Integrated Health Systems

1. Munroe Regional Medical Center Physician Education Session Prepared for: Key Physician Stakeholders Munroe Regional Medical Center Ocala, FL July 11, 2011

3. Ken Keller Vice President Chris Rowe Vice President

5. Munroe Regional Medical Center Medical Staff Education Session Prepared for: Medical Staff Munroe Regional Medical Center Ocala, FL September 15, 2011

6. 6 Southwind Team Ken Keller Vice President Chris Rowe Vice President

8. Invest in chronic disease management

9. Reduce utilization

10. Collaborate with post-acute providers

12. Reduce orders and consults

13. Track and analyze performance

14. Standardize care processes

15. Align physician incentives

16. Engage full physician enterpriseActions needed under all payment reforms Provider Quality and Cost Accountability Source: Health Care Advisory Board interviews and analysis; Southwind.

17. 8 Foundation for Aligning Independent Physicians

18. 9 Goals of Clinical Integration Goals of Clinical Integration Create a platform for the physicians and Munroe Regional to: Optimize clinical outcomes Enhance patient experience Create a culture of working together as a clinically integrated system Improve clinical outcomes through accelerating the adoption of evidence based protocols/medicine, clinical information technologies, and quality improvement techniques; Enable greater coordination of care among physicians and Munroe Regional across the continuum of care; Reduce unnecessary utilization, improve efficiency, and control the cost of care; Enable joint contracting with FFS payers based upon demonstrated ability to improve performance with financial incentives for continued improvement; and Align incentives for all those involved in healthcare financing and delivery

19. 10 What does Clinical Integration Achieve? Benefits of Clinical Integration Collaboration among physicians and hospital(s) in a way that increases the quality and efficiency of patient care; A powerful business, clinical, and legal strategy for physicians and hospital(s) to thrive within the advent of consumerism, pay-for-performance and mandated transparency; Comprehensive physician networks which are able to assert themselves forthrightly in legally compliant collective negotiations with fee for service health plans; and The foundation and infrastructure for succeeding in the upcoming era of “accountable care”

20. 11 Legal Compliance at Core of Success “Clinical Integration” Coined by the FTC Recognizes joint contracting may be acceptable on the basis of value creation for patients and payers Establishes a “Clinical Integration” concept as a defense against price-fixing challenges Allows for layering CI-related contracts on top of existing models of economic alignment Provides general concepts but limited detail on desired CI program structure “Clinical Integration is an active and ongoing program to evaluate and modify practice patterns by a network’s physician participants and create a high degree of interdependence and cooperation among the physicians to control costs and ensure quality.”

22. Involves all physicians in the networkPromotes collaboration and interdependence so physicians can achieve more than they likely could independently Program initiative have the potential to achieve “likely improvements” in health care quality and efficiency Joint contracting with fee-for-service health plans is “reasonably necessary” to achieve the efficiencies of the Clinical Integration program

24. Review of key documents and strategic priorities

25. Market conditions assessment

26. Structure and staffing infrastructure

27. Clinical protocols and performance targets

28. Data monitoring and report processing

29. Technology infrastructure

30. Goal clarification and stakeholder identification

31. Education and Q&A sessions with key executive and physician leaders

32. Identify potential physician championsStep Two– Strategy Implementation Providing legal counsel and support Enfranchising key stakeholders

34. 16 Our Commitment to You Ken Keller Vice President Chris Rowe Vice President KellerK@advisory.com 818.669.2180 RoweC@advisory.com 985.788.1522 Please do not hesitate to contact your team with any questions or comments.