Chapter 11: The Center for Global Oncology: Background and Operations
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Description
She begins by explaining that healthcare institutions nationwide were seeking partnerships when the decision was made to form the Center in 2008. She the talks about how the institutions contacted MD Anderson, how their needs were assessed, and how she partnered with Oliver Bogler, in Global Academic Programs, to satisfy those needs.
She sketches her main role, to identify and negotiate legal contracts with partner institutions, and provides examples, including consideration of financial gain for MD Anderson.
Ms. Hay also sketches the challenges involved in bringing institutional (and national) cultures together in multi-disciplinary care.
Identifier
HayAC_02_20150602_C11
Publication Date
6-2-2015
City
Houston, Texas
Interview Session
Topics Covered
The University of Texas MD Anderson Cancer Center - Building the Institution; Overview; Entrepreneurs, Biotechnology; The Administrator; Institutional Mission and Values; MD Anderson Culture; The Business of MD Anderson; The MD Anderson Brand, Reputation; MD Anderson History; Building/Transforming the Institution; Multi-disciplinary Approaches; Growth and/or Change; Business of Research; Fiscal Realities in Healthcare; Professional Path; Leadership
Transcript
Tacey Ann Rosolowski, PhD:
All right, we are recording. The time is 1:45, and today is June 2nd, 2015. I’m Tacey Ann Rosolowski, and today I’m in a conference room in—let’s see. This is the suite that’s the office of Can—the Cancer Network suite, right?
Amy Carpenter Hay:
That’s correct.
Tacey Ann Rosolowski, PhD:
Correct, okay. And I’m interviewing Amy Hay. This is our second session together, so thank you very much for making the time amid your very, very busy schedule.
Amy Carpenter Hay:
Oh, no, no. My pleasure.
Tacey Ann Rosolowski, PhD:
And we were—we were just kind of reviewing where we were from the last time. And you did, indeed, talk about Cooper. But I kind of wanted to go back in time just a tiny bit and talk more formally about the formation of the Center for Global Oncology.
Amy Carpenter Hay:
Okay.
Tacey Ann Rosolowski, PhD:
So I wonder if you could tell me about that. Would—that was in what year, about?
Amy Carpenter Hay:
Global Oncology predates the Cancer Network.
Tacey Ann Rosolowski, PhD:
Right.
Amy Carpenter Hay:
So Global Oncology was around the period of 2008 timeframe.
Tacey Ann Rosolowski, PhD:
Okay, yeah, because you became associate VP [vice president] in 2008, so that would have been—
Amy Carpenter Hay:
Yes, that would have been correct.
Tacey Ann Rosolowski, PhD:
Okay, okay.
Amy Carpenter Hay:
That’s when I came back to MD Anderson.
Tacey Ann Rosolowski, PhD:
Okay.
Amy Carpenter Hay:
So, the two to three years preceding that, I was the COO [chief operating officer] of the Proton Therapy Center, and—
Tacey Ann Rosolowski, PhD:
Right, you did tell us ProBeam—you told us about that, yeah.
Amy Carpenter Hay:
Exactly. And when they formed the Center for Global Oncology is when I returned back [inaudible].
Tacey Ann Rosolowski, PhD:
Right, okay. So, tell me about that process of forming the center, at that time. You know, why was it formed in 2008? What was going on in the institution?
Amy Carpenter Hay:
I think it was an acknowledgement that there was a lot of connectivity and relationships being formed both nationally and internationally, but it wasn’t being done in an organized and precise manner. It was being done on a one-off basis. And a couple of things predated that. One of them was the development of our relationship with Albert Einstein in São Paulo. And one of them was the development of our Radiation Oncology Center in Istanbul with American Hospital.
Tacey Ann Rosolowski, PhD:
Mm-hmm, you did talk about both of those.
Amy Carpenter Hay:
Both great opportunities, but they were kind of done one-offs, based on relationships. At the same time, there was a lot of movement in the national market around partnering. So, we were starting to get calls from other healthcare entities such as Banner Health that were interested in finding ways in which we could collaborate in oncology. So, there was both national and international forces that forced us to relook at the business, the clinical side, and the research side, in a more holistic fashion.
Tacey Ann Rosolowski, PhD:
So let me ask you, why was this a trend? What were institutions seeing the possibilities for this kind of partnering?
Amy Carpenter Hay:
I think it was kind of a natural acknowledgement, both nationally and internationally, of acute-care institutions acknowledging that they did not have specific expertise in oncology. While they might have oncology services, they did not have an oncology program. So as a result of that, you saw a lot of institutions—really more healthcare systems—reaching out to academic providers. So it was around this same time that you saw a large presence of people like Hopkins and people like Cleveland Clinic that are now our competitors, that were being also called, and asking for services. Not just in oncology, but kind of in any high intensity and tertiary service line. So, you were seeing oncology, you were seeing cardiology, you were seeing orthopedics as major areas in which health systems identified they didn’t have the in-house expertise.
Tacey Ann Rosolowski, PhD:
So, you know, you mentioned specifically that there was a reaching out to academic institutions. So part of this was that academic ob—institutions obviously are a repository of very intense specialists.
Amy Carpenter Hay:
Knowledge, mm-hmm.
Tacey Ann Rosolowski, PhD:
But there’s also the research piece. So, to what degree was the research piece desirable for these entities that were looking for partnership?
Amy Carpenter Hay:
It was critical. I mean, it’s part of what they were looking for, and it still is. I mean, most healthcare providers or acute-care networks are looking not just for the clinical delivery, but they’re also looking for the research side. So that’s a key component—specifically in the national accounts or the national partners—of what we collaborate on. They don’t have the research backing, nor should they. And they shouldn’t, and most don’t, have bench-top research. So, they need assistance from large academic providers that have that basic science knowledge that can be leveraged into translational research.
Tacey Ann Rosolowski, PhD:
So was this—I’m trying to get an understanding of, you know, what kind of resource the research represented for these partners. Did they want clinical trials to enroll patients in? Did they want researchers to partner with? You know, what was going on?
Amy Carpenter Hay:
They want clinical trials.
Tacey Ann Rosolowski, PhD:
Okay.
Amy Carpenter Hay:
So it’s all about the delivery. So, health networks are looking for a way to offer their patients clinical trials at home within their network.
Tacey Ann Rosolowski, PhD:
Okay.
Amy Carpenter Hay:
So it really is on the clinical-delivery side, and how research can be leveraged in order to provide that to patients closer to their home.
Tacey Ann Rosolowski, PhD:
Mm-hmm. So, the setup of the Center for Global Oncology—were you part of those setup discussions?
Amy Carpenter Hay:
At that time, I actually was over at the Proton Therapy Center.
Tacey Ann Rosolowski, PhD:
Okay.
Amy Carpenter Hay:
So I was—when they promoted Mitch Latinkic as the vice president of that area, he then invited me to come back. So, I was not part of that setup.
Tacey Ann Rosolowski, PhD:
The setup part. So, when you came in, I mean, what was the mission of the Global Oncology Center? What were the parts? And what part did you serve?
Amy Carpenter Hay:
The setup of the center was to put clinical care, business, and kind of their research component all together, and try to organize what we were doing nationally and internationally. At that time, it only included really our partner members—so we were negotiating Banner at the time, at the formation—and also, our international relationships. It also included—and the membership at the leadership level was Mitch Latinkic, Dr. Ed [Eduardo] Diaz [, Jr.], and Dr. Oliver Bogler. And, therefore, it also included the sister institutions as well. So those were the three main components of the Center for Global Oncology.
Tacey Ann Rosolowski, PhD:
The sister institutions being the academic partners—
Amy Carpenter Hay:
Yes.
Tacey Ann Rosolowski, PhD:
—through Global Academic Programs [GAP]?
Amy Carpenter Hay:
Yes, that’s correct.
Tacey Ann Rosolowski, PhD:
Yeah. That was just for the recorder’s sake. [laughter] And I did actually interview Oliver Bogler and—about GAP. And he talked to me about partnering with you, so I’d kind of like to get the story from your side, too. Because one of the interesting things to me was, when an institution would contact MD Anderson, what’s the process that that institution goes through, through the Center for Global Oncology, to figure out exactly how they can be given the services they need?
Amy Carpenter Hay:
Yeah, and at that point—which is a—definitely a moment in time—when individuals reached out to us, we as a group defined what they were asking for. And sometimes that was business, and sometimes that was pure research. If it was pure research, then it appropriately fit in the Global Academic Programs component. If it was pure business and clinical delivery, that would fit in the business and clinical side. Often it was both, so the, really, drive was to try to manage that. And a good example of that is Albert Einstein in São Paulo. They were our first sister institution. They were also our first MD Anderson Cancer Network associate member. So, we—there is overlap.
Tacey Ann Rosolowski, PhD:
So, to understand, São Paulo actually had—was both academic and business?
Amy Carpenter Hay:
Yes.
Tacey Ann Rosolowski, PhD:
Okay, mm-hmm.
Amy Carpenter Hay:
Yes, they are today. At the time, they weren’t. At the time, they were the first sister institution.
Tacey Ann Rosolowski, PhD:
Oh, okay.
Amy Carpenter Hay:
And over time, they have become a co-branded partner in our cancer network.
Tacey Ann Rosolowski, PhD:
So tell me about your sphere of influence within the center at that time.
Amy Carpenter Hay:
Well, I was working for Mitch Latinkic, who was the leader on the business-development side. So, my normal function was around both identifying, negotiating and supporting the legal contacting of any opportunities. And during that timeframe, and internationally it was focused on Albert Einstein in São Paulo. We closed Istanbul at American Hospital in Turkey. And then, a lion’s share of the time was spent focused on Banner at the MD Anderson—what is today the MD Anderson Banner facility. That took twelve to eighteen months to really do deep due diligence on Banner Health as a system and close the legal transaction. Because it was very important at that time that we ensure that it was very clinically integrated into MD Anderson, because there were some lessons learned with our previous relationship in Orlando. We had identified some ways that we could do much better and strengthen those ties, and we wanted to ensure that when we had our first partner with Banner, that when it came up and was operational, it really was completely integrated into MD Anderson, including the, you know, physicians, the recruitment, and the training of all the staff.
Tacey Ann Rosolowski, PhD:
So tell me about the types of legal issues that would arise in this kind of negotiation, ’cause not doing what you do—and most people don’t—I have no idea. You know, kind of—so, con—some concrete examples would help.
Amy Carpenter Hay:
You know, it’s across the board. So, if I tried to think through our partnerships, and what are the—when I had someone a draft contract, what are the things that they typically want to discuss? That’s probably a good way to put it. Always—and unfortunately or fortunately—foremost is always the business transaction. So, you know, the approach that we’ve taken, and we’ve continued over the years is to develop full oncology financial pro formas in which we estimate, based on the market, what we think the growth patterns are going to be, and then the associated financials. So—
Tacey Ann Rosolowski, PhD:
I’m sorry. I have no idea what that means. [laughs]
Amy Carpenter Hay:
Okay. So, financial pro forma means that we develop, based on the market, the number of new cancer cases that we think will come to that center.
Tacey Ann Rosolowski, PhD:
Oh, I see. Okay.
Amy Carpenter Hay:
And then, based on that, we develop both from a professional and from a technical perspective what we think the financial results of operating a full oncology program.
Tacey Ann Rosolowski, PhD:
Okay.
Amy Carpenter Hay:
And so, once we have created that, then both partners—in this circumstance, Banner, and MD Anderson—both agree that this is our business plan, for lack of a better word.
Tacey Ann Rosolowski, PhD:
Mm-hmm, okay, mm-hmm.
Amy Carpenter Hay:
This is the plan that we have to develop our business. This—these are the financial outcomes that we think will result. And also, and importantly in there, these are the expenses that will be incurred if we want to accomplish what we planned to do—things like staffing and equipment and facilities. So once that is complete, then you’re gonna have a much better discussion around the financial implications of the relationship.
Tacey Ann Rosolowski, PhD:
This may not be—I’m not sure if this is a relevant question or not, or when this might be relevant, but I assume that part of the motivation to co-brand with MD Anderson is that the MD Anderson name is worth something. How do you factor that into these kind of market projections?
Amy Carpenter Hay:
There is a—there is a fee for our relationships. We have looked at it as a fixed fee that is for our intellectual property and our expertise that we provide. And then, we’ve organized these in a fashion where there’s also a variable fee that is associated with the performance of the center. So, we—there is a financial component of this, and that financial component is used to ensure that we can reinvest back into the Main Campus. So, there’s two financial components. In addition to those two, we also have a yearly budget with all our partners in which they pay for our time and our travel. The way that MD Anderson has approached it, which I think has been successful thus far, is that our partners cover all of our cost. So as a state agency, one of our important considerations is that, if we are allocating any time or any resources, those resources are paid for, and we can take those funds and reinvest them back into the institution.
Tacey Ann Rosolowski, PhD:
Also, it’s a legitimate recognition of the intellectual value—
Amy Carpenter Hay:
Absolutely.
Tacey Ann Rosolowski, PhD:
—and the practical value that’s being offered. So, when you say “we”— “the partners cover our expenses”—I mean, whose time is being paid for here?
Amy Carpenter Hay:
MD Anderson’s. So—and when I say “MD Anderson,” it goes across the board: so, any doctors that work on the relationship, attend tumor boards, go to the locations, etc.; any support staff that focus on the relationship; things like pharmacists and nurses and technicians and even project managers that are responsible for ensuring that those relationships are managed appropriately and tightly interconnected.
Tacey Ann Rosolowski, PhD:
How—to what degree does your experience—I mean, you started as a patient-support assist—I’m trying to recall the exact name—
Amy Carpenter Hay:
Patient—PSC—patient service coordinator, uh-huh.
Tacey Ann Rosolowski, PhD:
Patient coordinator—[inaudible] coordinator. That’s it. I mean, you came up, really, through an interesting track. How has that helped you perform this kind of work now?
Amy Carpenter Hay:
Actually, I think it’s pretty pivotal in what I do and how I do it, because I grew up—and I often say I grew up at MD Anderson. I learned MD Anderson from the ground up. I know how to order a CT [computed tomography], and make a referral to a clinic, and navigate the system. So, I know MD Anderson from a provider perspective, and I know MD Anderson from a patient perspective through my work with patient advocacy. All of that allows you to understand the impact of what we’re doing in the network, both on the patients we’re serving and the providers here at MD Anderson. So, I think my background is pretty important. You know, I was actually saying—just today someone asked me how long I’ve been here, and this summer it’s coming up now on nineteen years. And part of that success, I’d like to think, is based on the fact that I have worked in such a diverse array of not only divisions and departments, but also at different patient access points. So, from the front door, to specialized services, to patient advocacy, I’ve learned MD Anderson, and that’s allowed me, then, to help translate that into different environments.
Tacey Ann Rosolowski, PhD:
Can you give me some examples of kind of communication challenges, or—you know, what you’re doing is figuring out how—you know, not only the legal issues, but just how to bring two organizational cultures together. I’m wondering the kinds of issues that arise in that process.
Amy Carpenter Hay:
Yeah, and that’s a—and especially in our partnerships nationally, that’s a really important component. If the cultures are not able to be bridged, then it’s going to be extremely difficult for the providers to find the right integrated connection. And part of that is two-sided. It’s an acknowledgement from MD Anderson’s side that not every location can be identical to what we have on 1515 Holcombe. And examples of that are not every partner will have the ability to have bench-top research. They shouldn’t. Not every partner will have the ability on day one to have super-sub-specialized delivery. That will take time based on volumes. On the other side of the equation, the partner must have a culture that is desiring to move toward excellence. So, if they are not interested in elevating their cancer-care delivery, then the cultures will never bridge. There has to be some give and take, and some focus on what the two organizations want to accomplish together, in a very methodical manner. It doesn’t happen overnight. It takes time. It’s the reason why we have usually a fairly long pre-op diligence period with partners—is to ensure that they fit our culture and we fit theirs. And I think this is a pretty important lesson learned in some of our past relationships. A—you know, the facility that we had in Orlando did some very good things for patients. But when it came time to fully integrate them, they, culturally, were not interested in doing that. And without the doctors—and it boils down to the doctors being able to relate and be open and be focused on what we’re trying to accomplish, then a partnership will never work. It will be a piece of paper—a legal document. It will not be a real relationship that impacts cancer patients.
Tacey Ann Rosolowski, PhD:
Tell me more about what the doctors may or may not do to push forward this cultural fit.
Amy Carpenter Hay:
Mm-hmm. Well, I think what I would state is the doctors at both locations, but specifically at the partner locations, have to be willing and open and motivated. And the—one of the ways that we do that is, in the diligence period, we meet with all of the potential doctors that want to be part of the program. In fact, we vet—and our division heads review and approve every single doctor in the partner membership. So those physicians now have a—not only a relationship, but an obligation to be part of MD Anderson, and how we do care—how do we deliver that to patients. So, you know, that—it really gets down to the doctors at the partner wanting to participate. You have to be willing and—not only willing, but you have to be committed and passionate about prospective, multidisciplinary, research-driven care. And if that’s not something that you’re interested in doing, then you shouldn’t be part of the MD Anderson program.
Tacey Ann Rosolowski, PhD:
Mm-hmm. So how would that play out in an actual situation with a patient? I mean, what would a physician actually do if a patient comes in with leukemia or breast cancer or prostate cancer? So, how would a patient know that they’re getting MD Anderson care if they’re in Banner, for example?
Amy Carpenter Hay:
Well, it—
Tacey Ann Rosolowski, PhD:
In terms of how the doctor interacts with them.
Amy Carpenter Hay:
The doctors have all been reviewed and approved. I would assume the patient would know because it says MD Anderson on the door.
Tacey Ann Rosolowski, PhD:
Sure, sure.
Amy Carpenter Hay:
But, you know, I think it’s more about the interaction of the physicians. So, the patient is seen at Banner MD Anderson. The case is reviewed in a multidisciplinary fashion. MD Anderson does tumor boards and joint conferences with Banner and with all of our partners, and reviews cases prospectively, not only by disease but also by modality. So, the patient, I think, has comfort by the fact that they have come to the co-branded location, therefore our commitment is to ensure that what they receive is MD Anderson care.
Tacey Ann Rosolowski, PhD:
So what you’re—what you’re saying is, basically, you need to move away from the model of doctors operating pretty much individual in—and suddenly physicians are operating in teams—multidisciplinary teams.
Amy Carpenter Hay:
Absolutely.
Tacey Ann Rosolowski, PhD:
Gotcha. Okay.
Amy Carpenter Hay:
That’s—and that’s the requirement to be co-branded in the program. So, you know, that’s the same feel that you should get in Houston—is the same feel you should get at our partner locations.
Tacey Ann Rosolowski, PhD:
Mm-hmm. And that is a real shift for some physicians. And I can see where, you know, there would be resistance. And some—are there ways in which some institutions just structurally don’t support that? Or maybe I should ask the question differently. You know, as you’re figuring out how to arrange the business relationships, are there certain structural changes that have to happen in an institution in order to make that multidisciplinary care possible?
Amy Carpenter Hay:
Yes. And, you know, contractually, we obligate some of those things. So, for example, at Banner, all the physicians are employed. There are no community physicians that participate. At Banner, all of the physicians are required—and we track participation in multidisciplinary care, tumor boards, etc. You know, from a healthcare-organizational perspective or a hospital perspective, there are things like closing your oncology practice. So, bylaws have to be changed, privileges have to be changed, in order to really make the location MD Anderson-only from an oncology perspective.
Tacey Ann Rosolowski, PhD:
Gotcha. Okay, all right, [inaudible].
Amy Carpenter Hay:
So that’s a big commitment, you know? It’s a big commitment of an organization to do that. You know, there are physicians—and every community has been the same—that have opted not to participate. And so, our partners have to know that going in, that there will be some pushback. There will be some—potentially folks that decide not to participate, which means that they’ll go to another hospital.
Tacey Ann Rosolowski, PhD:
Mm-hmm. Organizational change is tough. Are there certain supports or—that MD Anderson offers to help an organization move through that change period? How do you—how do you work with that?
Amy Carpenter Hay:
Mm-hmm. Well, we plan it all out with them. You know, we’ve done this a few times now, so we kind of have a nice model of what we suggest, and examples of bylaws and privileges and things like that. So, the intent is that, during the diligence and the pre-op period, that we work with them—are giving them all the tools to accomplish this. Now, at the end of the day, they have to do it themselves, but we’re giving them, really, the toolkit in order to make it happen.
Recommended Citation
Hay, Amy Carpenter and Rosolowski, Tacey A. PhD, "Chapter 11: The Center for Global Oncology: Background and Operations" (2015). Interview Chapters. 960.
https://openworks.mdanderson.org/mchv_interviewchapters/960
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