Advancing Oncology Care - Developing A Value Based Strategy

1. Advancing Oncology Care - Developing A Value Based Strategy Presented by: Dave Miller, MBA

2. Short Biography • Healthcare Administration Background • Hopkins for nearly 10 years • Administrator of Radiation Oncology and Molecular Radiation Sciences

3. Introduction

4. Introduction Choluteca Bridge, Honduras

5. Introduction Choluteca Bridge, Honduras Post Hurricane Mitch, 1998

6. Introduction

7. Agenda • Introduction • Market Conditions • Business Case • Measuring Value • Conclusion

8. Market Conditions

9. Regulatory Environment • Pay for Performance • Consolidation of Healthcare • Accountable Care • Expansion of Medicaid • Population Health • Meaningful Use/EMR

10. Demand Economics:Population Demographics Decreasing Mortality Trend Source: Department of Health and Human Services, Administration on Aging Aging Population & Increased Survivorship = Demand Growth Source: NCI, U.S. Census 2010 and CA Cancer J Clin 2012;62:10–29.

11. Demand Economics:Utilization Forecasts Source: Sg2, 2013 Cancer Service Line Snapshot Shift In Utilization – Outpatient Demand Outpaces Population Growth

12. Supply Economics:Oncologist Capacity Forecast Forecasting Supply of and Demand For Oncologists Baseline Forecast Potential Shortage of Up To 4,000 Oncologists by 2020 Unmet Demand Projected to Range from 9.4 – 15.1 Million Visits Source: AAMC, Center for Workforce Studies, March 2007. A Report to the American Society of Clinical Oncology (ASCO)

13. Summarize Increase in Regulatory Demands Increase in Patient Demand Shortfall in Oncology Supply We must respond despite incomplete information, market volatility, and an unclear target.

14. What can we do now?

15. Business Case Johns Hopkins Radiation Oncology Vision and Strategy

16. Johns Hopkins MedicineMission and Vision Tripartite Mission Statement The mission of Johns Hopkins Medicine is to improve the health of the community and the world by setting the standard of excellence in medical education, research and clinical care. Diverse and inclusive, Johns Hopkins Medicine educates medical students, scientists, health care professionals and the public; conducts biomedical research; and provides patient-centered medicine to prevent, diagnose and treat human illness.

17. The Johns Hopkins Health SystemRegional Growth GSS Free Standing 2010 Joint Venture HCGH Free Standing BMC Hospital Based JHH Hospital Based 2014 Growth Suburban Free Standing 2010 Acquisition Sibley Hospital Based 2011 Acquisition

18. Radiation Oncology Regional Vision Vision: Establish an Integrated System of Care GSS Free Standing Suburban Free Standing JHH Hospital Based BMC Hospital Based Sibley Hospital Based

19. Obstacles - Infrastructure Disparate Technology

20. Obstacles - Acceptance Executive Leadership Departmental Staff Inconsistent Motivations

21. Obstacles – Administrative Structure and Funding Administrative Structure Startup Funding Incremental Resources Not Available

22. Strategy • Mission Focus – Regional Clinical Care, Research, and Education • Standardized quality and safety practices • Improve access to advanced care & multidisciplinary clinics • Clinical trial availability Patient Centric Strategy General Acceptance. Cautious Integration.

23. Business Case Johns Hopkins Radiation Oncology Adding Value In a Consolidated Healthcare Environment

24. Transparency and Inclusion Presentation Approval Approval Implement Local Executive Teams Senior Executive Team Department Proposal Clinical Teams Transparent, Consistent Communication

25. Adding Value – Technology Integration • Advanced Clinical Care • Standardized clinical trial platform and capability • Enhance opportunities for training • Financial benefit Integrated Technology IT IT IT Provided opportunities for growth, incremental resources, and strategic advancement

26. Adding Value – Quality andSafety Advanced Quality And Safety • Standardized clinical practice and growth in clinical practice • Coordinated safety and quality programs • Financial benefits

27. Adding Value – Centralized Access Integrated Scheduling Decision Matrix • Integration: Management, Access, Information Systems • Centralized scheduling and financial clearance functions and personnel • Volume and resource growth Right Treatment, Right Provider, Right Location, Right Time.

28. Adding Value - Patient Impact • Single access point for appointments • Access to advanced treatments • Access to clinical trials • Elevated quality assurance and safety • Integrated coordination of care • Throughput efficiency

29. Adding Value – Responding to Market Conditions Operational and Capital Cost Reduction Enhancing Quality, Safety, and Efficiency Market and Patient Population Growth Advancing the Call to Action: Add Value by Actively Responding to Market Conditions

30. Applicable Takeaways • Proactively understand andrespond to market conditions • Start with mission and strategy • Leadership buy-in is critical • Always maintain focus on patients THINK CREATIVELY AND RALLY AROUND NEW AND INNOVATIVE IDEAS

31. Measuring Value

32. Defining Value Manufacturing1 Healthcare2 • Amount of Satisfaction Received • Patient Outcome Value Value • Price of Product or Service • Cost of Patient Care Bovet, Martha, Value Nets: Breaking the Supply Chain to Unlock Profits (New York: John Wiley & Sons, 2000). Porter, ME. What Is Value In Healthcare? N. Engl J Med 2010; 363:2477-8).

33. Relevance of Defining and Measuring Value in Healthcare Increased market share will increase populations served and drive financial viability Value added services improve market strength and position Develop internal processes to improve outcomes and/or lower cost Swayne L, Duncan WJ, and Ginter, PM., Strategic Management of Health Care Organizations (New York: John Wiley & Sons, 2008).

34. Michael Porter’s Value Chain Industry Model • Find opportunities to add value to outputs and customers • Revenue = Company Value. • Company Value > cost to add value, margin is generated. • Growth in Value and Margin provide competitive advantage Value Value 1. Mind Tools. http://www.mindtools.com/pages/article/newSTR_66.htm. Downloaded August 29, 2013

35. Radiation Oncology Support Activities • Regional business planning • Integrated billing and compliance • Streamlined regional access Practical Applications • Prostate, Breast, etc. • Tumor boards, MDC clinics • CME • Stereotactic • SARRP – Animal research platform • Oncospace – Data sharing analytics • Regional capital integration • Integration of IT systems • Integrated service contract management

36. Radiation Oncology Primary Activities Inbound Logistics Operations Outbound Logistics Consultation Clinic Simulation Dosimetry Quality Assurance Treatment Primary Care Product Marketing and Sales Service Customized Therapy Plans Market Outreach & Education Clinical Trial Availability Follow-Up Patient Education Value can improve outcomes, reduce cost, add margin, and increase competitive advantage

37. Radiation Oncology – Porter Value Chain Application Firm Infrastructure Mission & Margin Advancing the Mission Grow populations served Clinical trial access Translational opportunities Teaching Human Resource Management Technology Development Procurement Inbound Logistics Operations Outbound Logistics Marketing and Sales Service Consultation Dosimetry Treatment Outreach & Education Follow-Up Simulation Quality Assurance Primary Care Clinical Trials Patient Education Enhancing Value Provides Clinical Care, Research, and Teaching Mission Opportunities.

38. Enhancing Value – Johns Hopkins Pancreas Cancer MDC Inbound Logistics • More accurate diagnosis and staging • Enhance treatment planning Study of 203 pancreas cancer patients receiving single-day multidisciplinary consultation and evaluation VALUE ADDED Outbound Logistics • Advance treatments through clinical trials VALUE ADDED VALUE ADDED Technology Development • Increased research registry • Clinical trial development VALUE ADDED Service • Improved patient education Pawlik , et al. Ann SurgOncol. 2008; Aug;15(8):2081-2088. Epub 2008 May 7.

39. Enhancing Value - Clinical Analytics GlioblastomaPatients Alert! when uncommon Rx VALUE ADDED VALUE ADDED VALUE ADDED Operations • Quality Assurance check • Peer review tool Technology Development • Automated QA tools • Utilization of clinical data Outbound Logistics • Enhanced quality of treatment plans McNutt, et al. ONCOSPACE: AN RT DATA INFRASTRUCTURE Submitted 2013

40. Enhancing Value – StrategicPlanning Strategic Goals Firm Infrastructure Mission & Margin Human Resource Management Technology Development Procurement Inbound Logistics Operations Outbound Logistics Marketing and Sales Service Consultation Dosimetry Treatment Outreach & Education Follow-Up Simulation Quality Assurance Primary Care Clinical Trials Patient Education

41. Applicable Takeaways – Measuring Value Firm Infrastructure Mission & Margin Porter’s Value Chain Application • Identify and Assess value opportunities for patients Human Resource Management Technology Development Procurement Inbound Logistics Operations Outbound Logistics Marketing and Sales Service • Efficiency, Quality, Safety, Care Coordination, and Strategic Agility Consultation Dosimetry Treatment Outreach & Education Follow-Up Simulation Quality Assurance Primary Care Clinical Trials Patient Education • Continual assessment of strategy and tactics

42. Applicable Takeaways – Measuring Value Assessing Market Responses

43. Conclusion

44. Agenda • Introduction • Market Conditions • Business Case • Measuring Value • Conclusion

45. Conclusion Infrastructure Mission & Margin Innovation / Creativity Value / Measurement Opportunity / Success HR Technology Procurement In Ops Out Mkt Srv … A Little Pot of Gold Wouldn’t Hurt on Our Journey

46. Questions?