1. 2014 Rural Hospital Conference

2. The Cost of Doing Nothing is Too High  So, how do we partner to influence the health of our communities?

3. Our Mission Connect Collaborate Achieve To improve the health care delivery systems of our rural communities. 3

4. Skyline Hospital, White Salmon Who we are… 4 Adams Asotin Chelan Clallam Clark Columbia Cowlitz Douglas Franklin Garfield Grant Grays Harbor Island Jefferson King Kitsap Kittitas Klickitat Lewis Mason Pacific Thurston Lincoln Okanogan Pend Oreille Pierce San Juan Skagit Skamania Snohomish Spokane Stevens Wahkiakum Walla Benton Yakima Ferry Mason General Hospital, Shelton Whatcom Whitman Willapa Harbor Hospital, South Bend Snoqualmie Valley Hospital PeaceHealth United General Hospital, Sedro Woolley Ocean Beach Hospital, Ilwaco Forks Community Hospital Whidbey General Hospital, Coupeville Summit Pacific Medical Center, Elma Jefferson Healthcare, Port Townsend Morton General Hospital Prosser Memorial Hospital, Prosser Klickitat Valley Health, Goldendale

5. Board of Directors  Renée Jensen, Chair, Summit Pacific Medical Center  Kendall Sawa, Vice Chair, Ocean Beach Hospital  Rodger McCollum, Secretary/Treasurer, Snoqualmie Valley Hospital 5  Jim Chaney, Forks Community Hospital  Hilary Whittington, Jefferson Healthcare  Leslie Hiebert, Klickitat Valley Health  Eric Moll, Mason General Hospital  Tim Cournyer, Morton General Hospital  Jim Barnhart, PeaceHealth United General Medical Center  Julie Petersen, PMH Medical Center  Robb Kimmes, Skyline Hospital  Tom Tomasino, Whidbey General Hospital  Carole Halsan, Willapa Harbor Hospital

6. Strengths and Values  Membership is strong and committed  Leadership team that meets monthly  Expanded subcommittees to promote valuable exchanges: CFO, Nursing, Quality, HR, HIM, CMO, Business Office  Professional growth for leaders  Synergy to discuss and develop ideas  Forum for education  Work aligns and supports members missions  Flexible and nimble  Able to respond quickly to opportunities  Maximize the value of collaborative as affiliate partner  Promotes efficiencies  Grants  Shared contracting (Lab, Insurance, Compliance Hotline, ICD 10 Training) 6

7. What we do…  Convene hospitals for mutual support, exploration, development, preparation and implementation:  Innovation – tele-psychiatry, referral management, wellness program  Piloting new models – HIE and Rural ACO  Health care reform: Exchanges and Medicaid  Seek to reduce the unit cost of care for participating organizations  Joint contracts/negotiations: Reference lab, PACS  Shared services: ComplianceHotline, ICD 10 training  Sharing innovative programs and share best practices among members  Policies and procedures, cardiac and stroke guidelines, compliance  Reviews and reports on the status of quality measures and initiatives  Quality and critical access hospital requirements, as well as expanding services such as cardiology clinics and education. 7

8. Current Activities…  Strategic Focus 2014: Establish a Performance Quality Improvement Initiative  Focus on both clinical quality and financial measures  Goals:  Develop standardized benchmarking tools dashboards and metrics  Develop a process for quality and financial performance improvement across multiple hospitals  Explore models to scale PI through regional collaboratives (both formal and informal) and Statewide initiatives  Based on opportunities identified through benchmarking, complete at least one PI project (including an evaluation of the financial impact) during 2014  Partners: DOH, Office of Rural Health, WSHA, Terry Hill, NRHA  Bargaining/Benchmarking/Joint Contracting  Benchmarking: ED FTE/Visits, medication errors, staffing ratios tied volumes  Compliance Hotline  ICD 10 Training Contract  Insurance contracting through PHD Joint Operating Board (WRHC is Administrative/Fiscal Agent)  Joint Contracting Underway:  Lab: Estimated savings of $850,000 annually  GPO  PACS  Malpractice Insurance  Preparing for and implementing health care reform  Maximize the value collaborative as a affiliate partner  Preparing for a shift from volume to value based purchasing  Exploration of forming a rural ACO  HRSA HIT Grant – preparing hospitals to achieve meaningful use  Access to Resources: Shared services, best practices and learnings  Active Committees: CEO, CFO, Nursing & Quality, HR, HIM, Marketing and Foundation, Compliance, emerging CMO 8

9. PHD Joint Operating Board 9

10. Skyline Hospital, White Salmon PHD Joint Operating Board 10 Adams Asotin Chelan Clallam Clark Columbia Cowlitz Douglas Franklin Garfield Grant Grays Harbor Island Jefferson King Kitsap Kittitas Klickitat Lewis Mason Pacific Thurston Lincoln Okanogan Pend Oreille Pierce San Juan Skagit Skamania Snohomish Spokane Stevens Wahkiakum Walla Benton Yakima Ferry Mason General Hospital, Shelton Whatcom Whitman Willapa Harbor Hospital, South Bend Snoqualmie Valley Hospital, Snoqualmie Ocean Beach Hospital, Ilwaco Forks Community Hospital, Forks Whidbey General Hospital, Coupeville Summit Pacific Medical Center, Elma Jefferson Healthcare, Port Townsend Morton General Hospital, Morton Prosser Memorial Hospital, Prosser Cascade Valley Hospital, Arlington Skagit Valley Hospital, Mt. Vernon Valley General Hospital, Monroe Island Hospital, Anacortes Klickitat Valley Health, Goldendale Lincoln Hospital, Davenport Newport Hospital, Newport

11. PHD Joint Operating Board  Established in 2006  Contracts with WRHC to provide fiscal and administrative support and leadership  Authorized under RCW 70.44.240 and RCW 70.44.450  18 Public Hospital District hospitals have entered into an Interlocal Agreement, under the name PHD Joint Operating Board, authorizing collective negotiations with public and private health plans and provider groups.  Governance Structure  Board: 18 Public Hospital Districts  Chair: Tamara Cesena, Skagit Regional Health  Volunteer board with bylaws and clear participation agreements 11

12. Our Goals  To create economies of scales through a centralized contract negotiations process.  Enhance the expertise of contract negotiations.  Add resources to enable faster, more sophisticated interactions with insurance carriers.  Poise member public hospital districts in a stable position for the Health Insurance Exchange and Risk-Based/Value Based Contracting.  Share the lessons learned, processes and tools. 12

13. Current Activities  Develop and analyze models and strategies to negotiate, enter into and carry out joint agreements and contracts for health care service delivery and payment with public and private entities that operate within the State of Washington.  Engage in other collective negotiations with health plans or provider groups desiring to contract in the State of Washington;  Exploring models related to value-based and risk-based contracting and  Engage consultants as PHD deems necessary to assist in evaluating the various models and strategies under consideration.  Member advocacy  Share the lessons learned, processes and tools 13

14. Flex Activities 2013 -2014  Year 1:  Develop the framework and necessary infrastructure to effectively develop and implement a joint contracting model that is compliant with Washington State laws.  Year 2:  Convene a financial network to identify and share best practices for negotiating contracts with health plans and language and rates among our members with a specific focus on creating the organizational readiness and potential responses to valued based contracting 14

15. Questions? Contact for further information: Holly Greenwood, Executive Director, Washington Rural Health Collaborative PHD Joint Operating Board (360) 346-2351 holly@washingtonruralhealth.org www.washingtonruralhealth.org 15