1. Norris Cotton Cancer Center Global Update CTOP RETREAT May 2014

2. NCCC Organizational Chart

3. NCCC – Clinical Operations

4. Clinical Care Strategic Plan

5. Center Director Surgery Chair Medicine Chair Chief(s) Hematology Oncology Vice President Center Deputy Director Chief Radiation Oncology Nursing Director NCCC Steering Committee NCI-CCSG Admin Director Chair Pathology Chair Radiology NCI Cancer Center Support Grant Clinical Research Translational Research Clinical Cancer Committee Surgery Radiation Hematology Pathology Radiology Nursing Care Coordination Pharmacy Care Management Cancer Oncology Group Directors Patient Conferences (Tumor Boards) Head & Neck BMT Spine Thoracic Esophagus/Lung Pediatric Neuro Melanoma Lymphoma Cutaneous Lymphoma GYN GU Kidney/Prostate Bladder/Testis GI Colon/Liver/Pancreas Endocrine Thyroid/Pituitary Breast Comprehensive Interdisciplinary Clinics Clinical Care Team Palliation Care Pathways

6. Service Line Approach

7. NCCC Performance – By the Numbers Annual Gross Revenue…………………………………… $ 114mm Annual Net Revenue……………………………………… $ 50mm Annual Direct Expenses………………………………… $ 33mm Operating Margin (YTD)…………………………………. 3.4% Annual New Patients……………………………………… 3,600 Technical Units Delivered………………………………. 99,000 Total FTEs………………………………………………………. 193 Locations throughout New Hampshire and Vermont…………………………………………………… 17 Clinical research trials……………………………………… 160+ Basic and translational research projects…………. 200+ Residents and Fellows………………………………........ 9

8. NCCC – Immediate Focus NCI Core Grant Renewal Regional Affiliation Programs Quality and Safety Programs Patient Experience – Access Service-Line (COG) structure - Pathways Employee Engagement Managing in Changing Environment

9. Research/Quality Affiliation Comprehensive Affiliation Program Development Affiliation Trials, Tumor Boards, Education Branding, IRB Care Pathways, Multi Specialty Clinics Policies and Procedures Staff and Consulting Referral Development. Shared Financial Risk, Professional Services Quality Monitoring Marketing Regional Program

10. DH Initiatives Regional Affiliations ESI – Epic Business Systems Overlay Access Patient Experience Employee Engagement – Reward and Recognition Quality – Value Institute Innovation Zone Sustainability – Communication and Managing in Changing Environment

11. NCCC Challenges Changing from “site disease” to “cancer type disease” treatment approach – Molecular Tumor Boards Care Pathways – Cancer Oncology Groups – 13 Role in Population Health – Bundled Payment – Controlling and lowering costs – Increasing efficiencies – “selling our services” to other ACO’s Access Regional Strategy

12. Thank You