Value is a Prescription for Success Steve Hester, MD, MBA

1. Value is a Prescription for Success Steve Hester, MD, MBA Senior Vice President and Chief Medical Officer

2. Pilgrimage HealthcarePatients Deserve More Options…

3. Norton Healthcare Integrated Delivery Network of Five Not-for-Profit Hospitals 15 Out-patient Centers 1.6 Million yearly patient encounters $1.7 Billion yearly revenue 12,000 Employees 600 Employed Providers 2,000 Physician Medical Staff 1,857 Licensed Beds 60,000 Admissions/year

6. Who is Accountable for Care? Autonomy versus Paternalism “Flu Shot”

7. ACO Current State • Accountability is an Action… Not an Organization • ACA has pushed organizations to compete on quality and price rather than fee-for-service. • Currently 5% of Medicare Beneficiaries in an “ACO” • 89 initial CMS approved ACOs – only five with both upside and downside risk

8. ACCOUNTABLE CARE ORGANIZATION Components of an ACO Effective Health Management The Players • Employers • Patients • Hospitals • Acute, sub-acute and long-term care providers • Ambulatory care centers • Pharmaceutical companies • Medical device manufacturers • Care Givers (physicians, nurses, home health, clinical social worker, clinical psychologist, and other ancillary providers) • Payors • Federal government Hospitals / Sub-Acute & Long-Term Care / Ambulatory Care / Caregivers / Payors / Manufacturers / Federal & State Government/ Employers / • Manage population health • Patient attribution • Community outreach • Training and education • Behavior and change management • Segmentation and risk factor capabilities • Marketing Manage to Quality Standards Coordinate Items and Services Effective Health Management Cost and Efficiencies Manage to Quality Standards Coordinate Items and Services • Quality management (definition by population, not event or episode-driven) • Quality standards reporting • Disease management • Data management and analytics • Business intelligence management of clinical, operational and financial data Manage Costs and Efficiencies • Preventive care • Medical management • Telemedicine • Funding administration • Supply chain • Participation in Health Information Exchanges (HIEs) • Risk management • Finance and accounting • Disease management • Measurement of clinical, operational and financial key performance indicators Used with Permission KPMG HEALTHCARE

9. Journey for Accountable Care • Initiated as part of Brookings – Dartmouth Commercial Pilot in 2009 • Future plans for other manage care providers as model develops. • Patient population – 1.24 million in community • Current included groups: NHC employees/Humana employees – 10,000 • Approximately 300 physicians included • Primary Care and Specialists • Consideration to expand into other reimbursement partnerships • Bundled Payment • Shared Risk (smaller employers)

10. Strategy for Success • Accountability is an Action • Manage the Patient Through the Care Continuum • Patient and Community Engagement and Accountability • Transparency • Data Infrastructure Management and EMR • Patient, Provider, Payer, and Employer Partnerships • Change is Hard • Decrease Variation – Increase Personalization

11. Evolution of Analytics WHAT WILL happen and WHEN? WHY it happened? WHAT happened?

12. Transparency

14. Norton Healthcare – Humana Accountability Pilot

15. Norton Healthcare Accountability Pilot Dartmouth – Brookings ACO Pilot Performance Measurement Too few eligible cases.

16. Anti-Infective Purchasing/QTR/Patient Day

17. Clinical Effectiveness

18. The Future of Clinical Re-Engineering • Improved care coordination and communication • Improved access – physician extenders – email – phone call etc. • Prevention and early diagnosis • ED and Immediate Care Center visits • Increase generic medication utilization • Hospital re-admissions and multiple ED visits • Improved management of complex patients – Manage the Top 100 • Care Coordination and High Resource Utilizers

19. Evidence or Bias?

20. Disruptive Innovation Future of Healthcare

21. Think Differently – Treat Differently Future of Healthcare *The Volume-To-Value Revolution. Oliver Wyman

22. Resource Management

23. Questions Steve.Hester@NortonHealthcare.org