1. The Healthcare Perspective from ACOs 2015 Meals on Wheels Annual Conference August 31, 2015

2. Agenda: 3 Questions… Question 1: Why now? A little about us. Question 2: How do we move forward? Question 3: How can you help?

3. Question 1: Why now? What patient demographic and economic forces are driving change in health care? Why is it important we transform health care now?

4. Question 1: Why now? Baby Boomers entering Retirement Growth in Life Expectancy Federal Budget Issues Price of Health Care

5. Why now?

6. A new form of Health Care…

7. 7 About BJC HealthCare BJC Hospitals: Alton Memorial Hospital Barnes-Jewish Hospital Barnes-Jewish St. Peters Hospital Barnes-Jewish West County Hospital Boone Hospital Center Christian Hospital Missouri Baptist Medical Center Missouri Baptist Sullivan Hospital Parkland Health Center Progress West HealthCare Center St. Louis Children’s Hospital The Rehabilitation Institute of St. Louis BJC Health Services: BJC Medical Group BJC Behavioral Health BJC Corporate Health Services BJC Home Care Services BJC Long Term Care Services

8. About BJC Accountable Care Organization BJC ACO Composition – All BJC Acute Adult HSO’s plus…… 339 BJCMG Employed Providers 207 Independent Community Providers 546 BJC ACO Providers BJC ACO Specialties (500+ Physicians) Primary Care Allergy and Immunology Cardiology Dermatology Endocrinology ENT/Otolaryngology Gastroenerology General Surgery Geriatrics Gynecology, OB/GYN Hematology Infectious Diseases Nephrology Neurology Oncology Ophthalmology Orthopedic Surgery Physiatry, Rehabilitative Medicine Podiatry Pulmonology Rheumatology Urology Vascular Surgery 8

9. About BJC Accountable Care Organization Joined Medicare Shared Savings Program in July, 2012 1 of 2 first entrants in Missouri (1 st in St. Louis) 9 *ESRD and Aged/Dual also include Disabled beneficiaries

10. About BJC Accountable Care Organization BJC Accountable Care Organization serves over 2,000 Medicare-Medicaid Dual Eligibles. * BJC ACO presently manages over 2,000 dual-eligibles. 10

11. About BJC Accountable Care Organization BJC Accountable Care Organization serves urban, suburban and rural communities. 20.8% of BJC ACO attributed beneficiaries reside in rural Missouri and Illinois communities 11

12. BJC ACO Offerings Transitions of Care (RNs & MSW) ED Frequent Flyer Program (CHAP) Complex Care Management (RNs & MSW) Polypharmacy Support (STLCOP) ED/Admission Alerts (Technology) Remote Monitoring (Home Health) About BJC Accountable Care Organization 12

13. Question 2: How do we move forward? How do we as providers better manage and increase accountability for the full continuum of patient care? How do we provide better health care, better heath care experience, and better value to the communities we serve?

14. Question 2: How do we move forward? Providers Community Partners Payers Patients

15. Question 2: How can you help? How can community based programs and service organizations like Meals on Wheels assist ACO’s in population health?

16. Question 3: How can you help? 1.We must change the paradigm of what care is compensable by positioning Meals on Wheels and other community based partners as vital contributors in the provision of patient care. 2.To do this, we must focus on understanding the strategic niche of Meals on Wheels in population health management. 3.We must design service level agreements between Meals on Wheels and ACOs that apply this value to meet the needs of patients and providers… and at scale. 4.Through data, we must continuously evaluate the value provided by Meals on Wheels directly to the bottom line of managing population (payer) expenditures. Meals on Wheels and other community based partners ARE providers of care…and must be demonstrated as such to the payer community.

17. Question 3: How can you help? As an ACO…what are we looking for in contracts with community based partners? What provides competitive advantage? Seamless IT integration. Solid process for referring patients and communicating status. Breadth, quality and scalability of services performed. Timeliness (from referral to patient engagement). Patient satisfaction. Simplicity. Contribution to managing patient populations. Providers Community Partners Payers Patients

18. Thank you… My Contact Information: Erik Rasmussen Program Manager, Accountable Care BJC HealthCare 670 Mason Ridge Center Drive, Suite 300 St Louis, MO 63141 erasmussen@bjc.org 314/996-7733 www.bjcaco.org