Josyl Barchue – Memorial Sloan Kettering Cancer Center

Last year, in the wake of the COVID-19 pandemic, Memorial Sloan Kettering Cancer Center faced a critical crossroads at which treatment for hundreds of patients hung in the balance.

There was one treatment many patients desperately needed, and the pharmaceutical company that provided it was having problems with its supply chain. Eventually, representatives of that company conceded that they didn’t know when they would be able to get the treatment to MSK.

“So, credit to the people who work for us, they figured out all sorts of alternatives—whether it was to compound the treatment, synthesize a certain portion of it, recreate what we needed or acquire what we needed through other supply chains,” recounts Josyl Barchue, associate general counsel at MSK. “They really had some creative solutions, but we came down to needing to work with that company to have them either assist us to buy what we needed to compound it or figure out a license of some sort.”

Josyl Barchue | Associate General Counsel | Memorial Sloan Kettering Cancer Center | Photo by Andrew Henderson

Barchue had to negotiate with the company, and he says this was one of those times when he had to be very assertive in representing the interests of MSK’s patients—holding out an olive branch, but also brandishing a big stick: “We need to provide life-saving care to our patients, so you can work with us, or we’ll be having some different conversations later.”

The company was initially reluctant to help, and Barchue says money became too much of a sticking point.

“One of the critical portions of it was—and this is just exposing some of the worst parts of healthcare—their great concern was that we would not seek reimbursement for administering the treatment,” he explains. “And that’s not something that we can ethically do… We are required by law and regulation to seek reimbursement. But they were very insistent about the fact that they charge tens of thousands of dollars to administer a dose, and we could produce it and seek reimbursement for a lot less.”

Barchue assured the company’s representatives that MSK would seek full reimbursement; he also made clear that MSK was going to aggressively represent its patients.

“We got the outcome that we needed,” he says. “And ultimately, it did not come down to the financial elements. It came down to providing the best patient care. We effectively forced them to do that, and I’m totally okay with that.”

Streamlining contracts

Founded in 1884, MSK is a comprehensive cancer treatment provider with several locations in New York and New Jersey. At times, what Barchue does there is a matter of the utmost urgency, because even improving contracting efficiency can translate into critical hours and days in a cancer patient’s life. On the latter front, he’s been providing new agreements and creating new templates, ensuring MSK has the ability to enforce the necessary provisions and protections.

“I generally create a new playbook to go along with new contract templates—which really goes in depth by providing some negotiation postures or processes, best practices, what I think are dos and don’ts based on the particular needs of an engagement, whether it’s the organization or project-specific, or just what my experience tells me,” he says.

Barchue further trains procurement, contract management and contract administration teams on how to negotiate contracts, how to think the process through, how to incorporate playbooks and how to develop new approaches to the contracting process. His goal is to reduce their reliance on counsel, freeing him up to deal only with core issues and to be the last line of defense.

Photo by Andrew Henderson

“The more efficiently that we can get our contracts done and remove any loopholes or choke points in the processes, the faster we can get our patients the care they need,” he says. “So, whether it’s research-related, getting a piece of new technology for the clinical space, or a collaborative project that’s going to provide something new in a better way—all of these can be very urgently needed.”

Saving time while staying secure

Barchue also works on cybersecurity, about which he says MSK takes a very stringent approach. The cancer care center holds sensitive personal information about patients, from their medical conditions to their financial details, and as Barchue points out, this is no time for them to be fretting about whether their data is secure.

“They’re fighting their biggest battle and should not be concerned about data security,” he says.

Especially because there are often ongoing treatments, and thus a continuing need to use patients’ data, it’s important that MSK choose its partners wisely. Recent partnerships have included patient-facing application development providers, a new holistic approach to MSK’s electronic health record and various SaaS-based enhancements to data and records management.

“A lot of entities in the healthcare space just want to get as much data as they can, so they can make it more valuable,” Barchue says. “For us, we only want to use patient data to make a more valuable service for our patients, and nothing more.”

MSK works with its share of cutting-edge new companies who may not know all the requirements of working in the highly regulated medical sector, and in those cases, the cancer center will bring those companies in line with its standards, preparing them to work with other healthcare organizations, as well.

“We have to be very intentional about our reviews of the people that we work with,” he says. “And that’s where I come in, trying to create some efficiencies in that process. Because you can spend weeks, months or longer negotiating some of the particulars of cybersecurity, and then you’re using time that you don’t necessarily have.”

What God had in store

Today, Barchue is grateful to be doing what he does at “a great organization,” but it’s been a long journey. After initially envisioning a career as a surgeon at a young age, Barchue decided he wanted to work in the technology space. Then, as he got to college, his dreams of running his own tech company or taking over IBM gave way to a desire to work in the legal field.

Photo by Andrew Henderson

“I knew I was going down that path—I was very stubborn and very argumentative, and I enjoyed nothing more than a spirited debate,” he says. “And when my grandfather was young, he was a justice of the peace back on our home island in the Caribbean, and I always saw him that way, as kind of a righteous person, and there were judicial elements to him—so certainly a lot of that came from him.”

After earning his J.D. from Fordham Law School in 2010, Barchue became an attorney at the Office of the General Counsel for the Department of Veterans Affairs. At first, it was an incredible experience that allowed him to serve, he says. But over time, as he watched good work undone by changing political winds, he became disillusioned with the leadership at the Agency. In 2018, he left the VA for UnitedHealth Group, where he stayed, happily, until MSK pursued him for a role that he “couldn’t possibly turn down.”

It was a drastic shift in some ways, but Barchue now recognizes it as the road he was called to follow.

“There’s always a critical crossroads,” he says. “You just have to be really intentional about listening to what God has in store for you and be diligent about following that path.”

View this feature in the Vanguard Summer I 2023 Edition here.