1. Change is Inevitable…Are we Ready? The Impact of National Health Care Reform Presentation to: 20 th Annual Education Session Health Care Quality Institute Marco Island, FL June 27, 2014

2. PauseListenThinkPrayGo

3. Presentation Objectives Discuss the impact national health care reform is having on care delivery models, patient experience, and public health financing; Share strategies for addressing the rapid change and uncertainty health care; and Address the need to bring more value at a lower cost without jeopardizing quality.

4. ABOUT AHS http://itvs.org/films/waiting-room

5. Our Mission Caring, Healing, Teaching, Serving All

6. Excellence for All Safety Net Provider Alameda Health System Integrated Regional Network Our Vision AHS is recognized as a world-class patient and family centered system of care that promotes wellness, eliminates disparities and optimizes the health of our diverse communities … 2012 Assess and Plan 2013-2017 Build, Adapt, Transform 2022… Sustain system & manage pop H H E E W W F F J J

7. Organizational Overview 1864 Alameda County Infirmary opened on the Fairmont Campus 1927 Highland Hospital opened in Oakland 1960s Ambulatory health care services launched 1992 John George Psychiatric Pavilion opened 1990s Alameda County Medical Center (ACMC) was formed by merging Fairmont Hospital with Highland Hospital and John George Psychiatric 1998Alameda County Hospital Authority was created 2012Adopted 10 year Financial Plan and 5 year Strategic Plan 2013ACMC renamed and rebranded to Alameda Health System (AHS) Expanded Ambulatory – Same Day Services; San Leandro Hospital acquired 2014Alameda Hospital affiliation completed

8. Organizational Overview 849 licensed beds, 4,545 employees, 1000+ MDs, 5 acute hospitals, 3 SNFs and 4 Wellness centers Average Daily Census: 411; Discharges: 20,461, ED Visits: 146,932 OP Clinic Visits 312,465 ; Surgeries: 9,176; Births: 1,080; Operating budget: $805M Emergency Medicine, General Surgery, Internal Medicine, Orthopedics, Oral Maxillofacial Surgery, Podiatry Nurses, allied health professionals, pre-doctoral psychology interns Nationally recognized public health system Training tomorrow’s doctors (160/year) Training students/ providers

9. Market Presence Alameda Hospital Highland Hospital & Wellness Eastmont Wellness John George Psych Hospital Newark Wellness San Leandro Hospital Hayward Wellness Fairmont Hospital

11. Change Hard Inevitable Unavoidable

13. The nation is experiencing the most significant TRANSFORMATION of the health care delivery system since the launch of Medicare. Successful transformation is dependent on our ability to CHANGE. HITEC PPACA PCMHACOHBEVBP 2009 2010 2011 2012 2013 2014 Transformation

14. Patient Protection and Affordable Care Act Guaranteed Issue – Pre- existing condition clause Minimum health insurance standards Individual mandate Health Insurance Exchange Federal Subsidies for individuals, families, and small employers Medicaid expansion Medicare shift from FFS to bundled payments Employer mandate January 1, 2014 Changes

15. Alameda Health System ACCESS Market competitive standard for access in the communities we serve that supports organizational growth 5 SUSTAINABILITY Financial sustainability that supports growth and reinvestment to sustain our mission INTEGRATION Effective physician and hospital partnership that supports clinical integration leading to improved quality and experience for patients EXPERIENCE Patients feel valued, cared for and continue to choose us as their medical home/provider of care NETWORK Community engagement and external partnerships that align resources necessary for a sustainable clinically integrated network of care WORKFORCE Culture of excellence in the workforce that empowers staff to embrace and lead transformation to a high performance health system Strategic Goals

16. 2010 Federal Spending: $3.5T

17. Federal goal is to shrink that number year after year after year

22. Patient Experience

23. National Health Care Reform Accountable Care Organizations Medicare Innovation Projects Administrative Simplification Anti-Discrimination Provider Profiling

24. Change Hard Inevitable Unavoidable

25. Implementing a Turn Around Financial Focus Board Alignment Goal Alignment Build Excellence Focus on Culture Performance Improvement

26. 1: Recognize MegaForces Demographic Shifts Technology Changes Workforce Shortages Economy Accountable Care Payment Reform Health Care Consumerism ICD-10 Changing Regulations/Compliance

27. 2: Prepare and Empower

28. 3: Don’t Wait

29. 4: Plan, Do, Check, Act

30. 5: Influence Consumer Decision Making The Consumer Decision Model

31. Access Sustainability Experience Changing the Face of Health Care

32. Looking to the Future

33. The Four Agreements: Miguel Ruiz Don’t make assumptions Don’t take anything personally Be impeccable with your word Always do your best

34. Issues Before Us!

35. THANK YOU! Carladenise A. Edwards, Ph.D. CHIEF STRATEGY OFFICER