HJBR Jan/Feb 2022

CANCER WARS 20 JAN / FEB 2022 I  HEALTHCARE JOURNAL OF BATON ROUGE   MBP continued... a lot of the support services were provided by both. So, it just became kind of natural over the mid-1990s through really more like the mid-2000s through 2010 that it started to become clear that there were a lot of things we could do to coordinate care for patients better. That’s when we started really focus- ing on how we could make things more efficient. Then, in 2012, we formally entered an affiliation agreement, which was largely based on improving logistical coordination of care for patients and sharing resources rather than duplicating resources. That’s what we’re unwinding at this point. It largely has to do with philosophies and how health systems are evolving — large health. Editor: Is there a difference in the ideology/ philosophy of cancer care between your two groups? When did that start, and why? Stevens: Yeah, absolutely. I think the large health systems have got to figure out how to be all things to all people. The way eco- nomics are working in healthcare is that — and this is my appreciation of it — large health systems want to be able to provide care to people cradle to grave. The econom- ics behind that is that these health systems believe that in the future, they will be paid somewhat of an aggregate rate and that they will be at risk for the delivery of care to patients and that if they take in, for exam- ple, a fixed amount of payment to take care of a certain population and that they don’t control the inputs of all the care related that those individuals may need, that it would be unwieldy or impossible to provide care and have that be economical all at the same time. A lot of the large health system con- struction and consolidation that we see in the United States right now is driven largely by what people believe the future econom- ics and reimbursement structure will be for how people access healthcare. Cancer is obviously a part of healthcare, and inte- grating it into a health system is a goal and a desire of every large health system in the United States. Mary Bird Perkins, as we’ve been talking about, was started in 1968, and it’s been an independent organization focused on can- cer since that time. Trying to reconcile the ideology that the Mary Bird enterprise and desires and focus on cancer would have a check and balance that could interfere with it pursuing what it wanted to pursue was really where things broke down — that it would’ve become part of a health system that would’ve had to compete for resources along with all the other parts of the health system. That just didn’t work for the mis- sion that Mary Bird wanted to pursue. It’s not that their ideology is wrong. I under- stand exactly where large health systems are coming from, but being in the cancer care space for 30 years and working at the larg- est cancer care organization in the world, I’ve seen firsthand for my entire career how an exclusive focus on cancer and build- ing knowledgeable teams and resources and recruiting the best physicians focused on one particular type of disease makes a difference. We just couldn’t put the two together and make it work. Editor: To the public, the split seemed sud- den, irrevocable. Would you please share with us what was happening behind the scenes and how long this disassociationwas in the making? Stevens: We’d started back in late 2019 talk- ing about how to restructure the affiliation agreement and then, in 2020, jointly hired a consultant to work with us through that process and proceeded with that consul- tant through the date that we made that announcement. As the time ticked by, it became apparent that we were headed in different ideologies and that it wasn’t likely going to come together. In mid-2021 or late spring of ‘21 is when we reached out to OneOncology to start pursuing other alter- natives in the event the relationship didn’t continue at the level it was with Our Lady in the Lake. That’s the timeline behind it. The announcement appeared sudden, but there was about two years’ worth of work before we made that decision. There was a lot of transparent communication, both ways, leading up to that announcement. Editor: Tell us a littlemore about OneOncol- ogy for those not familiar with it.