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BANNER HEALTH OVERVIEW April 14th, 2018 Charlie Agee, MD Vice President, Care Management Chief Medical Officer, Academic Delivery

Agenda About Banner Health Care Management and Clinical Consensus Groups Outcomes and Sustainability Examples

About Banner Health

“Making health care easier, Mission & Values Our Nonprofit Mission “Making health care easier, so life can be better.” Our Values Customer Obsessed Relentless Improvement Courageously Innovate Disciplined Focus Foster Accountability Continuously Earn Trust This Mission statement drives reinvention focused on the consumer. It is our call to action and how Banner is going to win the heart of Sofia, and those we serve. Banner’s Values define the culture of Banner and how these values are demonstrated through actions and behaviors. We've simplified our values and created six new values to define the culture we want at Banner and expected behaviors to focus on consumers.

Banner at a Glance

Banner Health Operating Model Key Descriptors Banner Health Operating Model An Operating Company Performance-based, data-driven, outcomes focused Clinical quality focus Standardized best-practice operations and care delivery Continuously improving A Strong, Scalable Foundation Talent Mapping IT – a single, scalable IT platform – get the right people in the right place Centralized Support Services - for economies of skill and services

CARE MANAGEMENT & CLINICAL CONSENSUS GROUPS Governance structure Physician involvement with design and implementation of an EMR

Care Management Structure Medical Leadership is focused leading and supporting the delivery of consistently superior outcomes for patients Care Practice Support provides the structure and the function to allow our providers and clinicians to deliver consistently reliable care. Process Design and Improvement functions help design and improve care processes and practices. Clinical Innovation, Education, and Research function synergistically to provide standardized, accountable, consistent, and evidence-based clinical practice, educational, and research programs for Banner Health.

Clinical Consensus Groups (CCG) Purpose: Define expected clinical practices for Banner Health based on best available evidence, including practice- based evidence. Clinical Consensus Groups Many teams support the design and build of reliable systems for that standard of care Program management CCGs and Clinical Practice Development Process Engineering Clinicians and Engineers assist with Design Informatics Clinical & Medical Professionals assist with design & build Quality CPA Clinical Performance Analytics Clinical Education Translating the scientific understanding in the medical field to direct patient care has historically taken 17 years from proof of practice. Banner’s Clinical Consensus Groups, known as CCSs aim to shorten that time frame significantly. To support the CCG structure we have program management, process engineering, Informatics, Quality, Clinical Performance Analytics and Clinical education.

Clinical Consensus Group Accountabilities Identify opportunities for improving clinical care: Define expected clinical practices for Banner Health based on best available evidence including practice based evidence Approve clinical practice designs Charter define and design workgroups to operationalize how the clinical practices will be performed and implemented Review, revise and approve Computerized Provider Order Entry (CPOE) caresets, powerplans, etc… Attain appropriate collaboration and approvals for clinical practices Measure and monitor the success of the clinical practice

Clinical Consensus Groups ED Pulmonary Palliative Care NICU/Newborn Neurosciences Critical Care Behavioral Health Anesthesia Pediatrics Women’s Health Post Acute Care Medical Imaging Primary Care Hospital Medicine Cardiology Nephrology Surgery Pharmacy & Therapeutics Infectious Disease CV Surgery Oncology Ortho Clinical Leadership Team

“Engineering” New Models Research Practices Reach Consensus on requirements Define Describe reliable workflow and roles Develop tools Design Communicate and train Address issues Monitor Implement

Related Groups

Outcomes and Sustainability Examples

2017 Clinical Reliability Strategic Initiative Measure Definition Target/Stretch Desired Direction YTD Improve Care Reliability Reliability Achievement in Defined Care Domains Index 1/1.1 ↑ 1.114 Patient/Member Engagement Reliability Advance Directive Banner Employees* 14.9/16.5% 18.98% Acute Care Reliability Medication Reconciliation 76.1/79.7% 77.9% Care Practice Adherence for Observation Patients 48.0/53.0% 56.7% Preventive Care Reliability Care Practice Adherence for BHN Composite 67.0/71.3% 64.04% Chronic Care Reliability Chronic Care Practice Adherence for BHN Composite 77.3/81.2% 92.75% Complex Chronic Care Reliability Post-Acute Alignment 44.1/46.2% 46.0% 2017 Clinical Reliability Strategic Initiative

Strategic Initiative Trends

Care Practice Adherence Impact on Observation LOS

Central Line Associated Blood Stream Infections (CLABSI) Per 1000 patient days with a central line Source: Acute Care Board Report, 1/17/2018

Primary Stroke Center Time to Intravenous Thrombolytic Therapy Times - Median Added Tucson data, starting 4Q 2017 Linda Miller, CPA, 1/24/2018 Cerner, TSI

Blood Utilization for Hip/Knee Replacement BI Mature Initiatives Dashboard Cerner, 2/18/2017

C-sections for full term, singleton babies Obstetrical Care Early Elective Deliveries C-sections for full term, singleton babies All Data from Data Abstraction Midas 2/18/2017

Standardized Infection Ratio (SIR) CAUTI Results 2013-2016 Standardized Infection Ratio (SIR) 2014 1.175 2015 0.657 2016 0.566 Source: Infection Prevention

QUESTIONS Charlie Agee, MD Vice President, Care Management Chief Medical Officer, Academic Delivery http://bannerhealth.mediaroom.com