5 Key Features of the Next-Generation of Cancer Center Partnerships

What’s Trending: As Academic and Community Cancer Center Roles Converge, Affiliation Relationships Take New Form

A new class of partnerships in cancer care is emerging—characterized by higher-fidelity clinical integration, deeper strategic and financial alignment, and a research-first orientation.??

One of the chief factors driving the change is the convergence of academic and community cancer center roles, a key theme of a recent report on the future of cancer. This convergence has resulted from the scale achieved through community hospital mergers and the decentralization of National Cancer Institute (NCI)-designated cancer centers as they have added care environments closer to where patients live. A new issue brief highlights that the convergence is expected to upend traditional roles and redefine the ways in which community and academic providers compete and collaborate in the delivery of cancer care.?

Another driving force is evolving clinical research in oncology. As new therapies are increasingly targeted to unique “omic” signatures, the eligible patient populations are increasingly narrow. Simultaneously, researchers are recognizing the need for greater diversification of research populations. Consequently, academic centers need to extend their reach for clinical trials.?

With the emerging partnership models comes a need for wholesale change in the way NCI cancer centers manage and resource external affiliations and a resetting of expectations for community partners.?

Why It Matters?

While many existing academic-community cancer center partnerships have been based on an affiliation model, the next-generation partnerships are predicated on higher-fidelity clinical and strategic integration.??

The models for these partnerships are focused on 5 core features:?

1. A strategic network design and management structure. The first generation of NCI-community affiliations were built opportunistically—often featuring one-off negotiations, broad “menus” of offerings, and only tangential alignment with broader cancer center strategic aims. Now, models need to be more scalable, better aligned with broader organizational strategy, appropriately resourced, and professionally managed.

For example, the MD Anderson Cancer Network, which has partnerships with 6 large cancer centers across the country, is organized through a dedicated subsidiary company, with its own dedicated management team, Board of Directors, and budget. City of Hope is organizing its national footprint similarly, both through a direct-to-employer subsidiary, AccessHope, and its new division created to integrate Cancer Treatment Centers of America.? ?

2. Reach and scale that is no longer geographically bound. While the older model of NCI-community partnerships largely relied on in-state collaboration (primarily to drive referrals for complex disease), newer initiatives are increasingly borderless and targeting new segments of partnership. The most direct form of scale has been national expansion, including organizations like MD Anderson Cancer Center and Memorial Sloan Kettering Cancer Center, as well as newer national players like the Dana-Farber Brigham Cancer Care Collaborative (whose recently announced partner, The Christ Hospital Health Network, is the first member outside of the Northeast).

NCI centers are also pursuing scale via affiliation with entire integrated delivery networks (IDNs), migrating away from hospital-specific deals and seeking strategic partnerships that span states and regions. The Ohio State University and its James Cancer Network are a prime example—they recently advanced formal alignment with Mercy Health across multiple markets in the state of Ohio as part of the Healthy State Alliance.? ?

3. Dynamic clinical integration. A principal aim of the first generation of NCI-community affiliation was clinical integration, but it manifested in limited ways (e.g., shared clinical guidelines, retrospective quality data, and invitation to collaborate through peer review and joint tumor boards). The next-generation models are focused on authentic collaboration and harmonization of clinical outcomes that will continue to evolve with technology and treatment approaches.

These integrations include shared clinical pathways software (e.g., Dana-Farber’s Philips product extended to affiliates); co-located and collaborative clinical services (e.g., University of Colorado and US Oncology in Denver); and joint appointments for community-based faculty (e.g., UCSF and John Muir in the East Bay Cancer Collaborative).? ?

4. Deep financial integration. One of the fundamental challenges in first-generation affiliate models was a lack of incentive alignment. In contrast, many contemporary partnerships feature performance-based fees (like that constructed between Moffitt Cancer Center and Memorial Healthcare System in their joint malignant hematology and stem cell transplant program in Broward County). Others include modality-specific joint ventures (like the radiotherapy partnership between Johns Hopkins Medicine and the University of Maryland Medical Center). The most integrated models include “service line mergers” that create site-agnostic, multi-site models of cancer care (like those developed between Stanford Medicine and Sutter Health in Oakland, and between UCSF and John Muir in Berkley and Walnut Creek).

Shared risk will likely be a common feature in NCI and community cancer center models going forward—helping to resolve the issue of overlapping service areas and allowing for site-agnostic care optimization.

5. A research-first orientation. Integrated clinical research remains something of a final frontier for NCI-community affiliate networks. To date, few high-performing networks feature trials exported to community sites from NCI cancer center research portfolios. Historically, the limitation was on the community cancer program side, given a lack of infrastructure, insufficient experience administering complex clinical trials, and/or productivity-based compensation models that did not encourage time spent managing patients on research studies. Many larger community environments now are overcoming these challenges with sophisticated clinical trials offices; active and engaged investigators; and complex, early phase trial portfolios.

As a result, the onus has shifted back to the NCI center to build the systems and processes that enable multi-site clinical trials in their networks. For instance, Yale’s Smilow Cancer Hospital Network offers clinical trials across centers in Connecticut and Rhode Island, and the University of Hawaii offers clinical trials at partner sites throughout the Hawaiian Islands.? ?

What’s Next?

While the implications of the next-generation NCI-community partnership shift are still unfolding, early applications for healthcare organizations are clear:?

• NCI centers must reinvent their partnership offering to remain relevant. A review of the top 25 NCI centers reveals many neglected affiliate models, often attached to NCI centers that have been slipping from top-tier rankings over the past 3 to 5 years. Thoughtful partnership strategy is no longer optional because strong networks will be a critical component of remaining viable amid challenges for the academic cancer care model.?
• Community programs can and should expect more from their NCI partnerships. Community cancer programs have new scale and market leverage, affording them more agency in the design of NCI partnership. They also have access to more alignment options (beyond local players) as new national platforms emerge and the alignment marketplace becomes hypercompetitive. Community cancer programs should be more discerning as they evaluate partnership against next-generation needs.?
• Lines will blur, creating an NCI center “without walls.” As NCI affiliates give way to integrated partners, community programs will likely become natural, indistinguishable extensions of the NCI center. Faculty will move and work seamlessly between the environments, and operators will master the complexities of managing a multi-site, multi-ownership ecosystem. Most importantly, a mixed model will enable a single standard of care and standard of excellence, with patients as the true beneficiaries of these next-generation pairings.?

• Affiliation design and negotiation will become far more complex. As economically intertwined business arrangements replace traditional service models, the demands of partnership design will become intensive. NCI centers will need dedicated teams with extensive finance and legal expertise embedded in their affiliate network organizations to navigate collaborations.?
• NCI partnership will become a more powerful market device. Next-generation clinical integration should create the conditions necessary for true shared excellence and quality impact—in turn influencing behaviors of consumers and referring providers in a manner never fully realized in the first-generation models. Integrated partnerships will allow cutting-edge expertise and capabilities to extend to new geographies, with NCI centers and community partners directing patients to the most clinically appropriate and patient-accessible location.?

When implemented in their purest form, these next-generation partnerships will create seamless, multi-site care ecosystems. Community programs will be natural and indistinguishable extensions of the NCI center. And a shared standard of excellence will bring immense value to cancer patients.?

Learn more about the future of NCI-community cancer center partnerships in our latest issue brief, and explore our interactive dashboard of NCI networks.?

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