PYA Senior Consulting Manager Chris Wilson presented “Clinically Integrated Networks (CIN) and the Role for Radiation Oncology” at the SATRO® 16 Conference, April 24-25, 2014, at the Crowne Plaza Ravinia in Atlanta, Georgia.

1. April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Clinically Integrated
Networks and the Role
for Radiation Oncology
A Presentation For: SATRO® 16th Annual Conference
April 24-25, 2014

2. April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Why Clinical Integration?
• Today’s volume-based, fee-for-service system is
based on independence: each provider is paid for
providing a discrete service, without regard to
others’ performance.
• Tomorrow’s value-based payment systems,
however, will demand interdependence: providers
will be rewarded for quality and efficiency achieved
through collaborative care.

3. April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Fundamentals Driving
Clinical Integration

4. April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Adapting to your
“Customers” Demands

5. April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Defining Clinical Integration

6. April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Key Characteristics of a CIN
• Well-defined governance structure to promote
organizational goals while protecting individual
interests
• Physician-driven, professional management
• Data-driven
• Relentless focus on improving the health of the
population served
• Adherence to evidence-based medicine guidelines
and clinical protocols

7. April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Investing in Clinical Integration
as a Strategy

8. April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Demonstrating the Business
Case for Clinical Integration

9. April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Understanding Basic
CIN Economics

10. April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Recognizing the Unique Challenge
of Engaging Physicians

11. April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Developing a CIN

12. April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Launching a CIN

13. April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Operating the CIN

14. April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Recent Trends in Cancer Care
Clinical Integration Strategy

15. April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Recent Trends in Cancer Care Clinical
Integration Strategy
1. Patient-Centered Medical Home (PCMH) model is becoming
increasingly common for oncology to combat the high costs of
oncology services.
2. Commonalities Among Top Oncology Programs, such as
increasing focus on patient-centered care and cost-awareness.
3. Emerging Personalized, Molecular Treatments’ ability to
specifically target molecular abnormalities driving tumors.
4. Genome-based Cancer Care “Arms Race” on patient
genome sequencing capabilities to more precisely prevent and treat
cancer.
5. Genome (vs. Tumor Site) Driving Future of Cancer
Treatment to better treat patients’ specific cancers.

16. April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Patient-Centered Medical Homes
• CMS awarded a $19
million grant to
implement PCMH
models in seven
oncology practices
across the U.S.
Background
• Many oncology
centers are
developing oncology-
based medical homes
in an effort to improve
care and quality while
decreasing high costs
associated with
oncology.
Why PCMH?
• Accessible, comprehensive
and coordinated care
through a systems-based
approach.
• Clinical staff better serve
their patients by developing
and maintaining an active
partnership with them and
providing proactive,
preventative and chronic
care management, which in
turn, prevents complications
and hospitalizations.
Benefits

17. April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Patient-Centered Medical Homes
• Gaps between quality and care delivery standards in oncology could be addressed
by PCMH model.
• PCMH principals could encourage rational utilization of healthcare resources through
the use of:
 Evidence-based guidelines
 Reduced hospitalizations, ED visits, and imaging
 Increased engagement with patients, especially for end-of-life care decisions
• The Results Don’t Lie!
 Reduced hospitalizations, ER visits, imaging services, and diagnostics
 Improved coordination of services, patient communication, and overall efficiency
 The practice reduced its staff-to-physician ratio from 8.3 FTEs to 5.5 FTEs and increased
its patient base by 30 percent

18. April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Commonality Among Top
Oncology Programs
Oncology
leaders at
the nation’s
top
hospitals
shared 11
trends in
hospitals’
cancer
care…
Increasing outpatient care
Focusing on patient-centered care
Personalizing medicine through
genetic analysis for effective
treatment
Increasing cost awareness
Focusing on outcomes by
adhering to evidence-based
practices
Coordinating care through
technology
Offering services which
compliment patient’s treatment
Coordinating cancer services to
treat the whole patient
Enhancing survivorship programs
Offering palliative care services
Offering more educational
opportunities for patients

19. April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Emerging Personalized,
Molecular Treatments
 Ability to target agents
directed specifically to
molecular abnormalities
driving specific tumors
Yesterday… Today…
 Surgery
 Chemotherapy
 Radiation
Rough Tools: Personalized Medicine:

20. April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Genome-Based Cancer Care
“Arms Race”
• Cancer care providers, particularly academic
medical centers, are launching an “arms race” on
patient genome sequencing capabilities in order to
more precisely prevent and treat cancer.
– Johns Hopkins – “systematic genomic sequencing program”
– Phoenix Children’s Hospital – Ronald A. Matricaria Institute of
Molecular Medicine

21. April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Genome Driving Future of
Cancer Treatment

22. April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Clinical Integration and
Radiation Oncology
General Considerations

23. April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Consider: Transition to Coordinated
Care
• Consolidation of the Hospital Market
– The number of hospitals that are part of a health system
has been growing steadily for more than a decade.
– Almost 60% of hospitals are now part of a system.
– Health system executives are increasingly asking their
oncology service line leaders to devise plans that promote
coordination, collaboration, and more efficient use of
resources.

24. April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Consider: Transition to Coordinated
Care
• Many health systems were created through mergers and
acquisitions.
• Consequentially, cancer programs that were once
competitors may find themselves part of the same institution,
which is a challenging starting point for collaboration.
• Even if the cancer programs are located in different markets,
they will likely have different organizational models,
physician governance

25. April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Consider: Narrow Network Concerns
for Cancer Centers
Cancer patients relieved that they can get insurance
coverage because of the new health law may be
disappointed to learn that some of the nation’s best
cancer hospitals are off limits.

26. April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Consider: Narrow Network Concerns
for Cancer Centers
• The Associated Press surveyed 23 institutions around the
country that are part of the National Comprehensive Cancer
Network (NCCN).
• Only four out of the 19 nationally recognized comprehensive cancer
centers that responded to the survey said patients have access
through all the insurance companies in their state exchange.
• These patients may not be able to get the most advanced treatment,
including clinical trials and medications.

27. April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
The National Benchmark for
Oncology, 2013 Report on 2012
Data

28. April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Survey Responses
Response to survey question “Do you expect to be impacted by
an ACO [accountable care organization] in the coming year?”
• Practices, 93
• Full-time equivalent
physicians, 814

29. April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Survey Responses
Response to survey question “If yes, do you expect to
participate in risk/reward with the ACO [accountable care
organization]?”
• Practices, 67
• Full-time equivalent
physicians, 637

30. April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Survey Responses
Response to survey question “Do the physicians in your
practice regularly use practice guidelines or clinical pathways
for patient care?”
• Practices, 86
• Full-time equivalent
hematology/oncology
physicians, 663
• FTE physicians, 812

31. April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Survey Responses
Source of clinical pathways
• Practices, 46
• Full-time equivalent
hematology/oncology
physicians, 304
• FTE physicians, 391

32. April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Survey Responses
Response to survey question “How do you use clinical pathway
data?”
• Practices, 43
• Full-time equivalent
hematology/oncology
physicians, 291
• FTE physicians, 376

33. April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Why Clinical Integration?
• Today’s volume-based, fee-for-service system is
based on independence: each provider is paid for
providing a discrete service, without regard to
others’ performance.
• Tomorrow’s value-based payment systems,
however, will demand interdependence: providers
will be rewarded for quality and efficiency achieved
through collaborative care

34. April 24-25, 2014
Prepared for SATRO ® 16th Annual Conference
Christopher Wilson, J.D., M.P.H.
Senior Manager
cwilson@pyapc.com
913-232-5145