Dr. Roger Ray, Executive Vice President/Chief Medical Officer “The Experience of a Large IDN” November 1, 2013

Today’s Agenda Carolinas HealthCare System Key Drivers Imperatives Interim Measures of Performance 2

Carolinas HealthCare System Overview 3

Carolinas HealthCare System (CHS) Second largest public, healthcare system in the nation Largest healthcare system in the Southeast 40 hospitals, 11 nursing homes and over 900 outpatient service locations Over 2,300 employed physicians and nearly 400 residents delivering care in over 500 sites Forecasted 2013 net operating revenue: $7.8 billion AA-rated since

Breadth of CHS Summary of System 60,000 employees >900 care locations Nearly 7,500 licensed beds 11 long-term care facilities 12 home health agencies 9 hospice providers 8 freestanding EDs One of 5 academic medical centers in the state of North Carolina Summary of System 60,000 employees >900 care locations Nearly 7,500 licensed beds 11 long-term care facilities 12 home health agencies 9 hospice providers 8 freestanding EDs One of 5 academic medical centers in the state of North Carolina Key Statistics – Projected million patient encounters Over 6.2 million physician visits 281,393 inpatient discharges 573,323 adjusted discharges 1,079,393 ED visits Key Statistics – Projected million patient encounters Over 6.2 million physician visits 281,393 inpatient discharges 573,323 adjusted discharges 1,079,393 ED visits Rehabilitation Hospitals LiveWELL Carolinas Primary Care Practices Health Clinics Urgent Care Centers Hospitals Behavioral Health Nursing Homes Home Health Continuum of Care Emergency Care Centers Ambulatory Surgery Centers Hospice & Palliative Care Specialty Care Practices 5

Physician Services at CHS First practice in 1988 Over 600 locations across North Carolina, South Carolina and Northern Georgia Carolinas Physician Network NorthEast Physician Network Faculty Physicians Levine Cancer Institute Regional Physician Network (Scotland, Columbus, New Hanover, Cleveland, Wilkes, St. Luke’s and Anson) Regional Hospital Groups (Roper, Cone Health, AnMed, Murphy, MedWest, Blue Ridge, Stanly) Total CHS Employed Physicians: 2,317 First practice in 1988 Over 600 locations across North Carolina, South Carolina and Northern Georgia Carolinas Physician Network NorthEast Physician Network Faculty Physicians Levine Cancer Institute Regional Physician Network (Scotland, Columbus, New Hanover, Cleveland, Wilkes, St. Luke’s and Anson) Regional Hospital Groups (Roper, Cone Health, AnMed, Murphy, MedWest, Blue Ridge, Stanly) Total CHS Employed Physicians: 2,317 6

Clinical Integration Outreach Remote ICU monitoring center will enable consistent, high quality care across the System Levine Cancer Institute is focused on delivering care at the community level Branded Clinical Programs Levine Cancer Institute Carolinas Hospitalist Group Sanger Heart and Vascular Institute Neurosciences Institute Remote Critical Care Services Carolinas Stroke Network Carolinas Trauma Network Branded Clinical Programs Levine Cancer Institute Carolinas Hospitalist Group Sanger Heart and Vascular Institute Neurosciences Institute Remote Critical Care Services Carolinas Stroke Network Carolinas Trauma Network 7

Key Drivers 8

Prospering in a Changing Environment Volume Value team accountability standardization engaged physicians cost containment improved quality safe patient-centric transparency care coordination innovation team-based care information technology uncoordinated facility based variable Silo work volume-based fee for service reactive Issue-focused Individual patient focus Individual responsibility & autonomy Current Strain 9

Imperatives 10

#1. What are we trying to accomplish? Degree of Integration Impact on Value: Quality, Service, Cost Coordinated Operations Shared Clinical Standards Managing Care Across Continuum Assembling Scale for Leverage 11

Quality Service Cost #2. Focus on Value in Three Dimensions 12

#3. Determine Budgetary Constraints What Short-Term Outcomes Can Be Tolerated? 13

– Physician leadership and engagement – Team approach to care and improvement – Devotion to Evidence-Based Care (EBC) – Culture of accountability Providers that can develop innovative ways to meet demand, reduce cost and exceed quality requirements will prosper. #4. Procure Physician Leadership 14

#5. Transform Primary Care An integrated system of primary care that proactively identifies patients needs and provides appropriate level of coordinated continuum of care services leading to optimal patient outcomes, outstanding care experience, efficient utilization of resources. 15

#6. Reduce Readmissions and Overutilization Variation in Imaging Utilization by Network Type Hospital Outpatient Utilization Rates per 1000 Covered Lives Milliman MedInsight Benchmarks Well-managed networks using 45-60% less imaging than those managed loosely The Advisory Board, 2012 High cost drugs Unnecessary lab testing Testing in higher cost settings Avoidable ED visits Readmissions 16

#7. Integrate with palliative care, home health, etc. 17

#8. Leverage Virtual Care and… Growth of existing services Expansion of new services Connectivity Legislation 18

#9. Organize, Prioritize & Align Care Management 19

Interim Measures 20

CHS Recognitions Society for Thoracic Surgeons American College of Cardiology Project Impact CHS has been recognized nationally for delivery of high quality medical care and exceptional customer service. 21

CHS Disease Specific Certifications 55 22

CHS Is A Leading Health System DATA POINTS 1: OVERALL 2: Mortality 3: Complications 4: Patient Safety 5: Core Measures 6: ALOS 7: HCAHPS QUINTILES 80 to to to to 40 0 to Comparison group: N = 85 ©2012 Thomson Reuters. All rights reserved. 23

CMS National “HEN” Ratings HENPointsHENPoints Carolinas34Tennessee22 Nevada29UHC22 New York28Washington22 NC-VA28Iowa21 Ascension27Minnesota21 LifePoint27Intermountain18 Ohio27Michigan17 Dignity26Premier16 New Jersey26VHA15 DFW25NPHHI14 Georgia24AHA13 Ohio Children’s24TJC-R11 Pennsylvania22TCQPS8

Quality Update Appropriate Care – Manual Audits Q2 QCC FavorableFavorable

Diabetes Poor Control Hemoglobin A1c >9% HEDIS Definition FavorableFavorable **HEDIS 90%ile Commercial all LOB (INCLUDES A1C UNTESTED RATE)

27 Questions/Discussion