番茄社区

Unlike some other partnering ventures between leading academic cancer centers and community hospitals, the appears to be more about medicine than marketing.

Now in its third year, MSK has three alliance members, and plans to continue its growth by adding no more than one new institution a year, according to MSK president and CEO , MD.

During an exclusive interview with 番茄社区, Thompson explained that the alliance concept came out of MSK's 2012 strategic plan to extend and enhance new and innovative therapies to patients beyond its metropolitan New York City catchment area.

He said that 80% of MSK's patients come from within 50 miles, but with cancer diagnoses becoming more complex, and certain cancers being subdivided, "We realized that particularly with molecularly characterized trials it was becoming increasingly more difficult to enroll enough patients with those precise molecular characteristics."

He added that many patients were also finding it difficult to get involved in cancer care far from home, and 80% of cancer patients were receiving care at community or regional hospitals in their neighborhoods.

"We determined that 100 to 150 miles was the breaking point for patients to travel and began to look at like-minded community hospitals with similar missions within that radius that could partner with us to advance cancer care."

Partnering Up

Over the next several years, MSK identified two partners fitting that criteria, at Hartford (Conn.) Hospital and in Allentown, Pa. It then ventured further afield, adding (MCI) earlier this year.

Thompson identified New York State's upper Hudson Valley as the general geographical area MSK is eyeing for its fourth member after the Miami center has had a year to settle in more fully.

He said that Memorial also realized that it was already training more than 1,500 physicians and nurses annually as partners in its clinical training programs to treat patients in clinical regional and community hospitals in the region surrounding New York, and wanted to further extend its range to find patients who would be effectively eligible for clinical trials as part of its research and innovation mission.

In addition, he noted, "many like-minded regional care institutions were coming together around the country particularly in response to changes in accountable care organizations."

MSK's alliance describes the venture as "a transformative initiative to improve the quality of cancer care and the lives of cancer patients by bringing evidence-based, world-class standards to community healthcare providers."

What seems to differentiate the alliance from some other partnering with community-based hospitals is the bi-directional effort to learn and share among the institutions and an intensive commitment to best practices and quality cancer care.

MSK states on its website that typical alliances involve licensing standards of care but its alliance has a much greater integrated collaboration between physicians and health professional from all institutions, which can lead to better outcomes.

Hallmarks of the alliance include:

• Joint development of strategies to improve outcomes;
• Participation in disease management teams;
• On-site observations of new techniques;
• Sharing of educational resources;
• Quality and outcomes research;
• Expanded access to MSK clinical trials;
• Establishing MSK clinical trial sites at some alliance institutions;
• Collaborative efforts to measure outcomes including survival rates, quality of life, and total cost of care.

Another benefit is an annual CME conference that includes presentations from MSK and all alliance members. 番茄社区 observed the ongoing interaction among MSK and alliance oncologists and healthcare professions during a two-day conference this January in Miami.

When asked what other NCI cancer centers have comparable programs with community hospitals, Thompson mentioned and .

Some other academic-community hospital partnerships have been considered more "branding" exercises than meaningful medical models focusing on collaborative, integrated clinical care.

Importance of Geography

Thompson said that Hartford was almost equidistant between New York City and Boston, as was Lehigh Valley between New York City and Philadelphia, and both hospital systems met the stringent standards required for alliance membership.

MSK's interest in Miami was based on its emergence as a hybrid academic-community cancer center and the fact that many New York-based MSK patients spent the winter months in south Florida, and better local quality care and access to more clinical trials would be an added convenience for the snowbirds.

, MD, was jointly recruited by Hartford and MSK to become the Connecticut cancer center's first physician-in-chief in 2016, the year after he ended his term as president of the American Society of Clinical Oncology. He had been director of cancer research at Palo Alto Medical Foundation in California and was the rare community oncologist to lead ASCO.

During a phone interview, Yu said that Hartford became the alliance's charter member in 2014 and that both Hartford and MSK developed the cancer program together, perhaps partially in response to the ser on quality of care in oncology and accelerating the transfer of knowledge from academic to community cancer centers.

He has appointments both at MSK and Hartford and also serves as the alliance's director of health informatics reporting to MSK's physician-in-chief and chief medical officer , MD, PhD.

"The relationship with MSK is a true partnership and we have access to the rich portfolio of clinical trials at MSK. The goal is not to transfer patients from alliance centers to Memorial but to create an equal partnership where physicians are being treated respectfully as equals," he said, adding that alliance members form disease management teams that match their counterparts at MSK and foster dialogue to ensure the quality of care is the same as at MSK, and that Hartford will soon be involved in about 50 MSK trials.

After expanding east to Hartford, the alliance went west to Allentown, Pa., in 2015.

, MD, physician-in-chief of Lehigh Valley Health Network's Cancer Institute, told 番茄社区 that institutions interested in joining the alliance had to have standards of care on a multidisciplinary level at the same high level as Memorial so that the clinical trials data would be accurate, and due diligence required about 2 years.

"We want to ensure that patients receive proper care and care is continually improving," he said, noting that MSK approached Lehigh Valley Health Network initially about joining the alliance.

However, at that time, the cancer institute had a clinical trials arrangement with Florida's that had been formed through personal professional relationships. But the opportunity to enter a "deep" relationship with Memorial and increase standards of care and participate in MSK's clinical trials program was too good to pass up, and Lehigh Valley ended its relationship with Moffitt.

Nair said that joining the alliance has been the highlight of his 27-year career, and that the ongoing interaction with colleagues from MSK has been very rewarding and beneficial for patients, citing how genome-targeted therapy has helped save some lives.

His center is now involved in about 10 MSK trials with another 30 or 40 that will soon be active, and he has welcomed the developing recognition of Lehigh Valley's cancer program, noting, "A lot of elite physicians are now coming to us for jobs."

Boston to Miami

Miami Cancer Institute's entering the alliance was announced last year but officially started in late January, according to Michael J. Zinner, MD, who became MCI's founding chief executive officer and executive medical director a year ago after serving as clinical director of the Dana Farber-Brigham cancer center and surgeon-in-chief at Brigham and Women's Hospital in Boston.

Zinner told 番茄社区 that he had actually represented Dana-Farber in discussions with MCI a few years ago about the possibility of an affiliation, but nothing materialized at the time.

He said that independently a Baptist Health executive had learned about the alliance through a colleague who was at Hartford, prompting Miami to approach MSK.

A number of factors had to align before MSK was ready to head that far south, and Zinner admitted that his interest in developing a hybrid academic-community cancer center would probably not have been as strong if not for the potential alliance.

"I wasn't going to take 40 years of academic experience and training and turn it into running a community hospital alone without an academic relationship. It wasn't in the cards," he said.

But it seemed the cards that were on the table netted multiple winners.

Zinner said that alliance members had to comply with the standards of care and comprehensive sets of resources and capabilities employed at MSK, and that the Baptist Health cancer institute had several that were already in compliance and was currently helping MSK develop another in leukemia.

He added that working with MSK has been a truly bi-directional relationship, with MSK showing flexibility in adapting certain standards to meet regional needs, and that he has already been able to recruit 15 more physicians during the past year.

Comment