Duke Oncology Network

1. Duke Oncology Network Overview of Affiliated Programs Public Affairs and Marketing Network May 6, 2008

2. Duke University Health System

3. Duke University Health SystemLong history of Reaching Out 1939 American College of Surgeons Cancer Program Accreditation 1972 Duke Designated by the NCI as a Comprehensive Cancer Center 1974 Duke University Medical Center Clinical and Education Affiliations Established 1989 Duke Comprehensive Cancer Center Affiliations Program Established 2001 Integration of Cancer Affiliations between Cancer Center and Health System Initiatives 3

4. Duke Oncology Network

5. Duke Oncology Network Rationale for Developing Affiliate Relationships • Is consistent with Duke’s goal of becoming an internationally recognized leader in oncology medicine. • Enhances treatment options, outcomes, and the quality of life for members of the local community. • Generates funds in support of its academic mission. • Provides the opportunity to develop new markets and new sources of patients (in DUHS Service Area). • Enables Duke to maintain its pre-eminent position in research and education by adding sites for additional training opportunities and clinical research.

6. Duke Oncology NetworkMission Statement Providing state-of-art cancer care to patients in the communities we serve; Providing and promoting cancer prevention, screening, diagnosis and treatment through clinical research; Offering educational opportunities to healthcare practitioners and the community at large; and Enhancing the effectiveness and efficiency of cancer care delivery through performance improvement and outcomes measures. The mission of the Duke Oncology Network is to provide an array of oncology related services in a regional network of community cancer programs that have made a commitment toward excellence in cancer care. The Duke Oncology Network seeks to support and strengthen the mission of the affiliated organizations by: 6

7. Duke Oncology NetworkSites of Service Memorial Hospital of Martinsville & Henry County Oncology & Hematology of Southwest Virginia Associates St. Mary’s Hospital Maria Parham Medical Center Granville Medical Center Durham Regional Hospital Durham VA Duke Raleigh Hospital Comprehensive Cancer Care, PA Columbus County Hospital First Health Moore Regional Southeastern Regional Medical Center South Carolina Oncology Associates Beaufort Memorial Hospital Community Memorial Healthcenter Virginia Oncology Associates Person Memorial Hospital Northeast Medical Center Asheville VA Scotland Memorial Hospital Johnston Memorial Hospital Phoebe Putney Medical Center Florida Hospital Oncology Research Programs Bone Marrow Transplant Programs Oncology Program Development CALGB Affiliates Clinical Medical Oncology Practices Palm Beach Cancer Institute Clinical Radiation Oncology Clinics 7 Consultative Clinics

8. Duke Affiliations Anchor Communities DUMC Affiliated Counties Anchor Secondary Triangle

9. Duke Oncology Network Linda Sutton, MD Medical Director Duke Oncology Network Paul Lindia Associate Vice President Clinical Program Development Julie Clayton Staff Specialist Community PDC Physicians DON Med Onc Renee Muellenbach Director Duke Oncology Network Mid-Levels Faculty Rusty Anderson, MD Kaushik Sen, MD Brianne Buchanan, PA Lena Carver Staff Assistant Rhonda Bergey Staff Specialist Gail Leget, MD Beth Moore, , PA Ivy Altomare, MD Sharon Taylor, MD Vacant Monica Roberson Program Coordinator Kelvin Raybon, MD Gina Vaccaro, MD Vacant Melanie Watson Vacantt Marty Polovich Associate Director Financial Analyst III Nursing Director & Associate Director Remote Mkt Affil Ahmad Mahmood, MD Assoc Dir Clinical Trials Onc Clin Ops and Ed Programs Yuri Fesko, MD Angela Latta Medical Secretary Primary Responsibilities: 1) Affiliated program operations (admin operations/ interface with Hospital) 2) Program development 3) DON operations 4) Clinical trials (operations) 5) Education programs (logistics) 6) Contracting 7) Planning Linda Owen, PhD Clinical Trials Manager Primary Responsibilities: 1) MD practice oversight/ faculty development 2) Clinical care (MD and nursing) 3) Clinical trials (clinical aspect) 4) CME (clinical content) 5) Program development 6) Planning VACANT Clinic Supervisor Johnston Cancer Center Annie Langley, RN Research Nurse Primary Responsibilities: 1) Affiliated program operations (QA, nursing oversight, etc.) 2) Program development 3) Clinical care Chris Marino, RN Research Nurse Beth Clapp CCRP, AAS Regulatory Specialist Administrative (DUHS): 14.8 FTEs Clinical Providers (SOM): 6.2 FTE’s May 6, 2008

10. Network Services Divisions Clinical Planning and Market Research Duke Heart Network Specialty Outreach Programs/Contracting Services Affiliations and Market Development Operations Strategic 14 Admin/Support FTEs 6 DUHS Clinical FTE 4 PDC Physicians Duke Network Services Total FTEs ~ 40 Corporate Relations/DHD Duke Oncology Network Physician Recruitment

11. How Elements Work Together • Clinical Planning • Identify opportunities and strategies for clinical differentiation and new program growth • Extend service line vision across health system entities and network • Affiliations and Market Development • Identify opportunities for new business and new market development • Relationship management with CEOs and MDs in key referral markets • Physician sales and customer service • Oncology and Heart Networks • Build volume and share for affiliates and DUHS • Maintain involvement when care translates to local setting • Program design, development and operations • Advance clinical research and education • Affiliations Contracting • Off- site clinical activities and selected GME rotations • Outreach Clinics • Specialty programs in local communities • Advance education • Corporate Relations/ Duke Health Direct • Relationship management and sales for regional employers • Physician Recruitment • Servicing DUAP, CPDC, DUHS and selected SoM divisions

12. Defining Value of Network Services • Grow targeted referral volumes • DUH, PDC, DHRH, DRH, affiliated programs • Generate income from clinical activities • Specialty clinics and affiliated programs • Advance academic priorities • Clinical trainees and clinical trials • Improve access to Duke health care • New services to priority medical communities

13. Duke Oncology Network Affiliations • Tiered Affiliation Structure • Research Affiliation • Clinical Program Staffing and Management • Program Development Affiliation

14. Duke Oncology Network Qualifications for Affiliate Relationship • Patient care and the delivery of high quality services must be first and foremost. • Commitment from medical staff and administrative staff to work as partners and provide resources for the delivery of oncology services and to participate in clinical trials • Appropriate staffing • Adherence to regulatory requirements (IRB, etc.) • Senior administrative time and support • Information Systems • A long term agreement • Affiliate will maintain resources to support an ongoing, collaboratively developed QA/PI plan • Maintain JCAHO accreditation and ACoS designation

15. Research AffiliationsKey Research Functions • Access to clinical trials • In-house studies • National cooperative groups • Pharmaceutical industry • Collaborative research • Offer opportunities to be recognized in publications • Offer opportunities to participate in grant funding • Provide education and training of clinical trials staff • Provide assistance in the establishment of a Protocol Office • Provide current regulatory and IRB updates and support to facility-based IRB

16. Research AffiliationsKey Educational Functions • Participation in Tumor Boards by Duke faculty • Assistance in clinical training • Liaison with academic medical center physician colleagues • Recommendations for Faculty appointments • Coordination of medical and nursing symposia • Continuing nursing education for research nurses • Rotation for learners • Liaison with pharmacy contacts

17. Research AffiliationsKey Research Development Functions • Assessment of needs • Opportunities for telemedicine conferences • Assistance in cancer control initiatives • Assistance with the development of Quality Improvement Programs • Assistance with physician referral services • Access to other clinical program development efforts within the Duke Comprehensive Cancer Center and Oncology Network • Assistance with research policy and procedure development

18. Strength through communication The Duke Comprehensive Cancer Center partners with Duke Oncology Network affiliates to produce a co-branded newsletter highlighting research and patient care initiatives at Duke as well as news and events from the affiliate.

19. Strength through communicatione-newsletter for referringphysicians • Bi-monthly e-newsletter • Distributed to referring physicians • Highlights new trials or trials having difficulty accruing • Links to cancer.duke.edu for a complete listing of trials • Features a different cluster in each issue

20. Affiliations and Market Development

21. Supporting the Duke Oncology NetworkAffiliations and Market Development • Establish and maintain relationships with medical communities in the DUHS service area • Serve as the central point of contact for DUHS clinical program development and outreach activities • Primary market intelligence • Grow targeted referral volumes • Practice (>1500/yr) and Hospital ( > 100/yr) Visits in Targeted communities • Marketing Materials Hand Delivered (> 1000 sites/yr) • New Appointments – (personally facilitated) • Admissions – (personally facilitated) • New physicians identified • Identify opportunities for clinical program development that create “win-win” situations between DUHS and community providers • Planning process used • Liaison between referring physicians and DUHS to improve patient outcomes and expedite care • 24/7 customer service for referring physicians • Troubleshoot access problems • Market new and existing DUHS programs to referring physician • Promote education of community physicians and other healthcare providers.

22. Subspecialty Outreach Clinics and Affiliations Contracting Services

23. Develop Implement Manage Outreach Programs and Clinical ContractsMission / Role Provide Oversight in the establishment of clinics and/or contract management process to clinicians, business managers, DUHS and SoM staff Annually ensure alignment with DUHS and SoM strategic plans, renegotiate and/or terminate contracts for the provision of services Review Coordinate implementation of outreach clinics and contract review process with • Clinical Providers • Operational Managers • Legal Counsel • Risk Management Monitor and oversee outreach clinics and contracts to ensure compliance with regulatory requirements and contractual obligations with DUHS, DU and PDC administration, clinical care providers and sites

24. Duke Oncology NetworkDefining Value • Grow targeted referral volumes • 32 services in 25 communities • 4 CPDC, 3 PDC medical and 3 radiation oncology physician practices • Generate income from clinical activities • Net Income to DUHS from DON • ~50% of Oncology patient volume from Greater Triangle and Anchor regions • Advance academic priorities • 10 med onc fellows at 5 community sites, generates funds for DOM fellowship activities • Numerous self-supporting CME symposia and CME lectures (unrestricted educ grants) • Patient accruals to clinical trials • Funds to Duke through CALGB accruals • Improve access to Duke health care • Duke Raleigh Hospital – Medical and Radiation Oncology • Durham Regional Hospital – Radiation Oncology • Affiliated medical and radiation oncology sites