Geography of Care

In a high-value health care system, medical condition-specific IPUs need to expand geographically, rather than continuing to compete only locally or regionally. Value will increase quickly when superior providers serve more patients through strategic expansion, rather than through the purchase of full-service hospitals.

Traditional geographic expansion has been focused on acquiring health care facilities that merely reproduce the same services in the different areas without regard to value. In these expansions, care remained organized around traditional medical specialties and every site performed every procedure in an aim to provide a full set of services in every location. While that strategy was effective when hospitals had little to offer, the ever increasing complexity of medical care today means that every hospital should not be performing highly complex procedures or treating exceeding complex patients. Not every hospital needs a heart transplant program, or even cardiac surgery, yet that is what has happened in US health care expansion today.

Rational geographic expansion should occur through a hub-and-spoke model of satellite centers or through clinical affiliations with existing providers. Several premier organizations have already begun this geographic expansion. The Cleveland Clinic expanded but the main center in Cleveland served as the hub with its condition based IPUs. As they expanded their affiliate program, they did so in areas of their IPU expertise like cardiac care and care of end stage renal disease. They maintained Cleveland Clinic quality care through education and careful measurement.

Another system that expanded geographically through affiliation agreements is the Vanderbilt Health Affiliated Network (VHAN). With their main facility in Nashville as their hub, they expanded their care network over a 9 state area through affiliations.

The University of Texas MD Anderson Cancer Center geographically expanded initially through an MD Anderson Cancer Network that included certified member community affiliate sites who were evaluated on a regular basis with respect to concordance with MD Anderson clinical care guidelines for different cancer conditions. These tended to be relatively small medical oncology practices. They then expanded further by affiliating with large partner institutions who could provide IPU based comprehensive cancer care. Partnering with Banner Health Care in Arizona, Cooper University Health Care in New Jersey, Baptist Health in Jacksonville, UT Health in Tyler and San Antonio, and Scripps Health in San Diego, MD Anderson affiliated with established care delivery systems to provide their cancer care using the MD Anderson IPU model and credentialing of affiliated physicians at the geographic expansion site.

The major risk of geographic expansion is damage to the reputation of the main center if care at distant sites does not result in similar outcomes as the main center. Without rigorous outcome measurement, those assurances cannot be made to the organization or the public.