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

2. 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

3. 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

4. Dignity Health Today One of the largest health systems in the nation20
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

5. 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, MDs in foundation or employment models

6. 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

7. 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

8. Thank You