Leading Change in Health System TransformationGeorge Kerwin, President and CEO, Bellin Health

Helen Macfie, Chief Transformation Officer, MemorialCare Medical Centers

Al Kurose, President and CEO, Coastal Medical

L. Gordon Moore, Senior Medical Director, 3M Health Information Systems, Inc.

These presenters do not have anything to disclose.

February 22, 2017

Objectives

After this session, participants will be able to:

� Define one way they can improve their ability to manage the health of people they serve

� Identify the elements of will-building, vision and strategy setting in three organization’s leadership journey

� Understand how local market dynamics influence strategy setting for leaders undertaking population health management

How Bellin Health Began Taking Accountability for the Health of Its PopulationGeorge Kerwin, President and CEO, Bellin Health

Wisconsin4

Serving a Market of 636,682 People

Bellin Hospital, a 244-bed community hospital with proven excellence in

heart and vascular care; orthopedics and sports medicine; family

programs and services; cancer care; and minimally invasive procedures

including robotic surgery

Bellin Health Oconto Hospital, a 10-bed critical-access hospital in

Oconto

Bellin Medical Group and NorthReach Healthcare, a 121-member

primary care group with 32 clinic sites and proven excellence in disease

management and wellness care

Employer Clinics, 83 clinics located within employer facilities

FastCare Retail Clinics, 4 convenient care clinics in discount retail stores

Bellin Health Partners incorporates all of Bellin Health System, their

employed providers and approximately 116 independent providers

Bellin Psychiatric Center, a dominant provider of in- and outpatient

behavioral health services, staffed by 10 psychiatrists, 4 psychologists,

and 35 licensed mental health & addiction therapists

Unity Hospice, providing hospice and palliative care services

Bellin Health Overview 5

6

The Bellin Health Story

Lower healthcare costs measured as PEPY:

� Averaging 15% below the national average for 12 years totaling over $22 million less than average

� Strong culture maintained

� Employees as empowered

healthcare consumers

� Improved health (increasing

HRA scores)

� Marketplace credibility and leadership

Bellin’s Results

Encourage proper utilization, improve health, and createsmart healthcare consumers by:

� Redesigning our health plan

− Consumer Driven Health Plan

− Incentives for engagement and accountability

− Value-based primary care for specific conditions

� Providing resources

− Health Risk Assessments

− Personal Health Coaches

− Medical Home

� Utilizing our partners to receive the lowest cost/best value services

Bellin’s Solution

Huge healthcare costs measured as PEPY in 2002

� Double-digit increases: 30% projected 2002 to 2003 if no changes made to plan

� Unknown health status

� Heavy healthcare users

� Fear of culture impact if changes made

� Marketplace credibility

Bellin’s Problem

Progression of Health Benefit1. AWARENESSEarly 2000’s

• Health Care costs rapidly rising

2003

• Incentive for HRA with plan design

• Development of Health Coach Concept

• Senior Leadership Engagement is Key!

2005

• PBA created to reduce personal expenses and to raise awareness of

consumerism.

2. ENGAGEMENT2006

• HRA scores defined plan for engagement

• Plan of Improvement introduced with primary care

2009

• Pilot program with Health Coach for employees with score of 60 or less

• Six chronic diseases coverage covered at 100% for pilot group

• FastCare Benefit

3. ACCOUNTABILITY2010

• HRA scores define plan level for participant

• Wellness Certificate tied to two levels of PBA dollars

• Expanded coverage of six chronic disease conditions to be covered at

100% for all health plan participants

4. CULTURE OF HEALTH2011

• HRA scores define two premium levels

• Second Health Coach added for Bellin Employees and Spouses

• Culture of Heath Steering Team developed for the organization

2012

• HRA scores defined by three premium levels

2013

• Medical Home Incentive

• Referral Incentive

• Increased dollars tied to Wellness Certificate

8

Improved Health: HRA Results

Improved Experience

Prevention: 91% compliance with age and gender screenings – 6 years ago: only 20% of $50,000+ claims

Large Cases ($50,000+): 24% reduction in cases, 34% reduction in spend– Percent Large Case Spend: 27% to 19% of total spend

Removing Barriers: Value-based primary care with 695 individuals in chronic care condition program at an average visit cost of $286

9

-$3.9

-$2.5

-$1.9

-$2.1

-$1.3

-$1.2

-$0.6

-$1.1

-$2.0

-$1.7

-$2.6

-$2.5

-$2.2

$0.8

$0.5

2015

2014

2013

2012

2011

2010

2009

2008

2007

2006

2005

2004

2003

2002

2001

Bellin's Cost Difference Compared to Average (In Millions)

Improved Cost

$25.6+ Million Saved

OVER AVERAGE

UNDER AVERAGE

10

Providing solutions to over 2,500 employers

Establishing 115 employer clinics

Bell

11

12

Three Keys to Successfully Taking Accountability for the

Health of a Population

Build Will

Bellin Health Mission:

Bellin Health is a community-owned not-for-profit organization responsible for improving the health and

wellbeing of people living in Northeast Wisconsin and the Upper Peninsula of Michigan, and all others

we serve.

We carry out this responsibility through individualized care excellence, community health improvement,

and equitable healthcare financing plans –all designed to positively impact health and wellbeing. We are

steadfast in our commitment to providing compassionate, safe, and coordinated care that is accessible

and affordable for everyone.

We build trusted relationships and advance true collaboration, fueling our desire to constantly improve

and innovate.

13

Build Will

Bellin Health Vision:

The people in our region will be the healthiest in the nation, resulting in improved economic vitality in the communities we serve.

14

15Develop Capability: The New Integrated System

System of Production

Individual

Solutions To

Problem

System Clinical Care

Solutions Across the Continuum (Connected Experience)

Primary

Care

Specialty

Care

Acute

ServicesAfter

Care

Integrated System

Po

pu

lati

on F

am

ily &

C

om

mu

nity

R

eso

urce

s

Access

Platform

Team Based Care

Population

Health Needs

Manage Populations

Brown County Municipality • Covered Employee Health Plan Lives:

1,341 employees with health plan

3,462 total employees and dependents covered

• Health Costs:

3.3% average decrease last 4 years

2015 Brown County spend at $10,834/EE/ plan

2015 Av. WI County spend at $14,446/EE/p

• Health Risk Appraisal Scores:

5.7 points above national average

• Savings per year from average WI County spend:

$4,843,692 per yearBellin Strategic Partner &

“Win” for Employer

Deliver Results16

SYSTEM RESOURCES

• 715 Physicians

• 57 Primary Care Locations

• 3 Tertiary Hospitals

• 4 Critical Access Hospitals

• 1 Psychiatric Hospital with full-service Behavioral Health Clinic

• Hospice & Palliative Care Services

• Skilled Nursing Facilities (1 system-owned)

POPULATION SEGMENTS

• Employees, Children & Families 540,000 people

• Medicare160,000 people

• Medicaid 180,000 people

• Uninsured 120,000 people

• Total Population 1,000,000 people

2 Hospital Systems700 PhysiciansPopulation 1,000,000

Deliver Results - Pioneer 17

Deliver Results - Pioneer

1. Commercial

• Self-Funded

• Fully-Funded

• Individual

2. Medicare

• Medicare Advantage

• Fee-for-Service

3. Medicaid

4. Other

12% of Net Revenue

44%

of Net Revenue

27% of Net Revenue

10% of Net Revenue

7% of Net Revenue

Payer Segments by % of Net Revenue

18

Characteristics of Medicare Pioneer ACO• Medicare “Fee for Service” program

• ACO consists of Bellin, ThedaCare, and many independent physicians within the respective markets

• Members are assigned based on attribution methodology

• Shared savings program with risk for total cost of care

• Quality metrics determine the amount of shared savings

Deliver Results - Pioneer19

National Trend$10,914 (PY1)

$10,731 (PY1) $10,990 (PY2)

$8,419 (PY1)$8,583 (PY1)

$8,030 (PY1)

$8,451 (PY2)

$8,274 (PY2)

BTHP

20132012

$10,819 (PY3)

$8,355 (PY3)

$8,521 (PY3)

2014

Pioneer 2012-2014

Annual Cost Per Enrollee for All Medicare Pioneer ACOs

21

Clinical Quality for all Medicare Pioneer and Shared Savings ACOs

22