Conquest
Spring 1995

Joining Forces

The changing health care environment has prompted M. D. Anderson to work with former competitors to better serve patients throughout the country

By Mary Jane Schier

When M. D. Anderson was created in 1941, the enabling legislation allowed the establishment of "substations" for the diagnosis and treatment of cancer.

Now, more than 50 years later, this vision is coming true as M. D. Anderson is building a growing network of affiliated cancer centers.

At the same time, the institution is working with a variety of other health care providers to offer cancer care to patients around the country.

While some of this networking is driven by economic forces, it also promises to offer cancer patients more convenient, cost-effective services.

"Networking is fast becoming an important part of how M. D. Anderson provides cancer services," says Dr. Charles M. Balch, executive vice president for health affairs and a leader in planning the new outreach activities. "When all of our network programs are fully operational, M. D. Anderson will become an institution wi thout walls, which will put us in the strongest possible position to serve patients in a managed care environment."

M. D. Anderson's recent networking efforts include membership in a national organization of cancer centers, affiliation with a radiation therapy center in Fort Worth, and working more closely with the Harris County Hospital District to provide care for i ndigent cancer patients in the Houston area.

"M. D. Anderson's networking efforts have been stunning," says David G. Bradley, president of the Advisory Board Company in Washington, D.C., a firm that has evaluated how American hospitals are reacting to the changing health care environment. "From a dead stop, M. D. Anderson has moved faster, more intelligently and more effectively in the past year than any other academic medical center involved in the field of networking."

M. D. Anderson's most recent networking endeavor is membership in the National Comprehensive Cancer Network (NCCN), an organization of 13 leading American cancer centers that was announced in late January.

NCCN will develop and implement standards for all aspects of cancer care and will work with large employers and third-party payers on managed care agreements designed to make a full range of cancer treatments available to more patients. Services availab le will include cancer screening and prevention programs.

"State-of-the-art cancer services, geographic convenience and competitive prices will be the hallmarks of NCCN. Network members will offer complex and highly specialized cancer services not generally available in community oncology practices," says Dr. Balch, who is a member of NCCN's Executive Committee.

Dr. Balch predicts NCCN will be particularly valuable for large employers with offices or plants in multiple locations across the country.

"These employees and their insurance intermediaries can use a single network of world-class cancer providers through managed care contracts," he says.

Dr. Karen Miller, corporate health care manager for Houston-based Tenneco, agrees. "A large corporation like Tenneco, with some 50,000 employees scattered all across the country, should benefit from a relationship with a national network that will provide cost-effective care without compromising quality," she says.

NCCN already is working on cancer practice guidelines, realistic outcome expectations, promoting cost containment and quality assurance programs and educating consumers about the important role of research-based cancer centers in the care of cancer patie nts (see sidebar).

"We are not going to wait for health care reform at the national level. Our priority is to be a voice for the patient for what the standard of care ought to be because we believe that the right treatment at the time of diagnosis provides the best o utcome and also is the most cost effective," says Dr. Joseph V. Simone, physician-in-chief at Memorial Sloan-Kettering Cancer Center in New York City and medical director of NCCN.

M. D. Anderson's participation in NCCN and efforts to develop an integrated cancer care network are being coordinated by M. D. Anderson Cancer Center Outreach Corporation.

Both the Outreach Corporation, which was created in 1989, and M. D. Anderson Physicians Network, chartered in 1994, are not-for-profit corporations established to expand the institution's multidisciplinary cancer care expertise through partnerships wit h other health service providers. Robert N. Shaw is president and chief executive officer for both corporations.

"Our goal is to offer a continuum of cancer services in a seamless system that will provide the highest quality cancer care in the most convenient setting at the most effective cost," Shaw says.

Services available at M. D. Anderson Cancer Center-Orlando, which was the first joint program developed by the Outreach Corporation, also will be part of NCCN. The Orlando center opened in 1991 through a partnership with Orlando Regional Healthcare System.

Dr. Clarence H. Brown III, medical director of M. D. Anderson in Orlando, is elated about the national alliance. "We feel very fortunate to be the first community- based cancer care center in the new network. Our participation will further expand treatment options for patients in the Orlando area, especially those covered by managed care, and we will be able to add our outcome results to the national data," he says.

Another participant in NCCN activities will be the newly named M. D. Anderson Moncrief Radiation Center at Fort Worth. The Moncrief Radiation Center was given to M. D. Anderson in late 1994 in what was the largest gift in M. D. Anderson's history. The $44.2 million gift includes all assets of the widely respected Moncrief Radiation Center and its foundation, the Moncrief Radiation and Research Foundation.

When it opened in 1958, the Moncrief Radiation Center was the first freestanding community radiation therapy facility in the Southwest. Now it is the first satellite patient care program in Texas under direction of the M. D. Anderson Cancer Center Outre ach Corporation. Services are expected to be expanded beyond radiotherapy at the Fort Worth center in the future.

The Moncrief Radiation Center was named for W. A. "Monty" and Elizabeth Moncrief, who donated more than $7 million to support the facility. Their son, W. A. "Tex" Moncrief Jr., and his wife, Deborah, have given $5.9 million to M. D. Anderson, including $4 million for a new diagnostic imaging center now under construction and three endowed chairs for senior faculty members.

Closer to home, officials from M. D. Anderson and the Harris County Hospital District have been meeting for almost two years to evaluate existing cancer care and propose ways to extend services for the indigent population that both institutions are respo nsible for serving. Medical faculty from Baylor College of Medicine and The University of Texas Medical School, who staff the districtÕs two hospitals, have participated in the discussions.

Dr. David C. Hohn, vice president for patient care at M. D. Anderson, says he is optimistic that a plan will be developed to provide truly comprehensive services, including earlier cancer screening and prevention, to more Harris County patients who have limited access to health care.

Lois J. Moore, president of the Harris County Hospital District, notes, "By working closer together, we have an opportunity to maximize the resources for cancer care available to both of our organizations."

M. D. Anderson already is providing physicians for several services at one district hospital--LBJ Hospital--and expects to contribute clinical fellows at the same facility to work with faculty from The University of Texas Medical School.

The evolving cancer care program is expected to be patterned after the county's successful trauma care system developed years ago by the Harris County Hospital District and Baylor College of Medicine. With time, the cancer program could become a model o f its own by demonstrating how tough economic conditions encouraged medical providers to join forces for the common good. In this case, the beneficiaries will be indigent cancer patients who otherwise might not have received the best possible services in a timely manner.

Click here to read a sidebar to this story titled "Network to help standardize treatment"