1. Not for redistribution. © 2014 Oncology Management Services, Consultants in Medical Oncology & Hematology Will Value-Based Payment Systems Foster Better Survivorship Care Oncology PCMH John D. Sprandio, MD, FACP Chief Physician, Consultants in Medical Oncology and Hematology (CMOH), PC Chairman, Oncology Management Services, Inc

2. Not for redistribution. © 2014 Oncology Management Services, Consultants in Medical Oncology & Hematology Meeting Survivorship Needs Practice transformation, care delivery models Associated payment reforms Are care models and payment methods re- aligning patient and provider behavior and driving patient-centered care? What’s missing? When is it coming?

3. 1)Quality and Value in healthcare 2)Oncology PCMH model 3)Demonstration of results Non-risk adjusted practice data Preliminary risk-adjusted payer data 4)Benefits to Payers, Patients and Providers 5)Evolution of Oncology Payment Models 6)OMS Update Alternate payment models Scalability of Oncology PCMH model

8. Oncology PCMH Quality & Value Driver Diagram Triple Aim Patient-,Payer-,and Provider-Centered Outcomes Triple Aim Patient-,Payer-,and Provider-Centered Outcomes Primary Driver Care Team Environment Delivery Standards Services Primary Driver Care Team Environment Delivery Standards Services Secondary Drivers Process of Care Standards, Care Integration, E vidence Base National Committee for Quality Assurance PCSP Recognition PCOC standards American College of Surgeons Commission on Cancer Data Collection NCDB Treatment & PC Standards American College of Surgeons Commission on Cancer Data Collection NCDB Treatment & PC Standards NCCN Treatment Guidelines Survivorship Guidelines ASCO QOPI Standards Survivorship Guidelines Institute of Medicine National Quality Forum National Cancer Policy Forum Patient Advocacy Data NCCS, CSC, ACS American College of Physicians PCMH-N Engagement & Orientation Patient Responsibilities Practice Responsibilities Goals, Insurance Issues Engagement & Orientation Patient Responsibilities Practice Responsibilities Goals, Insurance Issues Patient Navigation Multidisciplinary Input Scheduling & Tracking Execution of Care Staging/Guideline Adherence Standardized Processes/Data Care Coordination Communication Execution of Care Staging/Guideline Adherence Standardized Processes/Data Care Coordination Communication Symptom Management On Demand Access/Visits Performance data collection Track success of Palliation Survivorship Care Standardized Care Plans Coordination Agreements Goals of Therapy Documented PS Driven Discussions Shared Decision Making Data Driven Improvement Multi-disciplinary Guideline Concordance Palliation Symptom Management Focus on Performance Status (PS) Avoidable Resource Utilization ER/Hospitalizations Imaging & Lab Patient & Family Experience of Care End of Life Care Hospice Enrollment Place at Time of Death Resource Utilization Survivorship Care Standardized Primary PCMH Total Cost Of Care Medical, Surgical, Lab Radiation, Imaging ©2014 Oncology Management Services, Ltd. Payer Based Episode and “OMH” Programs CMS & Commercial

9. Oncology PCMH Quality & Value Driver Diagram Triple Aim Patient-,Payer-,and Provider-Centered Outcomes Triple Aim Patient-,Payer-,and Provider-Centered Outcomes Primary Driver Care Team Environment Delivery Standards Services Primary Driver Care Team Environment Delivery Standards Services Secondary Drivers Process of Care Standards, Care Integration, E vidence Base National Committee for Quality Assurance PCSP Recognition PCOC standards American College of Surgeons Commission on Cancer Data Collection NCDB Treatment & PC Standards American College of Surgeons Commission on Cancer Data Collection NCDB Treatment & PC Standards NCCN Treatment Guidelines Survivorship Guidelines ASCO QOPI Standards Survivorship Guidelines Institute of Medicine National Quality Forum National Cancer Policy Forum Patient Advocacy Data NCCS, CSC, ACS American College of Physicians PCMH-N Engagement & Orientation Patient Responsibilities Practice Responsibilities Goals, Insurance Issues Engagement & Orientation Patient Responsibilities Practice Responsibilities Goals, Insurance Issues Patient Navigation Multidisciplinary Input Scheduling & Tracking Execution of Care Staging/Guideline Adherence Standardized Processes/Data Care Coordination Communication Execution of Care Staging/Guideline Adherence Standardized Processes/Data Care Coordination Communication Symptom Management On Demand Access/Visits Performance data collection Track success of Palliation Survivorship Care Standardized Care Plans Coordination Agreements Goals of Therapy Documented PS Driven Discussions Shared Decision Making Data Driven Improvement Multi-disciplinary Guideline Concordance Palliation Symptom Management Focus on Performance Status (PS) Avoidable Resource Utilization ER/Hospitalizations Imaging & Lab Patient & Family Experience of Care End of Life Care Hospice Enrollment Place at Time of Death Resource Utilization Survivorship Care Standardized Primary PCMH Total Cost Of Care Medical, Surgical, Lab Radiation, Imaging Payer Based Episode and “OMH” Programs CMS & Commercial ©2014 Oncology Management Services, Ltd.

10. Oncology PCMH Quality & Value Driver Diagram Triple Aim Patient-,Payer-,and Provider-Centered Outcomes Triple Aim Patient-,Payer-,and Provider-Centered Outcomes Primary Driver Care Team Environment Delivery Standards Services Primary Driver Care Team Environment Delivery Standards Services Secondary Drivers Process of Care Standards, Care Integration, E vidence Base National Committee for Quality Assurance PCSP Recognition PCOC standards American College of Surgeons Commission on Cancer Data Collection NCDB Treatment & PC Standards American College of Surgeons Commission on Cancer Data Collection NCDB Treatment & PC Standards NCCN Treatment Guidelines Survivorship Guidelines ASCO QOPI Standards Survivorship Guidelines Institute of Medicine National Quality Forum National Cancer Policy Forum Patient Advocacy Data NCCS, CSC, ACS American College of Physicians PCMH-N Engagement & Orientation Patient Responsibilities Practice Responsibilities Goals, Insurance Issues Engagement & Orientation Patient Responsibilities Practice Responsibilities Goals, Insurance Issues Patient Navigation Multidisciplinary Input Scheduling & Tracking Execution of Care Staging/Guideline Adherence Standardized Processes/Data Care Coordination Communication Execution of Care Staging/Guideline Adherence Standardized Processes/Data Care Coordination Communication Symptom Management On Demand Access/Visits Performance data collection Track success of Palliation Survivorship Care Standardized Care Plans Coordination Agreements Goals of Therapy Documented PS Driven Discussions Shared Decision Making Data Driven Improvement Multi-disciplinary Guideline Concordance Palliation Symptom Management Focus on Performance Status (PS) Avoidable Resource Utilization ER/Hospitalizations Imaging & Lab Patient & Family Experience of Care End of Life Care Hospice Enrollment Place at Time of Death Resource Utilization Survivorship Care Standardized Primary PCMH Total Cost Of Care Medical, Surgical, Lab Radiation, Imaging Payer Based Episode and “OMH” Programs CMS & Commercial ©2014 Oncology Management Services, Ltd.

11. Oncology PCMH Quality & Value Driver Diagram Triple Aim Patient-,Payer-,and Provider-Centered Outcomes Triple Aim Patient-,Payer-,and Provider-Centered Outcomes Primary Driver Care Team Environment Delivery Standards Services Primary Driver Care Team Environment Delivery Standards Services Secondary Drivers Process of Care Standards, Care Integration, E vidence Base National Committee for Quality Assurance PCSP Recognition PCOC standards American College of Surgeons Commission on Cancer Data Collection NCDB Treatment & PC Standards American College of Surgeons Commission on Cancer Data Collection NCDB Treatment & PC Standards NCCN Treatment Guidelines Survivorship Guidelines ASCO QOPI Standards Survivorship Guidelines Institute of Medicine National Quality Forum National Cancer Policy Forum Patient Advocacy Data NCCS, CSC, ACS American College of Physicians PCMH-N Engagement & Orientation Patient Responsibilities Practice Responsibilities Goals, Insurance Issues Engagement & Orientation Patient Responsibilities Practice Responsibilities Goals, Insurance Issues Patient Navigation Multidisciplinary Input Scheduling & Tracking Execution of Care Staging/Guideline Adherence Standardized Processes/Data Care Coordination Communication Execution of Care Staging/Guideline Adherence Standardized Processes/Data Care Coordination Communication Symptom Management On Demand Access/Visits Performance data collection Track success of Palliation Survivorship Care Standardized Care Plans Coordination Agreements Goals of Therapy Documented PS Driven Discussions Shared Decision Making Data Driven Improvement Multi-disciplinary Guideline Concordance Palliation Symptom Management Focus on Performance Status (PS) Avoidable Resource Utilization ER/Hospitalizations Imaging & Lab Patient & Family Experience of Care End of Life Care Hospice Enrollment Place at Time of Death Resource Utilization Survivorship Care Standardized Primary PCMH Total Cost Of Care Medical, Surgical, Lab Radiation, Imaging Payer Based Episode and “OMH” Programs CMS & Commercial ©2014 Oncology Management Services, Ltd.

14. 1)Quality and Value in healthcare 2)Oncology PCMH model 3)Demonstration of results Non-risk adjusted practice data Preliminary risk-adjusted payer data 4)Benefits to Payers, Patients and Providers 5)Evolution of Oncology Payment Models 6)OMS Update Alternate payment models Scalability of Oncology PCMH model

15. Not for redistribution. © 2014 Oncology Management Services, Consultants in Medical Oncology & Hematology

16. Not for redistribution. © 2013 Oncology Management Services, Consultants in Medical Oncology & Hematology USON/Milliman: Approximately 2 emergency room visits per chemotherapy patient per year (14 million commercially insured; 104,473 cancer patients) Source: Milliman analysis of Medstat 2007, Milliman Health Cost Guidelines 2009 © 2014 Oncology Management Services, Consultants in Medical Oncology & Hematology

17. USON/Milliman: Approximately 1 hospital admission per chemotherapy patient per year (n=14 million commercially insured; 104,473 cancer patients) Source: Milliman analysis of Medstat 2007, Milliman Health Cost Guidelines 2009

18. MeasureLine(s) of Business Hospitalizations per chemotherapy treatment (within 60 days) Commercial and Medicare Advantage ER Visits per chemotherapy treatment (within 60 days) Commercial and Medicare Advantage Hospice days in last 60 days of life per chemotherapy patient Medicare Advantage Only Hospitalizations in last 30 days of life per chemotherapy patient Medicare Advantage Only Chemotherapy treatment in last 30 days of life per chemotherapy patient Medicare Advantage Only Payer Risk-Adjusted Oncology PCMH Measures

19. Hospitalizations per chemotherapy treatment (within 60 days)

20. Hospitalizations in last 30 days of life per chemotherapy patient

21. Chemotherapy treatments in last 30 days of life per patient

22. Hospice days in Last 60 days of life (Medicare Advantage only) Initial 7 months of contract 15.25 CMOH 13.84 Plan Benchmark Yes 10% Better than Plan

23. 1)Quality and Value in healthcare 2)Oncology PCMH model 3)Demonstration of results Non-risk adjusted practice data Preliminary risk-adjusted payer data 4)Benefits to Payers, Patients and Providers 5)Evolution of Oncology Payment Models 6)OMS Update Alternate payment models Scalability of Oncology PCMH model

24. 30% of traditional Medicare tied to PCMH, ACO, Budgeted Payments by 2016 – 50% by 2018 90% of traditional Medicare will contain Quality & Value parameters by end of 2018

25. Not for redistribution. © 2015 Oncology Management Services, Consultants in Medical Oncology & Hematology Payment Reform UnitedHealthcare: Lee Newcomer, Episode and Bundled programs PCORI funded Oncology PCMH Project (SEPA) NCQA, OMS, ASCO, RAND, NCCS, IBC COME HOME PROJECT: OMH, CMMI, IOBS Horizon Blue Cross, RCCA: Medical Oncology Bundles Oncology Bundled Payment Consortium - OCM CAP, CMS, CMMI, multiple payers CMS Oncology Payment Reform TEP - OCM MITRE, Brookings, RAND, CMS, CMMI ASCO and COA Payment Reform Initiatives OMS Alternate Payment Methods (Pennsylvania) IBC, Keystone First, Capital Blue Cross

26. Not for redistribution. © 2014 Oncology Management Services, Consultants in Medical Oncology & Hematology CMS Oncology Care Model (OCM) Combined features of CMS Oncology Payment Reform TEP + CAP Bundled Payment Consortium Medical oncology treatment episodes - broadly applied PCMH Practice Transformation Patient Navigators Enhanced Coordination Structured Care Management Plan (IOM) 24/7 access to clinician with records Adherence to nationally recognized treatment guidelines Oncology specific EHR, stage 2 MU by end of year three Data driven quality improvement program

27. Not for redistribution. © 2014 Oncology Management Services, Consultants in Medical Oncology & Hematology CMS Oncology Care Model (OCM) Performance Metrics – reported quarterly Driven by Care Team execution of PCMH processes ER visits/Hospital admissions (episode + 6 months & EOL) CAHPS (oncology version) Comprehensive health assessment, including PS Psychological screening (once/episode) Palliative care (concurrently or via formal consultation) Transition coordination and follow-up testing/OP visits Medication reconciliation Pain management Hospice Utilization Resource Utilization (drugs, radiation therapy, imaging, laboratory) Results of data driven quality improvement efforts

28. Not for redistribution. © 2015 Oncology Management Services, Consultants in Medical Oncology & Hematology Standardization of Oncology PCMH Processes Standardized Engagement & Orientation Patient Navigation Shared Decision-Making Explanation – specific TNM & molecular staging Prediction – natural history, impact on performance status Treatment options – consensus based guidelines Financial counseling – patient OOP expenses Patient Preferences – life goals, family responsibilities, hobbies Plan of Care – discussed and mutually agreed upon Goals of therapy defined, modified – curative or palliative Written or electronic plan shared with patient/stakeholders Execution of Care Care coordination Symptom Management Survivorship Care Goals of therapy

29. Not for redistribution. © 2015 Oncology Management Services, Consultants in Medical Oncology & Hematology Standardization of Oncology PCMH Processes Patient Engagement & Orientation Patient Navigation Shared Decision-Making Execution of Care Care coordination Symptom Management Survivorship Care Treatment team is the survivorship care team “Care Management Plan” transitions to “Survivorship Care Plan” Care plan templates for site and stage (ASCO) Treatment and clinical summary (toxicities and co-morbidities) Genetic history, updating family history Documentation and management of residual symptoms Surveillance, screening, risk reduction, health promotion Community resource utilization Coordination agreements with primary care team (ACP PCMH-N) Responsibility matrix defined – primary, medical, radiation and surgical oncology Goals of therapy

30. 1)Quality and Value in healthcare 2)Oncology PCMH model 3)Demonstration of results Non-risk adjusted practice data Preliminary risk-adjusted payer data 4)Benefits to Payers, Patients and Providers 5)Evolution of Oncology Payment Models 6)OMS Update Alternate payment models Scalability of Oncology PCMH model

31. Not for redistribution. © 2014 Oncology Management Services, Consultants in Medical Oncology & Hematology Oncology Management Services (OMS) Local Contracting NCQA CMS TEP & Bundled Payment Consortium (OCM) PCORI Project Southeastern PA Capital Blue Cross Project (East Central PA) Regional Value Based Oncology IPA IRIS TM App development IRIS: integrates processes, work-flow, data collection, data presentation, response to data, documentation, communication and performance feedback to providers Aggregates, analyzes, re-organizes clinical and performance data in a consumable way that fits the work-flow of cancer care 90% of data collected and presented prior to physician entering the exam room – focus: shared complex decision-making Middleware, FHIR enabled, EMR agnostic app development Scalability of an Oncology PCMH Model

32. Not for redistribution. © 2014 Oncology Management Services, Consultants in Medical Oncology & Hematology Oncology Management Services (OMS) Local Contracting NCQA CMS TEP & Bundled Payment Consortium (OCM) PCORI Project Southeastern PA Capital Blue Cross Project (East Central PA) Regional Value Based Oncology IPA IRIS TM Development Scalability of an Oncology PCMH Model Payment reform and technology Payer and provider collaboration Technology - not just about data – it is a human endeavor Integration of “big data” of obvious importance “Small data” involved in shared decision-making is equally important Technology supporting the patient-physician interaction Is a template for practice transformation Defines care-team roles, efficient work flow, fixes accountability Enhances flow of information in complex care Central to reduction in unnecessary resource utilization

33. Thank you Contact Information John D. Sprandio jsprandio@cmoh.org Visit us at www.opcmh.com to register for OMS’ Healthcare Delivery Seminar

34. Not for redistribution. © 2015 Oncology Management Services, Consultants in Medical Oncology & Hematology Appendix

35. Not for redistribution. © 2015 Oncology Management Services, Consultants in Medical Oncology & Hematology Standardization of Oncology PCMH Processes Consistent approach by the care team Patient Engagement & Orientation Patient Navigation Shared Decision-Making Execution of Care Care coordination Symptom Management Survivorship Care Goals of therapy

36. Not for redistribution. © 2015 Oncology Management Services, Consultants in Medical Oncology & Hematology Standardization of Oncology PCMH Processes Patient Engagement & Orientation Define role of nurse and patient navigators, physicians, etc Modes of enhanced access & coordination defined Financial counseling – details of insurance coverage Patient reporting & practice responsibilities Practice as “Point of First Triage” Symptom and disease management strategies (nurse triage) Patient Portal education Patient Navigation Shared Decision-Making Execution of Care Care coordination Symptom Management Survivorship Care Goals of therapy

37. Not for redistribution. © 2015 Oncology Management Services, Consultants in Medical Oncology & Hematology Standardization of Oncology PCMH Processes Patient Engagement & Orientation Patient Navigation Lay Navigators Scheduling of all imaging, laboratory testing Precertification of necessary imaging Scheduling all external provider appointments Oncologic and non-oncologic Tracking test results and consultation reports to completion Re-scheduling when necessary Interface/scanning of reports Shared Decision-Making Execution of Care Care coordination Symptom Management Survivorship Care Goals of therapy

38. Not for redistribution. © 2015 Oncology Management Services, Consultants in Medical Oncology & Hematology Standardization of Oncology PCMH Processes Standardized Engagement & Orientation Patient Navigation Shared Decision-Making Explanation – specific TNM & molecular staging Prediction – natural history, impact on performance status Treatment options – consensus based guidelines Financial counseling – patient OOP expenses Patient Preferences – life goals, family responsibilities, hobbies Plan of Care – discussed and mutually agreed upon Goals of therapy defined – curative or palliative Written or electronic plan shared with patient/stakeholders Execution of Care Care coordination Symptom Management Survivorship Care Goals of therapy

39. Not for redistribution. © 2015 Oncology Management Services, Consultants in Medical Oncology & Hematology Standardization of Oncology PCMH Processes Patient Engagement & Orientation Patient Navigation Shared Decision-Making Execution of Care Standardized outpatient processes and work flow Patient self assessment questionnaire (PSAQ) Data collection and presentation drives decisions Adherence to multidisciplinary and chemotherapy guidelines Navigation, communication & coordination of all aspects of care Provider team accessibility Performance metrics monitored Care coordination Symptom Management Survivorship Care Goals of therapy

40. Not for redistribution. © 2015 Oncology Management Services, Consultants in Medical Oncology & Hematology Standardization of Oncology PCMH Processes Patient Engagement & Orientation Patient Navigation Shared Decision-Making Execution of Care Care coordination Multidisciplinary input – Primary, Surgery, Radiation, Medical Oncology Timeline of intervention discussed and scheduled Standardized communication among primary care & oncology teams Coordination of care between oncologist, primary and other specialists Coordination of care arrangements define responsibilities (PCMH-N) Transitions of care OP to ER or Admission, admission to OP Symptom Management Survivorship Care Goals of therapy

41. Not for redistribution. © 2015 Oncology Management Services, Consultants in Medical Oncology & Hematology Standardization of Oncology PCMH Processes Patient Engagement & Orientation Patient Navigation Shared Decision-Making Execution of Care Care coordination Symptom management – during and between OP visits Standardized symptom data collection, grading & documentation Auto-populated fields in documentation driving physician response Longitudinal view of success of symptom management Documentation of specific recommendations shared with patient Telephone triage 24/7 - standardized algorithms Documentation of type and disposition of every call Survivorship Care Goals of therapy

42. Not for redistribution. © 2015 Oncology Management Services, Consultants in Medical Oncology & Hematology Standardization of Oncology PCMH Processes Patient Engagement & Orientation Patient Navigation Shared Decision-Making Execution of Care Care coordination Symptom Management Survivorship Care Treatment team is the survivorship care team “Care Management Plan” transitions to “Survivorship Care Plan” Care plan templates for site and stage (ASCO) Treatment and clinical summary (toxicities and co-morbidities) Genetic history, updating family history Documentation and management of residual symptoms Surveillance activity and screening Community resource utilization Coordination agreements with primary care team (ACP PCMH-N) Responsibility matrix defined – primary, medical, radiation and surgical oncology Goals of therapy

43. Not for redistribution. © 2015 Oncology Management Services, Consultants in Medical Oncology & Hematology Standardization of Oncology PCMH Processes Standardized Engagement & Orientation Patient Navigation Shared Decision-Making Execution of Care Care coordination Symptom Management Survivorship Care Goals of therapy Performance Status driven decision making in non-curative setting Standardized PS measurement Documentation of ongoing goals dialogue based on PS changes Goals of therapy updated via replay of: Explanation, Prediction, Options, Patient Preference, Plan of Care Hospice utilization monitored

49. 1)Quality and Value in healthcare 2)Oncology PCMH model 3)Demonstration of results Non-risk adjusted practice data Preliminary risk-adjusted payer data 4)Benefits to Payers, Patients and Providers 5)Evolution of Oncology Payment Models 6)OMS Update Alternate payment models Scalability of Oncology PCMH model

51. 1)Quality and Value in healthcare 2)Oncology PCMH model 3)Demonstration of results Non-risk adjusted practice data Preliminary risk-adjusted payer data 4)Benefits to Payers, Patients and Providers 5)Evolution of Oncology Payment Models 6)OMS Update Alternate payment models Scalability of Oncology PCMH model

52. Projected % Reduction in Total Cancer Care Cost 1-3 Chemotherapy pathways program 4-6.3 Inpatient hospitalizations (5-25% reduction) 0.6-1.1 ER evaluations (20-40%) 0.1-.4 Diagnostics 0.9-1.9 End-of-life care coordination Total 6.6 – 12.7 % reduction Annual cancer “spend” $125B = $8-16B savings Adapted from international consultants assessment of OPCMH ® cancer care model

54. 1)Quality and Value in healthcare 2)Oncology PCMH model 3)Demonstration of results Non-risk adjusted practice data Preliminary risk-adjusted payer data 4)Benefits to Payers, Patients and Providers 5)Evolution of Oncology Payment Models 6)OMS Update Alternate payment models Scalability of Oncology PCMH model

55. Not for redistribution. © 2014 Oncology Management Services, Consultants in Medical Oncology & Hematology Oncology Management Services (OMS) Local Contracting NCQA CMS TEP & Bundled Payment Consortium (OCM) PCORI Project Southeastern PA Capital Blue Cross Project (East Central PA) Regional Value Based Oncology IPA IRIS TM App development IRIS: integrates processes, work-flow, data collection, data presentation, response to data, documentation, communication and performance feedback to providers Aggregates, analyzes, re-organizes clinical and performance data in a consumable way that fits the work-flow of cancer care 90% of data collected and presented prior to physician entering the exam room – focus: shared complex decision-making Middleware, FHIR enabled, EMR agnostic app development Scalability of an Oncology PCMH Model

56. Not for redistribution. © 2014 Oncology Management Services, Consultants in Medical Oncology & Hematology Oncology Management Services (OMS) Local Contracting NCQA CMS TEP & Bundled Payment Consortium (OCM) PCORI Project Southeastern PA Capital Blue Cross Project (East Central PA) Regional Value Based Oncology IPA IRIS TM Development Scalability of an Oncology PCMH Model Payment reform and technology Payer and provider collaboration Technology - not just about data – it is a human endeavor Integration of “big data” of obvious importance “Small data” involved in shared decision-making is equally important Technology supporting the patient-physician interaction Is a template for practice transformation Defines care-team roles, efficient work flow, fixes accountability Enhances flow of information in complex care Central to reduction in unnecessary resource utilization

57. Not for redistribution. © 2014 Oncology Management Services, Consultants in Medical Oncology & Hematology Oncology Management Services (OMS) Oncology PCMH program transformation services Local Contracting NCQA Collaboration CMS TEP & Bundled Payment Consortium (OCM) PCORI Project Southeastern PA Capitol Blue Cross Project Regional Value-Based Oncology IPA IRIS Development Scalability of an Oncology PCMH Model

58. Not for redistribution. © 2014 Oncology Management Services, Consultants in Medical Oncology & Hematology Oncology Management Services (OMS) Local Contracting Two active Alternative Payment Arrangements (CMOH) (1) 4.5 years duration Enhanced E&M, infusion service payments relative to all patients (2) 15 months duration Shared savings relative to all actively treated patients – ER visits, Admissions, and EOL related ER, admissions, hospice utilization Both contracts benchmarked against the market (3) Failed contractual experiment (5% of 12% of CMOH patients) NCQA Collaboration CMS TEP & Bundled Payment Consortium (OCM) PCORI Project Southeastern PA Capital Blue Cross Project (East Central PA) Regional Value-Based Oncology IPA IRIS TM Development Scalability of an Oncology PCMH Model

59. Not for redistribution. © 2014 Oncology Management Services, Consultants in Medical Oncology & Hematology Oncology Management Services (OMS) Local Contracting NCQA Collaboration Patient Centered Specialty Practice (PCSP) standards Extraction of Primary Care elements and features Prioritization of standards, features and elements for specialty care Draft development of Patient Centered Oncology Care (PCOC) Standards – refined in PCORI project in SEPA CMS TEP & Bundled Payment Consortium (OCM) PCORI Project Southeastern PA Capital Blue Cross Project (East Central PA) Regional Value-Based Oncology IPA IRIS TM Development Scalability of an Oncology PCMH Model

60. Not for redistribution. © 2014 Oncology Management Services, Consultants in Medical Oncology & Hematology Oncology Management Services (OMS) Local Contracting NCQA Collaboration CMS TEP & Bundled Payment Consortium (OCM) CMS technical expert panel contribution PCMH capabilities central to practice eligibility requirements CMS Oncology Care Model 2016 CAP Oncology Bundled Payment Consortium Episode based payment model around Medical Oncology Services Consortium influenced OCM model UHC MD Anderson Head & Neck Program (true bundle) PCORI Project Southeastern PA Capital Blue Cross Project (East Central PA) Regional Value-Based Oncology IPA IRIS TM Development Scalability of an Oncology PCMH Model

61. Not for redistribution. © 2014 Oncology Management Services, Consultants in Medical Oncology & Hematology Oncology Management Services (OMS) Local Contracting NCQA CMS TEP & Bundled Payment Consortium (OCM) PCORI Project, Southeastern PA NCQA led, PCORI funded oncology PCMH project NCQA, ASCO, OMS, RAND, IBC, Aetna, NCCS Five practices ranging from 4 to 44 physicians, 4 different EMRs PCOC standard under development (PCSP backbone) Reporting: Transformation, utilization and patient satisfaction Provider incentive: participation in Alternate Payment Arrangements Capital Blue Cross Project (East Central PA) Regional Value-Based Oncology IPA IRIS TM Development Scalability of an Oncology PCMH Model

62. Not for redistribution. © 2014 Oncology Management Services, Consultants in Medical Oncology & Hematology Oncology Management Services (OMS) Local Contracting NCQA CMS TEP & Bundled Payment Consortium (OCM) PCORI Project Southeastern PA Capital Blue Cross Project (East Central PA) Payer sponsored transformation support Payment reform aligned with CMS OCM Enhancement of E&M for all patients based on OMS confirmed practice PCMH capabilities and milestones Shared savings arrangement included Benchmark – the CBC network Five community based practices beginning 6/30/15 Regional Value-Based Oncology IPA IRIS TM Development Scalability of an Oncology PCMH Model

63. Not for redistribution. © 2014 Oncology Management Services, Consultants in Medical Oncology & Hematology Oncology Management Services (OMS) Local Contracting NCQA CMS TEP & Bundled Payment Consortium (OCM) PCORI Project Southeastern PA Capital Blue Cross Project (East Central PA) Regional Value-Based Oncology IPA Emergence of a large independent Primary Care Network Seeking Value-Based specialty providers Active discussions with referral base, providers and payers IRIS TM Development Scalability of an Oncology PCMH Model

64. Not for redistribution. © 2014 Oncology Management Services, Consultants in Medical Oncology & Hematology Oncology Management Services (OMS) Local Contracting NCQA CMS TEP & Bundled Payment Consortium (OCM) PCORI Project Southeastern PA Capital Blue Cross Project (East Central PA) Regional Value Based Oncology IPA IRIS TM App development IRIS: integrates processes, work-flow, data collection, data presentation, response to data, documentation, communication and performance feedback to providers Aggregates, analyzes, re-organizes clinical and performance data in a consumable way that fits the work-flow of cancer care 90% of data collected and presented prior to physician entering the exam room – focus: shared complex decision-making Middleware, FHIR enabled, EMR agnostic app development Scalability of an Oncology PCMH Model

65. Not for redistribution. © 2014 Oncology Management Services, Consultants in Medical Oncology & Hematology Oncology Management Services (OMS) Local Contracting NCQA CMS TEP & Bundled Payment Consortium (OCM) PCORI Project Southeastern PA Capital Blue Cross Project (East Central PA) Regional Value Based Oncology IPA IRIS TM Development Scalability of an Oncology PCMH Model Payment reform and technology Payer and provider collaboration Technology - not just about data – it is a human endeavor Integration of “big data” of obvious importance “Small data” involved in shared decision-making is equally important Technology supporting the patient-physician interaction Is a template for practice transformation Defines care-team roles, efficient work flow, fixes accountability Enhances flow of information in complex care Central to reduction in unnecessary resource utilization