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Confidential. This presentation is provided for the recipient only and cannot be reproduced or shared without Health Management Associates, Inc.s express.

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Presentation on theme: "Confidential. This presentation is provided for the recipient only and cannot be reproduced or shared without Health Management Associates, Inc.s express."— Presentation transcript:

1 Confidential. This presentation is provided for the recipient only and cannot be reproduced or shared without Health Management Associates, Inc.s express consent. © 2011 Health Management Associates, Inc. 1 Strategic Initiative with and

2 © 2011 Health Management Associates, Inc. Confidential. 2 Health Managements Mission of Enabling Americas Best Local Healthcare – Our focus is supporting South East Volusia communities Health Managements state wide presence in Florida and locally on the East Coast connecting physicians and hospitals systems like Bayfront, Shands, and Orlando Health Health Managements results for being a leader in both quality driven health care and healthy operations Partnership Benefits for Bert Fish Medical Center and South East Volusia County

3 © 2011 Health Management Associates, Inc. Confidential. 3 Bert Fish Medical Center Proposal Highlights Health Management leases assets and operations of Bert Fish Medical Center for $50,000,000 in cash, spends at least $40 million in capital spending and offers Joint Venture option which includes 50/50 Governance Pay annual property taxes like all other businesses and end community health care tax after 7 years All staff employees stay at same title and pay Bert Fish Medical Center keeps its charity care policy and mission to serve the poor Clinical Affiliation with Orlando Health

4 © 2011 Health Management Associates, Inc. Confidential. 4 Mission and Vision About Health Management Mission, Vision, and Values Quality Gary Newsome President and Chief Executive Officer Enabling Americas Best Local Health Care

5 © 2011 Health Management Associates, Inc. Confidential. 5 Guiding Principles PEOPLESERVICEQUALITYINNOVATIONFINANCEGROWTH MISSION: ENABLING AMERICAS BEST LOCAL HEALTH CARE. We are servant leaders.We do the right thing.We dont settle.

6 © 2011 Health Management Associates, Inc. Confidential. 6 One of worlds most admired companies in Health Care No. 1 company in Quality of Products / Services No. 1 in Social Responsibility States with Health Management Presence Not-for-profit Joint Ventures / Affiliations 70 facilities in 15 states +40,000 Associates +10,000 Physicians A focus on mid-sized communities Located primarily in the Southeastern U.S. including 22 hospitals in Florida Strong presence in markets with high retirement populations About Health Management

7 © 2011 Health Management Associates, Inc. Confidential. 7 Shands: Lake Shore, Live Oak, Starke Wuesthoff - Rockledge Wuesthoff - Melbourne Sebastian River St. Cloud RMC / Orlando Health Bayfront Medical Center Bert Fish Medical Center Health Management Hospitals (FY 2011) 22 (FL) Total Beds2,998 Admissions132,000 Surgeries116,000 ER Visits575,000 Net Revenue$2.08B Florida Network of Hospitals

8 © 2011 Health Management Associates, Inc. Confidential. 8 Health Management Associates Local Hospitals, National Recognition 58 hospitals/health systems are Joint Commission accredited and have received The Gold Seal of Approval TM. 41 hospitals/health systems were recognized as 2011 Top Performers on Key Quality Measures TM by The Joint Commission. 7 hospitals/health systems are certified as Primary Stroke Centers by The Joint Commission. 18 hospitals/health systems have received chest pain center accreditation by the Society of Cardiovascular Patient Care (formerly known as the Society of Chest Pain Centers).

9 © 2011 Health Management Associates, Inc. Confidential. 9 Vision for Nursing: Perspective from Six Pillars at Health Management People » Clinical Leader Program » Development of ACNO Program » CNE Orientation and Development » CNE Annual Conference » National Nursing Leadership Group Service and Quality » Alignment with disciplines throughout the company to enhance quality outcomes Nursing leads Corporate Patient Safety Committee Nursing Sensitive Scorecard Patient Safety Scorecard Disseminate best practices through various mechanisms Development of local collaborative interdisciplinary team model

10 © 2011 Health Management Associates, Inc. Confidential. 10 Information Technology Integration » Base system integrates with existing platforms including Meditech Hospital » Base system integrates with other ancillary, billing, and financial systems with minimal disruption Physician Clinics » Athena Health for EMR and practice management systems Meaningful Use – Fully implemented in 2012

11 © 2011 Health Management Associates, Inc. Confidential. 11 Bert Fish Medical Center Strategy HMA East Coast Network Market Share Opportunity Quality Outcomes Managed Care and Accountable Care Business Plan Kathy Burke Division CEO South Florida

12 © 2011 Health Management Associates, Inc. Confidential. 12 Health Management Associates Local Hospitals, National Recognition Florida Recognition Six hospitals/health systems (seven locations) are certified as Primary Stroke Centers by AHCA (Agency for Health Care Administration). Five hospitals are certified as Primary Stroke Centers by The Joint Commission. Three hospitals/health systems (three locations) have received chest pain center accreditation by the Society of Cardiovascular Patient Care; one hospital with chest pain accreditation by AHCA 13 hospitals were recognized as 2011 Top Performers on Key Quality Measures TM by The Joint Commission.

13 © 2011 Health Management Associates, Inc. Confidential. 13 Health Management Associates Local Hospitals, National Recognition Florida Medical Quality Assurance Inc. - Patient Safety Award First and only Certification Gynecological Surgical Center of Excellence in Florida; Only comprehensive stroke center in SW Florida HealthGrades: Americas Best 100 Hospitals, 2012 Distinguished Hospital Award for Clinical Excellence 2010, 2011, 2012 Blue Distinction for Hips and Knees by Florida Blue (2012); Breast Imaging Center of Excellence by the American College of Radiology (2012) Get With the Guidelines Stroke Gold Plus Award and Heart Failure Silver Award

14 © 2011 Health Management Associates, Inc. Confidential. 14 Health Management in Floridas East Coast Melbourne Rockledge Sebastian Health Management HospitalsAdmissionsSurgeriesER VisitsNet Revenue Wuesthoff - Rockledge12,7077,92637,348$206.4M Wuesthoff - Melbourne5,3186,11521,231$114.8M Sebastian Regional4,6605,59119,281$ 81.6M

15 © 2009 Health Management, Inc. Confidential. 15 Health Management East Coast Physician Network A Different Business with Different Metrics requiring Different Leadership Provide physicians with viable best practice options Over 1,500 medical staff physicians 113 physician & midlevel associates More than 375 associates 64 locations throughout Space Coast 350,000 annual patient encounters $59.2 Million Net Revenue

16 © 2011 Health Management Associates, Inc. Confidential. 16 Patient Egress from South East Volusia HospitalPSA/SSA Bert Fish Medical Center31.7 Halifax Health Med Ctr34.5 Florida Hospital Memorial11.9 Halifax Health Port Orange8.7 All Others13.2 Source: Florida inpatient data Jan 2011-Dec 2011 The Nielsen Company & Thomson Reuters Nearly 70% of patients from South East Volusia county leave the area for patient care services

17 © 2011 Health Management Associates, Inc. Confidential. 17 Health Care Quality Data Opportunities for Improvement Risk-Adj Mortality Composite%*Core Measures Mean Percent*HCAHPS Score % Top Box** Sources: * Whynotthebest.org ** Hospitalcompare.com 2/21/13

18 © 2011 Health Management Associates, Inc. Confidential. 18 Improving Quality and Customer Satisfaction at Bert Fish Medical Center Bench mark quality and operations results for hospital and medical staff with 70 other hospitals and 10,000 physicians Collaborate with Health Managements Florida hospitals for best practices in quality and operations Adopt advanced Clinical Protocols from Orlando Health and Shands Healthcare in Chest Pain and Stroke to expand facility services

19 © 2011 Health Management Associates, Inc. Confidential. 19 Managed Care – Keeping Bert Fish Independent and Connected Strategic Responses to New Payment Methodologies Value Based Purchasing Hospital-Physician Bundling Shared-Savings Model Degree of Management Challenge Engage physicians Standardize care processes Engage patients Track and analyze performance Leverage physician incentives Standardize devices Implement care maps Reduce orders and consults Implement evidence base guidelines Disease Registries Care Managers Partner with PCPs Deliver preventive & chronic disease management Reduce utilization Actions needed under all payment reforms Provider Cost Accountability Pay-for-Performance Source: Advisory Board

20 © 2011 Health Management Associates, Inc. Confidential. 20 Bert Fish Medical Center Business Strategy Adding Bert Fish to Health Managements Statewide and Local Insurance Plan Networks including future ACOs with Orlando Health and Shands Healthcare Establish large network of Primary Care Physicians including private and employed physicians and free standing ERs North and South of Bert Fish Medical Center Enhance Service Lines – Capital Spending and Physician Recruitment » Cardiology – Expand and Market Chest Pain Center » Stroke – Expand and Market Stroke Center » Surgery – Add robotics services for Orthopedics and daVinci

21 © 2011 Health Management Associates, Inc. Confidential. 21 Partnership Proposal Business Terms Joint Venture Option Governance Pete Lawson Executive Vice President Enabling Americas Best Local Health Care

22 © 2011 Health Management Associates, Inc. Confidential. 22 Bert Fish Medical Center Proposal Highlights Health Management leases assets and operations of Bert Fish Medical Center for $50,000,000 in cash, spends at least $40 million in capital spending and offers Joint Venture option which includes 50/50 Governance Pay annual property taxes like all other businesses and end community health care tax after 7 years All staff employees stay at same title and pay Bert Fish Medical Center keeps its charity care policy and mission to serve the poor Clinical Affiliation with Orlando Health

23 © 2011 Health Management Associates, Inc. Confidential. 23 Estimated Flow of Funds to SE Volusia Hospital District Cash From Lease Payment$50,000,000 Plus Inventory and Pre-Paids 2,600,000 Total Cash From HMA$52,600,000 +Plus Current Assets 23,200,000 +Plus Limited and Other Assets 8,500,000 Less Current Liabilities(12,600,000) Long Term Debt (21,500,000) Net Proceeds Following Transaction$50,200,000 Notes: August 31, 2012 unaudited balance sheet Pension obligation not required to be paid off at closing

24 © 2011 Health Management Associates, Inc. Confidential. 24 Bert Fish Medical Center Governance Bert Fish Medical Center Advisory Board Hospital Management Teams Medical Staffs Advisory Board permanent seats include designated: » One (1) Southeast Hospital District Member » One (1) Bert Fish Foundation Member

25 © 2011 Health Management Associates, Inc. Confidential. 25 Bert Fish Medical Center Advisory Board Comprised of Local Community Leaders, Physician Representatives and Hospital CEO » Typically comprised of 9-13 members: 60% lay members and 40% physicians » One (1) permanent member of the District and one (1) from the Bert Fish Foundation Establishes strategic direction Oversight for regulatory compliance (JCAHO, State, CMS) and patient safety Ensures quality of care and Medical Staff credentials Collaborates on operational objectives Serves as community liaisons and communication champions

26 © 2011 Health Management Associates, Inc. Confidential. 26 Clinical Component Access to Teaching Center Physicians Disease Management Protocols Clinical Trials Clinical Care Guidelines Telemedicine Business Component Common Branding and Shared Logo Physician Recruitment Service Expansion Capital Spending Network Platform Health Management Not-for-Profit Partnerships

27 © 2011 Health Management Associates, Inc. Confidential. 27 Health Management Associates BFMC, LLC Joint Venture Option – 80/20 Ownership and Equal Governance » SEVHD receives accelerated lease payment and new NFP holds 20% interest of BFMC, LLC » SEVHD maintains equal governance with Health Management of BFMC, LLC » Creates BFMC, LLC which holds assets and operations of BFMC » Health Management contributes cash and receives 80% interest of BFMC, LLC » Health Management manages LLC LLCOwnershipGovernance HMA80%50 SEVHD20%50 Equal Governance SEVHD receives cash and leases BFMC assets and operations to HMA and New Not For Profit holds 20% SEVHD – New Not For Profit

28 © 2011 Health Management Associates, Inc. Confidential. 28 Bert Fish Medical Center, LLC Board of Directors Governance Comprised of 4 Health Management and 4 SE Volusia Hospital District Members governing jointly Major, Majority, and Unanimous Decision Rights detailed in Operating Agreement including: » Annual Operating and Capital Budgets » Acquisition of other businesses » Capital calls » Debt defeasement or addition » Distribution amounts » New Member additions » Dissolution and Unwinds » Puts and Calls

29 © 2011 Health Management Associates, Inc. Confidential. 29 Estimated Partnership Flow of Funds to SE Volusia Hospital District Cash From Lease Payment$50,000,000 Plus Inventory and Pre-Paids 2,600,000 Total Cash From HMA$52,600,000 +Plus Current Assets 23,200,000 +Plus Limited and Other Assets 8,500,000 Less Current Liabilities(12,600,000) Long Term Debt (21,500,000) -Less 20% ownership of Joint Venture(10,500,000) Net Proceeds Following Transaction$39,7000,000 Notes: August 31, 2012 unaudited balance sheet Pension obligation not required to be paid off at closing

30 © 2011 Health Management Associates, Inc. Confidential. 30 Ending Health Care Tax (HMA) v. Keeping Tax (Halifax)

31 © 2011 Health Management Associates, Inc. Confidential. 31 Health Managements Mission of Enabling Americas Best Local Healthcare – Our focus is supporting South East Volusia communities Health Managements state wide presence in Florida and locally on the East Coast connecting physicians and hospitals systems like Bayfront, Shands and Orlando Health Health Managements results for being a leader in both quality driven health care and healthy operations Partnership Benefits for Bert Fish Medical Center and South East Volusia County

32 © 2011 Health Management Associates, Inc. Confidential. 32 Discussion and Feedback

33 © 2011 Health Management Associates, Inc. Confidential. 33 Sherrie Sitarik – CEO Orlando Health Orlando, FL (407) Tim Goldfarb – CEO Shands Healthcare Gainesville, FL (352) James Keaton, MD - Vice-Chancellor University of Mississippi Medical Center (601) David Knowiski – VP of Finance Catholic Health Partners Cincinnati, OH (513) Bruce Lawrence – CEO Integris Health Oklahoma City, OK (405) Steve Dupre – Vice Chairman Bayfront Medical Center St. Petersburg (727) Partnership References

34 © 2011 Health Management Associates, Inc. Confidential. 34 Case Study: University of Florida / Shands Healthcare Partnership Health Management Invested Capital in Yr 1: $6M » Public Hospital Authority contributed additional $2M for renovations » Renovated ICU » Renovated first floor » da Vinci robotic surgery » Open MRI New Services » Recruited 16 new physicians » Live Oak - Cardiology » Starke – General Surgery, Gyn » Lake Shore – Interventional Radiology, Neurology, Orthopedics Health Management acquired 60% ownership in 2010 » Shands Lake Shore, Live Oak, and Starke » Both organizations share governance equally » Health Management manages the partnership » State wide Chest Pain and Stroke programs Shands Lake Shore Regional Medical Center

35 © 2011 Health Management Associates, Inc. Confidential. 35 Case Study: St. Cloud Regional Partnership Capital Invested ($16M since 06) » Land Acquisition for MOB (4.56 acres) » GE 64-slice CT Scanner » OR Expansion: 4 MIS ORs » ER Renovation/New Fast Track » Digital Mammography » DaVinci Robotic Surgery New Services » Recruited 24 new physicians (09-12) » Wound Care w/ HBOT » ENT, Ophthalmology & Uro-gynecology » Partnerships with Jewett Orthopaedic Clinic & Orlando Heart Institute » Developing Outpatient Center in Lake Nona including ASC, Urgent Care, Imaging Center and Physician Offices 84 bed hospital formerly part of the Orlando Regional Health System Health Management acquired 80% majority interest in 2006 Current Projects under development: Build New 24 Bed ED and Cardiac Cath Lab

36 © 2011 Health Management Associates, Inc. Confidential. 36 Case Study: Wuesthoff Health System – Rockledge & Melbourne, FL Vertical Integration » Assisted Living Centers » Nursing Homes » Skilled Nursing Facilities » Home Care » Hospice & Palliative Care » Acute Care » Surgery and Imaging Centers » Home Medical Equipment » Regional Reference Lab Physician Relationships » Focus on splitter physicians » 83 employed physicians » Recruited Osler Medical Group » 47 multi-specialty physicians WuesthoffRockledgeMelbourneTotal Beds FTEs1, ,600 Discharges12,8305,32018,150 Births ,020 Surgeries7,6905,47013,160 ER Visits35,65021,07556,725 Net Revenue$226M$92M$318M Wuesthoff Health System – Rockledge Fiscal Year 2011


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