Most hospitals in Los Angeles County and elsewhere focus exclusively on serving the healthcare needs of their local communities. Beverly Grove-based Cedars-Sinai Health System has maintained this tradition, continually expanding its local medical care presence.
But Cedars-Sinai is also increasingly going global.
In the last four years alone, Cedars-Sinai has opened patient referral offices in Doha, Qatar; Mexico City; Quito in Ecuador; Shanghai; and Singapore. It has also partnered with hospitals and universities in several other countries.
It even has three international offices devoted to identifying venture investment opportunities in the host countries.
And just this last May, Cedars-Sinai took another huge step on the global stage: opening its first major outpatient clinic in London’s Harley Street Medical Area, the center of Britain’s private healthcare industry. It’s the first of several international clinics that Cedars-Sinai has planned.
“Through this expansion, we are enhancing global accessibility to Cedars-Sinai’s leading-edge medical expertise and outstanding patient care,” Heitham Hassoun, chief executive of Cedars-Sinai International, said in the announcement of the opening of the patient referral office in Singapore a couple years back. “We continue to build an international healthcare ecosystem.”
International outreach
Major research and teaching hospitals such as Cedars-Sinai have long had international programs focused on research collaborations and efforts to bring in patients from other countries with complex medical cases.
“There has always been this type of work going on: building up networks to take in referrals that are then elevated to the flagship hospital back home,” said Steven Shaprio, senior vice president for health affairs at USC. “And research partnerships for academic medical centers have been international for decades.”
Shapiro said USC’s international efforts have mostly focused on bringing to the Keck Medical Center campus overseas patients in need of complex care.
Likewise, UCLA Health focuses its international program on bringing patients from abroad with complex or hard-to-treat conditions to its facilities for treatment. Special care coordinators help these international patients navigate their journeys and treatment.
Cedars-Sinai’s international program grew out of these twin missions of care for international patients and academic research. The international division was formed in the 1990s to better coordinate these efforts.
“It was a dedicated, qualitydriven team that successfully drew patients from around the world to the medical center and laid the groundwork for the program we are building today,” Hassoun said in a 2023 blog post on the international program.
The team has also helped ease the experience of international patients once they are being treated at Cedars-Sinai Medical Center in Beverly Grove, assisting with the financial side and other support that the patients need. Hassoun said international patients now come from more than 100 countries.
In a recent podcast conducted by the industry publication Becker’s Healthcare, Hassoun said that when he joined Cedars in 2018 from Johns Hopkins Medicine in Baltimore, where he headed the global medicine program, he decided to expand Cedars-Sinai program.
“When I arrived (at Cedars), we were doing an excellent job with patients coming to us from places around the world to get care – often complex care,” he said in the podcast. “We need to do far more than that: we need to direct care closer to patients where they are and also improve the continuity of care and the care delivery in those communities.”
Patient referral centers
The first step toward this goal was the opening of a series of patient referral centers in key markets around the globe. The mission of these centers is to serve as the first point of contact for patients seeking Cedars-Sinai expert care. Patients are assessed to determine their care needs and then they are connected virtually to Cedars-Sinai specialists in cardiology, oncology, neurology and other areas of medicine.
The first of these patient referral centers opened in late 2022 in Doha as part of the View Hospital. That was followed by two openings in 2023 in Shanghai and Mexico City. In early 2024, another opened in Singapore; a fifth opened in Quito, Ecuador last year.
Since opening, these patient referral centers have also served as a base for business development and community engagement services.
Hassoun and other Cedars-Sinai executives have said patient referral centers will open in other markets, though no specifics have been provided so far.
London outpatient clinic
Cedars-Sinai this year took its overseas patient service presence a giant step further with the opening in May of its first major outpatient clinic on Cavendish Street in London’s Harley Street medical district, the center of Britain’s private healthcare industry.
Prior to this, Cedars-Sinai had a temporary smaller clinic nearby on Wimpole Street for about a year.
Unlike the patient referral centers, this clinic is staffed with doctors and other healthcare practitioners to “provide high-quality primary care, executive health and concierge medicine,” according to the announcement from Cedars-Sinai.
Spanning four floors, the new clinic features four private exam rooms designed for in-depth, personalized consultations. Patients can also access on-site diagnostic services, including ultrasound machines.
Like the referral centers in other countries, patients who visit the London clinic can get virtual second opinions from Cedars-Sinai specialists at the flagship Beverly Grove medical center. And Cedars-Sinai patients from Southern California who are visiting the United Kingdom can get care from the clinic.
“Cedars-Sinai Clinic London reflects our commitment to extend the high standard of care we provide to our Los Angeles and U.S. communities to patients in London and the (United Kingdom), allowing them to benefit from our personalized and innovative care,” Peter Slavin, chief executive of Cedars-Sinai Health System, said in the announcement.
Opening for-profit outpatient clinics on other countries is a rarity for U.S. hospitals, USC’s Shapiro said.
“Only a couple of U.S. hospitals have set up care facilities in other countries that I’m aware of and those have been (inpatient) hospitals,” he said.
Shapiro singled out the University of Pittsburgh Medical Center, which has operated a transplant hospital in Sicily for more than two decades and is now building a 250-bed academic hospital near Palermo in Sicily.
“The biggest challenge to U.S. hospitals doing more of this abroad is that it takes a lot of infrastructure to get it going,” Shapiro said. “Only highly capitalized institutions can do this.”
It also raises issues for hospital governing boards, he said. Opening hospitals in other countries can be seen as straying from a hospital’s principal mission to provide care for its local community, he added.
Joint venture hospital projects
Cedars-Sinai has also been developing hospitals overseas, but with one significant variation: always in partnership with a local medical or academic institution.
In late 2022, Cedars-Sinai, in affiliation with Elegancia Healthcare, a subsidiary of Lusail City, Qatar-based Estithmar Holding, opened the 240-bed View Hospital in Doha and continue to jointly operate it. Since then, Cedars Sinai and Elegancia Healthcare have put on an annual symposium at the hospital.
“Facilitating knowledge exchange between Cedars-Sinai physicians and our partners at the View Hospital will not only strengthen our ongoing collaboration but elevate the quality of patient care in Qatar and the entire region,” Harry Sax, medical director of the View Hospital, said in announcing last year’s symposium.
Cedars-Sinai also collaborated with Beijing-based Taikang Healthcare to develop the 1,100-bed Shenzhen Qianhai Taikang Hospital in Shenzhen, which opened in late 2024. The two parties subsequently signed a five-year strategic collaboration deal in which Cedars-Sinai provides administration training, clinical service line development, education through joint conferences and symposia, and assistance with healthcare operations.
“We are proud to have contributed to the development of this esteemed institution, which is a testament to the dedication and hard work of both our teams,” Hassoun of Cedars-Sinai International said at the time.
Research partnerships
Like most major research hospitals, Cedars-Sinai has long had partnerships with other institutions around the globe regarding its research-based projects. In the early 2000s, Cedars-Sinai took this a step further, setting up an ongoing partnership program with Sheba University in Ramat Gan, outside Tel Aviv in Israel.
The collaboration was initially established to advance cardiovascular treatment. It has since expanded over the years to include the study of the effects of microgravity on stem cells when taken aboard the International Space Station, the surgical process for inflammatory bowel disease, and in recent years, the integration of artificial intelligence into a wide range of treatment procedures.
Over the past five years, Cedars-Sinai has expanded its partnerships in Israel. These include joint fellowship training in oncology, gynecology, and endocrinology with Ichilov Hospital, research programs at Sourasky Medical Center, and cancer immunotherapy studies at the Weizmann Institute of Science.
“We have a deep bench of projects with our partners in Israel,” Shlomo Melmed, executive vice president of medicine and health sciences and dean of the medical faculty at Cedars-Sinai, said in a press release.
Cedars-Sinai has several other ongoing research collaborations. One includes medical student and faculty exchanges with the Khalifa University College of Medicine in Abu Dhabi, Dubai, which began in 2021. Another is the exploration of new therapies for gastrointestinal cancers with researchers at Seoul National University Hospital, which started in 2023. Additionally, a collaboration with Tsinghua University in Beijing began in 2024 and includes students from that university coming to Cedars-Sinai for two years of training.
Global venture investments
Beyond its clinics, referral offices, and research partnerships, Cedars-Sinai manages venture investments in London, Rotterdam, and Singapore. The latter two operate under the Coronet Ventures banner.
Coronet Ventures Netherlands was established in June of last year to invest in health and life sciences startups in that country.
“With Coronet Netherlands, we are building new global partnerships to access leading science, accelerate clinical translation and help bring breakthrough technologies to patients faster,” James Laur, chief executive of intellectual property and health ventures at Cedars-Sinai, said in announcement at the time. Laur is also the co-founder of the Cedars-Sinai Accelerator program that operates across the street from the flagship Beverly Grove campus.
In 2023, Coronet Ventures Singapore came on the scene with plans to make at least a dozen equity investments in healthcare-related startups in that island nation.
Cedars-Sinai also has made venture investments in healthcare firms in the United Kingdom. In January of last year, Cedars-Sinai announced a co-investment initiative with Oxford Science Enterprises, which in turn operates in partnership with Oxford University. The aim is to accelerate health and med-tech ventures that spin out of Oxford; the initiative’s first co-investment out of the gate was a $2 million stake in the neurology health tech startup Kneu Health.
“We are delighted to further pursue this ongoing relationship with Oxford Science Enterprises, which will serve our patients and strengthen the academic and clinical missions of Cedars-Sinai,” said Melmed, Cedars-Sinai’s executive vice president of medicine and health sciences.
Challenges operating abroad
In the podcast interview with Becker’s Healthcare, Hassoun said the most significant challenge when working in other countries is taking the time to understand both the market and culture of each country. And that requires teaming up with hospitals, universities or other entities in these countries
“When we invest, we don’t go it alone, we go in partnerships,” Hassoun said.
He added that revenue generation is also a challenge. “There aren’t many places with revenue streams similar to what we have in Los Angeles,” he said.
One way to approach this is to keep the investments relatively small scale, as opposed to standing up full hospitals in other countries.
“For us, doing these primary clinic nodes (like the one in London), it’s a $10 million to $20 million investment as opposed to a $200 million hospital,” he said in the podcast. “Besides being easier, that’s also how you can start to build the relationships with the doctors on the ground and the specialty markets.”
Looking ahead, Hassoun said Cedars-Sinai will need to strike a balance between arranging for patients to come to Cedars-Sinai in Los Angeles for complex care and building care facilities in local communities in these countries.
“You have to blend these two models,” he said.
