The West Clinic Forms Three-Way Partnership to Transform Cancer Care

by HCE Exchange on December 11, 2014

Erich-Mounce-thumbErich Mounce, President and Chief Executive Officer, The West Clinic

by Pete Fernbaugh

Located in Memphis, Tenn., The West Clinic is a physician-owned, single-specialty oncology group that has forged a reputation as one of the United States’ foremost community oncology practices.

Founded 30 years ago by local physician Dr. William H. West, The West Clinic was grown and established by two Memorial Sloan Kettering Cancer Care oncologists: Dr. Lee S. Schwartzberg and Dr. Kurt W. Tauer.

“Because the two of them have such strengths, Lee in the scientific clinical-trial background and Kurt with his ability to really make patients feel like they were being cared for in all aspects of oncology, the model was just a huge success and has grown phenomenally over the last 25 years,” Erich Mounce, president and chief executive officer, said.

The West Clinic currently employs or manages through contractual relationships 42 physicians within the group from multiple cancer specialties, including radiation oncology, surgical oncology, internal medicine, radiology, and palliative care and pain. The organization maintains 40 open clinical trials at any given time, allowing patients in Memphis to participate in drug therapies that aren’t available in most community oncologists’ offices, Mounce said.

Over the last three years, The West Clinic has hosted more than 900,000 patient encounters and averaged 10,000 to 11,000 new patients each year at its eight sites, along with approximately 2,800 analytic cancer cases.

“It’s grown to be a very large multi-site operation, but it’s been able to maintain its focus on research and on providing family care,” Mounce said.

A future of sustainability and community

When Mounce was hired in 2010, the major question confronting the organization was the future and how to maintain The West Clinic’s success for the next 25 years, while continuing to create a legacy within the community.

A variety of strategic reviews revealed a conundrum. The best direction for the Clinic was to form an all-in-one model that would include the construction of its own cancer hospital. However, Tennessee state law and the Affordable Care Act had both ruled that physicians could not own hospitals.

From these regulatory impediments grew the idea of a three-way partnership with two other organizations. This partnership would give The West Clinic access to all of the resources it would need 25 years into the future, yet the partnership could not be construed as physician ownership.

After exploring several different possibilities, The West Clinic settled on a partnership with the University of Tennessee Health Science Center and one of Memphis’ largest healthcare systems, Methodist Le Bonheur.

Together, Mounce said, these patient-centric organizations would determine the paradigm of cancer care in Memphis going forward.

They began with the formation of an Executive Cancer Council, the mission of which was to develop a defractionated approach to provider delivery, with the ultimate goal being to build an NCI-designated comprehensive cancer center over the next 10 years. As Mounce said, a comprehensive cancer center would solve the dilemma that confronts patients even to this day: having to go to multiple locations for different aspects of their treatment.

“It just seems to me that defractionizing healthcare and putting as much of those services in one place or on one campus makes all the sense in the world,” Mounce said. “It decreases overhead, you don’t have multiple check-in and checkout access points, and you are allowed to float staff. Plus, the patients love it.”

He added that Methodist Le Bonheur has agreed to direct essentially all cancer-related margin generated from oncology services 100 percent back into cancer care for the underserved community.

In addition, because of its new relationship with Methodist Le Bonheur, The West Clinic negotiated with its payers in advance to ensure they accepted its rate structure under a hospital-based model. This provided for essentially no increase in costs to the payers and more important, the Clinic’s patients.

Mounce expects the initial steps in the Council’s plan to be implemented within the next two years.

Confronting disparities of care

In Memphis, an African-American woman has a greater than 40 percent chance of dying from breast cancer than a Caucasian woman.

Beyond the defractionization of care, the three-way partnership also hopes to confront such disparities of care in its region. This will require attempting to face some of the city’s social-economic issues head-on.

A majority of the poor population in Memphis are African-Americans who are working for hourly wage jobs with limited transportation, which prevents them from accessing the available care.

“Even though many of our patients realize something may be wrong, they typically do not present for care until they’re in a much later stage of cancer,” Mounce said. “And that, of course, creates the disparity in the mortality.”

Working with Sandra Bailey, vice president of senior services at Methodist Le Bonheur, The West Clinic is an integral force within the Congregational Health Network (CHN), a network of churches in which members of the congregation take it upon themselves to pinpoint patients who need assistance in managing care.

CHN is also focused on educating the community and has begun sending West Clinic-trained liaisons into Memphis neighborhoods to instruct patients on the proper treatment of breast cancer. Furthermore, it has enlisted navigators to assist patients in being transported between care points.

“The reason why this partnership has been so successful is because it got buy-off from the senior-most organizational aspects of each entity from the boardroom down,” Mounce said. “The wonderful thing about our program is that the program is not only working from [a] performance perspective, but it is the right thing to do for the Memphis community. Our goal is to dramatically change the way cancer care is delivered in Memphis and the Mid-South community. As a believer in disruptive innovation, we have just got to disrupt the process of how we’ve delivered healthcare to effect this change.”

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