1. St. Joseph Hospital Cancer Center & Cancer Institute NCCCP Pilot Project

2. SJO Service Area Characteristics Dense urban population Ethic diversity –53.7 % Latino –17.3 % Asian –25.9 % White ~ 25% Undocumented migrants 53% Managed care > 30 Hospitals in region –7 within 3 mi of SJO

3. Cancer in Orange County 14,000 New Cases per Year 2,300 Breast 2,300 Prostate 1,700 Lung 1,400 Colorectal 1,200 Leukemia, Lymphoma and Myeloma 600 Melanoma

4. St. Joseph Hospital Cancer Center & Cancer Institute Pilot Project Interest

5. Aligned Goals & Initiatives Site-specific multidisciplinary care Patient navigation Cancer physician credentialing EMR Research expansion Cancer genetics expansion including biospecimens Improved support for disadvantaged patients

6. Increase National Collaboration NCI – Expand linkages with NCI Comprehensive Cancer Centers – Align SJO IT initiative with CaBIG development – Contribute and influence future of cancer care Other Pilot programs – Identify new approaches and best practices – Collaboration with programs of similar vision

7. Enhance Patient & Program Support Access to care & financial support guidance Navigation for disadvantaged patients Research expansion Cancer Genetics/Biospecimen expansion IT Integration of Survivorship plans

8. Challenges & Opportunities

9. Fragmented Care - Challenges Fragmented Care - Challenges  Private practice MDs (Local)  Multiple care locations (Local)  Managed care (Regional)  Access to care (Local, Regional, State)  Isolated data and patient information (Local)  Disparate IT systems or none (Local)

10. Fragmented Care - Opportunities  New cancer center (Local)  Site-specific multidisciplinary teams (Local)  Navigators (Local)  Cancer specialist credentialing (Local)  NCCN Guidelines (National)  Benchmarked outcomes (National)  IT connectivity (Local and National)  Research (Local, National)

12. Healthcare Disparities - Challenges  Cultural and language barriers  Undocumented patients  Financial limitations to access to care  ER frequent source for primary care  Financial assistance coordination  Lack of comprehensive approach to care  Lack of consistent approach to care

13. Healthcare Disparities - Opportunities  Mission Integration (Local)  Strong financial assistance program (Local)  Staff Recruitment/interpreter services (Local)  Community partnerships & outreach (Local, Regional & National)  Nurse practitioner for underserved (NCCCP)  Financial Assistance Counselor (NCCCP)

14. Expansion of Research & Biospecimen Repository - Challenges  MD awareness of available trials  Limited time/resources for private practice MDs  Not second nature for private practice MDs  Participant identification fragmented  Limited staff and resources – Hospital  Limited trials meeting patient needs and MD interest  Access to data for research capture and integration

15. Expansion of Research & Biospecimen Repository - Opportunities  Linkages with NCI Centers  Common EMR for participant ID and data capture  Hospital research team efforts  Navigator extension of research staff efforts  Philanthropic and external funding support  Hospital operations support for cancer research  Diverse patient populations for biospecimen sources

16. Community and Physician Experience

17. Strong Organizational Values and Commitment to Care for Community Mission Integration Strong financial assistance program Philanthropy to assist unmet care needs Organizational support for non-reimbursed services (dietician, counseling, RN navigators) Cancer center design and services – Resource Center – Supportive care – Common infusion center design

18. Physician- Led Multidisciplinary Teams Oncology Steering Committee (Leadership) Site-specific & program multidisciplinary teams – Case conferences – Business plans – Research – Website Oncology Council (Guidelines) Cancer Research (Oversight)

19. Cancer Center - Integration of Community, Patients, Physicians and Hospital Comprehensive services in single location Patient participation in design and philanthropy Community shared conference center Dedicated Multidisciplinary Center for integration of clinical expertise and support Infusion timeshare to reduce overhead and invite increased program collaboration Oncology EMR – individualized care/survivorship plans – MD connectivity