Barnes-Jewish Hospital
Navigating The Future Of Neurodegenerative Disease Services
Alan Dow, Director,
What are your key Roles and Responsibilities at Barnes-Jewish Hospital?
As the service line director for Neuroscience at Barnes- Jewish Hospital, part of the BJC Health System, I am responsible for strategic planning, new program/ business development, performance improvement, finance and the implementation of multi-disciplinary strategies across the care continuum. Working collaboratively with our Washington University Physicians partners and hospital clinical leaders, I identify and establish long- and short-term strategies relating to Neurology, Neurosurgery, Neuro-Oncology, and Neuro/Ortho Spine services across all hospital-based sites of care to expand treatment and service offerings to the patients we serve.
What are the major areas of growth opportunity you see in the neurodegenerative disease space?
It is an exciting time in the field of neurodegenerative diseases, with new therapies arriving on the market faster than we have ever seen before. Over the past few years, we have seen the first FDA-approved treatments for Alzheimer’s that have been shown to slow disease progression, and I had the privilege of leading our
operations team through the roll-out of Leqembi therapy for Alzheimer’s across our system. Together with Washington University, we now have one of the largest Alzheimer's treatment programs in the country, with more than 160 patients on Leqembi and more than 200 patients being evaluated for treatment. Given the substantial demand this therapy puts on system resources, implementing the Alzheimer’s infusion treatment was one of the most challenging and rewarding projects I have worked on in recent years. This treatment puts huge demands on imaging, infusion, and clinic platforms that require multi-disciplinary partnerships across the continuum to bring this therapy to our patients.
Building strong relationships with your physicians – especially your neurologists – is key to being prepared for what is coming through the pipeline in terms of novel treatments in such a dynamic sub-specialty
Another exciting area of opportunity was bringing high-frequency focused ultrasound to our region for the treatment of essential tremor and tremor-dominant Parkinson’s disease. Adding an outpatient-only treatment modality into our functional neurosurgery program was a strategic growth opportunity against an already stressed inpatient bed platform. Not only does focused ultrasound offer same-day improvement of tremor for patients indicated for this treatment, but the research implications of this modality and its counterpart (low-frequency focused ultrasound) have opened new doors into the research of novel treatments for such conditions as Epilepsy and brain tumors by temporarily breaking down the blood-brain barrier.
New treatments and therapies for ALS, Multiple Sclerosis, and other related diseases are also on the rise and are important to include in planning for infusion capacity and ancillary services.
How do you envision the future of neurodegenerative disease services, considering the various advancements in healthcare?
While it is undoubtedly an exciting time of innovation and novel treatments in the neurodegenerative disease space, healthcare systems need to prepare in advance for the challenges implementing these treatments will have on their teams and resources. Most, if not all, neurological conditions place huge demands on a system’s already stretched imaging and infusion platforms. As these treatments become more sophisticated, so are the requirements of the infrastructure, where 3T MRI machines become the standard for baseline testing. Neuroradiologists with specialized training are needed to help interpret more complex readings, to name a few. The demand for clinic capacity, especially for Alzheimer’s treatment, is skyrocketing; so are the demands on back-end office staff for more and more complex prior-authorizations and patient navigation through complex, multi-disciplinary care coordination. As new treatments for rare or previously untreatable neurological/ degenerative conditions are discovered and brought to market, the balance between what patients need and the payment mechanisms can afford will grow more stressed, and the associated pressures will fall mostly on our providers. Healthcare systems will need to ensure streamlined operations in their infusion centers as more treatments enter the five and six-digit per-dose price tags to avoid mission-compromising losses on drug costs.
What is your advice for budding professionals in the field?
Building strong relationships with your physicians – especially your neurologists – is key to being prepared for what is coming through the pipeline in terms of novel treatments in such a dynamic sub-specialty. Physicians are closer to the research and know what treatments are likely to be FDA-approved well in advance, which gives you the opportunity to better position your organization to be an early mover when the time comes. Expand your conversations beyond just neurological services to better understand the downstream impacts novel treatments may have on your ancillary services (radiology, infusion, therapy, etc.) to avoid potential roadblocks to implementation earlier in the process. It is such an exciting time to be in neuroscience as we are now seeing the first treatments that are designed to alter disease progression come to market. Being prepared with the necessary thought partners, resources, and a good plan for the “what might be” will be key to strategic growth in a competitive field where patients are willing to travel for novel treatments.
