1. Tulare Regional Medical Center

2. Agenda Key data Why change is necessary Ideal solutions Conclusion

3. Key Data 112 bed, acute-care hospital 3 Rural Health Clinics, 2 more clinics opening Medical tower expansion Significant growth potential

4. Service Area Demographics Population estimate: 171, 438 Average age: 30.3 57.9% Hispanic High poverty rates

6. Why Change is Necessary Lack of physician alignment Quality perception Disproportionate market share Current payer mix

7. Physician Alignment To remain competitive, physicians must be fully integrated into TRMC

8. Perceived Lack of Quality HCAHPS lower than state and national averages HCAHPS lower than Kaweah Delta Medical Center in almost every category Metric TRMCKaweah Delta Patients who would definitely recommend hospital 50%69% Patients who reported area around their room was always quiet at night 37%50%

9. TRMCs Current Market Share 80% of patients participate in government insurance programs 45% Medi-Cal Poor quality perception is hurting patient retention Potential patients directed elsewhere

11. Key Operating Indicators TRMC2010 OSHPD Net Rev/APD1,9463,124 Supply/APD264476 Labor/APD7301,590 Total/APD1,9153,082

12. Ideal Solutions Physician alignment

13. Renegotiate Physician Contracts Business development and physician communication What do they want? What do competitors offer? Sizeable share of the newly insured PPACA will increase commercial payers Focus on community needs

14. Optimize TRMCs Clinic Network Maintain 3 Rural Health Clinics and 2 1206(d) clinics RHCs Higher Medi-Cal reimbursement rates PPACA increasing Medi-Cal rates 2013-2014 Patient access to care Specialized care for the population

15. Optimize TRMCs Clinic Network 1206(d) Clinics Hospitals Higher Medicare reimbursement rates 100-113% Increased patient base Reinforce physician-TRMC alignment efforts Inpatient referrals

16. Optimize TRMCs Clinic Network Physicians No overhead, focus on patients New technology Community Increase quality perception Bring access to health care Programs for elderly

22. Establish Medical Foundation Key component of physician alignment Will help facilitate recruiting and retention PPACA influential in the move toward collaborative care

23. Conclusion Physician alignment with TRMC Care for population health needs Funnel patients to TRMC main campus Increase revenue generation 1206(d) and rural clinics are a first effort toward long-term Foundation goals

24. Mission Statement A patient-centered organization that sets the standard for patient experience and quality of care by pushing the boundaries of technology in service to our community.

25. References Abbott, D. (2009, March 12). Healdsburg hospital to partner with primary care. Sonoma West Times and News. Retrieved from http:// www.sonomawest.com/healdsburg/news Kaweah Delta Health Care District. (2012). Kaweah Delta welcomes second neonatologist to NICU. Retrieved from http://www.kaweahdelta.org/ news/view_details.asp?newsid=221 Mineful Demographics. (2010). Tulare household income. Retrieved from http://mineful.net/California/County/County_Income/ Tulare_County_CA_income_ignore.html Schiff, A. (2010). Hospital outpatient clinics--legal considerations impacting physicians. Retrieved from www.mdhealthlaw.com/ Studer Group. (2012). About Studer Group. Retrieved from http://www.studergroup.com/about_studergroup Taylor, M. (2006). Californias health care districts. Retrieved from http:// www.chcf.org

26. References Tulare County Association of Governments. (2008). Tulare county. Retrieved from http://www.tularecog.org/ Tulare Regional Medical Center. (2012). Tulare Regional Medical Center. Retrieved from http://www.tulareregional.org U.S. Department of Health and Human Services. (2006). Comparison of the rural health clinic and federally qualified health center programs. Retrieved from http://www.ask.hrsa.gov/downloads/fqhc- rhccomparison.pdf U.S. Department of Labor. (n.d.). General facts on women and job based health. Retrieved from http://www.dol.gov/ebsa/newsroom/ fshlth5.html U.S. House of Representatives. (2010). Compilation of patient protection and affordable care act. Retrieved from http://housedocs.house.gov/ energycommerce/ppacacon.pdf Weekly Probe. (2011). Hospitals use focus group to drive changes to surgical procedures. Retrieved from http://www.weeklyprobe.com/2011/12/ hospital-uses-focus-group-to-drive-changes-to-surgical-procedures/