Comprehensive Thoracic Oncology Program:

COG Update

CTOP Research Retreat

David NalepinskiDirector, Oncology Service Line & Business Operations

May 23, 2014

Conflict of Interest

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

Objectives:

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

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

The Patient at the Center…

• Screening• Referral

Oncology F/U

Diagnosis TreatmentSupportSurvivorship

Treatment Modality Chemotherapy

Treatment Modality Surgery

Treatment Modality Radiation

RadiologyPathology

DO

S M

ICRO

SYST

EMSE

CTIO

N

RESO

URC

ES

HEM

ON

C M

ICRO

SYST

EMSE

CTIO

N

RESO

URC

ES

RAD

ON

C M

ICRO

SYST

EMSE

CTIO

N

RESO

URC

ES

ANCI

LLAR

Y SE

RVIC

ESVA

RIO

US

SECT

ION

S /D

EPTS

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-SYSTEMCTOP MESO-SYSTEM

CTOP MESOSYSTEM

Surg Micro

system

Hem Micr

osystem

RadOnc

Microsyste

m

Incentives: Episodes, FFS, wRVU’s, Cost/Unit

Organization Vision – Market/Geopolitical System

Incentives: ACO, Quality/Cost, Capitation

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

CTOP COG Metrics….

Lung Financial Trends….

Lung Financial Trends….

Lung Financial Trends….

Esophagus Financial Trends….

Esophagus Financial Trends….

Esophagus Financial Trends….

New Lung Cancer Patients

New Lung Cancer Patients

New Lung Cancer Patients

New Esophagus Cancer Patients

New Esophagus Cancer Patients

New Esophagus Cancer Patients

Lung Cancer Referrals (w/ Upper Valley)

Lung Cancer Referrals (w/o Upper Valley)

Esophagus Cancer Referrals (w/ Upper Valley)

Esophagus Cancer Referrals (w/o Upper Valley)

Next Steps…

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

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

NCICancer Center Support

Grant

Clin

ical R

ese

arc

h

Transl

ati

onal R

ese

arc

h

Clinical Cancer Committee

Surgery

Radiation

Hematology

Pathology

Radiology

Nursing

Care Coordination

Pharmacy

Care Management

Can

cer

On

colo

gy G

rou

p

Dir

ecto

rs

Patient Conferences

(Tumor Boards)

Head & Neck

BMTSpine

ThoracicEsophagus/Lung

Pediatric

Neuro

Melanoma

LymphomaCutaneous Lymphoma

GYN

GUKidney/ProstateBladder/Testis

GIColon/Liver/

Pancreas

EndocrineThyroid/Pituitary

BreastComprehensive

Interdisciplinary Clinics

Clinical Care Team

Palliation

Care Pathways

Care Pathways

Clinical Research

Patient & Family Centered Care: Elements of Integrated & Coordinated Care

Cancer Oncology Group(s)

Patient Conference

(Tumor Board)

Inte

rdis

cip

lin

ary

Cli

nic

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)