1. Population Health Overview 2015

2. 2

3. Macro View of Population Health 3 David A. Kindig, MD, PhD

4. 4 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. Tied to the National Quality Strategy

5. 5 Vidant Health System of Care 12,000+ employees 8 hospitals 80 physician practices Outpatient, home health and hospice services Critical care transport Serving 1.4 million people in 29 counties, 1/3 of NC

6. 6 Definitions

7. 7 Definitions continued

8. 80% of patient encounters are in a physician’s office A Shifting Landscape

9. 9 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. Volume driven fee-for-service Across the board FFS cuts Fragmentation of delivery Variance in use/cost/quality Hospital as healthcare hub Immature use of information technology High cost Focus on sickness care Specialty/procedure driven Payer driven Passive consumer Current state of health care in America Intensive care Non-Acute/ specialty care Primary & preventative care TODAY 1766

10. 10 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. Winners and losers Greater accountability/transparency People-centered primary care E-health and other innovations New focus on population health and social determinants Risk-based, value-driven reimbursement (P4P) Cost reductions Quality across the continuum and focus on transitions Smaller hospitals with more intensive care New public and private partnerships Future State Intensive care Non-Acute/ specialty care Primary & preventive care TOMORROW

11. 11 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. Track one: Push Legislative “push/pull” to accountable care Cuts to Medicare FFS System Readmissions penalty HACs penalty Partnership for Patients Value-based purchasing Meaningful use penalties Private payors and Medicaid Bundled payment: 2016? Track two: Pull Disrupt existing system Medicare Shared Savings Program (MSSP) Pioneer State/Federal duals demo Medical home demo; new Innovation Center Primary Care Initiative Reducing readmissions from nursing homes demo Bundled payment demos

12. We are changing the way we do business Cost Restructuring Coordinated Care Fragmented Care Patient Centered Provider Centered Payment for Value Payment for Volume Care Systems Focused Facilities Focused Care Team Accountability Physician Accountability Longitudinal, Multi-Site Care Models Episodic, Hospital-Based Care Models Efficient, Evidence Based Care Inconsistent, Variable Methods Electronic Paper FUTURE TODAY Cost Reduction

13. Clinically Integrated Network: Coastal Plains Network

14. 14 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. Separate legal entity Physician and health system participation Will “make” and/or “buy” functions and services Many strategic and business decisions will need to be made in the next several months before the entity can be legally formed. Purpose – to be the entity that organizes and administers all regional provider population health efforts in eastern North Carolina. Coordination and Timing – building a CIN requires assembling components from finance, IT, independent physicians and health systems. The CIN will NOT be monolithic in it’s approach to the healthcare needs of eastern North Carolina Employers Medicare population Medicaid population Commercial Self insured employers Uninsured A CIN Vehicle to Pursue Population Health Initiatives

15. Clinically Integrated Network and Population Health 15 MSSP (Medicare Shared Savings Program) Our current “ACO” contract with CMS Involves VMG physicians only Over 17,000 fee for service Medicare patients Three year contract Only upside potential Medicaid Provider led ACO Will involve many partners Can be run through CP Network Employee Health Plan CP Network can be the vehicle to provide the Provider network and share quality/cost data Other Population Health Initiatives Bundled payment programs Risk contracting with private insurance A group of providers willing and capable of accepting accountability for the total quality and cost of care for a defined population. Coastal Plains Network (CP): Our Clinically Integrated Network (CIN). VH as the current sole Member (can expand). Allows sharing of data without competitive concerns. Goal to improve the quality and cost for patients. Other members can be added via contract. Many other programs can exist within this CIN

16. 16 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. Benefits of Clinical Integration Source: INTEGRIS Health Partners

17. 17 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. Clinical infrastructure requirements to successfully practice population health management: Comprehensive delivery platform » Integrated Primary Care Base » Strategically aligned and integrated Specialty Care Physicians » Broad geographic presence » Clinical Integration across the network » Hospitals and other facilities Patient Centered Medical Home (PCMH) Team-based care models Comprehensive Care Management Capability » Systems &Technology, Clinical Protocols, Human Resources (including embedded case managers) » IT Platform to facilitate clinical aggregation and integration Quality and Outcome monitoring, reporting and improvement competencies Performance Transparency Provider role and involvement

18. 18 PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC. 1.Identify/communicate/engage beneficiaries 2.Select and implement data analytics platform 3.Establish a public and physician communications plan and office 4.Identify your highest risk population (2-3% of patients that are currently or are predicted to be the highest utilizers) 5.Establish a process to capture and report 33 measures (GPRO) 6.Develop a plan to grow market share by using data analytics to identify leakage and develop action plan 7.Establish robust team based patient centered medical homes (PCMH) across the participating MSSP provider network 8.Establish and implement a care management plan for high risk patients 9.Define and finalize a shared savings distribution methodology 10.Assess post-acute care processes and local market providers Premier’s Top Ten Key Steps Taken by Successful ACOs

19. 19 Caring for a Population 60-80 % population 15-35% population 3-5% population

20. 20 Caring for a Population Top 5% = 47-50% Expenditure Top 5 % rising to High Risk 60-80 % population Trade high cost service for low cost management Navigate and coordinate care Reduce high cost utilization, slow progression to high risk Keep healthy Keep loyal 15-35% population 3-5% population

21. 21 Caring for a Population 60-80 % population Keep healthy and loyal Keep loyal 15-35% population 3-5% population

22. Changes we are making Care Management Annual Wellness Visits Healthy lifestyle goals MyChart engagement Preventive and Community Outreach Preventive services outreach Advance Care Planning Community & Faith Partnerships Wellness Services 22

23. 23 Caring for a Population Top 5 % rising to High Risk 60-80 % population Reduce high cost utilization, slow progression to high risk 15-35% population 3-5% population

24. Changes we are making Access and Patient Centered Medical Home Access to care Real time clinical decision making Chronic disease standards of care ED avoidance; Care plans Coaching/goal setting for life style and risk behaviors Team based care End of Life planning 24

25. 25 Caring for a Population Top 5% = 47-50% Expenditure Top 5 % rising to High Risk 60-80 % population Trade high cost service for low cost management Navigate and coordinate care 15-35% population 3-5% population

26. Changes we are making Transitional care and Care coordination Transitions of care protocols Remote home monitoring Telephonic case management Post acute visit with PCP < 7 days End of life conversations early and often Collaboration with SNFs 26

27. Outcomes 27 Over 6300 enrolled in TOC program (Oct to May) N=613/month enrolled in Remote Home Monitoring N=636/month enrolled in Home Health & Hospice

28. 2016 Work Plan Highlights Access and PCMH Map core services by practice type Ambulatory evidence based protocols and order sets for most common encounter types Shared decision making protocols Continue roll out of PCMH principles in Primary Care practices Optimize EHR work flows Care Coordination Implement ambulatory risk tool concept in EDs Assure complete and accurate flow of info between CC staff and Providers Plan to leverage SNF based medical directors Hardwire handover across all systems of care Explore utilization of paramedics for CC Care Management Complete phase 1 patient engagement training for providers and staff, begin phase 2 – health literacy, behavior mod, coaching for activation Use technology to provide individual health management information, tracking tools and integration with available locations – My Chart and Mobile app Explore virtual care options Preventive and Community Outreach Implement plans for faith-health partnerships Integrate community resources, services, programs into care delivery model Expand programs that bring care closer to where people live, learn, earn, pray and play Establish formal training and certification program for lay health advocates Address barriers to health – transportation & health literacy – thru partnerships w/community agencies 28

29. Measures of Population Health 29

30. Key Steps 30

31. We are changing the way we care for people Cost Restructuring Coordinated Care Fragmented Care Patient Centered Provider Centered Payment for Value Payment for Volume Care Systems Focused Facilities Focused Care Team Accountability Physician Accountability Longitudinal, Multi-Site Care Models Episodic, Hospital-Based Care Models Efficient, Evidence Based Care Inconsistent, Variable Methods Electronic Paper THE FUTURE IS NOW TODAY Cost Reduction

32. Questions?Thank you!

33. Population Health Overview 2015