1. Jamestown Health Department Agenda 1.Where Are We Now? 2.Where Are We Going? 3.Challenges

2. Jamestown Family Health Clinic OVERVIEW (October 2015 to June 2016) Total Patients in Epic: 12,000+ Individual Patients Seen YTD: 10,188 Total Visits: 37,009 Providers: MD/DO: 12 ARNP: 9 PA-C: 5 Counselor: 3 Pharmacist: 1 Where Are We Now?

3. Population Demographics Payor Mix% Commercial35% Medicaid17% Medicaid HMO1% Medicare41% Medicare HMO4% Other Govt2% Self-pay0% Worker's Comp1% Age SexFMTotal % 0-12257 0% 13-176881149 1% 18-29583415998 7% 30-396524421094 7% 40-497855251310 9% 50-5913609162276 15% 60-69230815613869 26% 70-79180514783283 22% 80-898477091556 10% 90-99273183456 3% 100+729 0% Total8690631715007 58%42% Where Are We Now?

4. Revenue Payer Mix: significant increase in Medicaid revenue Currently have about 34% Medicaid; increased by 10%. Open to New Medicaid (Apple Health) and Medicare Patients Medicare and Medicaid Encounter Rates Medicaid: $360 Medicare: PPS Rate $160.60 EP $214.46 NP/AWV/W2M Where Are We Now?

5. Revenue Family Medicine Where Are We Now?

6. Revenue Healthy Aging Where Are We Now?

7. Dental Received 300K Dental Foundation of Washington grant Added 4 new dental operatories Added Pediatric Dentist Where Are We Now?

8. Tribal Wellness YTD Home Services Foot and Nail Care Respite Care Clients Respite Care Hours Home Visits Transports Other Services Phone Calls Flu Shot Assistance Where Are We Now?

9. Jamestown Health Department 2.Where Are We Going?  Operational Goals  Wellness Program  Policy and Government

10. Operational Goals 1.Let’s Improve the Lives of Our Patients 2.Let’s Inspire and Develop Our People 3.Without a Margin, There is No Mission Where Are We Going?

11. Let’s Improve the Lives of Our Patients  Create Culture of Patient Centered Care  Healthy Hearts Initiative  Improve Patient Experience  QA/Compliance Where Are We Going?

12. Let’s Inspire and Develop Our People  FLIP – Frontline Leadership Initiative Program  Give a WOW Program  Create Happy and Dedicated Staff Where Are We Going?

13. Without a Margin, There is No Mission  Communicate Goals and Targets  Develop Lean Processes  Increase and Protect Revenue Streams Where Are We Going?

14. Tribal Wellness Program  New Diabetes Program  New Community Health Re-design  Better Communication of Programs  Collaboration of Services Where Are We Going?

15. Government and Policy  Active Participation o Northwest Portland Area Indian Health Board o American Indian Health Commission o Olympic Community of Health o Self-Governance  Policy Tracking o Medicaid 1115 Waiver o BHO Waiver o Legal Utilization of Health Net Profit Where Are We Going?

16. Jamestown Health Department 3.Challenges  Population Health Management  Value-Based Reimbursement  How Does a Tribal Health System Fit into Evolving National/State Plans