VISION 2020: Oncology Value-Based Strategic Planning ACE Annual Meeting January 28, 2016 ™
VISION 2020:
Oncology Value-Based Strategic Planning
ACE Annual Meeting
January 28, 2016
™
Oncology Solutions Overview
Emerging Strategic Planning Process
Value-Based Planning Framework
From Idea to Execution
Q&A / Discussion
03
About Oncology Solutions
With over 40 years of practical
experience as a cancer-exclusive firm,
Oncology Solutions has an unparalleled
perspective of the intricacies associated
with this evolving service line and the
shift toward value-based care.
Our approach to value-based care
design begins with the physicians and
extends to the care teams and
processes that surround the patient
throughout their journey. Through a
focus on high-tech, high touch care, we
lay the foundation for an intensely
human experience that improves
efficiency and outcomes.
By 2020, the world of cancer care will
experience a fundamental transition with
the adoption of a value-based framework.
This means providers will be reimbursed based on cost and
quality—not volume—and patients will choose to entrust their
care to those with a proven record of success.
Oncology Solutions works hand-in-hand with healthcare
professionals, including executives and physicians, to uncover
strategic opportunities for value-based care and to collaboratively
implement these changes.
We enhance individual cancer programs in order to create the
best patient experience and outcomes while enhancing
healthcare organizations’ financial performance.
Value-Based Strategic Planning
Value-Based
Care DesignPhysician Engagement
& Alignment
04
Oncology Solutions ACE Team
Alex Glonek
Senior Consultant
404.836.2000
Kelley D. Simpson
Senior Partner
404.836.2000
Alina Maleski Smith
Senior Analyst
404.836.2000
• 25 years oncology-specific experience with ideation to execution
• 300+ oncology service line planning implementation projects
• Expertise with strategic planning, physician integration, analytics, operational and implementation initiatives
• Blends business expertise with technical savvy
• Proficiency with organizing, interpreting and analyzing data to
uncover meaningful patterns and improve competitiveness
• Entrepreneurial spirt leading Oncology Solutions digital platform initiatives
• Extensive background in process improvement and data analytics
• Environmental assessment, cancer program assessment
techniques with strategy
• Recipient of 2012 Impact Award for development of analytic tools,
lending expertise and operational focus to client projects
Oncology Solutions Overview
Emerging Strategic Planning Process
Value-Based Planning Framework
From Ideation to Execution
Q&A / Discussion
06
Legacy Process for Strategic Planning
• Traditional model follows a path of self-evaluation,
visioning, determination of resource requirements and
then implementation
• Well-suited for a static environment
• Absent any significant macro level changes most
programs are good at assessing and mitigating program
gaps
• However…the model breaks down when national,
regional and local healthcare landscape begins to shift
• Faced with new complexities, what future are we
planning for and how does it affect the physicians,
technologies and services needed to succeed in
cancer?
Figure I: Traditional Process for Cancer Planning
An honest assessment of the
organization’s capabilities and the
market’s perception of our program.
WHO WE ARE
PHASE I
The vision of the leadership and
physicians about what our cancer
program will be in the future.
WHO WE WANT TO BE
PHASE II
The people, programs, technology that
we need to achieve the vision and
equip ourselves for success.
WHAT WE NEED
PHASE III
An implementation plan and change
management strategy to execute the
vision.
PLAN OF ACTION
PHASE IVPHASE I
WHO WE ARE
An honest assessment of the organization’s capabilities and the
market’s perception of our program.
PHASE II
Figure I: Traditional Process for Cancer Planning
An honest assessment of the
organization’s capabilities and the
market’s perception of our program.
WHO WE ARE
PHASE I
The vision of the leadership and
physicians about what our cancer
program will be in the future.
WHO WE WANT TO BE
PHASE II
The people, programs, technology that
we need to achieve the vision and
equip ourselves for success.
WHAT WE NEED
PHASE III
An implementation plan and change
management strategy to execute the
vision.
PLAN OF ACTION
PHASE IV
WHO WE WANT TO BE
The vision of the leadership and physicians about what our
cancer program will be in the future.
PHASE III
WHAT WE NEED
The people, programs and technology that we need to achieve
the vision and equip ourselves for success.
Figure I: Traditional Process for Cancer Planning
An honest assessment of the
organization’s capabilities and the
market’s perception of our program.
WHO WE ARE
PHASE I
The vision of the leadership and
physicians about what our cancer
program will be in the future.
WHO WE WANT TO BE
PHASE II
The people, programs, technology that
we need to achieve the vision and
equip ourselves for success.
WHAT WE NEED
PHASE III
An implementation plan and change
management strategy to execute the
vision.
PLAN OF ACTION
PHASE IV
PHASE IV
PLAN OF ACTION
An implementation plan and chance management strategy to
execute the vision.
Figure I: Traditional Process for Cancer Planning
An honest assessment of the
organization’s capabilities and the
market’s perception of our program.
WHO WE ARE
PHASE I
The vision of the leadership and
physicians about what our cancer
program will be in the future.
WHO WE WANT TO BE
PHASE II
The people, programs, technology that
we need to achieve the vision and
equip ourselves for success.
WHAT WE NEED
PHASE III
An implementation plan and change
management strategy to execute the
vision.
PLAN OF ACTION
PHASE IV
07
Emerging Process for Cancer Planning
• Phase 1: How does the expectation for value-based care change the way we assess our current capabilities and organizational readiness?
• Phase 3: What does cancer look like in a value-oriented ecosystem, and how quickly will we transition?
• Phase 2: What vision do we align under as payers, patients and regulatory agencies change the way we have always done business?
• Phase 4: How do we prepare for a new reality, and what tools, processes, partners, and leadership do we need to get from here to there?
• Phase 5: What does a value-based strategy require of us financially and operationally as we attempt to prioritize, sequence, and
implement transformative changes in our cancer program?
PHASE I
WHO WE ARE
An honest assessment of
the organization’s
capabilities and the market’s
perception of our program.
PHASE II
WHO WE WANT TO BE
The vision of the leadership
and physicians about what
our cancer program will be
in the future.
PHASE III
WHAT THE FUTURE HOLDS
How are the rules of the game
going to change as cancer care
moves to a value-based clinical
and financial paradigm?
PHASE IV
WHAT WE NEED
The people, programs and
technology that we need to
achieve the vision and equip
ourselves for success.
PHASE IV
PLAN OF ACTION
An implementation
plan and change
management strategy to
execute the vision.
Oncology Solutions Overview
Emerging Strategic Planning Process
Value-Based Planning Framework
From Ideation to Execution
Q&A / Discussion
09
What the Future Holds
• Cancer program administrators feel paralysis about preparing for the value-based future of cancer care
• Many feel their position is the equivalent of “fortune-telling”, leading to the reimagining and redesign of their
programs
• We strongly believe delaying value-based readiness is a mistake for long-term success
• No single expert has all the answers but there is unanimity on the forces that will change cancer care in coming
years
Fundamental
Change in the
Way Providers are Paid
01
Migration to
Ambulatory Care
02 03
Integrated
Delivery Networks
A New
Mindset of
Consumerism by Patients
04
Employers as
Discerning
Customers of Cost and Quality
05
10
Urgency Abounds
• Human capital intensive with skilled resources driving patient care management
2019Radiation Oncology Alternate Payment
Model Launch
< 2015 and BeyondVaried Commercial
Payer Pilots & APMs
2016CMS Oncology
Care Model Launch
2016-2018CMS FFS to Value
30% 2016; HHS 85%50% 2018; HHS 90%
ONCOLOGY VALUE-BASED PROPOSITION
• Highly IT infrastructure dependent with essential integration and reporting elements
• Reliant upon real-time analytics leading to expeditious outcomes reporting
• Real-time analytics leading to outcomes reporting expeditiously
• Requires new business and contracting models with various constituents
• Direct to consumer and shared decision making initiatives and tools
11
What is Value-Based Strategic Planning?
A ROADMAP TO VALUE-BASED CARE
Environmental ReviewThis situational assessment evaluates the unique market, cultural and
programmatic elements that define the current state of your cancer program.
The PlanPreparing for 2020 requires a precise, broadly endorsed and actionable plan for
value-based readiness. The future will reward organizations who are data-driven,
highly collaborative and executing from a forward-thinking playbook.
Business Case DevelopmentValue-based cancer care will require an unprecedented financial commitment to
patient experience, access and care personalization. Managing this investment in a
risk-based ecosystem requires a tailored financial approach to modeling and
capturing value-creation.
Value-Based Care DesignA strategic plan and business case are empty vessels without a sound
implementation approach. Preparing for 2020 will require a disciplined and
thoughtful execution of strategy, and a complete value-based overhaul of the
cancer care delivery model.02
Every cancer care program is unique and
influenced by an organization’s culture and
environment, necessitating candid dialogue
to arrive at actionable strategies that take
into account not just financial and
operational requirements, but all of the
nuances that drive patient-centered care.
Value-based strategy development should
be based on an in-depth process that
involves environmental review, a broadly
endorsed plan, business case justification
and care design—a holistic perspective of
the organization, resources, population andnetwork in which care is provided.
12
Cancer 2020: Environmental Review
68%
32%
Market evaluation provides an in-depth summary
of the current state of cancer services in your
catchment area.
MARKET STUDY
Our proprietary analytics size the market for
cancer patients, projecting incidence and
utilization through 2020.
POPULATION & CANCER ANALYTICS
The situational assessment relies on competitive
intelligence to inform the go-forward strategy for
program building.
COMPETITIVE LANDSCAPE
Provider engagement and alignment is critical to a successful
planning engagement, and a sustainable program. All key
stakeholders help to inform the program assessment.
PROVIDER ALIGNMENT & PERCEPTIONS
The managed care environment will heavily influence the
speed at which value-based care progresses. The
environmental review assesses the maturity of this climate.
PAYER MARKET MATURITY
A full-scale value-based gap analysis is performed to
determine the organizational, resource, network, and
population considerations for value.
VALUE-BASED READINESS
Environmental
Review
Value-Based
Strategic Planning
Business Case
DevelopmentValue-Based
Care Design
13
Cancer 2020: Value-Based Strategic Planning
O R
P N
Organization Resources
Population Network
Stakeholders Delivery
Inte
rnal F
acto
rsE
xte
rna
l F
acto
rs
• What collective vision are we working
towards?
• What leadership & governance structure
is necessary to lead in value?
• How are physicians engaged in the value-
based goals of the enterprise?
ORGANIZATION
• What systems allow for visibility into cost
and quality of care?
• How has care been standardized and
navigated to improve value?
• What capital and program investment is
required to succeed in the value-based
model?
RESOURCES
• Who is the customer in 2020? (i.e.,
patients, employers, payers)
• What unique value proposition resonates
with the customer?
• How do we assess and manage cancer
population risk?
• What specific positioning do we adopt
relative to competitors?
POPULATION
• What is the optimal level of integration in
the delivery model?
• How do we collaborate with payers to
succeed in the market?
• Which partner institutions will lend us scale
and care competency?
• How are we managing specialty care with
our partners?
NETWORK
Environmental
Review
Value-Based
Strategic Planning
Business Case
DevelopmentValue-Based
Care Design
14
Cancer 2020: Value-Based Strategic Planning
O R
P N
Organization Resources
Population Network
Stakeholders Delivery
Inte
rnal
Fac
tors
Ex
tern
al F
acto
rs
Do we have a culture of value?ORGANIZATION
• Who is the customer in 2020? (i.e.,
patients, employers, payers)
• What unique value proposition resonates
with the customer?
• How do we assess and manage cancer
population risk?
• What specific positioning do we adopt
relative to competitors?
POPULATION
BASIC TRANSITIONAL MATURE
Leadership
Program Governance
Institutional Commitment
Physician Alignment
Compensation Model
Medical Staff Profile
Collaborative Culture
Value-Based Readiness
Stakeholders Delivery
Inte
rnal F
acto
rsE
xte
rna
l F
acto
rs
15
Cancer 2020: Value-Based Strategic Planning
Are we equipped for the change?RESOURCES
• Who is the customer in 2020? (i.e.,
patients, employers, payers)
• What unique value proposition resonates
with the customer?
• How do we assess and manage cancer
population risk?
• What specific positioning do we adopt
relative to competitors?
POPULATION
Value-Based Readiness
O R
P N
Organization Resources
Population Network
Stakeholders Delivery
Inte
rnal
Facto
rs
Exte
rna
l
Facto
rs
BASIC TRANSITIONAL MATURE
Care Standardization
Process Optimization
Personalized Medicine
Multi-D/ Navigated Care
Disease-Focal Points
Information Technology
Facilities & Equipment
Stakeholders Delivery
Inte
rnal F
acto
rsE
xte
rna
l F
acto
rs
16
Cancer 2020: Value-Based Strategic Planning
Who are/will be our partners?NETWORK
• Who is the customer in 2020? (i.e.,
patients, employers, payers)
• What unique value proposition resonates
with the customer?
• How do we assess and manage cancer
population risk?
• What specific positioning do we adopt
relative to competitors?
POPULATION
Value-Based Readiness
O R
P N
Organization Resources
Population Network
Stakeholders Delivery
Inte
rnal
Facto
rs
Exte
rna
l
Facto
rs
BASIC TRANSITIONAL MATURE
System Standardization
Delivery Network
Payer Engagement
Employer Engagement
Care Access
Value-Based Partners
Academic/NCI Affiliation
Stakeholders Delivery
Inte
rnal F
acto
rsE
xte
rna
l F
acto
rs
17
Cancer 2020: Value-Based Strategic Planning
How is our value defined, measured
and communicated?
NETWORK
• Who is the customer in 2020? (i.e.,
patients, employers, payers)
• What unique value proposition resonates
with the customer?
• How do we assess and manage cancer
population risk?
• What specific positioning do we adopt
relative to competitors?
POPULATION
Value-Based Readiness
BASIC TRANSITIONAL MATURE
Risk Stratification
Consumer Engagement
Product Design
Product Transition
Screening & Surveillance
High Risk Pop. Mgmt.
Population Virtual Budget
O R
Organization Resources
Stakeholders Delivery
Inte
rnal
Facto
rs
Exte
rna
l
Facto
rs
Stakeholders Delivery
Inte
rnal F
acto
rsE
xte
rna
l F
acto
rs P
Population
N
Network
18
Cancer 2020: Value-Based Strategic Planning
O BASIC TRANSITIONAL MATURE Cancer 2020 Strategy
Leadership
Program Governance
Institutional Commitment
Physician Alignment
Compensation Model
Medical Staff Profile
Collaborative Culture
RCare Standardization
Process Optimization
Personalized Medicine
Multi-D/ Navigated Care
Disease-Focal Points
Information Technology
Facilities & Equipment
NSystem Standardization
Delivery Network
Payer Engagement
Employer Engagement
Care Access
Value-Based Partners
Academic Affiliation
PRisk Stratification
Consumer Engagement
Product Design
Product Transition
Screening & Surveillance
High Risk Pop. Mgmt.
Population Virtual Budget
Strategies
Tactics
Priorities
Investments
Timelines
Value-Based
Readiness
O R
Organization Resources
Stakeholders Delivery
Inte
rnal
Facto
rs
Exte
rna
l
Facto
rs
Stakeholders Delivery
Inte
rnal F
acto
rsE
xte
rna
l F
acto
rs P
Population
N
Network
19
Supporting Business Case
The Cancer 2020 strategic plan will dictate program leveland tumor-specific resources needed to support thevision (e.g., recruitment, technology, programs).
CANCER 2020: RESOURCE NEEDS
Unique market dynamics and vetted strategies will drivecaseload volume projections, forming the backbone ofthe cancer program’s financials.
CASELOAD PROJECTIONS
The market maturity and value-based planning willdetermine inputs for payer rates, shared savings, at-riskpayments and preferred provider status.
VALUE-BASED FINANCIAL INPUTS
The service-line financial model integrates expectedcaseloads, value-based financial inputs, and requiredinvestments to model program contribution and return.
FIVE-YEAR FINANCIAL MODEL
Risk-modeling demonstrates the range of possibleoutcomes, dependent on various value-based, risk-reward contracting scenarios and market penetration.
RISK MODELING/SENSITIVITY
Financial modeling will include robust discussions aboutthe timing of value-based transition, for both Medicareand commercial payers in the market.
FEE-FOR-SERVICE TRANSITION
Environmental
Review
Value-Based
Strategic Planning
Business Case
DevelopmentValue-Based
Care Design
Oncology Solutions Overview
Emerging Strategic Planning Process
Value-Based Planning Framework
From Ideation to Execution
Q&A / Discussion
Ideation to Execution
Implementation of disease-specific, patient-centered,
value-based care.
CARE DESIGN
Integration of value-enabling information
technology and hardware.
TECHNOLOGY
Multi-disciplinary physician and clinical support team engagement building value-centric tumor-specific programs.
CLINICAL PERFOMANCE GROUPS (CPG)
Standardization of clinical and care pathways -minimizing variation & enabling superior outcomes with optimized cost.
EVIDENCE-BASED CARE
Patient-centric processes and care design, focused on access, input, shared decision making and navigation.
PATIENT ENGAGEMENT
PLANNING EXECUTION
Environmental
Review
Value-Based
Strategic Planning
Business Case
DevelopmentValue-Based
Care Design
21
22
Ideation to Execution
• The world of cancer care will look profoundly different in 2020
reimagining cancer care ? START NOW
• Treatment will be highly personalized and driven by an informed consumer
• Patients will trust their care to those with proven outcomes
• Employers and payers will partner with those demonstrating best practice, narrowing networks for “best in class” providers
• Cancer 2020 requires a transformational, actionable strategic plan NOW
• Providers with real-time data reporting, strategic agility and continuing process improvement efforts will succeed
™
Oncology Solutions Overview
Emerging Strategic Planning Process
Value-Based Planning Framework
From Ideation to Execution
Q&A / Discussion