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16 th Annual Non-Profit Health Care Investors Conference William P. Santulli Executive Vice President, Chief Operating Officer Lee B. Sacks, M.D. Executive.

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Presentation on theme: "16 th Annual Non-Profit Health Care Investors Conference William P. Santulli Executive Vice President, Chief Operating Officer Lee B. Sacks, M.D. Executive."— Presentation transcript:

1 16 th Annual Non-Profit Health Care Investors Conference William P. Santulli Executive Vice President, Chief Operating Officer Lee B. Sacks, M.D. Executive Vice President, Chief Medical Officer James W. Doheny Vice President Finance, Corporate Controller New York, New York June 11, 2015

2 The following material and presentation contains information which is forward looking within the meaning of federal securities law. These forward-looking statements are based on the current plans and expectations of Advocate Health Care Network (“Advocate”) that, although believed to be reasonable, are subject to a number of known and unknown uncertainties and risks inherent in the operation of health care facilities, many of which are beyond Advocate’s control, that could significantly affect current plans and expectations and Advocate’s future financial position and results of operations. These forward-looking statements speak only as of the date made. Investors are cautioned not to unduly rely on such forward-looking statements This presentation should be reviewed in conjunction with Advocate’s December 31, 2014 and March 31, 2015 continuing disclosure reports.

3 Overview & Strategy William P. Santulli Executive Vice President, Chief Operating Officer

4 Hospitals (12) 4 teaching 1 children's 1 critical access 5 level 1 trauma centers Physicians 1,350 employed/affiliated 5,175 Advocate Physician Partners 6,400 Medical staff Post-acute Home health, hospice, LTACH & palliative care 33,700 associates $5.2B total revenue 17.8% market share Advocate Health Care

5 $661 M community benefit M community

6 Key Market Dynamics Provider consolidation Dominant health plan Narrow networks emerging Revenue - utilization and price Cost pressures

7 Advocate Well Positioned Top decile safety and health outcomes Strong brand Leading market position Pluralistic approach to physicians Population health leader Financial strength

8

9 Report Card

10 Market Share Leader

11 Strong Revenue Growth 11

12 NorthShore Merger Objectives Population health management New health plan products Opportunities for self-insured employers Broad and complementary geographies Increase competition by dramatically changing the way that managed care products are constructed and sold in the Chicago area.

13 Strong Alignment Values Top decile safety and quality Strong brands Highly integrated Large employed medical groups Strong management and governance Excellent teaching and research Double A ratings

14 Merger Structure Single board and management team Single signature managed care contracting Consolidated financial statements and system-wide capital allocation One obligated group planned

15 Advocate Medical Staff ~ 6,400 Advocate Physician Partners ~ 5,175 Aligned ~ 3,825 Employed /Affiliated ~ 1,350 Pluralistic Physician Platform

16 Employed Clinicians Double

17 Population Health Management Lee B. Sacks, M.D. Executive Vice President, Chief Medical Officer

18 Advocate’s Evolution To PHM 1980s – Capitation 1995 – APP formed 2003 – Clinical integration 2010 – ACO contract 2013/14 – Largest ACO

19 Strong Physician Engagement Advocate Medical Group BroMenn PHO Christ PHO Condell PHO Dreyer Medical Group Good Samaritan PHO Illinois Masonic PHO Lutheran General PHO Good Shepherd PHO To drive improvement in health outcomes, care coordination and value creation through an innovative and collaborative partnership with our physicians and the Advocate System. Sherman PHO Silver Cross PHO South Suburban PHO Trinity PHO Future Medical Group Future PHO

20 Changing Business Model Providers generate revenue by: Maximizing rates Maximizing volumes Taking financial risk for managing the health of a population, lowering costs and serve a greater number of unique patients

21 Advancing Commercial Approach Extension of Blue Cross shared savings and global capitation contracts Shared Savings ACO contracts  United  CIGNA  Others

22 Medicare Advantage Opportunity Chicago area Medicare population is over one million and growing 3% per year Low Medicare Advantage penetration

23 Medicaid Managed Care Illinois requires 50%+ of Medicaid population be enrolled in:  Accountable Care Entities (ACE)  Medicaid HMOs  Cook County Demonstration Medicaid ACE is fee for service with a care management fee until Jan. 1, 2016

24 Revenue Shifting to Value 24 Part B Capitation HMO Global Capitation HMO Fee-for-Service (FFS) FFS Population Management Bundled Payment

25 Value Based Agreements ContractLivesTotal Spend Commercial412,000$1.5 B Medicare Advantage 32,000$0.3 B Advocate Employee23,000$0.1 B Medicare ACO142,000$1.7 B Medicaid ACE100,000$0.2 B Total709,000$3.8 B

26 AdvocateCare ® Across the Continuum Acute Care ED Care Coordination Inpatient Care Coordination Outpatient Post Acute ED Hospital Patient-Centered Home Care Outpatient Care Managers Behavioral Health Medication Therapy Management ED Care Coordination Organization Alternative Site of Care Transitions Readmission Risk Assessment & Focused Interventions Inpatient Care Coordination Redesign Acute to Post Acute Transitions Hospital to Home Transition Coach Program SNF Post Acute Network Care Palliative Care Data & Analytics Risk Stratification/Predictive Modeling Disease Registries Utilization Management EMR/Meaningful Use Regional HIE Care Coordination

27 Tactics for Success Focus on the entire population not just the 5% poly-chronic to move the mean Retail & pricing transparency Adjust skill mix of the care team Benefit plan design is essential Behavioral health integration Leveraging “Big Data”

28 $2,000 decrease in SNF cost/case Medicare Shared Savings Program costs below target Commercial PPO/ACO  Cost trend negative  Total cost below market median Commercial HMO costs are below market Value Based Results

29 Shared savings is a transition model Well positioned for Medicaid managed care Medicare Advantage is an opportunity High Performance Network products for public/private exchanges Going Forward…

30 Financial Performance James W. Doheny Vice President Finance, Corporate Controller

31 Focus on Margin Management Intense focus on revenue and cost management as we pivot to PHM Revenue Revenue Cycle Standardization / Consolidation Clinical Documentation Improvement Coding Training and Education Cost Labor Cost and Productivity Clinical Effectiveness Supply Chain and Purchased Services

32 Strong Operating Performance 24 //

33 Consistently Solid Cash Flow 25 //

34 Diversified Investment Portfolio 27 Note: Both investment income and yield are net of fees. Expected return of 7.2%. Risk/return ratio at 0.76. //

35 Debt Profile = Low, Level and Long* Tax-exempt debt is $1.5 billion, average annual debt service is generally level through 2038 at $90 million and average life is 19 years. * Debt profile as of March 31, 2015

36 Well Diversified Debt Portfolio* Underlying Mix Product Mix Liquidity Mix * Debt portfolio as of March 31, 2015

37 Strong Coverage and Capitalization 31 //

38 Strong Cash to Debt Ratio 32 //

39 Well Funded Pension Plans 33 //

40 Substantial Liquidity Position 34 //

41 Large Capital Commitments Past 3 Years 35 //

42 Summary National leader in:  Safety and health outcomes  Population Health Management Market share leader and brand strength Growth through selective acquisitions Pluralistic approach to physicians Balance sheet strength and solid operating performance Double A bond ratings with stable (M/F) and positive (S&P) outlooks 42

43 Disclosure Audited financial statements, quarterly reports along with management’s discussion and analysis and the annual continuing disclosure report are available on the Advocate, Digital Assurance Certification, LLC and Municipal Securities Rulemaking Board websites. To view online visit: www.advocatehealth.com/body_full.cfm?id=2839 www.dacbond.com www.emma.msrb.org 31

44 Thank you!

45 Financial Trends Operating and Net Income (dollars in thousands) Note: Financial results for the three months ended March 31, 2015 are not necessarily indicative of the results that may be experienced during the year ending December 31, 2015.

46 Operating Cash Flow Margin (dollars in thousands) Note: Financial results for the three months ended March 31, 2015 are not necessarily indicative of the results that may be experienced during the year ending December 31, 2015. Financial Trends -- continued

47 Note: Financial results for the three months ended March 31, 2015 are not necessarily indicative of the results that may be experienced during the year ending December 31, 2015. EBITDA (dollars in thousands) Financial Trends -- continued

48 Investment Yield (dollars in thousands) Note 1: The 2015 first quarter YTD investment yield is not annualized. Note 2: Financial results for the three months ended March 31, 2015 are not necessarily indicative of the results that may be experienced during the year ending December 31, 2015. Financial Trends -- continued

49 (1)Calculation of days cash and investments on hand excludes the effect of the Medicaid Assessment program (2)Rolling twelve-month period ended March 31, 2015 (3)Excludes unrealized gains (losses) as defined under the Master Trust Indenture Financial Ratios Note: Financial results for the three months ended March 31, 2015 are not necessarily indicative of the results that may be experienced during the year ending December 31, 2015. Financial Trends -- continued

50 Advocate NorthShore Financial Profile Advocate* NorthShore** Rating (M/S&P/F)Aa2/AA/AAAa2/AA/NR Net Revenue$5 B$2 B Operating Margin6.3%6.8% Operating Cash Flow Margin 12.0%13.2% Net Margin7.8%9.4% Total Assets$10 B$3 B Days Cash on Hand383362 Cash to Debt294%454% Debt to Capitalization23.3%15.3% As of and for the year ended Dec. 31, 2014 * and Sept. 30, 2014**


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