Oncology Roundtable & Service Line Strategy Advisor

Oncology Roundtable & Service Line Strategy Advisor Oncology Market Trends Ready to Use Presentation Slides Prepared June 2014

Service Line Strategy Care Quality Growth Outlook Clinical Innovation Additional Resources Financial Outlook

Source: American Cancer Society New Cancer Diagnoses Increasing Growth Outlook Mortality Flat or Declining Cancer Deaths New Cancer Cases 2005-2014 2005-2014

Source: OncologyRoundtable Cancer Incidence Estimator. Incidence Will Continue to Rise as Population Ages Growth Outlook National Cancer Incidence Projections 2013-2023

Source: The Advisory Board’s Inpatient and Outpatient Market Estimator tools; Advisory Board Research and Analysis. Multiple Factors Drive Procedure Growth Tumor site categories include common procedures performed for each disease site, principally surgical resections, biopsies, and diagnostic procedures Growth Outlook Inducements and Barriers National Growth Trajectories Demographic Inpatient and Outpatient Procedures 2013-2018 Aging of the population increasing cancer incidence Clinical Surgical advancements shift care to outpatient setting, leading to lower inpatient volumes Market High degree of competition between providers for high revenue patient population Patient preference for full-service, hospital-based cancer centers for cancer treatment Expanded health care coverage may increase cancer screenings and lead to slight increase in diagnoses 1

Growth Outlook Source: Advisory Board Inpatient and Outpatient National Estimators. National volumes. Surgeries Continue To Shift To Outpatient Setting Total Breast Volume1, 2013 IP 5 Year Growth Rate OP 5 Year Growth Rate Breast OP Breast surgeries will increase sharply, including, for example, 26 percent expected growth in image guided fine needle aspirations OP IP 7% 11% n = 3,288,323 Total Thoracic Volume1, 2013 Thoracic Percutaneous lung biopsy will rise 25% by 2018, and collapsed lung treatments will increase by 25% 10% 22% n = 408,134

Source: The Advisory Board’s Inpatient and Outpatient Market Estimator tools; Advisory Board Research and Analysis. Outpatient Chemo and RT Growing Growth Outlook Inducements and Barriers National Growth Trajectories Outpatient Chemo and Radiation Therapy Visits 2013-2023 Demographic Aging of the population increasing cancer incidence Clinical M Increasing use of oral therapies reducing infusion center visits M M Radiation therapy fractions are declining due to hypofractionation and increased use of advanced treatment modalities, e.g. SBRT M M M Applications for IMRT expanding to new tumor sites; image guidance expected to enhance efficiency, appeal of this modality Market Outpatient chemo shifting from physician offices back to the hospital OP department Some commercial payers beginning to apply utilization controls, especially to RT

Source: “Projections of the Population by Selected Age Groups and Sex for the United States: 2015 to 2060,” U.S. Census data, 2013; Kantar Health; Oncology Roundtable Analysis; Advisory Board Inpatient and Outpatient Market Estimators. Growth Outlook Four Forces Shaping Oncology Growth 1 2 3 4 Demographics OutpatientShift Screening Volumes Clinical Innovations • As the population ages, more patients to present with cancer • More procedures can be performed in the outpatient setting • Chemo volumes shifting from physician offices back to HOPD due to changes in reimbursement • Changes to breast and prostate cancer screening guidelines may lead to volume declines • Rising number of lung CT screening programs increasing screening rates • Clinical innovations create new options for patients who were previously ineligible for treatment • Minimally invasive surgical techniques key innovation but value in question 172 53% 63% 12 Population growth of 65+ year olds from 2015 to 2030 Percent of mastectomies performed outpatient nationally in 2013 Number of lung cancer CT screening centers of excellence nationwide New molecular entities approved by the FDA in 2012, vs. 8 and 3 in 2011 and 2010

Service Line Strategy Care Quality Growth Outlook Clinical Innovation Additional Resources Financial Outlook

Medicare Reimbursement Changes in 2014 Free-Standing Sustainable Growth Rate forumla. Hospital-Based Source: Federal Register; Oncology Roundtable analysis. Financial Outlook Medical Oncology Radiation Oncology Physician Supervision • Reimbursement for separately payable drugs reduced to ASP+4.3% due to extension of the sequester cut • Increased reimbursement for most drug administration codes • Drug packaging threshold increased from $80 to $90 • Payments for 3D CRT, IMRT, IGRT and SRS increase • Payment for SBRT decreases significantly • Payment for proton beam therapy rebounds • CMS will begin enforcement of supervision requirements for CAHs and small rural hospitals Medical Oncology Radiation Oncology SGR Cuts • Overall impact of RVU changes results in 1% decrease to medical oncology • Payment for separately payable drugs remains cut due to extension of sequester cuts • Drug administration reimbursement declines • Overall impact of RVU changes results in 1% increase to radiation oncologists • Revenues per patient for radiation therapy treatment modalities mixed • Hopes that Congress would repeal and replace the SGR1 have diminished

Overview of Changes to Medicare RT Payment Hospital Reimbursement Increases for Most Common Modalities Source: CMS, CY 2014 Hospital Outpatient Prospective Payment System Final Rule with Comment Period, accessed at: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Hospital-Outpatient-Regulations-and-Notices-Items/CMS-1601-FC-.html on Dec. 10, 2013; Oncology Roundtable Financial Outlook Estimated Total HOPPS Revenues per Patient Assumes 35 fractions per patient. Assumes 1 fraction per patient. Assumes 3.3 fractions per patient. Assumes 25 fractions per patient. Additional 2% cut will be applied on a per claim basis due to the extension of the sequester.

Sequester Cuts Reduce Drug Payment to ASP+4.3% Congress Extended Sequester Cuts Through 2023 Source: CMS, CY 2014 Hospital Outpatient Prospective Payment System Final Rule with Comment Period, accessed at: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Hospital-Outpatient-Regulations-and-Notices-Items/CMS-1601-FC-.html on Dec. 10, 2013; Oncology Roundtable Financial Outlook Medicare Reimbursement for Separately Payable Drugs Average Sale Price. Sequester effectively cut reimbursement from ASP+6% to ASP+4.3% starting in April 2013 % of ASP Year

Key Areas of Regulatory Uncertainty Source: Oncology Roundtable analysis. Financial Outlook Sustainable Growth Rate formula. Physician Supervision FederalBudget Selection of Quality Metrics • Clarification of supervision requirements is ongoing, unclear where HOP Panel will focus next • To date, CMS has taken a passive approach to enforcement of supervision requirements; however that may change at any time • PQRS oncology measures remain the same • With the 2014 IPPS CMS added 15 new measures to the PPS-exempt Cancer Hospital Quality Reporting (PCHQS) program; potential for these metrics to be included in future hospital quality reporting requirements • 2% sequester cuts will extend to 2023 • Congress may have missed key window of opportunity to repeal and replacement of SGR1

Payers Concerned about Startling Cost Growth Driving Interest in Payment Reforms Source: “Cancer Patients Receiving Chemotherapy: Opportunities for Better Management.” Milliman Client Report, available at: http://publications.milliman.com/research/health-rr/pdfs/cancer-patients-receiving-chemotherapy.pdf, accessed August 23,2010; National Comprehensive Cancer Network, “Managed Care Organizations to Focus on Value in Oncology,” available at: http://www.nccn.org/about/news/ebulletin/2010-08-09/managed_care.asp?utm_source=NCCN+Global+List&utm_campaign=7b79e056c3-EB-N-0036-0810&utm_medium=email, accessed August 27, 2010; Oncology Roundtable interviews and analysis. Financial Outlook Annual Rate of Cost Growth For Commercial Patient Population 0.68% Cancer patients as a percentage of total commercially insured population 10% Cancer costs as a percentage of the total health care costs incurred

Numerous Approaches to Realigning Incentives Goal to Reduce Spending While Improving Quality Source: Oncology Roundtable interviews and analysis. Financial Outlook Fee-for-service. Payment Models Piloted in Oncology Complexity and Financial Risk Pathway Compliance Bonus Diagnosis/Treatment Bundle Fee Schedule Adjustments Episode-Based Pay Shared Savings + Adjustments to payments to incent greater use of generics, or better payment rates in return for quality initiatives Providers at risk for population; services billed FFS1 and providers share in savings if cost kept below pre-determined benchmark Bonus payment for reaching pre-determined pathway compliance rate One payment for select component of treatment, can include case management; remainder is FFS1 Single payment to both hospital and physician for all services related to care delivered within pre-defined episode

Strategic Implications of Reimbursement Changes Source: Oncology Roundtable analysis. Financial Outlook Physician Relations Competition Technology Investment • Declining income fueling interest in closer alignment with hospitals, including employment • Health care reforms leading oncologists and hospitals to form larger networks • Reimbursement advantage in the freestanding setting is disappearing, potentially helping hospitals compete, especially for radiation therapy volumes • Investment likely to slow for reasons other than payment, e.g. capital constraints, absence of new technologies • Current payment structure stifling innovation in image guidance and hypo-fractionation

Service Line Strategy Care Quality Growth Outlook Clinical Innovation Additional Resources FinancialOutlook

Oncology Lacks Broad Set of Feasible-to-Collect, Validated Measures Care Quality Source: Oncology Roundtable interviews and analysis. Breast conserving surgery. Quality Measurement A Major Challenge Oncology Quality Measures Examples Pros Cons

Quality Strategy Changing as Focus Shifts from Volumes to Value Source: Oncology Roundtable Research and Analysis Commission on Cancer. National Accreditation Program for Breast Centers. American College of Radiology. Responding to the Call for Value Care Quality Four Approaches to Demonstrating Value in Oncology Demonstrate Superior Outcomes • Five-year survival data • Quality of Life (QOL) • Patient Satisfaction Account for Affordability • Clinical pathways – P4, Via Oncology, Innovent • Medical Oncology Medical Home Document Care in Accordancewith Guidelines • Rapid Quality Reporting System (RQRS) • Quality in Oncology Practice Initiative (QOPI) Establish the Standard of Care • Accreditations: • CoC1 • NAPBC2 • ACR3

Guideline Concordance Essential to High Value Care Care Quality Source: Oncology Roundtable Research and Analysis Clinical Pathways Reduce Costs, Improve Quality Clinical Pathways Value Proposition Ensures Adherence to Guidelines Pathways built on guidelines therefore adherence establishes baseline for care quality Accounts forCost Pathways developed through an evaluation of guidelines to determine which regimen is most effective, least toxic, and – all else equal – least costly for a particular diagnosis Reduces Care Variation Target compliance rate ensures majority of patients receive care on optimal pathway Enables Comparative Outcomes Assessment Allows benchmarking of outcomes to identify optimal pathway over time

Pathways Slowly Gaining Traction Nationally Care Quality n=52 Source: 2012 Oncology Roundtable Quality Quickpoll. Do the Physicians at Your Cancer Program Use Clinical Pathways? Source of Clinical Pathways n=96 Do Not Use Clinical Pathways and Do Not Plan to Use in the Next Year Homegrown Currently Use Clinical Pathways Other Via Oncology P4 Pathways (P4 Healthcare Specialty Solutions) Plan to Use Clinical Pathways in Next Year Level I Pathways (Innovent/US Oncology)

Potential Oncology Growth Tactics Service Line Strategy Source: Oncology Roundtable Research and Analysis

Comprehensiveness of Services Vary By Market Aims Service Line Strategy - Define Program’s Market Identity Source: Oncology Roundtable Research and Analysis Target Areas for Development By Role in Market Community Center Comprehensive Center

Referrals Tied to Access, Efficiency, Coordination Source: Health Care Advisory Board interviews and analysis. Service Line Strategy - Secure Referring Physician Loyalty Factors Influencing Referral Decisions Direct Access to Specialist Ease of Scheduling Process • Accessing specialist for consults • Reaching specialist after-hours • Receiving assistance for oncologic emergencies • Getting “live” voice; providing web option • Efficient scheduling, help transferring records • Confirmation appointment was made Efficiency of Appointment Care Coordination • Number of days to appointment <5 days • Short appointment wait times • Ease of access to center (i.e. parking) • Improved communication among providers • Engage specialists and patient as “partners in care”, treatment decisions

Most Effective Physician Outreach Tactics Frequent, In-Person Contact Best for Loyal Referral Base Source: Crimson Market Advantage Research and Analysis Service Line Strategy - Secure Referring Physician Loyalty Effectiveness of Physician Marketing Approach Frequency of Outreach by Physician Loyalty Rating of Effectiveness 1 = Strongly Agree 6 = Strongly Disagree

Providers with Risk Shifting Referral Patterns Under New Incentives Service Line Strategy – Appeal to Value-Driven Referrers Source: Oncology Roundtable interviews and analysis. ACOs Shopping for High-Value Specialist Partners Taking Initiative Earns Referral Partnership Quality Scorecards Approached Physician ACO to Initiate Partnership Presented Quality Data to Physician ACO Clinical Improvements • Lower readmissions • Decreased infections, errors • Improved palliative care • Performance to cost benchmarks • Cancer service line director saw opportunity to secure referral partnership with ACO • Expressed interest in becoming care partner • Shared data and metrics from quality scorecards with ACO • Emphasized successful care coordination initiatives, treatment and care capabilities Financial Outcomes Case in Brief: Weiss Health1 • Health system ACO located in the Northeast, proactively approached local physician-led ACO to partner for breast cancer program • Impressed ACO with amount of data tracked through internal quality scorecards • Named ACOs “breast cancer center of excellence,” securing approximately 100 patients per year

Today’s Patients Want More Timely, Convenient Care Fast-Track Program Decreases Wait Time and Increases Referrals Source: Oncology Roundtable Research and Analysis Service Line Strategy - Ensure Timely, Convenient Access Pseudonym institution Midwest’s Fast-Track Program Results After Implementation 1 2 3 95% • Diagnosed patient slotted into available time or triaged to on-call oncologist to be seen same-day • If schedule does not permit full visit, patient offered brief, introductory consultation with specialist • Ancillary staff alerted to patient’s arrival and assembled to offer services, support Patients receive some or all care-planning services on same day through Fast-Track Case in Brief: Midland University Health1 15% • 490-bed teaching hospital in Midwest • Referral analysis revealed physicians sending patients to competitors to avoid appointment scheduling delays • Hospital developed Fast Track program to guarantee immediate appointment availability Increase in average monthly referrals after implementation of Fast-Track

Urgent Needs Leading to Costly Interventions High Price of Easily Treatable Symptoms Calls for Better Management Source: Mayer DK, et al., “Why Do Patients with Cancer Visit Emergency Departments? Results of a 2008 Population Study in North Carolina,” Journal of Clinical Oncology, 2011, 29: 2683-2688; “Cancer Patients receiving Chemotherapy: Opportunities for Better Management.” Milliman Client Report, available at: http://publications.milliman.com/research/health-rr/pdfs/cancer-patients-receiving-chemotherapy.pdf, accessed May 3, 2013; Oncology Roundtable interviews and analysis. Service Line Strategy - Ensure Timely, Convenient Access High Utilization of Emergency Department and Hospitalization for Cancer Patients Chief Complaint of Cancer Patients Presenting at Emergency Department n = 37,760 ED visits for every 1,000 chemotherapy patients 930 Hospitalizations for every 1,000 chemotherapy patients 380 $800 Average cost per ED visit $22 K Average cost per inpatient admission

Three Strategies for Meeting Patients’ Urgent Needs Symptom Management Options Vary in Level of Resources Required Source: Oncology Roundtable interviews and analysis. Service Line Strategy - Ensure Timely, Convenient Access Dedicated Urgent Care Facility • Dedicated space • Administrative and clinical staff • Referral protocols • Follow-up procedures • Patient education Flexible Add-On Capacity • Provider capacity • Provider education • Flexible scheduling • Patient education StandardizedTelephone Triage • Patient education • Administrative and/or clinical staff • Triage protocols Resource Intensity

Service Line Strategy - Attract Self-Directed Patients Source: Oncology Roundtable Research and Analysis Patient Navigation Provides Personal Touch Most Common Navigation Models

Unbundling the Oncology Care Continuum Service Planning Should Span Prevention, Treatment, and Follow-Up Source: Service Line Strategy Advisor research and analysis Service Line Strategy - Retain Patients Across the Care Continuum Description Key Program Components Risk Assessment/ Primary Prevention • Assess risk based on family history, exposure, lifestyle, genetic testing • Lifestyle counseling and chemoprevention • Community Outreach • Nutrition • Clinical Lab • Primary Care Screening/ Detection • Recommend screening for high-risk, asymptomatic patients • Testing for symptomatic patients • Diagnostic Imaging • Clinical Lab • Primary Care • Biopsy/appropriate imaging studies • Repeat exams to clarify diagnosisand confirm stage • Medical Oncology • Diagnostic Imaging Diagnosis and Staging • Surgery/excision • Radiation therapy • Chemo/hormone therapy • Palliative care • Radiation, Surgical and Medical Oncology • Interventional Radiology Treatment • Follow-up testing for recurrence • Follow-up care • Psychosocial services • Diagnostic Imaging • Medical Oncology • Mental Health Services Survivorship • End-of-life planning • Symptom and pain management • Psychosocial and spiritual support • Spiritual Care • Hospice • Specialist • Social Work • Mental Health Services Palliative Care

Engage Community Through Prevention, Screening Variety of Outreach Spreads Program Awareness, Identifies Patients Service Line Strategy - Retain Patients Across the Care Continuum Source: Oncology Roundtable Research and Analysis Community Outreach Primary Care Genetic Testing • Establish formal screening programs around key technology (i.e. CT, mammo) • Educate community about healthy living and avoiding carcinogens (i.e. sun exposure, smoking) • Organization of events, such as breast cancer walks, spreads awareness. • Attendees can complete risk assessment forms used to recommend screenings • Educate patients of specific actions they can take to reduce risk • Review patients history to assess risk of cancer • Refer patients for genetic testing and/or screening • Identifies genes that put a patient at higher risk of cancer • High risk patients may be more likely to regularly receive screening, increasing their chances of early detection and survival • Results must be interpreted correctly

Service Line Strategy - Retain Patients Across the Care Continuum Source: Oncology Roundtable Research and Analysis Multidisciplinary Care Improves Coordination Medical Oncologist Often at the Center of Complex Referral Pathways Multidisciplinary Approach Improves Adherence to Guidelines, Care Coordination… • Traditional multidisciplinary clinics schedule patients to see multiple providers during a single day; providers confer on treatment plan • “Virtual” multidisciplinary clinics schedule patients for clinic visits across the course of a week; then all providers discuss at multi-disciplinary treatment planning conference Radiation Oncologist Surgeon Radiologist Medical Oncologist …But Logistically Complex • Requires painstaking coordination of physicians’ time • Often inefficient use of physicians’ time • Billing is complex • Requires significant patient volumes to justify investment Other Specialist

Finding the Right Fit: Regionalization Models Distilling the Options Service Line Strategy - Expand The Program’s Reach Source: Oncology Roundtable Research and Analysis 1 2 3 Wholly-Owned Satellite Joint-Venture Satellite Affiliate Network Cancer program opens satellite facility, offering infusion services, clinic visits, and/or radiation therapy. Two hospitals, community or academic, partner to open satellite facility typically offering clinic visits, radiation therapy, and/or infusion services. Academic cancer program partners with community programs, offering range of services including clinical research, grand rounds, management support, and co-branding. Geographic Considerations Balancing Risk and Reward 1 2 3 Affiliate Network 3 • Number of Locations Joint-Venture Satellite 2 Wholly-Owned Satellite 1 Distance from Hub

Choosing the Appropriate Path for Expansion Service Line Strategy - Expand The Program’s Reach Three Motives for Establishing an Oncology Satellite Source: Oncology Roundtable Research and Analysis Strategy #1: Decompressing the Enterprise Strategy #2: Establishing a Beachhead Strategy #3: Market Power Play • Hospital dominant player in market, but straining to keep up with demand • Main campus lacks sufficient space to add capacity • New center improves access, frees up capacity at hub • Usually located in primary market • Hospital targeting high-growth areas to expand regional foothold • New center located in market without existing presence • Designed to serve outpatients without convenient local options • Potential to add new services (e.g., imaging, specialty consults) down the road • Hospital faced with strong competitive pressures, experiencing market share erosion • New center located proximal to competitors to compete “toe-to-toe” • Venture to focus on equaling (if not exceeding) competitor’s service offering

Future-Looking Technologies and Procedures in Oncology Clinical Innovation Source: Service Line Strategy Advisory Research and Analysis Ventricular Assist Devices. Cardiac Rhythm Management. Technology Pipeline for Oncology Services Radiation Oncology Surgical & Interventional Oncology Medical Oncology Oncology Imaging Targeted, personalized diagnostics and therapies PET/CT to be major player in future cancer care Rising presence of proton therapy Leveraging market move towards interventional therapies Single Room Proton Therapy • Next-gen proton therapy rooms aim to reduce the entry cost while still offering an innovative treatment • Single room treatment still faces hurdles such as rising competition, payer reluctance and low access to financing Expanding Role of da Vinci • da Vinci indication is expanding to gynecologic oncology indications, thyroidectomy and thoracic procedures Ablation Technology • Progressive ablation technology beginning to take hold across markets • Key challenges include incomplete efficacy and safety data Genetic testing • Genetic testing programs usually cater to many service lines • A genomic testing lab and genetic counseling center offer different services Targeted Therapies • Innovations in small molecule inhibitors and monoclonal antibodies aid in personalized medicine PET/CT • PET/CT is a growing need in emerging oncology programs • While many institutions have a mobile unit, a fixed PET/CT cements the institution’s commitment to high quality oncology care

Does Single Room Proton Improve The Model? Single Room Creates New Risk Profile; Cost Just One Of Many Challenges Source: Service Line Strategy Advisor research and analysis Clinical Innovation • Large Scale • Single Room

da Vinci Expand into New Onc Surgical Specialties Source: Service Line Strategy Advisor research and analysis Clinical Innovation General Surgery Urology Gynecology ENT Prostatectomy Hysterectomy Upper GI/ Foregut Surgery Thyroidectomy Transoral Robotic Surgery (TORS) Thyroid Thoracic Higher Nephrectomy Myomectomy Colorectal/ Gallbladder Surgery Lobectomy Degree of Robotic Adoption within Specialty Cystectomy Thymectomy Lower Higher Degree of Robotic Adoption by Specialty Lower

The Growing Role of Interventional Oncology Subspecialty Strives to Become a Fourth Pillar of Oncology Care Source: Service Line Strategy Advisor research and analysis Clinical Innovation Interventional Oncology Radiation Oncology Surgical Oncology Medical Oncology Interventional Oncology Progresses As Independent Alternative • Less invasive approaches emphasize patient comfort • Clinical data establishing credibility within medical community • Technological advancements target niche treatment roles I.O. Increases Independence Offers alternatives to traditional treatment options for liver, kidney indications I.O. as Last Resort Therapies used for palliation, last resort in patients failing traditional treatments Future Present Past I.O. Strictly Supportive Ancillary support, minimal involvement in patient care process I.O. Manages Care Interventional providers more involved throughout care continuum Further Growth for I.O. Programmatic development augments role of interventional treatments

Ablation Advances Address New Challenges Considerations for Investment in Ablation Technologies Source: Service Line Strategy Advisor research and analysis Clinical Innovation Innovative, But Risky Conservative, But Established Microwave Ablation (MWA) Irreversible Electroporation (IRE) Radiofrequency Ablation (RFA) Mechanism and Solution • Probe delivery of radiofrequency-generated electric current heats and destroys tumor - ideal for small, isolated lesions Key Challenge • Incomplete ablation is a risk, especially in tumors > 3 cm, due to insufficient heat to overcome charred tissue, heat sink of adjacent blood flow Mechanism and Solution • Probe delivery of electric field provides higher temperatures, faster heating to improve tumor kill, and bypass heat sink and insulation barriers Key Challenge • Ablation zone not as spherical as with RFA, and can be unpredictable, leaving risk of thermal damage to healthy, adjacent tissue Mechanism and Solution • High-voltage electrical bursts provide non-thermal, targeted tumor destruction, sparing adjacent healthy tissue from heat-based damage Key Challenge • Clinical literature in humans is immature, leading many to question safety and efficacy of the procedure 42

Clinical Innovation Comes with Additional Costs Personalized Medicine Demands Costly Additions to Care Pathway Source: Service Line Strategy Advisor research and analysis Clinical Innovation • Chemistry tests • Biopsy • Imaging • Systemic cytotoxic chemotherapy • Bone marrow transplant Traditional Care Pathway • Pathologic tissue staging Diagnosis Prognosis, Planning Treatment Emerging Standards • Targeted chemotherapeutics • Oral chemotherapy • Immunotherapy • Vaccine therapy • Clinical trials • Genetic testing • Flow cytometry • Molecular diagnostics • Pharmacogenomics New Tools Come with Program Needs The innovations permitting personalized medicine in oncology care require greater per-patient costs and investment in supportive infrastructure to ensure success

Genetics Program Requires Many Components Core Components of Genetics Clinic and Molecular Diagnostics Program Source: Service Line Strategy Advisor research and analysis Clinical Innovation Hospital Genomics Program Support Staff Genetic Counselors • Administrators • Nursing • Certified General Counselors • Specialized Counselors Pathology/Lab Referring Physicians • Internal testing lab • External testing service • General practitioners • Oncologists IT Infrastructure • Bio-informatics database • Medical record systems

A Comprehensive Solution for Your Oncology Strategic Needs Enhancing Oncology Service Line Strategy Oncology Roundtable Service Line Strategy Advisor • Service Line Assessment • Current and future service line performance evaluation to pinpoint growth and development opportunities • Unique insights based on market dynamics to drive fine-tuned recommendations • National Meeting Series • Two-day summits offering strategies and best practices to address contemporary challenges • On-demand executive summary webconferences for ongoing support • On-Demand Tools and Analytics • Over two dozen online tools to analyze market opportunity, benchmark performance, expedite best practice implementation • Technology and Service Business Plans • Comprehensive market and financial analysis to determine investment decisions • Concrete plans and prioritization accounting for institutional priorities, budget, and goals • Best Practice Library • Comprehensive library of over 500 best practices spanning all major domains (e.g., strategic planning, physician alignment, etc.) • System Service Rationalization • Strategic recommendations on clinical asset deployment and competitive strategy based on current system structure • Tactical recommendations for service investments and distribution • Facilitated Performance Improvement • On-demand access to dedicated consultants • “Ask Our Experts” model with immediate, customized response for your questions • Facilitated networking with successful programs

Oncology Roundtable & Service Line Strategy Advisor