Oncology Roundtable Oncology State of the Union The

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Oncology Roundtable Oncology State of the Union The Six Trends That Will Reshape Cancer

Oncology Roundtable Oncology State of the Union The Six Trends That Will Reshape Cancer Care Ashley Riley, MPH [email protected] com

2 The World Is Starting to Look Very Different Six Trends Shaping Cancer Care

2 The World Is Starting to Look Very Different Six Trends Shaping Cancer Care 1 Cancer is the number one killer in 22 states (and counting) 2 We are on our way to being a majority-minority country 3 Health care reimbursement and reform are at a turning point 4 Telehealth is breaking down cancer center walls 5 Health care “consumers” demand evidence of cost and quality performance 6 Genomic medicine is revolutionizing cancer care © 2018 The Advisory Board Company • advisory. com Source: Oncology Roundtable interviews and analysis.

3 Trend 1 Cancer Becoming the Number One Killer in America © 2018 The

3 Trend 1 Cancer Becoming the Number One Killer in America © 2018 The Advisory Board Company • advisory. com Source: https: //injuryfacts. nsc. org/all-injuries/preventable-death-overview/odds-of-dying/data-details/; https: //www. advisory. com/dailybriefing/2019/01/16/deaths? WT. mc_id=Email|Daily. Briefing+Headline|DBECTake|DBInfogram|DBA|DB|2019 Jan 16|ATest. DB 2019 Jan 16|||| &elq_cid=401455&x_id=003 C 000001 Cv 2 ut. IAB; Oncology Roundtable interviews and analysis.

4 An Older, More Complex, and More Costly Population Estimated Percentage of the US

4 An Older, More Complex, and More Costly Population Estimated Percentage of the US Population Age 65 and Over Percentage of Medicare Cancer Patients with Comorbidities 2015 45% growth in the number of new cancer cases from 2014 to 2030 20% 36% 13% 31% 10% 45% growth inwith the Beneficiaries number of new 4 or more cancer cases from conditions account 2014 to 2030 for 75% of total Medicare spend 26% 7% 1970 2010 © 2018 The Advisory Board Company • advisory. com 2030 Cancer Only 1 -2 Other Conditions 3 -4 Other Conditions 5 or More Conditions Source: Colby SL, Ortman JM, “The Baby Boom Cohort in the United States: 2012 to 2060, ” U. S. Census Bureau, May 2014, https: //www. census. gov/prod/2014 pubs/p 25 -1141. pdf; Medicare Chronic Conditions Dashboard, https: //www. cms. gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Dashboard/Chronic. Conditions-State/CC_State_Dashboard. html; Oncology Roundtable interviews and analysis.

5 Zeroing In on Indiana Similar Aging and Cancer Incidence Trends in Indiana Estimated

5 Zeroing In on Indiana Similar Aging and Cancer Incidence Trends in Indiana Estimated Percentage of the Indiana Population Age 65 and Over Estimated and Projected Cancer Incidence in Indiana +12. 9% 37 294 +7. 4% 35 473 33 028 18% 16% 2018 © 2018 The Advisory Board Company • advisory. com 2023 2018 2023 2028 Source: Demographic Profiler; Cancer Incidence Estimator; Oncology Roundtable interviews and analysis.

6 The Impact on Cancer Programs Preparing for an Aging and Polymorbid Population Focus

6 The Impact on Cancer Programs Preparing for an Aging and Polymorbid Population Focus on Top-of-License Practice and Multidisciplinary Care Provide coordinated, multidisciplinary care Grow cross-service line specialties (e. g. , cardio-oncology, geriatric oncology) Ensure top-of-license practice across the care team Improve transitions back to primary care Build the oncology workforce pipeline via outreach, community education, and rotations © 2018 The Advisory Board Company • advisory. com Source: Oncology Roundtable interviews and analysis.

7 Triage Survivors to Optimal Site of Care Transitions Save Oncologists Time for Their

7 Triage Survivors to Optimal Site of Care Transitions Save Oncologists Time for Their True Specialty Risk-Based Stratification of Survivors at Memorial Sloan Kettering Risk of recurrence, late effects Low Risk Medium Risk Survivorship NP 1 transitions patients back to PCP by discussing new care plan with patient and creating a transition note for the patient and PCP Survivorship NP continues managing patients in the survivorship clinic until they are ready for transition Survivors High Risk Survivorship NP may manage patients in the survivorship clinic indefinitely, but coordinates with PCP throughout Steps to Prepare Patients for Transition 1 Explain active treatment and post-treatment care plans to patients at the start of treatment 2 Reiterate transition plan as patients approach treatment completion and set patient expectations about recovery 3 Assure patients that the cancer center will remain a resource to them after their transition 1) Nurse practitioner. © 2018 The Advisory Board Company • advisory. com Source: Memorial Sloan Kettering Cancer Center, New York, NY; Oncology Roundtable interviews and analysis.

9 Transitions Going Smoothly Survivors and PCPs Comfortable with Management Data Supports Risk-Based Approach

9 Transitions Going Smoothly Survivors and PCPs Comfortable with Management Data Supports Risk-Based Approach . 02% Percentage of breast cancer survivors transitioned to their community PCP over a 22 -month period who required a return visit at Memorial Sloan Kettering Oncology Roundtable Related Resources Tactics to Support PCPs: • PCP-Led Survivorship Care • Engage Primary Care Providers • Further the Primary Care Partnership • Survivorship Interview Guide for PCPs Care Plans Proving Useful • Survivorship Education Resources for Primary Care Providers 33% Tactics to Support Survivors: • Prepare Patients for Survivorship Percentage of PCPs surveyed who reported that they would change their plan of care for survivors based on information in the survivorship care plan © 2018 The Advisory Board Company • advisory. com • Prepare Cancer Patients Early for the Transition to Survivorship Source: Memorial Sloan Kettering Cancer Center, New York, NY; Oncology Roundtable interviews and analysis.

10 Trend 2 US Set to Become ‘Majority-Minority’ Crossover Expected to Occur in 2044

10 Trend 2 US Set to Become ‘Majority-Minority’ Crossover Expected to Occur in 2044 Distribution of the US Population National Projections By 2030, minorities will comprise ≈45% of the population 62% 56% 44% 38% 2014 2060 White © 2018 The Advisory Board Company • advisory. com Minority Projected Percent Change in Race Distribution in Indiana from 2018 -2023 Race/Ethnicity Projected Percent Change Asian +14. 4% Hawaiian/Pacific Islander +10. 5% Multi-race +10. 1% American Indian/Alaskan Native +10% Other Race +9. 6% Black +3. 3% White +0. 4% Hispanic +11. 7% Non-Hispanic +0. 8% Source: Colby SL, Ortman JM, “Projections of the Size and Composition of the U. S. Population: 2014 to 2060, ” U. S. Census Bureau, March 2015, https: //www. census. gov/content/dam/Census/library/publications/2015/demo/p 251143. pdf; Demographic Profiler; Oncology Roundtable research and analysis.

11 Health Disparities a Major Issue Racial Disparities in Cancer-Related Deaths 22% 1. 4

11 Health Disparities a Major Issue Racial Disparities in Cancer-Related Deaths 22% 1. 4 x 25% of deaths among Hispanics in 2014 were cancer-related, making it the leading cause of death for Hispanics in America more likely Hispanic women are to die from cervical cancer compared to white women higher death rate for blacks than whites for all cancers combined © 2018 The Advisory Board Company • advisory. com Source: Cancer Facts & Figures for Hispanics and Latinos, http: //www. cancer. org/research/cancerfactsstatistics/hispanicslatinos; NCI, “Examples of Cancer Health Disparities, ” http: //www. cancer. gov/about-nci/organization/crchd/about-healthdisparities/examples; Oncology Roundtable research and analysis.

12 The Impact on Cancer Programs Caring for an Increasingly Diverse Patient Population Start

12 The Impact on Cancer Programs Caring for an Increasingly Diverse Patient Population Start Building a Diverse, Culturally Competent Workforce Now Train culturally competent staff and clinicians Build a pipeline to assemble a workforce that is representative of the community served Ensure access to resources and specialists to address specific populations’ challenges 1 Related Resources Find resources to help your team at our new resource page: The Health Disparities Initiative 1) Examples include access to interpreters and specialized resources for transgender patients. © 2018 The Advisory Board Company • advisory. com Source: Oncology Roundtable interviews and analysis.

13 Equip Staff to Identify and Address Disparities ACCURE Program Closes Racial Gap in

13 Equip Staff to Identify and Address Disparities ACCURE Program Closes Racial Gap in Lung Cancer Treatment Components of ACCURE 1 Program 1 Missed Appointment Alert Leverage EHR to alert providers when patient misses an appointment or treatment milestone 2 Trained Navigators Treatment Rates by Race for Lung Cancer Patients at Baseline and in ACCURE Group For Resection Only and Resection Plus SBRT 2 n=2, 044 in baseline group; n=100 in ACCURE group 100% 80% 3 70% Present race-specific feedback on treatment to care teams 4 96% 90% Use nurse navigators trained to deal with race-related barriers to care Provider Feedback 96% 80% 76% 60% 79% 64% 61% 55% Staff Education Conduct health equity training sessions every three months for health care staff 1) Accountability for Cancer Care Through Undoing Racism and Equity. 2) Stereotactic body radiation therapy. © 2018 The Advisory Board Company • advisory. com 50% Baseline, 2007 -2012 ACCURE, 2013 -2015 Black, Resection Only Black, Resection Plus SBRT White, Resection Only White, Resection Plus SBRT Source: Casey B, “ASTRO: Outreach Boosts Radiation Therapy Rates for Blacks, ” Aunt. Minnie. com, http: //www. auntminnie. com/index. aspx? sec=nws&sub=rad&pag=dis&Item. ID=115211; Oncology Roundtable interviews and analysis.

15 Trend 3 How Did We Get Here? Presidential candidates endorsing Medicare for All,

15 Trend 3 How Did We Get Here? Presidential candidates endorsing Medicare for All, 2016 Presidential candidates supporting Medicare for All, 20201 Presidential candidates supporting public option, 20201 Public support for Medicare for All …if it would do the following 56% Survey respondents who favor a national health plan in which all Americans would get their insurance from a single government health plan 1) Current as of June 26, 2019, according to a New York Times survey of the candidates. © 2018 The Advisory Board Company • advisory. com 71% 67% Guarantee insurance as a right Eliminate premiums and out-of-pocket costs 37% Eliminate private health insurance 37% Require most Americans to pay more in taxes Source: Kirzinger A et al. , “KFF health tracking poll – January 2019: The public on next steps for the ACA and proposals to expand coverage, ” Kaiser Family Foundation, January 23, 2019; “How the Democratic Candidates Responded to a Health Care Policy Survey, ” New York Times, June 23, 2019; Health Care Advisory Board interviews and analysis.

16 Reimbursement and Reform Are at a Turning Point Congress Choosing Between Payment Reform

16 Reimbursement and Reform Are at a Turning Point Congress Choosing Between Payment Reform and Payment Cuts Continue Payment Reforms Shift to Payment Cuts Providers accept alternative payment models and move rapidly away from fee-forservice status quo Providers remain in fee-forservice but face ever-more stringent reimbursement cuts Strategic Imperatives • Business model transformation • Radical cost-efficiency • Integration and system-wide care coordination • Asset and service rationalization • Fixed cost restructuring • Risk-based contracting strategy © 2018 The Advisory Board Company • advisory. com Source: Health Care Advisory Board interviews and analysis.

17 Oncology Care Model Entering Its Fourth Year Overview of the Oncology Care Model

17 Oncology Care Model Entering Its Fourth Year Overview of the Oncology Care Model (OCM) Who is participating? • 176 medical oncology practices • 10 payers • CMS How are practices paid? • Fee-for-service payments for all services to enrolled beneficiaries • Monthly enhanced oncology services What are the requirements for participating providers? • Provide 24/7 access to appropriate clinician with real-time access to medical records (MEOS) payment of $160 for six months upon initiation of chemo • Provide the core functions of – If the patient continues or resumes chemo, • Document a care plan with the practice can trigger subsequent episodes • Performance-based payment provided if practice reduces beneficiaries’ total Medicare billings and meets threshold for quality performance – Quality measured relative to other practices – Cost performance is evaluated against patient navigation 13 components recommended by the IOM • Treat patients on nationally recognized clinical guidelines • Use certified electronic health record technology (CEHRT) • Utilize data for continuous quality improvement historic performance © 2018 The Advisory Board Company • advisory. com Source: CMS, Oncology Care Model, https: //innovation. cms. gov/initiatives/oncology-care/; Oncology Roundtable interviews and analysis.

18 Not The Results We Were Hoping For Too Early To Draw Conclusions, But

18 Not The Results We Were Hoping For Too Early To Draw Conclusions, But Participants Split On Value Performance Period (PP) 1 results OCM participants’ perception of value Against the comparator group, the OCM cohort had… n=51 oncologists participating in OCM = Quality Small reductions in admissions and ICU stays at end of life Increased quality of care 33% Lowered cost of care 37% 27% 31% 8% 24% 12% = Costs Slightly declined total costs of care, not including MEOS payments 27% Key caveats • Delayed roll out of data • Many practices just starting to implement cost-savings initiatives • Methodology concerns, e. g. , attribution, No, not at all Too early to tell Yes, somewhat Yes, significantly tumor-specific risk adjustment, novel therapy adjustment © 2018 The Advisory Board Company • advisory. com Source: Abt Associates, “Evaluation of the Oncology Care Model” Performance Period One, ” December 2018; Genentech, “ 2018 Genentech Oncology Trend Report, ” April 2018, https: //www. genentechforum. com/content/dam/gene/managedcare/forum/pdfs/Oncology. Trends/2018_Genentech_Oncology_Trend_Report. pdf; Oncology Roundtable interviews and analysis.

20 Proposal For Radiation APM Released This Summer Five-year pilot projected to begin either

20 Proposal For Radiation APM Released This Summer Five-year pilot projected to begin either January 1, 2020 or April 1, 2020 Model basics • Will require participation from providers (including physician group practices, hospital outpatient departments, and freestanding centers) within randomly selected Core Based Statistical Areas • Providers treating beneficiaries with one of the 17 included cancer types will receive prospective payments for a 90 -day episode of care • Broken into professional component and technical component payments • Amounts based on proposed base rates, trend factors, and adjustments for participant’s casemix, historical experience, and geographic location • CMS will apply a discount factor of 4% for professional component and 5% for technical components • Participants can earn back withholds based on clinical data reporting, quality measure reporting and performance, and the CAHPS Cancer Care Radiation Therapy Survey • Will qualify as an Advanced APM and MIPS APM Find more information online at https: //innovation. cms. gov/initiatives/radiationoncology-model/ and subscribe to the Oncology Rounds blog to get our latest insights and takeaways from the proposal © 2018 The Advisory Board Company • advisory. com Source: Hubbard A, “RO-APM: What we know, what we don’t and what it all means, ” ASTRO Blog, February 14, 2019, https: //www. astro. org/Blog/February 2019/RO-APM-What-we-know, -what-we-don%E 2%80%99 t-and-what-it-all; Oncology Roundtable interviews and analysis.

21 The Impact on Cancer Programs Transitioning to Risk-Based Payment Cancer Leaders Need to

21 The Impact on Cancer Programs Transitioning to Risk-Based Payment Cancer Leaders Need to Build Nimble Programs and Manage Change Create a nimble organization that can adapt to unexpected and swift regulatory changes Evaluate staffing and operations to gain maximum efficiency Focus on prevention, informed screening, survivorship, and end-of-life care Provide proactive symptom management, navigation, and coordination across sites of care © 2018 The Advisory Board Company • advisory. com Source: Oncology Roundtable interviews and analysis.

22 Play Your Part Hairston Hospital 1 Works with PCPs to Increase HPV Vaccination

22 Play Your Part Hairston Hospital 1 Works with PCPs to Increase HPV Vaccination Leverage Data Use data to identify high incidence of cervical cancer in community Select Approach Decide to focus on increasing HPV vaccine uptake in the community Develop Partnership Partner with PCP specializing in adolescents and HPV vaccination Disseminate Information Distribute educational materials about HPV vaccination at community events Related Resources • Alberta Health Services, HPV Vaccination Decision Tool • Healthwise, HPV: Should I Get the Vaccine? 1) Pseudonym. © 2018 The Advisory Board Company • advisory. com Source: Oncology Roundtable interviews and analysis.

24 Target Navigation to Patients Who Will Benefit Most High-Need Patients at UAB Receive

24 Target Navigation to Patients Who Will Benefit Most High-Need Patients at UAB Receive More Frequent and Intense Support Characteristics of Navigated Patients at UAB High-Risk Patients Contacted at least once a week by navigator • Comorbidities • High distress • Poor prognosis • Lack of support • Specific medications • Advanced or complex disease Medium-Risk Patients Contacted at least once a month by navigator • Accepted navigation • Distress indicated • Active treatment • Socioeconomic need Low-Risk Patients • Refused navigation • No or low distress Contacted at least every • Robust social support • Completed treatment three months by navigator Navigator performs distress screening during outreach to identify and resolve patient issues © 2018 The Advisory Board Company • advisory. com Source: UAB Medicine, Birmingham, AL; Rocque GB, et al. , “The Patient Care Connect Program: Transforming Health Care Through Lay Navigation, ” Journal of Oncology Practice, 12, no. 6 (2016): e 633 -e 642; Oncology Roundtable interviews and analysis.

26 Worth the Investment UAB Demonstrated Significant Decrease in Utilization from Navigation RESOURCE UTILIZATION

26 Worth the Investment UAB Demonstrated Significant Decrease in Utilization from Navigation RESOURCE UTILIZATION 8% 6% Additional decrease in ED visits per quarter for navigated patients 1 11% Additional decrease in hospitalizations per quarter for navigated patients 1 Additional decrease in ICU admissions per quarter for navigated patients 1 COST SAVINGS $781 Additional reduction in total costs of care for each navigated patient 1 per quarter 2 $19 M Approximate total savings for all navigated patients across the network in one year Visit advisory. com/or/navigation for all of our resources 1) Compared to non-navigated patients. 2) Excludes Part D claims. © 2018 The Advisory Board Company • advisory. com Source: UAB Medicine, Birmingham, AL; Rocque GB, et al. , “Resource Use and Medicare Costs During Lay Navigation for Geriatric Patients with Cancer, ” JAMA Oncology, January 26, 2017, https: //www. ncbi. nlm. nih. gov/pubmed/28125760; Oncology Roundtable interviews and analysis.

27 Trend 4 Telehealth Is Breaking Down Cancer Center Walls Expanding Access and Enabling

27 Trend 4 Telehealth Is Breaking Down Cancer Center Walls Expanding Access and Enabling Real-Time Information Sharing Estimated Growth in Virtual Consults Millions of Visits in the US 26, 9 21, 5 16, 6 14, 5 Introducing Doctor Fitbit “Five to ten years down the line, the power of these devices to help consumers, health care providers, the whole health care ecosystem track and give diagnoses to people—I think it's incredibly tantalizing. ” James Park, CEO, Fitbit 5, 4 2, 1 2015 2020 Total Specialty Consults PCP Visits © 2018 The Advisory Board Company • advisory. com 72% Estimated growth in the global market for smart wearables, including activity trackers and smartwatches, between 2016 and 2020 Source: Japsen B, “Doctors’ Virtual Consults with Patients to Double by 2020, ” Forbes, August 9, 2015, http: //www. forbes. com/sites/brucejapsen/2015/08/09/as-telehealth-booms-doctor-video-consults-to-double-by 2020/#2 d 4 da 3675 d 66; Lamkin P, “Wearable Tech Market to Be Worth $34 Billion by 2020, ” Forbes, February 17, 2016, http: //www. forbes. com/sites/paullamkin/2016/02/17/wearable-tech-market-to-be-worth-34 -billion-by-2020/#5 ed 1133 a 3 fe 3; “'Doctor Fitbit': How the Wearables Company Sees Its Future, ” The Daily Briefing, April 20, 2016, https: //www. advisory. com/daily-briefing/2016/04/20/how-the-wearables-company-sees-its-future; Oncology Roundtable research and analysis.

28 The Impact on Cancer Programs The Growing Use of Telehealth Leverage Telehealth to

28 The Impact on Cancer Programs The Growing Use of Telehealth Leverage Telehealth to Enhance Efficiency, Improve Patient Engagement, and Collect Patient Data Build and train a workforce comfortable with and skilled at using technology Invest in technology specialists and support staff Invest in data security and management specialists Provide ongoing patient and provider education © 2018 The Advisory Board Company • advisory. com Source: Oncology Roundtable interviews and analysis.

29 Telemedicine Provides Access to the Community University of Virginia’s Telemedicine Cervical Cancer Screenings

29 Telemedicine Provides Access to the Community University of Virginia’s Telemedicine Cervical Cancer Screenings Factors Driving Clinic Development • High cancer rates in Southwest Virginia due to high tobacco use • Limited access to gynecologic oncologists in rural setting Components of Cervical Cancer Screening Clinic Local nurse practitioner performs colposcopy in community setting UVA gynecologic oncologist directs colposcopy via camera attached to colposcope, instructs NP where to biopsy Logistics Who? When? How? 150 high-risk patients with abnormal Pap test results since 2011 Once a month UVA gynecologic oncologist bills same E/M codes as an in-person visit © 2018 The Advisory Board Company • advisory. com Source: University of Virginia Health System, Charlottesville, VA; Oncology Roundtable interviews and analysis.

31 Think Different Cooper and Polaris Health Partner to Elevate Patient Engagement Breast Cancer

31 Think Different Cooper and Polaris Health Partner to Elevate Patient Engagement Breast Cancer Patient Pilot at MD Anderson Cancer Center at Cooper Inputs Watch Automatically Collects: • Heart rate • Steps • Time standing • Active calories Outputs Apple Watch Care Team Receives: • Dashboard color coded by severity of patient needs • Email alert when patient meets criteria for follow-up • Data over time Patients Report: Patient Receives: • Physical symptoms • Weekly dashboard of data • Distress • Daily summary of physical and behavioral health • Sleep © 2018 The Advisory Board Company • advisory. com Source: MD Anderson Cancer Center at Cooper, Camden, NJ; Polaris Health Directions, Wayne, PA; Oncology Roundtable interviews and analysis.

34 Extending Care Beyond the Office Provide Real-Time Information and Motivation em. POWER App

34 Extending Care Beyond the Office Provide Real-Time Information and Motivation em. POWER App on Apple Watch Displays daily and weekly data, such as: • • Provides daily challenges: • Join a Activity support group Distress • Go for a Pain brisk walk Fatigue After surgery there were days when I wanted to be in bed all day but this app made me get up and move…I wish the trial started six months earlier. . . Breast Cancer Survivor © 2018 The Advisory Board Company • advisory. com ! Considerations for Scaling Pilot • Technology infrastructure and support • Triage protocols for identified patient needs • Funding beyond initial pilot • Impact on cancer center workflow Source: Scipioni J, “How the Apple Watch Helps Cancer Patients in Treatment, ” Fox Business, February 29, 2016, http: //www. foxbusiness. com/features/2016/02/29/how-apple-watch-helps-cancer-patients-in-treatment. html; MD Anderson Cancer Center at Cooper, Camden, NJ; Polaris Health Directions, Wayne, PA; Oncology Roundtable interviews and analysis.

35 Successfully Decreasing Utilization Memorial Sloan Kettering Documents Impact of Remote Monitoring Study Design:

35 Successfully Decreasing Utilization Memorial Sloan Kettering Documents Impact of Remote Monitoring Study Design: Advanced solid tumor patients receiving chemotherapy were randomized to regularly report 12 common symptoms using the web-based Symptom Tracking and Reporting (STAR) platform or to receive usual care consisting of symptom management at the discretion of clinicians STAR Intervention Results Percentage of Cancer Patients Visiting the ED Across One Year Percentage of Cancer Patients Hospitalized Across One Year Percentage of Cancer Patients Alive at One Year 75% 69% 41% 45% 34% Usual Care STAR 17% 8% 9% Decrease Increase © 2018 The Advisory Board Company • advisory. com Source: Basch E, et al. , “Symptom Monitoring with Patient-Reported Outcomes During Routine Cancer Treatment, ” Journal of Clinical Oncology, 34, no. 6 (2016): 557 -565; Oncology Roundtable interviews and analysis.

37 Trend 5 Patients Acting More Like Consumers Disrupting Traditional Referral Patterns Growing Price

37 Trend 5 Patients Acting More Like Consumers Disrupting Traditional Referral Patterns Growing Price Sensitivity Increasing Access to Health Care Information Rising Expectations for Service • Rising health care costs • Access to and use of the Internet now nearly ubiquitous • Patients gaining experience with retail clinics (e. g. , Walgreens, Minute. Clinic) • More organizations publishing health care cost and quality data • Patients expect different type of doctor’s visit • Patients shouldering larger portion of health care costs • Patients developing habit of “shopping” for providers to maximize value of care © 2018 The Advisory Board Company • advisory. com • Growth in online communities and availability of patient reviews • Nature of patient-physician relationship changing; patients become more skeptical and empowered to make decisions about their care Source: Oncology Roundtable interviews and analysis.

38 Cost and Quality Data Can Be Overwhelming Programs Need to Make Sure Information

38 Cost and Quality Data Can Be Overwhelming Programs Need to Make Sure Information Is Empowering, Not Paralyzing Cancer Patients Already Doing Their Research 41% 25% of cancer patients looked at provider reviews or quality performance websites while selecting a provider Actual and Expected Availability of Provider Information CMS expands PCHQR 1 program Toda y Healthgrades includes Cancer CAHPS 3 scores Clinical pathways adherence reported publicly of cancer patients spent over one hour researching specialists; highest among all specialty patient populations surveyed National warehouse of survival data by provider published 2030 1) PPS-Exempt Cancer Hospital Quality Reporting Program. 2) Pennsylvania Health Care Quality Alliance. 3) Consumer Assessment of Healthcare Providers and Systems. © 2018 The Advisory Board Company • advisory. com PHCQA 2 publishes scores for five cancer care metrics online Consumer-facing tools allow patients to compare cancer providers’ cost and quality Source: What Do Consumers Want from Specialty Care? Market Innovation Center, The Advisory Board Company, Washington, DC; 2015 Cancer Patient Experience Survey; Oncology Roundtable interviews and analysis.

39 The Impact on Cancer Programs Increased Consumerism Focus on Providing Education and Effective

39 The Impact on Cancer Programs Increased Consumerism Focus on Providing Education and Effective Communication Train staff and clinicians to teach patients about quality measurement in cancer care Train staff and clinicians to educate patients about the costs of care and provide necessary support Prepare staff to become experts at persuasive communication Invest in the services and expertise that patients in your community value most © 2018 The Advisory Board Company • advisory. com Source: Oncology Roundtable interviews and analysis.

40 Maximizing Chances for Connection Sharp Health. Care Provides Physician Biographies, Photos, and Videos

40 Maximizing Chances for Connection Sharp Health. Care Provides Physician Biographies, Photos, and Videos Varieties of Online Physician Profiles Videos Number of Profile Views Allow patients to see physicians’ style of speaking Photos Help patients put a face to a name Biographies Describe physicians’ hobbies, reasons for becoming a doctor, and philosophy of care 2 x 3 x Times more likely patients are to view profile with video Times more likely patients are to view profile with photo Amount of Physician Information © 2015 The Advisory Board Company • advisory. com • 30624 B Source: Sharp Health. Care, San Diego, CA; Oncology Roundtable interviews and analysis.

42 Promote Full Transparency University of Utah Publishes All Patient Reviews Online John Doe

42 Promote Full Transparency University of Utah Publishes All Patient Reviews Online John Doe 1 Dr. Doe 1) Pseudonym © 2015 The Advisory Board Company • advisory. com • 30624 B Source: University of Utah, Salt Lake City, UT; Physician Practice Roundtable, Building the Service-Driven Medical Group, Washington, DC: Advisory Board, 2014; Oncology Roundtable interviews and analysis.

44 A Thoughtful Approach to Profile Design University of Utah’s Process to Publicize Physician

44 A Thoughtful Approach to Profile Design University of Utah’s Process to Publicize Physician Data Gathered Data • Compiled existing reviews on all major physician rating sites • Compared social media ratings with survey scores to ensure advantage of publishing scores Curated Content Streamlined Design • Identified necessary content for profile to be useful, credible • Created profiles 1 • Edited appearance to be consistent with typical rating sites (e. g. , five-star rating system) • Decided to include: – Ten provider communication metrics, wait times –Both positive and negative comments 99% • Tested webpage usability Managed Reactions • Showed physicians previews of their profiles three months before public launch • Met with physicians to discuss concerns 2 Of patient comments posted in their entirety 3 1) Resources loaned for start-up involved enterprise data warehouse architect, Social Content Office director and analyst, patient experience director and analyst. 2) Allow physicians to flag comments for review by system physician committee on a case-by-case basis. 3) 1 FTE data analyst monitors comments, in addition to other responsibilities; commentsfiltered only for personal attacks, inappropriate (e. g. , racist) remarks. © 2015 The Advisory Board Company • advisory. com • 30624 B Source: University of Utah, Salt Lake City, UT; Physician Practice Roundtable, Building the Service. Driven Medical Group, Washington, DC: Advisory Board, 2014; Oncology Roundtable interviews and analysis.

45 Transparent Data Draws Patient Attention Public Information Also Helps Motivate Clinical Providers Yearly

45 Transparent Data Draws Patient Attention Public Information Also Helps Motivate Clinical Providers Yearly Physician Profile Views Before and After Patient Reviews Posted Online Percentage of Hospital-Employed Physicians Achieving Top Scores Compared to National Cohort 128% increase 50% 1 148 720 25% 503 070 9% 3% Year prior to Year after posting patient reviews © 2015 The Advisory Board Company • advisory. com • 30624 B Top 10% Top 1% Year 0 Year 3 Source: University of Utah, Salt Lake City, UT; Physician Practice Roundtable, Building the Service-Driven Medical Group, Washington, DC: Advisory Board, 2014; Oncology Roundtable interviews and analysis.

46 Determine Patient Priorities Nebraska Medicine’s You. Tube Series Appeals to New Patients Key

46 Determine Patient Priorities Nebraska Medicine’s You. Tube Series Appeals to New Patients Key Steps to Developing Nebraska’s You. Tube Campaign 2. Physician Role-Play Physicians present diagnoses and health information to marketing team as if they were newly diagnosed patients 1. Recruit Physicians Recruit cancer center physicians to conduct mock interviews with marketing team © 2015 The Advisory Board Company • advisory. com • 30624 B 3. Analyze Dialogue Isolate physicians’ most commonly used words and phrases when having a diagnosis conversation 4. Create Videos Craft videos around content and key words used by physicians during diagnosis; tag videos with identified key words Source: Nebraska Medicine, Omaha, NE; Market Innovation Center, Advisory Board; Oncology Roundtable interviews and analysis.

48 Translating You. Tube Hits into ROI Use Comprehensive Analysis to Attract Patients Online

48 Translating You. Tube Hits into ROI Use Comprehensive Analysis to Attract Patients Online Nebraska’s Analytical Approach to Patient Concerns Analyze videos viewed to completion, including where viewers rewind content Use analysis to develop new critical content and inform development of marketing materials Determine key words and topics associated with critical content Results Attributed to Nebraska’s You. Tube Campaign 18% Increase in oncology volumes © 2015 The Advisory Board Company • advisory. com • 30624 B 16% Increase above budget and year-to-year financial performance Source: Nebraska Medicine, Omaha, NE; Market Innovation Center, Advisory Board; Oncology Roundtable interviews and analysis.

49 Trend 6 Precision Medicine Complex and Rapidly Evolving Precision Medicine Liquid Biopsies Checkpoint

49 Trend 6 Precision Medicine Complex and Rapidly Evolving Precision Medicine Liquid Biopsies Checkpoint Inhibitors High-Risk shared decision making CAR-T Cell Therapy © 2018 The Advisory Board Company • advisory. com Molecular Diagnostics FISH Patient-reported Outcomes Patient Engagement Immunotherapy PARP Inhibitors Tissue Banks Oncotype Dx Pharmacogenetics Umbrella Trials Biomarkers circulating tumor cells Genomics Companion Diagnostics Targeted treatment Proteomics Clinical validity DNA CDK-4 Inhibitors Next-Generation Sequencing Source: Oncology Roundtable interviews and analysis.

50 The Impact on Cancer Programs Advances in Personalized Medicine Equip the Care Team

50 The Impact on Cancer Programs Advances in Personalized Medicine Equip the Care Team to Put Personalized Medicine into Practice Include new expertise on the care team (e. g. , molecular scientists, bioethicists, data managers) Provide training and support to help physicians implement and stay up to date on clinical innovations Provide comprehensive education and support to patients Account for increased physician and nurse time needed to manage patients receiving complex therapies Maintain coordination across specialties as clinicians become more subspecialized © 2018 The Advisory Board Company • advisory. com Source: Oncology Roundtable interviews and analysis.

51 Develop a Comprehensive Strategy Precision Medicine Raises Many Thorny Questions Five Imperatives for

51 Develop a Comprehensive Strategy Precision Medicine Raises Many Thorny Questions Five Imperatives for Precision Medicine 1 2 3 4 5 Evaluate the Business Case for Precision Medicine Provide Support for Oncologists Develop Patient. Centered Standards Elevate the Role of Clinical Trials Harness the Power of Data © 2018 The Advisory Board Company • advisory. com Source: Oncology Roundtable interviews and analysis.

52 Right Test, Right Time, Right Treatment Syapse Platform Guides Oncologist at Point of

52 Right Test, Right Time, Right Treatment Syapse Platform Guides Oncologist at Point of Care Henry Ford’s Process for Integrating Precision Medicine into the Physician Workflow Provider identifies appropriate actions: Precision medicine team determines testing and treatment guidelines for system Integrates clinical and molecular information, as well as guidelines, into Syapse platform Providers see guidelines in EHR at point of care Order test Select clinical trial Experts include: • • • Oncologists Order treatment Pathologists Informaticists Research leads Population health experts © 2018 The Advisory Board Company • advisory. com Source: Henry Ford Health System, Detroit, MI; Oncology Roundtable interviews and analysis.

55 Make It Easy for Patients to Participate The Metastatic Breast Cancer Project (MBCP)

55 Make It Easy for Patients to Participate The Metastatic Breast Cancer Project (MBCP) Social Media Outlets Advocacy Groups >1 K patients signed up in first three months of launch • Patient clicks “Count • Patient signs consent to Me In” Button on homepage • Patient completes an online form enable MBCP to obtain medical record and stored tissue sample from treating institution • MBCP sends the patient a kit to collect saliva © 2018 The Advisory Board Company • advisory. com • MBCP sequences tumor and saliva samples • Results are shared with researchers • Patients are kept apprised of advancements and studies Source: Wagle N, et al. , “The Metastatic Breast Cancer Project: A National Direct-to-Patient Initiative to Accelerate Genomics Research, ” Journal of Clinical Oncology, 34 (2016): Suppl Abstr LBA 1519; Oncology Roundtable interviews and analysis.

57 The World Is Starting to Look Very Different Six Trends Shaping Cancer Care

57 The World Is Starting to Look Very Different Six Trends Shaping Cancer Care 1 Cancer is the number one killer in 22 states (and counting) 2 We are on our way to being a majority-minority country 3 Health care reimbursement and reform are at a turning point 4 Telehealth is breaking down cancer center walls 5 Health care “consumers” demand evidence of cost and quality performance 6 Genomic medicine is revolutionizing cancer care © 2018 The Advisory Board Company • advisory. com Source: Oncology Roundtable interviews and analysis.

58 Thank you! Questions? Feel free to reach out: Ashley Riley, MPH rileya@advisory. com

58 Thank you! Questions? Feel free to reach out: Ashley Riley, MPH [email protected] com © 2016 The Advisory Board Company • advisory. com