Over the last decade, remarkable progress has been made in cancer treatment, particularly with the introduction of CAR T-cell therapy. This cutting-edge treatment has opened new possibilities for patients with certain types of blood cancers, such as leukemia and lymphoma, offering hope where few options once existed.
Despite its transformative potential, implementing CAR T therapy and other advanced cancer treatments poses significant challenges for healthcare providers. These challenges include developing robust systems for patient communication, coordinating care across teams, streamlining billing processes, and maintaining a sharp focus on patient safety and operational efficiency.
At the forefront of addressing these challenges is Dr. Mohiddin Lone, a seasoned healthcare leader with expertise in process improvement. Based at City of Hope National Medical Center—one of the nation's leading cancer care institutions—Dr. Lone has played a pivotal role in the successful implementation of CAR T therapy.
Dr. Lone's extensive experience in healthcare management, coupled with his skills in process optimization and project leadership, has enabled him to tackle these complexities head-on. His career reflects a steadfast dedication to enhancing patient care and outcomes through strategic initiatives aimed at reducing wait times, improving operational systems, and elevating the overall patient experience.
Known for his collaborative approach and ability to navigate complex healthcare systems, Dr. Lone has become a respected leader in his field. His ability to unite diverse stakeholders and drive innovation has been instrumental in advancing CAR T therapy at City of Hope, benefiting patients and solidifying the institution's role as a trailblazer in oncology care.
Building the Foundation for CAR T Therapy
When CAR T therapy first received FDA approval, the City of Hope (COH) emerged as one of the earliest institutions authorized to administer this groundbreaking treatment. Driven by its proprietary technology and its robust involvement in preclinical and clinical programs targeting hematologic cancers and solid tumors, COH was uniquely positioned to lead the charge in making CAR T therapy accessible to patients. Collaborating with other institutions and companies, COH sought to advance this vital clinical research area while ensuring its therapies reached those in need.
Dr. Lone played a pivotal role in readying the institution for CAR T implementation. As part of a multidisciplinary leadership team, he orchestrated the operational rollout of the program by meticulously documenting the patient journey from start to finish. "We led the innovative process of operational readiness and infrastructure development for the first CAR T-cell therapy," Dr. Lone remarked, emphasizing the attention to detail that went into the program's design.
A critical component of this effort involved building an integrated EPIC infrastructure to support streamlined care delivery across the healthcare ecosystem. Dr. Lone highlighted the importance of this system, noting, "It ensured timely, uninterrupted communication between different areas of healthcare and communicating timely information to patients." This infrastructure not only facilitated coordination among key stakeholders, such as schedulers, nurses, pharmacy staff, and billing teams but also laid the foundation for seamless, patient-centered care.
By addressing every facet of the patient experience and creating robust communication channels, Dr. Lone and his team ensured the successful launch of the CAR T program. Their work underscores the significance of comprehensive infrastructure development in bringing innovative therapies from concept to reality, ultimately setting a new standard in advanced cancer care.
Scaling Life-Saving Solutions
Integrating CAR T therapy into a clinical setting came with significant challenges, given the innovative and unprecedented nature of the treatment. "There was no precedence of any relevant treatment, so everything was new," Dr. Lone explained. To navigate this, he and his team established a leadership group and steering committee to guide the process. This approach ensured that communication cascaded effectively to staff across different departments, creating clarity in roles and responsibilities.
The tight timeline for implementation added complexity. With just a few months to prepare, Dr. Lone's team adopted an agile approach, simultaneously onboarding patients while building the necessary infrastructure. This required collaboration with physicians and IT leaders to develop CAR T-specific tools, such as smart forms tailored for various treatments. Despite the pressure, Dr. Lone emphasized the importance of creating a robust structure from the outset to ensure operational efficiency and patient safety.
Another major hurdle was the high cost of CAR T therapy and the lack of established insurance guidelines. To address this, Dr. Lone began engaging insurance providers early in the process to develop payer contracts, ensuring that coverage options were available. For cases where insurance support was unclear, philanthropic funds were strategically utilized to help patients access the treatment.
Collaboration across departments was critical to overcoming these challenges and scaling access to CAR T therapy. "We created a cross-functional leadership team and established clear goals of developing a seamless process flow for patients," Dr. Lone shared. Regular meetings, defined milestones, and tools like project management platforms and SharePoint ensured accountability and progress tracking. By setting mechanisms for stakeholder feedback, the team maintained alignment and addressed issues in real time, enabling the efficient rollout of this life-saving therapy.
Driving Innovation in Gene Therapy
The administration of CRISPR-based gene-editing therapy requires a highly specialized skill set, particularly in stem cell transplantation and cellular therapy. According to Dr. Lone, "City of Hope (COH) has established itself as one of only a few top cancer hospitals with a well-reputed stem cell transplantation program," making it uniquely positioned to take on this groundbreaking treatment. With its existing infrastructure and expertise, COH was selected as one of the few authorized treatment centers (ATCs) in the US to offer CASGEVY, the first CRISPR-based gene-editing therapy approved by the FDA for sickle cell disease (SCD).
In December 2023, CASGEVY received FDA approval, opening the door to a one-time transformative treatment for approximately 16,000 eligible SCD patients. As Dr. Lone highlighted, "The Children's Cancer Center at COH became the only authorized treatment center (ATC) to offer the first CRISPR-based gene-editing therapy across the West Coast." This achievement not only underscores COH's leadership in advanced therapies but also demonstrates its commitment to bringing life-changing innovations to patients who need them most.
Establishing Sustainable Systems for Better Care
To support the financial and operational aspects of advanced therapies like CAR T and CRISPR, Dr. Lone spearheaded the creation of an EPIC-based infrastructure that tracks patients throughout their treatment journey. "The EPIC infrastructure created based upon the patient end-to-end journey helps track patients along the journey of active treatment," he explained. With treatment timelines often spanning over three months, this system integrates all hospital charges—both professional and institutional—into a unified Hospital Associated Receivable (HAR). Once treatment concludes, the billing team consolidates patient accounts and generates claims for payers, enabling timely billing and revenue collection while ensuring transparency and efficiency.
City of Hope's growing expertise in managing these therapies has also positioned it as a hub for expanding access to cutting-edge treatments. Since the initial rollout of CAR T therapy in 2018, patient numbers have risen dramatically, growing from just 11 patients to 231 in 2023. Dr. Lone highlighted the institution's dual role in providing FDA-approved treatments and offering clinical trials: "In addition to commercial CAR T, hundreds of patients continue to benefit from clinical trials that are either developed by COH scientists or in collaboration with other centers." These trials extend life-saving opportunities to patients and allow the organization to remain a leader in innovation.
Looking ahead, City of Hope is poised to replicate this success with CRISPR-based therapies, further solidifying its reputation as a center for novel treatments. "COH has lived up to its expectations by delivering huge numbers of CAR T treatments and now looking to do the same with CRISPR therapy programs," Dr. Lone remarked, emphasizing the institution's readiness to scale access and serve more communities. By maintaining a forward-looking approach, the City of Hope continues to expand its reach, ensuring that advanced therapies become more accessible to patients who need them most.
Transforming Lives with CAR T and CRISPR
Since the launch of CAR T therapy at City of Hope, over 800 patients have received this life-saving treatment. For many, CAR T represents a final chance offered only to those who have exhausted all other options. "CAR T is the last hope and only given to patients who have exhausted all other treatment options," Dr. Lone explained. Its impact has been profound, saving thousands of lives while extending life expectancy and significantly enhancing the quality of life for patients facing advanced cancer diagnoses.
Patients and their families have expressed deep gratitude for the transformative effects of this therapy. Dr. Lone reflected on the overwhelming positive feedback, noting how families have shared their appreciation for the new lease on life that CAR T therapy provides. While CRISPR-based therapies are still in their early stages at City of Hope, Dr. Lone is confident in their potential, stating, "We have no doubt that this treatment will also save thousands of lives." These advancements not only offer hope to those in dire need but also exemplify the power of cutting-edge science to redefine possibilities in cancer care.
The implementation of CAR T therapy at City of Hope marks a transformative achievement in healthcare, offering patients life-saving treatments that were once out of reach. It is a story of perseverance, innovation, and an unwavering commitment to patient care. Leaders like Dr. Mohiddin Lone exemplify the bold vision required to drive advancements in cancer treatment, leaving a legacy that continues to bring hope and healing to countless patients and their families.
Disclaimer: The medical information provided in this article is for educational purposes only and is not intended as a substitute for professional advice, diagnosis, or treatment. Please consult a qualified healthcare provider for any questions regarding a medical condition.
