0 Leading on Change, Leading on Health John August, Executive Director Union Delegate Conference, March 23,

1 The Legacy We Want to Achieve Union Coalition legacy statement

What Consumers Value in a Health Plan Base: All Qualified Respondents Under Age 65 (n=2140) “Assume for a moment you were faced with the decision of purchasing your own health insurance plan for you and/or your family. On the next few screens, we will be showing you possible features and benefits of health insurance plans. Given that you will have to make some tradeoffs in deciding which plan to purchase, for each one, please indicate which feature/benefit you would prefer the most and which you would prefer the least.” SOURCE: Strategic Health Perspectives 2010 Consumers Survey Low monthly premiums Unrestricted access to medical technologies Coverage for dependents Keeping my current doctor Low co-pay costs for generic drugs Reasonable co-pays for brand name drugs Direct access to all specialists Direct access to leading specialists in my area Unrestricted access to cutting edge medical devices Unrestricted access to cutting edge drugs Access to all brand-name drugs at low cost sharing Choice of hospitals Coverage for a wide selection of brand name durgs Access to prestigious institutions (e.g., Mayo) Relative importance of features/benefits

Health Plan Industry Trends Health care reform has increased the number of entities seeking to reposition with new relationships both within and outside their traditional domain. Realignment and Integration - Realigning business model to control costs HealthCare Partners acquires Talbert Medical Group Humana purchased Concentra (a multi-state outpatient care provider) Diversification - Expand into new lines of business United rebranded health care services and technology as Optum Aetna acquired Medicity (a health technology company) Consolidation - Maintain access to capital and leverage economies of scales United acquired Principal’s health plan business HealthSpring acquired Bravo Health (a Medicare Advantage health plan) Confidential - For Internal Use Only

Current Hospital Economics (per Camden Group)

Commercial Cost Shift Ends?

Consultants and Investment Banks Touting Value of KP Style Integration

Where We Are Today We spend twice as much on health care as other countries. Not what Garfield imagined:

Where We Stand 1 France 2 Italy 3 San Marino 4 Andorra 5 Malta 6 Singapore 7 Spain 8 Oman 9 Austria 10 Japan 11 Norway 12 Portugal 13 Monaco 14 Greece 15 Iceland 16 Luxembourg 17 Netherlands 18 United Kingdom 19 Ireland 20 Switzerland 21 Belgium 22 Colombia 23 Sweden 24 Cyprus 25 Germany 26 Saudi Arabia Health Care System Performance World Health Organization, United Arab Emirates 28 Israel 29 Morocco 30 Canada 31 Finland 32 Australia 33 Chile 34 Denmark 35 Dominica 36 Costa Rica 37 United States of America 38 Slovenia 39 Cuba 40 Brunei

The New Normal Jobs are not coming back

Federal Debt

It boils down to two words – Frontline leadership Our Challenge

Leading on change, leading on health For our patients and members, our communities, our union movement, our families, ourselves…. Frontline Leadership

To create a public face for our unions to show our commitment to leading on public health and shared prosperity. Our Goal

Total Health: Advice from the first physician “Eating alone will not keep man well; he must also take exercise, for food and exercise work together to produce health.” – Hippocrates, 460 BC – 370 BC

What It Will Take to Win A culture of engagement, learning, accountability and change….

Our Stark Choice The choice is stark: chop or improve. “If we permit chopping, I assure you that the chopping block will get very full – first with cuts to the most voiceless and poorest of us, but, soon after, to more and more of us. Fewer health insurance benefits, declining access, more out-of-pocket burdens, and growing delays. If we don’t improve, the cynics win.” - Don Berwick, past administrator, Centers for Medicare and Medicaid Services

Chop or Improve? We know from documented experience that the best way to create value is through an engaged workforce and continuous improvement. Taking the waste, cost, errors, and inefficiencies out of the system can only be done at the front line, by a respected and secure workforce.

. Our Response 1.Improve quality, service, safety and efficiency while preserving best place to work 2.Grow KP to protect our model of care, our unions and our jobs 3.Improve the health of our workforce 4.Improve the health of our communities