Orlando Health's partnership with UF Health on joint oncology program hits fast-track in 2014

When leaders of two powerhouse institutions in Florida established dialogue to strengthen their partnership, which for the most part had included some fellowships and residency rotations, it was a good start that perhaps unexpectedly turned into a great collaboration.

On Jan. 31, Orlando Health's MD Anderson Orlando officially became known as the University of Florida (UF) Cancer Center at Orlando Health, a Florida-centric program with a research portfolio and patient volume attractive to pharmaceutical companies wanting to expedite clinical studies. The joint oncology program propelled the institutions' status to the largest cancer program in Florida, and the fifth largest in the nation.

"This didn't come out of the blue," said David S. Guzick, president of UF Health, and UF senior vice president for health affairs. "We began discussions in 2012 to work toward an affiliation agreement."

Those discussions bore richer fruit than either institution initially expected, of particular importance at a time when cancer eclipsed heart disease as the leading cause of death in Florida.

In a Memorandum of Understanding (MOU) announced Oct. 14, 2010, between UF, Shands HealthCare, and Orlando Health, the second-largest hospital network in Central Florida and the fifth-largest nonprofit hospital in the United States, the intent was to work on new health initiatives to make care more accessible to patients in a 20-county region and expand training opportunities for physicians.

Under the terms of the agreement, the organizations were poised to form joint clinical programs in the areas of pediatrics, neuroscience, oncology, women's health, transplantation and cardiovascular medicine, including a plan to develop a regional comprehensive cardiac care program. UF Health also had an eye on increasing undergraduate and graduate medical residency and fellowship training opportunities at Orlando Health, and opening opportunities for conducting clinical trials through UF's impressive clinical research program, while also launching common approaches to quality care and safety initiatives.

The MOU announcement didn't specifically mention oncology.

"It's had unexpected benefits," said Mark Roh, MD, president of UF Health Cancer Center at Orlando Health, leader of MD Anderson Orlando since January 2012, when long-time leader "Buck" Brown III, MD, retired from the post after 36 years with Orlando Health.

At the time of the transition from Brown to Roh, both men expressed concerns about potential changes taking place under new leadership at the University of Texas MD Anderson Center in Houston. Since then, MD Anderson Houston has altered its mission, with the ambitious goal of treating 5 percent of all new cancer patients in the United States with sites nationwide. Its affiliation in 2009 with Banner Health in Phoenix, Az., to create Banner MD Anderson Cancer Center resulted in a new direction focused on high patient volume, one that didn't mesh well with Orlando Health's culture.

"Last July, we were still thinking maybe this could work out, but we made clear to Houston that Gainesville was a part of our future," said Roh. "We really wanted a three-way partnership, with three diverse strengths coming together in a unique way that created a lot of excitement. But I met with the president in Houston. He was not very interested, but said nevertheless, let's explore it."

When leaders of the three institutions began negotiating details on a conference call last August, "the first 45 minutes were really good," said Roh. "I was starting to feel a little hopeful. In my view, I'd spent 10 years in Houston, so I have a lot of affinity and affection (for MD Anderson Houston) and would like to see this pursued. But in the last 15 minutes of the conference call, it just plummeted and was clear they were interested only in signing a deal and not addressing the details. When it came down to meaningful change and program building, it just wasn't there."

By October, Roh knew a change must be made. "I often use the analogy that when you were an infant and toddler, you needed mom around," he said. "Once you became an adult and went to college, the needs weren't as great. That's where we were."

Brown, who had helped bring MD Anderson to Orlando, expressed his displeasure yet supported the decision. "Dr. Brown wasn't a proponent," noted Roh. "He was there from the beginning. You can imagine his allegiance."

Meanwhile, Guzick and Roh worked out details.

"The goal is to recognize that we have two extremely talented groups of individuals working at these cancer centers," said Guzick. "In the Orlando Health center, it's more tilted toward clinicians. In the cancer center at UF in Gainesville, it tends to be tilted toward a greater percentage of research scientists. The idea is to take advantage of the talents of all those individuals, put them together, and the whole exceeds the sum of the parts."

Addressing questions about possible employment changes in the transition from MD Anderson Orlando to UF Health Cancer Center at Orlando Health: the staff remains intact, said Roh, pointing out that Orlando Health employed all medical staff at MD Anderson Orlando.

"Very happily, everyone's stayed. In fact, some of those people like myself, who'd hoped to work out something with MD Anderson, are energized by the change," said Roh, a world-renowned liver oncologist who continues seeing patients in between administrative duties. "Now, they're our biggest cheerleaders. They see the opportunities and value of working at a table where both sides are equally represented. They see the clinical trial portfolio already starting to change considerably."

Guzick echoed Roh's comments.

"The doctors at Orlando Health stay the same," he said. "People here stay the same. The difference is we're coming together to establish jointly the best protocols we can develop to bring better quality of care to our oncology patients."

Orlando Health leaders will "always be grateful to MD Anderson," said Roh. "Without their participation and collaboration, the program wouldn't have grown to where it is now, and be attractive to UF. The gratefulness will always be there; we were just going in different directions."

NCI Designation Possibly Expedited

The new partnership between UF Health and Orlando Health to combine both oncology programs flourished before the affiliation agreement with MD Anderson expired on Jan. 31.

Three days earlier, Gov. Rick Scott announced a proposed bill to create the Florida Consortium of National Cancer Institute (NCI) Centers to have more NCI-designated centers in Florida to address the state's rising cancer rates.

"We're well-positioned to meet the criteria outlined in the governor's proposal," said David S. Guzick, MD, PhD, president of UH Health, and UF senior vice president for health affairs. "We have more than 100 ongoing cancer studies, and research funding for cancer alone totaled more than $36 million last year. Our joint oncology program uniquely positions us to be successful applicants for NCI designation, which is our goal and intention."

The proposed legislation would be funded through the William G. "Bill" Bankhead, Jr. and David Coley Cancer Research Program. The $80 million cancer research budget includes $20 million for peer-reviewed research grants and $60 million for helping existing cancer centers achieve NCI designation.

"The exciting part is together, yeah we're almost there," said Scott. "We need that extra investment. The government hopefully will step forward and provide that."

Guzick said UF Health and Orlando Health leaders look forward to competing for funds under the proposed budget allocation "that would accelerate this process."