April 19, 2023 1

Advancing Oncology Care - Developing A Value Based Strategy

Presented by:

Dave Miller, MBA

Short Biography

• Healthcare Administration Background

• Hopkins for nearly 10 years

• Administrator of Radiation Oncology and Molecular Radiation Sciences

2

Introduction

3

Introduction

4

Choluteca Bridge, Honduras

Introduction

5

Choluteca Bridge, Honduras

Post Hurricane Mitch, 1998

Introduction

6

Agenda

• Introduction

• Market Conditions

• Business Case

• Measuring Value

• Conclusion

7

Market Conditions

8

Regulatory Environment

9

• Pay for Performance

• Accountable Care

• Population Health

• Meaningful Use/EMR

• Consolidation of Healthcare

• Expansion of Medicaid

Demand Economics:Population Demographics

10

2000 2010 2020 2030 2040 20500

20

40

60

80

100

0.0

5.0

10.0

15.0

20.0

25.0

35 40

55

7281

89

US Population Trend, 65 Years and Older

Population Percent Population

Po

pu

lati

on

(m

illio

ns

)

Pe

rce

nt

To

tal P

op

ula

tio

n

Decreasing Mortality Trend

Source: Department of Health and Human Services, Administration on Aging Source: NCI, U.S. Census 2010 and CA Cancer J Clin 2012;62:10–29.

Aging Population & Increased Survivorship = Demand Growth

Demand Economics:Utilization Forecasts

11

Source: Sg2, 2013 Cancer Service Line Snapshot

Shift In Utilization – Outpatient Demand Outpaces Population Growth

Supply Economics:Oncologist Capacity Forecast

12

Forecasting Supply of and Demand For OncologistsBaseline Forecast

Source: AAMC, Center for Workforce Studies, March 2007. A Report to the American Society ofClinical Oncology (ASCO)

Potential Shortage of Up To 4,000 Oncologists by

2020

Unmet Demand Projected to Range

from 9.4 – 15.1 Million Visits

Summarize

April 19, 2023 13

Increase in Regulatory Demands

Increase in Patient Demand

Shortfall in Oncology Supply

We must respond despite incomplete information, market volatility, and an unclear target.

What can we do now?

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Market Changes

• Decreasing revenues• Transparent quality,

costs, and penalties• Information Systems

Investment• Increased demand for

services• Increased competition for

resources• Increased cost for

resources

Call to Action

• Efficiency – Operational, Resource Utilization, Administrative• Cost out• Increase volume

• Strategic and Operational agility

• Improve quality of care, safety, integrated care, and innovative management

Business Case

Johns Hopkins Radiation Oncology

Vision and Strategy

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Johns Hopkins MedicineMission and Vision

Tripartite Mission StatementThe mission of Johns Hopkins Medicine is to improve the health of the community and the world by setting the standard of excellence in medical education, research and clinical care. Diverse and inclusive, Johns Hopkins Medicine educates medical students, scientists, health care professionals and the public; conducts

biomedical research; and provides patient-centered medicine to prevent, diagnose and treat human illness.

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04/19/2023 17

The Johns Hopkins Health SystemRegional Growth

JHHHospitalBased

GSSFree

Standing

HCGHFree

Standing

2010 Joint

Venture

SuburbanFree

Standing

2010 Acquisition

SibleyHospitalBased

2011 Acquisition

BMC HospitalBased

2014 Growth

04/19/2023 18

Radiation Oncology Regional Vision

JHHHospitalBased

GSSFree

Standing

BMC Hospital

Based

SibleyHospitalBased

SuburbanFree

Standing

Vision:Establish an Integrated

System of Care

Obstacles - Infrastructure

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JHH GSS BMC Suburban Sibley

Linear Accelerator

Elekta(Primary)

ElektaElekta

(Planned)Varian

(Planned)Varian

Planning Pinnacle PinnaclePinnacle(Planned)

Eclypse(Planned)

Eclypse

OperatingSystem

Mosaiq MosaiqMosaiq

(Planned)Aria

(Planned)Aria

Simulator Philips PhilipsPhilips

(Planned)Philips Philips

EMR EPIC EPIC Meditech Meditech Affinity

Disparate Technology

Obstacles - Acceptance

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ExecutiveLeadership

DepartmentalStaff

Inconsistent Motivations

Obstacles – Administrative Structure and Funding

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Johns Hopkins Radiation Oncology

JHH, GSS, BMC

Planned Infrastructure

Suburban

No Planned Infrastructure

Sibley

No Planned Infrastructure

Administrative Structure StartupFunding

Incremental Resources Not Available

Strategy

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Patient CentricStrategy

• Mission Focus – Regional Clinical Care, Research, and Education

• Standardized quality and safety practices

• Improve access to advanced care & multidisciplinary clinics

• Clinical trial availability

General Acceptance.Cautious Integration.

Business Case

Johns Hopkins Radiation Oncology

Adding Value In a Consolidated Healthcare Environment

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Transparency and Inclusion

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DepartmentProposal

ClinicalTeams

LocalExecutive

Teams

SeniorExecutive

Team

Presentation Approval Approval

Implement

Transparent, Consistent Communication

Adding Value – Technology Integration

25

Linacs

PlanningSimulation

IT

IT

IT

Integrated Technology • Advanced Clinical Care

• Standardized clinical trial platform and capability

• Enhance opportunities for training

• Financial benefit

Provided opportunities for growth, incremental resources,

and strategic advancement

Adding Value – Quality andSafety

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Integrated Technology

Integrated Medical Physics

Leadership

Integrated Clinical

Programs

Advanced QualityAnd Safety

• Standardized clinical practice and growth in clinical practice

• Coordinated safety and quality programs

• Financial benefits

Adding Value – Centralized Access

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Effective, Adequate, Efficient

Access to Care

Tumor-Specific Cancer Expert

Appropriate Time Between

Diagnosis and Care Delivery

Convenient and Clinically

Appropriate Location Advanced

Radiation Technology and

Protocols

Tumor-Specific Multidisciplinary

Care Team

Integrated Scheduling Decision Matrix

Right Treatment, Right Provider, Right Location, Right Time.

• Integration: Management, Access, Information Systems

• Centralized scheduling and financial clearance functions and personnel

• Volume and resource growth

Adding Value - Patient Impact

• Single access point for appointments

• Access to advanced treatments

• Access to clinical trials

• Elevated quality assurance and safety

• Integrated coordination of care

• Throughput efficiency28

Adding Value – Responding to Market Conditions

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Market and PatientPopulation Growth

Operational and Capital CostReduction

Enhancing Quality, Safety, and Efficiency

Advancing the Call to Action: Add Value by Actively Responding to Market Conditions

Applicable Takeaways

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THINK CREATIVELY AND RALLY AROUND NEW AND

INNOVATIVE IDEAS

• Always maintain focus on patients

• Leadership buy-in is critical

• Start with mission and strategy

• Proactively understand and respond to market conditions

Measuring Value

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Defining Value

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Healthcare2Manufacturing1

Amount of Satisfaction

Received

Price of Product or

Service

Patient Outcome

Cost of Patient Care

Value

Value

1. Bovet, Martha, Value Nets: Breaking the Supply Chain to Unlock Profits (New York: John Wiley & Sons, 2000). 2. Porter, ME. What Is Value In Healthcare? N. Engl J Med 2010; 363:2477-8).

Relevance of Defining and Measuring Value in Healthcare

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Value added services improve market strength and position

Value added services

Enhance Competitive Advantage

Advance Mission

and Grow Margin

Increased market share will increase populations served and drive financial viability

Develop internal processes to improve outcomes and/or

lower cost

1. Swayne L, Duncan WJ, and Ginter, PM., Strategic Management of Health Care Organizations (New York: John Wiley & Sons, 2008).

Michael Porter’s Value Chain Industry Model

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Value

• Find opportunities to add value to outputs and customers

• Revenue = Company Value.

• Company Value > cost to add value, margin is generated.

• Growth in Value and Margin provide competitive advantage

1. Mind Tools. http://www.mindtools.com/pages/article/newSTR_66.htm. Downloaded August 29, 2013

Value

Radiation Oncology Support Activities

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•Strategic Management

•Financial Management

•Operations Management

Firm Infrastructure

•Subspecialty service lines

•Multidisciplinary collaboration

•Continuing education

Human Resource

Management

•Advanced techniques

•Medical Physics Research

•Clinical Informatics

Technology Development

•Capital Management

•Information Technology Infrastructure

•Service Contract

Procurement

• Regional business planning• Integrated billing and compliance• Streamlined regional access

• Prostate, Breast, etc.• Tumor boards, MDC clinics• CME

• Stereotactic• SARRP – Animal research platform• Oncospace – Data sharing analytics

• Regional capital integration• Integration of IT systems• Integrated service contract management

Practical Applications

Radiation Oncology Primary Activities

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Outbound LogisticsOperationsInbound Logistics

Consultation Clinic

SimulationQuality

AssuranceDosimetry

Treatment

Primary Care

ServiceMarketing and Sales

Follow-UpPatient

Education

Market Outreach & Education

Clinical Trial Availability

Value can improve outcomes, reduce cost, add margin, and increase competitive advantage

Product

Customized Therapy

Plans

Radiation Oncology – Porter Value Chain Application

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Firm Infrastructure

Human Resource Management

Technology Development

Procurement

Inbound Logistics Service

Marketing and Sales

Outbound LogisticsOperations

Mis

sio

n &

Ma

rgin

Simulation

Consultation

Quality Assurance

Dosimetry

Primary Care

Treatment

Clinical Trials

Outreach & Education

Patient Education

Follow-Up

Advancing the Mission

Grow populations

served

Clinical trial access

Translational opportunities

Teaching

Enhancing Value Provides Clinical Care, Research, and Teaching Mission Opportunities.

Enhancing Value – Johns Hopkins Pancreas Cancer MDC

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Change in Clinical Stage19%

Change in Diagnosis

3%

Change - Other

1%No

Change76%

Study of 203 pancreas cancer patients receiving single-day multidisciplinary consultation

and evaluation

Inbound Logistics• More accurate diagnosis and staging• Enhance treatment planning

VALU

E ADDED

Outbound Logistics• Advance treatments through clinical trialsVALUE ADDED

Technology Development• Increased research registry• Clinical trial development

VALUE ADDED

Service• Improved patient education

VALUE ADDED

Pawlik , et al. Ann Surg Oncol. 2008; Aug;15(8):2081-2088. Epub 2008 May 7.

Enhancing Value - Clinical Analytics

391. McNutt, et al. ONCOSPACE: AN RT DATA INFRASTRUCTURE Submitted 2013

Glioblastoma Patients

when uncommon RxAlert!

Operations• Quality Assurance check• Peer review tool

VALUE ADDED

Technology Development• Automated QA tools• Utilization of clinical data

VALUE ADDED

Outbound Logistics• Enhanced quality of treatment plans

VALUE ADDED

Enhancing Value – StrategicPlanning

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Radiation Oncology Clinical

Strategic Goals

Standardize Quality and

Safety Management

Drive Efficient Operations

Meet Financial Targets

Enhance Engagement

and Collaboration

Firm Infrastructure

Human Resource Management

Technology Development

Procurement

Inbound Logistics Service

Marketing and Sales

Outbound LogisticsOperations

Mission

& M

argin

Simulation

Consultation

Quality Assurance

Dosimetry

Primary Care

Treatment

Clinical Trials

Outreach & Education

Patient Education

Follow-Up

Strategic Goals

Applicable Takeaways – Measuring Value

April 19, 2023 41

Firm Infrastructure

Human Resource Management

Technology Development

ProcurementInbound Logistics Service

Marketing and Sales

Outbound LogisticsOperations

Mis

sio

n &

Ma

rgin

Simulation

Consultation

Quality Assurance

Dosimetry

Primary Care

Treatment

Clinical Trials

Outreach & Education

Patient Education

Follow-Up

Porter’s Value ChainApplication • Identify and Assess

value opportunities for patients

• Efficiency, Quality, Safety, Care Coordination, and Strategic Agility

• Continual assessment of strategy and tactics

Applicable Takeaways – Measuring Value

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Assessing Market Responses

Conclusion

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Agenda

• Introduction

• Market Conditions

• Business Case

• Measuring Value

• Conclusion

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Conclusion

April 19, 2023 45

Infrastructure

HR

Technology

Procurement

In SrvMktOutOps

Mission

& M

argin

Innovation / Creativity

Value / Measurement

Opportunity / Success

… A Little Pot of Gold Wouldn’t Hurt on Our Journey

Questions?

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