1. Alamance Regional Medical Center Albemarle Health Alleghany Memorial Hospital Angel Medical Center Annie Penn Hospital Anson Community Hospital Ashe Memorial Hospital, Inc. Betsy Johnson Regional Hospital Blowing Rock Hospital Blue Ridge Regional Hospital Broughton Hospital Brunswick Community Hospital Caldwell Memorial Hospital, Inc. Cape Fear Valley - Bladen County Hospital Cape Fear Valley Health System CarePartners Rehabilitation Hospital CarolinaEast Health System Carolinas Medical Center Carolinas Medical Center - Lincoln Carolinas Medical Center - Mercy Carolinas Medical Center - Northeast Carolinas Medical Center - Pineville Carolinas Medical Center - Union Carolinas Medical Center - University Carolinas Rehabilitation Carteret County General Hospital CaroMont Health, Inc. Catawba Valley Medical Center Central Carolina Hospital Central Regional Hospital Charles A Cannon, Jr. Memorial Hospital Chatham Hospital Cherokee Indian Hospital Cherry Hospital Cleveland Regional Medical Center Coastal Plain Hospital Columbus Regional Healthcare System Cone Health Behavioral Health Davie County Hospital Davis Regional Medical Center Department of Veterans Affairs Medical Center Asheville Department of Veterans Affairs Medical Center Durham Duke Raleigh Hospital Duke University Hospital Durham Regional Hospital FirstHealth Montgomery Memorial Hospital FirstHealth Moore Regional Hospital FirstHealth Richmond Memorial Hospital Forsyth Medical Center Franklin Regional Medical Center Frye Regional Medical Center Grace Hospital Granville Health System Halifax Regional Medical Center High Point Regional Health System Highland-Cashiers Hospital Highsmith-Rainey Specialty Hospital Holly Hill Hospital Hugh Chatham Memorial Hospital Iredell Health System J. Arthur Dosher Memorial Hospital Johnston Medical Center - Smithfield Kindred Hospital Kings Mountain Hospital, Inc. Lake Norman Regional Medical Center Lenoir Memorial Hospital, Inc. Lexington Memorial Hospital, Inc. LifeCare Hospitals of North Carolina Margaret R. Pardee Memorial Hospital Maria Parham Medical Center Martin General Hospital The McDowell Hospital Medical Park Hospital MedWest - Harris MedWest - Haywood MedWest - Swain Mission Health System Morehead Memorial Hospital Murphy Medical Center, Inc. Nash Health Care Systems New Hanover Regional Medical Center North Carolina Specialty Hospital Northern Hospital of Surry County Onslow Memorial Hospital Our Community Hospital The Outer Banks Hospital Park Ridge Health Pender Memorial Hospital Person Memorial Hospital Presbyterian Healthcare Presbyterian Hospital Huntersville Presbyterian Hospital Matthews Presbyterian Orthopaedic Hospital Randolph Hospital Rex Healthcare Rowan Regional Medical Center Rutherford Regional Medical Center Sampson Regional Medical Center Sandhills Regional Medical Center Scotland Health Care System Select Specialty Hospital-Durham Select Specialty Hospital-Winston-Salem Southeastern Regional Medical Center St. Luke’s Hospital Stanly Regional Medical Center Stokes-Reynolds Memorial Hospital, Inc. The Moses H. Cone Memorial Hospital Thomasville Medical Center Transylvania Regional Hospital UNC Hospitals Valdese Hospital Vidant Beaufort Hospital Vidant Bertie Hospital Vidant Chowan Hospital Vidant Duplin Hospital Vidant Edgecombe Hospital Wake Forest Baptist Medical Center Vidant Medical Center Vidant Pungo Hospital Vidant Roanoke-Chowan Hospital Wake Forest Baptist Health – Davie Hospital Wake Forest Baptist Health – Lexington Medical Center WakeMed WakeMed Cary Hospital WakeMed Fuquay-Varina WakeMed Zebulon/Wendell SNF and Outpatient Diagnostic Center Washington County Hospital Watauga Medical Center Wayne Memorial Hospital Wesley Long Community Hospital Wilkes Regional Medical Center Wilson Medical Center Women’s Hospital of Greensboro Yadkin Valley Community Hospital North Carolina Hospital Association

2. Threats Weaknesses Opportunities Strengths 2

3. Governor’s budget – Drops outpatient payments to 70% of costs from 80% $80 million minus MRI offset – Increases MRI/GAP retention to $43 million plus 29% Impact estimated at $137 million annually Can’t be recouped through MRI/GAP Medicaid expansion – $4.4 billion / 10 years Certificate of Need – $400 million/year for orthopedics plus ENT procedures 3

4. Tax reform – $250 million/year for sales tax exemption Mental Health – Community services, inpatient beds needed Medicaid HMO – $943 million/year, plus payment cuts, plus administrative hassles 4

5. Sources: American Hospital Association, DataGen. Value-Based Purchasing cannot be projected on a ten-year basis. Period of this table, 2012 - 2021

6. Healthcare Affordability Erosion of Public Trust Federal politics – Partisan Gridlock State politics – Majority of legislators have two years or less of experience 6

7. 72 Freshmen and Sophomores among 120 Representatives

8. 31 Freshmen and Sophomores among 50 Senators

9. Strengthen Community Care of North Carolina Take more ownership in the system Develop a more politically active workforce 9

10. Hospitals’ Missions – Care for everyone, every hour, every day without regard to ability to pay – Provide good jobs that don’t leave the community – Act as an incentive for economic development Quality Improvements Unified Hospital Field 10

11. Helping hospitals’ friends in the legislature 11

12. Mission: Improve delivery of quality, affordable healthcare in North Carolina through leadership, advocacy, information, & education Financial Services Communication & Public Relations Principles: Transparency, Collaboration, Innovation, Evidence-Based, Patient-Centered NC Center for Rural Health Community Health Improvement Collaborative Policy Development Payment Systems Core ServicesTransformation North Carolina Hospital Association Advocacy & Representation Education NC Quality Center NC Center for Affordable Health Care

13. 13

14. 14

15. Mission: Improve delivery of quality, affordable healthcare in North Carolina through leadership, advocacy, information, & education Financial Services Communication & Public Relations Principles: Transparency, Collaboration, Innovation, Evidence-Based, Patient-Centered NC Center for Rural Health Community Health Improvement Collaborative Policy Development Payment Systems Core ServicesTransformation North Carolina Hospital Association Advocacy & Representation Education NC Quality Center NC Center for Affordable Health Care

16. FY 09: 7.7 FY 10: 8.2 FY 11: 4.2 FY 12: 8.7

17. Third quarter 2012 Activity Summary

18. Mission: Improve delivery of quality, affordable healthcare in North Carolina through leadership, advocacy, information, & education Financial Services Communication & Public Relations Principles: Transparency, Collaboration, Innovation, Evidence-Based, Patient-Centered NC Center for Rural Health Community Health Improvement Collaborative Policy Development Payment Systems Core ServicesTransformation North Carolina Hospital Association Advocacy & Representation Education NC Quality Center NC Center for Affordable Health Care

19. WA MA ND MT IA NV MO IL MI KY TN MSALGA SC NC VA WV MD DE NJ NY VT NH ME FL RI CT CA AZ AR CO ID IN KS MN NE NM OH OK OR PA SD TX UT WI WY LA Alaska #28 Hawaii #2 Top 10 11-20 21- 30 31-40 41-50 Source: www.americashealthrankings.org, 2012 33th

20. Children in Poverty39 nd 42 rd Violent Crime27 th 30 rd Prevalence of Obesity34 th 39 th Prevalence of Smoking27 th 36 rd Premature Deaths37 th 37 th Infant Mortality46 th 44 th Lack of Health Insurance34 th 38 st – Since 1990, the U.S. uninsured rate has increased by 46% Source: www.americashealthrankings.org, 2010, U.S. Census Bureau Where NC was 2 years ago

21. Mission: Improve delivery of quality, affordable healthcare in North Carolina through leadership, advocacy, information, & education Financial Services Communication & Public Relations Principles: Transparency, Collaboration, Innovation, Evidence-Based, Patient-Centered NC Center for Rural Health Community Health Improvement Collaborative Policy Development Payment Systems Core ServicesTransformation North Carolina Hospital Association Advocacy & Representation Education NC Quality Center NC Center for Affordable Health Care

22. Decrease avoidable ED utilization Reduce avoidable Medicaid admissions Maximize Medicaid’s Preferred Drug List Improve collaboration with CCNC Enroll all eligible Medicaid patients in CCNC 22

23. 23

24. Alamance Regional Medical Center Albemarle Health Alleghany Memorial Hospital Angel Medical Center Annie Penn Hospital Anson Community Hospital Ashe Memorial Hospital, Inc. Betsy Johnson Regional Hospital Blowing Rock Hospital Blue Ridge Regional Hospital Broughton Hospital Brunswick Community Hospital Caldwell Memorial Hospital, Inc. Cape Fear Valley - Bladen County Hospital Cape Fear Valley Health System CarePartners Rehabilitation Hospital CarolinaEast Health System Carolinas Medical Center Carolinas Medical Center - Lincoln Carolinas Medical Center - Mercy Carolinas Medical Center - Northeast Carolinas Medical Center - Pineville Carolinas Medical Center - Union Carolinas Medical Center - University Carolinas Rehabilitation Carteret County General Hospital CaroMont Health, Inc. Catawba Valley Medical Center Central Carolina Hospital Central Regional Hospital Charles A Cannon, Jr. Memorial Hospital Chatham Hospital Cherokee Indian Hospital Cherry Hospital Cleveland Regional Medical Center Coastal Plain Hospital Columbus Regional Healthcare System Cone Health Behavioral Health Davie County Hospital Davis Regional Medical Center Department of Veterans Affairs Medical Center Asheville Department of Veterans Affairs Medical Center Durham Duke Raleigh Hospital Duke University Hospital Durham Regional Hospital FirstHealth Montgomery Memorial Hospital FirstHealth Moore Regional Hospital FirstHealth Richmond Memorial Hospital Forsyth Medical Center Franklin Regional Medical Center Frye Regional Medical Center Grace Hospital Granville Health System Halifax Regional Medical Center High Point Regional Health System Highland-Cashiers Hospital Highsmith-Rainey Specialty Hospital Holly Hill Hospital Hugh Chatham Memorial Hospital Iredell Health System J. Arthur Dosher Memorial Hospital Johnston Medical Center - Smithfield Kings Mountain Hospital, Inc. Lake Norman Regional Medical Center Lenoir Memorial Hospital, Inc. Lexington Memorial Hospital, Inc. LifeCare Hospitals of North Carolina Margaret R. Pardee Memorial Hospital Maria Parham Medical Center Martin General Hospital The McDowell Hospital Medical Park Hospital MedWest - Harris MedWest - Haywood MedWest - Swain Mission Health System Morehead Memorial Hospital Murphy Medical Center, Inc. Nash Health Care Systems New Hanover Regional Medical Center North Carolina Specialty Hospital Northern Hospital of Surry County Onslow Memorial Hospital Our Community Hospital The Outer Banks Hospital Park Ridge Health Pender Memorial Hospital Person Memorial Hospital Presbyterian Healthcare Presbyterian Hospital Huntersville Presbyterian Hospital Matthews Presbyterian Orthopaedic Hospital Randolph Hospital Rex Healthcare Rowan Regional Medical Center Rutherford Regional Medical Center Sampson Regional Medical Center Sandhills Regional Medical Center Scotland Health Care System Select Specialty Hospital-Durham Select Specialty Hospital- Winston-Salem Southeastern Regional Medical Center St. Luke’s Hospital Stanly Regional Medical Center Stokes-Reynolds Memorial Hospital, Inc. The Moses H. Cone Memorial Hospital Thomasville Medical Center Transylvania Regional Hospital UNC Hospitals Valdese Hospital Vidant Beaufort Hospital Vidant Bertie Hospital Vidant Chowan Hospital Vidant Duplin Hospital Vidant Edgecombe Hospital Wake Forest Baptist Medical Center Vidant Medical Center Vidant Pungo Hospital Vidant Roanoke-Chowan Hospital Wake Forest Baptist Health – Davie Hospital Wake Forest Baptist Health – Lexington Medical Center WakeMed WakeMed Cary Hospital WakeMed Fuquay-Varina WakeMed Zebulon/Wendell SNF and Outpatient Diagnostic Center Washington County Hospital Watauga Medical Center Wayne Memorial Hospital Wesley Long Community Hospital Wilkes Regional Medical Center Wilson Medical Center Women’s Hospital of Greensboro Yadkin Valley Community Hospital Questions?