The Changing Face of Healthcare Jonathan Nalli Chief Executive Officer, St. Vincent Senior Vice President, Ascension Healthcare, and Indiana Ministry

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1 The Changing Face of Healthcare Jonathan Nalli Chief Executive Officer, St. Vincent Senior Vice President, Ascension Healthcare, and Indiana Ministry Market Executive

2 Jonathan Nalli JONATHAN NALLI serves as Chief Executive Officer of St. Vincent. He also serves as Senior Vice President, Ascension Healthcare, and Indiana Ministry Market Executive. St. Vincent is a 20-hospital system and one of the largest employers that serves central and southern Indiana. Founded by the Daughters of Charity in 1881, St. Vincent is comprised of quaternary facilities, tertiary and critical access hospitals, specialty centers and a multi-specialty physician group. St. Vincent is part of Ascension, the nation s largest Catholic and non-profit health system, and a leader in medical excellence. St. Vincent delivers high quality care in service areas such as cardiovascular, women s health, pediatrics, neurosciences, cancer care, orthopedics, bariatrics and trauma. St. Vincent is also the second largest teaching system in the state, training more than 170 residents and fellows annually. In 2016, St. Vincent was named one of the nation s 15 Top Health Systems by Truven Health Analytics, a provider of data-driven analytics and solutions aimed at improving the cost and quality of healthcare. Mr. Nalli came to St. Vincent in 2014, after a 15-year career with Community Health Systems (CHS), where he served as an executive of multiple markets within the national health system. Prior to joining St. Vincent, he served as CEO of a region in northwest Indiana, where he focused on the growth and development of a comprehensive physician network and oversaw the development of new sites, as well as significant capital construction and renovation projects. Mr. Nalli was named to the Times of Northwest Indiana 20 Under 40 list in In 2014, he was honored as an Up & Comer by Modern Healthcare, the leader in healthcare business news, research and data. Honorees are recognized as the industry s rising stars who have made significant contributions in the areas of healthcare administration, management or policy. Mr. Nalli graduated from the University of Kentucky with a Bachelor of Health Sciences in Health Administration and earned his MBA from Drexel University in Philadelphia, Pennsylvania.

Ascension Health Footprint ~2,500 SITES OF CARE HOSPITALS BY TYPE General Acute Care 112 Rehabilitation Hospitals 6 Behavioral Health Hospitals 9 Long-Term Acute Care Hospitals 2 Hospitals Not

3 Ascension Health Footprint ~2,500 SITES OF CARE HOSPITALS BY TYPE General Acute Care 112 Rehabilitation Hospitals 6 Behavioral Health Hospitals 9 Long-Term Acute Care Hospitals 2 Hospitals Not Majority Owned Joint Venture or Management 13 Agreement SENIOR CARE AND LIVING FACILITIES Assisted Living 15 Continuum of Care Retirement Communities 8 Independent Living 2 Long Term Acute Care/Skilled Nursing 23 Multi-Service Line Communities 7 Other Senior Living (HUD, other) 2 PACE Programs 3 POST ACUTE SERVICE SITES Durable Medical Equipment 15 Home Health Services 42 Hospice Services 16 Outpatient Rehabilitation Centers 148 AMBULATORY CARE AND DIAGNOSTICS Ambulatory Surgery Centers Occupational Health Programs On-Site Employer Clinics Imaging Centers 110 Retail Lab Collection Sites 155 Primary Care Clinics 565 Retail Care Clinics 12 Retail Pharmacy Sites 45 Sleep Centers 31 Specialty Clinics 613 Virtual Care Programs 70 EMERGENCY SERVICES Free-standing ER and Urgent Care Sites Emergency Medical Services (EMS) COMMUNITY SERVICES Community Health Centers 16 Dispensary of Hope Sites 9 Mobile Clinical Services 26 Wellness Centers 23 Community/Social Programs 157

St. Vincent Ministries FY16 System Stats Ministries 20 Counties with Physical Presence 57 Associates 18,085 Employed or Aligned Medical Staff ~2,000 Hospital Beds 2,070 Sites of

4 St. Vincent Ministries FY16 System Stats Ministries 20 Counties with Physical Presence 57 Associates 18,085 Employed or Aligned Medical Staff ~2,000 Hospital Beds 2,070 Sites of Care 366 Inpatient Discharges 78,133 Newborn Births 8,430 Emergency Room Visits 313,496 Outpatient Visits 3,687,927 Sources: FY16 Operations report; FY16 Audited Financial Statements

5 Healthcare is a Puzzle

6 Patient Centered Care

Conceptual Changes Ø Illness Ø Acute Care Ø

7 Conceptual Changes Ø Illness Ø Acute Care Ø Inpatient Ø Individual Health Ø Fragmented Care Ø Independent Institutions Ø Service Duplication Ø Wellness Ø Primary Care Ø Outpatient Ø Community Well- being Ø Managed Care Ø Integrated Systems Ø Continuum of Services

8 Why is it important?

9 Improving Health Status in the Communities We Serve 2.4 Million 3, x 1 in 13 Current Indiana residents who will eventually develop cancer Hoosiers died from an injury in 2009 Increased risk for disability among Indiana adults with arthritis Or over 136,000 Indiana children have asthma 1st Million 2-4x Heart disease is the leading cause of death in Indiana Infant deaths per 1,000 live births one of the highest rates in the nation Number of overweight and obese Indiana adults Increased risk people with diabetes have for having a heart attack or stroke Source: Indiana State Department of Health

Clinically Integrated Systems of Care Hospital IP SV Indianapolis SV Women s Peyton Manning Children s Hospital SV Fishers SV Anderson Ancillary Centers 18

Hospitals 8 locations SV Seton SV Stress Center SV Heart Center SV Carmel SV Clay SV Dunn SV Frankfort SV Randolph SV Mercy SV Kokomo SV Salem SV Evansville

On-site Employer 4 Sleep Centers 8 new Ambulatory locations Retail 3 SVSP locations 14 clinics in collaboration with The Little Clinic Community-Based Care

Center Post- Acute Care Inpatient Rehab Skilled Nursing Facility Outpatient Rehab Home Care Rehab RHI RHI at SV Indpls SV Evansville Rehab Institute 18 OP

10 Clinically Integrated Systems of Care Hospital IP SV Indianapolis SV Women s Peyton Manning Children s Hospital SV Fishers SV Anderson Ancillary Centers 18 Imaging locations 40 Labs locations 1 Mammography Van Urgent Care 10 Locations Hospital OP / ASC 5 JV ASC 1 Wholly owned ASC JV Orthopedic Hospital Micro Hospitals 8 locations SV Seton SV Stress Center SV Heart Center SV Carmel SV Clay SV Dunn SV Frankfort SV Randolph SV Mercy SV Kokomo SV Salem SV Evansville SV Warrick SV Williamsport SV Jennings Tertiary Quaternary Acute Care Hospital Ambulatory Clinics 100 Primary Care 163 Specialty Practices 5 Occ Health 16 On-site Employer 4 Sleep Centers 8 new Ambulatory locations Retail 3 SVSP locations 14 clinics in collaboration with The Little Clinic Community-Based Care Home E-visits Retail Pharmacy Wellness and Fitness Center Physician Clinic Ambulatory Procedure Center Diagnostic/ Imaging Center Micro Hospital Urgent Care Center Post- Acute Care Inpatient Rehab Skilled Nursing Facility Outpatient Rehab Home Care Rehab RHI RHI at SV Indpls SV Evansville Rehab Institute 18 OP locations SNF / Memory Care Affiliated/Preferred Partner Network Home Care Ascension owned Hospice Virtual SV Indianapolis SV Anderson 7 telestroke sites 2 telecardiology sites

11 The Pieces to St. Vincent Clinically Integrated Care Worksite Wellness Executive Wellness Human /Sports Performance Care Management Center for Healthy Aging Transitions Clinic SNF Network Community Paramedicine Pilot

12 Improving Health Status in the Communities We Serve

13 Clinical Management Takes a Community

14 One Statewide Ministry

15 One National Ministry

MARIAN UNIVERSITY Indianapolis College of Graduate and Online Programs EDUCATING A NEW GENERATION OF HEALTHCARE PROFESSIONALS

MARIAN UNIVERSITY Indianapolis College of Graduate and Online Programs EDUCATING A NEW GENERATION OF HEALTHCARE PROFESSIONALS Choose a university where you can expand your mind and your heart. As the