Strategic Planning Committee

Transcription

1 Strategic Planning Committee April 6, :00AM ProVidence Suite Las Vegas, NV 89102

2 AGENDA University Medical Center of Southern Nevada UMC GOVERNING BOARD STRATEGIC PLANNING COMMITTEE April 6, :00 a.m. 800 Hope Place, Las Vegas, Nevada UMC Trauma Building, ProVidence Suite (5 th Floor) Notice is hereby given that a meeting of the UMC Governing Board Strategic Planning Committee has been called and will be held at the time and location indicated above, to consider the following matters: This meeting has been properly noticed and posted in the following locations: University Medical Center CC Government Center Third Street Building Regional Justice Ctr 1800 W. Charleston Blvd. 500 S. Grand Central Pkwy. 309 S. Third St. 200 Lewis Ave., 1 st Fl Las Vegas, NV Las Vegas, NV Las Vegas, NV Las Vegas, NV (Principal Office) City of Las Vegas City of Henderson 400 Stewart Ave. 240 Water St. Las Vegas, NV Henderson, NV The main agenda is available on University Medical Center of Southern Nevada s website For copies of agenda items and supporting back-up materials, please contact Terra Lovelin, Board Secretary, at (702) The Strategic Planning Committee may combine two or more agenda items for consideration. Items on the agenda may be taken out of order. The Strategic Planning Committee may remove an item from the agenda or delay discussion relating to an item at any time. Consent Agenda - All matters in this sub-category are considered by the Strategic Planning Committee to be routine and may be acted upon in one motion. Most agenda items are phrased for a positive action. However, the Strategic Planning Committee may take other actions such as hold, table, amend, etc. Consent Agenda items are routine and can be taken in one motion unless a Strategic Planning Committee member requests that an item be taken separately. For all items left on the Consent Agenda, the action taken will be staff's recommendation as indicated on the item. Items taken separately from the Consent Agenda by Committee members at the meeting will be heard in order. SECTION 1. OPENING CEREMONIES 1. Public Comment CALL TO ORDER PUBLIC COMMENT. This is a period devoted to comments by the general public about items on this agenda. If you wish to speak to the Committee about items within its jurisdiction but not appearing on this agenda, you must wait until the Comments by the General Public period listed at the end of this agenda. Comments will be limited to three minutes. Please step up to the speaker's podium, clearly state your name and address and please spell your last name for the record. If any member of the Committee wishes to extend the length of a presentation, this will be done by the Chair, or the Committee by majority vote. 1 Page 2 of 43

3 2. Approval of minutes of the regular meeting of the UMC Governing Board Strategic Planning Committee meeting on February 9, (For possible action) 3. Approval of Agenda. (For possible action) SECTION 2. BUSINESS ITEMS 4. Receive a report on the performance evaluation and bonus timeline for the CEO, management and employees. (For possible action) 5. Review 4 th Qtr 2016 Market Share Data (For possible action) 6. Presentation on Centennial Gateway Primary Care/Quick Care Development (For possible action) 7. Presentation on MRI expansion (For possible action) 8. Identify emerging issues to be addressed by staff or by the Strategic Planning Committee at future meetings, and direct staff accordingly. (For possible action) COMMENTS BY THE GENERAL PUBLIC A period devoted to comments by the general public about matters relevant to the Committee s jurisdiction will be held. No action may be taken on a matter not listed on the posted agenda. Comments will be limited to three minutes. Please step up to the speaker s podium, clearly state your name and address and please spell your last name for the record. All comments by speakers should be relevant to the Committee s action and jurisdiction. UMC ADMINISTRATION KEEPS THE OFFICIAL RECORD OF ALL PROCEEDINGS OF UMC GOVERNING BOARD STRATEGIC PLANNING COMMITTEE. IN ORDER TO MAINTAIN A COMPLETE AND ACCURATE RECORD OF ALL PROCEEDINGS, ANY PHOTOGRAPH, MAP, CHART, OR ANY OTHER DOCUMENT USED IN ANY PRESENTATION TO THE BOARD SHOULD BE SUBMITTED TO UMC ADMINISTRATION. IF MATERIALS ARE TO BE DISTRIBUTED TO THE COMMITTEE, PLEASE PROVIDE SUFFICIENT COPIES FOR DISTRIBUTION TO UMC ADMINISTRATION AND GENERAL COUNSEL. THE COMMITTEE MEETING ROOM IS ACCESSIBLE TO INDIVIDUALS WITH DISABILITIES. WITH TWENTY-FOUR (24) HOUR ADVANCE REQUEST, A SIGN LANGUAGE INTERPRETER MAY BE MADE AVAILABLE (PHONE: ). 2 Page 3 of 43

4 University Medical Center of Southern Nevada Governing Board Strategic Planning Committee February 9, 2017 UMC ProVidence Suite Trauma Building, 5 th Floor 800 Hope Place Las Vegas, Clark County, Nevada Thursday, February 9, :00 a.m. The University Medical Center Governing Board Strategic Planning Committee met in the ProVidence Suite, UMC Trauma Building, 5 th Floor, Las Vegas, Clark County, Nevada, on Thursday, February 9, 2017, at the hour of 9:00 a.m. The meeting was called to order at the hour of 9:05 a.m. Chair Raney and the following members were present, which constituted a quorum of the members thereof: CALL TO ORDER Board Members: Present: Eileen Raney, Chair Robyn Caspersen Renee Franklin Absent: Mike Saltman (Excused) Donald Mackay, MD (Excused) Also Present: Mason VanHouweling, Chief Executive Officer Tony Marinello, Chief Operating Officer Terra Lovelin, Board Secretary SECTION 1. OPENING CEREMONIES ITEM NO. 1 PUBLIC COMMENT Chair Raney asked if there were any persons present in the audience wishing to be heard on any item on this agenda. None present ITEM NO. 2 Approval of minutes of the regular meeting of the UMC Governing Board Strategic Planning Committee meeting on January 12, (For possible action) Page 4 of 43

5 UMC Governing Strategic Planning Committee February 9, 2017 Page 2 of 5 FINAL ACTION: A motion was made by Member Franklin that the minutes be approved as recommended. Motion carried by unanimous vote. ITEM NO. 3 Approval of Agenda (For possible action) FINAL ACTION: A motion was made by Member Franklin that the agenda be approved as amended. Motion carried by unanimous vote. SECTION 2. BUSINESS ITEMS ITEM NO. 4 Presentation on the UMC Facade & Beautification Project (For possible action) DISCUSSION: Matt Cova, Director of Business Development showed renderings of what our campus could look like with an improved appearance. He is looking for support from this committee to proceed to request budget consideration to help with the landscaping project. The architects who did work last year will be speaking with Matt again to do some interim solutions prior to a new tower being built. Mr. VanHouweling commented that we will also be discussing this project with the Smith Group to see how we can tie the buildings together. Official bids for this project will need to be obtained as costs will be in the millions. There is routine maintenance that needs to be accomplished. They are hoping July will be the start time of this project. This discussion will be brought back to the committee next month financial information. Right now, Mr. Cova is looking for approval for the concept. The committee agreed that maintenance and painting needs to occur. Chair Raney suggested not using the term Beautification, as this is more maintenance and a necessity. FINAL ACTION: None taken ITEM NO.5 Ambulatory Annual Overview (For possible action) DOCUMENT SUBMITTED: -Ambulatory Update, February 22, 2017 DISCUSSION: Andrew Chung, Associate Administrator gave an overview of where UMC is heading in the primary and ambulatory care market and how we compare to the market overall. Page 5 of 43

6 UMC Governing Strategic Planning Committee February 9, 2017 Page 3 of 5 Currently UMC has Seven Primary Cares, Seven Quick Cares, One Occupational Medicine Clinic and One HIV/AIDS Specialty Clinic (Wellness Center) Chair Raney brought up the current workers comp clinics in Las Vegas and the bad feedback she has received on them. She asked if UMC should be doing Workers Compensation (WC) claims. Mr. Chung replied that inefficiencies with processing WC claims created the need to consolidate at one location. With the new EHR system we are looking at bringing WC claims back to all locations. Currently WC claims are only processed at the Enterprise location. The main competitors of UMC are: -Care Now (16 locations) -SW Medical Associates (6 locations) -Concentra (4 locations) -Healthcare Partners (4 locations) There are approximately 68 locations identified in Clark Count as Urgent Care. Mr. VanHouweling mentioned a multi-services clinic that is opening through the Culinary Health Fund. This clinic will feed into UMC for more complex care and he has been meeting with Kathy Silver, President of the Culinary Health Fund for further discussions. Mr. Chung commented that UMC is looking at staffing models and extending hours at some of the Quick Cares. Member Franklin suggested that we do an evaluation of the Administrative and office staff at the clinics. One of the most common complaints she hears is how office staff in general, treat patients and visitors in some medical offices. Danita Cohen, Chief Experience Officer commented that the Administrative team has done a lot of work rounding within the clinics and most actually have better patient satisfaction scores than the main hospital. Her team has also trained the clinic staff to make sure they acknowledge and speak to patients who have been waiting for more than an hour for a Quick Care visit. Mr. Chung explained that we need to shift our mindset from a volume base to a value base. The doctor s template is for 21 patients per day, which equates to about a 20 minute appointment per patient. This varies by physician and staff does look at how they are managing their patient population. Ms. Cohen shared some of the advertising avenues that UMC is utilizing. Radio and TV spots are running during flu season as well as in the movie theaters. UMC ads are around the Town Square mall and the airport. Google Search places UMC to the top of the web page when people search and we also have a Yelp presence. UMC is also on Facebook, Instagram and Twitter and also does cross promotions in schools that are around the Quick Cares. UMC ads are in neighborhood zip code magazines as well. Page 6 of 43

7 UMC Governing Strategic Planning Committee February 9, 2017 Page 4 of 5 The new Primary Care commercial was shown to the committee as well as the Quick Care. Chair Raney suggested Ms. Cohen have a separate marketing page that highlights all the initiatives she just described, for the Board. Mr. Chung mentioned the new queuing system to be tested that allows people to see how long the wait will be at certain locations. The testing should go live in March. The renovations are complete at Nellis and ongoing at other UMC Quick Care locations. Pictures were shown and it was suggested that more artwork be implemented into the décor to brighten up the facility. Member Franklin suggested if it is not costly, to add a few more electrical outlets in the waiting rooms for charging devices. Ms. Cohen responded that we had charging stations installed but they were being destroyed as soon as we installed them. Member Caspersen thanked Mr. Chung for a great presentation and asked what UMC is doing to help drive folks into our primary care. Mr. Chung replied that a key component is a well aligned and developed physician network, and we don t have one yet. Chair Raney asked for a presentation from staff on a network we can contract with and would like included; marketing, and a trends page. Mr. Cova said this could be ready to present to this committee in two months. FINAL ACTION: None taken. ITEM NO. 6 Centennial Gateway Primary Care/Quick Care Development (For possible action) DOCUMENT SUBMITTED: 2016 Ambulatory Expansion DISCUSSION: Mr. Cova presented an overview of the development of the new Urgent Care location in the Centennial Hills area as well as a relocation of our primary care currently in our Rancho building. The new building is a two floor building that will have Urgent Care on the first Floor and Primary Care on the second floor. Centennial Hills is an underserved area and it makes sense financially. The current building was shown and comprises of 6,000 square feet on both floors. Page 7 of 43

8 UMC Governing Strategic Planning Committee February 9, 2017 Page 5 of 5 The Rancho building is very old and multiple consultants have told us that it can t function as a medical building and needs to be demolished. Member Caspersen suggested that Mr. Cova add to the slides which scenario these numbers are based on prior to showing it to the Audit and Finance Committee. She would also like the slides to show an aerial of where the Quick Care is going to move to. Three Proformas were requested from Chair Raney to show both sides of the operation, Quick Care and Primary Care, and the overview of them combined. FINAL ACTION: None taken ITEM NO. 8 Identify emerging issues to be addressed by staff or by the Strategic Planning Committee at future meetings, and direct staff accordingly. (For possible action) -Centennial presentation with suggested changes (next month) -Presentation on network contracting (In 2 months) -Telehealth (next month) -ACA update (next month) COMMENTS BY THE GENERAL PUBLIC: At this time, Chair Raney asked if there were any persons present in the audience wishing to be heard on any items not listed on the posted agenda. SPEAKER(S): Erin Kline and another individual (name was inaudible) who works at Centennial Hills Hospital introduced themselves. There being no further business to come before the Board at this time, at the hour of 11:32 a.m. Chair Raney adjourned the meeting. APPROVED: MINUTES PREPARED BY: Terra Lovelin Page 8 of 43

9 Page 9 of 43

10 2016 Market Share 1 Page 10 of 43

11 5,617 5,830 5,878 5,861 5, Market Share Overall Clark County Market Share Analysis: 2016 UMC Market Share 10.88% Market Share Sunrise Hospital and Medical Center Summerlin Hospital and Medical Center University Medical Center 10.50% 10.50% 10.52% 10.30% Overall Service Area Market remained relatively flat from 3 rd to 4 th quarter Market increased by 4% or 2,323 admissions from 2015 Q4 to 2016 Q4 Henderson Hospital opened and had 529 admits Internal 3rd in overall volume for market for the third consecutive quarter Decreased in 138 admissions of which 60% was related to Normal Newborn admissions (3 rd -4 th Quarter) 2016 Q4 had 106 more admissions than 2015 Q4 6.7% 5.9% 7.4% 4.5% 8.1% 2.1% 3.3% 3.0% 9.7% 0.9% 16.0% 10.2% 11.9% 10.3% Mountain View Hospital Saint Rose Dominican Hospital - Siena Campus Spring Valley Hospital and Medical Center Centennial Hills Hospital and Medical Center Valley Hospital and Medical Center Desert Springs Hospital and Medical Center Southern Hills Hospital and Medical Center North Vista Hospital Saint Rose Dominican Hospital - San Martin Campus Saint Rose Dominican Hospital - Rose De Lima Campus Henderson Hospital 2 Page 11 of 43

12 2016 Market Share Major Service Line Market Share Analysis: 2016 Q4 General Surgery 16% 40% 12% 9% 7% 9% 7% Obstetrics-Delivery 19% 31% 16% 9% 15% 10% Orthopedics 12% 43% 11% 11% 8% 7% 7% General Medicine Neurology Cardiac Services 32% 18% 15% 33% 19% 13% 38% 15% 14% 7% 8% 10% 10% 7% 7% 10% 10.7% 7% 8% 9% 9% UMC Sunrise Summerlin Mountain View St. Rose- Sienna Valley Rest 3 Page 12 of 43

13 2016 Market Share Overview of UMC Market Share: 2016 Q4 Service Line Analysis 3 rd -4 th Quarter Gastroenterology (+40) General medicine (+30) Neonatology (+15) Plastic Surgery (+11) Psychiatry (+10) Ophthalmology (+10) Volume Positive Normal Newborns (-84) Hematology (-63) Endocrinology (-39) Urology (-23) Infectious Disease (-20) Cardiac Surgery (-8) Volume Decline Market Notes: No changes to discuss at this time 4 Page 13 of 43

14 2016 Market Share Overall Market Share Analysis: 2016 Urban Core (19,720 Q4 Admissions) PSA (10,980 Q4 Admissions) SSA (19,452 Q4 Admissions) 16.6% 17.1% 17.3% 16.9% 16.3% 8.8% 8.7% 8.5% 8.0% 8.2% 5.3% 5.2% 5.7% 5.5% 5.5% rd to 4 th Quarter Analysis Overall Service Area Decreased 1% or 141 admissions Internal Decreased 4% or 142 admissions External Southern Hills decreased 19% or 58 admissions Summerlin decreased 11% or 133 admissions Sunrise decreased 2% or 87 admissions rd to 4 TH Quarter Analysis Overall Service Area Remained flat Internal Increased 3% or 27 admissions External Valley decreased 8% or 41 admissions Mountain View decreased 4% or 66 admissions St Rose- San Martin decreased 12% or 33 admissions Sunrise remained relatively flat Henderson Hospital had 101 admissions rd top 4 th Quarter Analysis Overall Service Area Remained flat Internal Remained relatively flat Increased 1% or 9 admissions External Valley decreased 7% or 50 admissions Sunrise admissions remained flat North Vista decreased 80% or 39 admissions St. Rose De Lima decreased 6% or 62 admissions Henderson Hospital had 316 admissions Page 14 of 43

15 Appendix 6 Page 15 of 43

16 2016 Market Share Overview of UMC Market Share: 2016 Q4 Admissions by Service Area 2016 Q4 Urban Core PSA SSA Other 11% 19% 56% 14% Market Notes: No market changes to discuss at this time. 7 Page 16 of 43

17 2016 Market Share Service Area Analysis by Hospital: 2016 Q4 Urban Core PSA SSA 16% 8% 5% 7% 28% 12% 8% 41% 3% 9% 24% 16% 64% 13% 11% 12% 18% 5% University Medical Center Sunrise Hospital and Medical Center Mountain View Hospital Valley Hospital and Medical Center Summerlin Hospital Rest University Medical Center Sunrise Hospital and Medical Center Mountain View Hospital Valley Hospital and Medical Center Summerlin Hospital Rest University Medical Center Sunrise Hospital and Medical Center Mountain View Hospital Valley Hospital and Medical Center Summerlin Hospital Rest 8 Page 17 of 43

18 2016 Market Share Overview of UMC Market Share: 2016 Q4 Admissions By Payor Mix Quarter 4 5% 3% 4% 17% 51% Medicaid Medicare HMO Self Pay, Indigent Referrals, & Charity Champus Other 20% Market Notes: Payor Mix remained relatively flat throughout the year 9 Page 18 of 43

19 2016 Market Share Age Population by Service Area: 2016 Q4 Urban Core PSA SSA 16% 28% 21% 21% 22% 16% 25% 31% 30% 28% 32% 30% Under & up Under & up Under & up Market Notes: No market changes to discuss at this time. 10 Page 19 of 43

20 2016 Ambulatory Expansion Centennial Hills Quick Care & Primary Care 1 Page 20 of 43

21 2016 Ambulatory Expansion Centennial Hills Ambulatory Close Rancho Primary care, but maintain Rancho Quick Care in current location Project Description Build new Primary and Quick Care in Centennial Hills Quick Care will occupy 1 st floor and Primary Care will occupy 2 nd floor in Centennial Hills Re-locate primary care out of older building Objectives of the Project Create new access point into UMC System Establish a Quick Care footprint in an area that is under-served Expected Results of the Project Return on investment in less than 5 years Increase in Volumes 2 Page 21 of 43

22 2016 Current Rancho Location Current Primary Care location and entire building to be demolished Will stay as Quick Care location 3 Page 22 of 43

23 Centennial Hills Quick Care & Primary Care Primary Care on 2 nd Floor Quick Care on 1st Floor 4 Page 23 of 43

24 2016 Ambulatory Expansion 5 Page 24 of 43

25 Proposed Location 12.9 miles or 15 minute drive 6 Page 25 of 43

26 Proposed Location 7 Page 26 of 43

27 Current Rancho Primary Care Re-location Distance to New Location 2.7 miles or 5 minute drive 8 Page 27 of 43

28 2016 Quick Care Competition Centennial Hills Rancho HCA - Red SMA - Purple UMC - Blue 9 Page 28 of 43

29 Current Population 34k with 9% growth in 5 years 49k w/ 7% growth in 5 years 10 Page 29 of 43

30 2016 Centennial Hills Quick Care/Primary Care Market Share: Hospital Downstream as % of Total Hospital Volume in Payor Mix 4% 43% 52% 0% 17% 22% 23% 15% 12% 1% 4% 10% Current Target Medicare HMO Medicaid Other Self Pay DRIVERS Zip Current UC Internal Good referral protocols from employed physician practices to hospital Average Household income at $85k High Visibility in heavy traffic shopping center External Household income is high and demographics skew significantly towards starter and mid-career families. No current competitors in zip code Traffic counts are strong and primarily local, indicating this will be a neighborhood care center for the nearby planned communities. BARRIERS Internal External Eventual Transition to Epic 11 Page 30 of 43

31 2016 Centennial Hills Primary Care Proposal: The Centennial Hills Primary Care Clinic will be a medical group practice office located on the second floor of a convenient retail strip above a proposed urgent care clinic. The group practice office will consist of employed physicians to provide additional access and entry into the UMC care continuum. Resource Highlights Facilities: Conversion of previous administrative office space to renovated lease of space (6,698 sq ft). 12 exam rooms and office space Equipment: EKG, Vital signs machines, Pyxis Medication Dispensing Systems Centennial Hills Primary Care (Family Practice/Internal Medicine Group Practice) Summary Overview Projected opening: 1 October exam rooms, and office space Staffed w/ 4 Primary Care Providers (MD & Family Nurse Practitioner) and support staff By Appointment Mon-Fri: 8am - 4:30pm Information Technology: Infrastructure built to accommodate EHR workflow Staff: (3) Physician / (1) NP / (1) Practice Supervisor / (5) LPN or CNA / (4) Admit Reps Marketing/Communications: Targeted direct mailers, local print, billboard, online search optimization 12 Page 31 of 43

32 2016 Centennial Hills Quick Care Proposal: The Centennial Quick Care will be an urgent care clinic located in a high-traffic retail strip to provide access and entry into the UMC care continuum via relationships with UMC Primary Care Clinics. Resource Highlights Facilities: Conversion of previous retail space (bank) to design-built lease of space (6,067 sq ft). 9 exam rooms, 2 triage/exam rooms, 2 observation/exam bays, 1 procedure room, lab, and x-ray room Centennial Hills Quick Care (Urgent Care Clinic) Summary Overview Projected opening: 1 September exam rooms, 2 triage/exam, 2 obs/exam bays, 1 procedure room, lab, and x-ray room Staffed w/ two (2) full-time providers (MD & Mid-level) and support staff M-F: 8am - 7:30pm Sa-Su: 8am - 5:00pm Equipment: X-Ray, EKG, Vital signs machines, Pyxis Medication Dispensing Systems Information Technology: Infrastructure built to accommodate EHR workflow Staff: (1) Physician / (+1) NP or PA / (1) Clinic Shift Supervisor (RN) / (1) Radiology Tech / (3) LPN or CNA / (2) Admit Reps Marketing/Communications: Targeted direct mailers, local print, billboard, online search optimization 13 Page 32 of 43

33 2016 Rancho Quick Care Overview: The Rancho Quick Care is a freestanding urgent care clinic with 12 exam rooms located near the corner of N. Rancho Drive and W. Craig Road. With close to 23,000 visits last fiscal year, it is one of our busier clinics in a medically underserved area. Resource Highlights Facilities: County-owned freestanding pad in commercial/retail zone. Equipment: X-Ray, EKG, Vital signs machines, Pyxis Medication Dispensing Systems Rancho UMC Quick Care Summary Overview Open since 1995 for urgent care; adjacent to aging UMC building currently used for Primary Care, formerly used for inpatient rehabilitation. 12 exam rooms, on-site radiology, and office space Staffed w/ 2 Urgent Care Providers with capacity for 3 rd, clinical support staff, M-F: 8am - 7:30pm Sa-Su: 8am - 5:00pm Information Technology: Infrastructure built to accommodate EHR workflow Staff: (2) Physicians + (1) Physician or PA as needed / (1) Practice Supervisor / (4) LPN or CNA / (3) Admit Reps / (1) X-Ray Tech 14 Page 33 of 43

34 Net Revenue Gross Revenue 2016 Actual Downstream Revenue from Rancho Primary Care Physician s Hospital Gross Revenue $894,278 $1,106,304 $1,000,735 Physician 1 Physician 2 Physician 3 Hospital Net Revenue $245,600 $222,163 $198,530 Physician 1 Physician 2 Physician 3 15 Page 34 of 43

35 Yearly Transfers Downstream Transfers (Quick Care Hospital Emergency Room) Centennial Yearly Transfers to Hospital ,000-15,000 15,001-17,000 17,001-19,000 19,001-21,000 21,000 & Above Visits Hospital Net Revenue h $1,800,000 $600,000 $840,000 $1,080,000 $1,320,000 13, ,001-17,000 17,001-19,000 19,001-21,000 21,000 & Above 16 Page 35 of 43

36 2016 Centennial Hills Primary Care Proforma Assumptions (Clinic only): Volume: Assume 43 visits per day yr 1, 45 in yr 2, 47 in yr 3, 49 in yr 4 and 51 in yr 5 Net Revenue: Used Payor Mix of current Primary Care operations Net Revenue per visit at $165 per visit for Physician Expenses: Annual Salary increase of 4% Physician Bonus target at $60k Lease expense approximately $103K for year 1 which includes Base Rent, Tenant Improvements and Common Area Maintenance (CAM). 3 months abatement structured in year 1. ($1.48 sq ft) All other expenses based off previous 12 months data Other Notes: Capital Outlay Urgent Care $850k yr 1 Allocated $80K for Information Technology Allocated $100K for Furniture and Fixtures Allocated $120K for Equipment Allocated $550k for Tenant Improvements 17 Page 36 of 43

37 Primary Care Proforma Proforma - Rancho RelocationPrimary Care Year 1 Year 2 Year 3 Year 4 Year 5 Total Clinic Visits 10,572 11,101 11,656 12,238 12,850 Total Clinic Net Revenue: $1,749,188 $1,836,647 $1,928,480 $2,024,904 $2,126,149 Salary and Wages $852,476 $886,575 $922,038 $958,920 $997,276 Benefits $442,540 $460,242 $478,651 $497,797 $517,709 Supplies (Medical and Non-Medical) $33,508 $35,183 $36,943 $38,790 $40,729 Purchased Services $4,460 $4,683 $4,917 $5,163 $5,421 Utilities $35,776 $37,565 $39,443 $41,415 $43,486 Other Expense $306,664 $321,997 $338,097 $355,002 $372,752 Rents & Leases $102,672 $102,672 $102,672 $102,672 $102,672 Total Expenses: $1,778,096 $1,848,917 $1,922,761 $1,999,759 $2,080,046 Income (LOSS) From Operations ($28,908) ($12,270) $5,719 $25,145 $46,103 ** Fully allocated cost is not shown as the incremental UMC support cost to manage the new clinic is included in the proforma ***Depreciation cost not included (Capital Outlay Yr 1 is $850k) 18 Page 37 of 43

38 Low-Medium-High Scenario Primary Care Only Low Volume Visits (Current Performance) Medium Volume - Visits High Volume - Visits 10,572 11,101 11,656 12,238 12,850 11,101 11,656 12,238 12,850 13,493 11,656 12,238 12,850 13,493 14,168 Year 1 Year 2 Year 3 Year 4 Year 5 Year 1 Year 2 Year 3 Year 4 Year 5 Year 1 Year 2 Year 3 Year 4 Year 5 Low Income Medium Income High Income $84,853 $65,603 $65,603 $46,103 $46,103 $46,103 $25,145 $25,145 $25,145 $5,719 Year 1 Year 2 Year 3 Year 4 Year 5 ($12,270) ($28,908) $5,719 Year 1 Year 2 Year 3 Year 4 Year 5 ($12,270) $5,719 Year 1 Year 2 Year 3 Year 4 Year 5 19 Page 38 of 43

39 2016 Centennial Hills Quick Care Proforma Assumptions (Clinic only): Volume: Assume 40 visits per day yr 1, 55 in yr 2, 60 in yr 3, 70 in yr 4 and 70 in yr 5 Net Revenue: Used Payor Mix of current QC operations Net Revenue per visit at $169 per visit for Physician and $144 per visit for Nurse Practitioner 38% growth (Approximately $858K) in year 2 based on volume increases Expenses: Annual Salary increase of 4% Physician Bonus target at $60k Lease expense approximately $107K for year 1 which includes Base Rent, Tenant Improvements and Common Area Maintenance (CAM). 3 months abatement structured in year 1. ($1.48 sq ft) All other expenses based off previous 12 months data Other Notes: Capital Outlay Urgent Care $1.2 M yr 1 Allocated $80K for Information Technology Allocated $137K for Furniture and Fixtures Allocated $360K for Equipment Allocated $623k for Tenant Improvements 20 Page 39 of 43

40 Centennial Hills Quick Care (Quick Care Only) Proforma - Quick Care Year 1 Year 2 Year 3 Year 4 Year 5 Revenue Total Clinic Visits 14,560 20,020 21,840 25,480 25,480 Total Clinic Net Revenue: $2,289,324 $3,147,820 $3,433,985 $4,006,316 $4,006,316 Salary and Wages $1,766,270 $1,800,758 $1,870,388 $1,942,804 $2,018,116 Benefits $600,987 $643,001 $675,151 $708,909 $744,354 Supplies (Medical and Non-Medical) $135,626 $150,417 $158,228 $168,833 $172,393 Purchased Services $44,796 $46,140 $47,524 $48,950 $50,418 Utilities $17,638 $18,167 $18,712 $19,274 $19,852 Other Expense $42,900 $8,137 $8,381 $8,633 $8,892 Rents & Leases $107,750 $189,290 $192,203 $194,387 $197,299 Total Expenses: $2,715,967 $2,855,911 $2,970,588 $3,091,789 $3,211,324 Income (LOSS) From Operations ($426,643) $291,909 $463,398 $914,528 $794,992 ** Fully allocated cost is not shown as the incremental UMC support cost to manage the new clinic is included in the proforma ***Depreciation cost not included (Capital Outlay Yr 1 is $1.2 M) 21 Page 40 of 43

41 Low-Medium-High Scenario Quick Care Only Low Volume - Visits Medium Volume - Visits (Proforma) High Volume - Visits 13,613 14,974 16,472 18,119 19,931 14,560 20,020 21,840 25,480 25,480 19,931 21,924 24,117 26,528 26,528 Year 1 Year 2 Year 3 Year 4 Year 5 Year 1 Year 2 Year 3 Year 4 Year 5 Year 1 Year 2 Year 3 Year 4 Year 5 Low Income Medium Income (Proforma) High Income $10,928 Year 1 Year 2 Year 3 Year 4 Year 5 $1,219,028 $1,099,494 ($168,500) $544,828 $1,051,692 $932,158 $479,652 $668,571 $915,642 $291,909 ($345,747) ($478,147) Year 1 Year 2 Year 3 Year 4 Year 5 Year 1 Year 2 Year 3 Year 4 Year 5 ($562,818) ($426,634) 22 Page 41 of 43

42 Centennial Hills Combined Location Proforma (Including Cannibalization) Proforma - Quick Care Year 1 Year 2 Year 3 Year 4 Year 5 Revenue Total Clinic Visits 14,560 20,020 21,840 25,480 25,480 Total Clinic Net Revenue: $2,289,324 $3,147,820 $3,433,985 $4,006,316 $4,006,316 Salary and Wages $1,766,270 $1,800,758 $1,870,388 $1,942,804 $2,018,116 Benefits $600,987 $643,001 $675,151 $708,909 $744,354 Supplies (Medical and Non-Medical) $135,626 $150,417 $158,228 $168,833 $172,393 Purchased Services $44,796 $46,140 $47,524 $48,950 $50,418 Utilities $17,638 $18,167 $18,712 $19,274 $19,852 Other Expense $42,900 $8,137 $8,381 $8,633 $8,892 Rents & Leases $107,750 $189,290 $192,203 $194,387 $197,299 Total Expenses: $2,715,967 $2,855,911 $2,970,588 $3,091,789 $3,211,324 Income (LOSS) From Operations ($426,643) $291,909 $463,398 $914,528 $794,992 Income (LOSS) From Operations (Cannibalization) ($695,428) $23,124 $194,613 $645,743 $526,207 ** Fully allocated cost is not shown as the incremental UMC support cost to manage the new clinic is included in the proforma ***Depreciation cost not included (Capital Outlay Yr 1 is $1.2 M) 23 Page 42 of 43

43 Projected Capital Expenditure Unrestricted Cash (Cash Not Allocated to Capital, EPIC, or Cash on Hand Reserve) FY 2017 FY 2018 Notes $ 37.1 M $25.0 M ED Expansion ($6. 0) M Blue Diamond Capital Outlay ($.93) M Blue Diamond Reserve ($1.56) M Centennial Hills Capital Outlay ($2.01) M Centennial Hills Reserve ($1.56) M Unrestricted Cash $25.0 M $25.0 M 24 Page 43 of 43