Interview with Corey Zankowski, CEO and Founder of Primum

Primum is a new company that helps oncologists, especially those in rural hospitals and clinics, connect with expert peers to make better-informed decisions, especially about complex cases.  We sat down with Cory Zankowski, CEO of Primum, to learn more about how they help community cancer centers.

Hi Corey, can you tell us a little about Primum?

Our goal is to equip community oncologists with the knowledge to offer exceptional care in the community so more patients can be treated close to home.

The current approach to seeking knowledge for oncologists is time-consuming and lacks efficiencies. It takes a lot of precious time to search through medical journals and news articles for valuable information on how to treat patients best. Because medical knowledge doubles roughly every 2.5 months, there is never enough time to keep up with every novel diagnostic, therapeutic, or change in guidelines.

If Primum is free for oncologists to use, how do you sustain the business?

To provide a free service to as many oncologists as possible, our business model offers Life Sciences partners paid subscriptions to de-identified Primum Q&A. Our partners can improve their understanding of how oncologists perceive and use different therapies. This information can guide their education, data generation, and even drug development programs. We never share the names of the oncologists involved in the conversations because we want oncologists to be comfortable sharing any questions they may have on Primum.

It sounds like Primum targets medical oncologists. How do you help radiation oncologists?

You raise a good point: pharmaceutical companies are the most likely consumers of our data and are primarily interested in understanding how various drugs are used to treat cancer patients. We have several radiation oncology experts supporting our community because radiation is used in 60% of all cancer patient care. One thing I learned at Varian is that cancer care is a team sport. Having spent my career in radiation oncology, I want to be sure that Primum can support radiation oncologists even if we don’t know yet how to monetize those conversations.

Community-based radiation oncologists can consult other radiation oncologists to discuss treatment strategies, fractionation schemes, and combination therapies like immunotherapy.  Radiation oncology is a highly innovative field where the next new technology is right around the corner. Imagine if a platform like Primum was available when IMRT was first introduced.  Many radiation oncologists have questions about the appropriate use or the right way to implement new techniques in their clinics, and Primum can be a source of information for them.  For example, we are seeing increased interest in radiopharmaceuticals. We are looking for experts familiar with these therapies to answer questions from our community.

How did you get involved with Primum?

At Varian, I spent over 15 years thinking of ways to expand global access to cancer care. We were focused mostly on bringing high-quality radiation therapy to lower- and middle-income countries and designing our products for those environments. I didn’t appreciate the large gap in access to care that exists between urban and rural communities here in North America until my mother was diagnosed with endometrial cancer. While she had the means to receive treatment anywhere in the world, she chose to be cared for in her hometown, close to friends, relatives, and her church.  Unfortunately, at that time, some of the more advanced technology was unavailable in her community. That experience challenged me to find ways to bring expertise to patients who cannot, or who choose not to travel to the experts.  Primum, while not the total solution, provides an important piece of the puzzle that, when complete, will increase the quality of care available in communities all around the country and hopefully the world.

What were you doing leading up to starting Primum?

Before joining Primum, I worked at Varian Medical Systems as their Chief Technology and Innovation Officer. During that time, I developed new ways to increase access to cancer care globally, and I became passionate about democratizing high-quality cancer care. We invested heavily in user experience, simplifying our portfolio, and redesigning our products for use in low-resource environments.

We developed AI-based treatment planning tools (RapidPlan) to transfer knowledge from an academic cancer clinic to community-based clinics so that any radiotherapy clinic worldwide could deliver exceptional cancer care. I learned a lot from those experiences and was eager to put them to work in our backyard here in North America.

What are you building next?

We are launching a mobile app because doctors value being able to ask questions when they are on the go, whether they are between patient visits, in a meeting, or at a conference. Once the mobile app is generally available, we’d like to add group chats to our platform. Having a group concept will allow us to create a stronger sense of community with our oncologists where they can create their own discussion groups. It also opens the door to forming multi-disciplinary expert teams that can quickly weigh in on extremely challenging cases with a complete perspective on that patient’s management. It will be a very nice, lightweight complement to weekly tumor boards.

What are your short-term and long-term goals with respect to Primum?

In the short term, we are all about delivering excellent service to community-based oncologists so that we become their go-to option for fast and effective virtual curbside consults.  We want to demonstrate broad traction with all types of oncologists so we can build a successful business model.

In the mid-term, we want to expand globally and offer our free consultation services to oncologists with the greatest need. We are excited about expanding into Latin America, India, Africa, and Southeast Asia, which continues the mission I started at Varian.  In the long term, we want to increase our scope outside of oncology into areas like neurological and cardiac treatment management. Our service and business models apply everywhere physicians consult frequently with other physicians.

How do you see healthcare evolving over the next several years?

The US has no choice but to get on board with value-based care. Healthcare innovation will likely focus on technologies, processes, and policies that optimize cost-effectiveness. We should expect to see an expansion in precision oncology if it reduces overall spending per patient while improving outcomes. There will be intense pressure on high-priced solutions if they improve patient outcomes only modestly.

I’m particularly bullish on adopting AI solutions across healthcare to solve various clinical and administrative problems. I predict you’ll see AI introduced first as a clinical productivity tool (faster contours) or an administrative tool (better charge capture and back-office data processing), then as a highly reliable clinical decision support tool we only dreamed of five years ago.

Do you see Primum ever extending beyond a pure oncologist network?  Say, physician to patient?  Or administrator to administrator?  Or even patient-to-patient?

We already support non-oncologist care providers with Primum. Oncology nurse practitioners, physician assistants, and advanced practice providers are already part of the oncology care community seeking guidance on Primum. If you look at our Experts, you will see benign hematologists, pharmacists, and even specialists in palliative care.

Many of the cancer care networks we work with have asked us about connecting healthcare providers, like PCPs, with oncologists in our community to answer basic questions at the start of a potential cancer patient’s journey.  We look forward to supporting HCPs in the community to help them take the right steps initially. Once we expand support to new disciplines in the cancer care space, it will be relatively straightforward to create various sub-networks for urologists, pulmonologists, physicists, and administrators on Primum. On a personal note, as a medical physicist, I am eager to create a subnetwork for physicists and dosimetrists who are deeply involved in the delivery of radiotherapy.

Our company focuses primarily on physician-to-physician conversations, but I wouldn’t rule out incorporating the patient into the discussion. We must be thoughtful as we add non-physician users to Primum and consider the impact on the core physician user of the platform.  Concern for the physician experience means that adding patients is further away on our roadmap.