1. 1 MHA Update and Strategic Outlook MRRN Meeting March 18, 2015 Brian Peters CEO-Designate

2. Full Disclosure - About MHA Established in 1919; Nonprofit (501C6) Approximately 100 employees Locations: Okemos campus; Downtown Lansing (CAC) Mission: We advocate for hospitals and the patients they serve. Primary Membership: hospitals / health systems Subsidiaries: MHA Service Corporation (for-profit) and MHA Health Foundation (501c3) HealthPAC (p erennial Top 10 independent Political Action Committee)

3. Physician Leadership at MHA 3 Gary L. Roth, D.O., FACOS, FCCM, FACS Medical Director Michigan Health & Hospital Association Keystone Center

4. Physician – Hospital Collaboration Medicaid Expansion Auto No-Fault GME Medical Liability Patient Safety & Quality Physician Leadership Education Economic Impact of Healthcare Report

5. The Outlook: Major Themes 5 More integrated More at-risk More transparent More importance attached to advocacy/public policy “56-20-1”

6. 6 More Integrated 1980: 236 Hospitals; 49,369 total beds –Nearly all independent 2015: 133 Hospitals; 24,617 total beds –20 systems = over 100 hospitals –8 out-of-state systems (4 for-profit) –36 Critical Access Hospitals (1,300 in U.S.) 65% of practicing Michigan physicians are either employed or “near-employed” by hospitals MHC – GLHIE merger

7. More At-Risk 7  Rise of high-deductible plans  577,000 enrolled in MI (5th highest in nation)  Private exchanges  70,000 in Michigan – and growing  Narrow networks  Value-Based Contracting  Reference pricing; shift from “cost-based pricing” to “price- based costing”  CMS payment penalties  Medicare enrollment = dramatic increase (Baby Boomers)  Medicaid Expansion = 500,000 new lives in Michigan  Patient loyalty to “brand” vs. consideration of price

8. More Transparent  MHA Keystone: Care Transitions  MHA Keystone: CA-UTI  MHA Keystone: ER  MHA Keystone: Gift of Life  MHA Keystone: ICU  MHA Keystone: OB  MHA Keystone: Safe Care  MHA Keystone: Sepsis  MHA Keystone: Surgery  MHA Keystone Hospital Engagement Network (HEN)  On the CUSP: Stop BSI  On the CUSP: Stop CA-UTI  MHA Patient Safety Organization (PSO) http://www.mhakeystonecenter.org/compare.htm

9. 9 Questions / Discussion BRIAN PETERS | CEO-Designate Michigan Health & Hospital Association 517-886-8223 Phone | 517-323-1132 Fax bpeters@mha.org www.mha.org