Dignity Health Population Health Management Julie Bietsch, VP PHM March, 2017

Impact of Change in ACA Who knows what is going to ultimately happen We believe that reform is necessary however elimination without an affordable solution is not an option Key provisions will probably survive i.e., children on parents policy, pre-existing conditions Medicaid Payment Reform worries us the most The CMMI Payment Innovation has led to significant changes and would hate to see that stop The conversion from Volume to Value cost us more than we thought FFS would be easier for our health system but not the right solution for our Country Dignity Health will continue to pursue quality and cost efficiency to improve health outcomes for our consumers

Dignity Health: Moving Towards Accountable Care Strategies to build a system poised to address the demands of accountable care Current Episodic Care Volume Driven/Fee-For-Service Payment Systems Acute Care Provider IT Systems in Silos Hospital-Physician Centric Interactions Future Population Management Bundled Payments/Pay-For-Performance Diversified and Integrated Delivery System Integrated Information Systems Across Multiple Care Delivery Locations (Acute, Ambulatory, Home Health, Retail) Horizon 2020 Strategies Growth, Cost, Quality, Integration, Connectivity, Leadership Mission, Vision and Values

Dignity Health Today One of the largest health systems in the nation 20 400+ 9,000 State Network Care Sites  Affiliated Physicians $16 56,000 39 Billion in Assets Employees Acute Care Hospitals 911,000 Value Based Members (Including 450,000 capitated lives) Provide integrated, patient-centered care to more than two million people annually Diversified service offerings and partnerships support population health Hospitals in Arizona, California, and Nevada Growing national footprint As of September 30, 2014

Dignity Health Service Area Value Based Agreements System-Level Business Strategy Southern CA Central CA Central Coast Bay Area Nevada SRQCN Sacramento GSSA North State NSQCN Arizona ACN Inland Emp SCICN-IE Bakersfield VIPN Ventura SCICN-Ven Sequoia SQCN LA North Valley SLO/SB PCQCN SF Santa Cruz Total Value Based Agreement membership 911k through December 2016 Models include CINs, Risk, ACO, PCMHs, Shared Savings, Narrow Networks, Bundles Products include HMO, PPO, EPO, Employer Relations, Commercial, Medicare Advantage, MSSP and Medicaid 5500 Total MDs in CINs, 1400 MDs in foundation or employment models

Key Pillars to Drive Success in Risk Models Establish integrated clinical teams & support with tools and data Align IPA relationships focused on clinical and business opportunity Acute & Post Acute Clinical Strategies Complex Care & Community Programs Align with physician partners working with hospital to join IPAs and accept patients Clinical team includes MD, Nurses, SW, Exec Dir, Analytics Transfer Center: ER admission focus MD peer to peer Ambulance Transfer Proactive working sessions with IPAs to implement initiatives to improve patient care Align incentives through draw rates, vendor contracts and shared savings programs LOA Process clinically reviews elective requests to non-Dignity Health facilities, negotiates tertiary and vendor contracts Attending, hospitalist & CM relationships & sharing of best practices and resources across system Focus on key competing hospitals for cause of admission and CAP Develop PAC preferred network that will accept patients and have better outcomes Predictive Analytics drives member identification & engagement. Shared with IPAs Improve delegation activities by payer Respite beds Substance Abuse, Mental Health and Homeless Population Programs

What do we want from Telehealth Focus on solutions to address the rising complexity of our baby boomer Senior population Deliver a solution to reduce cost pressures Offer more than a phone Solutions need to support social opportunities Solutions need to support the patient regardless of the settings

Thank You