Ochsner Health, MD Anderson Partnership Will Bring Full Clinical Integration to Cancer Program in Louisiana

The name Ochsner has been associated with cancer care for more than 80 years, ever since Alton Ochsner, MD, coauthored a 1939 paper that linked tobacco use to the rise in the number of lung cancer cases he was seeing.¹

In 1942, the surgeon founded the Ochsner Clinic, which became Ochsner Medical Center and the flagship of Ochsner Health, based in New Orleans, Louisiana. In the years since Hurricane Katrina in 2005, the health system has greatly expanded, in the number of facilities and physicians and in geographic reach.²

Now Ochsner’s cancer program is growing in a new way. On June 22, 2023, officials announced a partnership with The University of Texas MD Anderson Cancer Center in Houston, which will create Ochsner MD Anderson Cancer Center. In its first phase, the collaboration will reach patients in 7 locations in the New Orleans, Baton Rouge, and Covington areas, offering cancer care that is clinically integrated with MD Anderson’s standards, including clinical pathways. Patients in these areas will have access to additional clinical trials.³

Moore

To learn more about the partnership, Evidence-Based Oncology (EBO) visited Brian Moore, MD, FACS, a head and neck surgical oncologist who has been director of the Ochsner Cancer Institute since 2017.⁴ Moore discussed the origins and plans for the partnership, which he said started more than 3 years ago.

“We began with discussions of where we wanted to take our cancer program, how to get there, and how quickly,” Moore said. “Our cancer program has a rich heritage from a number of nationally known practices, particularly in various disciplines of surgical oncology,” Moore said.

Historically, cancer care was organized more at the department or individual physician level, rather than “really functioning as a true program.” This new partnership required Ochsner to demonstrate that participating sites were consistently delivering cancer care to MD Anderson clinical standards.

The Ochsner MD Anderson partnership in cancer care comes as “we’ve grown exponentially as a health system,” Moore said, with some sites of care still very new to the system. In the future, more Ochsner sites aim to be folded into the MD Anderson partnership, as they, too, become clinically integrated and able to demonstrate those standards.

Unlike some partnerships that are “administrative arrangements,” Moore emphasized, the driving force behind Ochsner MD Anderson is clinical integration, and this takes time.

A Shift Toward Academics, Research
Prior to 2005, “we were an outstanding community hospital that had some great training programs providing excellent clinical care,” he said. “In the absence of academic leaders in the area in the aftermath of Katrina, we really stepped into that void and tried to become more of an academic medical center. And we are truly an academic medical center—we train more residents and fellows than any other entity in the state, and we have several programs, such as transplant and otolaryngology, that are consistently ranked among the best in the nation. We just may not be as well-known.”

With plans to build a new medical school with Xavier University of Louisiana, a historically Black university located 10 minutes away,⁵ Ochsner will strike a better balance between “academic productivity and clinical activity,” Moore said, a key component in attracting and retaining the best physician-scientists. The Ochsner-Xavier relationship has many pieces: Precision medicine is a focus at the flagship site, The Gayle and Tom Benson Cancer Center. In 2020, this center added 115,000 square feet to its cancer facilities, which overlook the Mississippi River in Jefferson, Louisiana, just outside New Orleans. Meanwhile, Ochsner and Xavier University have jointly developed a graduate program to train more genetic counselors and physicians assistants.^6,7

There are precedents for the Ochsner MD Anderson partnership. Moore cites the Banner Health and MD Anderson collaboration in the Phoenix, Arizona, area, and Cooper Health in New Jersey.⁸ MD Anderson formed a partnership with Cooper University Health Care in Camden that aligned with the opening of Cooper Medical School at Rowan University. The MD Anderson at Cooper partnership helped revitalize Camden, and the 2022 announcement of a $2 billion expansion to Cooper credited the newfound stability with lifting the city’s bond rating to its highest level in 40 years.⁹

These arrangements were on Ochsner officials’ minds as they contemplated taking their cancer program to “the next level,” Moore said. Being familiar with the Banner and Cooper relationships, “this concept was familiar to us,” he said.

He expects clinical trial participation across the 2 institutions to look like a Venn diagram, with some trials being available at Ochsner sites, some at MD Anderson, and some available at both.

“We’re looking for a vehicle to move us toward the next level, from a very strong community cancer program to an academic destination leader in cancer care,” he said. “As much as we’re really excited about all the work that went into it, it’s just another step in our journey, to do everything we can to improve the lives of patients with cancer in Louisiana, in the communities we serve, and to be a place known for innovation in cancer care delivery—going beyond clinical research but also into the realm of actual complex care delivery.”

It’s About Relationships
Many Ochsner partners were already using Elsevier clinical pathways and taking part in peer review and case review based on disease state. The new relationship expands the circle, Moore said. “This gives us an additional voice in the room, because we have to make sure that not only does it meet our standards, but it also needs to meet MD Anderson’s standards,” he said.

Moore said Ochsner takes pride in its ability to integrate medical, surgical, and radiation oncology, to work well with the pharmacy team, and to do this at scale. “We’ve been committed for years to delivering multidisciplinary team-based care that’s world-class that allows patients to stay close to home,” he said.

He added, “If you’re a radiation oncologist planning treatment for a patient, you will share your plan with your partners who can critique it; you can modify it if needed and then look at your outcomes. In surgery, we have a strong infrastructure that promotes collaboration across disciplines to address common themes for improvement, and we are expanding our capabilities to do this across various campuses. We are trying to hold each other to the highest standards in clinical care and outcomes and do so in a transparent way.”

In the area of quality metrics, Moore said, there is a commitment to tracking readmission rates and other indicators and identifying areas or even individuals who need to improve—and then helping them do better. “Transparency helps our teams really get better,” he said.

How will the partnership help in times of crisis, such as a hurricane? Given New Orleans’ history of residents evacuating to Houston, will the process go more smoothly in the future? Moore said as the Ochsner network has expanded, everyone has gained experience at transfers within the network, but a transfer as far as Houston remains possible.

“All of health care, in reality, is about the relationships,” he said. The new partnership “expands and enriches our relationships that we have with cancer professionals in Houston, so we can see through the medical record and the basics of what happens to patients at MD Anderson. But it’s really about the connections that go not just through cancer network leaders but to the individual team level. Our navigation team was instrumental in facilitating seamless transitions of care for patients across our own system and even to MD Anderson in the aftermath of Hurricane Ida 2 years ago. This connectivity will be further enhanced by the relationships bred through our partnership.”

As physicians gain opportunities to integrate into multidisciplinary teams based in Houston in their specialties, they will form their own personal networks to lean on in times of crisis, Moore said. If a patient must be transferred, “simply knowing who to call makes the record exchange a lot easier,” he noted.

Ochsner’s Role in Population Health
Louisiana has a lot of cancer cases—it ranks among the 5 worst states for cancer incidence and survival—and historically the state medical system has not done well at diagnosing cancer when patients still had a chance at survival.¹⁰ What’s more, most cancers in Louisiana are tied to smoking, eating, and drinking,¹⁰ habits that are tied to the culture and difficult to break.

Amid these challenges, Ochsner is serving as a catalyst for Healthy State, a multiyear effort in partnership with Louisiana’s government, nonprofit, and business organizations to create healthier, happier, and more productive communities, with health equity at the forefront.¹¹ Ochsner has committed to spend $100 million over the first 5 years of the initiative, with tobacco cessation and healthy food access identified as early priorities.¹¹

When asked how the Ochsner relationship with MD Anderson might ultimately translate into improved cancer outcomes, Moore said these population health connections—which include screening, education, and access to preventative services such as the human papillomavirus (HPV) vaccine—were perhaps more important than adding clinical trials.

But doing a better job in prevention means access to good primary care, screening, education, and prevention, including the HPV vaccination—something that Moore feels strongly about given his vantage point as a head-and-neck surgeon (HPV is the predominant cause of head and neck cancer).¹² Access to all facets of health care is an area where Louisiana has not fared well historically, although in 2016 the state became the first in the Deep South to expand Medicaid.¹³

“When I say that we, as a cancer program, want to get out of business of taking care of cancer, it’s because I’d like us to do a better job of educating and preventing cancer through vaccination and working on the social determinants such as diet, housing security, and access to healthy food. I’m not naïve enough to think that that’s possible, but it certainly is an idealistic goal,” Moore said.

Because Ochsner has such as large footprint, he said, “We can make a huge impact on cancer simply by doing more of what we do in population health. If we do a good job vaccinating, we will have fewer patients with head and neck cancer to care for in 20 or 30 years. By focusing on screening and early detection, we can find cancers early enough so that the treatments to cure them may not have to be as toxic, or they can be cured with just 1 modality, like surgery. This is our greatest responsibility as a health system in cancer care.”

References
1. Ochsner A, DeBakey M. Primary pulmonary malignancy: treatment by total pneumonectomy; analysis of 79 collected cases and presentation of 7 personal cases. J Am Coll Surg. 1939;68:435-451. https://bit.ly/44BcAed
2. Coombs B. Ochsner: hospital powerhouse forged in wake of Katrina. CNBC. August 27, 2015. Accessed July 27, 2023. https://www.cnbc.com/2015/08/26/ochsner-hospital-powerhouse-forged-in-the-wake-of-katrina.html
3. Ochsner Health and MD Anderson announce partnership to create fully integrated cancer program in Louisiana. News release. Ochsner Health. June 22, 2023. Accessed July 27, 2023. https://bit.ly/44YRWEy
4. Brian Moore, MD. Ochsner Health. Accessed July 27, 2023. https://www.ochsner.org/doctors/brian-moore
5. Xavier University and Ochsner Health partner to create College of Medicine and pursue educational equity. News release. Xavier University New Orleans. January 17, 2023. Accessed July 27, 2023. https://bit.ly/4766DYp
6. The Gayle and Tom Benson Cancer Center. Ochsner Health. Accessed July 27, 2023. https://www.ochsner.org/locations/the-gayle-and-tom-benson-cancer-center
7. Ochsner Health and Xavier University announce two new graduate degree programs. News release. Ochsner Health. March 23, 2021. Accessed July 27, 2023. https://news.ochsner.org/news-releases/ochsner-health-and-xavier-university-announce-two-new-graduate-degree-programs
8. MD Anderson renews partnership with Banner Health. News release. MD Anderson. February 15, 2022. Accessed July 27, 2023. https://www.mdanderson.org/newsroom/md-anderson-renews-partnership-with-banner-health.h00-159537378.html
9. Cooper University Health Care and MD Anderson Cancer Center at Cooper announce new $2 billion expansion in Camden. Cooper University Health Care. September 19, 2022. Accessed July 27, 2023. https://blogs.cooperhealth.org/news/2022/09/cooper-university-health-care-and-md-anderson-cancer-center-at-cooper-announce-new-2-billion-expansion-in-camden/
10. In focus: reducing cancer deaths in Louisiana. America’s Heath Rankings. Updated 2022. Accessed July 27, 2023. https://www.americashealthrankings.org/learn/case-studies/louisiana
11. Caffrey M. Klein ME. How Ochsner, Xavier are working together to make Louisiana a healthy state. Am J Account Care. 2022;10(4):42-46. https://doi.org/10.37765/ajac.2022.89288
12. Rettig EM, D’Souza G. Epidemiology of head and neck cancer. Surg Oncol Clin N Am. 2015;24(3):379-396. doi: 10.1016/j.soc.2015.03.001.
13. Patel K. From worst to first: Louisiana makes great waves with Medicaid expansion. Brookings. January 15, 2016. Accessed July 27, 2023. https://www.brookings.edu/articles/from-worst-to-first-louisiana-makes-great-waves-with-medicaid-expansion/