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Health Care Education and Research
Billings Clinic Cancer Center Billings Clinic Cancer Center and the NCCCPand the NCCCP
June 25, 2007
Prepared For:NCCCP Pilot Launch
Prepared By:
Tom Purcell, MD, Director, Cancer Center, PI NCCCP Jon Ness, Chief Operating Officer
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A medical foundation built upon the following cornerstones:– An obsessive dedication to quality and service– A multi-specialty physician group practice in which a
“community of physicians” work together – 280 providers
– The partnering of 3,000 physicians, administrators, professional staff, and volunteers
– Not-for-profit, community-owned and governed– 272-bed hospital
What is Billings Clinic?
3
Our MissionHealth Care, Education, Research
Our VisionBy 2010, Billings Clinic will be recognized as the health care organization providing the best clinical quality, patient safety and service experience in the nation
Health Care Education and Research
Why are we interested in being a part of the NCCCP pilot
program?because …
1. Compatibility with our quality vision
2. Enables our physicians and program leaders to learn from our pilot program partners
3. Enables Billings Clinic to better serve our large geographic area
Our Backyard
Montana: 147,138 square miles and 922,002 people
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Geographical Challenges in Accessing NCI Cancer Centers
Billings
8
Factors Influencing Billings Clinic -
NCI Partnership Decision• 3rd largest private employer in Montana • Largest health care organization in Montana• 8 regional branch clinic locations• 20 Telemedicine Sites• 13 Teleradiology Sites• Seven CAH rural affiliations• Challenges to access to care in region• Strong cancer program; strong
infrastructure• Mission / commitment to serve the large
geographic region
Billings Clinic Service Area
Riverton
Fremont
Casper
Powell
Park
Cody
Hot Spring
s Thermopolis
Bighorn
Lovell
Greybull
Washakie
Worland
Sheridan
Sheridan
Johnson
Buffalo
Campbell
GilletteCrook
LincolnFlathead
Sanders
Mineral
Lake
Glacier
Missoula
Ravalli
Beaverhead
Granite
Deer Lodge
Powell
Toole
Pondera
Teton
Lewis & Clark Cascade
Jefferson
Silver Bow
Bro
adw
ate
r
Madison
Gallatin
Park
Sweet Grass
Stillw
ater
MeagherWheatlan
d
Judith Basin
Chouteau
Lib
er
ty
Hill
Blaine
Fergus
Golden Valley
CarbonBig Horn
Yellowstone
Musselshell
Petroleum
Phillips
Valley
Garfield
Rosebud
Tre
asu
re
Powder River
Carter
CusterFallon
Prairie Wibaux
Dawson
McCone
Richland
Roosevelt
SheridanDaniels
Missoula
Anaconda
Butte
Dillon
Bozeman
Havre
Lewistown
Livingston
Big Timber Columb
us Billings
Red Lodge
Hardin
Roundup
Forsyth Miles CityBaker
Glendive
Sidney
CulbertsonWolf PointGlasgow
PrimarySecondaryTertiary
Population Sq. MilesYellowstone130,219 2,635Secondary 54,146 26,101Tertiary 335,141 92,630TOTAL: 519,506 121,366Source: Claritas, Inc. 2002 Population Estimate
US Census Bureau Land Area Sizes
Area larger than 44 states, 49th in population
Service Region Locations
Riverton
Fremont
Casper
Powell
Park
Cody
Hot Spring
s Thermopolis
Bighorn
Lovell
Greybull
Washakie
Worland
Sheridan
Sheridan
Johnson
Buffalo
Campbell
Gillette
Crook
LincolnFlathead
SandersM
ineral
Lake
Glacier
Missoula
Ravalli
Beaverhead
Granite
Deer Lodge
Powell
Toole
Pondera
Teton
Lewis & Clark
Cascade
Jefferson
Silver Bow
Bro
adw
ate
r
Madison
Gallatin
Park
Sweet Grass
Stillw
ater
MeagherWheatlan
d
Judith Basin
Chouteau
Lib
er
ty
Hill
Blaine
Fergus
Golden Valley
CarbonBig Horn
Yellowstone
Musselshell
Petroleum
Phillips
Valley
Garfield
Rosebud
Tre
asu
re
Powder River
Carter
CusterFallon
PrairieWibaux
Dawson
McCone
Richland
Roosevelt
SheridanDaniels
Missoula
Butte
Dillon
Havre
Lewistown
Livingston
Columbus
Billings
Red Lodge
Hardin
RoundupForsyth Miles City Baker
Glendive
Sidney
Wolf PointGlasgow
Weston
Natrona
Great Falls
Kalispell
I-15 I-90
I-25
Williams
Williston
Divide
McKenzie
Dickinson
Gold
en
Valle
y
Billin
gs
Dunn
Stark
Slope
BowmanAdams
Hettin
ger
I-94
HWY 2
Scobey
Big Timber Colstrip
Bozeman
Affiliate Management Services
Columbus - Stillwater Hospital
Colstrip - Colstrip Clinic
Forsyth - Rosebud Healthcare
Lovell - North Big Horn Hospital
Red Lodge - Beartooth Hospital
Big Timber - Pioneer Medical Center
Livingston - Livingston Healthcare
Scobey - Daniels Memorial Hospital
Branch Locations & Number of Providers
Billings Clinic - Cody (6 MDs, 1 PA)
Bozeman OB/Gyn (6 MDs, 2 NPs, 1 PA)
Billings Clinic - Forsyth (1 PA)
Billings Clinic - Wellness Center (1 MD, 1 PA)
Billings Clinic - West (8 MDs, 1 PA)
Billings Clinic - Miles City (10 MDs, 4 PAs)
Billings Clinic - Red Lodge (4 MDs)
Billings Clinic - Columbus (2 MDs, 1 NP)
Billings Clinic - Heights (4 MDs, 1 PA)
Counties with Affiliate or Branch Clinic
Other Service Area Counties
Jan. 3, 2006
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Cardiovascular
Muscular-Skeletal Neurosciences
Cancer
Maternity/Children's Services
Best inNationAdult
Medicine
Diagnostic-Ancillary Services
Critical Care
Services
SurgicalServicesSpecialty
Medicine
Branch ClinicPerformance
West BillingsMedical Complex
Physician Recruitment/ Retention
ConvertAffiliate
Models (3)
RegionalEmergency/Trauma
Fixed-Wing/Helicopter RegionalizeClinical
Research
PhysicianReferral
Management
FocusSpecialty OutreachSites/Telemedicine
Direct to
Consumer
Expand Surgical
OR Capacity
P1
P1
P1
P2
P2
P3
P2
P1
P2
P3
Cancer P1
Initiatives as of March 2006Initiatives as of March 2006
Adult MedicinePrimary Care
P1
Equity ownership Livingston
Healthcare/Beartooth Hospital
Business DevelopmentPlan Initiatives
P1
Health Care Education and Research
Billings Clinic Cancer Center
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Billings Clinic Cancer Center
• 1350 Analytical Cancer Cases per year– Top five cancers: Breast, Colorectal, Lung , Melanoma,
Prostate
• 9 Outreach Medical Oncology Clinics• 6 Multidisciplinary Programs
– Breast, Gastrointestinal, Genitourinary Gynecologic, Hematologic, Thoracic
• 11 Providers– 5 Medical Oncologists, 2 Radiation Oncologists, 1
Gynecologic Oncologist, 1 Naturopath, 1 Medical Oncology Nurse Practitioner, 1 Gynecologic Oncology Physician Assistant
• 7 Care Navigators– Breast (1 diagnostic, 1 treatment), GI, GU, GYN, Heme,
Thoracic
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Healthcare Disparities
• Rural – distance to care, lack of access, 48/55 counties are designated as Health Professional Shortage Areas (HPSA), Medically Underserved Areas (MUA) and/or Physician Scarcity Areas (PSA)
• Uninsured – 18.4% Montanans (10th highest in nation)
• Poverty rate – 14.3% (10th lowest in nation)• American Indians – 4%, seven reservations• Health insurances – “no clinical trials”
clauses in contracts
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Local and Regional Challenges/Opportunities
• Distance to travel for care vs care within the rural community– Implementing regional screening programs – Penetrating the Indian Health Services – Managing Clinical Trials within rural areas– Cost of providing care with uninsured
• Lack of primary care providers in large geographic areas
• Access to regional expertise to develop, implement and manage program components– Nurse navigator– Rural provider participation
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Local, Regional and National Networks – resources that
help• Montana Cancer Control Coalition• American Cancer Society• County Health Departments• Regional Affiliated Hospitals• Outreach Specialty Clinics• Eastern Montana Telemedicine Network• Care Navigation• Hospice Affiliations• Mary Crowley Medical Research Center
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Regional Health Care Philosophy
• Formalize partnerships with physicians and community hospitals in the region to preserve access to quality, local health care
• Advocate partnerships that are based on trust, shared vision, values and goals
• Deploy information technology (EMR, Teleradiology)
• Utilize progressive management methods to achieve optimal operational, financial and clinical outcomes
• Promote stewardship with regional and critical access hospitals
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Current Rural Services Provided
• Medical Oncology Outreach Clinics– Nine sites throughout region– Local tumor boards within rural
communities
• Telemedicine (EMTN)– Weekly tumor boards with community
providers– Research and medical oncology clinics
• Teleradiology (GE PACs)• Reference Laboratory
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Current Rural Services Provided
• Critical Access Hospitals– Locally coordinated patient management
• Information Technology Services– EMR (Cerner)
• Access at outreach clinics• Web based access for community physicians
– Regional IS technical support services
• Care Navigation– Site specific care coordination by RN
navigator
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Community Experiences
• Care Navigation (6 RN treatment navigators, 1 RN breast diagnostic navigator)
• Telemedicine• Survivor Programs (TLC, Hope for Tomorrow,
City of Hope program, Survivor Day event)• Support Groups (General, Here and Now)• 8-9% of cancer patients are currently
enrolled in clinical trial• Community Education Programs (Lunch &
Learns, Smoking Cessation, etc)• Screening Programs (Title XV, colorectal)
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