vision 2020: ace annual meeting oncology value-based ... · focus on high-tech, high touch care, we...

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

[email protected]

404.836.2000

Kelley D. Simpson

Senior Partner

[email protected]

404.836.2000

Alina Maleski Smith

Senior Analyst

[email protected]

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

mailto:[email protected]






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


PHASE II





WHO WE ARE

PHASE I




WHO WE WANT TO BE

PHASE II




WHAT WE NEED

PHASE III



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.





WHO WE ARE

PHASE I




WHO WE WANT TO BE

PHASE II




WHAT WE NEED

PHASE III



vision.

PLAN OF ACTION

PHASE IV

PHASE IV

PLAN OF ACTION

An implementation plan and chance management strategy to

execute the vision.





WHO WE ARE

PHASE I




WHO WE WANT TO BE

PHASE II




WHAT WE NEED

PHASE III



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.





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


Care Design

14


O R

P N


Population Network


Inte

rnal

Fac

tors

Ex

tern

al F

acto

rs

Do we have a culture of value?ORGANIZATION




with the customer?


population risk?



POPULATION

BASIC TRANSITIONAL MATURE

Leadership

Program Governance

Institutional Commitment

Physician Alignment

Compensation Model

Medical Staff Profile

Collaborative Culture

Value-Based Readiness


Inte

rnal F

acto

rsE

xte

rna

l F

acto

rs

15


Are we equipped for the change?RESOURCES




with the customer?


population risk?



POPULATION


O R

P N


Population Network


Inte

rnal

Facto

rs

Exte

rna

l

Facto

rs


Care Standardization

Process Optimization

Personalized Medicine

Multi-D/ Navigated Care

Disease-Focal Points

Information Technology

Facilities & Equipment


Inte

rnal F

acto

rsE

xte

rna

l F

acto

rs

16


Who are/will be our partners?NETWORK




with the customer?


population risk?



POPULATION


O R

P N


Population Network


Inte

rnal

Facto

rs

Exte

rna

l

Facto

rs


System Standardization

Delivery Network

Payer Engagement

Employer Engagement

Care Access

Value-Based Partners

Academic/NCI Affiliation


Inte

rnal F

acto

rsE

xte

rna

l F

acto

rs

17


How is our value defined, measured

and communicated?

NETWORK




with the customer?


population risk?



POPULATION



Risk Stratification

Consumer Engagement

Product Design

Product Transition

Screening & Surveillance

High Risk Pop. Mgmt.

Population Virtual Budget

O R



Inte

rnal

Facto

rs

Exte

rna

l

Facto

rs


Inte

rnal F

acto

rsE

xte

rna

l F

acto

rs P

Population

N

Network

18


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



Inte

rnal

Facto

rs

Exte

rna

l

Facto

rs


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


Care Design





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


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

™





Q&A / Discussion

vision 2020: ace annual meeting oncology value-based ... · focus on high-tech, high touch care, we...

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