Presentation to 2014 Virginia Health Care Conference June 5, 2014

© 2014 The Advisory Board Company advisory.com 2 Trusted Advisor to America’s Leading Health Systems Three Decades of Experience Translating Policy into Practice Source: The Advisory Board Company. 1)Includes urban and rural health systems; academic medical centers and community hospitals; safety net hospitals; non-profit and for-profit hospitals; and the VA. Key Areas of Expertise Health care delivery system transformation targeted at higher quality and more efficient care, including development of ACOs and medical homes Improvements in clinical operations and health care cost reduction, such as strategies to decrease readmissions Development and effectiveness of health information technology and data analytics Health care financing and revenue management, including technologies to administer risk-based payments Health care workforce, leadership development, and staffing strategies Broad Membership Yields Deep Insights 2,200 Advisory Board health care professionals worldwide 3,600 Member institutions, including health systems in all 50 states 1 165,000 Members among the 100 largest US health systems 10,000 Research interviews annually with health care leaders 99>1,000 Health care leaders participating in memberships Small-to-medium community hospital members

© 2014 The Advisory Board Company advisory.com 3 Our Firm in Numbers RESEARCH AND INSIGHTS Dedicated to the most pressing issues and concerns in health care 300+ industry experts on call 200+ customizable forecasting and decision- support tools Memberships Offering Strategic Guidance and Actionable Insights PERFORMANCE TECHNOLOGIES National Peer Collaboratives Powered by Web-Based Analytic Platforms Leading provider: Over 50% of inpatient admissions in the United States flow through our technology platforms Over 1.5 million user sessions annually Key challenges addressed: physician performance, population health, revenue cycle, referral growth, surgical profitability, and supply/ service cost CONSULTING AND MANAGEMENT Seasoned, Hands-On Support and Practice Management Services 2,500+ years of “operator” experience in hospital and physician practices Principal terrains: hospital- physician alignment/practice management, transition to value-based care, revenue cycle optimization, hospital margin improvement Range of engagements from strategy/diagnostic to best practice installation to interim management to fully managed services TALENT DEVELOPMENT Partnering to Drive Workforce Impact and Engagement Impacted the achievement of 76,000+ executives, physicians, clinical leaders, and managers 17,000+ outcomes-driven workshops tailored to partners’ specific needs Survey Solutions Customized strategies for improving employee and physician engagement National health care-specific benchmarking database of 480,000 respondents 165,000+ health care leaders served globally $500+ million in realized value per year 1,300+ engagements completed 6,200+ employee-led improvement projects 3,600+2,200+1,500+ Hospitals and health care organizations in our membership Health care professionals employed Hospitals using our performance technologies

© 2014 The Advisory Board Company advisory.com 4 Scaling “Best Practices” to Accelerate and Sustain Transformation Advisory Board Approach to Innovation Health Care’s Original “Big Data” Asset Field Intelligence Data Science Proprietary Methodology Tomorrow’s problems today 80/20 process leverage points Scalable, sustainable BDPs Member activation model Our Sustainable ROI Model Directive Technologies Action, Not Analysis Performance Blueprints Roadmaps to Rapid Results Applied Expertise Right Expert Against Right Lever Network-Driven Innovation Iteratively Attacking Hard Problems Clinical Integration Referral Management Labor and Supply Cost Care Variation Driving Enterprise- Level Outcomes Patient Engagement Predictive Care Plans Network Optimization

© 2014 The Advisory Board Company advisory.com 5 Offering Data and Analytics to Improve Cost, Quality Performance Technologies Improving Value at Front Lines of Care Source: The Advisory Board Company. Advisory Board Technologies 360,000 Physician cost and quality profiles 1,500 Hospitals using Advisory Board technology 50% US admissions flowing through Advisory Board IT tools Advisory Board Technology Suite Improving Quality of Care Population Risk Management Preventive and Chronic Care Cross-continuum Care Management Patient Engagement and Experience Patient Safety and Care Quality Lowering Cost of Care Supply and Labor Costs Care Variation Reduction Aligning Incentives Value-based Contracting ICD-10 Transition Representative Results Achieved by ABC Members $385K $354K $25.38 $17.61

© 2014 The Advisory Board Company advisory.com 6 Gaps in awareness of all available information lead to sub-optimal outcomes Opportunity to Personalize Care Static Unstandardized Missing Data Case Manager Assesses Risk of Readmission Nurses Screen for Delirium Risk Care Managers Assess Risk of Non-Compliance ICU M.D. Office 6 th Floor Cardi ac Care Current Attempts to Improve Precision Fraught with Shortcomings

© 2014 The Advisory Board Company advisory.com 7 Natural Language Processing to Detect Risk Factors Buried in Clinician Notes Crimson Real-Time Clinical Analytics Sample Findings of Text Analytics

© 2014 The Advisory Board Company advisory.com 8 Algorithmic Early Warnings Enabling Proactive Risk-Reducing Interventions across Care Settings Crimson Real-Time Clinical Analytics Clinical Risk Surveillance Risk of DVT Core measure patient identification Sepsis early warning score Risk of mortality Referral Flags Pain management consult Mental health consult, undetected depression Palliative care consult Social work consult Clinical Utilization Risk Risk of readmission Risk of avoidable admission Risk of extended length of stay Risk of extended ICU LOS Revenue Risk Management Ensure medical necessity is met Alert to present on admission Documentation opportunities Computer- Assisted Coding Customized Surveillance Alerts

© 2014 The Advisory Board Company advisory.com 9 Precise Risk Stratification, Risk Factor Identification Drives Reduction Enabling Readmission Reduction within the Medicare Population at Baylor Health Change in HF and PN Readmissions Rates at Baylor Health System Readmissions Rate (%) Quarter (Time) Readmissions Rate (%) Quarter (Time) 16% relative reduction 70% relative reduction

© 2014 The Advisory Board Company advisory.com 10 1 in 4 Patients with Depression Conditions at High Risk for Readmission Identifying Population Level Risk Factors Enables Efficient Resource Allocation

© 2014 The Advisory Board Company advisory.com 11 Complementary Changes Required to Create a Value-based System Unlocking the Full Value of “Big Data” Stages of Analytical Progression and Value Creation Incentives Alignment Right rewards for clinical transformation Lowering costs (and perceived threats) of data sharing Integration with Workflow Minimally-disruptive to native workflows Contextually- appropriate “answers” IT Interoperability Lower the total cost of accessing data, systems Data unification across systems Cultural Transformation Comfort with performance transparency Data “improvement”, not data “perfection ” Descriptive Predictive Prescriptive How many of my diabetic patients are overdue for their a1C test? Which of my diabetic patients is least likely to respond to my outreach to get a blood test? Which outreach message should I send to each diabetic patient to maximize response rate?

© 2014 The Advisory Board Company advisory.com 12 Policy Can Play Role in Fostering Interoperability Lower Cost Connectivity Will Accelerate Innovation Require standard APIs in Meaningful Use Stage 3 Any API would need to be published, public, and open to use by any third- party Commonly required APIs should expand over time Opportunities for Policymakers to Encourage Interoperability Further specify standards for data transport Current standards make data transfer possible, but not financially viable Reducing financial barriers to data integration would spur rapid and broad innovation Drive greater data sharing between providers and payers Would facilitate better population health management At a minimum, providers should have access to full claims data under risk-sharing arrangements

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