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Health Care Education and Research Billings Clinic Cancer Center Billings Clinic Cancer Center and the NCCCP and 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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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?

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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

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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

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Our Backyard

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Montana: 147,138 square miles and 922,002 people

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Geographical Challenges in Accessing NCI Cancer Centers

Billings

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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

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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

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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

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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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