More than two decades ago, while raising a young family with my wife, I was diagnosed with thyroid cancer. From that point through full recovery, my care was coordinated and communicated between local physicians and centers and the larger regional hospital. 

At a community hospital, a local ENT arranged diagnostic imaging after feeling the lumps in my neck, then a local endocrinologist coordinated the diagnostic tests, and a surgeon performed my thyroidectomy.

When I needed radioactive iodine therapy, the hospital connected me with a regional specialty center that had the expertise and infrastructure to safely deliver and monitor that treatment. I recovered at home with the support of my family and community. Afterward, I returned to my local endocrinologist, who managed me for years.

This sort of treatment paradigm largely hasn’t existed for advanced cell and gene therapies (ACGTs) such as CAR T. In the 2010s, these emerged inside transplant and cellular therapy programs at major academic medical centers. At the time, centralizing care like this made sense because the therapies were new and directed toward the sickest patients, patient volumes were low, and toxicities like cytokine releasing syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANs) were complex and unfamiliar. By the middle of 2025, however, real-world experience and standardized clinical practices had matured to the point that manufacturers began expanding access to a broader set of hospitals.

Today, CAR T therapies are moving earlier in cancer treatment algorithms. Investigators are also demonstrating efficacy beyond cancer in autoimmune diseases, neurologic disorders, and other immune-mediated conditions. As more patients become candidates, healthcare delivery models will need to evolve and become more decentralized. The treatment journey will look less like a single-center experience and more like my thyroid cancer journey, with care distributed across coordinated networks of local and specialized providers.

An Alliance for Regenerative Medicine analysis of US claims data confirms this shift is already underway: community centers grew from 23 percent to 45 percent of the CGT administering network between 2018 and 2025, with total CGT claims volume up roughly 740 percent over the same period (1). As the trend accelerates, hospitals that have never considered themselves cell therapy centers are asking: where should a community hospital participate in the advanced cell therapy patient journey?

Community experience

Patients consistently prefer to receive as much of their care as possible close to home, but CAR T still seems confined to academic medical centers with apheresis programs, transplant services, cellular therapy laboratories, GMP facilities, specialized pharmacies, and 24/7 acute care teams.

Of the roughly 6,100 hospitals in the United States, more than 5,000 are classified as community hospitals and represent the principal point of healthcare access for most Americans.

Community hospitals can expand access by focusing where they already excel: maintaining patient relationships, performing diagnostic evaluations, supporting collections, co-managing care, monitoring recovery, and providing long-term follow-up. 

Rather than replicating the full advanced therapy center footprint, they can partner with established therapy programs, collection organizations, cell therapy laboratories, and manufacturers. Community hospitals can provide local access, care coordination, and long-term follow-up, while advanced therapy centers and blood centers supply the specialized collection, cell processing, and quality infrastructure required for safe and effective therapy delivery.

This model brings care closer to patients while leveraging, rather than duplicating, existing expertise. It also ensures most community hospital investments are incremental, building on existing strengths in oncology, critical care, pharmacy, emergency response, care coordination, and longitudinal patient management. Experienced partners can accelerate the learning curve and provide specialized expertise when needed. 

In doing so, community hospitals can retain patients within local care networks, strengthen relationships with specialty providers, expand downstream clinical services, and differentiate themselves in increasingly competitive healthcare markets. As ACGTs become more common, organizations that establish these capabilities early may be better positioned to participate in future care pathways rather than serving solely as referral points.

This model is currently the only scalable, economically sustainable path for advanced cell and gene therapy delivery. 

Improving participation

Participation will naturally progress through several stages. First, community clinicians need to recognize when patients may be candidates for advanced therapies and know how to connect them to the right treatment network early enough for therapy to remain an option. This requires investment in education, referral pathways, payer awareness, and clear communication between local specialists and advanced therapy programs. This stage follows most closely with my cancer story.

The next stage is advanced therapy readiness. This includes standardized toxicity pathways, emergency department education, pharmacy workflows, transfer agreements, reimbursement processes, patient navigation, data reporting, and clear escalation plans. These are structured extensions of things hospitals already do.

The third stage is active participation in advanced therapy delivery. Hospitals may support patient workup, collection, shared-care models, post-treatment monitoring, and clinical trials, with roles tailored to local demand and capabilities. Some may ultimately develop advanced therapy clinics or infusion programs, while others may create greater value through referral optimization, patient navigation, collection support, and longitudinal follow-up.

Hospitals already rely on specialized partners for functions that are impractical or inefficient to build internally, including IT security, sterilization, waste management, emergency department staffing, and complex diagnostics. This model allows hospitals to access highly specialized capability without becoming the specialist themselves.

Similarly, hospitals can expand their role in the CAR T ecosystem by partnering with organizations that already operate the infrastructure and expertise required for the manufacturing and cell handling. A recent industry analysis of CAR T manufacturing separately identifies apheresis network decentralization as a distinct value driver from administering site expansion, marking an opportunity to reduce patient travel burden independent of where the product is ultimately infused (2).

Manufacturing is best left to the organizations built for it: commercial CGT manufacturers, contract manufacturing organizations, and academic institutions. Commercialized ACGTs already have dedicated manufacturing sites. Rather than recreating these capabilities, community hospitals simply need to connect to the ecosystem that already has the infrastructure. 

Adapting to patient needs

Instead, the long-term differentiator may be the ability to recognize, monitor, and manage the unique complications associated with advanced immune-based therapies across diverse patient populations, creating a new type of specialist. Two decades ago, hospitals improved outcomes and efficiency by establishing hospitalists who focused on the unique needs of inpatient care. ACGTs may follow a similar path. 

Community hospitals already manage sepsis, shock, encephalopathy, and immune dysregulation every day. As CAR T and other immune cell therapies move into oncology, neurology, rheumatology, and autoimmune disease, healthcare systems may increasingly rely on clinicians with expertise in CRS, ICANS, HLH/MAS, cytopenias, and other immune-mediated complications regardless of the underlying diagnosis. The foundation is already in place.

CAR T is no longer confined to the walls of transplant centers, and the next generation of cell therapies will be even more distributed. The question for community hospitals is no longer whether to participate in ACGT care, but where to participate. Organizations that establish partnerships today, build experience in the first and last miles, and create sustainable models for advanced therapy support will be best positioned to expand access and capture value as these therapies move into mainstream medicine.

While some elements of care will always require highly specialized expertise and infrastructure, much of the patient journey will increasingly be delivered through coordinated networks designed to minimize the disruption these therapies impose on patients' lives.

Looking back, what I remember most about my cancer treatment is not the hospital where a particular part of my treatment was performed. It is that I was able to remain a husband, a father, and an active member of my community while receiving the care I needed. As ACGTs become part of routine medical practice, all patients everywhere should have the same opportunity.

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