1. Ascension Health NCCCP Pilot Sites Overview

2. 2 Ascension Health’s Mission, Vision and Values Our Mission... Directs us to serve all persons, particularly those poor and vulnerable, toward improving the health of individuals and communities. Our Vision... Propels us to contribute to the building of a strong, vibrant Catholic health ministry in the U.S. Our Values... We are called to: Service of the Poor, Reverence, Integrity, Wisdom, Creativity and Dedication.

3. 3 Fiscal Year 2006 Systemwide Statistics Discharges660,341 Inpatient Malignant Neoplasm Cases 82,805 Available beds 16,788 Number of births 74,942 Total surgical visits 531,938 Emergency visits2,073,619 Physician office visits3,530,176 Total outpatient visits 14,884,007 Employees 105,000

4. 4 Lourdes Health Network Pasco, WA Carondolet Health Network Tucson, AZ NCCCP Pilot Sites St.Vincent Indianapolis Hospital Indianapolis, Ind. (Lead Clinical) Brackenridge Hospital Austin, Texas (Lead Access) Columbia St. Mary’s Milwaukee, Wis.

5. 5 NCCCP Pilot Sites Early Stage Comprehensive Cancer Care Later Stage Comprehensive Cancer Care Later Stage Access Model Early Stage Access Model Brackenridge Hospital Austin, TX Columbia St. Mary’s Milwaukee, WI St.Vincent Hospital Indianapolis, IN

6. 6 Importance of NCCCP Project The best care available to all Making sure that our understanding of the value of new treatments is determined from their evaluation in all

7. 7 Importance of NCCCP Project “Consistent with our Mission, this initiative will allow Ascension Health to open the doors to thousands of cancer patients – including many who are poor and vulnerable – who otherwise would not have access to the excellent clinical care and cancer trials they need and deserve. This work supports our Strategic Direction in which we promise Healthcare That Works, Healthcare That Is Safe, and Healthcare That Leaves No One Behind, for Life.” – Anthony R. Tersigni, EdD, FACHE President and Chief Executive Officer Ascension Health

8. 8 Challenges and Opportunities Clinical Offers the highest quality cancer care – including clinical trials and end-of- life care – to those who need it Clinical trials must include all patients Disparities Breaks down barriers to care for thousands of cancer patients – including many who are poor and vulnerable – who otherwise would not have access to the care they need and deserve

9. 9 Ascension Health’s Call to Action Healthcare That Works Consistent, exceptional Ascension Health Experience and strive to achieve absolute satisfaction by 2020 Healthcare That Is Safe Zero preventable injuries and deaths by 2008 “A clinically obligated group” Healthcare That Leaves No One Behind 100% Access in every community by 2020

10. 10 Spreading Clinical Practices Across Ascension Health The Strategy – 8 priorities for action directly address outcomes 5 challenges in how we work together change the environment to make rapid and sustained change possible 369 days from July 08

11. 11 2,027 Ascension Health System Mortalities Avoided from Baseline

12. 12 Systemwide Spread -- Perinatal Safety

13. 13 Ascension Health Birth Trauma Rate

14. 14 National Rate is 6.5 birth traumas per 1000 live births. System Average is 1.7 birth traumas per 1000 live births. Comparison to National Rate: We are 74% lower than the national rate (favorable).

15. Neonatal Mortality is a death during the first 28 days prior to discharge in a live born inborn infant ≥ 24 weeks of gestational age without lethal malformation or abnormality. National Rate is 4.7 neonatal mortalities per 1000 live births. Goal is 0 (zero) neonatal mortalities per 1000 live births. System Average is 1.53 neonatal mortalities per 1000 live births. Comparison to National Rate: We are 67% lower than the national rate (favorable). Interpreting the Graph: Data points (dots or ministry lines) that are below the System average line indicate a neonatal mortality rate that is lower than the System average. 4.7 National Average

16. National Rate is 18.1 to 21.2 facility acquired pressure ulcers per 1000 inpatient days. System Average is 1.4 facility acquired pressure ulcers per 1000 inpatient days. Comparison to National Rate: We are 92% lower than the national rate (favorable). average.

17. 17 Ascension Health System Performance 2006

18. 18 2020 Goal of Healthcare That Leaves No One Behind = 100% Access What, and For Whom, is 100 Percent Access? 100% access means that all persons, particularly those persons who are uninsured or underinsured, receive healthcare services that: 1. Create, and support the best journey to improved health outcomes for each individual, and 2. Are funded in an adequate and sustainable fashion.

19. 19 Principles 1.We are committed to access for all. 2.Healthcare is a right required for human dignity. 3.We reject a “two-tiered” health system that separates those who can pay for services from those who cannot pay for services. 4.A comprehensive solution to finance the care of the uninsured and underinsured is the shared responsibility of public and private partners at the local, state and national levels. 5.Healthcare systems must redesign care to achieve safe, accessible care for the uninsured. 6.To achieve access to healthcare for all, a new model of access leadership involving inclusive, “ego-less” collaboration is required. Discussion Draft from Ascension Health Board of Trustees – March 14, 2007

20. 20  Setting/Defining a Broad 2020 Goal of 100% Access: Defined as Linking Improved Health Outcomes and Achieving Sustainable Funding  Showcasing Health Ministry Leadership by Initiating Pilot Access Models: Sites Catalyzed by the Federal Grant Funding from the Healthier Communities Access Program (HCAP)  Learning Together by Crafting the 5- Step Access Model: Synthesis of Learnings from Pilot Access Model Sites  Measuring Success Through Outcome Measures: Tracking Results of Access Models  Rewarding Health Ministries for Access Work: One Year System Incentive Rating Leadership Participation in Access Models’ Collaborative Work  Initiating Implementation Planning Through the Access Leadership Program: Translating the 5-Step Access Model to 18-Month Health Ministry Access Plans  Broadening the Impact of Health Ministry Leadership Through Influencing Community-Wide Systems’ Change Versus Episodic Hospital- Based Programs  Expanding Funding Sources: Seeking National Collaborative Partners and Local Partners to Match System Endowment Grants  Investing Local Resources to Access Work: Access Leadership Plans Integrated into ISFPs* and Health Ministry Organizational Structures  Engaging All Health Ministries in Access Work: Setting an At-Risk Compensation Plan for 28 Health Ministries to Complete Access Leadership Plans  Effective Systems / Models of Care for the Uninsured/Underinsured: Redesigning the Care Journey to Improved Health Outcomes  Outcome Measures: Measuring Improved Health Outcomes as Success  Sustainable Funding: Achieving Solutions for 100% Access  Incentives: Tied to Improving Health Outcomes for Uninsured/Underinsured and Achieving Sustainable Funding  New Model of Leadership Achieved: Integrating 100% Access Work into Health Ministry Operations Access Models: From Strategy to Operations Where We Have BeenWhere We Are TodayWhere We Want to Be *Integrated Strategic and Financial Plans Revised 10/25/06

21. 21 2007 Access Model Collaboratives Lourdes Health Network Pasco, WA Carondolet Health Network Tucson, AZ *Daughters of Charity Services San Antonio, TX *Seton Family of Hospitals Austin, TX Daughters of Charity Services New Orleans, LA *Our Lady of Lourdes Memorial Hospital Binghamton, NY *St. Vincent Health Indianapolis, IN Saint Thomas Health Services Nashville, TN *St. Vincent’s HealthCare Jacksonville, FL *Lourdes Health Network Pasco, WA *Carondelet Health Network Tucson, AZ Borgess Health Kalamazoo, MI *Daughters of Charity Services of Arkansas Dumas, AR Saint Mary’s of Michigan Saginaw, MI *St. Joseph Health System Tawas City, MI Genesys Health System Flint, MI *St. John Health Detroit, MI *Sacred Heart Health System Pensacola, FL *Seton Health Troy, NY *St. Vincent’s Health Svcs. Bridgeport, CT Good Samaritan Reg. Med. Ctr. Pottsville, PA *Carondelet Health Kansas City, MO *Columbia St. Mary’s Milwaukee, WI * Access Leadership Planning Program Participant

22. 22 Michael’s 3-month Healthcare Journey --- Without Insurance 2/20/04Acute Upper Respiratory InfectionBrackenridge Hospital ER (Ascension Health) 2/20/04BronchitisSt. David ER 3/9/04BackacheSt. David ER 3/11/04Lumbago, HypertensionSt. David ER 3/11/04Skin DisturbanceBrackenridge Hospital ER (Ascension Health) 4/1/04LumbagoSeton McCarthy (Ascension Health) 4/13/04NeuritisAustin Travis County FQHC 5/12/04Joint PainAustin Travis County FQHC 5/13/04LumbagoBrackenridge Hospital Outpatient (Ascension)

23. 23 SYSTEMIC CHANGE = 100% ACCESS Ascension Health’s 5-Step Model to 100% Access © Ascension Health 5.Sustainable Funding is Achieved for Care (State/local government; business; community partnerships) 4.Private Physicians Volunteer as Medical Homes/Specialists for the Uninsured and Underinsured 3.Care Models Achieve Improved Health Outcomes 2.Community Service Gaps Filled (Dental/Pharmaceutical/Mental Health) 1.Develop Community-wide Formal Infrastructure Leadership Coalitions Shared Information Systems Catalyst Funding

24. 24 National Access Outcome Measures Initiative (NAOMI)* * Work is underway to complete health outcome measures related to asthma and hypertension. *Approved by Board Executive Compensation Committee December 8, 2006

25. 25 Cumulative Number of Adult Medicaid Enrollees, April 2005 – December 2006 Through December 2006, 8,011 (33%) obtained coverage.