Chapter 17: MD Anderson Banner and Satellite Care Centers

Chapter 17: MD Anderson Banner and Satellite Care Centers

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Description

In this segment, Dr. Leach sketches the partnership established with Banner Healthcare in Gilbert Arizona, leading to the opening of MD Anderson Banner in 2011, the first fully autonomous center carrying the MD Anderson name. Dr. Leach explaining that the motive to expand beyond 1515 Holcombe comes from the MD Anderson mission –to cure cancer in Texas, the U.S. and the world. The center at Banner came about as MD Anderson experimented with a process of adapting MD Anderson care procedures to make them more universal. He notes that MD Anderson seeks out institutions with which there is a “meeting of minds” on how cancer services must be delivered.

Dr. Leach describes MD Anderson’s multi-disciplinary approach to treating patients, giving the example of the wide range of options that teams consider for prostate cancer.

Dr. Leach explains that MD Anderson is open to establishing partnerships with institutions that embrace a multi-disciplinary approach. MD Anderson does not need to seek out partners, as institutions approach MD Anderson. Dr. Leach next talks about the many lessons learned by establishing partnerships. He mentions MD Anderson Orlando, Florida, which he says eventually morphed into a Banner-like situation. He explains some of the financial challenges setting up MD Anderson Espana, an initiative that also became more like Banner. Through these experiments, “We now know what a good partner looks like.” Dr. Leach then discusses the regional care centers, explaining that they were created to offer patients more access to services.

Dr. Leach explains how MD Anderson insures the quality of care at satellite centers, giving an example of MD Anderson physicians in Houston confer via teleconference with colleagues at MD Anderson Espana.

Identifier

LeachL_04_20130429_ C17

Publication Date

4-29-2013

City

Houston, Texas

Topics Covered

The University of Texas MD Anderson Cancer Center - MD Anderson and Other Institutions; Institutional Mission and Values; Multi-disciplinarity, Teams, and Collaborations; The MD Anderson Brand, Reputation; Multi-disciplinary Approaches; Growth and/or Change; Obstacles, Challenges; Understanding the Institution; Overview; The Business of MD Anderson; Beyond the Institution

Transcript

Tacey Ann Rosolowski, PhD:

Right your story. Okay, so I’m Tacey Ann Rosolowski, and today is April 29, 2013, and I am in Pickens Tower at the MD Anderson main campus. Today I am interviewing Dr. Leon Leach for a supplementary session. The time is about four minutes after three. So thanks very much for agreeing to do this— Leon Leach, MBA, PhD Thank you.

Tacey Ann Rosolowski, PhD:

—and helping us recapture some material.

Tacey Ann Rosolowski, PhD:

So as I mentioned, I need to ask you a couple of questions about some of the strategic initiatives that expanded MD Anderson care beyond the boundaries of Holcombe. So I wonder if you could take me through the process of the development of MD Anderson about—you know—why was it that the institution decided to establish a care center there, and why Banner? Leon Leach, MBA, PhD Okay, well why we are outside the halls of 1515 Holcombe—?

Tacey Ann Rosolowski, PhD:

Uh-hunh (affirmative).

Leon Leach, MBA, PhD —is a good place to start. Our mission is to eliminate cancer in Texas, the nation, and the world. So we didn’t feel that because we’re a Texas institute, we’re necessarily limited to 1515 Holcombe Boulevard, or Texas, or the nation, for that matter. Banner really was linked to a strategy to understand how we could take what we do—our processes and procedures—and make them more universally available. One of the ways to do that would be seek out partners that were looking for the kind of expertise that we offer. So we did some preliminary planning about what that would look like, how we would do that, and there are several key thoughts. The partners need to be of like mind. And probably on the first point there is multidisciplinary care. We have a certain way of practicing medicine here—cancer medicine—and it deals with doing what’s right for the patient. Just because you walk into the surgeon’s door doesn’t mean you get surgery. Just because you walk in Cancer Medicine or Radiation Oncology doesn’t mean that we’re going to radiate you. There will be a team that looks at your situation, and there will be discussions with you as the patient as to what the options are. I often use prostate cancer because there is an array of options there ranging from radium implants to radiation therapy that’s traditional to the proton therapy which is a much newer way of treating several different types of cancers—prostate is one of them—to what they call watchful waiting, which is just if it’s not that aggressive and you’re probably not going to die from it, let’s just wait and see what it does. So you have all kinds of ways that you can treat that, and we’ll evaluate the patient and have a discussion with him based on what’s best—you know—what’s best for that individual patient. So what we look for in a partner is that same kind of mindset and a willingness to kind of follow what we do in treating cancer. We look to be able to have an impact, to be able to raise the bar in an area, and we look for people that are really looking for us. We want partners that are seeking out the kind of medicine that we practice, the way we go about doing things—tracking our quality and our outcomes—

Tacey Ann Rosolowski, PhD:

Did Banner get in touch with MD Anderson? How was that connection established? Leon Leach, MBA, PhD My recollection is probably vague on that. I can’t say—my recollection is they contacted us. We’re not really out there marketing our services per se. We know the kind of partner that we want. We have lots of discussions that usually don’t go anywhere because the other party just wants the MD name on their building. We won’t do that. If the MD Anderson name goes on the building, so do our guidelines, so do our pathways. And another thing that we’re looking for in this world is alignment with the hospital and the doctors. In the case of MD Anderson, they work for the same entity. Anderson owns the hospital, and the doctors are part of our faculty and they are employees, so to speak. So we look for a similar type of entities that have that kind of arrangement or are willing to move to that, and we look for the opportunity to have an impact on the area as far as raising the bar for the level of care. So with Banner, they pretty much all those criteria. And again, I have likened it before—if people didn’t want to do business with us, it’s like, wow, fishing and the fish are jumping in the boats—in the boat—and you get to pick which one you want to keep and you throw the ones back that aren’t as much of a prize, so to speak. That’s probably a crude analogy when it comes to medicine and healthcare and cancer, but Banner was very much of like mind, and that’s what we—that’s very important to us. So that’s how that arrangement came about. Most of these arrangements will take a year’s quick, because there are so many discussions that you have to have about not only the business details but more so on the medical side—the clinical side—as far as who we are, what we’re about, and how do we go about interfacing on medical issues. And we’re looking for a few more partners, kind of like—what is it?—the Marines looking for a few good men. We’re looking for a few good regional partners. We’re not out there beating the bushes, so to speak. It’s kind of, you’ll know ‘em when you see ‘em. And we prefer that they come to us, because that’s more of an expression of self interest—their self interest—than us going to them. But it’s—we view it more as a mission thing and the fact that our mission goes back to eradicating cancer in Texas, the nation, and the world. That’s kind of how Banner came about.

Tacey Ann Rosolowski, PhD:

What were some lessons learned over the course of establishing that relationship? Leon Leach, MBA, PhD Well, we did learn several lessons. I mean—we did a couple of bites of the apple, one with MD Anderson Orlando, and that one worked out very well, but it morphed into a very much Banner-like relationship over time. We didn’t go into it knowing what it would look like. We had a similar experience on the international front with MD Anderson España where we pretty much started as a cancer center from the ground up using an old Navy hospital with some folks who were really venture capitalists. And it turned out the early efforts were undercapitalized. We were able to recruit a quality staff, but it was tenuous at best going through that process when you’re not properly capitalized. Long story short, that evolved to a Banner-like model too with a hospital management company that’s really an international company that has—they have operations in Spain, but they’re also in the Caribbean and I believe they have one or two hospitals here in the United States. I know they have one. So—you know—they stepped up and basically bought the venture capitalists out. We didn’t have financial support—direct financial support—from the Spanish government, but they were very helpful in helping that entity integrate into their healthcare delivery system in Spain. They were very helpful in their willingness to help us with facility arrangements. There was a naval hospital that we converted. So a lot of it has to be the chemistry of the partners and things coming together and knowing what you want. We now know what a good partner looks like. But we went through a period where we kind of developed that to the point where we now understand it better.

Tacey Ann Rosolowski, PhD:

So it’s clear to me what MD Anderson can do for these institutions that are requesting partnership. What does MD Anderson get back? Leon Leach, MBA, PhD Well, the arrangements vary, but basically the theme is that we take a fee off the top. There may be something based on results, outcomes, and there may be some patient flow, because there are things—a stem cell transplant, that kind of thing—where patients may want to come here versus having it done locally.

Tacey Ann Rosolowski, PhD:

How much revenue does Banner, for example, represent to MD Anderson? Leon Leach, MBA, PhD Uh, I don’t have that statistic off the top of my head. I mean, right now our—these relationships are relatively small, but we do have the original relationships where MD Anderson has developed regional centers that basically ring the Houston area—The Woodlands and Katy and the Clear Lake area—and they’re done oftentimes in conjunction with another healthcare facility where we use their facilities and we have our doctors there, and the doctors are in our employ. And you know, that’s—we have a nice financial return all through those efforts.

Tacey Ann Rosolowski, PhD:

What was the reason for establishing the regional care centers? Leon Leach, MBA, PhD Basically the same principle—basically it’s curing cancer in Texas. Uh, 1515 Holcombe is maybe not as convenient of a spot. You come here, you know the parking, you know the challenges. A lot of people that wind up in our regional centers come here first for their diagnosis, and if it’s, let’s say, rad onc, radiation oncology, and they can get those services out in the satellite offices, more people are going there now first with a diagnosis, but it works the same way as the mother ship. You know, you have the team, and you have the evaluation of the patient, and it’s done in a multidisciplinary fashion. We do have some capacity to do surgeries out in the regional areas, but about thirty percent of the patients get sent in here for their surgery. So it’s a matter of trying to make yourself more accessible.

Tacey Ann Rosolowski, PhD:

And how does quality control work—you know—with Banner, with all the satellite centers? Leon Leach, MBA, PhD Well, I’m not going to pretend to be an expert on the clinical side. But there is a lot of involvement of medical directors at MD Anderson for your employee and a lot of coaching from the mother ship. You know, in Spain it’s interesting because we use teleconferencing there where the doctors will get together on a live video network that’s bouncing off a satellite and talk about particular cases for that week. Or one particular case, they may bring in a specialist in that area right here so that they don’t have to make the trip from Spain to reap the benefit from our expertise. So in today’s world, we’re very much linked electronically to our other sites.

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Chapter 17: MD Anderson Banner and Satellite Care Centers

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