospital [both in Nashville], and also through my previous residency training working at homeless shelters and other settings targeting vulnerable populations, that a lot of the barriers are local and quite modifiable.

Thinking even just recently, some of those solutions may include things like telehealth to reach remote populations; in-person interpreters or developing more multilanguage materials for patients; welcoming signage, not just for people of different cultures, but also for those of sex and gender minorities; and thinking in terms of patient and provider support tools to address social determinants of health in our workflows.

It’s why I’m really excited to be with Tennessee Oncology, which has 34 clinics and growing, and a business model about meeting patients in the communities where they live. We’re also a community practice that sees all patients regardless of insurance status.

EBO: Racial and ethnic minorities have long been associated with having worse cancer outcomes, and this gap persists despite new therapeutic innovations. What opportunities do you see regarding potential changes in how care is delivered both in and away from the clinic?

Martin: I think the first step in that question is just acknowledging its truth. Again, I was at Meharry Medical College, a historically Black college and university (HBCU), which is 1 of 4 HBCU medical schools, and affiliated with a social safety net hospital at National General Hospital, and I think from that [experience], there are a few misconceptions of people thinking that we can’t address racial disparities, especially for someone like myself who may not come from that background.

The first misconception is that gaining trust and rapport in the community is a nearly impossible feat. And in my experience, it actually only took me maybe 3 to 6 months, but the key was showing up day in and day out. And the mantra that I often reflect on is people don’t care how much you know, until they know how much you care. And caring for people is really about consistency and showing up for them day in and day out.

Misconception No. 2 is that we shouldn’t treat people differently, that somehow doing that goes against our principle of equality. But I’ve often found that embracing differences, respecting differences, and actually tailoring care plans that are aligned with those differences, can provide better care to folks. And in thinking about how some of those human traits could impact care plans, think about preferred days and weeks for people with 2 jobs, nights and weekend contacts, or having after hours contacts for people who don’t have English as their native language; helping with other barriers to appointments or treatment adherence; and then even thinking in terms of overall health and coordinating with mental health services, primary care services, and other community services. So, all these things play a big role in care, and I think just you have to walk the walk of meeting people comprehensively.

EBO: What factors should be considered in designing and implementing strategies that aim to improve health equity at the community level?

Martin: First, I think we have to acknowledge that while it’s really exciting that the medical community, and more specifically oncology, is now entering into this space, and championing health equity as a cause, the space is not new. There are a lot of people who have been trying to tackle this for a long time. So, instead of reinventing the wheel, we should be listening to people who have been leaders in this space.

Secondly, again, the community and patients need to be stakeholders. Developing things like community advisory boards, whether as a research instrument or even standard of care, is essential and [we must] put those voices on boards of directors, too. As I mentioned before, cultural shift is not just about patients, but also your employees. So, workplace culture, respect in the workplace and representation, even career growth and pipelines for people from historically disadvantaged backgrounds within your company are critical.

I would say you always need to provide something of value. That is the key difference between health equity and disparities. I think a lot of the work that we’ve been doing in this space for the past decade is really about defining disparities, and we need to make sure now that we know these disparities exist, if we’re going to do anything moving forward, we have to address those disparities, which takes action and takes providing something of value to the community.

And lastly, I’ve said this many times over—commitment over the long term and consistency—that is key. Equity cannot be just something that we do for a single day, or for a PR campaign, and then go about our day in the status quo. This has to be a permanent change in how we are addressing health care.

EBO: How about policy reform? What challenges do you see in cancer specifically, and how do you envision Tennessee Oncology’s involvement in advancing health equity at the state level and nationwide?

Martin: We definitely need to walk and chew gum at the same time and address many of these underlying policies that perpetuate the status quo. While I said before that so many barriers are local and modifiable, we need to be thinking of the big picture at the same time. I think some of the biggest challenges moving forward are how do we design policies, particularly around payment or reimbursement, that incentivize companies and providers for doing the right thing, especially for historically disenfranchised people.

We also need to connect policies that reward value-based care or cost efficiency to open up monetary space for those companies to then use those funds to do good work in the communities and to develop health equity campaigns. There is some progress in this space; alternative payment models, like the Oncology Care Model and Enhancing Oncology Model, are increasing their layers of accountability for quality of care metrics, health equity metrics, social determinants of health metrics.

It’s still in early iterations. Most of these are just holding practices accountable for having a plan, but we need to watch this space because I think more is to come on actually holding folks accountable for delivering on those plans.

Lastly, to any provider that works in academia and community practice, anywhere, be an advocate….Things move forward because of consistency. Policy is an endurance race, and you have to remain at the table.

[In] my other role as president of the Tennessee Oncology Practice Society, which is an ACCC affiliated state society, we’ve been working on policy at the state level for quite some time now and been championing some pretty big wins in pharmacy benefit manager (PBM) reform and telehealth. The upcoming docket has some really exciting things in terms of women’s health that overlap with oncology care, as well as prior authorization reform.
So, these things are all aligned, but at the end of the day, there are still so many things that we can do outside of policy for our practices, in our community, in our clinics that can champion the cause of health equity.

EBO: Any other thoughts you would like to share?

Martin: Just that it’s time to have these conversations with your colleagues, executives, and patients in the community. I think there’s a lot of fear about getting egg on your face or not being eloquent in the way you speak about this. But honestly, people forgive you for being genuine, for being passionate, and that’s how you learn anything.

I think back to when I started medical school, and having to present on patients, you’re going to have missteps and you’re going to have fumbles in front of other people. And I think the further along we get in our medical careers, the more we don’t want to experience that again—we feel like we’ve paid our dues. But this is a really important topic, and it’s going to take people feeling uncomfortable again in order to learn and grow and to create a medical community where we can build some momentum behind health equity. I think there are exciting things ahead.