1. Comprehensive Thoracic Oncology Program: COG Update CTOP Research Retreat David Nalepinski Director, Oncology Service Line & Business Operations May 23, 2014

2. Conflict of Interest I, David Nalepinski, have no conflict of interests related to the material presented within this presentation.

3. Objectives: The “Cancer Oncology Group” Defining the Grey Zone Aligning Priorities CTOP Metrics Next Steps

4. The Patient at the Center… A couple of definitions…. Clinical Microsystem: “a small group of people who work together in a defined setting on a regular basis to provide care and the individuals who receive that care”  Surgery, HemOnc, RadOnc…. Organized by subspecialties, sections and “cost centers” Clinical Mesosystem:  Connect microsystems, Surround microsystems..  Can HELP… or can HINDER microsystems  The Cancer Oncology Group (COG) is a mesosystem made up of microsystems Source: Value by Design: Developing Clinical Microsystems to Achieve Organizational Excellence

5. The Patient at the Center…

6. Screening Referral Oncology F/U Diagnosis Treatment Support Survivorship Treatment Modality Chemotherapy Treatment Modality Surgery Treatment Modality Radiation Radiology Pathology DOS MICROSYSTEM SECTION RESOURCES HEMONC MICROSYSTEM SECTION RESOURCES RADONC MICROSYSTEM SECTION RESOURCES ANCILLARY SERVICES VARIOUS SECTIONS /DEPTS Referring Providers/ Primary Care Tumor Board THINK PROGRESSION/HORIZONTAL/LONGITUDINAL Referring Providers/ Primary Care Nutrition/Rehab/Palliative Research/Clinical Trials Navigation/Care-Management Supportive Services Prevention/Education/Pop Health CTOP MESO-SYSTEM

7. CTOP MESOSYSTEM Surg Microsystem Hem Microsystem RadOnc Microsystem Incentives: Episodes, FFS, wRVU’s, Cost/Unit Organization Vision – Market/Geopolitical System Incentives: ACO, Quality/Cost, Capitation

8. COG (Mesosystem) Successes!! Tumor boards Clinical trials Interdisciplinary clinics Some pathway development Patient focused providers and staff Clear “financial impact” picture Strong Q/S program Concepts on the Cancer Center strategic plan

9. CTOP COG Metrics….

12. Lung Financial Trends….

15. Esophagus Financial Trends….

18. New Lung Cancer Patients

21. New Esophagus Cancer Patients

24. Lung Cancer Referrals (w/ Upper Valley)

25. Lung Cancer Referrals (w/o Upper Valley)

26. Esophagus Cancer Referrals (w/ Upper Valley)

27. Esophagus Cancer Referrals (w/o Upper Valley)

28. Next Steps…

29. Disease based Multidisciplinary membership Medical Director who is willing and able to establish the mission, goals, processes and procedures necessary to optimize the group/program in the areas of patient care, research, and education Accountability to the Meso-System… the COG Oncology Service Line Development

30. Center Director : Norris Cotton Cancer Center Clinical Organization Structure Surgery Chair Medicine Chair Chief(s) Hematology Oncology Vice President Center Deputy Director Chief Radiation Oncology Nursing Director NCCC Steering Committee NCI-CCSG Admin Director Chair Pathology Chair Radiology NCI Cancer Center Support Grant Clinical Research Translational Research Clinical Cancer Committee Surgery Radiation Hematology Pathology Radiology Nursing Care Coordination Pharmacy Care Management Cancer Oncology Group Directors Patient Conferences (Tumor Boards) Head & Neck BMT Spine Thoracic Esophagus/Lung Pediatric Neuro Melanoma Lymphoma Cutaneous Lymphoma GYN GU Kidney/Prostate Bladder/Testis GI Colon/Liver/Pancreas Endocrine Thyroid/Pituitary Breast Comprehensive Interdisciplinary Clinics Clinical Care Team Palliation Care Pathways

31. Clinical Research Patient & Family Centered Care: Elements of Integrated & Coordinated Care Cancer Oncology Group(s) Patient Conference (Tumor Board) Interdisciplinary Clinic Care Pathway Decisions Patient Navigation Clinical Diagnosis Treatment Schedule Coordination “Mini” Patient Care Conference(s) Treatment Modalities Measurement: Quality and Safety Care Management/Supportive Services/Palliation & EOL Survivorship Referral Patient Intake Suspected Diagnosis Measurement: Financial & Volume(s) Education Shared Decision Electronic Medical Record (eDH)