An NCI-designated Comprehensive Cancer Center
By Abe Rosenberg | May 4, 2018
Breakthroughs - Joseph Alvarnas 256x256 Joseph Alvarnas, M.D.
“I’m a storyteller.”
It’s a pretty unusual way for a doctor to describe himself. 
But for Joseph Alvarnas, M.D., stories play a key role in how he sees the medical profession, his role in it, and even why he became a physician in the first place.
At City of Hope, the veteran hematologist/oncologist wears so many hats — director of value based analytics, director of clinical quality of the leading-edge City of Hope Alpha Clinic and senior medical director of a growing City of Hope clinical network — one wonders how he navigates what must be a daily excursion through chaos.
“There is no ‘typical’ day,” he said with a smile. Rather, each day unfolds as “a living, breathing narrative that reframes in real time.”
He craves those narratives and they energize him, both as a physician totally devoted to his patients, and as a powerful advocate for better, more efficient and affordable health care, a "big picture" guy equally capable of shaping policy or soothing a worried patient’s nerves.

The Power of Storytelling

For as long as he can remember, Alvarnas has been drawn to the power of the human story.
The son of Portuguese immigrants, Alvarnas could barely speak English until he was 5 years old, though by age 3 he already knew he wanted to be a doctor. No one at home had much formal schooling, but they had stories, and Alvarnas drank them in.
“My dad was a janitor,” he recalled. “He had maybe a 4th grade education. But he had amazing friends, including one who was a Tuskegee Airman, and they were always telling great stories!”
In college, Alvarnas gravitated to classic literature, especially Shakespeare. But he also felt the pull of the science lab, and he realized that a career in medicine would “exercise both parts of my brain.” He considered pediatrics and psychiatry but chose to focus on cancer, which, he felt, could be “knowable and navigable on a deep level,” plus he relished the opportunity to involve himself in the uniquely long and deep stories typical of cancer patients.
And that involvement, say his colleagues, is a sight to behold.

The Human Connection 

“He’s exceptional,” said fellow hematologist Guido Marcucci, M.D. “He’s very professional but also very giving, down-to-earth. He connects on an emotional level. He’s an extremely nice person.”
Patients agree. It’s not unusual to see comments like “best doctor I ever had” on the many ratings and review sites. Nor is it unusual for those relationships to transcend the hospital.
“Many times,” said colleague Michael Rosenzweig, M.D., who considers Alvarnas both a friend and mentor, “Dr. Alvarnas has told me with pride the accomplishments his patients have achieved both during and after their treatments, (like) returning to work as a police officer or more personal achievements like having a child.”
Alvarnas said it works both ways.
I’m empowered by listening to patients," he said, "hearing their goals, their fears, what fulfills them.”
As for what fulfills him, it’s simple: “To come to work and know that what you do matters, and changes people’s lives.”

The Cost of Care

That’s one reason why this storyteller/hematologist is so excited about the tremendous potential of CAR T cell therapy, which re-engineers a patient’s immune cells to destroy cancer. Two FDA-approved CAR T cell treatments, one for leukemia, the other for lymphoma, have already reached the market, and hundreds of patients are enrolled in clinical trials for future drugs. The results so far, said Alvarnas, would have been “unimaginable” just a few years ago.
But this narrative has a down side. Modern medical miracles like CAR T cells carry a prohibitive cost, which Alvarnas said “incentivizes undertreatment,” and threatens to push leading-edge medical care beyond the reach of too many people. 
We must deal with financial toxicity,” he asserted. “A diagnosis of a life-threatening illness should not end in financial death.”
That’s where value analytics comes in. 
Alvarnas envisions a total rework of the health care system, moving away from the old approach of charging for each individual procedure, in favor of  “the long game:”
“The idea,” he said, “is to get people focused on doing the right thing, instead of just the transaction and the unit price.
Ultimately the goal is to take the patient from diagnosis all the way to restoration of wellness. How do you value that? Right now our medical language doesn’t capture that complexity. Nor have we figured out the value structure for innovation."

The Complexity of Cures

But Alvarnas has captured that complexity. In fact, he’s mastered it. And he never passes up an opportunity to wax expansive on the subject. Nevertheless, persuading doctors, hospitals and insurance companies to give up their old, highly profitable models is a tough task. Can he do it?
His friends are betting he can. They’ve seen him in action.
“He won’t tell you, but we know how intelligent he is,” said Marcucci, who wasn’t the least bit surprised to learn that the affable Alvarnas’s favorite Shakespearean character is the Fool (from "King Lear"). “He’ll joke around, laugh with everybody. But through his humor he reaches you and gets his truth across. Don’t fool with the Fool!”
“He has a unique approach and it’s extremely necessary,” continued Marcucci. “Plus, he has innate leadership skills and a very clear vision. He’s one of the very few who truly understands how we need to change the health care system in order to deliver first-class care at an affordable cost for patients, institutions and payers.”

Access to Excellence

Alvarnas also preaches accessibility, working to bring top-level care to patients beyond the main City of Hope campus in Duarte, California. He’s passionate about growing the City of Hope clinical network, now numbering 29 locations in Southern California, across Los Angeles, Ventura, Riverside, Orange and San Bernardino counties.
“We need to get this right,” he said. “We need to bring City of Hope care to those who would otherwise be disenfranchised. It’s about aligning all that matters to patients. We don’t exist in isolation. To be relevant, we have to be present.”
Being “present,” he said, means more than just showing up. Doctors must connect with the patients and communities they serve, and that includes embracing and respecting different cultures.
In other words, pay attention to patients’ stories.
The best health care is a partnership, not paternalistic,” he said. “Science alone won’t save us. It won’t be enough unless we link it with the human experience. We must never be tone deaf to human nature.”

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