Hartford Healthcare has touted its recent alliance with a renowned New York cancer research hospital as a strategy to improve and standardize the way its far-flung doctors provide care and expand the number of experimental treatments available to patients.
The five-hospital system’s charter membership in the Memorial Sloan Kettering Cancer Alliance is akin to a stamp of approval from U.S. News & World Report’s highest-ranked cancer hospital.
But prestigious as it is, the arrangement is not wholly unique.
Over the past two years, two other Connecticut hospitals have cemented partnerships with highly-ranked cancer research centers.
Bridgeport’s St. Vincent’s Medical Center became a member of the MD Anderson Cancer Network, adding itself to a list of a dozen other hospitals across the country linked to the Texas system. And New London’s Lawrence + Memorial Hospital, which opened a new cancer center last year, became one of Dana-Farber Cancer Institute’s only affiliates outside Massachusetts.
“The trend in general around partnership or collaboration has certainly increased over the last few years,” said Matt Farber, director of provider economics and public policy for the Association of Community Cancer Centers.
Indeed, a survey by the ACCC released this year found that 43 percent of cancer centers had some kind of partnership with an academic institution.
Though each varies, the major components of the arrangements generally include an accreditation process; physician access to expert oncologists to discuss cases or treatment protocols; and patient enrollment in clinical trials run by the major center.
And while hospital executives downplay it, Farber said there’s another important aspect to the partnerships: marketing, particularly the ability of local hospitals to plug the name of a major research institution.
That element, however, has attracted local critics too, who say some affiliate agreements seem to focus more on advertising than on improving patient outcomes. That’s a charge area hospital executives deny.
What’s in it for the big guys?
Traditionally, major cancer centers were reluctant to share their brand with community hospitals largely out of their control, but their mindset has changed in recent years, hospital executives say.
For one, local hospitals have something big centers want: patients. According to the federal government’s National Cancer Institute (NCI), 85 percent of cancer care takes place outside of major academic hospitals.
“I think maybe years ago the larger centers assumed, over time, that’s where patients would go, but the reality is that the trend really hasn’t changed,” said Cindy Czaplinski, St. Vincent’s clinical vice president of oncology. “People want local care close to home.”
More patients offer cancer centers a deeper pool of clinical trial candidates, which is important as research increasingly focuses on targeting specific gene mutations, rather than general types of cancer, such breast or lung. That shift makes finding the right patients for trials more difficult.
There are also some financial gains as hospitals typically pay a fee to their larger partners. Additionally, major centers that partner with smaller hospitals see helping to control and potentially cure cancer, even in a far away state, as part of their mission.
Alliance is new territory for both sides
Though Memorial Sloan Kettering has opened a network of outpatient centers across New York and New Jersey in recent years, its relationship in Hartford — designed by both parties from the ground up — is a first, said Dr. Richard Barakat, MSK deputy physician in chief.
“We have not offered or placed our brand in other locations,” Barakat said.
And while Hartford Healthcare has had research partnerships with various partners, the MSK alliance is much more involved, said Andrew Salner, director of Hartford Hospital’s cancer center.
Not only was the deal born out of year-long scrutiny and tweaking of cancer care standards across HHC — which Salner said treats approximately 6,000 new cancer cases a year — but it could double the number of clinical trials available to local patients, he said.
Officials at St. Vincent’s and L+M said their respective partnerships with MD Anderson and Dana-Farber both included a review of local standards they characterized as rigorous, an adoption of the larger partner’s best practices, and access to physician consultations with experts.
L+M inked its partnership not long before building a cancer center in Waterford. Dana-Farber advised L+M on the design and capabilities of the center, but took no equity in the project, L+M CEO Bruce Cummings said. Four Dana-Farber cancer physicians staff the center, which is unique among the Connecticut arrangements.
The economics of local cancer research
Many of Connecticut’s hospitals, big-name partnership or not, participate in cancer-related clinical trials backed both by government and industry.
The trials offer some hope for patients with difficult cases and they advance the understanding of how cancer should be treated.
Yale is the biggest research player, with approximately 400 clinical trials open, while Hartford Healthcare and St. Francis Hospital and Medical Center both say they have more than 100. St. Vincent’s has about a dozen with various partners, though it plans to offer MD Anderson trials in the next year or so. L+M, the smallest of the three providers, has just one open trial but is also hoping to add more.
But patient enrollment in research studies — which is a metric increasingly scrutinized by a major community cancer center accrediting body — takes resources. ACCC’s survey found that 43 percent of cancer center research programs are losing money and that more than a quarter have cut back in the past year.
Hospitals across the country have complained of low reimbursement rates for enrolling patients in NCI-funded trials. Congress has been of little help, holding NCI funding flat for the past decade.
Earlier this year, NCI was forced to consolidate some of its cooperative trial groups, which are key research partners for smaller hospitals.
“There is difficulty in completing these trials and there’s a decrease in funding for these trials,” said MSK’s Barakat, who estimated that MSK has 900 open clinical trials.
Partnerships with big centers that conduct many clinical trials could help local research programs be more efficient. HHC’s Salner said MSK will help eliminate some red tape and trial enrollment costs by acting as the system’s institutional review board, a type of ethics committee that determines if specific experimental treatments on humans are worth the risk.
“We now have one [institutional review board] for all of Hartford Healthcare instead of five separate ones,” Salner said.
Competitive pressures
So does the MSK Cancer Alliance put pressure on Hartford Hospital’s biggest local competitor, St. Francis Hospital and Medical Center, to do something similar?
No, said Kathleen Noone, a nurse and executive director of St. Francis’ cancer service lines. That’s because St. Francis’ cancer center has an established research program that works with industry and government partners, she said.
“Every hospital in Connecticut has probably looked at a variety of options,” Noone said. “If we were not already an organization with over 100 trials open, I think we would want to pause and take a look at that.”
Though Hartford Healthcare is Yale’s largest Connecticut competitor, Dr. Thomas Lynch, director of the Yale Cancer Center and physician in chief of Yale New Haven’s Smilow Cancer Hospital, said the MSK Cancer Alliance is a good thing for the state’s cancer patients.
“Any relationship that brings molecular profiling and clinical trials to the community is a fantastic advance in cancer,” Lynch said.
But Lynch said he is convinced such partnerships aren’t the most effective way to spread better cancer care.
Lynch said Yale’s approach — opening its own cancer outpatient centers across its territory — works best because it means Yale is directly responsible for patient outcomes in those facilities.
“I am certain this is the only way to ensure what’s happening in a comprehensive cancer center is happening in community sites,” he said. “We’re not franchising Smilow.”
He said he is wary of “affiliation-light” relationships, which he feels are more about sharing a name than advancing the treatment of disease.
“They’re done for marketing reasons and branding reasons,” Lynch said, adding that he didn’t wish to name any specific partnerships he views that way.
Area hospital executives all admit they have witnessed or experienced those types of affiliations, but say theirs are different.
“I would say I strongly disagree with that,” said Dr. Christopher Iannuzzi, St. Vincent’s oncology department chair.
Iannuzzi said his colleagues’ interactions with MD Anderson have in some cases directly resulted in altered treatments and radiation doses. And clinical trials are on the way, he added.
“Clearly this is not a rubber stamp,” he said. “We’re not just paying to have our name co-branded.”
Hartford Healthcare’s Salner said its MSK alliance will be the most in-depth partnership in the state, and not about marketing, though he admits physicians are excited to be associated with the famous institution.
MSK’s Barakat said he can’t speak to other relationships, but said his cancer center put a lot of thought into its Hartford partnership.
“I know the details of this one and this is a substantive relationship that is truly going to transform cancer care in the community,” he said.
At L+M, Cummings said he came across shallow partnership opportunities when his team was prospecting for a relationship, but that didn’t pique their interest.
“If we just paid a fee, we could get to use the name of a very well-known entity,” he said. “There are definitely partnerships out there that are very cosmetic. We were looking for something deeper.”
