February Virtual Forum Caregiver Experience and Value-Based Care

1. February Virtual Forum • Caregiver Experience and Value-Based Care • February 2019 • Our call will begin shortly. Please mute your phone and avoid placing this call on hold.

2. Welcome • Orest Holubec • Reflection • Linda Marzano • Safety Story • Deepak Sadagopan • Caregiver Experience • Greg Till • Value-based Care Discussion • Linda Marzano and Deepak Sadagopan • Q&A Session, Feedback, Closing • Orest Holubec

3. Virtual Engagement Forums | Objectives and Outcomes • OBJECTIVES • Discuss our future design as we journey toward Health 2.0 • Hear your feedback and suggestions • Drive awareness of communication tools and support resources • February Virtual Engagement Forum • (Today) • EXPECTED OUTCOMES • Increased visibility into our most critical initiatives • Better understanding of Health 2.0 initiatives • Messaging and communications that you can share with your regional teams • Monthly Virtual Engagement Forums • (Planning)

4. Forum Topics | Modernization and Functional Excellence 1 2 3 4 5 6 • August • September • October November January February • Care and Delivery Operations and Reduce Clinical Variation Diversification Ambulatory Summit: Accelerating to Health 2.0 • Enterprise Shared Services and Ministry Administration 2018 Review/ 2019 Transformation Preview andLearning 2.0 Caregiver Experience Value Based Care

5. Reflection

6. Safety Story

7. Caregiver Experience Aiming High in 2019

8. Putting it Together Mission, Values, Vision, Promise Caregiver Experience Strategy

9. After 3 years of studying impacts atPSJH, our data is clear … caregiver experience impacts the Triple Aim • At PSJH, patient satisfaction, patient safety, willingness to recommend are all better in units with higher CGX • At PSJH, sepsis mortality, CAUTI, C. diff, and CLABSI, and readmissions are lower in units with better CGX • While financial impact is still being measured at PSJH, many of our primary cost drivers (e.g., turnover, productivity, legal claims) are highly related to CGX.

10. Creating the experience our caregivers deserve: a major reason for our focus

11. Make a personal commitment to achieve an aspirational improvement in our caregivers’ experience. An inspiring experience where caregivers can fulfill their calling and offer their best care every day.

12. Let’s make the impossible, possible!

13. Live the values. Make a personal commitment to deliver our Promise; talk about it at every opportunity. Improve leader effectiveness; model accountability. Build relationships through regular conversations / leader rounding. Ask Core Leaders and Caregivers about the obstacles and challenges they face and what you can do. Connect caregivers’ role and contributions to the Mission. Our focus for 2019 remains steadfast.

14. It matters to them. …and, it matters to all of us.

15. Value Based Care February Virtual Forum Linda Marzano Senior Vice President, Value Based Care and Chief Executive Pacific Medical Centers Deepak Sadogopan VP, Population Health Informatics & Government Programs

16. The health outcomes of a group of individuals including the distribution of such outcomes within the group. Mainstream medicine has traditionally focused on individuals. Public Health is complementary to the population health approach. A priority includes reducing health inequities and addressing social determinants of health. 4 key pillars support a population health management strategy: Data Analytics Payer strategies Care model redesign-transition to Value Based care Population Health

17. Value-based healthcare is a healthcare delivery model in which providers, including hospitals and physicians, are paid based on patient health outcomes. Under value-based care agreements, providers are rewarded for helping patients improve their health, reduce the effects and incidence of chronic disease, and live healthier lives in an evidence-based way. Value-based care differs from a fee-for-service or capitated approach, in which providers are paid based on the amount of healthcare services they deliver. The “value” in value-based healthcare is derived from measuring health outcomes against the cost of delivering the outcomes. What is Value Based Care? Source: NEJM

18. Common Core elements that make up the value equation are Quality, Experience and Affordability

19. Types of Value Based Arrangements Categorizing VBC Arrangements Source: HCP-LAN

20. Industry Trends and PSJH Participation

21. Increasing movement to two-sided risk-based arrangements Led by significant policy shifts in Medicare leaning towards AAPMs (two-sided risk) Significant increase in commercial Shared Savings/Risk arrangements Value Based Models definitively shifting to two-sided risk arrangements Increase in Cat 3&4 covers downward shift in Cat 1 and Cat 2 models 2018 marked the End of FFS Medicare (outpatient services) as we know it Source: Healthcare Payment Learning & Action Network (HCP-LAN)

22. Commercial payers increase Shared Savings/Risk arrangements Medicare Advantage and Medicaid shows definitive shift towards capitated payments Industry trends indicate a faster shift to Value Based Models than previously expected Source: E&Y Research Source: Healthcare Payment Learning & Action Network (HCP-LAN)

23. PSJH Value Based Care Participation Trends Value Based Contract Participation Trends • Participation in commercial risk based contracts is increasing across all markets • Medicare revenue is being subject to increased risk and variability across markets • Medicaid risk contract trends are emerging across several markets – expected to continue to increase Note: 2018 data is YTD and expected to continue to change until EOY. Data does not include Heritage and Hoag.

24. We are Implementing a comprehensive strategic approach to succeed in Value Based Arrangements 1 2 3 Integrated Informatics Framework Portfolio of Products and Services Strategic Contract Partner Relationships

25. Products and Services Portfolio 1

26. We have developed an integrated informatics framework Supports business decision making, operations and performance optimization in value based arrangements 2 INTEGRATED INFORMATICS FRAMEWORK TO SUPPORT EACH REGION POST-CONTRACT PRE-CONTRACT Stratify Patient Population & Plan Care Management Aggregate data & measure performance Analyze benefit, cost & risk Collaborate with contract partners Analytic Models to help prioritization Assess compliance, social determinants, clinical and financial risk and opportunity Common Data Model Combines claims, administrative, reference data and clinical data elements + Data Infrastructure: Partner Data Exchange, Pre-Processing, Compute Engine, Virtualization & Containers Administrative & Claims Data Sources Clinical Data Sources External Reference Data Sources

27. Move away from buyer-seller to strategic partnerships Aligns commitments in value based arrangements to Products/Services competencies Minimizes variation across arrangements through the use of data and services addendum Services Addendum lays out which services will be provided as part of the contract Data Addendum is linked to the Services Addendum and identifies the data to be exchanged in order to meet the services identified in the contract We are pursuing strategic contract partner relationships 3

28. Case Study: Caregiver ACO

29. 2018 Performance Results: Quality

30. Caregiver ACO Avoidable ED Visits

31. Caregiver ACO: Utilization Management

32. Supporting regions in their transition to Value Based Care Informatics Infrastructure

33. We have created a single system-wide reference for our regions to assess & optimize performance across value based arrangements INTEGRATED INFORMATICS FRAMEWORK TO SUPPORT EACH REGION PRE-CONTRACT POST-CONTRACT Stratify Patient Population & Plan Care Management Aggregate data & measure performance Collaborate with contract partners Analyze benefit, cost & risk Analytic Models to help prioritization Assess contract compliance, financial risk Common Data Model Combines claims, administrative, reference data and clinical data elements + Data Infrastructure: Partner Data Exchange, Data pre-processing and storage Administrative & Claims Data Sources Clinical Data Sources External Reference Data Sources

34. Introducing Value Based AnalyticsA single system-wide point of reference for performance under value based arrangements Unified representation of performance across risk based arrangements. Aggregated from over 50 data sources Handy quick, brief reference of contract terms

35. Analyze different aspects of performance to identify opportunities Analyze Spend & Quality side by side Population Spend compared to benchmark Proportion of out of network spend Performance Trends & Gaps

36. Takeaways

37. Questions / Comments Please take yourself off mute and state your name and region.

38. Thank you!