Driving Economic Growth in the Community

Cancer Treatment Centers of America® (CTCA) employs more than 2,500 dedicated people serving cancer patients at four destination hospitals in suburban Chicago, Philadelphia, Tulsa and suburban Phoenix. CTCA serves as a major engine for economic growth and development in the communities we serve. For example, a new CTCA hospital adds a minimum of 500 new jobs and more than one-half billion dollars to the local economy in its first five years of operation.

Long term, CTCA provides ongoing economic benefit to local and state economies. More than 70 percent of the patients we serve travel to CTCA from out of state, with many traveling more than 500 miles one-way to access our unique care model. As a result, local businesses that provide lodging, dining, retail, entertainment and other services benefit from the patronage of our patients and their families and caregivers, creating additional revenue for local economies.

Getting Involved and Giving Back CTCA engages in the local landscape as a community partner and contributor. We support local communities and not-for-profits as well as several local and national cancer organizations. CTCA has provided hundreds of thousands of dollars to a wide range of organizations, including:

Each year, CTCA provides millions of dollars in uncompensated care to cancer patients from across the nation. In addition, CTCA recently created a not-for-profit organization to provide assistance to cancer patients struggling to pay for medical expenses.

Community OrganizationsLocal School ProgramsLocal Chambers of CommerceJunior AchievementBoy Scouts of AmericaGirl Scouts of AmericaBoys & Girls ClubsPolice OrganizationsChild Advocacy GroupsCivic and Fraternal OrganizationsFaith-based CharitiesLocal and National Business OrganizationsStatewide Leadership Counsels

Cancer OrganizationsGateway for Cancer ResearchSusan G. Komen for the CureGilda’s ClubsThe Wellness CommunityAmerican Cancer SocietyThe Leukemia & Lymphoma SocietyPancreatic Cancer Action NetworkBreast Cancer Network of StrengthMelanoma International FoundationNational Ovarian Cancer CoalitionNational Lung Cancer PartnershipUs TOO International Prostate Cancer Network Anna’s Belles (Ovarian Cancer Support)Assistance in HealthcareLocal Breast Cancer Coalitions

Economic Impact

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Driving Efficient Processes and Continuous Improvement

Tools for Continuous ImprovementAs a pioneer in the healthcare industry, Cancer Treatment Centers of America® (CTCA) was one of the first hospital systems to incorporate the proven business-efficiency disciplines of Lean Six Sigma Operations into every patient care and support initiative. This concept was first developed by the Toyota Production System (TPS) and is now widely used by leading service providers and manufacturers. Utilizing a dedicated, full-time in-house staff, we have integrated the concepts of Lean Six Sigma into all aspects of daily operations to drive a culture of continuous process improvement throughout the organization. All employees, from frontline stakeholders to executives, are empowered to apply these principles in their daily activities to support patient care.

The Lean Thinking programs remove waste from various business processes to enhance overall value. With efficient processes in place, CTCA has eliminated thousands of hours of non value-added time annually to benefit our patients.

Implementing Lean Thinking throughout the system also helps to:

• Reduce errors and increase hospital quality

• Speed up the flow of work

• Eliminate excess tasks, inventory, duplication and motion

• Use teamwork to promptly identify and address problems as they arise

• Increase the value of service for patients

Efficiency

Efficiency Improved Through Advanced Information Technology Implemented in 2008, our comprehensive, patient-centric system was specifically designed to support the unique model of care delivered at our hospitals. Our customized Electronic Health Record (EHR) system adds value to each patient’s treatment experience, improves quality of care and safety, enhances operations and communications efficiency, and advances data collection and analysis.

Ultimately, the EHR improves the ease and timeliness with which care is delivered and the overall efficiency of hospital operations.

Success of Efficiency at CTCA During FY 2009

Decreasing Waste and Errors• Reduced chemotherapy waste by 57.3%.

• Improved precision and speed of work.

Increasing Value• Corrected all defects in Imaging Department— resulting in formal accreditation for CT, Nuclear Medicine, MRI and PET modalities.

• Improved medication compliance for surgery patients to ensure 100% administration.

Reducing Patient Wait Times• Reduced patient wait time for port access procedures from an average of 41 minutes to 10.6 minutes, despite a 27% increase in patient volume.

• Reduced the number of appointments that are greater than 15 minutes late from 43% to 11%. Timelier appointments had the added downstream benefit of reducing overtime in the department by 24%.

Note: FY2009 - July 2008 - June 2009

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Improving Survival Rates and Patient Outcomes

Outcomes

Cancer Treatment Centers of America® (CTCA) strives to deliver the best treatment results in the market. Our clinicians continually research and employ innovative and promising cancer treatments and technologies to provide patients with advanced, cutting-edge options that treat the whole person.

Survival ResultsCTCA currently tracks clinical survival results for a number of cancer types and compares them with those in a national database called the National Cancer Institute’s Surveillance Epidemiology and End Results (SEER). SEER collects and publishes cancer incidence and survival data from population-based cancer registries covering approximately 26 percent of the U.S. population.

Advanced-Stage Prostate Cancer Results atCancer Treatment Centers of America®

Advanced-Stage Breast Cancer Results atCancer Treatment Centers of America®

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Quality of Life Results at CTCA

Emotional Cognitive Social

The above graph reflects results reported in 2008 to the American Association of Cancer Research and includes a sample of 294 cancer patients (including breast, colorectal, pancreatic, lung, prostate, and other) treated at Cancer Treatment Centers of America® between April 2001 and November 2004. All results are delivered on a 100 point scale with higher numbers equating to a higher quality of life.

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Patients Treated at CTCA Hospitals are Highly Likely to Recommend CTCA to Another Cancer Patient

Would Recommend Hospital

The above graph reflects results reported by 6,410 patients in FY10, compared to data presented in the Hospital Benchmark Reference: “Would you recommend this hospital to a friend?,” produced by Bain & Company, dated December 19, 2007 by Julie Coffman & Phyllis Yale.

Quality of Life ResultsWhile it is common among patients undergoing aggressive cancer therapy to experience an initial deterioration in their quality of life, patients at CTCA often report steady, and often improved, quality of life during the first three months of therapy at our hospitals. CTCA has built a fully-integrated model that augments traditional therapies with a range of evidence-based complementary therapies such as naturopathic medicine, nutrition support, mind-body medicine, oncology rehabilitation and spiritual counseling. CTCA is one of the only cancer hospital networks in the nation to incorporate quality of life measurements as part of the routine clinical program. Enhanced quality of life allows the patient to:

• Better engage in daily activities

• Return to work more quickly

• Maintain professional productivity

• Better manage complex treatment side effects

Patient Satisfaction CTCA implements a widely used methodology known as Net Promoter Score, which allows for the real-time evaluation of service quality and patient satisfaction. By industry standards, a score of 75 percent or above is considered high. Consistently scoring above 90 percent, CTCA ranks among the highest recorded in any industry.

In addition, representatives at each CTCA hospital administer satisfaction surveys and hold weekly focus groups for patients and caregivers. By conducting such extensive patient satisfaction surveys, we have been told by respondents that 92 percent of patients would refer others to CTCA, compared to a national hospital average of approximately 55 percent of patients who are willing to refer another patient.

Delivering Quality Cancer Care

Individualized, Patient-Focused CareAt Cancer Treatment Centers of America® (CTCA), we believe in a patient’s fundamental right to be informed about the best available options for treatment. Our model is built around clinicians treating patients with respect and compassion.

• Working together, each patient’s care team develops a comprehensive treatment plan built around the patient’s unique needs

• Our nurse to patient ratio of 1-to-6 enables the delivery of comprehensive and accurate care through increased time with the patient

• CTCA administers satisfaction surveys and holds weekly focus groups for patients and caregivers to better understand how we can improve each patient’s treatment experience

• Every clinician, every hospital design element and every piece of equipment at CTCA exists to meet the needs of our cancer patients

• Cancer patients and their families experience a welcoming, positive environment of hope and compassion

World-Class ExpertiseExperienced in treating many types of adult cancer, especially advanced stage and complex diseases, CTCA physicians pay close attention to and treat additional medical issues that often occur alongside cancer, such as diabetes, respiratory, heart and digestive conditions. CTCA provides a comprehensive, patient-centered treatment model to meet their needs. CTCA is constantly searching for and acquiring the latest, and most cutting-edge medical technologies and tools available in order to provide cancer patients with powerful and thorough treatment options.

Quality

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AccreditationsCTCA cancer hospitals are accredited by a number of professional healthcare organizations, including the following:

• The Joint Commission

• American Association of Blood Banks

• College of American Pathologists

• American College of Radiology

• American College of Surgeons Commission on Cancer

Multidisciplinary Care TeamAt CTCA, every patient has their own integrated care team of cancer experts. This team meets three times a week to discuss each patient staying with the hospital so care can be coordinated and enhanced. Our electronic health records (EHR) system allows care teams to work collaboratively from a single patient record, which helps to keep the entire team updated on the medical status and individual treatment needs of each patient. Depending on the unique needs, diagnosis and desire of the patient, each care team may consist of:

• A medical, surgical and radiation oncologist

• A naturopathic clinician

• A nutritionist

• A rehabilitation therapist

• A mind-body therapist

• A spiritual counselor

• A physician specializing in pulmonology, hematology, gynecology, gastroenterology, anesthesiology, orthopedic oncology and other specialties

Offering Advanced Treatment Options, Innovative Technologies & Supportive Therapies

Technology

World Class Treatments & TechnologiesAs part of our integrated approach, Cancer Treatment Centers of America® (CTCA) constantly searches for and acquires the latest cutting-edge medical technology and tools to diagnose and treat cancer. Some of these treatments/technologies include:

• TomoTherapy® HI-ART

• High-Dose Rate (HDR) Brachytherapy

• TheraSphere®

• Calypso® 4D Localization SystemTM / GPS for the Body®

• TrilogyTM

• Large Bore CT/RT With Simulation

• Accelerated Partial Breast Irradiation

• Mammosite® RTS

• YAG Laser

• Interventional Angiography

• Photodynamic Therapy (PDT)

• Navigational Bronchoscopy

• Autofluorescence Bronchoscopy

• Endobronchial Ultrasound (EBUS)

• Pulmonary Function Testing (PFT)

• CellSearchTM

• Oncotype DX®

• Metronomic/Fractioned-Dose Chemotherapy

• Intra-Arterial Chemotherapy (IAC)

• Intraperitoneal Chemotherapy (IPC)

• Chemoembolization

• Intrathecal Chemotherapy

• Chronotherapy

• Local Hyperthermia

• Radiofrequency Ablation (RFA)

• Sentinel Lymph Node Biopsy

• ERBEJETTM 2

• Kyphoplasty/Vertebroplasty

• Biotherapy / Immunotherapy

• Stem Cell Transplant and Cell Therapy

NOTE: The above list of treatment options is not exhaustive of all

modalities available within CTCA hospitals.

Mind-Body Medicine (Psychoneuroimmunology)

• Mind-body therapists provide individual, group and family counseling, support groups, stress management techniques, relaxation and guided imagery training, laughter/humor therapy, cognitive reframing and energy therapies.

• Mind-body therapists work with other clinicians to help patients cope with the emotional effects of cancer as well as treatment-related side effects, such as nausea, difficulty sleeping, energy loss, depression, stress and muscle tension.

Oncology Rehabilitation• Rehabilitation therapists provide physical therapies, occupational therapies, speech and language pathology, lymphedema prevention and treatment, auriculotherapy and manual therapies.

• Rehabilitation therapists help patients build strength and endurance, improve mobility, balance, coordination and cognition, and reduce treatment-related side effects, such as nausea, dry mouth, hiccups, difficulty swallowing, shortness of breath, dizziness and fatigue.

Spiritual Support• Chaplains work within patients’ belief systems to provide individual and group prayer, family consultations, weekly interfaith worship and communion services, crisis intervention, patient rights issues, 24/7 on-call visitation, prayer and counseling.

• Chaplains strive to nurture patients’ spiritual well-being to help carry them through difficult times, reduce stress, anxiety and depression, and provide patients with a source of peace, purpose and comfort.

Complementary Alternative Medicine TherapiesCTCA also provides evidence-based complementary therapies to ease the side effects of conventional therapies and help patients continue with their treatment regime with fewer interruptions. This results in an enhanced quality of life throughout treatment.

Nutrition Therapy• Dietitians provide personal meal plans, menus and recipes, vitamin and mineral supplementation and nutritional support. Dietitians work with oncologists to keep patients nourished, prevent malnutrition, rebuild body tissue, support immune function and enhance overall well-being.

Naturopathic Medicine• Naturopaths assist physicians to provide clinical nutrition, botanical medicine (e.g., herbs, minerals, vitamins), homeopathy, hydrotherapy, classical Chinese medicine (e.g., acupressure) and manipulative therapy.

• Naturopaths work with oncologists to provide safe, natural therapies—alongside conventional treatments—to help support normal metabolism, boost the immune system and alleviate treatment-related side effects, such as nausea, constipation, diarrhea and fatigue.

Pain Management• Pain specialists provide pharmacological pain control, behavioral techniques, neurological and neurosurgical interventions and transcutaneous electric nerve stimulation (TENS).

• Pain specialists collaborate with surgeons and radiologists to find appropriate pain control methods to help improve patients’ eating, sleeping, activity, mood, concentration and overall quality of life.

© 2010 Rising Tide, Kft. BDT0110

Creating Value for our Business Partners

Efficient Costs for Purchasers and PayersEmployers want the best possible care for employees and dependents who are undergoing cancer treatment, just as patients want to return to “normal life” as quickly as possible. The Cancer Treatment Centers of America® (CTCA) model coordinates the typically decentralized process of cancer care under one roof and applies principals of Lean thinking to streamline the overall patient experience. This allows the system to operate as one of the most efficient providers of cancer care in the country, according to a study by Milliman, Inc. Overall costs are managed by:

• Superior outcomes as driven by our integrated model and application of evidence based clinical pathways

• Reduced test duplication using our comprehensive, coordinated care model

• Decreased total time to treatment due to the application of Lean Six Sigma efficiency principles

• Improved internal efficiency and error reduction with use of a system-wide Electronic Health Record (EHR)

Impact on the Workforce Patients undergoing cancer treatment can suffer from symptoms that negatively impact their quality of life, causing increased absenteeism and often the election of short- or long-term disability. CTCA strives to enhance each patient’s quality of life during and after treatment to reduce the costs associated with lost employee productivity, which can be a burden for both patients and employers.

CTCA further increases time at home and in the workplace for patients through decreased scheduling delays, wait times for treatment and internal errors. We also provide a multidisciplinary team of cancer experts who collaborate under one roof, eliminating the need for patients to travel to multiple locations for specialist visits.

Value

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• CTCA care teams collaborate under one roof and meet three times a week to discuss individual patient care.

• We regularly conduct patient surveys and focus groups to discover new opportunities to improve each patient’s treatment experience.

Our comprehensive care model and focus on quality of life and efficient processes helps patients return to work sooner, stay at work with fewer interruptions, and increase professional productivity.

Our commitment to provide high-quality, comprehensive patient care while ensuring the most efficient processes distinguishes CTCA from peer treatment facilities in measurable and tangible ways:

• Most CTCA patients begin treatment within 24 hours of scheduling their initial appointment. Insurance verification, collection of medical records, appointment scheduling, and travel and lodging arrangements are all completed before a patient’s first visit. This eliminates thousands of non-value-added hours annually.

• We have reduced the average time to register new patients to under 10 minutes, the time to receive results of most diagnostic tests to within hours, and significantly improved turnaround times for many tasks, such as a 20 percent time reduction in chemotherapy preparation.