Cancer Affiliate Program

Podcast Transcript

Dale Shepard, MD, PhD: Cancer Advances, a Cleveland Clinic podcast for medical professionals. Exploring the latest innovative research and clinical advances in the field of oncology. Thank you for joining us for another episode of Cancer Advances. I'm your host, Dr. Dale Shepard, a medical oncologist here at Cleveland Clinic overseeing our Taussig Phase I and Sarcoma Programs. Today I'm happy to be joined by Shannon Faulhaber, director of strategic growth for the Taussig Cancer Institute. She's here today to talk to us about cancer affiliations. Welcome, Shannon.

Shannon Faulhaber: Hi, nice to be here.

Dale Shepard, MD, PhD: So maybe to start out, you can give us a little bit about your role here at the Cleveland Clinic, and then we'll talk a little bit more specifically about the strategic growth and affiliations.

Shannon Faulhaber: So with my role as the director of strategic growth, I manage all of our outreach and growth efforts. That includes the affiliation and acquisition programs and any other growth opportunities that come our way, like new buildings and new programs that we develop in Northeast Ohio.

Dale Shepard, MD, PhD: So when you say affiliate, let's just start from there. What does it mean to be an affiliate?

Shannon Faulhaber: An affiliate is a partner, a contracted partner, that comes on through our cancer program. They're not employed by the Cleveland Clinic. They are independent. Hospitals are independent physician programs. They do come on for a variety of reasons. We have a whole menu of services that we can offer them, and we're here to support them.

Dale Shepard, MD, PhD: When we think about affiliations, are these sort of like a brick and mortar group of oncologists or radiation oncologists? Or is this maybe working with a group just for a program or a particular project?

Shannon Faulhaber: It's typically brick and mortar. So the different groups that will come to us are small community-based cancer centers that want a connection to a larger academic center or our sub-specialized physicians. We do get some private practice physicians that also want the same connection to a larger healthcare setting so they have access to all of the different resources that we have here that they might not have.

Dale Shepard, MD, PhD: What are some of the resources that you find the community groups are most interested in?

Shannon Faulhaber: Number one thing that they are interested in is connection to our physicians. They want to have access to our disease-based teams. They want to submit cases to tumor boards. They want to know our Care Pass, lots of questions on education and different quality indicators.

Dale Shepard, MD, PhD: And so who would qualify to be an affiliate? What kind of groups would we be looking for to affiliate with?

Shannon Faulhaber: The number one thing we look for in a partner is alignment with our quality standards, alignment with our patients first attitude here at the Cleveland Clinic. We're really looking for partners that have our same core values. We talk to people and if they don't express those same interests, we move on to the next partner. But we have a lot of people that come on and want to talk to us because they know our high standards and they want to align with those.

Dale Shepard, MD, PhD: And so from a quality standpoint, certainly if we're going to have a partner and we want to maintain that quality, it makes sense, because it's our reputation as well as theirs. How do we keep track of that? Once we have an affiliate, they're not employed. How do we work with groups to maintain that quality?

Shannon Faulhaber: It's a good question. And it was a heavy lift to get that set up. What we do when we first sign on a new affiliate after the contract is signed, we have a comprehensive team that goes on site, and we do a full on-site assessment. And that assessment looks at everything from those quality standards really benchmarked in regulatory bodies, and then our core SOPs and policies here at the Cleveland Clinic. And then we also dive deeper into radiation oncology from that. That defines whether or not they move forward with our branding, and then it also is our foundation in how we move forward with our work plan.

Dale Shepard, MD, PhD: So, ideally, if we have a potential affiliate, we would like for them to sort of be a bit like-minded to start with, and maybe that would be the best partner instead of someone that says, "Hey, I like the way you guys do things. We'd like to set that up here."

Shannon Faulhaber: That's exactly right. We don't want to start from scratch. We want to be able to help people and bring something to the table and move them to the next level. But they already have to have that strong foundation from the physician group, as well as their executive teams. We need to have everybody who is going to be involved in the contract on board to invest time and resources to make the affiliation work.

Dale Shepard, MD, PhD: How about geography? How does that play in to affiliations?

Shannon Faulhaber: We have found that our best affiliations are more than four hours away. So that way, we can still service patients that might need to come to our main campus for specialized surgeries or transplants, things like that, but far enough away that we're serving a different patient population.

Dale Shepard, MD, PhD: I guess just as a way to think through this, how long have we been setting up affiliations?

Shannon Faulhaber: About 10 years now, little over 10 years.

Dale Shepard, MD, PhD: So quite a while, so we have a lot of practice.

Shannon Faulhaber: We do. Yeah, we've had quite a few. We've had a few that have gone away. We had a really nice one in Chicago for quite a few years, and they were acquired by another hospital. So we go through different phases with our different affiliations. Just recently, we expanded our affiliation in Kentucky. They started with two of their sites under our affiliation, and we've moved to have all five of their cancer sites included now.

Dale Shepard, MD, PhD: Now if patients are looking to seek oncology care somewhere in the country where we might have an affiliation, how do they know that? How do we let patients know that they're going to get, for lack of better way to put it, Cleveland Clinic care in their own hometowns?

Shannon Faulhaber: After we go through that initial quality assessment and the affiliate is cleared for branding, the affiliate partner works with us to come up with a marketing plan and so they can have branding on their building. They can use it on any of their written collateral or reason announcement. They do media announcements, news stories, patient stories, anything that they want to do, our marketing team works with them directly to make sure it's aligned with what we would like to see. And then they roll it out on their own markup.

Dale Shepard, MD, PhD: And, at any given time, about how many affiliates do we have?

Shannon Faulhaber: We're averaging about two right now. So each affiliate is a very heavy lift. We do it with all internal resources. We really lean on our teams that are seeing patients or have other jobs so that we know that we're doing directly what we would do in the cancer center here. So having too many affiliates would be overwhelming, so we are very discreet on who we actually bring onto our program.

Dale Shepard, MD, PhD: You mentioned before that one of the things that an affiliate might be looking for, things like tumor boards and access to physicians. I'm going to selfishly ask what's in it for us? What benefits do we get from having an affiliate?

Shannon Faulhaber: That's a great question. So number one, I would say that we get referrals, and we are getting those more complex patients. We know that when patients need a higher level of care that the community centers can't offer because they're smaller, they're coming to the right place and seeing the right people. We also get brand recognition in these markets that we wouldn't be in otherwise. And the core part of our program is that we do think that we have a very high quality cancer program, one of the best in the world. And we do want to spread this out and put our quality and our focus within cancer care in the smaller communities that wouldn't otherwise have it.

Dale Shepard, MD, PhD: And so is there a way that we can grow more quickly and make those decisions on these affiliates and grow the program, as you mentioned? Understandably, it's a lot of time and a lot of effort. Is there a way to streamline this?

Shannon Faulhaber: I think one of our number one barriers is that people don't know that we have the affiliate program. So any work that we can do to spread the word that we have an established affiliate program would get us across the country a little bit more. Again, we're particular on who we want to partner with, so sometimes it's hard to find the right partner.

Dale Shepard, MD, PhD: And I guess having done this for a while, are there particular groups or service lines that make a lot more sense for affiliations? So medical oncology, certainly, people want to get their care close to home. If you get too far away, they may not want to come here for a surgery, and those affiliates may not have the surgeons necessary to do the procedures we're looking for. So have there been particular whens, in terms of surgery versus radiation or oncology? Or how does that normally present itself?

Shannon Faulhaber: When we look at our demographics or where the affiliate should go, having them in our surrounding states really has been how we're more successful with the affiliate program. So then we can get those more complicated surgeries. And we're confident that when they go over to medical and radiation oncology, and they do need to stay closer to home, their path started where we would have aligned originally. Right now, we don't have a very comprehensive surgical program to offer to people. That is something that we're developing now.

Dale Shepard, MD, PhD: What do you think is next from an affiliation standpoint? You mentioned that mostly these are kind of free standing, like a group. What about affiliations where we may not be fully invested in terms of an affiliation, but we work with them on tumor boards or second opinion referrals and things like that. Is that something that would fit within this affiliation structure? Or is that something we're working on entirely separately?

Shannon Faulhaber: No, definitely, that would fit directly in the affiliation structure. And I think it's something that we need to begin to explore, especially with the new telemedicine emphasis. There's so many more ways that we can now service patients across the country and not have to have these really formal contracts and go through the whole quality assessment, but still be able to influence care and support all the community physicians.

Dale Shepard, MD, PhD: Right. Take a lot of the things we do in rare tumors, for instance, has really opened up. The telemedicine really helped open up that care to people who wouldn't have it otherwise. And we've kind of overlapped with our affiliate plans, but unfortunately, there are more restrictions on where we could do that.

Shannon Faulhaber: It would be really fun if we could set up rare tumor board for the outside. Have we talked about that in the past?

Dale Shepard, MD, PhD: We haven't talked about that, but it's certainly a good idea.

Shannon Faulhaber: Yeah.

Dale Shepard, MD, PhD: Because this is one of the areas where, oftentimes, we're getting people from a distance, and they come here, and their local oncologist, understandably, just hasn't seen it. So you can't fault them. They're seeing a lot of other thing, and they don't see the rare things that we will. But would be a nice way to maybe dovetail with the affiliate program.

Shannon Faulhaber: I would love to set that up with you if you want to. I bet we could get that going.

Dale Shepard, MD, PhD: As we think about Cleveland Clinic, we're in Abu Dhabi, in London, and we have the consult service in Canada, is there any move toward any affiliations that would partner with those programs?

Shannon Faulhaber: We don't have any international affiliation partners in the works now. One of our big focuses is definitely Florida, though. Our Florida region is growing. We acquired the two hospitals within the last few years, and there's a lot of interest with partnering in cancer in the Florida region. So I think that's going to be one of our focuses in the upcoming year.

Dale Shepard, MD, PhD: Because we don't have cancer care specifically in Las Vegas, but we have a footprint in neurosciences. Is there any advantage to considering that area just because we have brand recognition in the area?

Shannon Faulhaber: I would love it. I haven't heard any interest in moving cancer out there. I did recently ask whether or not they were doing any diagnosis of cancer in Las Vegas, and I was told no. They're really strictly with the brain health, but yeah, that would be a great opportunity.

Dale Shepard, MD, PhD: What else do you think is going to make our affiliation program move forward? What are the next things that we should be looking at?

Shannon Faulhaber: I think that sets us apart within our affiliation program is our personalized, direct contact that physicians have with our specialists here. And we need to continue to emphasize that and promote that, and that's how we going to move the program forward.

Dale Shepard, MD, PhD: And I got to tell you, it's pretty painless. I will routinely get a phone call from someone, and they'll say, "Hey, can I just run something by you?" And it's tremendously helpful for everyone. The local physician gets some reassurance that maybe what he is doing is the right thing to do; gets an idea of something else, if he hadn't thought of it. The patient doesn't have to travel here just to hear what we had to offer, and it's pretty quick and easy. So certainly, from the oncologist's standpoint, it seems to work pretty well.

Shannon Faulhaber: That's what I hear. And I'm also told over and over again that it's kind of what you guys do as physicians. Someone asks you a question, you answer the question, and you give them as much of your knowledge as you're able to.

Dale Shepard, MD, PhD: And I think the more we can work with affiliations and codify that into a way that makes good sense, I think it's a win for everyone.

Shannon Faulhaber: Yeah, I agree, especially for the patient.

Dale Shepard, MD, PhD: Yeah, absolutely. So any particular area of the country other than Florida that we should be looking at? We have people listening in, and I guess the other call to action would be if anyone is listening, and they weren't really thinking about affiliations but would like to, and that they get in contact with us to have those initial discussions.

Shannon Faulhaber: They can contact me directly. So I vet all the inquiries that come in through the program. We do have an affiliate webpage that's on the Cleveland Clinic main website, and I'm happy to take all inquiries.

Dale Shepard, MD, PhD: Perfect. So is there a particular website where people could go to get some additional information about affiliations?

Shannon Faulhaber: They can go to clevelandclinic.org/canceraffiliates

Dale Shepard, MD, PhD: Well, thank you very much for joining. I appreciate your insights and all the work you're doing to improve the care for cancer patients around our region.

Shannon Faulhaber: Thank you. Thanks for having me.

Dale Shepard, MD, PhD: This concludes this episode of Cancer Advances. You will find additional podcast episodes on our website, clevelandclinic.org/canceradvancespodcast. Subscribe to the podcast on iTunes, Google Play, Spotify, SoundCloud, or wherever you listen to podcasts. And don't forget, you can access real time updates from Cleveland Clinic's Cancer Center experts on our ConsultQD website at consultqd.clevelandclinic.org/cancer. Thank you for listening. Please join us again soon.