# Presentation: 328306

## Billings Clinic Cancer Center 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

**Notes:**
Thank you – this is an honor and privilege.... Etc.

## 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

- 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?**

**Notes:**
Talk about the medical foundation and the strong partnering that makes Billings Clinic an ideal model for this pilot.  The goals and objectives of the organization are aligned and solid.  

Perhaps state that this model has afforded Billings Clinic to participate in multiple national projects and has moved the organization into the national spotlight for patient safety, quality and ......

## Our Mission

- Health Care, Education, Research
**Our Vision**
- By 2010, Billings Clinic will be recognized as the health care organization providing the best clinical quality, patient safety  and service experience in the nation

## Why are we interested in being a part of the NCCCP pilot program?

**because ...**
**Compatibility with our quality vision **
**Enables our physicians and program leaders to learn from our pilot program partners**
**Enables Billings Clinic to better serve our large geographic area**

**Notes:**
This is key to the presentation... why did we want to participate in this pilot... what influenced us as an organization to seek out this partnership...what did we see within our community that we haven’t met the need?

So...
We know advancing research, reaching the underserved/underrepresented and contributing to the advances of cancer information is the right thing to do

We, both Billings Clinic and the Billings Clinic Cancer Center, have the infrastructure to accomplish the pilot project objectives.

and... our location ...

## Our Backyard

**Our Backyard**

**Notes:**
Frontier

Geographic challenges to reach the people in the region.

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

**Notes:**
Size, population

## Geographical Challenges in Accessing NCI Cancer Centers 

- Billings

**Notes:**
No NCI centers within a 5 state region surrounding Billings.

## 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

**Notes:**
Describe our infrastructure and how our partnership with the NCI will be enhances by the foundation that is already established.

## Billings Clinic Service Area

**Billings Clinic Service Area**

*Riverton*

**Fremont**

*Casper*

*Powell*

**Park**

*Cody*

**Hot Springs**

*Thermopolis*

**Bighorn**

*Lovell*

*Greybull*

**Washakie**

*Worland*

**Sheridan**

*Sheridan*

**Johnson**

*Buffalo*

**Campbell**

*Gillette*

**Crook**

**Lincoln**

**Flathead**

**Sanders**

**Mineral**

**Lake**

**Glacier**

**Missoula**

**Ravalli**

**Beaverhead**

**Granite**

**Deer Lodge**

**Powell**

**Toole**

**Pondera**

**Teton**

**Lewis & Clark**

**Cascade**

**Jefferson**

**Silver Bow**

**Broadwater**

**Madison**

**Gallatin**

**Park**

**Sweet **
**Grass**

**Stillwater**

**Meagher**

**Wheatland**

**Judith **
**Basin**

**Chouteau**

**Liberty**

**Hill**

**Blaine**

**Fergus**

**Golden Valley**

**Carbon**

**Big Horn**

**Yellowstone**

**Musselshell**

**Petroleum**

**Phillips**

**Valley**

**Garfield**

**Rosebud**

**Treasure**

**Powder River**

**Carter**

**Custer**

**Fallon**

**Prairie**

**Wibaux**

**Dawson**

**McCone**

**Richland**

**Roosevelt**

**Sheridan**

**Daniels**

*Missoula*

*Anaconda*

*Butte*

*Dillon*

*Bozeman*

*Havre*

*Lewistown*

*Livingston*

*Big Timber*

*Columbus*

*Billings*

*Red Lodge*

*Hardin*

*Roundup*

*Forsyth*

*Miles City*

*Baker*

*Glendive*

*Sidney*

*Culbertson*

*Wolf Point*

*Glasgow*

**Primary**

**Secondary**

**Tertiary**

**                              ****Population     Sq. Miles**
**Yellowstone****	****130,219****	****    2,635**
**Secondary****	****54,146****	****  26,101**
**Tertiary****	**_**335,141**__**	**__**  92,630**_
**TOTAL:****	****519,506****	****121,366**

- Source: Claritas, Inc. 2002 Population Estimate
-              US Census Bureau Land Area Sizes

**Area larger than 44 states, 49****th**** in population**

**Notes:**
Current region... describe how this is changing, growing for cancer care.

## Service Region Locations

**Service Region Locations**

*Riverton*

**Fremont**

*Casper*

*Powell*

**Park**

*Cody*

**Hot Springs**

*Thermopolis*

**Bighorn**

*Lovell*

*Greybull*

**Washakie**

*Worland*

**Sheridan**

*Sheridan*

**Johnson**

*Buffalo*

**Campbell**

*Gillette*

**Crook**

**Lincoln**

**Flathead**

**Sanders**

**Mineral**

**Lake**

**Glacier**

**Missoula**

**Ravalli**

**Beaverhead**

**Granite**

**Deer Lodge**

**Powell**

**Toole**

**Pondera**

**Teton**

**Lewis & Clark**

**Cascade**

**Jefferson**

**Silver Bow**

**Broadwater**

**Madison**

**Gallatin**

**Park**

**Sweet **
**Grass**

**Stillwater**

**Meagher**

**Wheatland**

**Judith **
**Basin**

**Chouteau**

**Liberty**

**Hill**

**Blaine**

**Fergus**

**Golden Valley**

**Carbon**

**Big Horn**

**Yellowstone**

**Musselshell**

**Petroleum**

**Phillips**

**Valley**

**Garfield**

**Rosebud**

**Treasure**

**Powder River**

**Carter**

**Custer**

**Fallon**

**Prairie**

**Wibaux**

**Dawson**

**McCone**

**Richland**

**Roosevelt**

**Sheridan**

**Daniels**

*Missoula*

*Butte*

*Dillon*

*Havre*

*Lewistown*

*Livingston*

*Columbus*

*Billings*

*Red Lodge*

*Hardin*

*Roundup*

*Forsyth*

*Miles City*

*Baker*

*Glendive*

*Sidney*

*Wolf Point*

*Glasgow*

**Weston**

**Natrona**

*Great Falls*

*Kalispell*

**I-15**

**I-90**

**I-25**

**Williams**

*Williston*

**Divide**

**McKenzie**

*Dickinson*

**Golden Valley**

**Billings**

**Dunn**

**Stark**

**Slope**

**Bowman**

**Adams**

**Hettinger**

**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

**Notes:**
More on the infrastructure.  

The cancer outreach sites are not on this map, but they range from the highline from Glasgow to Williston, from Livingston to Miles City and down to Cody and Sheridan,Wy.

## P1

***Cardiovascular***

***Muscular-***
***Skeletal***

***Neurosciences***

***Cancer***

***Maternity/***
***Children's Services***

**Best in**
**Nation**

**Adult **
**Medicine**

**Diagnostic-**
**Ancillary Services**

***Critical ***
***Care***
***Services***

**Surgical**
**Services**

**Specialty Medicine **

**Branch Clinic**
**Performance**

**West Billings**
**Medical Complex**

**Physician **
**Recruitment/ Retention**

**Convert**
**Affiliate **
**Models (3)**

**Regional**
**Emergency/Trauma**
**Fixed-Wing/Helicopter**

**Regionalize**
**Clinical**
** ****Research**

**Physician**
**Referral**
**Management**

**Focus**
**Specialty Outreach**
**Sites/Telemedicine**

**Direct **
**to**
**Consumer**

**Expand **
**Surgical **
**OR Capacity**

**P1**

**P1**

**P1**

**P2**

**P2**

**P3**

**P2**

**P1**

**P2**

**P3**

**Cancer**

**P1**

- Initiatives as of March 2006

**Adult Medicine****Primary Care**

**P1**

**Equity ownership **
**Livingston**
**Healthcare/Beartooth Hospital**

- Business DevelopmentPlan Initiatives

**P1**

**Notes:**
Cancer and outreach are on the top of Billings Clinic priorities

You may want to mention the new cancer center

## Billings Clinic Cancer Center

## 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

**Notes:**
Specifics on the infrastructure for the cancer center.

## 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

**Notes:**
This is key information that they want to have described

Statistics about our regional - factors that led us to seek out this partnership with the NCI

## 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

**Notes:**
What challenges do our patients have and what are the challenges and opportunities we have to meet those challenges.

## 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

**Notes:**
Talk about the close relationships we have with these organizations

## 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

**Notes:**
Describe how we interact and communicate with coalitions and organizations in the region.  What is important about these influences/relationships.

## 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

**Notes:**
This is to address what we currently do within the “extra-local” community – both for patients and providers.  Note that some of this is repetitive, but really goes into more detail/ specifics.

## 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

**Notes:**
continued

## Slide 20

**Notes:**
Communication with region through telemedicine

## 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)

**Notes:**
This is key for the presentation

Describe what our experience in now with the communities we serve... patients, both locally and regionally.

FY...
Title XV is the breast and cervical cancer program.

## Questions ?

***Questions ?***