1. Over past 25 years, only State with worsening Age-adjusted Death Rates Death Rate US Tulsa and Oklahoma Oklahoma: Last in the US in health system performance. Only state with worsening death rate. Last in US in physicians per capita. Tulsa - 14 year difference in life expectancy. Upper quarter of health care spending. Innovative health system and insurance expansions. OU School of Community Medicine: Nations first School of Community Medicine Serves as the regions platform for change Goal – Improve health of entire communities; 1.Recruit for and maintain altruism – MDs, PAs, Nurse Practitioners – using clinical experiences, scholarship and loan payback efforts to motivate. 2.Curriculum – add public health, systems engineering, student run clinical services. 3.Expansive network of innovative primary care, specialty care programs out in neighborhoods most in need - e.g. 19 school based clinics. 4.Patient Centered Medical Home – for uninsured and Medicaid populations implemented. 5.Partners with OU social work, early childhood education, school systems, urban planners etc. 6.Health Information Technologies – patient to doctor, doctor to doctor: reduced need for face to face visits by 52%. Consortia in place for Health Information Exchange and Health Information Coordination. 14 year difference In life expectancy between North and South Tulsa

2. Pharmacy & Health Foods Urgent Care Services Specialty Dx/Rx Services Surgical & Intensive Services Chronic Disease Service Wellness & Fitness Clubs HEALTH CARE SYSTEM Diagnostic Testing & Imaging Advanced Medical Home 2011 EMR & HIE Web-based Communication Portals Decision Support EMR & HIE Web-based Communication Portals Decision Support Team Based - Primary Care Health Information Integration / Coordination Team Based - Primary Care Health Information Integration / Coordination

3. Getting Organized - Tulsa Health (black = established, blue = in development or proposed) Acute – Walk In Care: OU Bedlam Evening Clinics OU Bedlam Evening Pharmacy OU Bedlam Evening Clinics Case Management and Referral Programs Good Samaritan Clinics Safety Net Clinics Emergency Rooms: Saint Francis Hospital St. John Medical Center Hillcrest Medical Center OSU Medical Center ER Diversion Programs: OU Tisdale Health Center Urgent Care Clinic OU ER Diversion and Follow Up Clinic OSU / St. John Program Prevention Initiatives Front Doors to Care 211 Line Baby Line OU Nursing Prenatal Care Harvard Project - Cycle of Poverty PENN Project – Anchor Community Schools I N S U R E O K L A H O M A -- M E D I C A I D Primary Care Clinics and Medical Homes OU Bedlam Longitudinal Clinic – PCMH Model 6 sessions / week OU School-based Clinic = 19 sites – PCMH Model OU Housing Authority Clinics = 2 – PCMH Model OU Micro-clinics – Day Center for the Homeless – 5 days per week Neighbor for Neighbor, Neighbors Along the Line, OU Physicians Clinics – Hillcrest – PCMH Schusterman Center - PCMH OSU Physicians Clinics – SW Boulevard, Houston Park OSU Physicians – Country Club Gardens Morton Clinics – FQHC – Lansing Park, East Tulsa Community Health Connections – FQHC - East Tulsa, 3 rd and Lewis. Patient Centered Medical Home Patient Portal with IBM Greater Tulsa Health Access Network – Greater THAN – Health Information Exchange and Care Coordination Specialty Care MAP / Voucher Specialty Care Network Northland Imaging Center OU Physicians Clinics at St. John, Saint Francis and Hillcrest Medical Centers, OU Schusterman Center Clinics OSU Physicians Clinics at OSU MC, Houston Park, SW Boulevard OU OB Outreach – e.g. Margaret Hudson. Porter, Community Health Connections OU Xavier Breast Health Clinic OU Bedlam Specialty Clinics – Derm, HIV, Gynecology, Hep C Heart Intervention Project OU Diabetes Center OU Cancer Institute OU Tisdale Specialty Health Center Doc 2 Doc e-consultations between primary care and specialists Intensive Outpatient Programs PACT Teams – Severe mental illness COPES Team – Emergency Psychiatry ER Frequent Flyer Team – Multiple medical illnesses Pharmacy Services Tulsa County Pharmacy OU STEP Pharmacy OU Bedlam Pharmacist Program and 5 community pharmacies Clancy 8 / 2009

4. Our Organizations Enthusiasm Levels: A Project Lifecycle Sept 08 Mar 09 Planning Announcement Implementation Culture Crisis Successful Progress/Projects ENERGY / SUPPORT TIMELINE