1. Health Care, Education and Research May 5, 2014 Your Hospitals Path to the Second Curve: Integration and Transformation Scott A. Duke Vice President Regional Services Billings Clinic

2. Journey to Affiliati on

3. Glendive Medical Center Located in Glendive, MT Critical Access Hospital (CAH) 25-bed Skilled nursing facility 71-bed Veteran skilled nursing facility 80-bed Assisted living facility 13-unit Gabert Clinic21 Medical Staff Employees350+ FTE

4. The Journey to AffiliationWhy? Stable Medical Staff Strong community support Good quality and safety outcomes Growth and positive financial performance Completed a major construction project AHA Report Hospitals and Health Systems of the Future PPACA Volume-to-Value Must do strategies Core organization competencies

5. Focus Areas Medical provider and clinical integration Focus on quality outcomes Working in care teams Population Health Retention and recruitment of staff Electronic Health Record (EHR) Shared administration and governance Increased purchasing power

6. Anticipated Benefits Improved emphasis on quality and safety Patient Centered CareMedical Homes Accountable Care Organizations (ACO) Participation in insurance networks Improved patient access Create consistent/efficient processes Shared resources for recruitment/retention

7. Process Attributes Strategic planning process Board Committee Scope of work and timeline Various stakeholders; Board, Community, Medical Staff, Leadership, Employees Focused on what vs. who to partner Research--gather information and data Defined Affiliation

8. Definition of Affiliation Does NOT Include.... Requirement of referrals Loss of jobs and benefits Relinquishing local governance and decision making Sale or transfer of facility ownership Changing foundation and auxiliary ownership Includes.... Medical provider integration, including recruitment assistance Clinical integration Shared governance and strategic planning Management agreement including CEO Operational efficiencies Information technology Group purchasing

9. Process Attributes (cont.) Developed attributes and benefits Invited/site visit regional organizations Ongoing review and analysis Created a Summary of Findings Developed/wrote a White Paper Identified/selected potential partner Held community and employee forums Agreement Negotiations –Legal Review

10. Lessons Learned Mission, Vision, Values Driven Focus on the care model Strategic ProcessStructure Involve diverse group of stakeholders Share regular updates Conduct research and site visits Rigorous Due Diligence process Plan for future considerations

11. Future Considerations Name change and branding Medical provider employment, CMO Merger

12. Regional Services Summary

13. Overview Billings Clinic is a not-for-profit organization structured as a medical foundation that serves Montana, northern Wyoming and the western Dakotas 285-licensed bed acute care hospital located in Billings, Montana A multi-specialty physician group practice based in Billings with branch clinics in Miles City and Bozeman, Montana, and Cody, Wyoming A long-term care facility and a research center Manage 11 Critical Access Hospitals and Clinics in Montana and Wyoming A physician-led, integrated health care organization, the Clinic has 3,750 employees, including 260 physicians and 90 advanced practitioners offering more than 50 specialties 100 specialty care clinics per month at 23 regional locations for residents of rural Montana, Wyoming, and North Dakota

14. Partnership Philosophy in the Region Our intent is to create an integrated rural health care system that leverages resources and expertise Value exceptional patient-centered care and financial strength while demonstrating our commitment to community-based health care Advocate partnerships that are based on trust, shared vision, values and goals Transfer health care knowledge and expertise to partnering organizations thus fostering sound decision-making Utilize progressive management methods to achieve optimal operational, financial and clinical outcomes

15. Regional Strategic Pillars

16. Management and Affiliation Relationships Pioneer Medical Center* (Big Timber) 1997 Colstrip Medical Center (Colstrip) 1998 North Big Horn Hospital (Lovell WY) 1999 Daniels Memorial Health Care (Scobey) 2001 Beartooth Billings Clinic* (Red Lodge)2002 Stillwater Billings Clinic* (Columbus) 2002 Livingston HealthCare* (Livingston) 2002 Roundup Memorial Healthcare (Roundup) 2010 Sheridan Memorial HealthCare (Plentywood) 2012 Glendive Medical Center* (Glendive) 2013 Wheatland Memorial Hospital (Harlowton) 2014 *Affiliation

18. Regional Attributes Management Agreement11 Facilities Core Services15 Areas Affiliation Agreement Shared Governance Regional Advisory Board (RAB) System Development

19. Health Care, Education and Research Questions? Thank you!