IMPROVING HEALTH OUTCOMES OF PATIENTS WE SERVE

IMPROVING HEALTH OUTCOMES OF PATIENTS WE SERVE April 2016

UPDATE To watch a video and learn more about innovative developments, please visit Hospitals Form Network to Improve Health Care Access and Coordinated Care for Patients Health care across the nation is changing rapidly. To address these changes, hospitals and health systems are innovating new ways to improve the health of populations, enhance the experience and outcomes of the patients, and reduce per capita cost of care for the benefit of communities. The Health Network of Missouri (HNM) comprises Bothwell Regional Health Center in Sedalia, Capital Region Medical Center in Jefferson City, Hannibal Regional Healthcare System in Hannibal, Lake Regional Health System in Osage Beach, Saint Francis Healthcare System in Cape Girardeau, and University of Missouri (MU) Health Care in Columbia. The program s structure allows members to work together as partners on common goals while enabling each hospital or health system to serve the health care needs of its own community and preserve its independence and unique identity. The six members serve patients in counties throughout central, northeast and southeast Missouri and have more than 1,000 hospital beds, nearly 11,000 employees and approximately 1,200 employed and affiliated physicians. The three task forces actively seek opportunities to be more efficient, increase impact, and improve the lives of people across Missouri. HNM allows members to work together on common goals, including improving health care access and coordinated care for patients. These health systems work together to share best practices in business, clinical and operational practices. Major initiatives of the HNM task forces include: Continuing to improve the health outcomes of patients Sharing data and best practices Improving access to care Ensuring patient care among various providers is coordinated seamlessly through a clinically integrated network Lowering health care costs and creating efficiencies that will benefit the patients and communities HNM systems serve 2 \ Health Network of Missouri \ April 2016

CARE COORDINATION TASK FORCE CO-CHAIRS: RANDALL HAIGHT, MD SENIOR VICE PRESIDENT OF MEDICAL AFFAIRS, CAPITAL REGION MEDICAL CENTER MIKE SEDA DIRECTOR OF REGIONAL OPERATIONS, TIGER INSTITUTE FOR HEALTH INNOVATION, STEVE WHITT, MD CHIEF MEDICAL OFFICER AND SENIOR ASSOCIATE DEAN FOR CLINICAL AFFAIRS, MU SCHOOL OF MEDICINE A touch of tech The objectives of the Care Coordination Task Force are to achieve demonstrable improvement in care coordination between network organizations and to reinforce seamless care transitions between home, community and quaternary care. During the past year, the task force has implemented several initiatives to help meet these objectives. The initial focus was to identify the clinically-relevant information needed to effectively manage patients transitioning between the emergency department, acute care and ambulatory settings, and ensure the data was available for providers in advance of patient care. A system was developed that automated the delivery of information to the appropriate provider using electronic faxes. The system ensures better coordination of care among HNM providers and facilitates improved health outcomes and lower health costs within the network. An alternative solution was identified to transition from faxes to a system that is integrated into electronic medical records. In addition, a comprehensive IT assessment was completed at each institution to better understand members existing platforms and capabilities for managing patients receiving care at HNM organizations. This evaluation helped members understand which existing systems can be leveraged for near-term improvement of care coordination and identified necessary investments to achieve longer-term goals. FUTURE TASKS Migrate clinical communications system to an electronic system that is integrated into providers electronic medical records. Identify and implement a common longitudinal record for HNM that ensures all HNM providers have a holistic view of patient care, regardless of which member delivered the care. Health Network of Missouri \ April 2016 \ 3

Population Health and Quality Improvement Task Force CO-CHAIRS, POPULATION HEALTH: CO-CHAIRS, QUALITY IMPROVEMENT: VINCE COOPER DIRECTOR OF PAYER STRATEGY, MU HEALTH KEVIN MCROBERTS SENIOR VICE PRESIDENT OF OPERATIONS, LAKE REGIONAL HEALTH SYSTEM TOM DIEMER, MD VICE PRESIDENT OF QUALITY, SAINT FRANCIS HEALTHCARE SYSTEM KRISTIN HAHN-COVER, MD CHIEF QUALITY OFFICER, Laying the foundation To meet the objective of developing network capabilities for risk sharing and bearing, Capital Region Medical Center, Hannibal Regional Healthcare System, Lake Regional Health System and MU Health Care are participating in a shared savings agreement. Saint Francis Healthcare System also signed an agreement and will join the shared savings pool in April 2016. The health systems are using data reported on quarterly scorecards to improve quality and efficiency of the population being managed. In order to compare systems performance against the greater marketplace, they are using data from the payer. Common focus areas include diabetes management and avoidable emergency room visits. Strategic initiatives are underway to address quality and utilization measures for HNM health system employee health plan populations. Teams are currently evaluating data and available resources to assess, report and improve these measures. This work will not only help HNM employees, but it will provide a solid foundation for initiatives that can be marketed to other employers. Furthermore, to enhance our ability to manage the populations we are focused on, HNM is working with Cerner on an initiative that would equip the six health system facilities with the necessary infrastructure to provide point-of-care tools for management of patients. FUTURE TASKS The Centers for Medicare & Medicaid Services (CMS) has mandated that MU Health Care and Saint Francis Healthcare System participate in the Comprehensive Joint Replacement (CJR) bundled payment initiative. This is the first time that CMS has mandated providers to participate in a value-based payment initiative. This program will begin on April 1, 2016 and conclude on Dec. 31, 2020. The HNM health systems will use the CMS CJR model to identify opportunities and improve performance on Medicare hip and ankle joint procedures related to post-acute care. 4 \ Health Network of Missouri \ April 2016

ALLIANCE INITIATIVES TASK FORCE CO-CHAIRS: TOM TISONE EXECUTIVE DIRECTOR, HEALTH NETWORK OF MISSOURI TONY HALL ASSISTANT VICE PRESIDENT AND CHIEF PROCUREMENT OFFICER, UM SYSTEM The Alliance Initiatives Task Force is focused on identifying, evaluating and implementing initiatives to support members in servicing their communities health needs. The task force is active in creating solutions in several sub areas, including resident physician recruitment and retention. During the past year, HNM hosted two receptions for residents to explore employment opportunities within the network hospitals. A total of 125 residents in various specialties attended the receptions, many of whom are in the interview process with HNM members. The task force will continue to track the employment status of residents to assess the effectiveness of the program. To enhance the resident to rural track via Mizzou s Area Health Education Center Program, several HNM members are exploring the possibility of having their health system become rural training sites for future physicians in their communities. This initiative is proving effective in recruiting and retaining future physicians in the pilot communities. HNM supply chain leaders are analyzing tactics to improve supply chain and pharmacy services. Some member hospitals have expanded group purchasing organization options by accessing the university s academic tier pricing as a secondary affiliate to MU. In addition, a capital alignment project is underway to assess upcoming capital spending for all six health systems. An independent third party will evaluate the data, determine potential cost savings and provide equipment recommendations. BRAD MYERS DIRECTOR OF PHARMACY SERVICES, Exploring every avenue BRITTNEA COLLINS PRACTICE MANAGER, ELLIS FISCHEL CANCER CENTER, The oncology service line directors are researching ways to gain economies in remote physics and dosimetry, best practices in American College of Radiology review preparation, and sharing current options to ensure compliance with the Commission on Cancer s new survivorship requirements. In addition, they are researching market share analysis, reviewing medical oncology scribe utilization and evaluating the potential use of MU Health Care s genetics program via telemedicine. Improving market share is a key area of focus for the women s service line. Service line directors are discussing and evaluating practice standards relative to obstetrics nurse staffing, advanced cardiac life support requirements, after hours triage and the Association of Women s Health, Obstetric, and Neonatal Nurses toolkit experiences. Additionally, there have been several reimbursement information discussions and potential purchasing collaborations. One shining example of such collaboration involved a service line director sharing the details of an ultrasound purchase with her peers. She quickly learned that the equipment offered features she did not need, so she was able to modify the purchase and save her hospital $15,000. Cardiology service line directors continue to share information about best practices for advanced practice registered nurses, catheter lab purchasing opportunities, program development, labor cost benchmarking, equipment standardization and various clinical protocols that could potentially result in cost savings and workplace efficiency. The orthopaedic service line leaders are participating in a learning collaborative on the CMS CJR project. MU Health Care shared its Musculoskeletal Value Analysis review process, Bothwell Regional Health Center and MU Health Care completed an orthopaedic affiliation that included the Bothwell Regional Health Center s acquisition of a local orthopaedic group, and the group worked on the OrthoBiologics purchasing collaboration. These projects continue to enhance and ensure orthopaedic service line growth. FUTURE TASKS HNM will focus on enhanced collaboration in four service lines: cardiology, oncology, orthopaedics and women s health. A Request for Proposal for IVIg/Albumin is also underway, and may become the first of many cost savings opportunities for the network. Health Network of Missouri \ April 2016 \ 5

H e a lt h N e t w o r k o f M i s s o u r i M e m b e r s BOTHWELL REGIONAL HEALTH CENTER HANNIBAL REGIONAL HEALTHCARE SYSTEM Bothwell Regional Health Center is a 145-bed regional health center serving west-central Missouri with comprehensive health and wellness services including surgical, cancer, orthopaedic, cardiovascular, women s health and therapy services. The organization also operates 13 primary and specialty care locations. For more information on Bothwell Regional Health Center and its services, visit www.brhc.org. Hannibal Regional Healthcare System is the parent organization of Hannibal Regional Hospital, Hannibal Regional Medical Group and Hannibal Regional Hospital Foundation. Hannibal Regional Hospital (HRH) is a 91-bed acute care hospital providing comprehensive health and wellness services to more than 125,000 residents in the tri-state area and has been recognized by Healthgrades as a 2013 and 2014 Outstanding Patient Experience Award recipient ranking HRH among the top 10 percent in the nation for patient care. Hannibal Regional Medical Group is a growing multispecialty physician group delivering primary, specialty and express care services at nine locations in Missouri and Illinois. For more information on Hannibal Regional Healthcare System, visit www.hannibalhealth.org. CAPITAL REGION MEDICAL CENTER Capital Region Medical Center, located in Jefferson City, is an affiliate hospital of University of Missouri Health Care, and encompasses a full service hospital, a comprehensive cancer program at Goldschmidt Cancer Center, and an expansive clinic system covering eight counties. Within the hospital, the Inpatient Rehabilitation Center is one of the few accredited hospital-based rehabilitation centers in the state. Capital Region s fitness facility, the Sam B. Cook Healthplex, is the community s only hospital-based, medically directed fitness facility and is home to adult and pediatric outpatient therapy services. From prenatal and obstetric care to orthopaedic and cardiovascular services, Capital Region provides innovative health care, advancing its mission to improve the health and wellness of the people and communities it serves. For more information, visit www.crmc.org. 6 \ Health Network of Missouri \ April 2016 LAKE REGIONAL HEALTH SYSTEM Lake Regional Health System in Osage Beach provides comprehensive health care services for residents and visitors in a five-county region surrounding the Lake of the Ozarks. The hospital, a three-time recipient of the Missouri Quality Award, is a state-designated Level II Stroke Center and Level III Trauma Center. Lake Regional also operates 27 clinics, including primary, specialty and urgent care, as well as rehab therapy clinics, retail pharmacies and home health services throughout the lake area. To learn more, visit www.lakeregional.com.

Health Network of Missouri Members SAINT FRANCIS HEALTHCARE SYSTEM Saint Francis Healthcare System is anchored by Saint Francis Medical Center, which is a 282-bed facility serving more than 650,000 people throughout Missouri, Illinois, Kentucky, Tennessee and Arkansas. Guided by its mission to provide a ministry of healing and wellness inspired by its Christian philosophy and values, the medical center has become a progressive, innovative regional tertiary care referral center. Saint Francis major service lines, which have received national recognition, include the Neurosciences Institute, Orthopedic Institute, Family BirthPlace (featuring the region s first Level III Neonatal Intensive Care Unit), Heart Hospital, Emergency and Level III Trauma Center with Convenient Care, Cancer Institute and Fitness Plus. Saint Francis is proud to be the only employer in Missouri ranked on Modern Healthcare magazine s prestigious Best Places to Work in Healthcare list for six consecutive years (2008-2013). For more information, visit www.sfmc.net/healthcare-system. As part of the state s premier academic medical center, MU Health Care offers a full spectrum of care, ranging from primary care to highly specialized, multidisciplinary treatment for patients with the most severe illnesses and injuries. Patients from each of Missouri s 114 counties are served by approximately 6,000 employees, nurses and health care professionals at MU Health Care. For more information, visit www.muhealth.org. Health Network of Missouri \ April 2016 \ 7

Health Network of Missouri STRUCTURE CAPITAL REGION MEDICAL CENTER LAKE REGIONAL HEALTH SYSTEM UNIVERSITY OF MISSOURI HEALTH CARE BOTHWELL REGIONAL HEALTH CENTER HANNIBAL REGIONAL HEALTH SYSTEM SAINT FRANCIS HEALTHCARE SYSTEM Gaspare Calvaruso Jim Wisch Randall Haight, MD Michael E. Henze Dennis Michaelree Robert Hyatt, MD Mitch Wasden Brian Steines Steve Whitt, MD James Robertson David Floyd Philip Fracica, MD Todd Ahrens Tim Polley Michael Bukstein, MD Steve Bjelich Clyde Nenninger Tom Diemer, MD Board of Managers Legal Counsel Mark Thompson Finance and Accounting Amy Roe-Quilici Communications Board President Mitch Wasden Executive Director Tom Tisone Administrative Assistant Karla Church Project Manager Gregory Brown Care Coordination Task Force Population Health/ Quality Improvement Task Force Alliance Initiatives Task Force