2019 oncology state of the union - advisory · source: oncology roundtable interviews and analysis....

Oncology Roundtable

2019 Oncology State of the UnionConfronting new financial pressures

copy2019 Advisory Board bull All rights reserved bull WF1088267-a 0701

ROAD MAP2

A growing margin problem1

2 Three emerging cost pressures

3 Driving innovation


3

A sign of the times

Utah health plan for state employees starts pharmacy tourism to Tijuana

Source Alberty E ldquoTo fight high drug prices Utah will pay for public employees to go fill prescriptions in Mexicordquo The Salt Lake Tribune October 29 2018 httpswwwsltribcomnews20181028fight-high-drug-prices Oncology Roundtable interviews and analysis

To fight high drug

prices Utah will pay for public employees to go fill prescriptions

in Mexico

The Salt Lake Tribune

October 28 2018

PEHP pharmacy tourism option

bull Covers 160000 public employees

and their families

bull Offering plane tickets to San

Diego transportation to Tijuana

and $500 cash for patients who

need specific drugs

bull Drugs include those for MS

autoimmune disorders and

prostate cancer (Zytiga)

ldquoWhy wouldnrsquot we pay $300 [in transportation

costs] to go to San Diego drive across to Mexico

and save the system tens of thousands of

dollars If it can be done safely we should be all

over thatrdquo

Rep Norman Thurston R-Provo


4

A poster child for high costs

National focus on drugs puts cancermdashfairly or unfairlymdashin the spotlight

Source Milliman ldquoCost Drivers of Cancer Care A Retrospective Analysis of Medicare and Commercially InsurerdPopulation Claim Data 2004-2014rdquo April 2016 httpwwwmillimancomuploadedFilesinsight2016trends -in-cancer-carepdf IQVIA ldquoGlobal Oncology Trends 2018 Innovation Expansion and Disruptionrdquo May 24 2018 httpswwwiqviacominstitutereportsglobal-oncology-trends-2018 Oncology Roundtable interviews and analysis

35

63

36

62

Medicare Commercial

Cancer Non-cancer

Growth in costs per patient

2004-2014

n=41098 Medicare cancer patients

n=129507 commercial cancer patients

ldquoThe Punishing Cost

of Cancer Carerdquo

ldquoCost of Cancer Is

Becoming Unaffordablerdquo

The New York

Times

TIME

ldquoInsurers Push to Rein in

Spending on Cancer Carerdquo

The Wall

Street Journal

Drug costs on everyonersquos radar

increase in average

cost of new cancer

drugs from 2007-2017100


5

Exacerbated by rising demand

Utilization will increase with aging population expanding treatment options

Source Colby SL Ortman JM ldquoThe Baby Boom Cohort in the United States 2012 to 2060rdquo US Census Bureau May 2014 httpswwwcensusgovprod2014pubsp25-1141pdf Medicare Chronic Conditions Dashboard httpswwwcmsgovResearch-Statistics-Data-and-SystemsStatistics-Trends-and-ReportsDashboardChronic-Conditions-StateCC_State_Dashboardhtml httpswwwajpmonlineorgarticleS0749-3797(12)00146-8fulltext ldquoGlobal Cancer Immunotherapies Market to 2024 - Increased Uptake of Immune Checkpoint Inhibitors Driving Growth Supported by a Large Robust Pipelinerdquo Research and Markets July 2018 httpswwwresearchandmarketscomresearch9rpwcxglobal_cancerw=4 Oncology Roundtable interviews and analysis

160

178

194

2017 2022 2027

Estimated number of new cancer

cases in the US

55estimated increase in US

population over 65 years of

age from 2010 to 2030

Factors driving increased cancer volumes

33estimated increase in

obesity prevalence in the

US from 2010 to 2030


global revenue from cancer

immunotherapy market

from 2018 to 2024

Treatment

options

Lifestyle

factors

Aging

population

In millions

I


6

Forcing purchasers to double down on spend

Source Oncology Roundtable interviews and analysis

1 2 3

Drug costs

bull Drug pricing reform

bull 340B

reimbursement

bull Prior authorization

bull Pathways

bull Site neutrality

bull Site-of-care

policies

Site of care Provider choice

bull Network

design

bull Centers of

excellence

Three areas of focus for payers and employers to control costs


7

If you canrsquot beat lsquoemhellip

1 Drug costs

Source Sood N et al ldquoThe Flow of Money Through the Pharmaceutical Distribution Systemrdquo USC Schaeffer Center for Health Policy amp Economics June 2017 Oncology Roundtable interviews and analysis

Amazon-PillPack

Acquisition gives Amazon instant access to all 50 states where PillPack is licensed as a

mail-order drug company

Incumbents vertically integrate New entrants attempt to gain foothold

1) Advisory Board is a subsidiary of UnitedHealth Group the parent company of UnitedHealthCare All Advisory Board research expert perspectives and recommendations remain independent

2) Intermediaries include wholesaler PBM pharmacy

Likely strategy Seek cost and revenue wins

bull Cut out middle men in the pharmaceutical supply chain to lower price reduce own

benefit spend

bull Offer an integrated transparent employer health solution and self-pay consumer platform offer as B2B service to others

bull Capture pharmacy revenue through PillPack

Insurer PBM Pharmacy

Aetna CVS Caremark CVS Pharmacy

Cigna Express Scripts Accredo

UnitedHealth Care1 CatamaranRx BriovaRx

BlueCrossPrime Therapeutics

Walgreens

Integrate medical and pharmacy in attempts to better use advanced analytics steer patients to affiliated specialty pharmacy

Prevent competitors from gaining a leg up through greater vertical integration

Fend off disruption secure pharmaceutical revenue streams

approximate fraction of total drug spending attributable to intermediaries in the pharmaceutical supply chain2

13

Goals of integration Gain competitive edge


8

Public payers extremely concerned

Trying to control drug costs through transparency and competition

Source Federal Register ldquoMedicare and Medicaid Programs Regulation To Require Drug Pricing Transparencyrdquo Centers for Medicare amp Medicaid Services October 2018 Increases in Reimbursement for Brand-Name Drugs in Part D US Department of Health amp Human Services Office of Inspector General June 2018 ldquoOffice of Generic Drugs Annual Report for 2017rdquo US Food amp Drug Administration July 2018 Commins J ldquoMedicare Advantage Plans Given Negotiating Power on Part B Drug Pricesrdquo HealthLeaders August 2018 Leonard K ldquoSenate unanimously passes bill banning pharmacy gag clauses in Medicarerdquo Washington Examiner September 2018 Oncology Roundtable interviews and analysis

generic drugs approved in 20171027

FDA expedites drug approval processWe are not counting on

voluntary reductions in pricerdquo

Alex Azar Secretary of HHS

US Senate Hearing June 26 2018

Medicare advantage

utilization constraints

MA plans now have the

option to impose prior

authorization and step

therapy requirements on drug

formularies for Part B drugs

estimates $24B in savings

Notable federal actions to address rising drug costs in 2018

Patients Right to Know

Drug Prices Act

Blocks insurers and pharmacy

benefit managers (PBMs)

from prohibiting pharmacies of

informing customers of lower

priced drug options outside of

their insurance

Drug pricing

transparency

Proposed CMS rule

would require drug

manufacturers to post list

prices of drugs in direct-

to-consumer

advertisements


9

Seeking parity with international drug prices

Innovation Center to test new payment model for Medicare Part B drugs

Source Federal Register ldquoMedicare Program International Pricing Index Model for Medicare Part B Drugsrdquo Centers for Medicare amp Medicaid Services October 2018 Oncology Roundtable interviews and analysis

New ldquomodel vendorsrdquo responsible for

negotiating drug prices competing for

provider business and billing Medicare1

Provisions of proposed International Pricing

Index Model for Medicare Part B drugs

CMS reimbursement indexed to prices

paid by international countries phased in

over five year period

Providers reimbursed a set add-on

payment amount instead of average sales

price plus 623

Subset of Part B

single-source drugs

and biologicals in

select geographic

regions1) Model vendors can be wholesalers specialty pharmacies group purchasing organizations manufacturers individual or groups of

physicians and hospitals manufacturers Part D sponsors andor other entities that satisfy vendor qualification requirement s

2) Physician and hospital add-on payment is a set amount calculated based on what CMS would have paid in the absence of the model reflecting 6 percent of historical drug costs (before sequestration) redistributed as a set payment

3) Medicare pays ASP plus 43 post-sequestration

Physician-

administered

drugs

All prescription drugs

higher acquisition cost in the US

compared to 16 other developed

economies for 27 Part B drugs

included in CMS analysis

80

Subset of drugs currently included

Drugs in

model

1

2

3


10

Targeting pharmacy benefit managers

Unclear implications of Part D rebate proposal on federal spending

Source Sachs R ldquoTrump Administration Releases Long-Awaited Drug Rebate Proposalrdquo HealthAffairs February 1 2019 httpswwwhealthaffairsorgdo101377hblog20190201545950full Oncology Roundtable interviews and analysis

Current regulatory safe harbor

bull Pharmaceutical companies encouraged to

set high list price for drug

bull Negotiate with PBMs for rebate off the

list price

bull Rebates paid to PBM after sale to patient

savings usually not passed on to patient

bull Patients often responsible for list price

rather than lower negotiated price

New safe harbor regulations

bull Two new safe harbors could include

ndash Rebates passed onto patient at point

of sale

ndash Flat service fee payment made to PBMs

not tied to list price of drug

bull Goal is to lower out-of-pocket payments for

beneficiaries and list prices

bull Biggest impact on competitive drug markets

Potential implications

Patient spend would likely decrease Federal spend depends on stakeholder response

Monthly premiums

Out-of-pocket costs

$1399B increase from 2020-2029 according to

one analysis

$996B decrease from 2020-2029 according to

another analysis


11

Trying to de-mystify the drug value equation

Source McGinley L ldquoCancer drug prices are so high that doctors will test cutting dosesrdquo The Washington Post June 8 2017 httpswwwwashingtonpostcomnewsto-your-healthwp20170608how-these-cancer-doctors-plan-to-reduce-patients-drug-costs-without-touching-pricesutm_term=603e11ac7682 Oncology Roundtable interviews and analysis

Value in Cancer Care

Consortium (vi3c)

bull Nonprofit started by

oncologists with goal of

improving access

affordability sustainability

bull Trials focus on optimizing

delivery of drugs and

comparing regimens

bull Early trial showing equal

outcomes with reduced

dosage of abiraterone

with food leads NCCN to

update prostate cancer

guidelines in March 2019

1 2 3

Innovation and Value

Initiative (IVI)

bull Non-profit with the goal of

building a platform to

assess value of treatments

tailored to individual needs

and interests

bull Current open-source value

models include RA and

EGFR+ NSCLC

bull Allows users to compare

treatment options and

sequencing based on

preferences and desired

outcomes

Three organizations focusing on drug ldquovaluerdquo

Institute for Clinical and

Economic Review (ICER)

bull Independent research

organization that provides

ldquovalue-based price

benchmarkrdquo reflecting

appropriate pricing

relative to impact on

outcomes

bull Framework consists of

care value (comparison of

clinical and cost

effectiveness) and health

system value (measure of

five-year budget impact on

health systems)


12

Private payers seek to inflect treatment decisions

Turn to prior authorizations and clinical pathways

Source ASCO Daily News ldquoASCO Ensures Clinical Pathways in Oncology Promote Patient Carerdquo ASCO Daily News May 26 2016 httpsamascoorgdaily-newsasco-ensures-clinical-pathways-oncology-promote-patient-care ldquoMagellan Rx Management Medical Pharmacy Trend Report Eighth Edittionrdquo Magellan Rx Management httpswww1magellanrxcommedia722153tr2017_final_for-website-usepdf ldquoGenentech Oncology Trend Report Ninth Editionrdquo Genentech httpswwwgenentech-forumcomcontentdamgenemanagedcareforumpdfsOncology -Trends2017_Genentech_Oncology_Trend_Reportpdf 2017 Trending Now in Cancer Care Survey Oncology Roundtable interviews and analysis

1) 48 of payers following cancer treatment pathways indicate that they provide incentives to physicians to treat on pathway

The burden of prior

authorization increasing

89of cancer programs indicate that the

percentage of services requiring prior

authorization has increased over the

past 12 months

91 of payers use prior

authorizations to control

oncology costs

50 of payers have increased

prior authorization under the

medical benefit since 2015

$350 paid by Anthem to

oncologists each month per

patient treated on pathway

34 of payers follow cancer

treatment pathways1

Exploring clinical

pathways programs

Cancer Care Quality

Program

BlueCross BlueShield of

North Carolinarsquos Medical

Oncology Program

Sample payer programs


13

Ongoing controversy around 340B rate cuts

Ruling jeopardizes 2018 cuts impact unclear while awaiting further activity

Source ldquoReport to the Congress Overview of the 340B Drug Pricing Programrdquo Medicare Payment Advisory Commission May 2015 ldquoCY 2018 Hospital Outpatient Prospective Payment System Final Rulerdquo CMS ldquoCY 2019 Hospital Outpatient Prospective Payment System Final Rulerdquo CMS ldquo340B cuts are illegal judge rules Is lsquohavocrsquo coming for hospitalsrsquo The Daily Briefing Advisory Board Jan 2 2019 Gaty B lsquoCourt reverses 340B reimbursement cutrsquo Urology Times Jan 30 2019 Oncology Roundtable interviews and analysis

1) MEDPAC using language from HRSA in May 2015 report

2) MEDPAC estimate from May 2015 report

3) Rate cut excludes vaccines and pass-through drugs

4) Average Sales Price

5) Childrenrsquos hospitals PPS-exempt cancer hospitals and rural sole community hospitals exempted from the payment rate cut Critical access hospitals and Maryland waiver hospitals are not affected

6) Hospital Outpatient Prospective Payment System

7) American Hospital Association Association of American Medical Colleges Americas Essential Hospitals Eastern Maine Healthcare Systems Henry Ford Health System in Detroit and Park Ridge Health Hendersonville North Carolina sued CMS over the cuts in September 2018

340B program overview

bull Created in 1992 the 340B Drug Pricing Program requires drug manufacturers to provide separately

payable Part B drugs to eligible health care organizations at reduced prices

bull The programrsquos intent is to ldquostretch

scarce federal resources as far as possible to provide more care to

more patientsrdquo1

bull An estimated 45 of hospitals participate in 340B2

340B cuts in the 2018 2019 final Medicare rules

bull Reimbursement for separately payable Part B drugs 3 cut from ASP4+6 to ASP-225 in 2018 for most hospitals5 resulting in $16B estimated savings in 2018

bull Savings redistributed to non-drug HOPPS6 services across all hospitals

bull Rate cuts extended to 115 non-excepted HOPDs in 2019

Legal update

bull In December 2018 a federal judge issued a permanent injunction on the 340B rate cuts on the grounds that CMS overstepped its authority

bull The judge did not vacate the 2018 final rule but requested further briefing from HHS and the lawsuit plaintiffs7 to determine remedy

bull Imminent impact unlikely given likely appeal from CMS

and uncertainty surrounding current state


14

Private payers home in on cost differential

Source ldquoCost Drivers of Cancer Care A Retrospective Analysis of Medicare and Commercially Insured Population Claim Data 200 4-2014rdquo Milliman httpwwwmillimancomuploadedFilesinsight2016trends-in-cancer-carepdf ldquoThe Value of Community Oncology Site of Care Cost Analysisrdquo Community Oncology httpswwwcommunityoncologyorgwp-contentuploads201709Site-of-Care-Cost-Analysis-White-Paper_92517pdf ldquoMagellan Rx Management Medical Pharmacy Trend Report Eighth Editionrdquo Magellan Rx Management httpswww1magellanrxcommedia722153tr2017_final_for-website-usepdf Oncology Roundtable interviews and analysis

6

46

2004 2014

Percentage of chemotherapy infusions

delivered in hospital-based setting

For private payers

increase in costs for infused chemotherapy per

patient per year in hospital-based setting for

private payers compared to physician office

42

Brand namePhysician

officeHospital

outpatient

Herceptin $4131 $7737

Rituxan $7328 $11451

Avastin $2415 $9471

Remicade $4691 $10995

2 Site of care

Increase in hospital-based infusions contributing to higher costs

Cost of select infused drugs to

private payers by site of care


15

Moving to manage site of care

Private payers looking to shift infusions to lowest-cost setting

Source ldquoEMD Serono Specialty Digest 12th edition Managed Care Strategies for Specialty Pharmaciesrdquo EMD Serono httpspecialtydigestemdseronocomDefaultaspx Oncology Roundtable interviews and analysis

Commercial health

plan goals

Cost-containment

programs

Require preferred site

use with limited medical

exception

Contact patients to

recommend lower-cost

site of care

Encourage patients to

select lower-cost sites

with reduced cost sharing

12

64

report ldquomoving infusions to

the lowest-cost site of carerdquo

as the top priority for the

next 12-24 months



as a top five priority for the

next 12-24 months

report that site-of-care

initiatives are the most

important strategy to

manage specialty drug costs

19


16

CMS taking significant steps towards site neutrality

Source ldquoCY 2019 HOPPS Final Rulerdquo CMS httpswwwcmsgovMedicareMedicare-Fee-for-Service-PaymentHospitalOutpatientPPSindexhtml Oncology Roundtable interviews and analysis

Overview of CMSrsquo activity towards

establishing site neutrality

2016

Creates modifier to track off-

campus HOPD services

2017

Sets payment for non-excepted

HOPDs are 50 of HOPPS rate

2018

Reduces payment for non-excepted

HOPDs to 40 of HOPPS rate

2019

Sets two-part clinic visit payment rate

cut at all off-campus HOPDs

$110

$192

$159

$124

Physicianoffice

2018 2019 2020

Clinic visit G0463 payment rates

Off-campus HOPDs

13 difference in

reimbursement rate

by 2020

Reducing clinic visit payment for all off-campus HOPDs this year


17

Refresher Excepted vs non-excepted sites

Some off-campus HOPDs receive site-neutral rates for all services

Source CMS CY 2019 HOPPS Final Rule Advisory Board research and analysis

1) Except for routine clinic visit code G0463 for which excepted off-campus providers will be paid only 70 of the HOPPS rate in 2019

2) Facilities that are forced to move as a result of extraordinary circumstances (eg natural disaster) will not lose their excepted status Extraordinary circumstance determination made at discretion of CMS Regional Office

Defining an Off-Campus HOPD

Non-excepted providersExcepted off-campus providers

bull Off-campus hospital outpatient departments

that did not furnish services payable under

HOPPS prior to November 2 2015

bull Previously excepted providers that have lost

excepted status since January 1 2017


that furnished services payable under

HOPPS prior to November 2 2015 or that

were mid-build at that time

Receive full HOPPS rate1 Receive 40 of HOPPS rate

bull Any point of the HOPD is located at

least 250 yards from any point of the

hospital facility

bull Financial operations and clinical

services fully integrated with those

of the main hospital

bull Held out to public as part of the

main hospital

Facility Relocation2

Change in HOPD and

Hospital Relationship

Excepted Status Can Be Lost in

Two Ways


18

Employer health spending continues to grow

Oncology costs rising to the top of their priority list

3 Provider choice

Source HCCI ldquo2016 Health Care Cost and Utilization Reportrdquo January 2018 Willis Towers Watson ldquoBest Practices in Health Care Empl oyer Survey Reportrdquo January 31 2018 PwC ldquoMedical cost trend Behind the numbers 2018rdquo June 2017 Mercer ldquoMercer Survey Shows Employers Face a 43 Increase in 2018 US Health Benefit Cost Highest Since 2011 But Trend Stablerdquo September 18 2017 Nobel J et al ldquoCancer and the Workplace The Employer Perspectiverdquo Northeast Business Group on Health httpnebghorgwp-contentuploads201510CancerWorkplace_FINALpdf Henry J Kaiser Family Foundation Oncology Roundtable interviews and analysis

28 27

4146

2013 2014 2015 2016

Employer health care spending continues to rise

Oncology a major financial burden

of employersrsquo claims are

cancer-related

1of employersrsquo medical

costs are cancer-related

12estimated employer spend on direct

and indirect costs of cancer in 2015

$264B

Percent change in annual spending per person relative to previous year


19

Adding new layers of control

Embracing activation in addition to delegation

Source Health Care Advisory Board Oncology Roundtable interviews and analysis

Spectrum of options for controlling health benefits expense

Activation

bull Shift employees to public exchange

bull Trade Cadillac tax

for employer mandate penalty

Drop coverage

bull Encourage employee uptake of HDHPs

bull Outsource administrative

burden to third party such as a private exchange

Shift risk

Delegation Abdication

bull Curate network design to influence employee choice

bull Active episodic-specific steerage

Manage proactively

Recent era of employer strategy

Emerging era of employer strategy


20

Centers of excellence regain momentum

Source ldquoNext Generation Health Carerdquo Healthcare Financial Managementrdquo httpwwwbdcadvisorscomwp-contentuploads2016030316_hfm_Next_Gen_Healthcarepdf Mayo Clinic Rochester MN Walmart Bentonville AR Oncology Roundtable interviews and analysis

Looking for partners to drive quality reduce costs

3

9

18

12

16

26

22

19

39

50

31

30

31

19

15

Cancer

Cardiovascular

Knees hips or

spine

Bariatric surgery

Transplants

Yes with incentives Yes but no incentives

Status of large employersrsquo contracts with

centers of excellenceWalmart and Mayo Clinic

bull Expanded center of excellence

partnership in 2015 to include breast lung

colon and rectal cancers

bull Employees diagnosed with cancer

encouraged to have case reviewed to

determine if they would benefit from

traveling to Mayo

bull If travel is recommended Walmart covers

cost for employee and family member

CASE EXAMPLE

30of eligible

employees travel

to Mayo for care

55of patients who travel

have treatment plans

changed


21

Oncology Roundtable insight

Cancer programsrsquo price is purchasersrsquo

top cost priority

The private and public sectors are using the mechanisms

most within their control to rein in oncology spendmdash

namely cutting reimbursement to providers and steering

patients to lower-cost sites of care Cancer programs

need to monitor local market activity react swiftly to

changing regulations and optimize their cost structure to

protect volumes and revenue



22

The margin problem

Expense growth already outpacing revenue growth for most hospitals

Source Moodyrsquos Investors Service ldquoUS NFP amp Public Hospitalsrsquo Annual Medians Show Expense Growth Topping Revenues for Second Yearrdquo August 28 2018 Moodyrsquos Investors Service ldquoRevenue Growth and Cash Flow Margins Hit All -Time Lows in 2013 US Not-for-Profit Hospital Mediansrdquo August 2014 Health Care Advisory Board Toward True Sustainability Washington DC Advisory Board 2018 Rege A ldquoThe No 1 priority for hospital CEOs Cost controlrdquo Beckerrsquos Hospital Review July 11 2018 httpswwwbeckershospitalreviewcomhospital -management-administrationthe-no-1-priority-for-hospital-ceos-cost-controlhtml Oncology Roundtable interviews and analysis

Revenue and expense growth rates

for non-profit hospitals

2009-2017 medians

2

4

6

8

2010 2012 2014 2016 2018

Revenue growth Expense growth

Staffing

Traditional financial

pressures

Drugs and supplies

Capital investments

Service utilization


23

Resources to maximize oncology margins


bull Reduce Unwarranted Care Variation in Oncology

bull Redesigning Cancer Care Delivery

for the Era of Accountability

bull The Three-Step Cancer Staffing Makeover

bull Oncology Volumes Staffing and Operations Benchmark Generators

bull Improving End-of-Life Care for Cancer Patients

bull The Infusion Center Billing Strategy Playbook

bull Infusion Center Pro Forma

bull Prior Authorization for Physician-Administered Drugs

bull Use Financial Data to Diagnose

Gaps in Performance

bull 5 Things You Need to Know About Specialty Pharmacy Strategy

bull Cancer Patient Financial

Navigation

bull Help Patients Understand Their Financial Responsibility

bull Tap into All Available

Assistance

bull Oncology Growth Strategy

bull The Tumor Site Strategy Toolkit

bull Online Cancer Program

Marketing

bull Cancer Patient Experience Survey Resources

bull Elevating Oncology Referral

Strategy

bull Strategic Employer Partnerships for Cancer Care

bull Clinical Innovations in Oncology

Register now for Managing Oncology Drug Costs on June 13 by visiting advisorycom

Contain cost

growth

Maximize revenue

capture

Capture new

growth


24

Meeting the demands of the future will prove costly

Three trends impacting future cancer program investments


1) Includes 247 patient access one navigator one data analyst and upfront cost of care planning software

Annual cost of meeting initial requirements for Oncology Care Model participation1

Start-up cost including lab equipment data management and annual salaries for

precision medicine capabilities

Annual salary cost for dietitian palliative care and behavioral health specialists

~$400Kgt$1M$500K-$1M

Evolving diagnostic and

treatment options

Increasing consumer

demands

bull Purchasers increasingly

deploy reimbursement

models that reward value

over volume

bull Changing payment models

force providers to live in

prolonged period of

investment experimentation

bull Rapid increase in

knowledge of how to detect

diagnose and treat cancer

bull New costly innovations

spur investment in

expertise and infrastructure

despite unclear

reimbursement

bull Patients become more

involved in decisions about

where they go and stay

for care

bull Focus on best-in-class

experience creates urgency

to invest in expensive

service enhancements

Shifting payment

models

Sample costs


25

Confronting new financial pressures


Ma

rgin

s

Value-based care

Clinical innovations

Patient experience

Immediate cost pressures Emerging cost pressures

Staffing

Drugs and supplies

Capital investments

Service utilization

1

2

3


ROAD MAP26





27

What have we learned so far

Years of payment reform experiments raise more questions than answers

Pressure 1 Value-based care


1) Regional Cancer Care Associates

Both parties need to weigh the administrative

burden of payment reform against the number

of patients it will cover and benefit

Bundled payments

Shared savings and ACOs

Oncology medical homes

bull MD Anderson and UHC

bull Moffitt and UHC

bull 21st Century Oncology and Humana

bull RCCA1 and Horizon BCBS

bull Miami Cancer Institute and Florida Blue

bull Moffitt and Florida Blue

bull Aetna Oncology Medical Home

Collaborative

bull Priority Healthrsquos Michigan Oncology

Medical Home Demonstration Project

Key takeawaysSample private payer-led

value-based oncology models

It is often difficult to pinpoint the reasons for

success or failure but top opportunities to reduce

costs are standardizing care reducing ED and

hospital use and improving end-of-life care

The biggest benefit to payers and providers is

developing relationships and sharing data to

better understand the cost and quality of care


28

The 800-pound gorilla takes on oncology

Oncology Care Model entering its fourth year

Source CMS Oncology Care Model httpsinnovationcmsgovinitiativesoncology-care Oncology Roundtable interviews and analysis

bull 176 medical oncology practices

bull 10 payers

bull CMS

Who is

participating

bull Fee-for-service payments for all services to enrolled beneficiaries

bull Monthly enhanced oncology services

(MEOS) payment of $160 for six months upon initiation of chemo

ndash If the patient continues or resumes chemo practice can trigger subsequent episodes

How are

practices paid

bull Performance-based payment provided if practice reduces beneficiariesrsquo total Medicare billings and meets threshold for

quality performance

ndash Quality measured relative to other practices

ndash Cost performance is evaluated against

historic performance

bull Provide 247 access to appropriate clinician with real-time access to medical records

bull Provide the core functions of patient navigation

bull Document a care plan with the 13 components recommended by

the IOM

bull Treat patients on nationally recognized clinical guidelines

bull Use certified electronic health

record technology (CEHRT)

bull Utilize data for continuous quality improvement

What are the requirements

for participating providers

Overview of the Oncology Care Model (OCM)


29

Not the results we were hoping for

Too early to draw conclusions but participants split on value

Source Abt Associates ldquoEvaluation of the Oncology Care Modelrdquo Performance Period Onerdquo December 2018 Genentech ldquo2018 Genentech Oncology Trend Reportrdquo April 2018 httpswwwgenentech-forumcomcontentdamgenemanagedcareforumpdfsOncology -Trends2018_Genentech_Oncology_Trend_Reportpdf Oncology Roundtable interviews and analysis

=

Performance Period (PP) 1 results

Quality

Against the comparator group

the OCM cohort hadhellip

Small reductions in admissions

and ICU stays at end of life

= Costs

Slightly declined total costs of care

not including MEOS payments

Key caveats

bull Delayed roll out of data

bull Many practices just starting to implement cost-savings initiatives

bull Methodology concerns eg attribution

tumor-specific risk adjustment novel therapy adjustment

37

33

27

27

24

31

12

8

Loweredcost ofcare

Increasedquality of

care

No not at all Too early to tell

Yes somewhat Yes significantly

OCM participantsrsquo perception of value

n=51 oncologists participating in OCM


30

Dec

PP1 external

evaluation

published

Only two more years till planned end point

Participants reach critical decision point in 2019

1) After initial reconciliation but before true up Percentage will likely decrease slightly

Source ldquoCMS announces additional opportunities for clinicians to join innovative care approaches under the Quality Payment Programrdquo Centers for Medicare amp Medicaid Services httpswwwcmsgovNewsroomMediaReleaseDatabasePress-releases2016-Press-releases-items2016-10-25html ldquoOncology Care Model Overviewrdquo Association of Community Cancer Centers httpoiaccc-cancerorgadvocacyOCM-Overviewasp Strawbridge L ACCC Oncology Care Model Collaborative Workshop at the ACCC 44th Annual Meeting and Cancer Business Summit Washington DC March 16 2018 Oncology Roundtable interviews and analysis

Timeline of key OCM events

July-Sept

Measurement

Period 1

July 1

OCM begins

w ith 190

participating

practices

June 30

End of

Performance

Period 1

Nov-Dec

OCM registry

available to

report clinical

and quality data

June 30

Anticipated

performance

period end date

201820172016 2019 2020 2021

Summer-Fall

Practices that have not earned a

bonus in any of f irst four

performance periods decide to

enter two-sided risk or drop out

Jan 1

Practices can

enter into either

tw o-sided risk

option

PP1 PP2

25 30

Percent of participants earning

a bonus

PP31

33

bull Reduced discount (25)

bull Stop-gain and stop-loss amounts based on revenue rather than cost benchmark

bull Minimum loss threshold of 25 before recoupment activated

Highlights of new two-sided risk model


31

Comparing the options

Source CMMI OCM Performance Payment Methodology December 17 2018 innovationcmsgovFilesxocm-pp3beyond-pymmethpdf Oncology Roundtable interviews and analysis

Risk Arrangement

One-sided risk Original two-sidedrisk Alternative two-sided risk

OCM discount 4 of benchmark 275 of benchmark 25 of benchmark

Performance-based payment

based onhellip

Actual lt target Actual lt target Actual lt target


calculated onhellip

Target ndash actual Target ndash actual Target ndash actual

Stop-gain 20 of benchmark 20 of benchmark 16 of revenue + chemo

Recoupment is the following is

truehellip

NA Actual gt target Actual gt benchmark

Recoupment based on this

differencehellip

NA Actual - target Actual ndash benchmark

Stop-loss NA 20 of benchmark 8 of revenue + chemo

Advanced APM status No Yes Yes


32

This isnrsquot new territory for CMS

1) Medicare Shared Savings Program Source Cinque M ldquoThe strategy many ACOs call the secret to MSSP success rdquo Advisory Boardrsquos Daily Briefing November 21 2013 Lazerow R ldquoFour takeaways on the recent ACO results CMS Fact Sheet August 25 2016 Sinclair H ldquoLast yearrsquos MSSP results are out Here are our 5 key takeawaysrdquo Advisory Boardrsquos Daily Briefing October 31 2017 Oncology Roundtable interviews and analysis

MSSP1 Participation and Financial Performance 2012-2017

Program performance

year

Number of

ACOs

Spending below target

savings

Spending below target no savings

Spending above target

Net impact to Medicare

PY1 2012-2013 220 26 27 47 ($78M)

PY 2014 333 28 27 46 ($50M)

PY 2015 392 31 21 48 ($216M)

PY 2016 432 31 25 44 ($39M)

PY 2017 472 34 26 39 $314


33

Still evolving the model

ldquoPathways to Successrdquo rule at end of 2018 changes MSSP again


Current Structure Change New Structure

Track 1

3-year agreement upside-only

Consolidated and adapted

BASIC Track

5-year agreement

First two years upside-only

Last three years 30 fixed loss rateTrack 1+

3-year agreement 30 fixed loss rate

Track 2

3-year agreement up to 60 loss rateEliminated

No equivalent financial model under proposed structure

Track 3

3-year agreement up to 75 loss rateRebranded

ENHANCED Track

5-year agreement up to 75 loss rate


34

No shortage of ideas for OCM 20

Source HHS Physician-Focused Payment Model Technical Advisory Committee httpsaspehhsgovproposal-submissions-physician-focused-payment-model-technical-advisory-committee Oncology Roundtable interviews and analysis

Comprehensive

Cancer Care

Delivery Model

Patient-Centered

Oncology Payment

Model (PCOP)

1 2 3

Recommended for implementation

Recent oncology-related models proposed to physician-focused Payment

Model Technical Advisory Committee (PTAC)

Active proposals letters of intent submitted

bull Submitted by Community Oncology Alliance (COA)

bull Builds on Oncology Care

Model but starts with any treatment and follows patients to survivorship or end of life

bull One- and two-sided risk

options both including risk-adjusted care management

feeds and shared savings based on total costs of care

bull Submitted by ASCO

bull Provides supplemental payment for treatment

planning care management and clinical trial participation

bull Includes a two-sided risk

option based on quality measurement reporting

and treatment pathway compliance

Making Accountable

Sustainable Oncology

Networks (MASON)

bull Based on principles of Community Oncology Medical Home (COME HOME)

bull Participants would be equipped with triage pathways diagnostic and therapeutic pathways

cognitive computing platform and data science processes

bull Cost targets based on Oncology

Payment Categories (OPCs) shared savings based on cost and quality performance


35

Radiation therapy bundle in the works

Expecting a proposal in the coming months

Source Hubbard A ldquoRO-APM What we know what we donrsquot and what it all meansrdquo ASTRO Blog February 14 2019 httpswwwastroorgBlogFebruary-2019RO-APM-What-we-know-what-we-donE28099t-and-what-it-all Oncology Roundtable interviews and analysis

What we know Top questions

bull Will the model be mandatory

bull How many practices will be required

to participate

bull Will it meet the criteria to be an

advanced alternative payment model

bull How will payment methodology be

constructed

bull How will payment be made to centers

that bill globally

bull Which 17 cancer types will be included

Mandated by Congress in

2015 Patient Access and

Medicare Protection Act

Will be applicable to

hospital and

freestanding providers

Will include prospective payment

for 90-day episode of care one

payment at beginning of episode

and one at conclusion


36


Value-based care model redesign will

result in continuous changes to your

investment roadmap

The lack of clear results from oncology payment reform to

date means that providers and payers will continue to

iterate on existing models and experiment with alternative

models in the coming years This puts cancer programs at

risk of sinking money into ineffective program redesign

initiatives To avoid doing this cancer programs need to

prioritize investments that are win-win in both worlds such

as evidence-based care improved access symptom

management and data infrastructure



37

Entering a new age of science

Are you expecting new types of competition

Pressure 2 Clinical innovations

Source Cooke H ldquoFDA approved 23adnMe Inc to distribute direct-to-consumer genetic test for colorectal cancer riskrdquo Prevent Cancer January 2019 httpspreventcancerorg201901fda-approves-23andme-inc-to-distribute-direct-to-consumer-genetic-test-for-colorectal-cancer-risk Sneed A ldquoMail-Order CRISPR Kits Allow Absolutely Anyone to Hack DNArdquo Scientific American November 2 2017ldquohttpswwwscientificamericancomarticlemail -order-crispr-kits-allow-absolutely-anyone-to-hack-dna Oncology Roundtable

interviews and analysis

Direct-to-consumer testing

ldquoPrevent Cancer Foundationreg

warns the test may have unintended consequences for

cancer preventionrdquo

ldquoMail-Order CRISPR Kits

Allow Absolutely Anyone to Hack DNArdquo

ldquoExperts debate what amateur scientists

could accomplish with the powerful DNA editing toolmdashand whether its ready

availability is cause for concernrdquo

At-home DNA repair

ldquoFDA Approves 23andMe to Distribute

Direct-to-Consumer Genetic Test for Colorectal Cancer Riskrdquo


38

Wersquove already come a long way

Improvements in cancer detection treatment decreases mortality rates

Source SEER httpseercancergovstatfactshtmlallhtml American Society of Clinical Oncology httpwwwcancernet Hanna N Einhorn LH ldquoTesticular Cancer A Reflection on 50 Years of Discoveryrdquo Journal of Clinical Oncology 32 no 28 (2014) 3085-3092 Oncology Roundtable interviews and analysis

Longstanding focus on

personalizing treatment for outsized gains

increase in five-

year survival for chronic

myeloid leukemia due

to the use of Gleevec

2x

9x increase in five-

year survival for

testicular cancer due to

the use of cisplatin

214

201

187

172

156

1992 1998 2004 2010 2016

Cancer mortality rates in the US

Cancer-related deaths per 100000 population

gt25M deaths avoided since 1992


39

Transforming how we detect and treat cancer

Prevalence

Adoptive cell transfer1 Organoids

Tra

nsfo

rma

tive

po

ten

tia

l o

ve

r n

ext 3

-5 y

ea

rs

Widespread In research


Liquidbiopsies

Breathalyzer

Checkpoint inhibitors

Oncolyticvaccines

Real-time efficacymonitoring

1) Includes CAR T and tumor infiltrating lymphocyte (TIL) therapies

Sample diagnostic and treatment innovations

Hormone therapy

Single target gene testing

Multi-gene panels

Next-generationsequencing

Whole-exome sequencing

Antibody drug conjugates


40

Aiming for actionable less invasive follow up

More work needed before liquid biopsies become standard of care

Cancer detection

Source Razavi P et al ldquoPerformance of a high-intensity 508-gene circulating-tumor DNA (ctDNA) assay in patients with metastatic breast lung and prostate cancerrdquo Journal of Clinical Oncology 2017 httpswwwascoorgabout-ascopress-centernews-releasesliquid-biopsy-tests-people-cancer-expert-review Oncology Roundtable d interviews and analysis

1) Circulating tumor DNA

Tumor DNA in the bloodstream detects

cancer or used for molecular testing

Blood vessel

ctDNA1

Blood cell

ctDNA extracted

Sequenced and analyzed

Cancer mutations detected and

actionable next steps taken

1

2

3

Case in Brief GRAIL Inc

bull Silicon Valley startup developing blood test to

detect cancer in asymptomatic people that reads circulating tumor DNA (ctNA)

bull In an early study 90 of advanced cancer patients receiving the test had at least one mutation detected in tumor tissue that was also

detected in the blood

Not ready for primetime

ldquoLike all new things in medicine the use of

ctDNA assays in routine cancer care requires

evidence of clinical utility At present there is

insufficient evidence of clinical validity and

utility for the majority of ctDNA assays in

advanced cancerhelliprdquo

Daniel F Hayes MD FACP FASCOASCO expert review


41

Something even less invasive A breathalyzer

Commercialization of nanoscale sensor technology in the works

Source Nakhleh et al ldquoDiagnosis and Classification of 17 Diseases from 1404 Subjects via Pattern Analysis of Exhaled Moleculesrdquo ACS Nano 2017 Oncology Roundtable interviews and analysis

Breath analysis process

Diseases detected by

breathalyzer test

Patient breathes into breathalyzer device with artificially intelligent nanotechnology sensors

86

Sensors detect and quantify pre-identified organic compounds in exhaled air

accuracy of disease detection and discrimination

between diseases in tests to date

No injections or blood draw

Instant results

Lower cost than traditional blood tests

bull Lung cancer

bull Colorectal cancer

bull Head and neck cancer

bull Ovarian cancer

bull Bladder cancer

bull Prostate cancer

bull Kidney cancer

bull Gastric cancer

bull Crohnrsquos Disease

bull Ulcerative Colitis

bull Irritable Bowel Syndrome

bull Idiopathic Parkinsonrsquos

bull Atypical

Parkinsonism

bull Multiple Sclerosis

bull Pulmonary Arterial

Hypertension

bull Pre-eclampsia

bull Chronic Kidney Disease

Benefits of breathalyzer


42

Widespread use of biomarker testing

99 of physicians report using tests for some of their patients

Tumor biomarker testing

Source Genentech ldquo2018 Genentech Oncology Trend Reportrdquo April 2018 httpswwwgenentech-forumcomcontentdamgenemanagedcareforumpdfsOncology -Trends2018_Genentech_Oncology_Trend_Reportpdf Oncology Roundtable interviews and analysis

46

30

17

18

19

15

9

5

22

35

44

36

9

10

17

17

6

12

14

25

Liquid biopsy

Broad next-generationgenome

sequencing

Multigene panel

FDA-approvedcompaniondiagnostic

0 1-10 10-25 25-50 gt50

Percent of physicians using biomarker tests

n=200

Percent of physiciansrsquo patients receiving each test

Mean percent of patients receiving

each test

30

24

17

10


43

Struggling to keep up

Challenges evaluating test quality predicting reimbursement

Source Genentech ldquo2018 Genentech Oncology Trend Reportrdquo April 2018 httpswwwgenentech-forumcomcontentdamgenemanagedcareforumpdfsOncology-Trends2018_Genentech_Oncology_Trend_Reportpdf Kuderer N et al ldquoComparison of 2 Commercially Available Next-Generation Sequencing Platforms in Oncologyrdquo JAMA Oncology July 2017 httpsjamanetworkcomjournalsjamaoncologyfullarticle2593039 CMS ldquoDecision Memo for Next Generation Sequencing (NGS) for Medicare Beneficiaries with Advanced Cancer httpswwwcmsgovmedicare-coverage-databasedetailsnca-decision-memoaspxNCAId=290 Oncology Roundtable interviews and analysis

1) Nine patients received both Guardant360 and FoundationOne tests

next-generation sequencing

tests approved by the FDA at

end of 2018

Comparison of two commercially

available NGS platforms1

5

22 of alterations

identified by both

tests were

concordant

25 of drugs were

recommended for

the same patients

by both platforms

Currently covers

bull Patients with recurrent metastatic or advanced-stage disease

bull Tests with FDA approval as companion diagnostic and indication for use in patientrsquos

cancer type

Does not cover

bull FDA-approved tests detecting germline BRCA

mutations in early-stage patients

CMS to revisit national coverage determination

on NGS testing

Percent of managed care organizations with

policies to cover biomarker tests

13

22

38FDA-approved

companion diagnostics

Multi-gene panels

Whole-exome

sequencing

n=100


44

A win-win for cost and quality

Two promising innovations aim to limit use of ineffective treatment

Source Landhuis E ldquoTumor lsquoorganoidsrsquo may speed cancer treatmentrdquo ScienceNews December 17 2018 Boston University Biomedical Optical Technologies Lab httpwwwbuedubotlab Oncology Roundtable interviews and analysis

Tumor tissue removed

Use of organoids in drug

screening and selection

Grown in a lab to create 3D organoids

Multiple cancer drugs tested on each organoid revealing which drug the tumor will respond to

Multiscale imaging to monitor

real-time tumor response

Case in Brief BOTLab

bull Researchers at Boston Universityrsquos

Biomedical Optical Technology Lab (BOTLab)

develop wearable probe to monitor breast

tumors

bull Received $100000 in funding from American

Cancer Society and Global Center for Medical

Innovation to bring technology to market

Near-infrared

spectroscopy

bull Measures tumorrsquos hemoglobin metabolism water and fat level

bull Allows for real-time monitoring of tumor

response to chemotherapy

number of PubMed results for ldquocancer

organoidrdquo articles published between

January 2016 and March 2019

877


45

A shifting landscape of cancer drugs

Treatment innovations

Source Mullard A ldquo2016 FDA drug approvalsrdquo Nature Reviews Drug Discovery 2017 Aitken M ldquoMedicines Use and Spending in the US A Review of 2015 and Outlook to 2020rdquo IMS Institute for Healthcare Informatics 2016 ldquo2016 Profile Biopharmaceutical Industryrdquo PhRMA 2016 ldquoWhat Are Biologics Questions and Answersrdquo US Food amp Drug Administration 2015 ldquoNCI Dictionary of Cancer Termsrdquo NIH National Cancer Institute ldquoWhat Is Gene Therapyrdquo NIH 2017 Oncology Roundtable interviews and analysis

Biologics Complex (and typically high-cost) drugs manufactured from living microorganisms plants or animal cells

Gene therapy Using genes to treat or prevent disease by

bull Replacing a mutated gene with a

healthy copy

bull Inactivating a mutated gene

bull Inserting a new gene into cells

Immunotherapy A biological therapy that stimulates or suppresses the immune system (or immune cells) to help

the body fight disease (eg cytokines vaccines checkpoint inhibitors)

CAR T Chimeric antigen receptor (CAR) T-cell therapy an emerging type of immunotherapy that reprograms genes of

T cells to recognize and kill diseased cells

1

2

Two ways to target tumors more precisely

Mechanism Outcome

Drug binds to specific bio-molecules or

cell types

Genes inserted or altered to combat disease

Eradicates source of errant signaling mechanism

Influence malfunctioning cellular pathways

of drugs approved in 2018 were personalized

40expected increase in cancer immunotherapy market from 2018-2024

300number of CAR T trials in the US in 2018

144


46

Changing the treatment paradigm

Keytruda is first with FDA approval based on tumor genetics not location

Source Le D et al ldquoMismatch repair deficiency predicts response of solid tumors to PD-1 blockaderdquo Science 2017 Kolata G ldquoCancer Drug Proves to Be Effective Against Multiple Tumorsrdquo The New York Times 2017 Oncology Roundtable interviews and analysis

Case in Brief Keytruda

(pemprolizumab)

bull Checkpoint inhibitor that targets

the PD-1PD-L1 cellular pathway

bull First approved drug for use

against all tumors that share a

common genetic mutationmdash

microsatellite instability-high

(MSI-H) or mismatch repair

deficient (dMMR)mdashregardless of

location in the body

Identifying shared gene mutation across tumor types

Identified tumor mutations (MSI-H andor dMMR) that prevent tumor from repairing DNA

4of cancer patients have the genetic mutation susceptible

to pembrolizumab

$13Kper-month cost of Keytruda infusion

53of tumors with radiographic evidence showing

tumor shrinking

21of patients with tumors completely eliminated

In phase I study of other anti-PD-1 agent nivolumab found an ldquoexceptional responderrdquo where colon tumor disappeared

Researchers analyzed patientrsquos cancer cells and found a plethora of mutated genes and abnormal proteins

1

2

3

4 Studied patients with 12 different cancers that shared the MSI-H andor dMMR mutation to test clinical efficacy of pemprolizumab found tremendous response rates


47

Use of immunotherapy skyrocketing

Cost continues to be providersrsquo biggest barrier

Source Abt Associates ldquoEvaluation of the Oncology Care Modelrdquo Performance Period Onerdquo December 2018 Genentech ldquo2018 Genentech Oncology Trend Reportrdquo April 2018 Tang J et al ldquoThe clinical trial landscape for PD1PDL1 immune checkpoint inhibitorsrdquo Nature Reviews Drug Discovery no 17 (2018) 845-855 Oncology Roundtable interviews and analysis

72

33

25

19

Challenges associated with

checkpoint inhibitor-based therapies

n=110 cancer programs

Tumor site 2014-2015 2016-2017

Lung 14 305

Head and neck 09 216

Kidney 05 441

Melanoma 564 824

Cost

reimbursement

Availability

access to drugs

Knowledge

of new

drugs

Comfort

managing side

effects

Percent of Medicare cancer patients

receiving checkpoint inhibitors

increase in the number of active trials evaluating checkpoint inhibitors from 2017 to 2018

33


48

CAR T generates exciting results for liquid tumors

Leukemia drug is the first gene therapy approved by FDA

Source ldquoFDA approval brings first gene therapy to the United Statesrdquo US Food amp Drug Administration 2017 Kolata G ldquoNew Gene-Therapy Treatments Will Carry Whopping Price Tagsrdquo The New York Times 2017 Oncology Roundtable interviews and analysis

1) Within three months

83remission rate following

treatment with Kymriah1

$475Kcost of one-time

Kymriah injection

Promising resultshellip hellipat eye-popping cost

Reprogramming the immune system

with CAR T-cell therapy

T cells extracted from patient

Genes sent to and manipulated in lab

Engineered cells infused into patient

T cells trigger death of cancerous cells

FDA-approved CAR T-cell

therapies

Novartisrsquos Kymriah

bull Approved for treatment of adolescent

acute lymphoblastic leukemia

bull Priced at $475000

Kite Pharmarsquos Yescarta

bull Approved for treatment of aggressive

B-cell non-Hodgkin lymphoma


Select toxicities

bull Delirium

bull Anaphalaxis

bull Autoimmune

response

bull Neurologic adverse

effects

bull Cytokine release

syndrome


49

Underscoring the systemrsquos inability to keep up

Current reimbursement doesnrsquot come close to covering provider costs

Source Swetlitz I ldquoHospitals are saving lives with CAR-T Getting paid is another storyrdquo STATNews March 12 2019 httpswwwstatnewscom20190312hospitals-arent-getting-paid-for-car-tutm_source=STAT+Newslettersamputm_campaign=c6a2eb5301-Cancer_Briefingamputm_medium=emailamputm_term=0_8cab1d7961-c6a2eb5301-151230725 Oncology Roundtable interviews and analysis

1) Inpatient Prospective Payment System

Progression of CAR T reimbursement by CMS

2017

bull FDA approves Kymriah and Yescarta

bull Experts estimate total costs of $500K-1M including

therapy hospitalization supplies and labor

2018

bull CMS sets Medicare part B reimbursement rates for the

drugs at $500K and $400K respectively

bull CMS sets 2019 IPPS1

payment at maximum of $186500 per case

2019

bull CMS proposes increasing new technology add-on

payment to total of ~$243K in inpatient setting

bull Includes proposal that providers have to enroll beneficiaries in CMS-approved

registry for two years

ldquoThe CAR T story is an example of how government

programs often fail to keep pace with innovationrdquo

Seema Verma

CMS Administrator


50

Stressing the importance of real-world data

Opportunity for pharma and providers to work together


7

4

4

9

8

11

26

15

6

44

40

34

15

33

45

Strongly disagree Somewhat disagree Undecided

Somewhat agree Strongly agree

Real-world data are essential for sound coverage and reimbursement decisions

about cancer treatments

Managed care organizationsrsquo perceptions on real-world data in

coverage determinations

n=100

Patient-reported outcomes and quality-of-life surveys in real-world settings are

important in coverage determinations

Within the next five years products unable to show benefit in real-world settings within a reasonable timeframe will lose coverage


51


Clinical innovations will force programs to weigh

two new investmentsmdashthe cost of the innovation

and the infrastructure needed to support it

While many programs want to immediately start

implementing clinical innovations there are two

financial consequences of doing so First

reimbursement is lagging behind scientific advances

Programs need to carefully evaluate and contribute to

the evidence base supporting innovations Second

programs need to consider new organizational

investments such as enhanced lab capabilities

molecular expertise clinical decision support patient

support and data management



52

Breaking traditional health behavior patterns

Oncology still referrals driven but patients playing more active role

Pressure 3 Patient experience


Rising expectations

for service

Increasing access to health

care information

bull Access to and use of the Internet now nearly ubiquitous

bull More organizations

publishing health care cost and quality data

bull Growth in online communities and availability of patient

reviews

bull Patients gaining experience with different-in-kind providers (eg Walgreens

MinuteClinic)

bull Nature of patient-physician relationship changing

patients more skeptical and questioning

1 2

Patients becoming more influential decision-makers

Growing price

sensitivity

bull Rising health care costs

bull Patients shouldering larger portion of health care costs

bull Patients increasingly

including costs in-network coverage when selecting providers

3


53

At the heart of everything you do

Majority of programs investing in patient-centered services

Source 2016 Cancer Support Services Volumes Staffing and Operations Benchmarks Oncology Roundtable interviews and analysis

Sample cancer program

investmentsPressures forcing programs to revisit

investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4

Mounting budget pressure makes it

difficult to fund non-reimbursed services

Growing patient population means

more demand for services

Heightening workforce shortages forces

programs to evaluate capacity and demand

Increasing competition makes it critical to

differentiate program for patients physicians


54

330 310

240

120

Feature 1 Feature 2 Feature 3 Feature 4

Figuring out what matters most to patients

Source 2019 Cancer Patient Experience Survey Oncology Roundtable interviews and analysis

Cancer Patient Experience Survey

Questions included

bull Demographics (eg age sex tumor type stage race)

bull Priorities and behaviors when choosing a provider and

receiving care

bull Preferences for survivorship support services

1201 patients and survivors

diagnosed in last five years

Advantages of MaxDiff surveys

Allow researchers to

understand the magnitude

of difference between

ranked attributes

Force respondents to

choose between attributes

preventing ceiling effects

1

2

Interpreting MaxDiff results

Utility scores for the set of attributes sum to 100 Utility scores

represent the relative value of each attribute


55

What matters when selecting a provider


08

14

16

29

31

34

48

49

55

65

108

111

123

133

175Doctor who specializes in my particular cancer

Technology and treatment options

Clinical quality (eg survival rates)

In-network for my insurance

Accreditation (eg Commission on Cancer)

Patient support services

Costs Irsquom responsible for

Reputation (eg US News ldquotop doctorsrdquo report)

When deciding where to go for care which feature is most and least important to you

n=1201 cancer patients

Recommendation from my doctor

Recommendation from my family and friends

Location

Availability of appointments

Facility and amenities

Customer service

Availability of clinical trials

Mean utility scores


56

Cancer patients doing their research


3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other

Community website forum or blog

Employee health navigation site

General ratings website

I did not consult any resources

Social media website

Medicare or other government website

Medical-focused ratings website

Major search engine

Cancer-specific website

Family friends or colleagues

My health insurance company

Cancer center physician practice website

My doctor

Which of the following resources did you use when deciding where to go for your cancer care


48 of cancer patients searched

online when deciding where

to go for care

21average number of sites

consulted by patients

searching online


57

Itrsquos not enough just to attract patients


3

4

6

7

10

13

13

17

18

20

23

28

I wanted to spend less money on my care

I couldnt get appointments when I needed them

I wanted a nicer facility and better amenities

I wanted access to clinical trials

I wanted better support services

They could not provide the treatment I needed

Friends or family recommended a different provider

I wanted a location that was closer to my homework

I found a higher quality program

I wanted better customer service

I wanted moredifferent treatment options

I found a different doctor who specializes in my care

Why did you change cancer care providers


11 of cancer patients said they changed care

providers at some point during their treatment


58

Patient priorities for services and amenities


15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110

All of my care takes place in one building

Specialized symptom management

Multidisciplinary care clinics

Nurse phone line for help with symptoms

Survivor support services after finishing treatment

Patient education services

Help scheduling and coordinating my appointments

Support services for my family

Across treatment which services would have been most valuable and least valuable to you


Online portal to view test results contact care team

Help with nutrition

Extended hours of operation

Complementary and alternative medicine

Access to genetic testing and counseling

Parking that is convenient and affordable

Free or discounted transportation

One point of contact to help me understand my care

Financial counseling

Social and mental health services during treatment

Religious and spiritual services

Mean utility scores


59

Going above and beyond

Source True W Modernizing the Patient Experience Through Technology The Experience Enginerdquo ACCC October 2 2018 httpswwwaccc-cancerorgacccbuzzblog-post-templateaccc-buzz20181002modernizing-the-patient-experience-through-technology-the-experience-engine WFTV ldquolsquoBetty the robot helps Orlando Health UF Health Cancer Center patientsrdquo January 9 2018 httpswwworlandohealthcancercomcontent-hubbetty-the-robot-helps-orlando-health-cancer-center-patients Oncology Roundtable interviews and analysis

ldquoHenry Ford looks to boost patient

experience with technologyrdquo

ldquorsquoBetty the robot helps Orlando Health

UF Health Cancer Center patientsrdquo

Working with The Experience Engine (TE2)

a company that has worked with cruise ships

and Disney to modernize customer experience

In testing phase to determine patient

experience and efficiency impact of

using a robot to assess patient distress

ldquoWe want to use this to do whatever we possibly can to remove any ounce of worry or stress that is not medical-relatedrdquo

Steven Kalkanis MD Medical Director Henry Ford Cancer institute

ldquoMaybe a little R2D2 a little Baymax if yoursquove seen Big Hero 6 Those are a few of the inspirationsrdquo

David Metcalf PhD Institute for Simulation and Training University of Central Florida


60


The costs of patient acquisition and retention

are going up

Given increased pressure to differentiate your cancer

program and retain patients cancer programs will need

to weigh investments in marketing improving operations

and developing new services While this is not new

terrain for oncology providers it will require additional

investment in understanding and gaining insight into

what your market needs and wants in a cancer provider



ROAD MAP61





62

Facing our new cost pressures

Thoughtful investment is integral to effective cancer program strategy


Patient

experience

Value-

based careChanging payment

models force providers

to live in prolonged

period of investment

experimentation

Emerging health care

consumers create

urgency to invest in

expensive service

enhancements

Evolving diagnostics and

treatment options spur investment

despite unclear reimbursement


Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization

Immediate cost priorities Emerging cost priorities

Value-based care


Patient experience

1

2

3

Key to ensuring

financial sustainability

Key to achieving

market advantage

Cancer providersrsquo financial priorities


64

What wersquore all aiming for

Intermountainrsquos innovation efforts drives improved outcomes

Source Intermountain Healthcare Salt Lake City UT Haslem D et al ldquoPrecision oncology in advanced cancer patients improves overall survival with lower weekly healthcare costsrdquo Oncotarget February 2 2018 Oncology Roundtable interviews and analysis

Provider selects treatment based on available evidence

Provider orders genomic test on EHR through Syapse platform

Provider receives test results from Syapse in easy-to-understand format

Syapse prompts provider to report patient outcomes

Intermountain analyzes outcomes data across patients

Intermountainrsquos clinical decision

support platform

Outcomes data they will track includes survival adverse events

hospitalED visits therapies received

imaging results and costs

Plan to include outcomes data at point of care allowing providers to see

how similar patients performed on therapies

Intermountain incorporates findings into internal treatment guidelines

69lower costs in last three months of life for patients on targeted treatment

2xgreater overall survival for patients on targeted treatment


65

Building a foundation for success

In-depth discussion of your top priorities

bull How patients make trade-offs when choosing providers

bull Where programs are most vulnerable to patient leakage

bull Innovative strategies to drive engagement and reduce turnover for key team members

bull Lessons to develop data-driven staffing models

bull Guidance on managing political dynamics and working effectively with system and site leaders

bull Frameworks for making principled decisions for investment

bull Tactics to align strategy and care delivery across sites

What matters most to cancer

patients

Building the engaged

oncology workforce

How to survivemdashand

thrivemdashin a system

Networking reception

Get to know your peers through targeted group

discussion

Optional tools workshop

Explore data from our 2019 Cancer Patient

Experience Survey

Implementation tools

Use complementary tools and resources to implement change

at your program in follow up

Additional features of this yearrsquos Oncology Roundtable National Meeting


LEGAL CAVEAT

Advisory Board has made efforts to verify the accuracy of the information it provides to members This report relies on data obtained from many sources however and Advisory Board cannot guarantee the accuracy of the information

provided or any analysis based thereon In addition Advisory Board is not in the business of giving legal medical accounting or other professional advice and its reports should not be construed as professional advice In particular members should not rely on any legal commentary in this report as a basis for action or assume that any tactics described herein would be permitted by applicable law or

appropriate for a given memberrsquos situation Members are advised to consult with appropriate professionals concerning legal medical tax or accounting issues before implementing any of these tactics Neither Advisory Board nor its officers directors trustees employees and agents shall be liable for any claims liabilities or expenses relating to (a) any errors or omissions in this report whether caused

by Advisory Board or any of its employees or agents or sources or other third parties (b) any recommendation or graded ranking by Advisory Board or (c) failure of member and its employees and agents to abide by the terms set forth herein

Advisory Board and the ldquoArdquo logo are registered trademarks of The Advisory Board Company in the United States and other countries Members are not permitted to

use these trademarks or any other trademark product name service name trade name and logo of Advisory Board without prior written consent of Advisory Board All other trademarks product names service names trade names and logos used within these pages are the property of their respective holders Use of other company trademarks product names service names trade names and logos or

images of the same does not necessarily constitute (a) an endorsement by such company of Advisory Board and its products and services or (b) an endorsement

of the company or its products or services by Advisory Board Advisory Board is not affiliated with any such company

IMPORTANT Please read the following

Advisory Board has prepared this report for the exclusive use of its members

Each member acknowledges and agrees that this report and the information contained herein (collectively the ldquoReportrdquo) are confidential and proprietary to Advisory Board By accepting delivery of this Report each member agrees toabide by the terms as stated herein including the following

1 Advisory Board owns all right title and interest in and to this Report Except

as stated herein no right license permission or interest of any kind in this Report is intended to be given transferred to or acquired by a memberEach member is authorized to use this Report only to the extent expressly authorized herein

2 Each member shall not sell license republish or post online or otherwise this

Report in part or in whole Each member shall not disseminate or permit the use of and shall take reasonable precautions to prevent such dissemination or use of this Report by (a) any of its employees and agents (except as stated below) or (b) any third party

3 Each member may make this Report available solely to those of its employees

and agents who (a) are registered for the workshop or membership program of which this Report is a part (b) require access to this Report in order to learn from the information described herein and (c) agree not to disclose this Report to other employees or agents or any third party Each member shall use and shall ensure that its employees and agents use this Report for its

internal use only Each member may make a limited number of copies solely as adequate for use by its employees and agents in accordance with the terms herein

4 Each member shall not remove from this Report any confidential markings copyright notices andor other similar indicia herein

5 Each member is responsible for any breach of its obligations as stated herein by any of its employees or agents

6 If a member is unwilling to abide by any of the foregoing obligations thensuch member shall promptly return this Report and all copies thereof to Advisory Board

Oncology Roundtable

Project DirectorDeirdre Saulet

sauletdadvisorycom

202-568-7863

Program Leadership Alicia DaughertyShay Pratt

Design Consultant Hailey Kessler


ROAD MAP2





3

A sign of the times



To fight high drug


in Mexico


October 28 2018



and their families




need specific drugs








over thatrdquo



4




35

63

36

62

Medicare Commercial

Cancer Non-cancer


2004-2014




of Cancer Carerdquo



The New York

Times

TIME



The Wall

Street Journal


increase in average

cost of new cancer

drugs from 2007-2017100


5




160

178

194

2017 2022 2027


cases in the US











from 2018 to 2024

Treatment

options

Lifestyle

factors

Aging

population

In millions

I


6



1 2 3

Drug costs


bull 340B

reimbursement


bull Pathways


bull Site-of-care

policies


bull Network

design

bull Centers of

excellence



7


1 Drug costs


Amazon-PillPack








benefit spend








Walgreens





13



8









Medicare advantage










Drug Prices Act






their insurance

Drug pricing

transparency

Proposed CMS rule

would require drug



to-consumer

advertisements


9














price plus 623

Subset of Part B

single-source drugs

and biologicals in

select geographic





Physician-

administered

drugs






80


Drugs in

model

1

2

3


10








list price








of sale








Monthly premiums

Out-of-pocket costs


one analysis


another analysis


11




Consortium (vi3c)



improving access




comparing regimens







1 2 3


Initiative (IVI)





and interests



EGFR+ NSCLC



sequencing based on


outcomes








appropriate pricing


outcomes



clinical and cost




health systems)


12





The burden of prior





past 12 months



oncology costs








treatment pathways1

Exploring clinical

pathways programs

Cancer Care Quality

Program



Oncology Program



13
















more patientsrdquo1






Legal update






14



6

46

2004 2014



For private payers




42

Brand namePhysician

officeHospital

outpatient


Rituxan $7328 $11451

Avastin $2415 $9471

Remicade $4691 $10995

2 Site of care





15




Commercial health

plan goals

Cost-containment

programs



exception

Contact patients to


site of care




12

64




next 12-24 months




next 12-24 months





19


16





2016



2017



2018



2019



$110

$192

$159

$124

Physicianoffice

2018 2019 2020


Off-campus HOPDs

13 difference in

reimbursement rate

by 2020



17




















hospital facility





main hospital


Change in HOPD and



Two Ways


18



3 Provider choice


28 27

4146

2013 2014 2015 2016




cancer-related





$264B



19





Activation




Drop coverage




Shift risk




Manage proactively




20




3

9

18

12

16

26

22

19

39

50

31

30

31

19

15

Cancer

Cardiovascular

Knees hips or

spine

Bariatric surgery

Transplants










traveling to Mayo



CASE EXAMPLE

30of eligible

employees travel

to Mayo for care



changed


21



top cost priority










22

The margin problem





2009-2017 medians

2

4

6

8

2010 2012 2014 2016 2018


Staffing


pressures

Drugs and supplies

Capital investments

Service utilization


23













Gaps in Performance



Navigation



Assistance




Marketing



Strategy




Contain cost

growth

Maximize revenue

capture

Capture new

growth


24









~$400Kgt$1M$500K-$1M


treatment options

Increasing consumer

demands




over volume



prolonged period of






spur investment in


despite unclear

reimbursement




for care





Shifting payment

models

Sample costs


25



Ma

rgin

s

Value-based care


Patient experience


Staffing

Drugs and supplies

Capital investments

Service utilization

1

2

3


ROAD MAP26





27









Bundled payments










Collaborative













28





bull 10 payers

bull CMS

Who is

participating





How are

practices paid


quality performance







the IOM









29




=


Quality





= Costs



Key caveats





37

33

27

27

24

31

12

8

Loweredcost ofcare

Increasedquality of

care






30

Dec

PP1 external

evaluation

published






July-Sept

Measurement

Period 1

July 1

OCM begins

w ith 190

participating

practices

June 30

End of

Performance

Period 1

Nov-Dec

OCM registry

available to

report clinical

and quality data

June 30

Anticipated

performance

period end date

201820172016 2019 2020 2021

Summer-Fall





Jan 1

Practices can

enter into either

tw o-sided risk

option

PP1 PP2

25 30


a bonus

PP31

33






31



Risk Arrangement




based onhellip



calculated onhellip




truehellip



differencehellip





32




Program performance

year

Number of

ACOs


savings




PY1 2012-2013 220 26 27 47 ($78M)

PY 2014 333 28 27 46 ($50M)

PY 2015 392 31 21 48 ($216M)

PY 2016 432 31 25 44 ($39M)

PY 2017 472 34 26 39 $314


33





Track 1



BASIC Track

5-year agreement




Track 2



Track 3


ENHANCED Track



34



Comprehensive

Cancer Care

Delivery Model

Patient-Centered

Oncology Payment

Model (PCOP)

1 2 3

















Making Accountable


Networks (MASON)







35







to participate




constructed


that bill globally






hospital and







36




investment roadmap












37















At-home DNA repair




38






increase in five-




2x


year survival for



214

201

187

172

156

1992 1998 2004 2010 2016





39


Prevalence


Tra

nsfo

rma

tive

po

ten

tia

l o

ve

r n

ext 3

-5 y

ea

rs



Liquidbiopsies

Breathalyzer


Oncolyticvaccines




Hormone therapy


Multi-gene panels





40



Cancer detection





Blood vessel

ctDNA1

Blood cell

ctDNA extracted




1

2

3















41






breathalyzer test


86





Instant results


bull Lung cancer



bull Ovarian cancer

bull Bladder cancer


bull Kidney cancer

bull Gastric cancer





bull Atypical

Parkinsonism



Hypertension

bull Pre-eclampsia




42





46

30

17

18

19

15

9

5

22

35

44

36

9

10

17

17

6

12

14

25

Liquid biopsy


sequencing

Multigene panel


0 1-10 10-25 25-50 gt50


n=200



each test

30

24

17

10


43







end of 2018



5

22 of alterations

identified by both

tests were

concordant

25 of drugs were

recommended for

the same patients

by both platforms

Currently covers



cancer type

Does not cover




on NGS testing



13

22

38FDA-approved


Multi-gene panels

Whole-exome

sequencing

n=100


44















tumors




Near-infrared

spectroscopy







877


45







healthy copy







1

2


Mechanism Outcome


cell types







144


46





(pemprolizumab)













to pembrolizumab



tumor shrinking




1

2

3



47




72

33

25

19




Tumor site 2014-2015 2016-2017

Lung 14 305


Kidney 05 441

Melanoma 564 824

Cost

reimbursement

Availability

access to drugs

Knowledge

of new

drugs

Comfort

managing side

effects




33


48








Kymriah injection









therapies









Select toxicities

bull Delirium

bull Anaphalaxis

bull Autoimmune

response


effects


syndrome


49






2017




2018





2019







Seema Verma

CMS Administrator


50




7

4

4

9

8

11

26

15

6

44

40

34

15

33

45







n=100





51

















52





Rising expectations

for service


care information





reviews


MinuteClinic)



1 2


Growing price

sensitivity





3


53






investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4










54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




3

A sign of the times



To fight high drug


in Mexico


October 28 2018



and their families




need specific drugs








over thatrdquo



4




35

63

36

62

Medicare Commercial

Cancer Non-cancer


2004-2014




of Cancer Carerdquo



The New York

Times

TIME



The Wall

Street Journal


increase in average

cost of new cancer

drugs from 2007-2017100


5




160

178

194

2017 2022 2027


cases in the US











from 2018 to 2024

Treatment

options

Lifestyle

factors

Aging

population

In millions

I


6



1 2 3

Drug costs


bull 340B

reimbursement


bull Pathways


bull Site-of-care

policies


bull Network

design

bull Centers of

excellence



7


1 Drug costs


Amazon-PillPack








benefit spend








Walgreens





13



8









Medicare advantage










Drug Prices Act






their insurance

Drug pricing

transparency

Proposed CMS rule

would require drug



to-consumer

advertisements


9














price plus 623

Subset of Part B

single-source drugs

and biologicals in

select geographic





Physician-

administered

drugs






80


Drugs in

model

1

2

3


10








list price








of sale








Monthly premiums

Out-of-pocket costs


one analysis


another analysis


11




Consortium (vi3c)



improving access




comparing regimens







1 2 3


Initiative (IVI)





and interests



EGFR+ NSCLC



sequencing based on


outcomes








appropriate pricing


outcomes



clinical and cost




health systems)


12





The burden of prior





past 12 months



oncology costs








treatment pathways1

Exploring clinical

pathways programs

Cancer Care Quality

Program



Oncology Program



13
















more patientsrdquo1






Legal update






14



6

46

2004 2014



For private payers




42

Brand namePhysician

officeHospital

outpatient


Rituxan $7328 $11451

Avastin $2415 $9471

Remicade $4691 $10995

2 Site of care





15




Commercial health

plan goals

Cost-containment

programs



exception

Contact patients to


site of care




12

64




next 12-24 months




next 12-24 months





19


16





2016



2017



2018



2019



$110

$192

$159

$124

Physicianoffice

2018 2019 2020


Off-campus HOPDs

13 difference in

reimbursement rate

by 2020



17




















hospital facility





main hospital


Change in HOPD and



Two Ways


18



3 Provider choice


28 27

4146

2013 2014 2015 2016




cancer-related





$264B



19





Activation




Drop coverage




Shift risk




Manage proactively




20




3

9

18

12

16

26

22

19

39

50

31

30

31

19

15

Cancer

Cardiovascular

Knees hips or

spine

Bariatric surgery

Transplants










traveling to Mayo



CASE EXAMPLE

30of eligible

employees travel

to Mayo for care



changed


21



top cost priority










22

The margin problem





2009-2017 medians

2

4

6

8

2010 2012 2014 2016 2018


Staffing


pressures

Drugs and supplies

Capital investments

Service utilization


23













Gaps in Performance



Navigation



Assistance




Marketing



Strategy




Contain cost

growth

Maximize revenue

capture

Capture new

growth


24









~$400Kgt$1M$500K-$1M


treatment options

Increasing consumer

demands




over volume



prolonged period of






spur investment in


despite unclear

reimbursement




for care





Shifting payment

models

Sample costs


25



Ma

rgin

s

Value-based care


Patient experience


Staffing

Drugs and supplies

Capital investments

Service utilization

1

2

3


ROAD MAP26





27









Bundled payments










Collaborative













28





bull 10 payers

bull CMS

Who is

participating





How are

practices paid


quality performance







the IOM









29




=


Quality





= Costs



Key caveats





37

33

27

27

24

31

12

8

Loweredcost ofcare

Increasedquality of

care






30

Dec

PP1 external

evaluation

published






July-Sept

Measurement

Period 1

July 1

OCM begins

w ith 190

participating

practices

June 30

End of

Performance

Period 1

Nov-Dec

OCM registry

available to

report clinical

and quality data

June 30

Anticipated

performance

period end date

201820172016 2019 2020 2021

Summer-Fall





Jan 1

Practices can

enter into either

tw o-sided risk

option

PP1 PP2

25 30


a bonus

PP31

33






31



Risk Arrangement




based onhellip



calculated onhellip




truehellip



differencehellip





32




Program performance

year

Number of

ACOs


savings




PY1 2012-2013 220 26 27 47 ($78M)

PY 2014 333 28 27 46 ($50M)

PY 2015 392 31 21 48 ($216M)

PY 2016 432 31 25 44 ($39M)

PY 2017 472 34 26 39 $314


33





Track 1



BASIC Track

5-year agreement




Track 2



Track 3


ENHANCED Track



34



Comprehensive

Cancer Care

Delivery Model

Patient-Centered

Oncology Payment

Model (PCOP)

1 2 3

















Making Accountable


Networks (MASON)







35







to participate




constructed


that bill globally






hospital and







36




investment roadmap












37















At-home DNA repair




38






increase in five-




2x


year survival for



214

201

187

172

156

1992 1998 2004 2010 2016





39


Prevalence


Tra

nsfo

rma

tive

po

ten

tia

l o

ve

r n

ext 3

-5 y

ea

rs



Liquidbiopsies

Breathalyzer


Oncolyticvaccines




Hormone therapy


Multi-gene panels





40



Cancer detection





Blood vessel

ctDNA1

Blood cell

ctDNA extracted




1

2

3















41






breathalyzer test


86





Instant results


bull Lung cancer



bull Ovarian cancer

bull Bladder cancer


bull Kidney cancer

bull Gastric cancer





bull Atypical

Parkinsonism



Hypertension

bull Pre-eclampsia




42





46

30

17

18

19

15

9

5

22

35

44

36

9

10

17

17

6

12

14

25

Liquid biopsy


sequencing

Multigene panel


0 1-10 10-25 25-50 gt50


n=200



each test

30

24

17

10


43







end of 2018



5

22 of alterations

identified by both

tests were

concordant

25 of drugs were

recommended for

the same patients

by both platforms

Currently covers



cancer type

Does not cover




on NGS testing



13

22

38FDA-approved


Multi-gene panels

Whole-exome

sequencing

n=100


44















tumors




Near-infrared

spectroscopy







877


45







healthy copy







1

2


Mechanism Outcome


cell types







144


46





(pemprolizumab)













to pembrolizumab



tumor shrinking




1

2

3



47




72

33

25

19




Tumor site 2014-2015 2016-2017

Lung 14 305


Kidney 05 441

Melanoma 564 824

Cost

reimbursement

Availability

access to drugs

Knowledge

of new

drugs

Comfort

managing side

effects




33


48








Kymriah injection









therapies









Select toxicities

bull Delirium

bull Anaphalaxis

bull Autoimmune

response


effects


syndrome


49






2017




2018





2019







Seema Verma

CMS Administrator


50




7

4

4

9

8

11

26

15

6

44

40

34

15

33

45







n=100





51

















52





Rising expectations

for service


care information





reviews


MinuteClinic)



1 2


Growing price

sensitivity





3


53






investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4










54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




4




35

63

36

62

Medicare Commercial

Cancer Non-cancer


2004-2014




of Cancer Carerdquo



The New York

Times

TIME



The Wall

Street Journal


increase in average

cost of new cancer

drugs from 2007-2017100


5




160

178

194

2017 2022 2027


cases in the US











from 2018 to 2024

Treatment

options

Lifestyle

factors

Aging

population

In millions

I


6



1 2 3

Drug costs


bull 340B

reimbursement


bull Pathways


bull Site-of-care

policies


bull Network

design

bull Centers of

excellence



7


1 Drug costs


Amazon-PillPack








benefit spend








Walgreens





13



8









Medicare advantage










Drug Prices Act






their insurance

Drug pricing

transparency

Proposed CMS rule

would require drug



to-consumer

advertisements


9














price plus 623

Subset of Part B

single-source drugs

and biologicals in

select geographic





Physician-

administered

drugs






80


Drugs in

model

1

2

3


10








list price








of sale








Monthly premiums

Out-of-pocket costs


one analysis


another analysis


11




Consortium (vi3c)



improving access




comparing regimens







1 2 3


Initiative (IVI)





and interests



EGFR+ NSCLC



sequencing based on


outcomes








appropriate pricing


outcomes



clinical and cost




health systems)


12





The burden of prior





past 12 months



oncology costs








treatment pathways1

Exploring clinical

pathways programs

Cancer Care Quality

Program



Oncology Program



13
















more patientsrdquo1






Legal update






14



6

46

2004 2014



For private payers




42

Brand namePhysician

officeHospital

outpatient


Rituxan $7328 $11451

Avastin $2415 $9471

Remicade $4691 $10995

2 Site of care





15




Commercial health

plan goals

Cost-containment

programs



exception

Contact patients to


site of care




12

64




next 12-24 months




next 12-24 months





19


16





2016



2017



2018



2019



$110

$192

$159

$124

Physicianoffice

2018 2019 2020


Off-campus HOPDs

13 difference in

reimbursement rate

by 2020



17




















hospital facility





main hospital


Change in HOPD and



Two Ways


18



3 Provider choice


28 27

4146

2013 2014 2015 2016




cancer-related





$264B



19





Activation




Drop coverage




Shift risk




Manage proactively




20




3

9

18

12

16

26

22

19

39

50

31

30

31

19

15

Cancer

Cardiovascular

Knees hips or

spine

Bariatric surgery

Transplants










traveling to Mayo



CASE EXAMPLE

30of eligible

employees travel

to Mayo for care



changed


21



top cost priority










22

The margin problem





2009-2017 medians

2

4

6

8

2010 2012 2014 2016 2018


Staffing


pressures

Drugs and supplies

Capital investments

Service utilization


23













Gaps in Performance



Navigation



Assistance




Marketing



Strategy




Contain cost

growth

Maximize revenue

capture

Capture new

growth


24









~$400Kgt$1M$500K-$1M


treatment options

Increasing consumer

demands




over volume



prolonged period of






spur investment in


despite unclear

reimbursement




for care





Shifting payment

models

Sample costs


25



Ma

rgin

s

Value-based care


Patient experience


Staffing

Drugs and supplies

Capital investments

Service utilization

1

2

3


ROAD MAP26





27









Bundled payments










Collaborative













28





bull 10 payers

bull CMS

Who is

participating





How are

practices paid


quality performance







the IOM









29




=


Quality





= Costs



Key caveats





37

33

27

27

24

31

12

8

Loweredcost ofcare

Increasedquality of

care






30

Dec

PP1 external

evaluation

published






July-Sept

Measurement

Period 1

July 1

OCM begins

w ith 190

participating

practices

June 30

End of

Performance

Period 1

Nov-Dec

OCM registry

available to

report clinical

and quality data

June 30

Anticipated

performance

period end date

201820172016 2019 2020 2021

Summer-Fall





Jan 1

Practices can

enter into either

tw o-sided risk

option

PP1 PP2

25 30


a bonus

PP31

33






31



Risk Arrangement




based onhellip



calculated onhellip




truehellip



differencehellip





32




Program performance

year

Number of

ACOs


savings




PY1 2012-2013 220 26 27 47 ($78M)

PY 2014 333 28 27 46 ($50M)

PY 2015 392 31 21 48 ($216M)

PY 2016 432 31 25 44 ($39M)

PY 2017 472 34 26 39 $314


33





Track 1



BASIC Track

5-year agreement




Track 2



Track 3


ENHANCED Track



34



Comprehensive

Cancer Care

Delivery Model

Patient-Centered

Oncology Payment

Model (PCOP)

1 2 3

















Making Accountable


Networks (MASON)







35







to participate




constructed


that bill globally






hospital and







36




investment roadmap












37















At-home DNA repair




38






increase in five-




2x


year survival for



214

201

187

172

156

1992 1998 2004 2010 2016





39


Prevalence


Tra

nsfo

rma

tive

po

ten

tia

l o

ve

r n

ext 3

-5 y

ea

rs



Liquidbiopsies

Breathalyzer


Oncolyticvaccines




Hormone therapy


Multi-gene panels





40



Cancer detection





Blood vessel

ctDNA1

Blood cell

ctDNA extracted




1

2

3















41






breathalyzer test


86





Instant results


bull Lung cancer



bull Ovarian cancer

bull Bladder cancer


bull Kidney cancer

bull Gastric cancer





bull Atypical

Parkinsonism



Hypertension

bull Pre-eclampsia




42





46

30

17

18

19

15

9

5

22

35

44

36

9

10

17

17

6

12

14

25

Liquid biopsy


sequencing

Multigene panel


0 1-10 10-25 25-50 gt50


n=200



each test

30

24

17

10


43







end of 2018



5

22 of alterations

identified by both

tests were

concordant

25 of drugs were

recommended for

the same patients

by both platforms

Currently covers



cancer type

Does not cover




on NGS testing



13

22

38FDA-approved


Multi-gene panels

Whole-exome

sequencing

n=100


44















tumors




Near-infrared

spectroscopy







877


45







healthy copy







1

2


Mechanism Outcome


cell types







144


46





(pemprolizumab)













to pembrolizumab



tumor shrinking




1

2

3



47




72

33

25

19




Tumor site 2014-2015 2016-2017

Lung 14 305


Kidney 05 441

Melanoma 564 824

Cost

reimbursement

Availability

access to drugs

Knowledge

of new

drugs

Comfort

managing side

effects




33


48








Kymriah injection









therapies









Select toxicities

bull Delirium

bull Anaphalaxis

bull Autoimmune

response


effects


syndrome


49






2017




2018





2019







Seema Verma

CMS Administrator


50




7

4

4

9

8

11

26

15

6

44

40

34

15

33

45







n=100





51

















52





Rising expectations

for service


care information





reviews


MinuteClinic)



1 2


Growing price

sensitivity





3


53






investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4










54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




5




160

178

194

2017 2022 2027


cases in the US











from 2018 to 2024

Treatment

options

Lifestyle

factors

Aging

population

In millions

I


6



1 2 3

Drug costs


bull 340B

reimbursement


bull Pathways


bull Site-of-care

policies


bull Network

design

bull Centers of

excellence



7


1 Drug costs


Amazon-PillPack








benefit spend








Walgreens





13



8









Medicare advantage










Drug Prices Act






their insurance

Drug pricing

transparency

Proposed CMS rule

would require drug



to-consumer

advertisements


9














price plus 623

Subset of Part B

single-source drugs

and biologicals in

select geographic





Physician-

administered

drugs






80


Drugs in

model

1

2

3


10








list price








of sale








Monthly premiums

Out-of-pocket costs


one analysis


another analysis


11




Consortium (vi3c)



improving access




comparing regimens







1 2 3


Initiative (IVI)





and interests



EGFR+ NSCLC



sequencing based on


outcomes








appropriate pricing


outcomes



clinical and cost




health systems)


12





The burden of prior





past 12 months



oncology costs








treatment pathways1

Exploring clinical

pathways programs

Cancer Care Quality

Program



Oncology Program



13
















more patientsrdquo1






Legal update






14



6

46

2004 2014



For private payers




42

Brand namePhysician

officeHospital

outpatient


Rituxan $7328 $11451

Avastin $2415 $9471

Remicade $4691 $10995

2 Site of care





15




Commercial health

plan goals

Cost-containment

programs



exception

Contact patients to


site of care




12

64




next 12-24 months




next 12-24 months





19


16





2016



2017



2018



2019



$110

$192

$159

$124

Physicianoffice

2018 2019 2020


Off-campus HOPDs

13 difference in

reimbursement rate

by 2020



17




















hospital facility





main hospital


Change in HOPD and



Two Ways


18



3 Provider choice


28 27

4146

2013 2014 2015 2016




cancer-related





$264B



19





Activation




Drop coverage




Shift risk




Manage proactively




20




3

9

18

12

16

26

22

19

39

50

31

30

31

19

15

Cancer

Cardiovascular

Knees hips or

spine

Bariatric surgery

Transplants










traveling to Mayo



CASE EXAMPLE

30of eligible

employees travel

to Mayo for care



changed


21



top cost priority










22

The margin problem





2009-2017 medians

2

4

6

8

2010 2012 2014 2016 2018


Staffing


pressures

Drugs and supplies

Capital investments

Service utilization


23













Gaps in Performance



Navigation



Assistance




Marketing



Strategy




Contain cost

growth

Maximize revenue

capture

Capture new

growth


24









~$400Kgt$1M$500K-$1M


treatment options

Increasing consumer

demands




over volume



prolonged period of






spur investment in


despite unclear

reimbursement




for care





Shifting payment

models

Sample costs


25



Ma

rgin

s

Value-based care


Patient experience


Staffing

Drugs and supplies

Capital investments

Service utilization

1

2

3


ROAD MAP26





27









Bundled payments










Collaborative













28





bull 10 payers

bull CMS

Who is

participating





How are

practices paid


quality performance







the IOM









29




=


Quality





= Costs



Key caveats





37

33

27

27

24

31

12

8

Loweredcost ofcare

Increasedquality of

care






30

Dec

PP1 external

evaluation

published






July-Sept

Measurement

Period 1

July 1

OCM begins

w ith 190

participating

practices

June 30

End of

Performance

Period 1

Nov-Dec

OCM registry

available to

report clinical

and quality data

June 30

Anticipated

performance

period end date

201820172016 2019 2020 2021

Summer-Fall





Jan 1

Practices can

enter into either

tw o-sided risk

option

PP1 PP2

25 30


a bonus

PP31

33






31



Risk Arrangement




based onhellip



calculated onhellip




truehellip



differencehellip





32




Program performance

year

Number of

ACOs


savings




PY1 2012-2013 220 26 27 47 ($78M)

PY 2014 333 28 27 46 ($50M)

PY 2015 392 31 21 48 ($216M)

PY 2016 432 31 25 44 ($39M)

PY 2017 472 34 26 39 $314


33





Track 1



BASIC Track

5-year agreement




Track 2



Track 3


ENHANCED Track



34



Comprehensive

Cancer Care

Delivery Model

Patient-Centered

Oncology Payment

Model (PCOP)

1 2 3

















Making Accountable


Networks (MASON)







35







to participate




constructed


that bill globally






hospital and







36




investment roadmap












37















At-home DNA repair




38






increase in five-




2x


year survival for



214

201

187

172

156

1992 1998 2004 2010 2016





39


Prevalence


Tra

nsfo

rma

tive

po

ten

tia

l o

ve

r n

ext 3

-5 y

ea

rs



Liquidbiopsies

Breathalyzer


Oncolyticvaccines




Hormone therapy


Multi-gene panels





40



Cancer detection





Blood vessel

ctDNA1

Blood cell

ctDNA extracted




1

2

3















41






breathalyzer test


86





Instant results


bull Lung cancer



bull Ovarian cancer

bull Bladder cancer


bull Kidney cancer

bull Gastric cancer





bull Atypical

Parkinsonism



Hypertension

bull Pre-eclampsia




42





46

30

17

18

19

15

9

5

22

35

44

36

9

10

17

17

6

12

14

25

Liquid biopsy


sequencing

Multigene panel


0 1-10 10-25 25-50 gt50


n=200



each test

30

24

17

10


43







end of 2018



5

22 of alterations

identified by both

tests were

concordant

25 of drugs were

recommended for

the same patients

by both platforms

Currently covers



cancer type

Does not cover




on NGS testing



13

22

38FDA-approved


Multi-gene panels

Whole-exome

sequencing

n=100


44















tumors




Near-infrared

spectroscopy







877


45







healthy copy







1

2


Mechanism Outcome


cell types







144


46





(pemprolizumab)













to pembrolizumab



tumor shrinking




1

2

3



47




72

33

25

19




Tumor site 2014-2015 2016-2017

Lung 14 305


Kidney 05 441

Melanoma 564 824

Cost

reimbursement

Availability

access to drugs

Knowledge

of new

drugs

Comfort

managing side

effects




33


48








Kymriah injection









therapies









Select toxicities

bull Delirium

bull Anaphalaxis

bull Autoimmune

response


effects


syndrome


49






2017




2018





2019







Seema Verma

CMS Administrator


50




7

4

4

9

8

11

26

15

6

44

40

34

15

33

45







n=100





51

















52





Rising expectations

for service


care information





reviews


MinuteClinic)



1 2


Growing price

sensitivity





3


53






investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4










54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




6



1 2 3

Drug costs


bull 340B

reimbursement


bull Pathways


bull Site-of-care

policies


bull Network

design

bull Centers of

excellence



7


1 Drug costs


Amazon-PillPack








benefit spend








Walgreens





13



8









Medicare advantage










Drug Prices Act






their insurance

Drug pricing

transparency

Proposed CMS rule

would require drug



to-consumer

advertisements


9














price plus 623

Subset of Part B

single-source drugs

and biologicals in

select geographic





Physician-

administered

drugs






80


Drugs in

model

1

2

3


10








list price








of sale








Monthly premiums

Out-of-pocket costs


one analysis


another analysis


11




Consortium (vi3c)



improving access




comparing regimens







1 2 3


Initiative (IVI)





and interests



EGFR+ NSCLC



sequencing based on


outcomes








appropriate pricing


outcomes



clinical and cost




health systems)


12





The burden of prior





past 12 months



oncology costs








treatment pathways1

Exploring clinical

pathways programs

Cancer Care Quality

Program



Oncology Program



13
















more patientsrdquo1






Legal update






14



6

46

2004 2014



For private payers




42

Brand namePhysician

officeHospital

outpatient


Rituxan $7328 $11451

Avastin $2415 $9471

Remicade $4691 $10995

2 Site of care





15




Commercial health

plan goals

Cost-containment

programs



exception

Contact patients to


site of care




12

64




next 12-24 months




next 12-24 months





19


16





2016



2017



2018



2019



$110

$192

$159

$124

Physicianoffice

2018 2019 2020


Off-campus HOPDs

13 difference in

reimbursement rate

by 2020



17




















hospital facility





main hospital


Change in HOPD and



Two Ways


18



3 Provider choice


28 27

4146

2013 2014 2015 2016




cancer-related





$264B



19





Activation




Drop coverage




Shift risk




Manage proactively




20




3

9

18

12

16

26

22

19

39

50

31

30

31

19

15

Cancer

Cardiovascular

Knees hips or

spine

Bariatric surgery

Transplants










traveling to Mayo



CASE EXAMPLE

30of eligible

employees travel

to Mayo for care



changed


21



top cost priority










22

The margin problem





2009-2017 medians

2

4

6

8

2010 2012 2014 2016 2018


Staffing


pressures

Drugs and supplies

Capital investments

Service utilization


23













Gaps in Performance



Navigation



Assistance




Marketing



Strategy




Contain cost

growth

Maximize revenue

capture

Capture new

growth


24









~$400Kgt$1M$500K-$1M


treatment options

Increasing consumer

demands




over volume



prolonged period of






spur investment in


despite unclear

reimbursement




for care





Shifting payment

models

Sample costs


25



Ma

rgin

s

Value-based care


Patient experience


Staffing

Drugs and supplies

Capital investments

Service utilization

1

2

3


ROAD MAP26





27









Bundled payments










Collaborative













28





bull 10 payers

bull CMS

Who is

participating





How are

practices paid


quality performance







the IOM









29




=


Quality





= Costs



Key caveats





37

33

27

27

24

31

12

8

Loweredcost ofcare

Increasedquality of

care






30

Dec

PP1 external

evaluation

published






July-Sept

Measurement

Period 1

July 1

OCM begins

w ith 190

participating

practices

June 30

End of

Performance

Period 1

Nov-Dec

OCM registry

available to

report clinical

and quality data

June 30

Anticipated

performance

period end date

201820172016 2019 2020 2021

Summer-Fall





Jan 1

Practices can

enter into either

tw o-sided risk

option

PP1 PP2

25 30


a bonus

PP31

33






31



Risk Arrangement




based onhellip



calculated onhellip




truehellip



differencehellip





32




Program performance

year

Number of

ACOs


savings




PY1 2012-2013 220 26 27 47 ($78M)

PY 2014 333 28 27 46 ($50M)

PY 2015 392 31 21 48 ($216M)

PY 2016 432 31 25 44 ($39M)

PY 2017 472 34 26 39 $314


33





Track 1



BASIC Track

5-year agreement




Track 2



Track 3


ENHANCED Track



34



Comprehensive

Cancer Care

Delivery Model

Patient-Centered

Oncology Payment

Model (PCOP)

1 2 3

















Making Accountable


Networks (MASON)







35







to participate




constructed


that bill globally






hospital and







36




investment roadmap












37















At-home DNA repair




38






increase in five-




2x


year survival for



214

201

187

172

156

1992 1998 2004 2010 2016





39


Prevalence


Tra

nsfo

rma

tive

po

ten

tia

l o

ve

r n

ext 3

-5 y

ea

rs



Liquidbiopsies

Breathalyzer


Oncolyticvaccines




Hormone therapy


Multi-gene panels





40



Cancer detection





Blood vessel

ctDNA1

Blood cell

ctDNA extracted




1

2

3















41






breathalyzer test


86





Instant results


bull Lung cancer



bull Ovarian cancer

bull Bladder cancer


bull Kidney cancer

bull Gastric cancer





bull Atypical

Parkinsonism



Hypertension

bull Pre-eclampsia




42





46

30

17

18

19

15

9

5

22

35

44

36

9

10

17

17

6

12

14

25

Liquid biopsy


sequencing

Multigene panel


0 1-10 10-25 25-50 gt50


n=200



each test

30

24

17

10


43







end of 2018



5

22 of alterations

identified by both

tests were

concordant

25 of drugs were

recommended for

the same patients

by both platforms

Currently covers



cancer type

Does not cover




on NGS testing



13

22

38FDA-approved


Multi-gene panels

Whole-exome

sequencing

n=100


44















tumors




Near-infrared

spectroscopy







877


45







healthy copy







1

2


Mechanism Outcome


cell types







144


46





(pemprolizumab)













to pembrolizumab



tumor shrinking




1

2

3



47




72

33

25

19




Tumor site 2014-2015 2016-2017

Lung 14 305


Kidney 05 441

Melanoma 564 824

Cost

reimbursement

Availability

access to drugs

Knowledge

of new

drugs

Comfort

managing side

effects




33


48








Kymriah injection









therapies









Select toxicities

bull Delirium

bull Anaphalaxis

bull Autoimmune

response


effects


syndrome


49






2017




2018





2019







Seema Verma

CMS Administrator


50




7

4

4

9

8

11

26

15

6

44

40

34

15

33

45







n=100





51

















52





Rising expectations

for service


care information





reviews


MinuteClinic)



1 2


Growing price

sensitivity





3


53






investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4










54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




7


1 Drug costs


Amazon-PillPack








benefit spend








Walgreens





13



8









Medicare advantage










Drug Prices Act






their insurance

Drug pricing

transparency

Proposed CMS rule

would require drug



to-consumer

advertisements


9














price plus 623

Subset of Part B

single-source drugs

and biologicals in

select geographic





Physician-

administered

drugs






80


Drugs in

model

1

2

3


10








list price








of sale








Monthly premiums

Out-of-pocket costs


one analysis


another analysis


11




Consortium (vi3c)



improving access




comparing regimens







1 2 3


Initiative (IVI)





and interests



EGFR+ NSCLC



sequencing based on


outcomes








appropriate pricing


outcomes



clinical and cost




health systems)


12





The burden of prior





past 12 months



oncology costs








treatment pathways1

Exploring clinical

pathways programs

Cancer Care Quality

Program



Oncology Program



13
















more patientsrdquo1






Legal update






14



6

46

2004 2014



For private payers




42

Brand namePhysician

officeHospital

outpatient


Rituxan $7328 $11451

Avastin $2415 $9471

Remicade $4691 $10995

2 Site of care





15




Commercial health

plan goals

Cost-containment

programs



exception

Contact patients to


site of care




12

64




next 12-24 months




next 12-24 months





19


16





2016



2017



2018



2019



$110

$192

$159

$124

Physicianoffice

2018 2019 2020


Off-campus HOPDs

13 difference in

reimbursement rate

by 2020



17




















hospital facility





main hospital


Change in HOPD and



Two Ways


18



3 Provider choice


28 27

4146

2013 2014 2015 2016




cancer-related





$264B



19





Activation




Drop coverage




Shift risk




Manage proactively




20




3

9

18

12

16

26

22

19

39

50

31

30

31

19

15

Cancer

Cardiovascular

Knees hips or

spine

Bariatric surgery

Transplants










traveling to Mayo



CASE EXAMPLE

30of eligible

employees travel

to Mayo for care



changed


21



top cost priority










22

The margin problem





2009-2017 medians

2

4

6

8

2010 2012 2014 2016 2018


Staffing


pressures

Drugs and supplies

Capital investments

Service utilization


23













Gaps in Performance



Navigation



Assistance




Marketing



Strategy




Contain cost

growth

Maximize revenue

capture

Capture new

growth


24









~$400Kgt$1M$500K-$1M


treatment options

Increasing consumer

demands




over volume



prolonged period of






spur investment in


despite unclear

reimbursement




for care





Shifting payment

models

Sample costs


25



Ma

rgin

s

Value-based care


Patient experience


Staffing

Drugs and supplies

Capital investments

Service utilization

1

2

3


ROAD MAP26





27









Bundled payments










Collaborative













28





bull 10 payers

bull CMS

Who is

participating





How are

practices paid


quality performance







the IOM









29




=


Quality





= Costs



Key caveats





37

33

27

27

24

31

12

8

Loweredcost ofcare

Increasedquality of

care






30

Dec

PP1 external

evaluation

published






July-Sept

Measurement

Period 1

July 1

OCM begins

w ith 190

participating

practices

June 30

End of

Performance

Period 1

Nov-Dec

OCM registry

available to

report clinical

and quality data

June 30

Anticipated

performance

period end date

201820172016 2019 2020 2021

Summer-Fall





Jan 1

Practices can

enter into either

tw o-sided risk

option

PP1 PP2

25 30


a bonus

PP31

33






31



Risk Arrangement




based onhellip



calculated onhellip




truehellip



differencehellip





32




Program performance

year

Number of

ACOs


savings




PY1 2012-2013 220 26 27 47 ($78M)

PY 2014 333 28 27 46 ($50M)

PY 2015 392 31 21 48 ($216M)

PY 2016 432 31 25 44 ($39M)

PY 2017 472 34 26 39 $314


33





Track 1



BASIC Track

5-year agreement




Track 2



Track 3


ENHANCED Track



34



Comprehensive

Cancer Care

Delivery Model

Patient-Centered

Oncology Payment

Model (PCOP)

1 2 3

















Making Accountable


Networks (MASON)







35







to participate




constructed


that bill globally






hospital and







36




investment roadmap












37















At-home DNA repair




38






increase in five-




2x


year survival for



214

201

187

172

156

1992 1998 2004 2010 2016





39


Prevalence


Tra

nsfo

rma

tive

po

ten

tia

l o

ve

r n

ext 3

-5 y

ea

rs



Liquidbiopsies

Breathalyzer


Oncolyticvaccines




Hormone therapy


Multi-gene panels





40



Cancer detection





Blood vessel

ctDNA1

Blood cell

ctDNA extracted




1

2

3















41






breathalyzer test


86





Instant results


bull Lung cancer



bull Ovarian cancer

bull Bladder cancer


bull Kidney cancer

bull Gastric cancer





bull Atypical

Parkinsonism



Hypertension

bull Pre-eclampsia




42





46

30

17

18

19

15

9

5

22

35

44

36

9

10

17

17

6

12

14

25

Liquid biopsy


sequencing

Multigene panel


0 1-10 10-25 25-50 gt50


n=200



each test

30

24

17

10


43







end of 2018



5

22 of alterations

identified by both

tests were

concordant

25 of drugs were

recommended for

the same patients

by both platforms

Currently covers



cancer type

Does not cover




on NGS testing



13

22

38FDA-approved


Multi-gene panels

Whole-exome

sequencing

n=100


44















tumors




Near-infrared

spectroscopy







877


45







healthy copy







1

2


Mechanism Outcome


cell types







144


46





(pemprolizumab)













to pembrolizumab



tumor shrinking




1

2

3



47




72

33

25

19




Tumor site 2014-2015 2016-2017

Lung 14 305


Kidney 05 441

Melanoma 564 824

Cost

reimbursement

Availability

access to drugs

Knowledge

of new

drugs

Comfort

managing side

effects




33


48








Kymriah injection









therapies









Select toxicities

bull Delirium

bull Anaphalaxis

bull Autoimmune

response


effects


syndrome


49






2017




2018





2019







Seema Verma

CMS Administrator


50




7

4

4

9

8

11

26

15

6

44

40

34

15

33

45







n=100





51

















52





Rising expectations

for service


care information





reviews


MinuteClinic)



1 2


Growing price

sensitivity





3


53






investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4










54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




8









Medicare advantage










Drug Prices Act






their insurance

Drug pricing

transparency

Proposed CMS rule

would require drug



to-consumer

advertisements


9














price plus 623

Subset of Part B

single-source drugs

and biologicals in

select geographic





Physician-

administered

drugs






80


Drugs in

model

1

2

3


10








list price








of sale








Monthly premiums

Out-of-pocket costs


one analysis


another analysis


11




Consortium (vi3c)



improving access




comparing regimens







1 2 3


Initiative (IVI)





and interests



EGFR+ NSCLC



sequencing based on


outcomes








appropriate pricing


outcomes



clinical and cost




health systems)


12





The burden of prior





past 12 months



oncology costs








treatment pathways1

Exploring clinical

pathways programs

Cancer Care Quality

Program



Oncology Program



13
















more patientsrdquo1






Legal update






14



6

46

2004 2014



For private payers




42

Brand namePhysician

officeHospital

outpatient


Rituxan $7328 $11451

Avastin $2415 $9471

Remicade $4691 $10995

2 Site of care





15




Commercial health

plan goals

Cost-containment

programs



exception

Contact patients to


site of care




12

64




next 12-24 months




next 12-24 months





19


16





2016



2017



2018



2019



$110

$192

$159

$124

Physicianoffice

2018 2019 2020


Off-campus HOPDs

13 difference in

reimbursement rate

by 2020



17




















hospital facility





main hospital


Change in HOPD and



Two Ways


18



3 Provider choice


28 27

4146

2013 2014 2015 2016




cancer-related





$264B



19





Activation




Drop coverage




Shift risk




Manage proactively




20




3

9

18

12

16

26

22

19

39

50

31

30

31

19

15

Cancer

Cardiovascular

Knees hips or

spine

Bariatric surgery

Transplants










traveling to Mayo



CASE EXAMPLE

30of eligible

employees travel

to Mayo for care



changed


21



top cost priority










22

The margin problem





2009-2017 medians

2

4

6

8

2010 2012 2014 2016 2018


Staffing


pressures

Drugs and supplies

Capital investments

Service utilization


23













Gaps in Performance



Navigation



Assistance




Marketing



Strategy




Contain cost

growth

Maximize revenue

capture

Capture new

growth


24









~$400Kgt$1M$500K-$1M


treatment options

Increasing consumer

demands




over volume



prolonged period of






spur investment in


despite unclear

reimbursement




for care





Shifting payment

models

Sample costs


25



Ma

rgin

s

Value-based care


Patient experience


Staffing

Drugs and supplies

Capital investments

Service utilization

1

2

3


ROAD MAP26





27









Bundled payments










Collaborative













28





bull 10 payers

bull CMS

Who is

participating





How are

practices paid


quality performance







the IOM









29




=


Quality





= Costs



Key caveats





37

33

27

27

24

31

12

8

Loweredcost ofcare

Increasedquality of

care






30

Dec

PP1 external

evaluation

published






July-Sept

Measurement

Period 1

July 1

OCM begins

w ith 190

participating

practices

June 30

End of

Performance

Period 1

Nov-Dec

OCM registry

available to

report clinical

and quality data

June 30

Anticipated

performance

period end date

201820172016 2019 2020 2021

Summer-Fall





Jan 1

Practices can

enter into either

tw o-sided risk

option

PP1 PP2

25 30


a bonus

PP31

33






31



Risk Arrangement




based onhellip



calculated onhellip




truehellip



differencehellip





32




Program performance

year

Number of

ACOs


savings




PY1 2012-2013 220 26 27 47 ($78M)

PY 2014 333 28 27 46 ($50M)

PY 2015 392 31 21 48 ($216M)

PY 2016 432 31 25 44 ($39M)

PY 2017 472 34 26 39 $314


33





Track 1



BASIC Track

5-year agreement




Track 2



Track 3


ENHANCED Track



34



Comprehensive

Cancer Care

Delivery Model

Patient-Centered

Oncology Payment

Model (PCOP)

1 2 3

















Making Accountable


Networks (MASON)







35







to participate




constructed


that bill globally






hospital and







36




investment roadmap












37















At-home DNA repair




38






increase in five-




2x


year survival for



214

201

187

172

156

1992 1998 2004 2010 2016





39


Prevalence


Tra

nsfo

rma

tive

po

ten

tia

l o

ve

r n

ext 3

-5 y

ea

rs



Liquidbiopsies

Breathalyzer


Oncolyticvaccines




Hormone therapy


Multi-gene panels





40



Cancer detection





Blood vessel

ctDNA1

Blood cell

ctDNA extracted




1

2

3















41






breathalyzer test


86





Instant results


bull Lung cancer



bull Ovarian cancer

bull Bladder cancer


bull Kidney cancer

bull Gastric cancer





bull Atypical

Parkinsonism



Hypertension

bull Pre-eclampsia




42





46

30

17

18

19

15

9

5

22

35

44

36

9

10

17

17

6

12

14

25

Liquid biopsy


sequencing

Multigene panel


0 1-10 10-25 25-50 gt50


n=200



each test

30

24

17

10


43







end of 2018



5

22 of alterations

identified by both

tests were

concordant

25 of drugs were

recommended for

the same patients

by both platforms

Currently covers



cancer type

Does not cover




on NGS testing



13

22

38FDA-approved


Multi-gene panels

Whole-exome

sequencing

n=100


44















tumors




Near-infrared

spectroscopy







877


45







healthy copy







1

2


Mechanism Outcome


cell types







144


46





(pemprolizumab)













to pembrolizumab



tumor shrinking




1

2

3



47




72

33

25

19




Tumor site 2014-2015 2016-2017

Lung 14 305


Kidney 05 441

Melanoma 564 824

Cost

reimbursement

Availability

access to drugs

Knowledge

of new

drugs

Comfort

managing side

effects




33


48








Kymriah injection









therapies









Select toxicities

bull Delirium

bull Anaphalaxis

bull Autoimmune

response


effects


syndrome


49






2017




2018





2019







Seema Verma

CMS Administrator


50




7

4

4

9

8

11

26

15

6

44

40

34

15

33

45







n=100





51

















52





Rising expectations

for service


care information





reviews


MinuteClinic)



1 2


Growing price

sensitivity





3


53






investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4










54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




9














price plus 623

Subset of Part B

single-source drugs

and biologicals in

select geographic





Physician-

administered

drugs






80


Drugs in

model

1

2

3


10








list price








of sale








Monthly premiums

Out-of-pocket costs


one analysis


another analysis


11




Consortium (vi3c)



improving access




comparing regimens







1 2 3


Initiative (IVI)





and interests



EGFR+ NSCLC



sequencing based on


outcomes








appropriate pricing


outcomes



clinical and cost




health systems)


12





The burden of prior





past 12 months



oncology costs








treatment pathways1

Exploring clinical

pathways programs

Cancer Care Quality

Program



Oncology Program



13
















more patientsrdquo1






Legal update






14



6

46

2004 2014



For private payers




42

Brand namePhysician

officeHospital

outpatient


Rituxan $7328 $11451

Avastin $2415 $9471

Remicade $4691 $10995

2 Site of care





15




Commercial health

plan goals

Cost-containment

programs



exception

Contact patients to


site of care




12

64




next 12-24 months




next 12-24 months





19


16





2016



2017



2018



2019



$110

$192

$159

$124

Physicianoffice

2018 2019 2020


Off-campus HOPDs

13 difference in

reimbursement rate

by 2020



17




















hospital facility





main hospital


Change in HOPD and



Two Ways


18



3 Provider choice


28 27

4146

2013 2014 2015 2016




cancer-related





$264B



19





Activation




Drop coverage




Shift risk




Manage proactively




20




3

9

18

12

16

26

22

19

39

50

31

30

31

19

15

Cancer

Cardiovascular

Knees hips or

spine

Bariatric surgery

Transplants










traveling to Mayo



CASE EXAMPLE

30of eligible

employees travel

to Mayo for care



changed


21



top cost priority










22

The margin problem





2009-2017 medians

2

4

6

8

2010 2012 2014 2016 2018


Staffing


pressures

Drugs and supplies

Capital investments

Service utilization


23













Gaps in Performance



Navigation



Assistance




Marketing



Strategy




Contain cost

growth

Maximize revenue

capture

Capture new

growth


24









~$400Kgt$1M$500K-$1M


treatment options

Increasing consumer

demands




over volume



prolonged period of






spur investment in


despite unclear

reimbursement




for care





Shifting payment

models

Sample costs


25



Ma

rgin

s

Value-based care


Patient experience


Staffing

Drugs and supplies

Capital investments

Service utilization

1

2

3


ROAD MAP26





27









Bundled payments










Collaborative













28





bull 10 payers

bull CMS

Who is

participating





How are

practices paid


quality performance







the IOM









29




=


Quality





= Costs



Key caveats





37

33

27

27

24

31

12

8

Loweredcost ofcare

Increasedquality of

care






30

Dec

PP1 external

evaluation

published






July-Sept

Measurement

Period 1

July 1

OCM begins

w ith 190

participating

practices

June 30

End of

Performance

Period 1

Nov-Dec

OCM registry

available to

report clinical

and quality data

June 30

Anticipated

performance

period end date

201820172016 2019 2020 2021

Summer-Fall





Jan 1

Practices can

enter into either

tw o-sided risk

option

PP1 PP2

25 30


a bonus

PP31

33






31



Risk Arrangement




based onhellip



calculated onhellip




truehellip



differencehellip





32




Program performance

year

Number of

ACOs


savings




PY1 2012-2013 220 26 27 47 ($78M)

PY 2014 333 28 27 46 ($50M)

PY 2015 392 31 21 48 ($216M)

PY 2016 432 31 25 44 ($39M)

PY 2017 472 34 26 39 $314


33





Track 1



BASIC Track

5-year agreement




Track 2



Track 3


ENHANCED Track



34



Comprehensive

Cancer Care

Delivery Model

Patient-Centered

Oncology Payment

Model (PCOP)

1 2 3

















Making Accountable


Networks (MASON)







35







to participate




constructed


that bill globally






hospital and







36




investment roadmap












37















At-home DNA repair




38






increase in five-




2x


year survival for



214

201

187

172

156

1992 1998 2004 2010 2016





39


Prevalence


Tra

nsfo

rma

tive

po

ten

tia

l o

ve

r n

ext 3

-5 y

ea

rs



Liquidbiopsies

Breathalyzer


Oncolyticvaccines




Hormone therapy


Multi-gene panels





40



Cancer detection





Blood vessel

ctDNA1

Blood cell

ctDNA extracted




1

2

3















41






breathalyzer test


86





Instant results


bull Lung cancer



bull Ovarian cancer

bull Bladder cancer


bull Kidney cancer

bull Gastric cancer





bull Atypical

Parkinsonism



Hypertension

bull Pre-eclampsia




42





46

30

17

18

19

15

9

5

22

35

44

36

9

10

17

17

6

12

14

25

Liquid biopsy


sequencing

Multigene panel


0 1-10 10-25 25-50 gt50


n=200



each test

30

24

17

10


43







end of 2018



5

22 of alterations

identified by both

tests were

concordant

25 of drugs were

recommended for

the same patients

by both platforms

Currently covers



cancer type

Does not cover




on NGS testing



13

22

38FDA-approved


Multi-gene panels

Whole-exome

sequencing

n=100


44















tumors




Near-infrared

spectroscopy







877


45







healthy copy







1

2


Mechanism Outcome


cell types







144


46





(pemprolizumab)













to pembrolizumab



tumor shrinking




1

2

3



47




72

33

25

19




Tumor site 2014-2015 2016-2017

Lung 14 305


Kidney 05 441

Melanoma 564 824

Cost

reimbursement

Availability

access to drugs

Knowledge

of new

drugs

Comfort

managing side

effects




33


48








Kymriah injection









therapies









Select toxicities

bull Delirium

bull Anaphalaxis

bull Autoimmune

response


effects


syndrome


49






2017




2018





2019







Seema Verma

CMS Administrator


50




7

4

4

9

8

11

26

15

6

44

40

34

15

33

45







n=100





51

















52





Rising expectations

for service


care information





reviews


MinuteClinic)



1 2


Growing price

sensitivity





3


53






investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4










54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




10








list price








of sale








Monthly premiums

Out-of-pocket costs


one analysis


another analysis


11




Consortium (vi3c)



improving access




comparing regimens







1 2 3


Initiative (IVI)





and interests



EGFR+ NSCLC



sequencing based on


outcomes








appropriate pricing


outcomes



clinical and cost




health systems)


12





The burden of prior





past 12 months



oncology costs








treatment pathways1

Exploring clinical

pathways programs

Cancer Care Quality

Program



Oncology Program



13
















more patientsrdquo1






Legal update






14



6

46

2004 2014



For private payers




42

Brand namePhysician

officeHospital

outpatient


Rituxan $7328 $11451

Avastin $2415 $9471

Remicade $4691 $10995

2 Site of care





15




Commercial health

plan goals

Cost-containment

programs



exception

Contact patients to


site of care




12

64




next 12-24 months




next 12-24 months





19


16





2016



2017



2018



2019



$110

$192

$159

$124

Physicianoffice

2018 2019 2020


Off-campus HOPDs

13 difference in

reimbursement rate

by 2020



17




















hospital facility





main hospital


Change in HOPD and



Two Ways


18



3 Provider choice


28 27

4146

2013 2014 2015 2016




cancer-related





$264B



19





Activation




Drop coverage




Shift risk




Manage proactively




20




3

9

18

12

16

26

22

19

39

50

31

30

31

19

15

Cancer

Cardiovascular

Knees hips or

spine

Bariatric surgery

Transplants










traveling to Mayo



CASE EXAMPLE

30of eligible

employees travel

to Mayo for care



changed


21



top cost priority










22

The margin problem





2009-2017 medians

2

4

6

8

2010 2012 2014 2016 2018


Staffing


pressures

Drugs and supplies

Capital investments

Service utilization


23













Gaps in Performance



Navigation



Assistance




Marketing



Strategy




Contain cost

growth

Maximize revenue

capture

Capture new

growth


24









~$400Kgt$1M$500K-$1M


treatment options

Increasing consumer

demands




over volume



prolonged period of






spur investment in


despite unclear

reimbursement




for care





Shifting payment

models

Sample costs


25



Ma

rgin

s

Value-based care


Patient experience


Staffing

Drugs and supplies

Capital investments

Service utilization

1

2

3


ROAD MAP26





27









Bundled payments










Collaborative













28





bull 10 payers

bull CMS

Who is

participating





How are

practices paid


quality performance







the IOM









29




=


Quality





= Costs



Key caveats





37

33

27

27

24

31

12

8

Loweredcost ofcare

Increasedquality of

care






30

Dec

PP1 external

evaluation

published






July-Sept

Measurement

Period 1

July 1

OCM begins

w ith 190

participating

practices

June 30

End of

Performance

Period 1

Nov-Dec

OCM registry

available to

report clinical

and quality data

June 30

Anticipated

performance

period end date

201820172016 2019 2020 2021

Summer-Fall





Jan 1

Practices can

enter into either

tw o-sided risk

option

PP1 PP2

25 30


a bonus

PP31

33






31



Risk Arrangement




based onhellip



calculated onhellip




truehellip



differencehellip





32




Program performance

year

Number of

ACOs


savings




PY1 2012-2013 220 26 27 47 ($78M)

PY 2014 333 28 27 46 ($50M)

PY 2015 392 31 21 48 ($216M)

PY 2016 432 31 25 44 ($39M)

PY 2017 472 34 26 39 $314


33





Track 1



BASIC Track

5-year agreement




Track 2



Track 3


ENHANCED Track



34



Comprehensive

Cancer Care

Delivery Model

Patient-Centered

Oncology Payment

Model (PCOP)

1 2 3

















Making Accountable


Networks (MASON)







35







to participate




constructed


that bill globally






hospital and







36




investment roadmap












37















At-home DNA repair




38






increase in five-




2x


year survival for



214

201

187

172

156

1992 1998 2004 2010 2016





39


Prevalence


Tra

nsfo

rma

tive

po

ten

tia

l o

ve

r n

ext 3

-5 y

ea

rs



Liquidbiopsies

Breathalyzer


Oncolyticvaccines




Hormone therapy


Multi-gene panels





40



Cancer detection





Blood vessel

ctDNA1

Blood cell

ctDNA extracted




1

2

3















41






breathalyzer test


86





Instant results


bull Lung cancer



bull Ovarian cancer

bull Bladder cancer


bull Kidney cancer

bull Gastric cancer





bull Atypical

Parkinsonism



Hypertension

bull Pre-eclampsia




42





46

30

17

18

19

15

9

5

22

35

44

36

9

10

17

17

6

12

14

25

Liquid biopsy


sequencing

Multigene panel


0 1-10 10-25 25-50 gt50


n=200



each test

30

24

17

10


43







end of 2018



5

22 of alterations

identified by both

tests were

concordant

25 of drugs were

recommended for

the same patients

by both platforms

Currently covers



cancer type

Does not cover




on NGS testing



13

22

38FDA-approved


Multi-gene panels

Whole-exome

sequencing

n=100


44















tumors




Near-infrared

spectroscopy







877


45







healthy copy







1

2


Mechanism Outcome


cell types







144


46





(pemprolizumab)













to pembrolizumab



tumor shrinking




1

2

3



47




72

33

25

19




Tumor site 2014-2015 2016-2017

Lung 14 305


Kidney 05 441

Melanoma 564 824

Cost

reimbursement

Availability

access to drugs

Knowledge

of new

drugs

Comfort

managing side

effects




33


48








Kymriah injection









therapies









Select toxicities

bull Delirium

bull Anaphalaxis

bull Autoimmune

response


effects


syndrome


49






2017




2018





2019







Seema Verma

CMS Administrator


50




7

4

4

9

8

11

26

15

6

44

40

34

15

33

45







n=100





51

















52





Rising expectations

for service


care information





reviews


MinuteClinic)



1 2


Growing price

sensitivity





3


53






investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4










54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




11




Consortium (vi3c)



improving access




comparing regimens







1 2 3


Initiative (IVI)





and interests



EGFR+ NSCLC



sequencing based on


outcomes








appropriate pricing


outcomes



clinical and cost




health systems)


12





The burden of prior





past 12 months



oncology costs








treatment pathways1

Exploring clinical

pathways programs

Cancer Care Quality

Program



Oncology Program



13
















more patientsrdquo1






Legal update






14



6

46

2004 2014



For private payers




42

Brand namePhysician

officeHospital

outpatient


Rituxan $7328 $11451

Avastin $2415 $9471

Remicade $4691 $10995

2 Site of care





15




Commercial health

plan goals

Cost-containment

programs



exception

Contact patients to


site of care




12

64




next 12-24 months




next 12-24 months





19


16





2016



2017



2018



2019



$110

$192

$159

$124

Physicianoffice

2018 2019 2020


Off-campus HOPDs

13 difference in

reimbursement rate

by 2020



17




















hospital facility





main hospital


Change in HOPD and



Two Ways


18



3 Provider choice


28 27

4146

2013 2014 2015 2016




cancer-related





$264B



19





Activation




Drop coverage




Shift risk




Manage proactively




20




3

9

18

12

16

26

22

19

39

50

31

30

31

19

15

Cancer

Cardiovascular

Knees hips or

spine

Bariatric surgery

Transplants










traveling to Mayo



CASE EXAMPLE

30of eligible

employees travel

to Mayo for care



changed


21



top cost priority










22

The margin problem





2009-2017 medians

2

4

6

8

2010 2012 2014 2016 2018


Staffing


pressures

Drugs and supplies

Capital investments

Service utilization


23













Gaps in Performance



Navigation



Assistance




Marketing



Strategy




Contain cost

growth

Maximize revenue

capture

Capture new

growth


24









~$400Kgt$1M$500K-$1M


treatment options

Increasing consumer

demands




over volume



prolonged period of






spur investment in


despite unclear

reimbursement




for care





Shifting payment

models

Sample costs


25



Ma

rgin

s

Value-based care


Patient experience


Staffing

Drugs and supplies

Capital investments

Service utilization

1

2

3


ROAD MAP26





27









Bundled payments










Collaborative













28





bull 10 payers

bull CMS

Who is

participating





How are

practices paid


quality performance







the IOM









29




=


Quality





= Costs



Key caveats





37

33

27

27

24

31

12

8

Loweredcost ofcare

Increasedquality of

care






30

Dec

PP1 external

evaluation

published






July-Sept

Measurement

Period 1

July 1

OCM begins

w ith 190

participating

practices

June 30

End of

Performance

Period 1

Nov-Dec

OCM registry

available to

report clinical

and quality data

June 30

Anticipated

performance

period end date

201820172016 2019 2020 2021

Summer-Fall





Jan 1

Practices can

enter into either

tw o-sided risk

option

PP1 PP2

25 30


a bonus

PP31

33






31



Risk Arrangement




based onhellip



calculated onhellip




truehellip



differencehellip





32




Program performance

year

Number of

ACOs


savings




PY1 2012-2013 220 26 27 47 ($78M)

PY 2014 333 28 27 46 ($50M)

PY 2015 392 31 21 48 ($216M)

PY 2016 432 31 25 44 ($39M)

PY 2017 472 34 26 39 $314


33





Track 1



BASIC Track

5-year agreement




Track 2



Track 3


ENHANCED Track



34



Comprehensive

Cancer Care

Delivery Model

Patient-Centered

Oncology Payment

Model (PCOP)

1 2 3

















Making Accountable


Networks (MASON)







35







to participate




constructed


that bill globally






hospital and







36




investment roadmap












37















At-home DNA repair




38






increase in five-




2x


year survival for



214

201

187

172

156

1992 1998 2004 2010 2016





39


Prevalence


Tra

nsfo

rma

tive

po

ten

tia

l o

ve

r n

ext 3

-5 y

ea

rs



Liquidbiopsies

Breathalyzer


Oncolyticvaccines




Hormone therapy


Multi-gene panels





40



Cancer detection





Blood vessel

ctDNA1

Blood cell

ctDNA extracted




1

2

3















41






breathalyzer test


86





Instant results


bull Lung cancer



bull Ovarian cancer

bull Bladder cancer


bull Kidney cancer

bull Gastric cancer





bull Atypical

Parkinsonism



Hypertension

bull Pre-eclampsia




42





46

30

17

18

19

15

9

5

22

35

44

36

9

10

17

17

6

12

14

25

Liquid biopsy


sequencing

Multigene panel


0 1-10 10-25 25-50 gt50


n=200



each test

30

24

17

10


43







end of 2018



5

22 of alterations

identified by both

tests were

concordant

25 of drugs were

recommended for

the same patients

by both platforms

Currently covers



cancer type

Does not cover




on NGS testing



13

22

38FDA-approved


Multi-gene panels

Whole-exome

sequencing

n=100


44















tumors




Near-infrared

spectroscopy







877


45







healthy copy







1

2


Mechanism Outcome


cell types







144


46





(pemprolizumab)













to pembrolizumab



tumor shrinking




1

2

3



47




72

33

25

19




Tumor site 2014-2015 2016-2017

Lung 14 305


Kidney 05 441

Melanoma 564 824

Cost

reimbursement

Availability

access to drugs

Knowledge

of new

drugs

Comfort

managing side

effects




33


48








Kymriah injection









therapies









Select toxicities

bull Delirium

bull Anaphalaxis

bull Autoimmune

response


effects


syndrome


49






2017




2018





2019







Seema Verma

CMS Administrator


50




7

4

4

9

8

11

26

15

6

44

40

34

15

33

45







n=100





51

















52





Rising expectations

for service


care information





reviews


MinuteClinic)



1 2


Growing price

sensitivity





3


53






investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4










54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




12





The burden of prior





past 12 months



oncology costs








treatment pathways1

Exploring clinical

pathways programs

Cancer Care Quality

Program



Oncology Program



13
















more patientsrdquo1






Legal update






14



6

46

2004 2014



For private payers




42

Brand namePhysician

officeHospital

outpatient


Rituxan $7328 $11451

Avastin $2415 $9471

Remicade $4691 $10995

2 Site of care





15




Commercial health

plan goals

Cost-containment

programs



exception

Contact patients to


site of care




12

64




next 12-24 months




next 12-24 months





19


16





2016



2017



2018



2019



$110

$192

$159

$124

Physicianoffice

2018 2019 2020


Off-campus HOPDs

13 difference in

reimbursement rate

by 2020



17




















hospital facility





main hospital


Change in HOPD and



Two Ways


18



3 Provider choice


28 27

4146

2013 2014 2015 2016




cancer-related





$264B



19





Activation




Drop coverage




Shift risk




Manage proactively




20




3

9

18

12

16

26

22

19

39

50

31

30

31

19

15

Cancer

Cardiovascular

Knees hips or

spine

Bariatric surgery

Transplants










traveling to Mayo



CASE EXAMPLE

30of eligible

employees travel

to Mayo for care



changed


21



top cost priority










22

The margin problem





2009-2017 medians

2

4

6

8

2010 2012 2014 2016 2018


Staffing


pressures

Drugs and supplies

Capital investments

Service utilization


23













Gaps in Performance



Navigation



Assistance




Marketing



Strategy




Contain cost

growth

Maximize revenue

capture

Capture new

growth


24









~$400Kgt$1M$500K-$1M


treatment options

Increasing consumer

demands




over volume



prolonged period of






spur investment in


despite unclear

reimbursement




for care





Shifting payment

models

Sample costs


25



Ma

rgin

s

Value-based care


Patient experience


Staffing

Drugs and supplies

Capital investments

Service utilization

1

2

3


ROAD MAP26





27









Bundled payments










Collaborative













28





bull 10 payers

bull CMS

Who is

participating





How are

practices paid


quality performance







the IOM









29




=


Quality





= Costs



Key caveats





37

33

27

27

24

31

12

8

Loweredcost ofcare

Increasedquality of

care






30

Dec

PP1 external

evaluation

published






July-Sept

Measurement

Period 1

July 1

OCM begins

w ith 190

participating

practices

June 30

End of

Performance

Period 1

Nov-Dec

OCM registry

available to

report clinical

and quality data

June 30

Anticipated

performance

period end date

201820172016 2019 2020 2021

Summer-Fall





Jan 1

Practices can

enter into either

tw o-sided risk

option

PP1 PP2

25 30


a bonus

PP31

33






31



Risk Arrangement




based onhellip



calculated onhellip




truehellip



differencehellip





32




Program performance

year

Number of

ACOs


savings




PY1 2012-2013 220 26 27 47 ($78M)

PY 2014 333 28 27 46 ($50M)

PY 2015 392 31 21 48 ($216M)

PY 2016 432 31 25 44 ($39M)

PY 2017 472 34 26 39 $314


33





Track 1



BASIC Track

5-year agreement




Track 2



Track 3


ENHANCED Track



34



Comprehensive

Cancer Care

Delivery Model

Patient-Centered

Oncology Payment

Model (PCOP)

1 2 3

















Making Accountable


Networks (MASON)







35







to participate




constructed


that bill globally






hospital and







36




investment roadmap












37















At-home DNA repair




38






increase in five-




2x


year survival for



214

201

187

172

156

1992 1998 2004 2010 2016





39


Prevalence


Tra

nsfo

rma

tive

po

ten

tia

l o

ve

r n

ext 3

-5 y

ea

rs



Liquidbiopsies

Breathalyzer


Oncolyticvaccines




Hormone therapy


Multi-gene panels





40



Cancer detection





Blood vessel

ctDNA1

Blood cell

ctDNA extracted




1

2

3















41






breathalyzer test


86





Instant results


bull Lung cancer



bull Ovarian cancer

bull Bladder cancer


bull Kidney cancer

bull Gastric cancer





bull Atypical

Parkinsonism



Hypertension

bull Pre-eclampsia




42





46

30

17

18

19

15

9

5

22

35

44

36

9

10

17

17

6

12

14

25

Liquid biopsy


sequencing

Multigene panel


0 1-10 10-25 25-50 gt50


n=200



each test

30

24

17

10


43







end of 2018



5

22 of alterations

identified by both

tests were

concordant

25 of drugs were

recommended for

the same patients

by both platforms

Currently covers



cancer type

Does not cover




on NGS testing



13

22

38FDA-approved


Multi-gene panels

Whole-exome

sequencing

n=100


44















tumors




Near-infrared

spectroscopy







877


45







healthy copy







1

2


Mechanism Outcome


cell types







144


46





(pemprolizumab)













to pembrolizumab



tumor shrinking




1

2

3



47




72

33

25

19




Tumor site 2014-2015 2016-2017

Lung 14 305


Kidney 05 441

Melanoma 564 824

Cost

reimbursement

Availability

access to drugs

Knowledge

of new

drugs

Comfort

managing side

effects




33


48








Kymriah injection









therapies









Select toxicities

bull Delirium

bull Anaphalaxis

bull Autoimmune

response


effects


syndrome


49






2017




2018





2019







Seema Verma

CMS Administrator


50




7

4

4

9

8

11

26

15

6

44

40

34

15

33

45







n=100





51

















52





Rising expectations

for service


care information





reviews


MinuteClinic)



1 2


Growing price

sensitivity





3


53






investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4










54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




13
















more patientsrdquo1






Legal update






14



6

46

2004 2014



For private payers




42

Brand namePhysician

officeHospital

outpatient


Rituxan $7328 $11451

Avastin $2415 $9471

Remicade $4691 $10995

2 Site of care





15




Commercial health

plan goals

Cost-containment

programs



exception

Contact patients to


site of care




12

64




next 12-24 months




next 12-24 months





19


16





2016



2017



2018



2019



$110

$192

$159

$124

Physicianoffice

2018 2019 2020


Off-campus HOPDs

13 difference in

reimbursement rate

by 2020



17




















hospital facility





main hospital


Change in HOPD and



Two Ways


18



3 Provider choice


28 27

4146

2013 2014 2015 2016




cancer-related





$264B



19





Activation




Drop coverage




Shift risk




Manage proactively




20




3

9

18

12

16

26

22

19

39

50

31

30

31

19

15

Cancer

Cardiovascular

Knees hips or

spine

Bariatric surgery

Transplants










traveling to Mayo



CASE EXAMPLE

30of eligible

employees travel

to Mayo for care



changed


21



top cost priority










22

The margin problem





2009-2017 medians

2

4

6

8

2010 2012 2014 2016 2018


Staffing


pressures

Drugs and supplies

Capital investments

Service utilization


23













Gaps in Performance



Navigation



Assistance




Marketing



Strategy




Contain cost

growth

Maximize revenue

capture

Capture new

growth


24









~$400Kgt$1M$500K-$1M


treatment options

Increasing consumer

demands




over volume



prolonged period of






spur investment in


despite unclear

reimbursement




for care





Shifting payment

models

Sample costs


25



Ma

rgin

s

Value-based care


Patient experience


Staffing

Drugs and supplies

Capital investments

Service utilization

1

2

3


ROAD MAP26





27









Bundled payments










Collaborative













28





bull 10 payers

bull CMS

Who is

participating





How are

practices paid


quality performance







the IOM









29




=


Quality





= Costs



Key caveats





37

33

27

27

24

31

12

8

Loweredcost ofcare

Increasedquality of

care






30

Dec

PP1 external

evaluation

published






July-Sept

Measurement

Period 1

July 1

OCM begins

w ith 190

participating

practices

June 30

End of

Performance

Period 1

Nov-Dec

OCM registry

available to

report clinical

and quality data

June 30

Anticipated

performance

period end date

201820172016 2019 2020 2021

Summer-Fall





Jan 1

Practices can

enter into either

tw o-sided risk

option

PP1 PP2

25 30


a bonus

PP31

33






31



Risk Arrangement




based onhellip



calculated onhellip




truehellip



differencehellip





32




Program performance

year

Number of

ACOs


savings




PY1 2012-2013 220 26 27 47 ($78M)

PY 2014 333 28 27 46 ($50M)

PY 2015 392 31 21 48 ($216M)

PY 2016 432 31 25 44 ($39M)

PY 2017 472 34 26 39 $314


33





Track 1



BASIC Track

5-year agreement




Track 2



Track 3


ENHANCED Track



34



Comprehensive

Cancer Care

Delivery Model

Patient-Centered

Oncology Payment

Model (PCOP)

1 2 3

















Making Accountable


Networks (MASON)







35







to participate




constructed


that bill globally






hospital and







36




investment roadmap












37















At-home DNA repair




38






increase in five-




2x


year survival for



214

201

187

172

156

1992 1998 2004 2010 2016





39


Prevalence


Tra

nsfo

rma

tive

po

ten

tia

l o

ve

r n

ext 3

-5 y

ea

rs



Liquidbiopsies

Breathalyzer


Oncolyticvaccines




Hormone therapy


Multi-gene panels





40



Cancer detection





Blood vessel

ctDNA1

Blood cell

ctDNA extracted




1

2

3















41






breathalyzer test


86





Instant results


bull Lung cancer



bull Ovarian cancer

bull Bladder cancer


bull Kidney cancer

bull Gastric cancer





bull Atypical

Parkinsonism



Hypertension

bull Pre-eclampsia




42





46

30

17

18

19

15

9

5

22

35

44

36

9

10

17

17

6

12

14

25

Liquid biopsy


sequencing

Multigene panel


0 1-10 10-25 25-50 gt50


n=200



each test

30

24

17

10


43







end of 2018



5

22 of alterations

identified by both

tests were

concordant

25 of drugs were

recommended for

the same patients

by both platforms

Currently covers



cancer type

Does not cover




on NGS testing



13

22

38FDA-approved


Multi-gene panels

Whole-exome

sequencing

n=100


44















tumors




Near-infrared

spectroscopy







877


45







healthy copy







1

2


Mechanism Outcome


cell types







144


46





(pemprolizumab)













to pembrolizumab



tumor shrinking




1

2

3



47




72

33

25

19




Tumor site 2014-2015 2016-2017

Lung 14 305


Kidney 05 441

Melanoma 564 824

Cost

reimbursement

Availability

access to drugs

Knowledge

of new

drugs

Comfort

managing side

effects




33


48








Kymriah injection









therapies









Select toxicities

bull Delirium

bull Anaphalaxis

bull Autoimmune

response


effects


syndrome


49






2017




2018





2019







Seema Verma

CMS Administrator


50




7

4

4

9

8

11

26

15

6

44

40

34

15

33

45







n=100





51

















52





Rising expectations

for service


care information





reviews


MinuteClinic)



1 2


Growing price

sensitivity





3


53






investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4










54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




14



6

46

2004 2014



For private payers




42

Brand namePhysician

officeHospital

outpatient


Rituxan $7328 $11451

Avastin $2415 $9471

Remicade $4691 $10995

2 Site of care





15




Commercial health

plan goals

Cost-containment

programs



exception

Contact patients to


site of care




12

64




next 12-24 months




next 12-24 months





19


16





2016



2017



2018



2019



$110

$192

$159

$124

Physicianoffice

2018 2019 2020


Off-campus HOPDs

13 difference in

reimbursement rate

by 2020



17




















hospital facility





main hospital


Change in HOPD and



Two Ways


18



3 Provider choice


28 27

4146

2013 2014 2015 2016




cancer-related





$264B



19





Activation




Drop coverage




Shift risk




Manage proactively




20




3

9

18

12

16

26

22

19

39

50

31

30

31

19

15

Cancer

Cardiovascular

Knees hips or

spine

Bariatric surgery

Transplants










traveling to Mayo



CASE EXAMPLE

30of eligible

employees travel

to Mayo for care



changed


21



top cost priority










22

The margin problem





2009-2017 medians

2

4

6

8

2010 2012 2014 2016 2018


Staffing


pressures

Drugs and supplies

Capital investments

Service utilization


23













Gaps in Performance



Navigation



Assistance




Marketing



Strategy




Contain cost

growth

Maximize revenue

capture

Capture new

growth


24









~$400Kgt$1M$500K-$1M


treatment options

Increasing consumer

demands




over volume



prolonged period of






spur investment in


despite unclear

reimbursement




for care





Shifting payment

models

Sample costs


25



Ma

rgin

s

Value-based care


Patient experience


Staffing

Drugs and supplies

Capital investments

Service utilization

1

2

3


ROAD MAP26





27









Bundled payments










Collaborative













28





bull 10 payers

bull CMS

Who is

participating





How are

practices paid


quality performance







the IOM









29




=


Quality





= Costs



Key caveats





37

33

27

27

24

31

12

8

Loweredcost ofcare

Increasedquality of

care






30

Dec

PP1 external

evaluation

published






July-Sept

Measurement

Period 1

July 1

OCM begins

w ith 190

participating

practices

June 30

End of

Performance

Period 1

Nov-Dec

OCM registry

available to

report clinical

and quality data

June 30

Anticipated

performance

period end date

201820172016 2019 2020 2021

Summer-Fall





Jan 1

Practices can

enter into either

tw o-sided risk

option

PP1 PP2

25 30


a bonus

PP31

33






31



Risk Arrangement




based onhellip



calculated onhellip




truehellip



differencehellip





32




Program performance

year

Number of

ACOs


savings




PY1 2012-2013 220 26 27 47 ($78M)

PY 2014 333 28 27 46 ($50M)

PY 2015 392 31 21 48 ($216M)

PY 2016 432 31 25 44 ($39M)

PY 2017 472 34 26 39 $314


33





Track 1



BASIC Track

5-year agreement




Track 2



Track 3


ENHANCED Track



34



Comprehensive

Cancer Care

Delivery Model

Patient-Centered

Oncology Payment

Model (PCOP)

1 2 3

















Making Accountable


Networks (MASON)







35







to participate




constructed


that bill globally






hospital and







36




investment roadmap












37















At-home DNA repair




38






increase in five-




2x


year survival for



214

201

187

172

156

1992 1998 2004 2010 2016





39


Prevalence


Tra

nsfo

rma

tive

po

ten

tia

l o

ve

r n

ext 3

-5 y

ea

rs



Liquidbiopsies

Breathalyzer


Oncolyticvaccines




Hormone therapy


Multi-gene panels





40



Cancer detection





Blood vessel

ctDNA1

Blood cell

ctDNA extracted




1

2

3















41






breathalyzer test


86





Instant results


bull Lung cancer



bull Ovarian cancer

bull Bladder cancer


bull Kidney cancer

bull Gastric cancer





bull Atypical

Parkinsonism



Hypertension

bull Pre-eclampsia




42





46

30

17

18

19

15

9

5

22

35

44

36

9

10

17

17

6

12

14

25

Liquid biopsy


sequencing

Multigene panel


0 1-10 10-25 25-50 gt50


n=200



each test

30

24

17

10


43







end of 2018



5

22 of alterations

identified by both

tests were

concordant

25 of drugs were

recommended for

the same patients

by both platforms

Currently covers



cancer type

Does not cover




on NGS testing



13

22

38FDA-approved


Multi-gene panels

Whole-exome

sequencing

n=100


44















tumors




Near-infrared

spectroscopy







877


45







healthy copy







1

2


Mechanism Outcome


cell types







144


46





(pemprolizumab)













to pembrolizumab



tumor shrinking




1

2

3



47




72

33

25

19




Tumor site 2014-2015 2016-2017

Lung 14 305


Kidney 05 441

Melanoma 564 824

Cost

reimbursement

Availability

access to drugs

Knowledge

of new

drugs

Comfort

managing side

effects




33


48








Kymriah injection









therapies









Select toxicities

bull Delirium

bull Anaphalaxis

bull Autoimmune

response


effects


syndrome


49






2017




2018





2019







Seema Verma

CMS Administrator


50




7

4

4

9

8

11

26

15

6

44

40

34

15

33

45







n=100





51

















52





Rising expectations

for service


care information





reviews


MinuteClinic)



1 2


Growing price

sensitivity





3


53






investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4










54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




15




Commercial health

plan goals

Cost-containment

programs



exception

Contact patients to


site of care




12

64




next 12-24 months




next 12-24 months





19


16





2016



2017



2018



2019



$110

$192

$159

$124

Physicianoffice

2018 2019 2020


Off-campus HOPDs

13 difference in

reimbursement rate

by 2020



17




















hospital facility





main hospital


Change in HOPD and



Two Ways


18



3 Provider choice


28 27

4146

2013 2014 2015 2016




cancer-related





$264B



19





Activation




Drop coverage




Shift risk




Manage proactively




20




3

9

18

12

16

26

22

19

39

50

31

30

31

19

15

Cancer

Cardiovascular

Knees hips or

spine

Bariatric surgery

Transplants










traveling to Mayo



CASE EXAMPLE

30of eligible

employees travel

to Mayo for care



changed


21



top cost priority










22

The margin problem





2009-2017 medians

2

4

6

8

2010 2012 2014 2016 2018


Staffing


pressures

Drugs and supplies

Capital investments

Service utilization


23













Gaps in Performance



Navigation



Assistance




Marketing



Strategy




Contain cost

growth

Maximize revenue

capture

Capture new

growth


24









~$400Kgt$1M$500K-$1M


treatment options

Increasing consumer

demands




over volume



prolonged period of






spur investment in


despite unclear

reimbursement




for care





Shifting payment

models

Sample costs


25



Ma

rgin

s

Value-based care


Patient experience


Staffing

Drugs and supplies

Capital investments

Service utilization

1

2

3


ROAD MAP26





27









Bundled payments










Collaborative













28





bull 10 payers

bull CMS

Who is

participating





How are

practices paid


quality performance







the IOM









29




=


Quality





= Costs



Key caveats





37

33

27

27

24

31

12

8

Loweredcost ofcare

Increasedquality of

care






30

Dec

PP1 external

evaluation

published






July-Sept

Measurement

Period 1

July 1

OCM begins

w ith 190

participating

practices

June 30

End of

Performance

Period 1

Nov-Dec

OCM registry

available to

report clinical

and quality data

June 30

Anticipated

performance

period end date

201820172016 2019 2020 2021

Summer-Fall





Jan 1

Practices can

enter into either

tw o-sided risk

option

PP1 PP2

25 30


a bonus

PP31

33






31



Risk Arrangement




based onhellip



calculated onhellip




truehellip



differencehellip





32




Program performance

year

Number of

ACOs


savings




PY1 2012-2013 220 26 27 47 ($78M)

PY 2014 333 28 27 46 ($50M)

PY 2015 392 31 21 48 ($216M)

PY 2016 432 31 25 44 ($39M)

PY 2017 472 34 26 39 $314


33





Track 1



BASIC Track

5-year agreement




Track 2



Track 3


ENHANCED Track



34



Comprehensive

Cancer Care

Delivery Model

Patient-Centered

Oncology Payment

Model (PCOP)

1 2 3

















Making Accountable


Networks (MASON)







35







to participate




constructed


that bill globally






hospital and







36




investment roadmap












37















At-home DNA repair




38






increase in five-




2x


year survival for



214

201

187

172

156

1992 1998 2004 2010 2016





39


Prevalence


Tra

nsfo

rma

tive

po

ten

tia

l o

ve

r n

ext 3

-5 y

ea

rs



Liquidbiopsies

Breathalyzer


Oncolyticvaccines




Hormone therapy


Multi-gene panels





40



Cancer detection





Blood vessel

ctDNA1

Blood cell

ctDNA extracted




1

2

3















41






breathalyzer test


86





Instant results


bull Lung cancer



bull Ovarian cancer

bull Bladder cancer


bull Kidney cancer

bull Gastric cancer





bull Atypical

Parkinsonism



Hypertension

bull Pre-eclampsia




42





46

30

17

18

19

15

9

5

22

35

44

36

9

10

17

17

6

12

14

25

Liquid biopsy


sequencing

Multigene panel


0 1-10 10-25 25-50 gt50


n=200



each test

30

24

17

10


43







end of 2018



5

22 of alterations

identified by both

tests were

concordant

25 of drugs were

recommended for

the same patients

by both platforms

Currently covers



cancer type

Does not cover




on NGS testing



13

22

38FDA-approved


Multi-gene panels

Whole-exome

sequencing

n=100


44















tumors




Near-infrared

spectroscopy







877


45







healthy copy







1

2


Mechanism Outcome


cell types







144


46





(pemprolizumab)













to pembrolizumab



tumor shrinking




1

2

3



47




72

33

25

19




Tumor site 2014-2015 2016-2017

Lung 14 305


Kidney 05 441

Melanoma 564 824

Cost

reimbursement

Availability

access to drugs

Knowledge

of new

drugs

Comfort

managing side

effects




33


48








Kymriah injection









therapies









Select toxicities

bull Delirium

bull Anaphalaxis

bull Autoimmune

response


effects


syndrome


49






2017




2018





2019







Seema Verma

CMS Administrator


50




7

4

4

9

8

11

26

15

6

44

40

34

15

33

45







n=100





51

















52





Rising expectations

for service


care information





reviews


MinuteClinic)



1 2


Growing price

sensitivity





3


53






investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4










54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




16





2016



2017



2018



2019



$110

$192

$159

$124

Physicianoffice

2018 2019 2020


Off-campus HOPDs

13 difference in

reimbursement rate

by 2020



17




















hospital facility





main hospital


Change in HOPD and



Two Ways


18



3 Provider choice


28 27

4146

2013 2014 2015 2016




cancer-related





$264B



19





Activation




Drop coverage




Shift risk




Manage proactively




20




3

9

18

12

16

26

22

19

39

50

31

30

31

19

15

Cancer

Cardiovascular

Knees hips or

spine

Bariatric surgery

Transplants










traveling to Mayo



CASE EXAMPLE

30of eligible

employees travel

to Mayo for care



changed


21



top cost priority










22

The margin problem





2009-2017 medians

2

4

6

8

2010 2012 2014 2016 2018


Staffing


pressures

Drugs and supplies

Capital investments

Service utilization


23













Gaps in Performance



Navigation



Assistance




Marketing



Strategy




Contain cost

growth

Maximize revenue

capture

Capture new

growth


24









~$400Kgt$1M$500K-$1M


treatment options

Increasing consumer

demands




over volume



prolonged period of






spur investment in


despite unclear

reimbursement




for care





Shifting payment

models

Sample costs


25



Ma

rgin

s

Value-based care


Patient experience


Staffing

Drugs and supplies

Capital investments

Service utilization

1

2

3


ROAD MAP26





27









Bundled payments










Collaborative













28





bull 10 payers

bull CMS

Who is

participating





How are

practices paid


quality performance







the IOM









29




=


Quality





= Costs



Key caveats





37

33

27

27

24

31

12

8

Loweredcost ofcare

Increasedquality of

care






30

Dec

PP1 external

evaluation

published






July-Sept

Measurement

Period 1

July 1

OCM begins

w ith 190

participating

practices

June 30

End of

Performance

Period 1

Nov-Dec

OCM registry

available to

report clinical

and quality data

June 30

Anticipated

performance

period end date

201820172016 2019 2020 2021

Summer-Fall





Jan 1

Practices can

enter into either

tw o-sided risk

option

PP1 PP2

25 30


a bonus

PP31

33






31



Risk Arrangement




based onhellip



calculated onhellip




truehellip



differencehellip





32




Program performance

year

Number of

ACOs


savings




PY1 2012-2013 220 26 27 47 ($78M)

PY 2014 333 28 27 46 ($50M)

PY 2015 392 31 21 48 ($216M)

PY 2016 432 31 25 44 ($39M)

PY 2017 472 34 26 39 $314


33





Track 1



BASIC Track

5-year agreement




Track 2



Track 3


ENHANCED Track



34



Comprehensive

Cancer Care

Delivery Model

Patient-Centered

Oncology Payment

Model (PCOP)

1 2 3

















Making Accountable


Networks (MASON)







35







to participate




constructed


that bill globally






hospital and







36




investment roadmap












37















At-home DNA repair




38






increase in five-




2x


year survival for



214

201

187

172

156

1992 1998 2004 2010 2016





39


Prevalence


Tra

nsfo

rma

tive

po

ten

tia

l o

ve

r n

ext 3

-5 y

ea

rs



Liquidbiopsies

Breathalyzer


Oncolyticvaccines




Hormone therapy


Multi-gene panels





40



Cancer detection





Blood vessel

ctDNA1

Blood cell

ctDNA extracted




1

2

3















41






breathalyzer test


86





Instant results


bull Lung cancer



bull Ovarian cancer

bull Bladder cancer


bull Kidney cancer

bull Gastric cancer





bull Atypical

Parkinsonism



Hypertension

bull Pre-eclampsia




42





46

30

17

18

19

15

9

5

22

35

44

36

9

10

17

17

6

12

14

25

Liquid biopsy


sequencing

Multigene panel


0 1-10 10-25 25-50 gt50


n=200



each test

30

24

17

10


43







end of 2018



5

22 of alterations

identified by both

tests were

concordant

25 of drugs were

recommended for

the same patients

by both platforms

Currently covers



cancer type

Does not cover




on NGS testing



13

22

38FDA-approved


Multi-gene panels

Whole-exome

sequencing

n=100


44















tumors




Near-infrared

spectroscopy







877


45







healthy copy







1

2


Mechanism Outcome


cell types







144


46





(pemprolizumab)













to pembrolizumab



tumor shrinking




1

2

3



47




72

33

25

19




Tumor site 2014-2015 2016-2017

Lung 14 305


Kidney 05 441

Melanoma 564 824

Cost

reimbursement

Availability

access to drugs

Knowledge

of new

drugs

Comfort

managing side

effects




33


48








Kymriah injection









therapies









Select toxicities

bull Delirium

bull Anaphalaxis

bull Autoimmune

response


effects


syndrome


49






2017




2018





2019







Seema Verma

CMS Administrator


50




7

4

4

9

8

11

26

15

6

44

40

34

15

33

45







n=100





51

















52





Rising expectations

for service


care information





reviews


MinuteClinic)



1 2


Growing price

sensitivity





3


53






investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4










54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




17




















hospital facility





main hospital


Change in HOPD and



Two Ways


18



3 Provider choice


28 27

4146

2013 2014 2015 2016




cancer-related





$264B



19





Activation




Drop coverage




Shift risk




Manage proactively




20




3

9

18

12

16

26

22

19

39

50

31

30

31

19

15

Cancer

Cardiovascular

Knees hips or

spine

Bariatric surgery

Transplants










traveling to Mayo



CASE EXAMPLE

30of eligible

employees travel

to Mayo for care



changed


21



top cost priority










22

The margin problem





2009-2017 medians

2

4

6

8

2010 2012 2014 2016 2018


Staffing


pressures

Drugs and supplies

Capital investments

Service utilization


23













Gaps in Performance



Navigation



Assistance




Marketing



Strategy




Contain cost

growth

Maximize revenue

capture

Capture new

growth


24









~$400Kgt$1M$500K-$1M


treatment options

Increasing consumer

demands




over volume



prolonged period of






spur investment in


despite unclear

reimbursement




for care





Shifting payment

models

Sample costs


25



Ma

rgin

s

Value-based care


Patient experience


Staffing

Drugs and supplies

Capital investments

Service utilization

1

2

3


ROAD MAP26





27









Bundled payments










Collaborative













28





bull 10 payers

bull CMS

Who is

participating





How are

practices paid


quality performance







the IOM









29




=


Quality





= Costs



Key caveats





37

33

27

27

24

31

12

8

Loweredcost ofcare

Increasedquality of

care






30

Dec

PP1 external

evaluation

published






July-Sept

Measurement

Period 1

July 1

OCM begins

w ith 190

participating

practices

June 30

End of

Performance

Period 1

Nov-Dec

OCM registry

available to

report clinical

and quality data

June 30

Anticipated

performance

period end date

201820172016 2019 2020 2021

Summer-Fall





Jan 1

Practices can

enter into either

tw o-sided risk

option

PP1 PP2

25 30


a bonus

PP31

33






31



Risk Arrangement




based onhellip



calculated onhellip




truehellip



differencehellip





32




Program performance

year

Number of

ACOs


savings




PY1 2012-2013 220 26 27 47 ($78M)

PY 2014 333 28 27 46 ($50M)

PY 2015 392 31 21 48 ($216M)

PY 2016 432 31 25 44 ($39M)

PY 2017 472 34 26 39 $314


33





Track 1



BASIC Track

5-year agreement




Track 2



Track 3


ENHANCED Track



34



Comprehensive

Cancer Care

Delivery Model

Patient-Centered

Oncology Payment

Model (PCOP)

1 2 3

















Making Accountable


Networks (MASON)







35







to participate




constructed


that bill globally






hospital and







36




investment roadmap












37















At-home DNA repair




38






increase in five-




2x


year survival for



214

201

187

172

156

1992 1998 2004 2010 2016





39


Prevalence


Tra

nsfo

rma

tive

po

ten

tia

l o

ve

r n

ext 3

-5 y

ea

rs



Liquidbiopsies

Breathalyzer


Oncolyticvaccines




Hormone therapy


Multi-gene panels





40



Cancer detection





Blood vessel

ctDNA1

Blood cell

ctDNA extracted




1

2

3















41






breathalyzer test


86





Instant results


bull Lung cancer



bull Ovarian cancer

bull Bladder cancer


bull Kidney cancer

bull Gastric cancer





bull Atypical

Parkinsonism



Hypertension

bull Pre-eclampsia




42





46

30

17

18

19

15

9

5

22

35

44

36

9

10

17

17

6

12

14

25

Liquid biopsy


sequencing

Multigene panel


0 1-10 10-25 25-50 gt50


n=200



each test

30

24

17

10


43







end of 2018



5

22 of alterations

identified by both

tests were

concordant

25 of drugs were

recommended for

the same patients

by both platforms

Currently covers



cancer type

Does not cover




on NGS testing



13

22

38FDA-approved


Multi-gene panels

Whole-exome

sequencing

n=100


44















tumors




Near-infrared

spectroscopy







877


45







healthy copy







1

2


Mechanism Outcome


cell types







144


46





(pemprolizumab)













to pembrolizumab



tumor shrinking




1

2

3



47




72

33

25

19




Tumor site 2014-2015 2016-2017

Lung 14 305


Kidney 05 441

Melanoma 564 824

Cost

reimbursement

Availability

access to drugs

Knowledge

of new

drugs

Comfort

managing side

effects




33


48








Kymriah injection









therapies









Select toxicities

bull Delirium

bull Anaphalaxis

bull Autoimmune

response


effects


syndrome


49






2017




2018





2019







Seema Verma

CMS Administrator


50




7

4

4

9

8

11

26

15

6

44

40

34

15

33

45







n=100





51

















52





Rising expectations

for service


care information





reviews


MinuteClinic)



1 2


Growing price

sensitivity





3


53






investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4










54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




18



3 Provider choice


28 27

4146

2013 2014 2015 2016




cancer-related





$264B



19





Activation




Drop coverage




Shift risk




Manage proactively




20




3

9

18

12

16

26

22

19

39

50

31

30

31

19

15

Cancer

Cardiovascular

Knees hips or

spine

Bariatric surgery

Transplants










traveling to Mayo



CASE EXAMPLE

30of eligible

employees travel

to Mayo for care



changed


21



top cost priority










22

The margin problem





2009-2017 medians

2

4

6

8

2010 2012 2014 2016 2018


Staffing


pressures

Drugs and supplies

Capital investments

Service utilization


23













Gaps in Performance



Navigation



Assistance




Marketing



Strategy




Contain cost

growth

Maximize revenue

capture

Capture new

growth


24









~$400Kgt$1M$500K-$1M


treatment options

Increasing consumer

demands




over volume



prolonged period of






spur investment in


despite unclear

reimbursement




for care





Shifting payment

models

Sample costs


25



Ma

rgin

s

Value-based care


Patient experience


Staffing

Drugs and supplies

Capital investments

Service utilization

1

2

3


ROAD MAP26





27









Bundled payments










Collaborative













28





bull 10 payers

bull CMS

Who is

participating





How are

practices paid


quality performance







the IOM









29




=


Quality





= Costs



Key caveats





37

33

27

27

24

31

12

8

Loweredcost ofcare

Increasedquality of

care






30

Dec

PP1 external

evaluation

published






July-Sept

Measurement

Period 1

July 1

OCM begins

w ith 190

participating

practices

June 30

End of

Performance

Period 1

Nov-Dec

OCM registry

available to

report clinical

and quality data

June 30

Anticipated

performance

period end date

201820172016 2019 2020 2021

Summer-Fall





Jan 1

Practices can

enter into either

tw o-sided risk

option

PP1 PP2

25 30


a bonus

PP31

33






31



Risk Arrangement




based onhellip



calculated onhellip




truehellip



differencehellip





32




Program performance

year

Number of

ACOs


savings




PY1 2012-2013 220 26 27 47 ($78M)

PY 2014 333 28 27 46 ($50M)

PY 2015 392 31 21 48 ($216M)

PY 2016 432 31 25 44 ($39M)

PY 2017 472 34 26 39 $314


33





Track 1



BASIC Track

5-year agreement




Track 2



Track 3


ENHANCED Track



34



Comprehensive

Cancer Care

Delivery Model

Patient-Centered

Oncology Payment

Model (PCOP)

1 2 3

















Making Accountable


Networks (MASON)







35







to participate




constructed


that bill globally






hospital and







36




investment roadmap












37















At-home DNA repair




38






increase in five-




2x


year survival for



214

201

187

172

156

1992 1998 2004 2010 2016





39


Prevalence


Tra

nsfo

rma

tive

po

ten

tia

l o

ve

r n

ext 3

-5 y

ea

rs



Liquidbiopsies

Breathalyzer


Oncolyticvaccines




Hormone therapy


Multi-gene panels





40



Cancer detection





Blood vessel

ctDNA1

Blood cell

ctDNA extracted




1

2

3















41






breathalyzer test


86





Instant results


bull Lung cancer



bull Ovarian cancer

bull Bladder cancer


bull Kidney cancer

bull Gastric cancer





bull Atypical

Parkinsonism



Hypertension

bull Pre-eclampsia




42





46

30

17

18

19

15

9

5

22

35

44

36

9

10

17

17

6

12

14

25

Liquid biopsy


sequencing

Multigene panel


0 1-10 10-25 25-50 gt50


n=200



each test

30

24

17

10


43







end of 2018



5

22 of alterations

identified by both

tests were

concordant

25 of drugs were

recommended for

the same patients

by both platforms

Currently covers



cancer type

Does not cover




on NGS testing



13

22

38FDA-approved


Multi-gene panels

Whole-exome

sequencing

n=100


44















tumors




Near-infrared

spectroscopy







877


45







healthy copy







1

2


Mechanism Outcome


cell types







144


46





(pemprolizumab)













to pembrolizumab



tumor shrinking




1

2

3



47




72

33

25

19




Tumor site 2014-2015 2016-2017

Lung 14 305


Kidney 05 441

Melanoma 564 824

Cost

reimbursement

Availability

access to drugs

Knowledge

of new

drugs

Comfort

managing side

effects




33


48








Kymriah injection









therapies









Select toxicities

bull Delirium

bull Anaphalaxis

bull Autoimmune

response


effects


syndrome


49






2017




2018





2019







Seema Verma

CMS Administrator


50




7

4

4

9

8

11

26

15

6

44

40

34

15

33

45







n=100





51

















52





Rising expectations

for service


care information





reviews


MinuteClinic)



1 2


Growing price

sensitivity





3


53






investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4










54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




19





Activation




Drop coverage




Shift risk




Manage proactively




20




3

9

18

12

16

26

22

19

39

50

31

30

31

19

15

Cancer

Cardiovascular

Knees hips or

spine

Bariatric surgery

Transplants










traveling to Mayo



CASE EXAMPLE

30of eligible

employees travel

to Mayo for care



changed


21



top cost priority










22

The margin problem





2009-2017 medians

2

4

6

8

2010 2012 2014 2016 2018


Staffing


pressures

Drugs and supplies

Capital investments

Service utilization


23













Gaps in Performance



Navigation



Assistance




Marketing



Strategy




Contain cost

growth

Maximize revenue

capture

Capture new

growth


24









~$400Kgt$1M$500K-$1M


treatment options

Increasing consumer

demands




over volume



prolonged period of






spur investment in


despite unclear

reimbursement




for care





Shifting payment

models

Sample costs


25



Ma

rgin

s

Value-based care


Patient experience


Staffing

Drugs and supplies

Capital investments

Service utilization

1

2

3


ROAD MAP26





27









Bundled payments










Collaborative













28





bull 10 payers

bull CMS

Who is

participating





How are

practices paid


quality performance







the IOM









29




=


Quality





= Costs



Key caveats





37

33

27

27

24

31

12

8

Loweredcost ofcare

Increasedquality of

care






30

Dec

PP1 external

evaluation

published






July-Sept

Measurement

Period 1

July 1

OCM begins

w ith 190

participating

practices

June 30

End of

Performance

Period 1

Nov-Dec

OCM registry

available to

report clinical

and quality data

June 30

Anticipated

performance

period end date

201820172016 2019 2020 2021

Summer-Fall





Jan 1

Practices can

enter into either

tw o-sided risk

option

PP1 PP2

25 30


a bonus

PP31

33






31



Risk Arrangement




based onhellip



calculated onhellip




truehellip



differencehellip





32




Program performance

year

Number of

ACOs


savings




PY1 2012-2013 220 26 27 47 ($78M)

PY 2014 333 28 27 46 ($50M)

PY 2015 392 31 21 48 ($216M)

PY 2016 432 31 25 44 ($39M)

PY 2017 472 34 26 39 $314


33





Track 1



BASIC Track

5-year agreement




Track 2



Track 3


ENHANCED Track



34



Comprehensive

Cancer Care

Delivery Model

Patient-Centered

Oncology Payment

Model (PCOP)

1 2 3

















Making Accountable


Networks (MASON)







35







to participate




constructed


that bill globally






hospital and







36




investment roadmap












37















At-home DNA repair




38






increase in five-




2x


year survival for



214

201

187

172

156

1992 1998 2004 2010 2016





39


Prevalence


Tra

nsfo

rma

tive

po

ten

tia

l o

ve

r n

ext 3

-5 y

ea

rs



Liquidbiopsies

Breathalyzer


Oncolyticvaccines




Hormone therapy


Multi-gene panels





40



Cancer detection





Blood vessel

ctDNA1

Blood cell

ctDNA extracted




1

2

3















41






breathalyzer test


86





Instant results


bull Lung cancer



bull Ovarian cancer

bull Bladder cancer


bull Kidney cancer

bull Gastric cancer





bull Atypical

Parkinsonism



Hypertension

bull Pre-eclampsia




42





46

30

17

18

19

15

9

5

22

35

44

36

9

10

17

17

6

12

14

25

Liquid biopsy


sequencing

Multigene panel


0 1-10 10-25 25-50 gt50


n=200



each test

30

24

17

10


43







end of 2018



5

22 of alterations

identified by both

tests were

concordant

25 of drugs were

recommended for

the same patients

by both platforms

Currently covers



cancer type

Does not cover




on NGS testing



13

22

38FDA-approved


Multi-gene panels

Whole-exome

sequencing

n=100


44















tumors




Near-infrared

spectroscopy







877


45







healthy copy







1

2


Mechanism Outcome


cell types







144


46





(pemprolizumab)













to pembrolizumab



tumor shrinking




1

2

3



47




72

33

25

19




Tumor site 2014-2015 2016-2017

Lung 14 305


Kidney 05 441

Melanoma 564 824

Cost

reimbursement

Availability

access to drugs

Knowledge

of new

drugs

Comfort

managing side

effects




33


48








Kymriah injection









therapies









Select toxicities

bull Delirium

bull Anaphalaxis

bull Autoimmune

response


effects


syndrome


49






2017




2018





2019







Seema Verma

CMS Administrator


50




7

4

4

9

8

11

26

15

6

44

40

34

15

33

45







n=100





51

















52





Rising expectations

for service


care information





reviews


MinuteClinic)



1 2


Growing price

sensitivity





3


53






investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4










54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




20




3

9

18

12

16

26

22

19

39

50

31

30

31

19

15

Cancer

Cardiovascular

Knees hips or

spine

Bariatric surgery

Transplants










traveling to Mayo



CASE EXAMPLE

30of eligible

employees travel

to Mayo for care



changed


21



top cost priority










22

The margin problem





2009-2017 medians

2

4

6

8

2010 2012 2014 2016 2018


Staffing


pressures

Drugs and supplies

Capital investments

Service utilization


23













Gaps in Performance



Navigation



Assistance




Marketing



Strategy




Contain cost

growth

Maximize revenue

capture

Capture new

growth


24









~$400Kgt$1M$500K-$1M


treatment options

Increasing consumer

demands




over volume



prolonged period of






spur investment in


despite unclear

reimbursement




for care





Shifting payment

models

Sample costs


25



Ma

rgin

s

Value-based care


Patient experience


Staffing

Drugs and supplies

Capital investments

Service utilization

1

2

3


ROAD MAP26





27









Bundled payments










Collaborative













28





bull 10 payers

bull CMS

Who is

participating





How are

practices paid


quality performance







the IOM









29




=


Quality





= Costs



Key caveats





37

33

27

27

24

31

12

8

Loweredcost ofcare

Increasedquality of

care






30

Dec

PP1 external

evaluation

published






July-Sept

Measurement

Period 1

July 1

OCM begins

w ith 190

participating

practices

June 30

End of

Performance

Period 1

Nov-Dec

OCM registry

available to

report clinical

and quality data

June 30

Anticipated

performance

period end date

201820172016 2019 2020 2021

Summer-Fall





Jan 1

Practices can

enter into either

tw o-sided risk

option

PP1 PP2

25 30


a bonus

PP31

33






31



Risk Arrangement




based onhellip



calculated onhellip




truehellip



differencehellip





32




Program performance

year

Number of

ACOs


savings




PY1 2012-2013 220 26 27 47 ($78M)

PY 2014 333 28 27 46 ($50M)

PY 2015 392 31 21 48 ($216M)

PY 2016 432 31 25 44 ($39M)

PY 2017 472 34 26 39 $314


33





Track 1



BASIC Track

5-year agreement




Track 2



Track 3


ENHANCED Track



34



Comprehensive

Cancer Care

Delivery Model

Patient-Centered

Oncology Payment

Model (PCOP)

1 2 3

















Making Accountable


Networks (MASON)







35







to participate




constructed


that bill globally






hospital and







36




investment roadmap












37















At-home DNA repair




38






increase in five-




2x


year survival for



214

201

187

172

156

1992 1998 2004 2010 2016





39


Prevalence


Tra

nsfo

rma

tive

po

ten

tia

l o

ve

r n

ext 3

-5 y

ea

rs



Liquidbiopsies

Breathalyzer


Oncolyticvaccines




Hormone therapy


Multi-gene panels





40



Cancer detection





Blood vessel

ctDNA1

Blood cell

ctDNA extracted




1

2

3















41






breathalyzer test


86





Instant results


bull Lung cancer



bull Ovarian cancer

bull Bladder cancer


bull Kidney cancer

bull Gastric cancer





bull Atypical

Parkinsonism



Hypertension

bull Pre-eclampsia




42





46

30

17

18

19

15

9

5

22

35

44

36

9

10

17

17

6

12

14

25

Liquid biopsy


sequencing

Multigene panel


0 1-10 10-25 25-50 gt50


n=200



each test

30

24

17

10


43







end of 2018



5

22 of alterations

identified by both

tests were

concordant

25 of drugs were

recommended for

the same patients

by both platforms

Currently covers



cancer type

Does not cover




on NGS testing



13

22

38FDA-approved


Multi-gene panels

Whole-exome

sequencing

n=100


44















tumors




Near-infrared

spectroscopy







877


45







healthy copy







1

2


Mechanism Outcome


cell types







144


46





(pemprolizumab)













to pembrolizumab



tumor shrinking




1

2

3



47




72

33

25

19




Tumor site 2014-2015 2016-2017

Lung 14 305


Kidney 05 441

Melanoma 564 824

Cost

reimbursement

Availability

access to drugs

Knowledge

of new

drugs

Comfort

managing side

effects




33


48








Kymriah injection









therapies









Select toxicities

bull Delirium

bull Anaphalaxis

bull Autoimmune

response


effects


syndrome


49






2017




2018





2019







Seema Verma

CMS Administrator


50




7

4

4

9

8

11

26

15

6

44

40

34

15

33

45







n=100





51

















52





Rising expectations

for service


care information





reviews


MinuteClinic)



1 2


Growing price

sensitivity





3


53






investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4










54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




21



top cost priority










22

The margin problem





2009-2017 medians

2

4

6

8

2010 2012 2014 2016 2018


Staffing


pressures

Drugs and supplies

Capital investments

Service utilization


23













Gaps in Performance



Navigation



Assistance




Marketing



Strategy




Contain cost

growth

Maximize revenue

capture

Capture new

growth


24









~$400Kgt$1M$500K-$1M


treatment options

Increasing consumer

demands




over volume



prolonged period of






spur investment in


despite unclear

reimbursement




for care





Shifting payment

models

Sample costs


25



Ma

rgin

s

Value-based care


Patient experience


Staffing

Drugs and supplies

Capital investments

Service utilization

1

2

3


ROAD MAP26





27









Bundled payments










Collaborative













28





bull 10 payers

bull CMS

Who is

participating





How are

practices paid


quality performance







the IOM









29




=


Quality





= Costs



Key caveats





37

33

27

27

24

31

12

8

Loweredcost ofcare

Increasedquality of

care






30

Dec

PP1 external

evaluation

published






July-Sept

Measurement

Period 1

July 1

OCM begins

w ith 190

participating

practices

June 30

End of

Performance

Period 1

Nov-Dec

OCM registry

available to

report clinical

and quality data

June 30

Anticipated

performance

period end date

201820172016 2019 2020 2021

Summer-Fall





Jan 1

Practices can

enter into either

tw o-sided risk

option

PP1 PP2

25 30


a bonus

PP31

33






31



Risk Arrangement




based onhellip



calculated onhellip




truehellip



differencehellip





32




Program performance

year

Number of

ACOs


savings




PY1 2012-2013 220 26 27 47 ($78M)

PY 2014 333 28 27 46 ($50M)

PY 2015 392 31 21 48 ($216M)

PY 2016 432 31 25 44 ($39M)

PY 2017 472 34 26 39 $314


33





Track 1



BASIC Track

5-year agreement




Track 2



Track 3


ENHANCED Track



34



Comprehensive

Cancer Care

Delivery Model

Patient-Centered

Oncology Payment

Model (PCOP)

1 2 3

















Making Accountable


Networks (MASON)







35







to participate




constructed


that bill globally






hospital and







36




investment roadmap












37















At-home DNA repair




38






increase in five-




2x


year survival for



214

201

187

172

156

1992 1998 2004 2010 2016





39


Prevalence


Tra

nsfo

rma

tive

po

ten

tia

l o

ve

r n

ext 3

-5 y

ea

rs



Liquidbiopsies

Breathalyzer


Oncolyticvaccines




Hormone therapy


Multi-gene panels





40



Cancer detection





Blood vessel

ctDNA1

Blood cell

ctDNA extracted




1

2

3















41






breathalyzer test


86





Instant results


bull Lung cancer



bull Ovarian cancer

bull Bladder cancer


bull Kidney cancer

bull Gastric cancer





bull Atypical

Parkinsonism



Hypertension

bull Pre-eclampsia




42





46

30

17

18

19

15

9

5

22

35

44

36

9

10

17

17

6

12

14

25

Liquid biopsy


sequencing

Multigene panel


0 1-10 10-25 25-50 gt50


n=200



each test

30

24

17

10


43







end of 2018



5

22 of alterations

identified by both

tests were

concordant

25 of drugs were

recommended for

the same patients

by both platforms

Currently covers



cancer type

Does not cover




on NGS testing



13

22

38FDA-approved


Multi-gene panels

Whole-exome

sequencing

n=100


44















tumors




Near-infrared

spectroscopy







877


45







healthy copy







1

2


Mechanism Outcome


cell types







144


46





(pemprolizumab)













to pembrolizumab



tumor shrinking




1

2

3



47




72

33

25

19




Tumor site 2014-2015 2016-2017

Lung 14 305


Kidney 05 441

Melanoma 564 824

Cost

reimbursement

Availability

access to drugs

Knowledge

of new

drugs

Comfort

managing side

effects




33


48








Kymriah injection









therapies









Select toxicities

bull Delirium

bull Anaphalaxis

bull Autoimmune

response


effects


syndrome


49






2017




2018





2019







Seema Verma

CMS Administrator


50




7

4

4

9

8

11

26

15

6

44

40

34

15

33

45







n=100





51

















52





Rising expectations

for service


care information





reviews


MinuteClinic)



1 2


Growing price

sensitivity





3


53






investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4










54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




22

The margin problem





2009-2017 medians

2

4

6

8

2010 2012 2014 2016 2018


Staffing


pressures

Drugs and supplies

Capital investments

Service utilization


23













Gaps in Performance



Navigation



Assistance




Marketing



Strategy




Contain cost

growth

Maximize revenue

capture

Capture new

growth


24









~$400Kgt$1M$500K-$1M


treatment options

Increasing consumer

demands




over volume



prolonged period of






spur investment in


despite unclear

reimbursement




for care





Shifting payment

models

Sample costs


25



Ma

rgin

s

Value-based care


Patient experience


Staffing

Drugs and supplies

Capital investments

Service utilization

1

2

3


ROAD MAP26





27









Bundled payments










Collaborative













28





bull 10 payers

bull CMS

Who is

participating





How are

practices paid


quality performance







the IOM









29




=


Quality





= Costs



Key caveats





37

33

27

27

24

31

12

8

Loweredcost ofcare

Increasedquality of

care






30

Dec

PP1 external

evaluation

published






July-Sept

Measurement

Period 1

July 1

OCM begins

w ith 190

participating

practices

June 30

End of

Performance

Period 1

Nov-Dec

OCM registry

available to

report clinical

and quality data

June 30

Anticipated

performance

period end date

201820172016 2019 2020 2021

Summer-Fall





Jan 1

Practices can

enter into either

tw o-sided risk

option

PP1 PP2

25 30


a bonus

PP31

33






31



Risk Arrangement




based onhellip



calculated onhellip




truehellip



differencehellip





32




Program performance

year

Number of

ACOs


savings




PY1 2012-2013 220 26 27 47 ($78M)

PY 2014 333 28 27 46 ($50M)

PY 2015 392 31 21 48 ($216M)

PY 2016 432 31 25 44 ($39M)

PY 2017 472 34 26 39 $314


33





Track 1



BASIC Track

5-year agreement




Track 2



Track 3


ENHANCED Track



34



Comprehensive

Cancer Care

Delivery Model

Patient-Centered

Oncology Payment

Model (PCOP)

1 2 3

















Making Accountable


Networks (MASON)







35







to participate




constructed


that bill globally






hospital and







36




investment roadmap












37















At-home DNA repair




38






increase in five-




2x


year survival for



214

201

187

172

156

1992 1998 2004 2010 2016





39


Prevalence


Tra

nsfo

rma

tive

po

ten

tia

l o

ve

r n

ext 3

-5 y

ea

rs



Liquidbiopsies

Breathalyzer


Oncolyticvaccines




Hormone therapy


Multi-gene panels





40



Cancer detection





Blood vessel

ctDNA1

Blood cell

ctDNA extracted




1

2

3















41






breathalyzer test


86





Instant results


bull Lung cancer



bull Ovarian cancer

bull Bladder cancer


bull Kidney cancer

bull Gastric cancer





bull Atypical

Parkinsonism



Hypertension

bull Pre-eclampsia




42





46

30

17

18

19

15

9

5

22

35

44

36

9

10

17

17

6

12

14

25

Liquid biopsy


sequencing

Multigene panel


0 1-10 10-25 25-50 gt50


n=200



each test

30

24

17

10


43







end of 2018



5

22 of alterations

identified by both

tests were

concordant

25 of drugs were

recommended for

the same patients

by both platforms

Currently covers



cancer type

Does not cover




on NGS testing



13

22

38FDA-approved


Multi-gene panels

Whole-exome

sequencing

n=100


44















tumors




Near-infrared

spectroscopy







877


45







healthy copy







1

2


Mechanism Outcome


cell types







144


46





(pemprolizumab)













to pembrolizumab



tumor shrinking




1

2

3



47




72

33

25

19




Tumor site 2014-2015 2016-2017

Lung 14 305


Kidney 05 441

Melanoma 564 824

Cost

reimbursement

Availability

access to drugs

Knowledge

of new

drugs

Comfort

managing side

effects




33


48








Kymriah injection









therapies









Select toxicities

bull Delirium

bull Anaphalaxis

bull Autoimmune

response


effects


syndrome


49






2017




2018





2019







Seema Verma

CMS Administrator


50




7

4

4

9

8

11

26

15

6

44

40

34

15

33

45







n=100





51

















52





Rising expectations

for service


care information





reviews


MinuteClinic)



1 2


Growing price

sensitivity





3


53






investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4










54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




23













Gaps in Performance



Navigation



Assistance




Marketing



Strategy




Contain cost

growth

Maximize revenue

capture

Capture new

growth


24









~$400Kgt$1M$500K-$1M


treatment options

Increasing consumer

demands




over volume



prolonged period of






spur investment in


despite unclear

reimbursement




for care





Shifting payment

models

Sample costs


25



Ma

rgin

s

Value-based care


Patient experience


Staffing

Drugs and supplies

Capital investments

Service utilization

1

2

3


ROAD MAP26





27









Bundled payments










Collaborative













28





bull 10 payers

bull CMS

Who is

participating





How are

practices paid


quality performance







the IOM









29




=


Quality





= Costs



Key caveats





37

33

27

27

24

31

12

8

Loweredcost ofcare

Increasedquality of

care






30

Dec

PP1 external

evaluation

published






July-Sept

Measurement

Period 1

July 1

OCM begins

w ith 190

participating

practices

June 30

End of

Performance

Period 1

Nov-Dec

OCM registry

available to

report clinical

and quality data

June 30

Anticipated

performance

period end date

201820172016 2019 2020 2021

Summer-Fall





Jan 1

Practices can

enter into either

tw o-sided risk

option

PP1 PP2

25 30


a bonus

PP31

33






31



Risk Arrangement




based onhellip



calculated onhellip




truehellip



differencehellip





32




Program performance

year

Number of

ACOs


savings




PY1 2012-2013 220 26 27 47 ($78M)

PY 2014 333 28 27 46 ($50M)

PY 2015 392 31 21 48 ($216M)

PY 2016 432 31 25 44 ($39M)

PY 2017 472 34 26 39 $314


33





Track 1



BASIC Track

5-year agreement




Track 2



Track 3


ENHANCED Track



34



Comprehensive

Cancer Care

Delivery Model

Patient-Centered

Oncology Payment

Model (PCOP)

1 2 3

















Making Accountable


Networks (MASON)







35







to participate




constructed


that bill globally






hospital and







36




investment roadmap












37















At-home DNA repair




38






increase in five-




2x


year survival for



214

201

187

172

156

1992 1998 2004 2010 2016





39


Prevalence


Tra

nsfo

rma

tive

po

ten

tia

l o

ve

r n

ext 3

-5 y

ea

rs



Liquidbiopsies

Breathalyzer


Oncolyticvaccines




Hormone therapy


Multi-gene panels





40



Cancer detection





Blood vessel

ctDNA1

Blood cell

ctDNA extracted




1

2

3















41






breathalyzer test


86





Instant results


bull Lung cancer



bull Ovarian cancer

bull Bladder cancer


bull Kidney cancer

bull Gastric cancer





bull Atypical

Parkinsonism



Hypertension

bull Pre-eclampsia




42





46

30

17

18

19

15

9

5

22

35

44

36

9

10

17

17

6

12

14

25

Liquid biopsy


sequencing

Multigene panel


0 1-10 10-25 25-50 gt50


n=200



each test

30

24

17

10


43







end of 2018



5

22 of alterations

identified by both

tests were

concordant

25 of drugs were

recommended for

the same patients

by both platforms

Currently covers



cancer type

Does not cover




on NGS testing



13

22

38FDA-approved


Multi-gene panels

Whole-exome

sequencing

n=100


44















tumors




Near-infrared

spectroscopy







877


45







healthy copy







1

2


Mechanism Outcome


cell types







144


46





(pemprolizumab)













to pembrolizumab



tumor shrinking




1

2

3



47




72

33

25

19




Tumor site 2014-2015 2016-2017

Lung 14 305


Kidney 05 441

Melanoma 564 824

Cost

reimbursement

Availability

access to drugs

Knowledge

of new

drugs

Comfort

managing side

effects




33


48








Kymriah injection









therapies









Select toxicities

bull Delirium

bull Anaphalaxis

bull Autoimmune

response


effects


syndrome


49






2017




2018





2019







Seema Verma

CMS Administrator


50




7

4

4

9

8

11

26

15

6

44

40

34

15

33

45







n=100





51

















52





Rising expectations

for service


care information





reviews


MinuteClinic)



1 2


Growing price

sensitivity





3


53






investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4










54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




24









~$400Kgt$1M$500K-$1M


treatment options

Increasing consumer

demands




over volume



prolonged period of






spur investment in


despite unclear

reimbursement




for care





Shifting payment

models

Sample costs


25



Ma

rgin

s

Value-based care


Patient experience


Staffing

Drugs and supplies

Capital investments

Service utilization

1

2

3


ROAD MAP26





27









Bundled payments










Collaborative













28





bull 10 payers

bull CMS

Who is

participating





How are

practices paid


quality performance







the IOM









29




=


Quality





= Costs



Key caveats





37

33

27

27

24

31

12

8

Loweredcost ofcare

Increasedquality of

care






30

Dec

PP1 external

evaluation

published






July-Sept

Measurement

Period 1

July 1

OCM begins

w ith 190

participating

practices

June 30

End of

Performance

Period 1

Nov-Dec

OCM registry

available to

report clinical

and quality data

June 30

Anticipated

performance

period end date

201820172016 2019 2020 2021

Summer-Fall





Jan 1

Practices can

enter into either

tw o-sided risk

option

PP1 PP2

25 30


a bonus

PP31

33






31



Risk Arrangement




based onhellip



calculated onhellip




truehellip



differencehellip





32




Program performance

year

Number of

ACOs


savings




PY1 2012-2013 220 26 27 47 ($78M)

PY 2014 333 28 27 46 ($50M)

PY 2015 392 31 21 48 ($216M)

PY 2016 432 31 25 44 ($39M)

PY 2017 472 34 26 39 $314


33





Track 1



BASIC Track

5-year agreement




Track 2



Track 3


ENHANCED Track



34



Comprehensive

Cancer Care

Delivery Model

Patient-Centered

Oncology Payment

Model (PCOP)

1 2 3

















Making Accountable


Networks (MASON)







35







to participate




constructed


that bill globally






hospital and







36




investment roadmap












37















At-home DNA repair




38






increase in five-




2x


year survival for



214

201

187

172

156

1992 1998 2004 2010 2016





39


Prevalence


Tra

nsfo

rma

tive

po

ten

tia

l o

ve

r n

ext 3

-5 y

ea

rs



Liquidbiopsies

Breathalyzer


Oncolyticvaccines




Hormone therapy


Multi-gene panels





40



Cancer detection





Blood vessel

ctDNA1

Blood cell

ctDNA extracted




1

2

3















41






breathalyzer test


86





Instant results


bull Lung cancer



bull Ovarian cancer

bull Bladder cancer


bull Kidney cancer

bull Gastric cancer





bull Atypical

Parkinsonism



Hypertension

bull Pre-eclampsia




42





46

30

17

18

19

15

9

5

22

35

44

36

9

10

17

17

6

12

14

25

Liquid biopsy


sequencing

Multigene panel


0 1-10 10-25 25-50 gt50


n=200



each test

30

24

17

10


43







end of 2018



5

22 of alterations

identified by both

tests were

concordant

25 of drugs were

recommended for

the same patients

by both platforms

Currently covers



cancer type

Does not cover




on NGS testing



13

22

38FDA-approved


Multi-gene panels

Whole-exome

sequencing

n=100


44















tumors




Near-infrared

spectroscopy







877


45







healthy copy







1

2


Mechanism Outcome


cell types







144


46





(pemprolizumab)













to pembrolizumab



tumor shrinking




1

2

3



47




72

33

25

19




Tumor site 2014-2015 2016-2017

Lung 14 305


Kidney 05 441

Melanoma 564 824

Cost

reimbursement

Availability

access to drugs

Knowledge

of new

drugs

Comfort

managing side

effects




33


48








Kymriah injection









therapies









Select toxicities

bull Delirium

bull Anaphalaxis

bull Autoimmune

response


effects


syndrome


49






2017




2018





2019







Seema Verma

CMS Administrator


50




7

4

4

9

8

11

26

15

6

44

40

34

15

33

45







n=100





51

















52





Rising expectations

for service


care information





reviews


MinuteClinic)



1 2


Growing price

sensitivity





3


53






investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4










54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




25



Ma

rgin

s

Value-based care


Patient experience


Staffing

Drugs and supplies

Capital investments

Service utilization

1

2

3


ROAD MAP26





27









Bundled payments










Collaborative













28





bull 10 payers

bull CMS

Who is

participating





How are

practices paid


quality performance







the IOM









29




=


Quality





= Costs



Key caveats





37

33

27

27

24

31

12

8

Loweredcost ofcare

Increasedquality of

care






30

Dec

PP1 external

evaluation

published






July-Sept

Measurement

Period 1

July 1

OCM begins

w ith 190

participating

practices

June 30

End of

Performance

Period 1

Nov-Dec

OCM registry

available to

report clinical

and quality data

June 30

Anticipated

performance

period end date

201820172016 2019 2020 2021

Summer-Fall





Jan 1

Practices can

enter into either

tw o-sided risk

option

PP1 PP2

25 30


a bonus

PP31

33






31



Risk Arrangement




based onhellip



calculated onhellip




truehellip



differencehellip





32




Program performance

year

Number of

ACOs


savings




PY1 2012-2013 220 26 27 47 ($78M)

PY 2014 333 28 27 46 ($50M)

PY 2015 392 31 21 48 ($216M)

PY 2016 432 31 25 44 ($39M)

PY 2017 472 34 26 39 $314


33





Track 1



BASIC Track

5-year agreement




Track 2



Track 3


ENHANCED Track



34



Comprehensive

Cancer Care

Delivery Model

Patient-Centered

Oncology Payment

Model (PCOP)

1 2 3

















Making Accountable


Networks (MASON)







35







to participate




constructed


that bill globally






hospital and







36




investment roadmap












37















At-home DNA repair




38






increase in five-




2x


year survival for



214

201

187

172

156

1992 1998 2004 2010 2016





39


Prevalence


Tra

nsfo

rma

tive

po

ten

tia

l o

ve

r n

ext 3

-5 y

ea

rs



Liquidbiopsies

Breathalyzer


Oncolyticvaccines




Hormone therapy


Multi-gene panels





40



Cancer detection





Blood vessel

ctDNA1

Blood cell

ctDNA extracted




1

2

3















41






breathalyzer test


86





Instant results


bull Lung cancer



bull Ovarian cancer

bull Bladder cancer


bull Kidney cancer

bull Gastric cancer





bull Atypical

Parkinsonism



Hypertension

bull Pre-eclampsia




42





46

30

17

18

19

15

9

5

22

35

44

36

9

10

17

17

6

12

14

25

Liquid biopsy


sequencing

Multigene panel


0 1-10 10-25 25-50 gt50


n=200



each test

30

24

17

10


43







end of 2018



5

22 of alterations

identified by both

tests were

concordant

25 of drugs were

recommended for

the same patients

by both platforms

Currently covers



cancer type

Does not cover




on NGS testing



13

22

38FDA-approved


Multi-gene panels

Whole-exome

sequencing

n=100


44















tumors




Near-infrared

spectroscopy







877


45







healthy copy







1

2


Mechanism Outcome


cell types







144


46





(pemprolizumab)













to pembrolizumab



tumor shrinking




1

2

3



47




72

33

25

19




Tumor site 2014-2015 2016-2017

Lung 14 305


Kidney 05 441

Melanoma 564 824

Cost

reimbursement

Availability

access to drugs

Knowledge

of new

drugs

Comfort

managing side

effects




33


48








Kymriah injection









therapies









Select toxicities

bull Delirium

bull Anaphalaxis

bull Autoimmune

response


effects


syndrome


49






2017




2018





2019







Seema Verma

CMS Administrator


50




7

4

4

9

8

11

26

15

6

44

40

34

15

33

45







n=100





51

















52





Rising expectations

for service


care information





reviews


MinuteClinic)



1 2


Growing price

sensitivity





3


53






investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4










54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




ROAD MAP26





27









Bundled payments










Collaborative













28





bull 10 payers

bull CMS

Who is

participating





How are

practices paid


quality performance







the IOM









29




=


Quality





= Costs



Key caveats





37

33

27

27

24

31

12

8

Loweredcost ofcare

Increasedquality of

care






30

Dec

PP1 external

evaluation

published






July-Sept

Measurement

Period 1

July 1

OCM begins

w ith 190

participating

practices

June 30

End of

Performance

Period 1

Nov-Dec

OCM registry

available to

report clinical

and quality data

June 30

Anticipated

performance

period end date

201820172016 2019 2020 2021

Summer-Fall





Jan 1

Practices can

enter into either

tw o-sided risk

option

PP1 PP2

25 30


a bonus

PP31

33






31



Risk Arrangement




based onhellip



calculated onhellip




truehellip



differencehellip





32




Program performance

year

Number of

ACOs


savings




PY1 2012-2013 220 26 27 47 ($78M)

PY 2014 333 28 27 46 ($50M)

PY 2015 392 31 21 48 ($216M)

PY 2016 432 31 25 44 ($39M)

PY 2017 472 34 26 39 $314


33





Track 1



BASIC Track

5-year agreement




Track 2



Track 3


ENHANCED Track



34



Comprehensive

Cancer Care

Delivery Model

Patient-Centered

Oncology Payment

Model (PCOP)

1 2 3

















Making Accountable


Networks (MASON)







35







to participate




constructed


that bill globally






hospital and







36




investment roadmap












37















At-home DNA repair




38






increase in five-




2x


year survival for



214

201

187

172

156

1992 1998 2004 2010 2016





39


Prevalence


Tra

nsfo

rma

tive

po

ten

tia

l o

ve

r n

ext 3

-5 y

ea

rs



Liquidbiopsies

Breathalyzer


Oncolyticvaccines




Hormone therapy


Multi-gene panels





40



Cancer detection





Blood vessel

ctDNA1

Blood cell

ctDNA extracted




1

2

3















41






breathalyzer test


86





Instant results


bull Lung cancer



bull Ovarian cancer

bull Bladder cancer


bull Kidney cancer

bull Gastric cancer





bull Atypical

Parkinsonism



Hypertension

bull Pre-eclampsia




42





46

30

17

18

19

15

9

5

22

35

44

36

9

10

17

17

6

12

14

25

Liquid biopsy


sequencing

Multigene panel


0 1-10 10-25 25-50 gt50


n=200



each test

30

24

17

10


43







end of 2018



5

22 of alterations

identified by both

tests were

concordant

25 of drugs were

recommended for

the same patients

by both platforms

Currently covers



cancer type

Does not cover




on NGS testing



13

22

38FDA-approved


Multi-gene panels

Whole-exome

sequencing

n=100


44















tumors




Near-infrared

spectroscopy







877


45







healthy copy







1

2


Mechanism Outcome


cell types







144


46





(pemprolizumab)













to pembrolizumab



tumor shrinking




1

2

3



47




72

33

25

19




Tumor site 2014-2015 2016-2017

Lung 14 305


Kidney 05 441

Melanoma 564 824

Cost

reimbursement

Availability

access to drugs

Knowledge

of new

drugs

Comfort

managing side

effects




33


48








Kymriah injection









therapies









Select toxicities

bull Delirium

bull Anaphalaxis

bull Autoimmune

response


effects


syndrome


49






2017




2018





2019







Seema Verma

CMS Administrator


50




7

4

4

9

8

11

26

15

6

44

40

34

15

33

45







n=100





51

















52





Rising expectations

for service


care information





reviews


MinuteClinic)



1 2


Growing price

sensitivity





3


53






investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4










54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




27









Bundled payments










Collaborative













28





bull 10 payers

bull CMS

Who is

participating





How are

practices paid


quality performance







the IOM









29




=


Quality





= Costs



Key caveats





37

33

27

27

24

31

12

8

Loweredcost ofcare

Increasedquality of

care






30

Dec

PP1 external

evaluation

published






July-Sept

Measurement

Period 1

July 1

OCM begins

w ith 190

participating

practices

June 30

End of

Performance

Period 1

Nov-Dec

OCM registry

available to

report clinical

and quality data

June 30

Anticipated

performance

period end date

201820172016 2019 2020 2021

Summer-Fall





Jan 1

Practices can

enter into either

tw o-sided risk

option

PP1 PP2

25 30


a bonus

PP31

33






31



Risk Arrangement




based onhellip



calculated onhellip




truehellip



differencehellip





32




Program performance

year

Number of

ACOs


savings




PY1 2012-2013 220 26 27 47 ($78M)

PY 2014 333 28 27 46 ($50M)

PY 2015 392 31 21 48 ($216M)

PY 2016 432 31 25 44 ($39M)

PY 2017 472 34 26 39 $314


33





Track 1



BASIC Track

5-year agreement




Track 2



Track 3


ENHANCED Track



34



Comprehensive

Cancer Care

Delivery Model

Patient-Centered

Oncology Payment

Model (PCOP)

1 2 3

















Making Accountable


Networks (MASON)







35







to participate




constructed


that bill globally






hospital and







36




investment roadmap












37















At-home DNA repair




38






increase in five-




2x


year survival for



214

201

187

172

156

1992 1998 2004 2010 2016





39


Prevalence


Tra

nsfo

rma

tive

po

ten

tia

l o

ve

r n

ext 3

-5 y

ea

rs



Liquidbiopsies

Breathalyzer


Oncolyticvaccines




Hormone therapy


Multi-gene panels





40



Cancer detection





Blood vessel

ctDNA1

Blood cell

ctDNA extracted




1

2

3















41






breathalyzer test


86





Instant results


bull Lung cancer



bull Ovarian cancer

bull Bladder cancer


bull Kidney cancer

bull Gastric cancer





bull Atypical

Parkinsonism



Hypertension

bull Pre-eclampsia




42





46

30

17

18

19

15

9

5

22

35

44

36

9

10

17

17

6

12

14

25

Liquid biopsy


sequencing

Multigene panel


0 1-10 10-25 25-50 gt50


n=200



each test

30

24

17

10


43







end of 2018



5

22 of alterations

identified by both

tests were

concordant

25 of drugs were

recommended for

the same patients

by both platforms

Currently covers



cancer type

Does not cover




on NGS testing



13

22

38FDA-approved


Multi-gene panels

Whole-exome

sequencing

n=100


44















tumors




Near-infrared

spectroscopy







877


45







healthy copy







1

2


Mechanism Outcome


cell types







144


46





(pemprolizumab)













to pembrolizumab



tumor shrinking




1

2

3



47




72

33

25

19




Tumor site 2014-2015 2016-2017

Lung 14 305


Kidney 05 441

Melanoma 564 824

Cost

reimbursement

Availability

access to drugs

Knowledge

of new

drugs

Comfort

managing side

effects




33


48








Kymriah injection









therapies









Select toxicities

bull Delirium

bull Anaphalaxis

bull Autoimmune

response


effects


syndrome


49






2017




2018





2019







Seema Verma

CMS Administrator


50




7

4

4

9

8

11

26

15

6

44

40

34

15

33

45







n=100





51

















52





Rising expectations

for service


care information





reviews


MinuteClinic)



1 2


Growing price

sensitivity





3


53






investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4










54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




28





bull 10 payers

bull CMS

Who is

participating





How are

practices paid


quality performance







the IOM









29




=


Quality





= Costs



Key caveats





37

33

27

27

24

31

12

8

Loweredcost ofcare

Increasedquality of

care






30

Dec

PP1 external

evaluation

published






July-Sept

Measurement

Period 1

July 1

OCM begins

w ith 190

participating

practices

June 30

End of

Performance

Period 1

Nov-Dec

OCM registry

available to

report clinical

and quality data

June 30

Anticipated

performance

period end date

201820172016 2019 2020 2021

Summer-Fall





Jan 1

Practices can

enter into either

tw o-sided risk

option

PP1 PP2

25 30


a bonus

PP31

33






31



Risk Arrangement




based onhellip



calculated onhellip




truehellip



differencehellip





32




Program performance

year

Number of

ACOs


savings




PY1 2012-2013 220 26 27 47 ($78M)

PY 2014 333 28 27 46 ($50M)

PY 2015 392 31 21 48 ($216M)

PY 2016 432 31 25 44 ($39M)

PY 2017 472 34 26 39 $314


33





Track 1



BASIC Track

5-year agreement




Track 2



Track 3


ENHANCED Track



34



Comprehensive

Cancer Care

Delivery Model

Patient-Centered

Oncology Payment

Model (PCOP)

1 2 3

















Making Accountable


Networks (MASON)







35







to participate




constructed


that bill globally






hospital and







36




investment roadmap












37















At-home DNA repair




38






increase in five-




2x


year survival for



214

201

187

172

156

1992 1998 2004 2010 2016





39


Prevalence


Tra

nsfo

rma

tive

po

ten

tia

l o

ve

r n

ext 3

-5 y

ea

rs



Liquidbiopsies

Breathalyzer


Oncolyticvaccines




Hormone therapy


Multi-gene panels





40



Cancer detection





Blood vessel

ctDNA1

Blood cell

ctDNA extracted




1

2

3















41






breathalyzer test


86





Instant results


bull Lung cancer



bull Ovarian cancer

bull Bladder cancer


bull Kidney cancer

bull Gastric cancer





bull Atypical

Parkinsonism



Hypertension

bull Pre-eclampsia




42





46

30

17

18

19

15

9

5

22

35

44

36

9

10

17

17

6

12

14

25

Liquid biopsy


sequencing

Multigene panel


0 1-10 10-25 25-50 gt50


n=200



each test

30

24

17

10


43







end of 2018



5

22 of alterations

identified by both

tests were

concordant

25 of drugs were

recommended for

the same patients

by both platforms

Currently covers



cancer type

Does not cover




on NGS testing



13

22

38FDA-approved


Multi-gene panels

Whole-exome

sequencing

n=100


44















tumors




Near-infrared

spectroscopy







877


45







healthy copy







1

2


Mechanism Outcome


cell types







144


46





(pemprolizumab)













to pembrolizumab



tumor shrinking




1

2

3



47




72

33

25

19




Tumor site 2014-2015 2016-2017

Lung 14 305


Kidney 05 441

Melanoma 564 824

Cost

reimbursement

Availability

access to drugs

Knowledge

of new

drugs

Comfort

managing side

effects




33


48








Kymriah injection









therapies









Select toxicities

bull Delirium

bull Anaphalaxis

bull Autoimmune

response


effects


syndrome


49






2017




2018





2019







Seema Verma

CMS Administrator


50




7

4

4

9

8

11

26

15

6

44

40

34

15

33

45







n=100





51

















52





Rising expectations

for service


care information





reviews


MinuteClinic)



1 2


Growing price

sensitivity





3


53






investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4










54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




29




=


Quality





= Costs



Key caveats





37

33

27

27

24

31

12

8

Loweredcost ofcare

Increasedquality of

care






30

Dec

PP1 external

evaluation

published






July-Sept

Measurement

Period 1

July 1

OCM begins

w ith 190

participating

practices

June 30

End of

Performance

Period 1

Nov-Dec

OCM registry

available to

report clinical

and quality data

June 30

Anticipated

performance

period end date

201820172016 2019 2020 2021

Summer-Fall





Jan 1

Practices can

enter into either

tw o-sided risk

option

PP1 PP2

25 30


a bonus

PP31

33






31



Risk Arrangement




based onhellip



calculated onhellip




truehellip



differencehellip





32




Program performance

year

Number of

ACOs


savings




PY1 2012-2013 220 26 27 47 ($78M)

PY 2014 333 28 27 46 ($50M)

PY 2015 392 31 21 48 ($216M)

PY 2016 432 31 25 44 ($39M)

PY 2017 472 34 26 39 $314


33





Track 1



BASIC Track

5-year agreement




Track 2



Track 3


ENHANCED Track



34



Comprehensive

Cancer Care

Delivery Model

Patient-Centered

Oncology Payment

Model (PCOP)

1 2 3

















Making Accountable


Networks (MASON)







35







to participate




constructed


that bill globally






hospital and







36




investment roadmap












37















At-home DNA repair




38






increase in five-




2x


year survival for



214

201

187

172

156

1992 1998 2004 2010 2016





39


Prevalence


Tra

nsfo

rma

tive

po

ten

tia

l o

ve

r n

ext 3

-5 y

ea

rs



Liquidbiopsies

Breathalyzer


Oncolyticvaccines




Hormone therapy


Multi-gene panels





40



Cancer detection





Blood vessel

ctDNA1

Blood cell

ctDNA extracted




1

2

3















41






breathalyzer test


86





Instant results


bull Lung cancer



bull Ovarian cancer

bull Bladder cancer


bull Kidney cancer

bull Gastric cancer





bull Atypical

Parkinsonism



Hypertension

bull Pre-eclampsia




42





46

30

17

18

19

15

9

5

22

35

44

36

9

10

17

17

6

12

14

25

Liquid biopsy


sequencing

Multigene panel


0 1-10 10-25 25-50 gt50


n=200



each test

30

24

17

10


43







end of 2018



5

22 of alterations

identified by both

tests were

concordant

25 of drugs were

recommended for

the same patients

by both platforms

Currently covers



cancer type

Does not cover




on NGS testing



13

22

38FDA-approved


Multi-gene panels

Whole-exome

sequencing

n=100


44















tumors




Near-infrared

spectroscopy







877


45







healthy copy







1

2


Mechanism Outcome


cell types







144


46





(pemprolizumab)













to pembrolizumab



tumor shrinking




1

2

3



47




72

33

25

19




Tumor site 2014-2015 2016-2017

Lung 14 305


Kidney 05 441

Melanoma 564 824

Cost

reimbursement

Availability

access to drugs

Knowledge

of new

drugs

Comfort

managing side

effects




33


48








Kymriah injection









therapies









Select toxicities

bull Delirium

bull Anaphalaxis

bull Autoimmune

response


effects


syndrome


49






2017




2018





2019







Seema Verma

CMS Administrator


50




7

4

4

9

8

11

26

15

6

44

40

34

15

33

45







n=100





51

















52





Rising expectations

for service


care information





reviews


MinuteClinic)



1 2


Growing price

sensitivity





3


53






investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4










54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




30

Dec

PP1 external

evaluation

published






July-Sept

Measurement

Period 1

July 1

OCM begins

w ith 190

participating

practices

June 30

End of

Performance

Period 1

Nov-Dec

OCM registry

available to

report clinical

and quality data

June 30

Anticipated

performance

period end date

201820172016 2019 2020 2021

Summer-Fall





Jan 1

Practices can

enter into either

tw o-sided risk

option

PP1 PP2

25 30


a bonus

PP31

33






31



Risk Arrangement




based onhellip



calculated onhellip




truehellip



differencehellip





32




Program performance

year

Number of

ACOs


savings




PY1 2012-2013 220 26 27 47 ($78M)

PY 2014 333 28 27 46 ($50M)

PY 2015 392 31 21 48 ($216M)

PY 2016 432 31 25 44 ($39M)

PY 2017 472 34 26 39 $314


33





Track 1



BASIC Track

5-year agreement




Track 2



Track 3


ENHANCED Track



34



Comprehensive

Cancer Care

Delivery Model

Patient-Centered

Oncology Payment

Model (PCOP)

1 2 3

















Making Accountable


Networks (MASON)







35







to participate




constructed


that bill globally






hospital and







36




investment roadmap












37















At-home DNA repair




38






increase in five-




2x


year survival for



214

201

187

172

156

1992 1998 2004 2010 2016





39


Prevalence


Tra

nsfo

rma

tive

po

ten

tia

l o

ve

r n

ext 3

-5 y

ea

rs



Liquidbiopsies

Breathalyzer


Oncolyticvaccines




Hormone therapy


Multi-gene panels





40



Cancer detection





Blood vessel

ctDNA1

Blood cell

ctDNA extracted




1

2

3















41






breathalyzer test


86





Instant results


bull Lung cancer



bull Ovarian cancer

bull Bladder cancer


bull Kidney cancer

bull Gastric cancer





bull Atypical

Parkinsonism



Hypertension

bull Pre-eclampsia




42





46

30

17

18

19

15

9

5

22

35

44

36

9

10

17

17

6

12

14

25

Liquid biopsy


sequencing

Multigene panel


0 1-10 10-25 25-50 gt50


n=200



each test

30

24

17

10


43







end of 2018



5

22 of alterations

identified by both

tests were

concordant

25 of drugs were

recommended for

the same patients

by both platforms

Currently covers



cancer type

Does not cover




on NGS testing



13

22

38FDA-approved


Multi-gene panels

Whole-exome

sequencing

n=100


44















tumors




Near-infrared

spectroscopy







877


45







healthy copy







1

2


Mechanism Outcome


cell types







144


46





(pemprolizumab)













to pembrolizumab



tumor shrinking




1

2

3



47




72

33

25

19




Tumor site 2014-2015 2016-2017

Lung 14 305


Kidney 05 441

Melanoma 564 824

Cost

reimbursement

Availability

access to drugs

Knowledge

of new

drugs

Comfort

managing side

effects




33


48








Kymriah injection









therapies









Select toxicities

bull Delirium

bull Anaphalaxis

bull Autoimmune

response


effects


syndrome


49






2017




2018





2019







Seema Verma

CMS Administrator


50




7

4

4

9

8

11

26

15

6

44

40

34

15

33

45







n=100





51

















52





Rising expectations

for service


care information





reviews


MinuteClinic)



1 2


Growing price

sensitivity





3


53






investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4










54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




31



Risk Arrangement




based onhellip



calculated onhellip




truehellip



differencehellip





32




Program performance

year

Number of

ACOs


savings




PY1 2012-2013 220 26 27 47 ($78M)

PY 2014 333 28 27 46 ($50M)

PY 2015 392 31 21 48 ($216M)

PY 2016 432 31 25 44 ($39M)

PY 2017 472 34 26 39 $314


33





Track 1



BASIC Track

5-year agreement




Track 2



Track 3


ENHANCED Track



34



Comprehensive

Cancer Care

Delivery Model

Patient-Centered

Oncology Payment

Model (PCOP)

1 2 3

















Making Accountable


Networks (MASON)







35







to participate




constructed


that bill globally






hospital and







36




investment roadmap












37















At-home DNA repair




38






increase in five-




2x


year survival for



214

201

187

172

156

1992 1998 2004 2010 2016





39


Prevalence


Tra

nsfo

rma

tive

po

ten

tia

l o

ve

r n

ext 3

-5 y

ea

rs



Liquidbiopsies

Breathalyzer


Oncolyticvaccines




Hormone therapy


Multi-gene panels





40



Cancer detection





Blood vessel

ctDNA1

Blood cell

ctDNA extracted




1

2

3















41






breathalyzer test


86





Instant results


bull Lung cancer



bull Ovarian cancer

bull Bladder cancer


bull Kidney cancer

bull Gastric cancer





bull Atypical

Parkinsonism



Hypertension

bull Pre-eclampsia




42





46

30

17

18

19

15

9

5

22

35

44

36

9

10

17

17

6

12

14

25

Liquid biopsy


sequencing

Multigene panel


0 1-10 10-25 25-50 gt50


n=200



each test

30

24

17

10


43







end of 2018



5

22 of alterations

identified by both

tests were

concordant

25 of drugs were

recommended for

the same patients

by both platforms

Currently covers



cancer type

Does not cover




on NGS testing



13

22

38FDA-approved


Multi-gene panels

Whole-exome

sequencing

n=100


44















tumors




Near-infrared

spectroscopy







877


45







healthy copy







1

2


Mechanism Outcome


cell types







144


46





(pemprolizumab)













to pembrolizumab



tumor shrinking




1

2

3



47




72

33

25

19




Tumor site 2014-2015 2016-2017

Lung 14 305


Kidney 05 441

Melanoma 564 824

Cost

reimbursement

Availability

access to drugs

Knowledge

of new

drugs

Comfort

managing side

effects




33


48








Kymriah injection









therapies









Select toxicities

bull Delirium

bull Anaphalaxis

bull Autoimmune

response


effects


syndrome


49






2017




2018





2019







Seema Verma

CMS Administrator


50




7

4

4

9

8

11

26

15

6

44

40

34

15

33

45







n=100





51

















52





Rising expectations

for service


care information





reviews


MinuteClinic)



1 2


Growing price

sensitivity





3


53






investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4










54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




32




Program performance

year

Number of

ACOs


savings




PY1 2012-2013 220 26 27 47 ($78M)

PY 2014 333 28 27 46 ($50M)

PY 2015 392 31 21 48 ($216M)

PY 2016 432 31 25 44 ($39M)

PY 2017 472 34 26 39 $314


33





Track 1



BASIC Track

5-year agreement




Track 2



Track 3


ENHANCED Track



34



Comprehensive

Cancer Care

Delivery Model

Patient-Centered

Oncology Payment

Model (PCOP)

1 2 3

















Making Accountable


Networks (MASON)







35







to participate




constructed


that bill globally






hospital and







36




investment roadmap












37















At-home DNA repair




38






increase in five-




2x


year survival for



214

201

187

172

156

1992 1998 2004 2010 2016





39


Prevalence


Tra

nsfo

rma

tive

po

ten

tia

l o

ve

r n

ext 3

-5 y

ea

rs



Liquidbiopsies

Breathalyzer


Oncolyticvaccines




Hormone therapy


Multi-gene panels





40



Cancer detection





Blood vessel

ctDNA1

Blood cell

ctDNA extracted




1

2

3















41






breathalyzer test


86





Instant results


bull Lung cancer



bull Ovarian cancer

bull Bladder cancer


bull Kidney cancer

bull Gastric cancer





bull Atypical

Parkinsonism



Hypertension

bull Pre-eclampsia




42





46

30

17

18

19

15

9

5

22

35

44

36

9

10

17

17

6

12

14

25

Liquid biopsy


sequencing

Multigene panel


0 1-10 10-25 25-50 gt50


n=200



each test

30

24

17

10


43







end of 2018



5

22 of alterations

identified by both

tests were

concordant

25 of drugs were

recommended for

the same patients

by both platforms

Currently covers



cancer type

Does not cover




on NGS testing



13

22

38FDA-approved


Multi-gene panels

Whole-exome

sequencing

n=100


44















tumors




Near-infrared

spectroscopy







877


45







healthy copy







1

2


Mechanism Outcome


cell types







144


46





(pemprolizumab)













to pembrolizumab



tumor shrinking




1

2

3



47




72

33

25

19




Tumor site 2014-2015 2016-2017

Lung 14 305


Kidney 05 441

Melanoma 564 824

Cost

reimbursement

Availability

access to drugs

Knowledge

of new

drugs

Comfort

managing side

effects




33


48








Kymriah injection









therapies









Select toxicities

bull Delirium

bull Anaphalaxis

bull Autoimmune

response


effects


syndrome


49






2017




2018





2019







Seema Verma

CMS Administrator


50




7

4

4

9

8

11

26

15

6

44

40

34

15

33

45







n=100





51

















52





Rising expectations

for service


care information





reviews


MinuteClinic)



1 2


Growing price

sensitivity





3


53






investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4










54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




33





Track 1



BASIC Track

5-year agreement




Track 2



Track 3


ENHANCED Track



34



Comprehensive

Cancer Care

Delivery Model

Patient-Centered

Oncology Payment

Model (PCOP)

1 2 3

















Making Accountable


Networks (MASON)







35







to participate




constructed


that bill globally






hospital and







36




investment roadmap












37















At-home DNA repair




38






increase in five-




2x


year survival for



214

201

187

172

156

1992 1998 2004 2010 2016





39


Prevalence


Tra

nsfo

rma

tive

po

ten

tia

l o

ve

r n

ext 3

-5 y

ea

rs



Liquidbiopsies

Breathalyzer


Oncolyticvaccines




Hormone therapy


Multi-gene panels





40



Cancer detection





Blood vessel

ctDNA1

Blood cell

ctDNA extracted




1

2

3















41






breathalyzer test


86





Instant results


bull Lung cancer



bull Ovarian cancer

bull Bladder cancer


bull Kidney cancer

bull Gastric cancer





bull Atypical

Parkinsonism



Hypertension

bull Pre-eclampsia




42





46

30

17

18

19

15

9

5

22

35

44

36

9

10

17

17

6

12

14

25

Liquid biopsy


sequencing

Multigene panel


0 1-10 10-25 25-50 gt50


n=200



each test

30

24

17

10


43







end of 2018



5

22 of alterations

identified by both

tests were

concordant

25 of drugs were

recommended for

the same patients

by both platforms

Currently covers



cancer type

Does not cover




on NGS testing



13

22

38FDA-approved


Multi-gene panels

Whole-exome

sequencing

n=100


44















tumors




Near-infrared

spectroscopy







877


45







healthy copy







1

2


Mechanism Outcome


cell types







144


46





(pemprolizumab)













to pembrolizumab



tumor shrinking




1

2

3



47




72

33

25

19




Tumor site 2014-2015 2016-2017

Lung 14 305


Kidney 05 441

Melanoma 564 824

Cost

reimbursement

Availability

access to drugs

Knowledge

of new

drugs

Comfort

managing side

effects




33


48








Kymriah injection









therapies









Select toxicities

bull Delirium

bull Anaphalaxis

bull Autoimmune

response


effects


syndrome


49






2017




2018





2019







Seema Verma

CMS Administrator


50




7

4

4

9

8

11

26

15

6

44

40

34

15

33

45







n=100





51

















52





Rising expectations

for service


care information





reviews


MinuteClinic)



1 2


Growing price

sensitivity





3


53






investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4










54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




34



Comprehensive

Cancer Care

Delivery Model

Patient-Centered

Oncology Payment

Model (PCOP)

1 2 3

















Making Accountable


Networks (MASON)







35







to participate




constructed


that bill globally






hospital and







36




investment roadmap












37















At-home DNA repair




38






increase in five-




2x


year survival for



214

201

187

172

156

1992 1998 2004 2010 2016





39


Prevalence


Tra

nsfo

rma

tive

po

ten

tia

l o

ve

r n

ext 3

-5 y

ea

rs



Liquidbiopsies

Breathalyzer


Oncolyticvaccines




Hormone therapy


Multi-gene panels





40



Cancer detection





Blood vessel

ctDNA1

Blood cell

ctDNA extracted




1

2

3















41






breathalyzer test


86





Instant results


bull Lung cancer



bull Ovarian cancer

bull Bladder cancer


bull Kidney cancer

bull Gastric cancer





bull Atypical

Parkinsonism



Hypertension

bull Pre-eclampsia




42





46

30

17

18

19

15

9

5

22

35

44

36

9

10

17

17

6

12

14

25

Liquid biopsy


sequencing

Multigene panel


0 1-10 10-25 25-50 gt50


n=200



each test

30

24

17

10


43







end of 2018



5

22 of alterations

identified by both

tests were

concordant

25 of drugs were

recommended for

the same patients

by both platforms

Currently covers



cancer type

Does not cover




on NGS testing



13

22

38FDA-approved


Multi-gene panels

Whole-exome

sequencing

n=100


44















tumors




Near-infrared

spectroscopy







877


45







healthy copy







1

2


Mechanism Outcome


cell types







144


46





(pemprolizumab)













to pembrolizumab



tumor shrinking




1

2

3



47




72

33

25

19




Tumor site 2014-2015 2016-2017

Lung 14 305


Kidney 05 441

Melanoma 564 824

Cost

reimbursement

Availability

access to drugs

Knowledge

of new

drugs

Comfort

managing side

effects




33


48








Kymriah injection









therapies









Select toxicities

bull Delirium

bull Anaphalaxis

bull Autoimmune

response


effects


syndrome


49






2017




2018





2019







Seema Verma

CMS Administrator


50




7

4

4

9

8

11

26

15

6

44

40

34

15

33

45







n=100





51

















52





Rising expectations

for service


care information





reviews


MinuteClinic)



1 2


Growing price

sensitivity





3


53






investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4










54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




35







to participate




constructed


that bill globally






hospital and







36




investment roadmap












37















At-home DNA repair




38






increase in five-




2x


year survival for



214

201

187

172

156

1992 1998 2004 2010 2016





39


Prevalence


Tra

nsfo

rma

tive

po

ten

tia

l o

ve

r n

ext 3

-5 y

ea

rs



Liquidbiopsies

Breathalyzer


Oncolyticvaccines




Hormone therapy


Multi-gene panels





40



Cancer detection





Blood vessel

ctDNA1

Blood cell

ctDNA extracted




1

2

3















41






breathalyzer test


86





Instant results


bull Lung cancer



bull Ovarian cancer

bull Bladder cancer


bull Kidney cancer

bull Gastric cancer





bull Atypical

Parkinsonism



Hypertension

bull Pre-eclampsia




42





46

30

17

18

19

15

9

5

22

35

44

36

9

10

17

17

6

12

14

25

Liquid biopsy


sequencing

Multigene panel


0 1-10 10-25 25-50 gt50


n=200



each test

30

24

17

10


43







end of 2018



5

22 of alterations

identified by both

tests were

concordant

25 of drugs were

recommended for

the same patients

by both platforms

Currently covers



cancer type

Does not cover




on NGS testing



13

22

38FDA-approved


Multi-gene panels

Whole-exome

sequencing

n=100


44















tumors




Near-infrared

spectroscopy







877


45







healthy copy







1

2


Mechanism Outcome


cell types







144


46





(pemprolizumab)













to pembrolizumab



tumor shrinking




1

2

3



47




72

33

25

19




Tumor site 2014-2015 2016-2017

Lung 14 305


Kidney 05 441

Melanoma 564 824

Cost

reimbursement

Availability

access to drugs

Knowledge

of new

drugs

Comfort

managing side

effects




33


48








Kymriah injection









therapies









Select toxicities

bull Delirium

bull Anaphalaxis

bull Autoimmune

response


effects


syndrome


49






2017




2018





2019







Seema Verma

CMS Administrator


50




7

4

4

9

8

11

26

15

6

44

40

34

15

33

45







n=100





51

















52





Rising expectations

for service


care information





reviews


MinuteClinic)



1 2


Growing price

sensitivity





3


53






investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4










54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




36




investment roadmap












37















At-home DNA repair




38






increase in five-




2x


year survival for



214

201

187

172

156

1992 1998 2004 2010 2016





39


Prevalence


Tra

nsfo

rma

tive

po

ten

tia

l o

ve

r n

ext 3

-5 y

ea

rs



Liquidbiopsies

Breathalyzer


Oncolyticvaccines




Hormone therapy


Multi-gene panels





40



Cancer detection





Blood vessel

ctDNA1

Blood cell

ctDNA extracted




1

2

3















41






breathalyzer test


86





Instant results


bull Lung cancer



bull Ovarian cancer

bull Bladder cancer


bull Kidney cancer

bull Gastric cancer





bull Atypical

Parkinsonism



Hypertension

bull Pre-eclampsia




42





46

30

17

18

19

15

9

5

22

35

44

36

9

10

17

17

6

12

14

25

Liquid biopsy


sequencing

Multigene panel


0 1-10 10-25 25-50 gt50


n=200



each test

30

24

17

10


43







end of 2018



5

22 of alterations

identified by both

tests were

concordant

25 of drugs were

recommended for

the same patients

by both platforms

Currently covers



cancer type

Does not cover




on NGS testing



13

22

38FDA-approved


Multi-gene panels

Whole-exome

sequencing

n=100


44















tumors




Near-infrared

spectroscopy







877


45







healthy copy







1

2


Mechanism Outcome


cell types







144


46





(pemprolizumab)













to pembrolizumab



tumor shrinking




1

2

3



47




72

33

25

19




Tumor site 2014-2015 2016-2017

Lung 14 305


Kidney 05 441

Melanoma 564 824

Cost

reimbursement

Availability

access to drugs

Knowledge

of new

drugs

Comfort

managing side

effects




33


48








Kymriah injection









therapies









Select toxicities

bull Delirium

bull Anaphalaxis

bull Autoimmune

response


effects


syndrome


49






2017




2018





2019







Seema Verma

CMS Administrator


50




7

4

4

9

8

11

26

15

6

44

40

34

15

33

45







n=100





51

















52





Rising expectations

for service


care information





reviews


MinuteClinic)



1 2


Growing price

sensitivity





3


53






investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4










54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




37















At-home DNA repair




38






increase in five-




2x


year survival for



214

201

187

172

156

1992 1998 2004 2010 2016





39


Prevalence


Tra

nsfo

rma

tive

po

ten

tia

l o

ve

r n

ext 3

-5 y

ea

rs



Liquidbiopsies

Breathalyzer


Oncolyticvaccines




Hormone therapy


Multi-gene panels





40



Cancer detection





Blood vessel

ctDNA1

Blood cell

ctDNA extracted




1

2

3















41






breathalyzer test


86





Instant results


bull Lung cancer



bull Ovarian cancer

bull Bladder cancer


bull Kidney cancer

bull Gastric cancer





bull Atypical

Parkinsonism



Hypertension

bull Pre-eclampsia




42





46

30

17

18

19

15

9

5

22

35

44

36

9

10

17

17

6

12

14

25

Liquid biopsy


sequencing

Multigene panel


0 1-10 10-25 25-50 gt50


n=200



each test

30

24

17

10


43







end of 2018



5

22 of alterations

identified by both

tests were

concordant

25 of drugs were

recommended for

the same patients

by both platforms

Currently covers



cancer type

Does not cover




on NGS testing



13

22

38FDA-approved


Multi-gene panels

Whole-exome

sequencing

n=100


44















tumors




Near-infrared

spectroscopy







877


45







healthy copy







1

2


Mechanism Outcome


cell types







144


46





(pemprolizumab)













to pembrolizumab



tumor shrinking




1

2

3



47




72

33

25

19




Tumor site 2014-2015 2016-2017

Lung 14 305


Kidney 05 441

Melanoma 564 824

Cost

reimbursement

Availability

access to drugs

Knowledge

of new

drugs

Comfort

managing side

effects




33


48








Kymriah injection









therapies









Select toxicities

bull Delirium

bull Anaphalaxis

bull Autoimmune

response


effects


syndrome


49






2017




2018





2019







Seema Verma

CMS Administrator


50




7

4

4

9

8

11

26

15

6

44

40

34

15

33

45







n=100





51

















52





Rising expectations

for service


care information





reviews


MinuteClinic)



1 2


Growing price

sensitivity





3


53






investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4










54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




38






increase in five-




2x


year survival for



214

201

187

172

156

1992 1998 2004 2010 2016





39


Prevalence


Tra

nsfo

rma

tive

po

ten

tia

l o

ve

r n

ext 3

-5 y

ea

rs



Liquidbiopsies

Breathalyzer


Oncolyticvaccines




Hormone therapy


Multi-gene panels





40



Cancer detection





Blood vessel

ctDNA1

Blood cell

ctDNA extracted




1

2

3















41






breathalyzer test


86





Instant results


bull Lung cancer



bull Ovarian cancer

bull Bladder cancer


bull Kidney cancer

bull Gastric cancer





bull Atypical

Parkinsonism



Hypertension

bull Pre-eclampsia




42





46

30

17

18

19

15

9

5

22

35

44

36

9

10

17

17

6

12

14

25

Liquid biopsy


sequencing

Multigene panel


0 1-10 10-25 25-50 gt50


n=200



each test

30

24

17

10


43







end of 2018



5

22 of alterations

identified by both

tests were

concordant

25 of drugs were

recommended for

the same patients

by both platforms

Currently covers



cancer type

Does not cover




on NGS testing



13

22

38FDA-approved


Multi-gene panels

Whole-exome

sequencing

n=100


44















tumors




Near-infrared

spectroscopy







877


45







healthy copy







1

2


Mechanism Outcome


cell types







144


46





(pemprolizumab)













to pembrolizumab



tumor shrinking




1

2

3



47




72

33

25

19




Tumor site 2014-2015 2016-2017

Lung 14 305


Kidney 05 441

Melanoma 564 824

Cost

reimbursement

Availability

access to drugs

Knowledge

of new

drugs

Comfort

managing side

effects




33


48








Kymriah injection









therapies









Select toxicities

bull Delirium

bull Anaphalaxis

bull Autoimmune

response


effects


syndrome


49






2017




2018





2019







Seema Verma

CMS Administrator


50




7

4

4

9

8

11

26

15

6

44

40

34

15

33

45







n=100





51

















52





Rising expectations

for service


care information





reviews


MinuteClinic)



1 2


Growing price

sensitivity





3


53






investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4










54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




39


Prevalence


Tra

nsfo

rma

tive

po

ten

tia

l o

ve

r n

ext 3

-5 y

ea

rs



Liquidbiopsies

Breathalyzer


Oncolyticvaccines




Hormone therapy


Multi-gene panels





40



Cancer detection





Blood vessel

ctDNA1

Blood cell

ctDNA extracted




1

2

3















41






breathalyzer test


86





Instant results


bull Lung cancer



bull Ovarian cancer

bull Bladder cancer


bull Kidney cancer

bull Gastric cancer





bull Atypical

Parkinsonism



Hypertension

bull Pre-eclampsia




42





46

30

17

18

19

15

9

5

22

35

44

36

9

10

17

17

6

12

14

25

Liquid biopsy


sequencing

Multigene panel


0 1-10 10-25 25-50 gt50


n=200



each test

30

24

17

10


43







end of 2018



5

22 of alterations

identified by both

tests were

concordant

25 of drugs were

recommended for

the same patients

by both platforms

Currently covers



cancer type

Does not cover




on NGS testing



13

22

38FDA-approved


Multi-gene panels

Whole-exome

sequencing

n=100


44















tumors




Near-infrared

spectroscopy







877


45







healthy copy







1

2


Mechanism Outcome


cell types







144


46





(pemprolizumab)













to pembrolizumab



tumor shrinking




1

2

3



47




72

33

25

19




Tumor site 2014-2015 2016-2017

Lung 14 305


Kidney 05 441

Melanoma 564 824

Cost

reimbursement

Availability

access to drugs

Knowledge

of new

drugs

Comfort

managing side

effects




33


48








Kymriah injection









therapies









Select toxicities

bull Delirium

bull Anaphalaxis

bull Autoimmune

response


effects


syndrome


49






2017




2018





2019







Seema Verma

CMS Administrator


50




7

4

4

9

8

11

26

15

6

44

40

34

15

33

45







n=100





51

















52





Rising expectations

for service


care information





reviews


MinuteClinic)



1 2


Growing price

sensitivity





3


53






investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4










54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




40



Cancer detection





Blood vessel

ctDNA1

Blood cell

ctDNA extracted




1

2

3















41






breathalyzer test


86





Instant results


bull Lung cancer



bull Ovarian cancer

bull Bladder cancer


bull Kidney cancer

bull Gastric cancer





bull Atypical

Parkinsonism



Hypertension

bull Pre-eclampsia




42





46

30

17

18

19

15

9

5

22

35

44

36

9

10

17

17

6

12

14

25

Liquid biopsy


sequencing

Multigene panel


0 1-10 10-25 25-50 gt50


n=200



each test

30

24

17

10


43







end of 2018



5

22 of alterations

identified by both

tests were

concordant

25 of drugs were

recommended for

the same patients

by both platforms

Currently covers



cancer type

Does not cover




on NGS testing



13

22

38FDA-approved


Multi-gene panels

Whole-exome

sequencing

n=100


44















tumors




Near-infrared

spectroscopy







877


45







healthy copy







1

2


Mechanism Outcome


cell types







144


46





(pemprolizumab)













to pembrolizumab



tumor shrinking




1

2

3



47




72

33

25

19




Tumor site 2014-2015 2016-2017

Lung 14 305


Kidney 05 441

Melanoma 564 824

Cost

reimbursement

Availability

access to drugs

Knowledge

of new

drugs

Comfort

managing side

effects




33


48








Kymriah injection









therapies









Select toxicities

bull Delirium

bull Anaphalaxis

bull Autoimmune

response


effects


syndrome


49






2017




2018





2019







Seema Verma

CMS Administrator


50




7

4

4

9

8

11

26

15

6

44

40

34

15

33

45







n=100





51

















52





Rising expectations

for service


care information





reviews


MinuteClinic)



1 2


Growing price

sensitivity





3


53






investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4










54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




41






breathalyzer test


86





Instant results


bull Lung cancer



bull Ovarian cancer

bull Bladder cancer


bull Kidney cancer

bull Gastric cancer





bull Atypical

Parkinsonism



Hypertension

bull Pre-eclampsia




42





46

30

17

18

19

15

9

5

22

35

44

36

9

10

17

17

6

12

14

25

Liquid biopsy


sequencing

Multigene panel


0 1-10 10-25 25-50 gt50


n=200



each test

30

24

17

10


43







end of 2018



5

22 of alterations

identified by both

tests were

concordant

25 of drugs were

recommended for

the same patients

by both platforms

Currently covers



cancer type

Does not cover




on NGS testing



13

22

38FDA-approved


Multi-gene panels

Whole-exome

sequencing

n=100


44















tumors




Near-infrared

spectroscopy







877


45







healthy copy







1

2


Mechanism Outcome


cell types







144


46





(pemprolizumab)













to pembrolizumab



tumor shrinking




1

2

3



47




72

33

25

19




Tumor site 2014-2015 2016-2017

Lung 14 305


Kidney 05 441

Melanoma 564 824

Cost

reimbursement

Availability

access to drugs

Knowledge

of new

drugs

Comfort

managing side

effects




33


48








Kymriah injection









therapies









Select toxicities

bull Delirium

bull Anaphalaxis

bull Autoimmune

response


effects


syndrome


49






2017




2018





2019







Seema Verma

CMS Administrator


50




7

4

4

9

8

11

26

15

6

44

40

34

15

33

45







n=100





51

















52





Rising expectations

for service


care information





reviews


MinuteClinic)



1 2


Growing price

sensitivity





3


53






investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4










54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




42





46

30

17

18

19

15

9

5

22

35

44

36

9

10

17

17

6

12

14

25

Liquid biopsy


sequencing

Multigene panel


0 1-10 10-25 25-50 gt50


n=200



each test

30

24

17

10


43







end of 2018



5

22 of alterations

identified by both

tests were

concordant

25 of drugs were

recommended for

the same patients

by both platforms

Currently covers



cancer type

Does not cover




on NGS testing



13

22

38FDA-approved


Multi-gene panels

Whole-exome

sequencing

n=100


44















tumors




Near-infrared

spectroscopy







877


45







healthy copy







1

2


Mechanism Outcome


cell types







144


46





(pemprolizumab)













to pembrolizumab



tumor shrinking




1

2

3



47




72

33

25

19




Tumor site 2014-2015 2016-2017

Lung 14 305


Kidney 05 441

Melanoma 564 824

Cost

reimbursement

Availability

access to drugs

Knowledge

of new

drugs

Comfort

managing side

effects




33


48








Kymriah injection









therapies









Select toxicities

bull Delirium

bull Anaphalaxis

bull Autoimmune

response


effects


syndrome


49






2017




2018





2019







Seema Verma

CMS Administrator


50




7

4

4

9

8

11

26

15

6

44

40

34

15

33

45







n=100





51

















52





Rising expectations

for service


care information





reviews


MinuteClinic)



1 2


Growing price

sensitivity





3


53






investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4










54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




43







end of 2018



5

22 of alterations

identified by both

tests were

concordant

25 of drugs were

recommended for

the same patients

by both platforms

Currently covers



cancer type

Does not cover




on NGS testing



13

22

38FDA-approved


Multi-gene panels

Whole-exome

sequencing

n=100


44















tumors




Near-infrared

spectroscopy







877


45







healthy copy







1

2


Mechanism Outcome


cell types







144


46





(pemprolizumab)













to pembrolizumab



tumor shrinking




1

2

3



47




72

33

25

19




Tumor site 2014-2015 2016-2017

Lung 14 305


Kidney 05 441

Melanoma 564 824

Cost

reimbursement

Availability

access to drugs

Knowledge

of new

drugs

Comfort

managing side

effects




33


48








Kymriah injection









therapies









Select toxicities

bull Delirium

bull Anaphalaxis

bull Autoimmune

response


effects


syndrome


49






2017




2018





2019







Seema Verma

CMS Administrator


50




7

4

4

9

8

11

26

15

6

44

40

34

15

33

45







n=100





51

















52





Rising expectations

for service


care information





reviews


MinuteClinic)



1 2


Growing price

sensitivity





3


53






investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4










54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




44















tumors




Near-infrared

spectroscopy







877


45







healthy copy







1

2


Mechanism Outcome


cell types







144


46





(pemprolizumab)













to pembrolizumab



tumor shrinking




1

2

3



47




72

33

25

19




Tumor site 2014-2015 2016-2017

Lung 14 305


Kidney 05 441

Melanoma 564 824

Cost

reimbursement

Availability

access to drugs

Knowledge

of new

drugs

Comfort

managing side

effects




33


48








Kymriah injection









therapies









Select toxicities

bull Delirium

bull Anaphalaxis

bull Autoimmune

response


effects


syndrome


49






2017




2018





2019







Seema Verma

CMS Administrator


50




7

4

4

9

8

11

26

15

6

44

40

34

15

33

45







n=100





51

















52





Rising expectations

for service


care information





reviews


MinuteClinic)



1 2


Growing price

sensitivity





3


53






investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4










54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




45







healthy copy







1

2


Mechanism Outcome


cell types







144


46





(pemprolizumab)













to pembrolizumab



tumor shrinking




1

2

3



47




72

33

25

19




Tumor site 2014-2015 2016-2017

Lung 14 305


Kidney 05 441

Melanoma 564 824

Cost

reimbursement

Availability

access to drugs

Knowledge

of new

drugs

Comfort

managing side

effects




33


48








Kymriah injection









therapies









Select toxicities

bull Delirium

bull Anaphalaxis

bull Autoimmune

response


effects


syndrome


49






2017




2018





2019







Seema Verma

CMS Administrator


50




7

4

4

9

8

11

26

15

6

44

40

34

15

33

45







n=100





51

















52





Rising expectations

for service


care information





reviews


MinuteClinic)



1 2


Growing price

sensitivity





3


53






investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4










54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




46





(pemprolizumab)













to pembrolizumab



tumor shrinking




1

2

3



47




72

33

25

19




Tumor site 2014-2015 2016-2017

Lung 14 305


Kidney 05 441

Melanoma 564 824

Cost

reimbursement

Availability

access to drugs

Knowledge

of new

drugs

Comfort

managing side

effects




33


48








Kymriah injection









therapies









Select toxicities

bull Delirium

bull Anaphalaxis

bull Autoimmune

response


effects


syndrome


49






2017




2018





2019







Seema Verma

CMS Administrator


50




7

4

4

9

8

11

26

15

6

44

40

34

15

33

45







n=100





51

















52





Rising expectations

for service


care information





reviews


MinuteClinic)



1 2


Growing price

sensitivity





3


53






investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4










54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




47




72

33

25

19




Tumor site 2014-2015 2016-2017

Lung 14 305


Kidney 05 441

Melanoma 564 824

Cost

reimbursement

Availability

access to drugs

Knowledge

of new

drugs

Comfort

managing side

effects




33


48








Kymriah injection









therapies









Select toxicities

bull Delirium

bull Anaphalaxis

bull Autoimmune

response


effects


syndrome


49






2017




2018





2019







Seema Verma

CMS Administrator


50




7

4

4

9

8

11

26

15

6

44

40

34

15

33

45







n=100





51

















52





Rising expectations

for service


care information





reviews


MinuteClinic)



1 2


Growing price

sensitivity





3


53






investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4










54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




48








Kymriah injection









therapies









Select toxicities

bull Delirium

bull Anaphalaxis

bull Autoimmune

response


effects


syndrome


49






2017




2018





2019







Seema Verma

CMS Administrator


50




7

4

4

9

8

11

26

15

6

44

40

34

15

33

45







n=100





51

















52





Rising expectations

for service


care information





reviews


MinuteClinic)



1 2


Growing price

sensitivity





3


53






investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4










54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




49






2017




2018





2019







Seema Verma

CMS Administrator


50




7

4

4

9

8

11

26

15

6

44

40

34

15

33

45







n=100





51

















52





Rising expectations

for service


care information





reviews


MinuteClinic)



1 2


Growing price

sensitivity





3


53






investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4










54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




50




7

4

4

9

8

11

26

15

6

44

40

34

15

33

45







n=100





51

















52





Rising expectations

for service


care information





reviews


MinuteClinic)



1 2


Growing price

sensitivity





3


53






investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4










54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




51

















52





Rising expectations

for service


care information





reviews


MinuteClinic)



1 2


Growing price

sensitivity





3


53






investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4










54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




52





Rising expectations

for service


care information





reviews


MinuteClinic)



1 2


Growing price

sensitivity





3


53






investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4










54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




53






investment strategy

93employ clinical

navigators

77offer exercise

therapies

76employ dietitians

1

2

3

4










54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




54

330 310

240

120





Questions included



receiving care








ranked attributes




1

2





55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




55



08

14

16

29

31

34

48

49

55

65

108

111

123

133













Location



Customer service


Mean utility scores


56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




56



3

3

3

4

4

5

7

12

15

19

23

33

34

81

Other








Major search engine





My doctor





to go for care



searching online


57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




57



3

4

6

7

10

13

13

17

18

20

23

28


















58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




58



15

21

23

23

30

33

35

35

44

45

46

54

59

67

71

90

92

109

110












Help with nutrition










Mean utility scores


59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




59


















60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




60



are going up










ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




ROAD MAP61





62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




62




Patient

experience

Value-





experimentation


consumers create


expensive service

enhancements





Provider

strategy


63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




63

A holistic view


Staffing

Drugs and supplies

Capital investments

Service utilization


Value-based care


Patient experience

1

2

3

Key to ensuring


Key to achieving

market advantage



64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




64










support platform










65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




65











patients


oncology workforce





discussion



Experience Survey






LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863




LEGAL CAVEAT






















Oncology Roundtable


sauletdadvisorycom

202-568-7863



2019 oncology state of the union - advisory · source: oncology roundtable interviews and analysis....

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