1. Steve Hester, MD, MBA Senior SVP, Chief Medical Officer Norton Healthcare Effective Care Delivery Across the Continuum

2. 2013 Total encounters 2,214,079 Per Day Statistics: Average Daily Census…………………………………….…….875 Admissions………………………………………………………….168 Surgeries (IP & OP)………………………………………………134 Outpatient visits (excluding ER)…………………………1,080 ER visits……………………………………………………………….570 Freestanding Diagnostic visits………………………………..69 Practice visits (primary care & specialists)…………4,045 Total encounters per day…………………………………..6,066 Norton Healthcare

3. Norton Medical Group Norton Medical Group Profile 2013 Total Visits1,465,657 Primary Care, ICC, and Pediatrics674,334 Specialist Visits791,323 Total Locations128 Total Visits per day4,015 Total Primary Care Visits per day1,847 Total Specialist Visits per day2,168 Total ICC Visits161,805

4. Healthcare – A System in Chaos The health care system is under duress Irresistible drivers of change include: – Medical progress – Aging population – Global economy Challenges for providers and patients: – Too many people involved, too much to do, no one with all the information, no one with full accountability – Result: Chaos  gaps in quality and safety, inefficiency

5. Specialty Physician Home ICC Diagnostic Center Skilled Nursing; LTAC; Rehab Patient Home Home Health Hospital - ER services, OP services, IP stays Value in the Future = Patient Care Continuum Care Team Center Wellness Center

6. Changing Care Delivery Hospital Practices: Improved management of complex patients –Complex Care Management –Multidisciplinary Plans of Care through electronic health record –Increased emphasis to social barriers Physician Practices: Patient-centered care –Patient Centered Medical Home (PCMH) –Practice redesign –Payor collaboration –Wellness – increased screening & lifestyle coaching

7. Why now? Physician Centered Care  Patient Centered Care PhysicianPatientNursePharmacist Social Worker Physical Therapist PatientPhysicianPharmacist Physican Therapist Nurse Social Worker

8. Required Support for Patient Success Overcoming health system barriers Education where knowledge deficits exist Communication between patient, care provider, and the community

9. The Future Patient Experience Patient Navigation: Result of Fragmented Healthcare Patients will truly be in control of their care. Never have to traverse the complicated health system alone. Be informed of the care they are provided and be better able to make knowledgeable decisions.

10. Navigation Results Cancer patient rates as an example: – The screening rate improved 10.8 - 17.1% – Adherence to diagnostic services after an abnormality was detected improved 21 - 29.2%. This information provided by: a patient navigation intervention. Cancer. 2007; 109(2 suppl):359-367.

11. Next Steps in Patient Navigation Commitment from all stakeholders for sustainability Standardization of the methodology and certification process Defined standards and metrics for billing

12. Norton Healthcare’s Patient Navigator Program NHC Patient Navigators Discuss Medications Schedule Follow-ups Go over discharge instructions Provide additional information Answers all questions Assists the patient in overcoming barriers

13. Questions?