Gaining Buy-In Toolkit Showcasing the Value of the MLP Approach

©2015 The Advisory Board Company advisory.com 2 Prepared Slides to Showcase Value of MLP Approach Gaining Buy-In Toolkit Copy and paste slides 3-8 into the beginning of your presentation to hospital / clinic executives Insert data from your MLP into slide 8 –*Note: If suggested data points are unavailable, select accessible and relevant metrics that showcase value of MLP What should you use the toolkit for? Directions for using toolkit Hospital board meeting presentations Source: The Advisory Board Company interviews and analysis. Provider education on benefits of MLP model Other hospital or community meetings

©2015 The Advisory Board Company advisory.com 3 Social Determinants Driving Patient Outcomes Source: J. Michael McGinnis, et. al, “The Case For More Active Policy Attention To Health Promotion”, Health Affairs, March 2002, available at: Katherine Magnuson and Elizabeth Votruba-Drzal, “Enduring Influences of Childhood Poverty”, Vol. 26, 2009, available at: Jeanne Brooks-Gunn, “The Effects of Poverty on Children”, Children and Poverty, Vol. 7, No. 2,1997, available at: The Advisory Board Company interviews and analysis. Social and Environmental Risk Factors Unstable Family Income Environmental Hazards Insufficient Access to Food Inadequate School Services Lack of Health Insurance Substandard, Unsafe Housing 2x Annual short-stay hospital episodes for children in poverty compared with children in non-poverty Premature deaths in the U.S. attributed to social circumstances 15%

©2015 The Advisory Board Company advisory.com 4 Medical Approach Alone Often Not Enough Legal Intervention Required for Complex Social Needs Source: Beck, Andrew, et. al., “Doctors and Lawyers Collaborating to HeLP Children—Outcomes from a Successful Partnership between Professions”, Journal of Health Care for the Poor and Underserved, 24(2013): Sandel, Megan et. al., “Medical-Legal Partnerships: Transforming Primary Care By Addressing The Legal Needs Of Vulnerable Populations”, Health Affairs 29, No. 9 (2010): 1697–1705, The Advisory Board Company interviews and analysis. Unfulfilled Legal Needs “Most at-risk individuals might not know when their social problems actually have legal solutions. And even if at-risk individuals realize the legal nature of their problems, they then must struggle to find legal assistance.” ” Megan Sandel, MD, MPH, Department of Pediatrics, Boston University School of Medicine 1-3 Average number of unmet legal needs among low- income households 50% Low to moderate income households with at least one unmet legal need Patient presents with problems that may be managed through a standard medical intervention Health and wellness impacted by psychosocial factors that require social worker, case manager support Medical Needs Psychosocial Needs Legal Needs Outcomes affected by broader socioeconomic causes that are best addressed through legal intervention Demand for Multifactorial Intervention

©2015 The Advisory Board Company advisory.com 5 Medical-Legal Partnerships Fill Important Gap Strengthening Health System Ability to Identify, Treat Legal Needs Legal Status Immigration (asylum, Violence Against Women Act) Criminal record issues Personal/Family Stability Guardianship, custody, divorce Domestic violence Child abuse and neglect Advance directives, estate planning Income/Insurance Insurance access and benefits Food stamps Disability benefits Social Security benefits Housing & Energy Shelter access Access to housing subsidies Sanitary housing conditions Utilities access Foreclosure prevention Education/Employment Americans with Disabilities Act compliance Discrimination Individuals with Disabilities in Education Act compliance Legal Needs That Impact Health (I-HELP Model) Source: National Center for Medical –Legal Partnerships, “Core Components and Activities”, legalpartnership.org/model/core-components, The Advisory Board Company interviews and analysis.

©2015 The Advisory Board Company advisory.com 6 Fee-for-Service World Shared Savings/Risk- Based World Value-Based Fee-for-Service World The Shift from Volume to Value Incentives Moving Toward Population Health Focus Strategic Growth Levers Across Payment Models Profitable ProceduresEngaged Patients Cross-Continuum Care Management Infrastructure Total Cost of Care Reduction Procedural Specialists Payer Price Escalation Multidisciplinary Care Teams Efficiently-Managed Care Episodes Episodic Payment Margin Expansion Source: The Advisory Board Company interviews and analysis.

©2015 The Advisory Board Company advisory.com 7 MLPs Strengthen Value-Based Strategy Partnerships Essential Component of Higher Quality, Lower Cost Care Role of Medical-Legal Partnerships Under Value-Based Care Performance Category Accountable Care Imperatives Role of Medical-Legal Partnership Utilization Expense Management Clinical Outcomes Proactively manage chronic illness to avoid low-margin inpatient utilization Reduce inappropriate or duplicative care delivery Manage total cost of care for a defined patient population Target avoidable spending across health system Minimize preventable admissions, readmissions Promote community wellness for at-risk populations Improves at-risk patient management and ongoing wellness, reducing unnecessary hospitalizations Minimizes overall costs by addressing the social determinants driving downstream spending Supports better population health by targeting the environmental risk factors influencing clinical outcomes Source: The Advisory Board Company interviews and analysis.

©2015 The Advisory Board Company advisory.com 8 Delivering Results for Underserved Patients MLP Approach Resolving Legal Issues Impacting Health $XX # # Recovered back benefits associated with MLP Positive legal outcomes as a result of MLP Patients assisted by MLP Suggested Data Timeframe