UNOS and the OPTN Planning for the Future

1. UNOS and the OPTNPlanning for the Future 2012 Spring Regional Meetings

2. Planning for Change Why? Why now?

3. Planning is bringing the future into the present so that you can do something about it now.

4. How has the OPTN evolved?

5. UNOS and the Future Why is discussion so urgent? • Gaps and opportunities identified in internal and external assessments of organization • Additional emphasis on patient safety creates new operational demands • IT near overload, and new contract rebid will likely include new, unfunded requirements • Successful rebid of contract will require agreement on how to address these issues

6. UNOS’ Purpose We have to be able to answer: • Why does UNOS exist? • What is our purpose? The answer to those questions will help clarify: • What activities we undertake • Whywe do them

7. UNOS Purpose For the sake of discussion, we developed 3 models of alternative purposes and the relationship of each to: • Key contract and non-contract activities • The degree of Board control over the organization’s activities • The degree of risk related to the organization’s purpose and activities • The non-contract revenue needed to support the purpose and its activities

8. Overview of Three Modelswith Related Activities

9. Comparison of Models

10. Risk/Benefit Considerations Assumptions: • There are risks related to: • Not making changes in the way we do business • Making significant changes going forward • As part of clarifying UNOS’ purpose, priority activities and non-contract revenue needs, it is also essential to make an informed decision regarding: • The amount of risk members are willing to assume • The degree of control members want • What it will take for members to feel satisfied with UNOS • Models A, B and C are rank-ordered in terms of non-contract revenue potential

11. Risk/Benefits : Related to Models

12. “The key to wisdom is knowing all the right questions.” - John Simone

13. Change is constant HRSA issued a Request for Information (RFI) asking for feedback on OPTN performance in these areas: • Updating allocation and other policies • Access to deliberations and policy process • Available information • Continuous improvement assistance to transplant centers and OPOs

14. What do we see on the horizon? HRSA RFI – new expanded work: • KPD from pilot to national program • Public involvement in policy-making process • Expanded monitoring • Education in safety and disease transmission • Expanded research capabilities • IT advancements

15. Changes to UNOS Board of Directors Why? Board’s long-term strategic vision for UNOS: be “more than just the OPTN contractor” – a robust member support organization and the world leader in transplantation services

16. Changes to OPTN/UNOS Board of Directors • UNOS Corporate Advisory Subcommittee • UNOS Finance Committee • UNOS Technology Advisory Subcommittee • OPTN Strategic Planning Task Force

17. Corporate Advisory Subcommittee

18. Finance Subcommittee 20

19. Differentiation of CAC and Finance Subcommittee Responsibilities

20. OPTN Planning Task • Rationale for OPTN Planning Task of the Executive Committee • Example: HRSA comments in North Highland report • How far should OPTN go, in the short term, to address HRSA patient safety concerns? • How should we plan for patient safety over the next 10 years? • Work reduction; for example: do we need HRSA and CMS audits? • Example: OPTN mission has changed twice since 2000 to include living donors and then VCA • What additional changes do we need to anticipate? • Information gathering and assessment in partnership with HRSA may strengthen HRSA confidence and relationship 22

21. OPTN Strategic Planning Task 23

22. Information Technology Advisory Subcommittee

23. What else do we need to anticipate? • Oversight of VCA transplants • IT demands outstrip resources • Patient safety responsibilities are likely to grow

24. How might allocation/distribution be addressed in the future? • Developing allocation systems • Mature allocation systems • Geography

25. What will OPTN/UNOS patient safety role be? Need to develop common understanding of patient safety approach • Constructive vs. punitive • Complement, not duplicate CMS and other agencies • Use of data for early warning signs • Expanded educational offerings

26. CMS and the OPTN • From CMS conditions of participation for transplant centers – • Main focus of CMS is “regulatory oversight of transplant centers” • Main focus of OPTN policies and bylaws is organ allocation, credentialing of transplant surgeons/physicians, collegial relationship with transplant hospitals to help improve performance • “OPTN policies and bylaws are voluntary, until approved (i.e., codified) by the Secretary.” The only policy so approved is data submission • CMSis “responsible for establishing minimum standards to protect patient health and safety, and for implementing oversight mechanisms to assure that transplant centers provide quality transplant and living donor care to Medicare beneficiaries through the development of health and safety requirements.”

27. What do we need to anticipate with IT? • What’s next after Chrysalis? • What do we want from DonorNet (and what will we pay for?) • How do we prioritize new policies to keep them from overloading the IT system again?

28. What’s the plan?

30. “It’s been a long time coming. But I know a change is gonna come.” - Sam Cooke

31. OPTN Strategic Plan • Organ allocation • Patient safety • Education • Prioritization within fiscal realities

32. UNOS Strategic Plan • Ability to deliver OPTN plan • Additional services for members • Revenue-generating activities to ease pressure on registration fees • Board engagement and oversight

33. Not everything that is faced can be changed, but nothing can be changed until it is faced. - James Baldwin

34. Ongoing communication will be key • Ongoing dialogue with members – for input, feedback • Updates in member e-newsletter, Update, other venues

35. Overview of Next Steps

36. “Good plans shape good decisions. That’s why good planning helps to make elusive dreams come true.” - Lester Robert Bittel, writer (b. 1918)