Innovation in Academic Medical Center and Community Oncology Alignment

2. Innovation in Academic Medical Center and Community Oncology Alignment

3. Panelists • Mark L. Sobczak, M.D. Senior Vice President and Chief Network Officer, Fox Chase Cancer Center • Ann Raish, M.H.A. Vice President, Oregon Health Sciences University OHSU Knight-Legacy Health Cancer Collaborative • Tony Melaragno, M.D. Chief Administrative Officer, Legacy Good Samaritan Medical Center • Holly Goe, RN, MSN Vice President IU Health Cancer Centers, IU Health

4. Fox Chase Cancer Center Partners • Established in 1986 as the 1st Cancer Network in U.S. • Dedicated Program Staff (12) • Medical Director(s) • Nurses – Project Managers • Clinical Research Staff • Business Planning & Analysis • Marketing • Vision: • To advance the role of the Fox Chase Cancer Center as an NCI designated Comprehensive Cancer Center by expanding clinical research and improving oncologic services through the region via the dissemination of knowledge and collaboration with community hospital partners

6. Maximizing Co-Branding Benefits 1. Measure the brand's potential to attract more patients • Like Ford, Kia, and Mercedes - different brands carry different connotations and levels of recognition. Moreover, a particular brand’s reputation may vary from market to market. Programs seeking to co-brand with FCCC have assessed the power of the Fox Chase brand name through independent market research. • Several of our partners conduct an annual telephone survey to ask the residents of their service area: "If you were diagnosed with cancer, where would you go for treatment?“ The top answer in southeastern Pennsylvania and southern New Jersey is consistently the Fox Chase Cancer Center. • These survey results enable our current and potential partners to both quantify the value of their own brand and to measure the brand power of an academic affiliate. 2. Mitigate the risks of co-branding with quality audits and monitoring • One of the Fox Chase Cancer Center’s Board of Directors biggest concerns regarding the licensing of our brand to affiliates is that it will be damaged if partner programs fail to uphold our high care standards. The Fox Chase Cancer Center Partners Program protects our brand’s value through quarter quality audits and ongoing quality monitoring. • The quarterly quality auditing and monitoring involves: • Clear, upfront communication of quality standards • Consistent application of standards • Regular progress updates on community program performance through identified metrics • Incorporating community program quality goals with FCCC standards Source: Advisory Board Oncology Roundtable

7. Maximizing Co-Branding Benefits 3. Regional Brand exclusivity • All of the FCCC partner institutions enjoy regional exclusivity Fox Chase shares its name with only one community program in a given region thereby enhancing brand impact. Both the community partner and Fox Chase benefit from building exclusivity into affiliation agreements. • This exclusive partnership assures community programs that the brand will differentiate them from other local competitors. The Fox Chase Cancer Center benefits from avoiding brand dilution—when the brand loses its unique or positive reputation because of how common it is—and potential conflicts of interest. FCCC also enjoys enhanced patient referrals from the areas surrounding the partner sites as a result. 4. Establish clear co-branding standards • Detailed co-branding standards benefit both community and academic programs. The Fox Chase Cancer Center Partner’s program sites sometimes feel that FCCC is slow to approve individual co-branding requests, such as using the academics’ name in a press release, newspaper article, or radio ad, but this is necessary to ensure a clear and correct public message. • FCCC is invested in ensuring that co-branding is consistent across our affiliate network. • Co-branding guidelines help academic programs ensure that the brand is used consistently and appropriately. For community programs, guidelines enhance the usability of the brand and ensure that co-branding opportunities are not missed due to confusion or delays. Source: Advisory Board Oncology Roundtable

8. “Innovation in Academic Medical Center and Community Oncology Alignment” Ann Raish VP, Oncology Services, Oregon Health & Science University Tony Melaragno, MD Chief Administrative Officer Legacy Good Samaritan Medical Center

9. OHSU Knight - Legacy Health Cancer Collaborative • The Knight Cancer Institute is an NCI designated Cancer Center and is led by Dr. Brian Druker who pioneered personalized cancer medicine with research that led to the treatment approach of targeted therapies & Gleevec. • OHSU is Oregon’s only public health & research university - a place where healing, teaching & discovery come together • OHSU hospital & clinics see over 231,000 pediatric & adult patients annually with 88% of these patients coming from Oregon. • Legacy Health is the largest non profit, locally owned health system in the Portland and Vancouver WA area. There are 6 hospitals, more than 50 clinics, lab, research and hospice facilities.

10. OHSU Knight Interest Promotes Knight Mission to a larger Community base At the OHSU Knight Cancer Institute, we see a world without cancer. As pioneers in personalized cancer medicine, we continue to change the way the world understands and fights this disease. We will: • Provide individually-tailored, compassionate care for every patient, from diagnosis through survivorship • Discover new ways to prevent cancer • Develop new personalized cancer therapies We will end cancer as we know it • Available resource in Community Hematology Oncology • Working with strong Community Partner, Legacy Health, opportunity to move considerable market share to collaborative • Develop a new model of care in preparation for Oregon Accountable Care Organization

11. Collaborative Goals: • Efficiently deliver leading-edge medical and radiation oncology integrated through standardized cancer care systems and processes • Create a platform for the development of innovative, cost-effective, community and evidence-based medical and radiation oncology care delivery models. • Manage chronic cancer conditions • Optimally utilize information technology • Improve patient access to care • Bring personalized medicine approach to the region’s cancer patients

12. OHSU Knight – Legacy Health Cancer Collaborative OHSU KNIGHT LEGACY HEALTH Ownership/Governance $$ $$ $$ Shared Profit/Loss

13. Geographic Footprint OHSU Knight/Legacy Health Oncology Collaboration • A Emanuel • B NW Portland • C Tualatin • D Gresham • E Salmon Creek • F Marquam Hill • G Beaverton G F BVTN OHSU

14. Provider Arrangements

15. Why Collaborate with OHSU • OHSU Community Oncology had offices on 3 of our campuses • Multiple previous successful collaborative efforts between Legacy and OHSU • Bone marrow transplant consortium > 15 years • Collaboration in Inpatient rehab > 4 years • Longstanding relationship between two organizations Eye Institutes • Mutual interest in advancing Cancer Research • OHSU Medical oncologists generally continued care of patients on Legacy campuses • Legacy cancer services liked the OHSU oncologists

16. BUILD BUY COLLABORATE • SITUATION – Growing, successful cancer program without in-house medical oncology • Expanding surgical oncology group desires ready access to medical oncologists for newly diagnosed patients • Radiation oncologists complaining cancer patients diagnosed on campus are being treated elsewhere • Cancer nurse navigators and cancer research staff are not able to focus efforts on system hospital campuses • Ancillary services are being diverted to outside resources • Physician Needs Analysis demonstrates more than sufficient Medical oncologists in catchment area • Decision made to look for collaboration partner vice build own program from scratch

17. Road to Success – Obstacles to Overcome • Deciding what’s in and not it in collaboration • Both groups had to give up some control • Need to collaborate in community cancer care while still remaining competitive in other areas of cancer care such as surgical oncology • Continual building of trust • Overcoming traditional, longstanding referral patterns • Winning over colleagues on all campuses • Figuring out how to fairly share finances • Putting together the very detailed logistics of putting it all together for go-live

18. Road to Success – Obstacles to Overcome • Always keeping the ultimate goal, objectives, and reasons for collaboration in clear view of all involved parties • BE PATIENT AND STAY THE COURSE

19. Academic Medical Center & Community Oncology Alignment Holly Goe, RN, MSN Vice President IU Health Cancer Centers

20. Indiana Cancer Summary • In Indiana, over 30,000 residents are diagnosed with cancer annually - many because of lifestyle • In 2010, Indiana had the 10th highest adult smoking and obesity rates in the country • 2 of every 5 Hoosiers will eventually develop a form of cancer during their lifetime • In Indiana, during 2008, 70% of all cancer cases occurred among people ages 55–84 • Lung, breast, prostate, colon, skin are the leading cancers

21. IU Health Cancer Centers Statewide Network La Porte Elkhart St. Joseph Lagrange Steuben Porter Noble Lake De Kalb Starke Marshall Kosciusko Whitley Fulton Allen Pulaski Jasper • 18 Hospitals • 1 Academic Health Center • (Methodist, University, Riley) • 3 Suburban Hospitals • 5 Large Community Hospitals • 5 Critical Access Hospitals • 2 Small non-critical Access Hospitals Newton Huntington Miami Cass Wabash White Adams Wells Benton Carroll Blackford Grant Howard Tippecanoe Warren Jay Tipton Clinton Delaware Hamilton Randolph Madison Fountain Boone Montgomery Hancock Wayne Henry Hendricks Parke Vermillion Rush Putnam Marion Shelby Union Morgan Johnson Franklin Clay Vigo Fayette Owen Decatur Brown Bartholomew Dearborn Ripley Sullivan Greene Ohio Monroe Jennings Jackson Lawrence Jefferson Daviess Martin Knox Scott Switzerland Washington Orange Clark Pike Dubois Gibson Crawford Harrison Perry Floyd Warrick Spencer Posey Vanderburgh

22. Where we were … • We were not functioning as a coordinated network of providers, operating under common service, operations, quality, metrics, and outcomes standards. • We were not presenting a unified vision. • We had the breadth and depth to be the market leader, but we lacked coordination and organization. • We were a coalition at best, not a system. • We needed to create an overarching service-line vision.

23. Strategy • Organizethe service line as a network of community-based cancer centers linked to each other and centrally to an NCI-designated cancer center • Operatethe service line in a matrix accountability fashion to the leadership of the health system, the physician groups, and the academic health center. • Leveragethe overall health system brand to create a specific assurance of quality cancer care for patients and families.

24. IU Health Cancer Centers Strategy • 4 Work Groups Created • Navigation • Symptom Management • Palliative Care • Survivorship 2011 June 2011 October 2012 February 2012 February 2013 Cancer Service Line Established 3rd Summit: Implementation Presentations 1st Summit: Workgroups Established 4th Summit: IUHCC All-Stars 2012 2013 5th Summit: Statewide Strategy Shared Strategic Vision with CEOs 2nd Summit: Workgroup Recommendations December 2011 July 2012 June 21, 2013

25. Cancer Service Line Vision – Based upon Pillars • Quality and Safety • Improve the health of our patients and community by creating a state-wide, comprehensive oncology network • Be the preeminent provider for cancer care in Indiana • Positively transform the quality, organization, and delivery of cancer care in Indiana • Services • Be patient-centered and outcomes-driven in all strategies and operations • Quality care delivered in the community, to be most convenient for patients and families • Defined by programs, not by buildings • Education and Research • Integrate education and research with all clinical activities at all sites • People • Recruit and retain superior cancer providers (Top Talent) • Growth • Be a successful business model for system • Align cancer services across the system

26. Co-Branding throughout the State • Measure the brand’s potential to attract more patients • Community programs are motivated by academic brand names • Academic programs are motivated to grow / protect market share • Mitigate the risks of co-branding with quality audits and monitoring • Pathways • Medical Oncology Co-Management Agreement • Negotiate for regional brand exclusivity • Hub and Spoke Regional Approach • Create clear co-branding standards • Consistency, consistency, consistency Deline, M. (2013). Four lessons to maximize co-branding benefits. The Advisory Board Company.

27. Metrics for Success • Increase Patient Satisfaction Scores • Improvement in oncology quality scorecard values (C3PR criteria) • Growth in outpatient oncology-related activities (symptom management) • Growth in state-wide oncology Market Share • Growth in contribution margin for the service line from 2012 baseline. • Increase in US News &World Report rankings for cancer • Reduce overall cost of oncology outpatient care on an annualized basis

28. Clinical Pathways • Evidence based treatment plan (medical and radiation) for specific cancer state and stage • Clinical trial, if appropriate, is first choice • Cover 95% of cancers • Disease specific committees review evidence and usage at quarterly meetings • IU Health Track (YTD): • Capture Rate: 80.4% (Med), 99.1% (Rad) • On Pathway Rate: 76.0% (Med), 74.4% (Rad)

29. Medical Oncology Co-Management Agreement • The goal of the co-management agreement is to align physicians and IUH in quality improvement and cost reduction initiatives. • Two components: Base management and incentives • Incentive Project Teams: • Reduce ED utilization (Navigation) • Reduce hospital readmissions (Symptom Management) • Improve quality of end-of-life care (Palliative Care) • Improve inpatient perception of care (Satisfaction) • Improve efficiency of hospital admission and discharge process • Implement Cerner ambulatory EMR to achieve meaningful use targets

30. Cancer Patient & Family Advisory Council (PFAC) • 1st PFAC created at IU Health (June 2012)– entirely cancer focused • 12 members • Have cancer, had cancer, lost a loved one to cancer • Received treatment at IU Health • Meets monthly • IU Health Cancer Executive Team attends along with inpatient and outpatient oncology staff and medical, surgical, and radiation oncology physicians • Frequently completes homework in between meetings

31. Accountable Care Imperatives