Leader Broadcast 1Q15 Performance Update Population Health

1. Leader Broadcast1Q15 Performance UpdatePopulation Health Please silence phones and pagers May 26, 2015

2. Welcome Dan Evans President and CEO

3. Active First Quarter • New adult academic health center location announced • IU Health Bloomington Hospital to create regional academic health center with IU • IU Health North hosted its Magnet designation site visit • Influenced the reform of the Religious Freedom Restoration Act (RFRA) • Published the 2014 Mission and Values Integration Annual Report (iuhealth.org/about-iu-health)

4. ISDH Annual Licensure Survey • Congratulations to team members at AHC facilities! • Final report cited eight deficiencies which can be remedied • Thank you Survey Team for managing a success ISDH visit

5. Agenda • 1Q15 Performance & Strategic Choices Update • Dennis Murphy, Executive Vice President and COO • Population Health • Chester Ho, MD, Regional Chief Medical Officer and Pediatrician • Q&A Session • TEXT 317-771-3170

6. Performance Update Dennis Murphy Executive Vice President and COO

7. People Pillar: Turnover April 2015 *YTD April 2015

8. People Pillar: Focus Team Engagement Survey Engagement surveys are closed. Thank you for participating! • Participation Rates: • Press Ganey will visit the last two weeks of July to provide survey results • Leaders will … • Be provided with materials to help them understand their results • Be expected to share results with team members/providers • Receive support material to help them develop meaningful action plans • Be expected to THANK team members/providers for their participation

9. Access Results Primary Care Campaign Why grow Primary Care? • Improve access • Meet patients’ needs • Build referral base for specialty care • Support population health • Strengthen 3rd party payer negotiations

10. Service: 2015 Primary Care Performance • 20,710 new primary care patients have been served YTD (through April). • Year-over-year growth is 27.5% YTD which is 124.3% to goal.

11. Safety, Quality & Population Health Scorecard: March 2015

12. Quality: Notable Improvements • University Hospital: Ranked 8/123 hospitals in UHC for Q4 2014 • Focus on PSI-15 (accidental puncture/laceration) & preoperative surgical wellness • Ball Memorial: Hand Hygiene Process • Bloomington Hospital: CLABSI & CAUTI Rates decreased significantly after RIEs • Riley: Serious Safety Events decreased • 27 (2013) 7 (2014) 2 (YTD 2015)

13. Research Pillar: 2015 Goal & Focus • Goal • IU Health will enroll at least 6,786 patients in IRB-approved translational & clinical trial protocols system-wide • Status • As of April 30, IU Health has enrolled 1,939 patients in protocols meeting the criteria (5,817 annualized) • Focus • IU Health & CTSI’s Clinical Trials Office are working with clinical researchers to ensure the appropriate infrastructures are in place

14. Education Pillar: 2015 Goal & Focus • Education • Partnering with IUSM, IU Health will increase the number of clinician-educators system-wide by 47(to a total of 874) • Status • As of March 30, there have been 544 clinician educators participate in medical student education with IUSM • Focus • IU Health, in conjunction with IUSM, is identifying & recruiting additional clinician educators system-wide

15. Financials: Cumulative Operating Income

16. Financials: Areas of Focus • Operating income has been favorable at least in part due to higher than budgeted volumes • Monthly operating income targets get more challenging • All entities should be developing actionable improvement plans, & then executing these plans • Look for non-labor improvements (LOS, Lab, Radiology) • Reductions in practice variation • Appropriate supply use • Increased utilization of existing assets • Hours of operation • Throughput

17. Areas of Focus • Continued improvements are necessary in order to fund the entire strategy • Facilities, Strategic Scope, & Core Capabilities • Continue use of Lean tools to identify opportunities to eliminate waste & engage the workforce • Our performance of patient satisfaction & quality are critical for short term & long term business success

18. Strategy Choices Update

19. Aligning All Facets of Operations

20. Strategic Choices: Highlights • IU Health Plans: Growth is 10% ahead of target YTD • Destination Services: Process for investing in growth & development of destination clinical services is active; reviewing multiple proposals • Analytics / Information Management: • All System hospitals on common platform by the end of 2015 • Continued development of Electronic Data Warehouse (EDW) • Partnership to develop cost accounting tools Mission/Vision/Values Value Proposition Scope Capabilities Organization Architecture Strategic Priorities/Objectives

21. Talent Recruitment & Development • New performance management system nearing launch phase • Will replace a number of existing HR & performance management systems (e.g. LEM, Contribution Management) • Software will streamline: • Implementation of goals • Succession development • Performance management • Compensation programs • IU Health Leadership Institute has launched • Aimed at several levels of system leaders: executive, senior & foundational • Focus on leadership skills, change management, people management Mission/Vision/Values Value Proposition Capabilities Scope Organization Architecture Strategic Priorities/Objectives

22. Chester Ho, MD Regional Chief Medical Officer  Pediatrician

23. Population Health2015 Update Change the health of Indiana by changing the way healthcare is delivered.

24. What is Population Health? ” ” ” ” ” ” A holistic, ongoing patient-centered approach to health through a high performance network – Practice Clinical Leader Population Health is about redesigningcare delivery to achieve better outcomes and lower costs – Hospital Administrator Care is delivered across the continuous setting through a physician led care team – Medical Director An approach from managing one patient at a time to managing a comprehensive panel of patients – Medical Care Advisor Data, analytics and evidence based medicine that drive an improved patient experience – Accountable Care Organization (ACO) I feel more in control of my health – now I feel more confident in working with my doctor – Patient Population Health can be defined in varying ways,

25. Population Health Service LineManaged Populations Current Risk Populations = 150K lives • IU Health Plans 63K lives • Medicare Advantage • Employees, Commercial • Exchange • MDwise 87K lives • Exchange • Medicaid • All future risk or pay for performance contracted lives will be managed in the Population Health Model

26. Population Health Service Line Clinical Operations • “Wherever and whenever provided”: statewide, multi-regional • Standardized processes • Outpatient programs • IUHP Indianapolis and Arnett regions since 2013 • Expanded to Bloomington at the end of 2014 • Expanding to Ball this summer • Hospital Transitions Program active at all IUH Hospitals • Telephonic follow up on patients discharging from any IUH Hospital • Home Visit also for patients in the “Triangle” • Embedded Care Mgrs at Methodist, North, West, Arnett, Bloomington, and Ball Hospitals

27. Model of care supports & works throughthe Patient-Physician relationship IU Health System & Affiliate Physicians Hospitals IU Health Population Health Services Stratification, Clinical Program Management, Care Plan Development, Care Coordination IU Health Plans & Other Risk Payers Productive Interaction Prepared, Proactive Physician Team Engaged, Activated Patient/ Caregiver Optimizes Choices and Care Population Health Goals: Better Health, Lower Costs, Better Patient Experience

28. Population Health Model of Care • Risk stratification of all managed populations • Patient outreach and engagement is key • Medical Care done by the providers, clinics, hospitals, & services • Providers supported by Pop Health Care Team • RN care managers, pharmacists, social workers, & dietitians • Specific clinical programs by condition & risk • High touch, frequent follow up model for patients & providers • Data & Analytics to see if we are meeting our goals • Physician-led & Physician aligned

29. Stratifying the Population Highest Need Moderate Need Short-term Need Stratification Lens Risk Stratification Lens Who should we target for care management?

30. Stratifying the Population with Data and Clinical Expertise High need patients Need Strata Stratification Algorithm Condition Care Moderate need patients • Physician • Care Team Judgment of the physician has been shown to be the single best predictor of patient outcomes • Medical claims • Clinical • Health-risk assessment • Referral • EMR • Lab • Pharmacy • Medical & Rx Costs • Utilization • Biometrics • Risk Adjustment • Medication adherence • Chronic Conditions Low need Well patients Maintain good health & wellness & utilize self care tools Complex care

31. Outpatient Care Management Process & PATH visits Risk stratification, Roster review Generates patient lists 2. Patient Engagement Process: 1. Patient Identification Process: Patient Outreach by Care Mgr &/or Practice 3. Care Management Process: High, Med, Low risk programs Patient/Caregiver, Physician, Care Manager, Pharmacist Assess Patient Needs & Priorities Evaluate Outcomes Huddle Create Care Plan/Goals Coach Patient Coordinate Care Pre-PATH Prep PATH Visit

32. Complex Care Program ActivityJan-Apr 2015 1Number of patients after excluding those who were considered ineligible for engagement or outreach (deceased, unable to reach, etc.) 2Engaged is defined as having successfully completed at least one assessment among program statuses of: Case Assigned, Declined to Participate, Engaged, Enrolled, Problems Resolved/Goals Met, and Outreach in Progress (as of 5/11/2015) Number of PATH visits may include multiple visits by Engaged patients 3Inclusive of patients eligible and engaged

33. PATH Visit ForecastVisits Conducted Jan-Apr 2015 2015 Goal: 100 PATH Visits Conducted Each Month *as of 4/30/2015

34. Transition Program Overview • Home visit 2 days post-D/C • Post-D/C transitions plan • Communication w/PCP-EMR • Medications reconciled • Follow up Office Visit • Handoff to PCP • Pt identified as High Risk Discharge by stratification or Physician’s choice Home Hospital Stable Health • Transitions Care Team works with Patient & Family • Home visit recommended & scheduled • Hospitalist to PCP communication • Telephonic follow-up weekly at minimum or as needed for 30 days • Communication w/ PCP via EMR

35. Hospital Readmissions Comparison • Hospital Transitions process started April-May 2014

36. Transition Care Program ActivityJan-Apr 2015

37. A Patient’s Story: Complex Care • Patient in early 80’s • Patient has had Type II Diabetes for majority of • adult life • Patient is struggling with obesity • In need of education and encouragement in controlling diabetes “ Optimal patient care begins with getting the patient involved in their care ” -Heather Haas RN, BSNCare Manager When we met How we helped Where we are now • Patient’s A1C level was high and the patient was uneducated on how to control this • Sugar levels were often high in the mornings • Patient needed education on diet • Patient is struggling with obesity • Patient suffered lower body pain that inhibited routine exercise • Patient was not sleeping well and was often fatigued • Care Advisor educated patient on how to better control diabetes through diet changes • PCP consulted with a podiatrist for a patient evaluation • The patient learned how to control lower body pain and can now do moderate exercise • Care Advisor encouraged patient to wear CPAP at night in order to feel less fatigued and get better sleep • Patient’s A1C level has decreased and the patient is better able to control the condition • Patient has been educated on diet and is now making healthier life choices • Pain has decreased due to new medical equipment • Patient is sleeping better and has less daytime fatigue

38. Question & Answer