Transparency has become even more important in the past year as we begin the health care reform discussion. There is not a signature event in Nashville to bring quality, marketing, transparency, and technology together. The Naked Hospital event will take the user experience from high level strategy through national and state legislative issues through practical hands on tools to walk away with. The event will focus on how and why health systems and hospitals should focus on quality reporting as well as financial reporting. At the end of the day, all of this puts additional strains on the information systems and resources deployed by most health systems and hospitals. How will they cope? What is the next step?

2. Breakfast Sponsor

3. Briefing:Health System Reform: Update Paul Keckley, Ph.D., Executive Director Deloitte Center for Health Solutions Washington, DC Nashville, TN August 6, 2009

5. ROI for Personalized Therapeutics (1/09)

6. Health Care and Public Policy: What Do Americans Really Want (1/09)

7. Reducing Costs While Improving Care in the U.S. Health System: The Health Reform Pyramid (1/09)

8. 2009 Survey of U.S. Health Care Consumers (3/09)

9. Comparative Effectiveness (5/09)

10. Academic Medicine: Sustainability (6/09)

11. Episode Based Payments (Summer 2009)

12. The Long Term Care Market in Medicaid: Ticking Time Bomb (Summer 2009)

13. Wellness and Healthy Living: New Business Models and Opportunities (Summer 2009)

14. Retail Medicine: Update (Summer 2009)

15. Medical Tourism: Update (Summer 2009)

17. Consumer-Directed Health Plans: Update

18. Medicaid Medical Management

19. The Medical Home

20. Medical Tourism

21. Price Transparency in Health Care

22. Retail Medicine

23. Preparing for ICD-10

24. Retail Pharmacy and Disease Management

25. Connected Care: Technology Enabled Care at Home

26. 2008 Survey of Health Care Consumers

27. Best Practices in Greening in Health Care Organizations1

29. Unemployment at 9.4%: highest since 1939

30. Banking industry solvency: 19 major banks stress tested

31. TARP program underway: results unknown, $140 billion yet to deploy

32. Containing health costs—key element in economic recovery

33. Fastest growing expense in households, companies and government

34. Only industry with employment increase since 12/07 downturn

35. The new administration—“change…yes we can”

36. Health care, energy, education priorities

37. Access to health insurance—campaign 2008 focus, but costs now a major theme2 Copyright © 2009 Deloitte Development LLC. All rights reserved.

39. Health costs: +6.2% CAGR

40. Government spending for health care (Medicare and Medicaid): +7.2%

41. Private sector spending for health care: +5.3%

42. 25% of entire federal budgetAnnual health care expenditures in the United States have gone from $27.5 billion in 1960 to $2.24 trillion in 2007 and are projected to reach $4.35 trillion by 2018. Source: Department of Health and Human Services, Center for Medicare and Medicaid Services, the National Health Expenditures Accounts (NHEA) 3 Copyright © 2009 Deloitte Development LLC. All rights reserved.

43. Since December 2007, 6 million overall jobs have been lost; however, health care jobs have increased 190,000 Source: Labor Department 4 Copyright © 2009 Deloitte Development LLC. All rights reserved.

44. Consumer inclined toward reform: “The system isn’t working very well…” Only 1 in 5 consumers give the U.S. health care system an above-average report card grade; those grading the system “F” outnumber those giving it an “A” by 6 to 1. Source: 2009 Survey of US Health Consumers 5

45. Consumers believe system is wasteful 52% of Americans feel that at least half of health costs are wasted. Source: 2009 Survey of U.S. Health Consumers 6 Copyright © 2009 Deloitte Development LLC. All rights reserved.

46. Not a system…a federation of interests that’s fragmented, costly Administrators/Watchdogs Regulators Media Professional Societies/ Special Interests Insurers Innovators Academic Medicine Pharma BioTech Accrediting Agencies Employers HCIT Device Service Providers Disruptors Hospitals Outpatient Facilities Long Term Care Allied Health Professionals Disease Management CAM Physicians Consumers 7 Copyright © 2009 Deloitte Development LLC. All rights reserved.

48. May 11, 2009 to Major Trade organizations: Cut CAGR to 4.7%, reduce costs by $2 trillion (2008 – 2018)

49. June 3, 2009: Everything on the table—mandates, employer tax exclusion, employer mandate, public plan, et al. Bill this summer.8 Copyright © 2009 Deloitte Development LLC. All rights reserved.

51. February 17: President Obama signs $787B stimulus package (America’s Recovery and Reconstruction Act) that includes $145B for health care

52. February 26: President announces “down payment on health reform”—a $634B 10-year fund to pay for long-term health reforms; cuts to pharmaceutical companies and Medicare Advantage plans plus increased taxes for those earning more than $250,000

53. March 11: Congress approves $410B appropriation to operate government through September 2009, including modest increases in a few areas of health care—primary care, NIH, National Service Corps

54. April 29: Passage of FY10 budget; targeted investments in health reforms (FDA, bundled payments); 8% overall growth in federal spending for Medicaid and Medicare but effective rate increase of 0.1%; insurance reform9 Copyright © 2009 Deloitte Development LLC. All rights reserved.

55. Presidential news conference on July 22, 2009:“health insurance reform” 1 Health reform is necessary to reduce escalating costs of the system that threaten economic recovery. The result of inaction is economic collapse: employers will drop employee benefits coverage or shift financial burdens to employees who cannot afford premiums. The “status quo” is not an option. 2 Reform of the system must be deficit neutral: added costs for covering “47 million lacking insurance” (there are actually 45.7 million) and changes to the delivery system must be offset by savings or new revenues. The White House believes a combination of two-thirds from savings and one-third from taxes on high income households is the appropriate funding mechanism. 3 The President supports a public plan option available to uninsured and under-insured individuals and small businesses. Repeating an oft-used phrase, the President supports the public plan option to “keep the plans honest” and provide competition to commercial plans. NOTE: A positive earnings report from “a major plan” released today was referenced as evidence plans benefit at the expense of patients by denying coverage or refusing to pay for needed care. 4 Agreement among legislators is a “work in progress”: there is agreement that individual mandates, a comparative effectiveness program, health insurance exchanges, fraud reduction, health information technology utilization and integrated delivery systems are key elements. Pressed about partisan issues and defections among moderate Democrats due to the costs of the plan, the President defaulted to the legislative process: messy, necessary, and soon to result in a reform bill. The forthcoming work in the Senate Finance Committee is a key part of the process. 5 Key industry stakeholders support the need for reform: in his remarks and responses to reporters’ questions, three references to AARP and two each to AMA, ANA and PhRMA were used to suggest the White House has industry support. 6 To deflect criticism of government intrusion in coverage decisions and payment calculations for providers, the White House supports the development of an independent board to make recommendations. Congress would have 30 days to prevent implementation based on a vote. It would make determinations about advisable diagnostic and therapeutics based on evidence and costs. It would also set payment rates for providers based on its assessment of comparative effectiveness and value. NOTE: Sen. Jay Rockefeller proposed MedPAC as the independent entity; OMB Director had previously proposed a new entity, IMAC (Independent Medicare Advisory Commission). 7 The President anticipates signing a bill in 2009 but did not state his determination of a bill by the August recess. 10

56. Key players: Congressional Committee leadership Senate Finance Committee Senate Health Education, Labor and Pensions CHUCK GRASSLEY: Senior Senator from Iowa TED KENNEDY: Senior Senator from Massachusetts MAX BAUCUS: Senior Senator from Montana House Ways and Means Committee House Energy and Commerce Committee House Education and Labor GEORGE MILLER: Member of the U.S. House of Representatives from California's 7th district CHARLES RANGEL: Member of the U.S. House of Representatives from New York’s 15th district HENRY WAXMAN: Member of the U.S. House of Representatives from California's 30th district 11

57. Key players: Two offices of health reform Kathleen Sebelius: United States Secretary of Health and Human Services Nancy-Ann DeParle: Director of the White House Office on Health Reform 12 Copyright © 2009 Deloitte Development LLC. All rights reserved.

58. Some major proposals have emerged: more to come 13 Copyright © 2009 Deloitte Development LLC. All rights reserved.

59. The most delicate issues will be: 14 Copyright © 2009 Deloitte Development LLC. All rights reserved.

61. Administrative simplification, coordination of care, utilization management key initial focus(excerpt from publicly available document) 15

62. The reform bill will likely include four strategies to reduce cost to fund improved quality and increased access for uninsured It will take 6 years implement major reforms Savings can be more than $2 trillion if implementation is accelerated via payment reform, IT adoption Net result: reduce CAGR to 4.5% 4 Consumerism Focus: CDHPs, transparency, PHRs, incentives, value Coordination of care Focus: Primary Care 2.0 Model (the new “Medical Home”) 3 Comparative Effectiveness/Evidence – based Medicine Focus: (1) Personalized medicine, (2) comparative effectiveness; episode based payments to acute organizations 2 Health Care Information Technology Focus: (1) e-prescribing, (2) care coordination (3) administrative cost reduction 1 16 Copyright © 2009 Deloitte Development LLC. All rights reserved.

63. The impact of major reforms will vary by sector Modest Moderate impact Significant impact 17 Copyright © 2009 Deloitte Development LLC. All rights reserved.

64. Paying for health reform: proposed sources of funding 18

65. Contact information For more information, please contact: Paul H. Keckley, Ph.D., Executive Director, Deloitte Center for Health Solutionspkeckley@deloitte.com202-220-2150 For more information on the Center's view of health care in the new administration, please visit: www.deloitte.com/us/healthreform And visit our website to subscribe to our content:www.deloitte.com/CenterforHealthSolutions/subscribe Copyright © 2009 Deloitte Development LLC. All rights reserved.

66. US Congressman Marsha Blackburn 7th District of Tennessee

68. BREAK SPONSOR

70. TRACK SPONSOR

72. Looking under the covers - Measuring Quality/Value A Panel Discussion - August 6, 2009 John R Morrow www.HospitalValueIndex.com

73. A Panel Discussion - August 6, 2009 Agenda John R. Morrow – The Ratings Guy Justin Lansing – Credence Healthcare Eddie Pearson – Healthstream Miriam Paramore -- Emdeon

74. A Panel Discussion - August 6, 2009 What is Value?Why Transparency? Transparency is a form of openness, a medium of communication and a measure for accountability; opposite of privacy. Banking - R. Levine, policy of transparency improved efficiency Corporate – Sarbanes-Oxley Act – confidence in capital markets Management – PCAOB –oversight, independence, disclosures Media – FOIA provides access Politics – ethics, law, policy, economics, media, social new media Research – Peer review, double blinded clinical trial Sports – World Anti Doping Agency

75. A Panel Discussion - August 6, 2009 Transparency in Health Care Before HCFA realized it was a purchaser of health care we relied on FOIA for: Financial, and Operating Reports Clinical experience Outcomes Mortality Complications Research

76. A Panel Discussion - August 6, 2009 Transparency in Hospitals After CMS realized spending, utilization outcomes and experience were all different: Ratings outpaced CMS w/Web & social media Industry shamed by IOM findings Quality differentiation made markets Info systems and industry standards drive new insights Greater disclosures by CMS forces accountability Value based purchasing to determine reimbursement Better management embraces disclosure & accountability

77. A Panel Discussion - August 6, 2009 What We Can Now See Core Process Measures Patient Safety Indicators HCAHPS – Patient Experience Financial reporting Clinical reporting – RAMI, RACI, Post discharge mortality & readmissions Population utilization

78. A Panel Discussion - August 6, 2009 What We Want to See and Do Institutional – more of the same…faster. Purchaser/Employer Sponsored – what’s under the shell, what’s it all mean Consumer/Patient/Person – How about the real price? My personal records and data? Everything that John and thepanel can show me…Why Not?

79. A Panel Discussion - August 6, 2009 How? Defining Value by provider engages the patient/provider relationship For routine care, services are a commodity where quality is not always a factor, For complicated cases, experience with better outcomes becomes a factor, All require disclosure and transparency so the patient can apply their own value judgment and participate in their own decision making about utilization, Value incorporates all known aspects of outcomes with a published fair price.

80. A Panel Discussion - August 6, 2009 Value is what Value does Outcomes Mortality & Complication rates Patient Safety Indicator rates Readmission rates Efficiency rates Satisfaction & Experience Rates Post-discharge functional status SF-36 Affordability

81. A Panel Discussion - August 6, 2009 Value like Transparency Creates efficiencies, removes barriers Improves communication – EMR/PHR Differentiates to the community Form990 Integrates the patient into the care process Builds the foundation of the medical home Shares the responsibility and accountability Increases compliance; realigns priorities

82. A Panel Discussion - August 6, 2009 Your Panel Justin Lanning – Credence Healthcare Eddie Pearson – HealthStream Miriam Paramore – Emdeon John Morrow – www.HospitalValueIndex.com

88. August 6, 2009 45 Transparency in Healthcare Miriam Paramore, SVP Strategy & Government Affairs

89. Emdeon: A Leader inToday’s National Health Information Network 155 million Patients 350,000 1,200 5 billion Providers Payers RCM & Payment Distribution Healthcare Information PBM Services ePrescribing Pharmacies 55,000 46 46 Emdeon – We make healthcare efficient.

90. efficient healthcare 47 Emdeon – We make healthcare efficient.

91. Healthcare Reform Is Demanding Price Transparency (Senate HELP Bill) 48

92. Healthcare Reform Is Demanding Price Transparency (House Tri-Committee Bill) 49

93. What is Transparency Hard? 50 Emdeon – We make healthcare efficient. Price Healthcare is not retail – there is no price at the point of service What a hospital charges is not the “price” What an insurance company pays is the “price” But the consumer can’t buy at that “price” Quality Data is not digital Lack of standards means even digital data is meaningless There is no good clinical information exchange Consumer-friendly communication of medical terms is difficult

94. HIMSS Price and Quality Reporting White Paper (coming very soon) 51 HIMSS Financial Systems Steering Committee 6 Public-Private Collaborations 7 State & Local Initiatives 5 Value Driven Healthcare Initiatives 3 Business Coalitions Total = 21 separate initiatives

95. efficient healthcareFunding Healthcare Reform 52 Emdeon – We make healthcare efficient.

96. Where Does the Money Go? 85% 15% Admin Costs = $360 B Cost of Care = $2 T Total U.S. Healthcare Spend = $2.4 Trillion 53

97. “Gang of 6” Letter to President Obama 54 54 Emdeon – We make healthcare efficient.

98. “Gang of 6” Recommendations 55 Utilization of care Cost of doing business Administrative simplification: Streamlining the claims processing system will allow clinicians and other personnel to spend less time and fewer resources on paperwork, lowering costs for everyone. Chronic care 55 Emdeon – We make healthcare efficient.

99. U.S. Healthcare Efficiency Index™Launched December 2008 56 56

100. U.S. Healthcare Efficiency Index™Advisory Council (partial list) 57 57 Emdeon – We make healthcare efficient.

102. Peter Orzag: Cuts will save Medicare patients money “as much as $43 billion in reduced premiums for prescription drug coverage over the next 10 years.”$43 billion over 10 years through Medicare/Medicaid cuts vs. $150 billion over 5 years through HIT 58 Emdeon – We make healthcare efficient.

103. what would u dow/ $150 B?ushealthcareindex.com

105. Discussion

107. TRACK SPONSOR

108. Panel Discussion: PHR, EHR or EMR – A real solution or just Alphabet soup? Moderator: Daniel Fell, Partner NDP Panelist: Steve Starkey, COO/CIO, HMS Mikell van derLaan, Manager of Architecture, CHS PHR EHR EMR

109. Discussion

111. Lunch Sponsor