Improving Community Health: Mercy Health Mission Overview

ADURO Foundry June 2018 1

Foundational Elements Our Mission We extend the healing ministry of Jesus by improving the health of our communities with emphasis on people who are poor and under- served. Our Values Compassion Human Dignity Sacredness of Life Excellence Justice Service Our Promise To make lives better mind, body and spirit. To genuinely enjoy being of service. To make healthcare easier. 2

Mercy Healths mission is to improve the health of our communities with emphasis on the poor and underserved Catholic Ministry serving 7 regions across Ohio and Kentucky. Merging with Bon Secours to create 5th largest Catholic health system in country. Almost 11M patient encounters annually 1,000+ points of care 43 Almost $2M in community benefit each day 57k+ Mercy Health 2.1k+ Providers hospitals Employees Bon Secours 3

Achieving our vision: Strategic pillars are our pathway to success Our 2020 Vision Mercy Health is the preferred choice in our communities for reliable, compassionate, high value care at the time and place those we serve need or want it. Through innovative practices, processes and partnerships, we will grow the ministry and maintain financial stability. 4

Challenges: Our workforce will grow in 5 major ways in our new strategic plan 1. Change healthcare delivery by adding microsites 2. Grow our contingent (nonemployed) workforce 3. Add & transform other delivery systems PCPs Affiliate Physicians Outpatient Revenue Cycle Freestanding EDs/Urgent care Food Service 4. Grow our portfolio of health- related subsidiaries 5. Address external labor market forces Union contract negotiations (RNs in SEIU & UAW) Ensemble (Revenue Cycle) Labor market shortages (Physicians, RNs, Medical Assistants) Ensemble IQ (Analytics) Unemployment Rate (4.1%) at 16 year low Transfer Center Shift from Boomer to Millennial workforce Healthcare Employment Cost Index (ECI) is at an all-time high 5

bv Mercy Health Well-being Case Study 6

Just five years ago, Mercy Healths benefits program was fractured and ineffective Disaggregated, inefficient strategy and designs 4,500 employees and family members with diabetes; roughly 400 with out of control diabetes Poor health of our caregivers Employee Emergency Room utilization exceeded benchmark by 15% Utilization of Mercy Health providers was a suggestion, not an expectation Year over year pharmacy trend of 15%+, including 40%+ specialty trend High risk individuals driving high plan cost 7

Aligned infrastructure and strategy needed to begin the journey Plan #1 #2 #3 Single system team and strategy Limited menu of benefit design options Focus on driving care to our high quality network Streamlined administration 8

Robust pharmacy management drives negative trend 2017 marked the beginning of aggressive pharmacy management in partnership with Mercy Health Pharmacy $85 Per member per month Rx $82.58 $80 $78.34 $75 Pharmacy Tactics (2017) $70.83 $70 $67.39 - Plan design drives domestic, de- marginalized utilization $65 $63.35 $63.08 $60 - Aggressive PBM discounts & rebates 2015 2016 2017 Mercy Health - Net of Rebates - Variable copay program Mercy Health - Net of Rebates & Med to Rx - Responsive, in-sourced formulary MedImpact Hospital Benchmark - Virtual and in-person medication therapy management Pharmacy and Specialty Trend - Move infusions to pharmacy plan 9

In partnership with Mercy Health Select, we care for our sickest colleagues and their families 42% $600 percentage of identified members with Diabetes who are enrolled amount of incentive provided to members in reduced pharmacy copays Care Management (2016) 22% 5% 5% reduction in PMPM costs for Rx related claims since program began in January - Leverage aligned EHR - Ambulatory Care Coordination to manage rising risk expected improvement in number of patients with controlled HBA1C - Care Transition Coordination to manage inpatient discharges expected improvement in medication and formulary adherence - Shared savings (with downside risk) motivates our providers Targeting our diabetics with a best practice diabetes management program - Manage robust network of care - Diabetes Management launched in 2018 10

Improving access to lower points of care 1,082 26% number of calls in 58 days (Avg 17 Jan, Avg 20 Feb) Percentage of callers with a pre-call plan to go to ED were triaged and redirected to lower level of care Nurse Access Line (2018) - Partnered with our 24/7/365 Transfer Center to launch 463 ER claims in Jan 2018, down from 595 (Q1 monthly Avg) - Guides employees to lower cost care if an ER visit is not appropriate Initial results are promising of our goal to reduce ER utilization below hospital benchmarks - Non-emergent ER visits subject to $200 penalty - Enhance domestic utilization by referring to Mercy Health providers 11

Be Well Within encourages our caregivers to care for themselves 100% 1.55 16.5% 90% 20.5% 1.50 21.8% 23.3% 1.51 80% 1.45 70% 1.40 60% 1.41 1.35 1.38 50% Be Well Within (2014) 1.30 40% 1.25 30% - Incentive-driven, outcomes-based design 1.26 1.20 20% 33.6% 30.3% 30.1% 27.2% 1.15 10% - Naturally Slim mindful eating program 0% 1.10 2014 2015 2016 2017 - Online/mobile engagement platform 0 Health Opportunities 1-2 Health Opportunities - Mercy-supported screenings 3+ Health Opportunities Average Health Opps - Human performance coaching 17% decrease in average health opportunities over three years, driving a projected $13M in savings in 2018 alone - Cultural campaigns w/ champions 12

Successful five-year journey for Mercy Healths health plan Data Point 2012 2017 Medical and Rx Trend $392 $370 (PMPM) Domestic Utilization (Total 56% 72% Paid) ER Utilization (per 1,000) 256 219 IP Utilization (per 1,000) 100 65 Scripts (per member) 9.7 8.9 Be Well Within Screenings 45% 69% 13

Background: The Be Well Within Center Our Home Office on-site clinic Count of Level of Service By Appointment Length All figures shown cover May 2017 April 2018 unless otherwise stated 14

Background: The Be Well Within Center Our Home Office on-site clinic Patient Distribution by Member Type New Patient vs. Established Patient Distribution 15

Background: The Be Well Within Center Our Home Office on-site clinic Patients by Age Bucket Count of Appointments by Time and Day Patients per Home Zip code 16

Background: The Be Well Within Center Our Home Office on-site clinic Number of Encounters by Payor Incoming Net Payment Including Copays 17