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The Origin of COTA and Using Real World Data During a Pandemic with Dr. Andrew Pecora


During this episode of Real World Talk, host Kevin Keogh talks with Dr. Andrew Pecora of OMI (Outcomes Matter Innovations). In 2011, Dr. Pecora founded COTA and has been an innovator in the oncology space for over 25 years. Dr. Pecora talks about the origin of COTA after discovering 1 out of every $3 is wasted in healthcare.


  • In the first part of the episode, Dr. Andrew Pecora discusses his background and what motivated him to start COTA.
  • Over the years, Dr. Pecora has been involved in the evolution of hematology oncology and stem cell biology and immunology – particularly their application in cancer.
  • Because of Dr. Pecora’s leadership in these fields, he was invited to participate in a group of people in the U.S. that analyzed the total cost of care issues the nation was facing.
  • Dr. Pecora discusses the challenges the pandemic creates with the documentation of a patient’s journey.
  • Sheltering in place has created unintended consequences for cancer patients who are sitting at home – many with active cancers growing in their body and unlikely to seek care or early diagnosis.
  • Since the colonoscopies have stopped during the pandemic, some professionals believe that there are already 150,000 undiagnosed cases of colon cancer in the U.S.
  • Dr. Pecora describes COTA’s collaboration with Hackensack Meridian Health and the use of their Epic system, which is an electronic medical record system, to extract large amounts of data for COVID-19 infected patients.
  • Dr. Pecora discusses the challenges COVID-19 poses for the field of oncology, which include interruption in business flow, maintaining employment of highly trained professionals and simply covering the costs associated with running a practice.
  • During the pandemic, those participating in the evidence accelerator (a collaboration between COTA, Hackensack Meridian Health and the Reagan-Udall Foundation), realized that each patient was a treasure trove of information and had the ability to extract massive quantities of data in a very short amount of time.
  • The evidence accelerator provided an ability to answer fundamental questions for the CDC and FDA well in advance of other peer reviewed publications.
  • Dr. Pecora builds a metaphor to discuss how COTA’s solutions equate to the services Uber provides.
  • COTA’s promise is around the ability to have an overarching view of real world data and even determine the “best value-based road” for patients.
  • Dr. Pecora discusses how organizations can prepare for a value-based care world.
  • Dr. Pecora discusses the challenges a rise in healthcare creates, most importantly taking resources away from other necessities such as military, roads, education and more.
  • At some point, there will be a tipping point with real world data and it’ll come as companies work with the FDA to embrace real world evidence more and more.
  • Dr. Pecora concludes the interview by discussing a point where CMS moves to utilizing real world data and evidence, “ultimately this will catch up to the point where CMS will be like, all right, well, you know, the country has moved, we’re going to do it. And then, you know, when Godzilla says we’re going, right, we’re going right.”

Key Points

  • According to Dr. Pecora, “…as more and more therapies come to market and people are living longer and aging, that total cost of care burden as a percentage of the total economy was becoming disproportionate.”
  • Dr. Pecora discussed the origination of COTA, “we’ve in fact…may have been wasting one out of $3, in the application of healthcare. And so I started to think about the problem and realized that unlike the biology problems that I deal with…this was not a biology problem. This was an information technology problem.”
  • When discussing the impact of COVID-19, Dr. Pecora stated “I have seen several examples of people presenting with way more advanced cancer than they otherwise would have presented with…had this COVID-19 problem not existed. You see most cancers double every 30 days. So two or three months is material in the amount of cancer in your body and how far it can spread.”