MHA S 2018 VALUE REPORT TO MEMBERS

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FOR Patients FOR Communities FORward $30 million reduction in Medicaid sick tax $75 million avoidance of hospital assessment to stabilize insurance markets $36 million full funding for Institutions for Mental Diseases $5.5 million for six hospital capital projects Nearly $18 for every dues dollar direct financial benefit plus MHA S 2018 VALUE REPORT TO MEMBERS As a member-driven organization, MHA prides itself on providing exceptional value for your dues. Here are just some of the ways MHA has brought value to Maryland s hospitals in the past year.

2017-2018 EXECUTIVE COMMITTEE OF THE BOARD Officers Mary Pat Seurkamp, Ph.D. Chair; Trustee, Greater Baltimore Medical Center, President Emerita, Notre Dame of Maryland University Joseph Ross Vice Chair; President & CEO, Meritus Health Robert Chrencik Vice Chair; President & CEO, University of Maryland Medical System Timothy Hearn Treasurer; Board Member, Sheppard Pratt Health System; Senior Managing Director, Mid-Atlantic Region, JLL Terry Forde Secretary; President & CEO, Adventist HealthCare Chairs, Standing Committees & Policy Boards Sherry Perkins, Ph.D., RN, FAAN Chair, Council on Clinical & Quality Issues; Executive Vice President & COO, University of Maryland Capital Region Health Samuel Moskowitz Chair, Council on Financial Policy; President, MedStar Franklin Square Medical Center Dean Teague Chair, Council on Legislative & Regulatory Policy; President & CEO, CalvertHealth Medical Center Jill Donaldson - Chair, Maryland Healthcare Education Institute; Vice President, Operations, MedStar Medical Group Eric Wagner Chair, Maryland Hospital Association Political Action Committee; Executive Vice President, Insurance and Diversified Operations, MedStar Health Trustee Councillors-at-Large Harry Johnson Former Board Chair, Greater Baltimore Medical Center; Partner, Whiteford Taylor Preston, LLP Mary Louise Preis Board Member, Mercy Medical Center; Retired Executive, CitiFinancial Mark Higdon Trustee, Peninsula Regional Medical Center; Retired Partner, KPMG MidAtlantic Healthcare Advisory Practice CEO Councillors-at-Large Victoria Bayless President & CEO, Anne Arundel Medical Center Richard Bennett, M.D. President, Johns Hopkins Bayview Medical Center Neil Meltzer President & CEO, LifeBridge Health Redonda Miller, M.D. President, Johns Hopkins Hospital Thomas Mullen President & CEO, Mercy Medical Center Karen Olscamp President & CEO, University of Maryland Baltimore Washington Medical Center Harsh Trivedi, M.D. President & CEO, Sheppard Pratt Health System Independent Councillors-at-Large Diane Bell-McKoy President & CEO, Associated Black Charities Stuart Guterman Health Economics Consultant Ex-Officio Bob Atlas President & CEO, Maryland Hospital Association AFFILIATES Prime, the shared services/group purchasing subsidiary of the Maryland Hospital Association, and the Chesapeake Registry Program, MHA s staffing subsidiary, provided $460,000 to MHA in fiscal year 2018 to support advocacy efforts and other work. The Maryland Healthcare Education Institute continues to work with members on the changing demands of population health management and an increased focus on reducing health disparities, as well as the consistent challenges created by an aging health care workforce. Targeted programming was brought to a number of hospital campuses this past year, where MHEI staff worked individually and with groups of hospital staff totaling nearly 2,500 participants. Nearly one-third of MHEI members use MHEI for customized, specific, targeted programs and development. The Chesapeake Registry Program helps hospitals meet their evolving staffing needs by securing access to vetted, high-quality temporary staff including nurses and allied health providers. The Registry offers a user-friendly software interface with real-time data to access staffing credentials. In the past year,1.08 million hours of clinical personnel time were furnished. 6820 Deerpath Road, Elkridge, MD 21075-6234 410.379.6200 www.mhaonline.org

FOR PATIENTS, FOR COMMUNITIES, FORWARD In the midst of great change, from federal policies to statewide election-year politics to new leadership at your hospital association, the theme of this year s meeting For Patients, For Communities, Forward reflects the innovation and creativity with which you are taking care of people and communities. No matter what changes swirl around you, your organization, and MHA as your chief advocate, our focus together remains strong: getting people the right care, at the right time, in the right setting. From quality improvements to population health partnerships and so much more, we are keeping our state at the leading edge of innovation. Bob Atlas As you fulfill your 24/7 commitment to the people you serve, MHA lives every day our commitment to help you and your organization thrive. We know that hospitals need the right environment to flourish, and it is both our privilege and responsibility to make it so. This brief report highlights some of the ways MHA has delivered value for your organization over the past year. It is a reflection of the priorities that you, through your participation in MHA, have set. We appreciate your dedication to your association and to the work that we do together. Bob Atlas President & CEO Mary Pat Seurkamp, Ph.D. Mary Pat Seurkamp, Ph.D. Chair

ANNUAL HIGHLIGHTS MHA serves hospitals in many ways, but focuses on three: Advocacy before the Maryland General Assembly, Governor, U.S. Congress, and the federal executive branch Representation before state and federal regulators, including the Health Services Cost Review Commission Collaboration on issues of quality and patient safety Following are some highlights that demonstrate the progress hospitals have made in the past year. Advocacy Engaged in final-stage negotiations on the Enhanced Total Cost of Care Model, the successor to Maryland s All-Payer Model. The new model will begin in January 2019 Secured a $30 million reduction in the $365 million sick tax for fiscal year 2019 Helped pass legislation to create a multi-million dollar grant program that supports community-based treatment for behavioral health services Defeated trial lawyers bills that would worsen Maryland s liability climate, including legislation that would have increased the cap on non-economic damages in medical malpractice and wrongful death lawsuits, and a bill to make it easier for punitive damages to be awarded Fought off legislation that would have required hospitals to report the value of their not-for-profit tax exemptions to the state comptroller, with direct union influence on accompanying regulations Successfully advocated for legislation to stabilize Maryland s commercial insurance market, without adding any financial burden to hospitals, which would have endangered the state s unique model Defeated a bill to repeal the 20 percent rule and potentially create professional witnesses in liability cases Quality By the end of the past year, Maryland s hospitals: Committed to mitigating Maryland s opioid crisis by adopting strict emergency department guidelines for the prescription of opioids, developing specialized discharge processes for patients with substance use disorders, and performing intensive screenings for new patients to identify potential substance use disorders Reduced preventable infections and complications by approximately one-half over a three-year period Reduced the readmissions rate by 9 percent Reduced the rate of delivery by C-section for first-time mothers by 7 percent Created more than 76,000 care alerts/plans to share information among providers and reduce avoidable readmissions Continued to support the Equity of Care initiative to reduce health disparities Financial $5.5 million for 11 hospital capital projects $36 million for the state s three Institutions for Mental Diseases $30 million reduction in the $365 million Medicaid sick tax

MEMBER ENGAGEMENT MHA is a member-driven organization, the only state hospital association led by hospital trustees (the board is composed of the chief elected trustee leader or a designee). Without your help and guidance, MHA could not do what it does to help hospitals. Below are some ways that hospital leaders are engaging with MHA to contribute to an environment that helps hospitals thrive: 119 individuals Governance Participation on MHA boards, committees, councils, work groups, task forces and more. 48 Advocacy Engagement in the legislative and regulatory advocacy process. General Assembly 85 bills on which MHA and its members testified Health Services Cost Review Commission 15 individuals testified before the HSCRC 8 represented 484 individual contributions MHA PAC 39 represented $145,775 in total contributions Hospital Initiatives Statewide programs to improve care for patients and communities. Opioid Prescribing Guidelines Care Alerts/ Care Plans Neonatal Abstinence Syndrome Collaborative Reducing First-time C-sections Improving Sepsis Survival 100% hospital participation 238% increase in the number of high-risk Medicare patients enrolled 97% of birthing hospitals participating 97% of birthing hospitals participating 26% reduction in deaths due to sepsis Affiliate Engagement Helping hospitals and health systems with staffing and purchasing needs. Prime (MHA s group purchasing subsidiary) Chesapeake Registry (MHA s supplemental staffing subsidiary) 100% hospital participation $114.8 million in purchases 38 participating >1 million staffing hours

MHA MEMBERS 2018 Adventist HealthCare Adventist HealthCare Behavioral Health & Wellness Services Adventist HealthCare Physical Health & Rehabilitation Adventist HealthCare Shady Grove Medical Center Adventist HealthCare Washington Adventist Hospital Anne Arundel Medical Center Atlantic General Hospital Bon Secours Baltimore Health System Brook Lane CalvertHealth Medical Center Children s National Medical Center Doctors Community Hospital Fort Washington Medical Center Frederick Regional Health System Garrett Regional Medical Center Greater Baltimore Medical Center HealthSouth Chesapeake Rehabilitation Hospital Holy Cross Health Holy Cross Germantown Hospital Holy Cross Hospital Johns Hopkins Health System Howard County General Hospital Johns Hopkins Bayview Medical Center The Johns Hopkins Hospital Mt. Washington Pediatric Hospital Suburban Hospital Kennedy Krieger Institute LifeBridge Health Carroll Hospital Center Northwest Hospital Sinai Hospital of Baltimore McCready Health MedStar Health MedStar Franklin Square Medical Center MedStar Good Samaritan Hospital MedStar Harbor Hospital MedStar Montgomery Medical Center MedStar Southern Maryland Hospital Center MedStar St. Mary s Hospital MedStar Union Memorial Hospital Mercy Medical Center Meritus Health NIH Clinical Center Peninsula Regional Medical Center Saint Agnes Hospital Sheppard Pratt Health System Union Hospital of Cecil County University of Maryland Medical System Mt. Washington Pediatric Hospital University of Maryland Baltimore Washington Medical Center University of Maryland Capital Region Health - University of Maryland Laurel Regional Hospital - University of Maryland Prince George s Hospital Center University of Maryland Charles Regional Medical Center University of Maryland Harford Memorial Hospital University of Maryland Medical Center University of Maryland Medical Center Midtown Campus University of Maryland Rehabilitation & Orthopaedic Institute University of Maryland Shore Medical Center at Chestertown University of Maryland Shore Medical Center at Dorchester University of Maryland Shore Medical Center at Easton University of Maryland St. Joseph Medical Center University of Maryland Upper Chesapeake Medical Center VA Maryland Health Care System Western Maryland Health System