System Director, Oncology Service Line Oncology Service Line LAPS-U10 Implementation “A Business Case for Improved UCHealth Integration” W. Thomas Purcell, MD, MBA System Director, Oncology Service Line tom.purcell@ucdenver.edu

Background NIH/NCI funding for cancer cooperative group trials dramatically changed with introduction of “NCTN” --- National Clinical Trials Network CU Cancer Center has been leader in SWOG for years in old system (affiliates and numerous silos) Expectation that we would be leaders in the new “NCTN” as Lead Academic Participating Site “LAPS” participant with UCH, PVHS and MHS as essential clinical components LAPS U10 Grant submitted in 2012; announced in October 2013--- ~$675k/yr x 5yrs

Geographic Importance to the State and Region National Cancer Institute Comprehensive Cancer Center UCCC Cancer Center Comprehensive Cancer Center 2800 new analytical cases / yr 4500 new patients / yr Patient Referral Density (UCH)

Untapped opportunity for a distinctive cancer program

Competitor Weaknesses – items for UC Health differentiation Overall care coordination difficult– multiple EMRs Not ideally suited for multidisciplinary care Survival rates not published or available Minimal subspecialty emphasis – most med/rad oncologists are generalists Positioning for personalized medicine- research for biomarker or molecular targets leading to clinical trial enrollment

Putting “the Patient First” Oncology Service Line Vision… Establish UC Health as the nation’s preeminent integrated delivery system for Oncology Services, as evidenced by the highest 5 year survival rates and best patient experience. Putting “the Patient First” in Decision Making To achieve this, the service line must have complete transparency common quality/safety metrics consistent clinical pathways and adherence outstanding access for patients and physicians recognized research leader across the world

System Director Oncology Region CEO/CMO/COO/CFO UCHealth Oncology Service Line – Org Chart CMO/ Interim CEO System Director Oncology Region CEO/CMO/COO/CFO South Oncology Services Central Oncology Services North Oncology Services Rob Hoyer Sloan Mayes Tom Purcell Jamie Bachman Matt Sorensen JoAnn Lovins Rob Marschke

Operations Joint Operating Committee (JOC) Clinical Integration JOC Oncology Service Line structure… To achieve the vision the Service Line will organize by groups that report to a Steering Committee Administrative Service Line Leader Physician Service Line Leader MD - Medical Oncology MD - Radiation Oncology Region CEO(s) Oncology Service Line Steering Group Operations Joint Operating Committee (JOC) Clinical Integration JOC Research JOC Maes Bachman Lovins Kellackey Strategic Planning for each location (local and system approaches) North, Central, South Litchtenberger

Research JOC Positioning for LAPS grant implementation March 2014 for cooperative group studies LAPS is foundation for future “Cancer Research Network” for entire UC Health Disease program leaders vital for clinical trial prioritization

Disease Program Leaders are the cornerstone for system-wide approach North, Central and South program leaders for each specific disease collaborate on: clinical operations research protocol prioritization quality improvement EPIC/beacon treatment plans merge / standardization North Program Leader Central Program Leaders South Program Leader

Issues…at least some of them! No UC Health infrastructure for clinical research---- hence RAMP Committee Integration between School of Medicine and Cancer Center with UC Health Regulatory cIRB versus local Funding…. LAPS “cost” ~ $1.3 million per year

Differentiating Research Committees and Charges Establish system-wide policies for health system Determine processes within health system across service lines RAMP Research Administration Management & Planning Steering Committee Forum for Researchers to bring forward issues Sounding Board for getting feedback on proposed new processes including the Office of Clinical Research (OCR) initiative on Anschutz Campus RAF Research Advisory Forum Streamline processes within service line Increase research activity across system Improve alignment of clinical delivery and research Service Line JOCs Model: Oncology Research Joint Operating Committee

RAMP---LAPS connection! 4 RAMP Primary Subcommittees: Compliance; Business & Finance; IT and Operations (all but IT have formed workgroups). Established a model for the organization of regional infrastructure Determined responsibilities residing at the regional level vs system level and established framework for workflow Aligned Oncology Research Pharmacy practices in UC Health Have roadmaps for alignment of operations across pharmacy and lab services. Working on pathology and radiology services

Outstanding priorities to support LAPS IT Subcommittee / updates to EPIC Pricing Methodology and standards Alignment of policies North/South draft policy on IRB of Record with UCD – create agreements as needed Alignment of North/South Consent/HIPAA standard language with UCD Agreement on standard CIRB language that will be used across all regions

Cancer Tsunami is Coming!

Thank You