The Michigan Society of Hematology and Oncology (MSHO) was formed in 1985 in response to unfavorable changes in Medicare reimbursement and inconsistent coverage issues with Michigan's private payers that jeopardized specialists' ability to deliver quality care. In 1989, MSHO became actively involved in the first state legislation mandating oncology drug coverage. This law was expanded to include off-label indications. This landmark legislation led to development of an Off-Label Oncology Panel review process that is still viable and has been emulated throughout the country. MSHO was invited to deliver Congressional testimony on Michigan's law as Congress formulated the Omnibus Reconciliation Act of 1993, which included provisions requiring Medicare coverage of off-label indications when included in certain drug compendia and peer-reviewed journals. Throughout its twenty-year history, MSHO has paid careful attention to membership recruitment and retention. Regional policymakers and regulators have given MSHO access because they understand that we represent 90% of the state's cancer specialists. As of today, the Michigan Society of Hematology and Oncology includes 313 physicians from private practice and academic medical center settings. Our organization provides educational, reimbursement, legislative advocacy and networking services to physician members as well as their nurse practitioners, physician assistants, oncology nurses, practice managers and billing staff members. Surveying and targeting the unique, local needs of our practices and clinics and employing a variety of communication vehicles keeps the Society relevant and valuable to its members. MSHO recognizes the importance of actively involving the practice administrators in all we do. This specific group can readily identify issues, encourage staff participation in Society initiatives and make sure the physicians maintain their membership. The alliance of the physicians and their administrators is something unique to the Michigan Society of Hematology and Oncology and crucial to our continued success. As an additional benefit, MSHO offers an active Group Purchasing Organization with contracts and partnerships accessible to both large and small practices. Since the founding of the Society, strong physician leadership and vision have driven MSHO's achievements. Our Board of Directors currently numbers 22 oncologists/hematologists representing all geographic areas of Michigan. The composition of the Board is well balanced. Physicians from large practices, solo practitioners and representatives from all of Michigan's academic medical centers are active Board members. Many Board members hold positions in national clinical and professional advocacy organizations. The talent and expertise that each of these overscheduled specialists bring to our Society is impressive. Being an MSHO Board member requires regular attendance at meetings and participation in subcommittees. With labor divided among so many competent and devoted members, burnout is low. As a group there is a great mutual respect and dedication to our core mission. Our members are connected with statewide and national stakeholders in cancer care. MSHO participates in the Michigan Cancer Consortium, facilitates the Michigan Working Group to Improve Cancer Outcomes and has ties to many local and national patient advocacy groups. The Society appoints the Hematology and Oncology Carrier Advisory Committee Members to our Medicare carrier, Wisconsin Physician Services. We have quarterly meetings with the medical policy team at our state's largest private payer, Blue Cross and Blue Shield of Michigan. We also work closely with the Michigan Department of Community Health, the Michigan Association of Health Plans, and individual payers. Education, networking and communication build strong allegiance to MSHO. Rather than being separate functions of the Society, the integration of these services promotes our mission and creates member ownership of our organization. Our CME program faculty is traditionally recruited from Michigan academic medical centers. We offer yearly ASH and ASCO Updates and an Annual Meeting Symposium that reviews the current information on specific tumors. This is an opportunity for community oncologists to recognize those who are the local thought leaders on specific topics. We offer a yearly Oncology Fellows Board Review that confirms our educational mission and dedication to the future of oncology care in the state. OCN pre-test trainings, clinical research workshops, and the Annual Oncology Nurse Network Retreat and dinner meetings advance professional growth and offer nurses an opportunity to meet and share with others in like and different practice settings. Oncology manager roundtables, hospital-based oncology economic updates and quarterly reimbursement meetings address the challenges of the business of oncology. In 2004, MSHO implemented an intensive, week-long academic oncology managers certification course focusing on health care finance, risk management, e-systems, contracting, outcomes measurement, and employment practices. All educational meetings are carefully designed to offer a setting conducive to networking and disseminating information about all MSHO initiatives. Quarterly newsletters, monthly fax-blasts, the MSHO Web site and direct mailings support education opportunities. The Society provides the services of a full-time reimbursement specialist to support practices. Figure 2