Background: The rapid development of oral chemotherapy agents brings unique challenges. These drugs must be treated with the same vigilance as parenteral chemotherapy. The oral chemotherapy system is not optimized or integrated across our hospital. A quality assessment survey identified the need for a better means to monitor and improve oral chemotherapy patient outcomes. Methods: Patient and staff satisfaction with the current process was measured. A chartered multidisciplinary task force reviewed existing practice and developed a program to identify patients, ensure drug access, standardize prescription and consent, ensure on-going clinical support including patient education, regimen specific adherence monitoring, toxicity assessment and address patient concerns. Current state process mapping and gap analysis identified eighty-seven points where care could break down. A risk mitigating model was developed to include clinically reviewed electronic orders, nursing and pharmacist order review, specialty pharmacy, Medication Assistance Program (MAP) to assist with access and co-payment, patient education, day 5 and 21 pharmacist to patient phone calls, multidisciplinary flow sheet documentation, EMR report to track patients and outcomes and standardized patient education and provider training. The implementation team addresses process challenges identified via clinical team feedback e.g. therapy delays and implements fixes. Results: See table below. Specialty pharmacy revenue is directed to supporting non-profit clinical care at a time when revenue sources are being cut. MAP co-pay support exceeds $2.3 million. Conclusions: A patient-centered multidisciplinary care model integrating clinical, operational, financial and technology resources optimized care. Our improvement approach created opportunities for collaboration between pharmacists, physicians and nurses and can be adapted for many settings.