Building Regional Systems of Care in the North Olympic Peninsula

1. Building Regional Systems of Care in the North Olympic Peninsula June 28, 2011 Presented By: Eric Lewis, CEO Olympic Mike Glenn, CEO Jefferson Camille Scott, CEO Forks Marcel Loh, CAO Swedish

2. About Olympic Medical Center • Sole Community Hospital / Rural Referral Center (PPS Reimbursement) • $130 Million Net Revenue in 2010 • 80-bed hospital • Olympic Medical Physicians – multispecialty group with 50+ providers • Home health agency • Payor Mix • 73% Medicare & Medicaid / 5% uninsured / 22% commercial

3. History of North Olympic Peninsula Healthcare Collaborative • CEO Monthly/Quarterly Meetings (Camille Scott, Vic Dirksen and Myself) - Discussing Ways to Work Together • OMC’s Experience • Seattle Cancer Care Alliance • Radia and Northwest Pathology • Vic Dirksen • Rural strategic plan • Camille Scott • Prior experience

4. Common Challenges • Game Changers • The Great Recession • Government Reimbursement • Businesses and Individuals • Health Care Reform • EMR Requirements • Work Force Shortages

5. Process to Select a Tertiary Medical Center Affiliation Boards Met in Chelan – June 2010 Request for Information Sent – Sept. 2010 Proposals Received – October 2010 Three Finalists Selected – November 2010 Site Visits – January / February 2011 Swedish Medical Center Selected as Finalist – March 2011

6. Request for Information • Finding a Partner not a Vendor • 15 Questions • Clinical Services • Electronic Medical Records • Health Care Reform • Strategic Vision • Involvement of Board members, medical staff leaders, and senior leadership

7. Selection Criteria More Local Services Improve Quality, Safety, Efficiency, and Coordination of Local Delivery System EMR Option Support Services (Buying Group) Mission and Culture Fit ACO Capable Collaboration, Long-term Possibilities and References

8. What is the Proposed Affiliation Not an asset deal or an merger Goal is to remain a locally owned and controlled hospital A long-term (20 years) contractual relationship based on mutual benefits System with a small “s” Independence vs. Integration

9. About Jefferson Healthcare • Critical Access Hospital • $65 Million Net Revenue in 2010 • 25-bed hospital including level-four emergency department, comprehensive surgical services, labor and delivery and intensive care • Primary and specialty physician clinics • Outpatient diagnostic imaging, lab, physical therapy and other services • Home health and hospice services

10. Benefits of Affiliation • Scale and access to a broad health services network • Framework for regional affiliation(s) • Platform for North Olympic Hospitals to participate in population health management in a meaningful and responsive way, • Tertiary care referral base for our patients. • Enterprise wide, fully integrated EMR • Buying Group and other support services

11. Affiliation Agreement • Four Primary Components: • EMR/Epic • Increasing availability and improving local care • Coordinating access to Swedish tertiary/quaternary services • Other administrative services

12. EMR/Epic • Affiliation with Swedish provides pathway to Epic • Epic currently used/being implemented by Swedish Medical Center (First Hill, Cherry Hill, Ballard, Edmonds, Issaquah), MultiCare (Tacoma General, Mary Bridge, Good Samaritan, Allemore), Providence Everett Medical Center, Providence St. Peter Hospital, UW Medicine O/P Clinics, Valley Medical Center, Group Health

13. Why Swedish Medical Center • Clinical Services • Epic / Integration Advantages • Strong Willingness to Form Affiliation • Historical Relationships • Opportunities to Improve Local Delivery System • ACO Capabilities • Location

14. Forks Community Hospital • So… What’s In It For Us? • Survival • Sustainability/Support • Safety in Numbers

15. Swedish Health ServicesA vision for Swedish Health Network________________________________

16. Mission and Vision Our Mission Improve the health and well-being of each person we serve Our Vision Demonstrate the highest-quality, best-value health care to all we serve

17. Swedish Today Puget Sound’s largest nonprofit health system • 5 hospital system (4 existing, 1 under construction) • 3 ambulatory centers • Home care division • Medical group (14 primary care clinics, 40-plus specialty clinics) 17

18. Nonprofit, Non-Taxpayer Supported • Swedish provides more than $110 million per year in community benefit activities, including: • Charity care • Medicaid subsidies • Research, medical education, health screenings and other health activities • Expanding the health-care safety net: • Specialty Care Clinic • Medical Home • Dental Residency Program • Global Health Initiative

19. Swedish at a Glance • The Swedish Profile • 9,400 employees • 2,750 physicians • 1,462 licensed beds • Annual Statistics • 51,500 admissions • 35,000 surgeries • 8,500 babies born • 151,000 emergency visits Awards NRC Consumer Choice (12 years in a row) 2010 Leapfrog Top Hospitals 2010 & 2009 Press Ganey Summit Award 2008 U.S. News – Stroke 2007 U.S. News – Endocrinology 2007 Health Grades 2005 Codman Award – Stroke Care 2005 Washington State Quality Award

20. Quality and Safety Improvement • Leading performance on • Inpatient mortality • Ventilator-assisted pneumonia • AMI time to treatment • Improved Patient Safety • Program goals • Lowest infection ratesLowest mortality ratesHighest performance on evidence-based medicine 20

21. Developing a Culture of Safety Adopt best practices in human error and event prevention Change behaviors Long-term commitment 21

22. Swedish Health Network • Swedish Health Network will establish collaborative relationships with community hospitals by: • Maintainingclinical best practices • Assuring appropriate services are available to patients close to home • Providing optimal access to leading edge technologies

23. The Swedish Story A Vision of Excellence • 1910 • Dr. Nils Johanson sees the need for a first-class, nonprofit hospital. He convinces 10 fellow Swedish immigrants to buy $1,000 bonds. Swedish begins as a 24-bed hospital.

24. Establishing Common Goals and Objectives Key outcomes that represent the common goals of affiliation strategies: • Providing an increased level and availability of community (acute care) hospital services to residents in outlying communities. • Establishing patient and provider access to a standardized electronic medical record (EPIC), resulting in continuity of care and increased quality outcomes. • Providing opportunities that foster the retention and recruitment of a quality medical staff. • Establishing a strong, closely linked network of primary care and specialty physicians. • Maximizing the opportunities for improved quality for the organization.

25. Health Network will define institutional synergies Strategic synchronized fit: • Similar patient centric missions • Organizations that are community-based, locally controlled • Clinical services complement one another • Shared positive support • Commitment to reform and transformation • A pledge to continuity of care delivery

26. Technology That Supports Quality Locally • Epic Clinical Information System • Fully implemented at all facilities • Implementation in process at Issaquah and Swedish Edmonds • Provides continuity of care • Telestroke • Allows community hospitals to treat stroke patients • Provides remote consults with neuro specialists • Established at Swedish in 2006 • eICU • Remote intensivist coverage • Results in lower mortality & LOS • Swedish was first to introduce it to NW region in 2004 26

27. Potential Affiliation Opportunities • Access to technology and support • EPIC • Back-office applications (PeopleSoft) • Telehealth • Group Purchasing • Co-branding opportunities • Increased patient access and services • Enhance opportunities for physicians • Professional education and training for support staff • Physician recruitment • Business development strategies • Ad hoc specialty consultation engagements • Quarterly action planning sessions with affiliates • Annual affiliate symposiums with Swedish Health Network leadership

28. Outcomes and Expectations • Community access to enhanced acute care and tertiary services • Investment in the local community consistent with the Swedish mission • Position Swedish Health Network partners in a regional health system, that enhances the quality, scope and value of health care in the region

29. Questions?