An International Perspective –

Tradition vs Transition:

Innovative Responses

Catholic Health Australia2017 National ConferenceAugust 29, 2017

John D. DoyleExecutive Vice President, AscensionPresident and CEO, Ascension Holdingsand Ascension Holdings International

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Scope of services…

Catholic Healthcare Internationally

• Catholic healthcare comprises 26% of the world’s healthcare facilities

• 34,000 Catholic clinics, aged care facilities and special needs facilities

• 5,500 Catholic acute care hospitals outside the U.S.

• 65% of Catholic hospitals are located in developing countries

• 200 Catholic hospitals in Oceania, the highest number in the last 30 years

• 1,039 Catholic hospitals in Europe, a decrease of 49% over the last 30 years

• 1,000 Catholic hospitals in Asia, stable over the last 30 years

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• 150 fewer Catholic hospitals in the U.S., and fewer than 300 single-sponsor hospitals

• Now, about 650 lay hospital CEOs in the U.S., and zero religious hospital CEOs

Last 50 Years…

U.S. Catholic Healthcare

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Ascension: Care of Persons in Poverty a Priority

Fiscal Year End June 30, 2016

Total Assets $32.5 Billion

Total Operating Revenue $21.9 Billion

Income from Operations $753.2 Million

Excess of revenue and gains $461.4 Millionover expenses and losses, controlling interest

Care of persons living in poverty and

community benefit

programs: $1.82BILLION

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Our Future Vision

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Always Aligned with our Mission, Vision, Values

Our Future Vision

Our Mission Our Vision Our Values

Rooted in the loving ministry of Jesus as healer, we commit ourselves to serving all persons with special attention to those who are poor and vulnerable.

Our Catholic health ministry is dedicated to spiritually centered, holistic care which sustains and improves the health of individuals and communities.

We are advocates for a compassionate and just society through our actions and our words.

We envision a strong, vibrant Catholic health ministry in the United States which will lead to the transformation of healthcare.

We will ensure service that is committed to health and well-being for our communities and that responds to the needs of individuals throughout the life cycle.

We will expand the role of the laity, in both leadership and sponsorship, to ensure a Catholic health ministry of the future.

Service of the Poor – Generosity of

spirit, especially for persons most in need

Reverence – Respect and compassion for

the dignity of diversity of life

Integrity – Inspiring trust through personal leadership

Wisdom – Integrating excellence

and stewardship

Creativity – Courageous innovation

Dedication – Affirming the hope and joy of our ministry

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Strategic Direction

Our Future Vision

Our outward

promise to those

we serve

Enabled by focused

inner strengths

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• Delivering improved health outcomes

• Ensuring an enhanced experience for those we serve and their families

• Creating an enhanced experience for providers

• Making healthcare delivery more affordable

Quadruple Aim

Our Future Vision

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Three Core Themes

Our Future Vision

We are a Vibrant Catholic Health Ministry

We are Entrusted Stewards

We are Re-imagining Health

Serving as a visible manifestation of the Catholic Church’s commitment to all people, with special focus on the complex needs of persons in poverty and those most vulnerable

Strengthening the ministry’s legacy for the future by stewarding and growing our financial resources, foster inspired people to flourish, and safeguarding the environment

Co-creating healthier communities by pursuing holistic, high-quality, affordable solutions across the continuum of care and redefining how we work together within the broader health ecosystem

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Our 2025 View of the World

Our Future Vision

Consumers will take a more active role in making health-related decisions and improving their health.

Technology will support new care models that enable providers to expand capacity, improve efficiency, and build stronger relationships with larger populations than before.

Clinical integration will be the norm, and coordination will increase across the continuum.

Healthcare costs will continue to rise and regulatory complexity will increase.

Competition for consumers, providers, and associates will be fierce globally.

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Ascension Care Delivery Map

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Ascension Continuum of Care Sites

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AMBULATORY CARE AND DIAGNOSTICS

Ambulatory Surgery Centers 66

Occupational Health Programs 55

On-Site Employer Clinics 76

Free-Standing Imaging Sites 110

Retail Lab Collection Sites 155

Primary Care Clinics 565

Retail Care Clinics 12

Retail Pharmacy Sites 45

Sleep Centers 31

Specialty Clinics 613

Virtual Care Programs 70

EMERGENCY SERVICES

Free-Standing ER and Urgent Care Sites 74

Emergency Medical Services (EMS) 21

SENIOR CARE AND LIVING FACILITIES

Assisted Living 15

Continuum of Care Retirement

Communities8

Independent Living 2

Long Term Acute Care/Skilled Nursing 23

Multi-Service Line Communities 7

Other Senior Living (HUD, Other) 2

PACE Programs 3

HOSPITALS BY TYPE

Acute Care Hospitals 109

Rehabilitation Hospitals 5

Behavioral Health Hospitals 9

Long-Term Acute Care Hospitals 2

TOTAL 125

Hospitals Not Majority Owned –

Joint Venture or Management Agreement15

2,500

Sites of Care

POST ACUTE SERVICE SITES

Durable Medical Equipment 15

Home Health Services 42

Hospice Services 16

Outpatient Rehabilitation Centers 148

COMMUNITY SERVICES

Community Health Centers 16

Dispensary of Hope Sites 9

Mobile Clinical Services 26

Wellness Centers 23

Community/Social Programs 157

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One Ascension Journey

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1. Integration of Ascension Identity and Brand Strategy

One Ascension Journey

• Successful launch of Ascension brand in 2 U.S. states – Wisconsin and Michigan, first signage in place

• Next four markets beginning in the coming year

• More people remember the Ascension name now – and research shows it means more to people that the local system is part of Ascension

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2. Innovations in Safety and Clinical Quality

One Ascension Journey

• Enhanced capabilities of clinical leaders to lead with quality

• Person and Family Engagement pilots

• Leadership in infection prevention

• Clinically integrated systems of care

• Focus on eliminating preventable disparities in care

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Ascension’s Quality Journey

One Ascension Journey: Innovations in Safety and Clinical Quality

2002-2008 Zero Preventable Deaths

2009-2015 Healing without Harm (High Reliability)

2016-2022 Zero Preventable Health Outcome Disparities

• Significant improvement

• Proven system spread for multiple initiatives

• Spread to other systems• Institute for Healthcare Improvement

• U.S. Centers for Medicare and Medicaid Partnership for Patients collaboration

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Mortality Reduction

One Ascension Journey: Lives Saved Each Year Compared to FY04 Baseline

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One Ascension Journey: Improved Health Outcomes

Reductions in healthcare-associated infections:

11.8% decrease from baseline for observed/expected (excess readmission index) 30-day readmissions for all diagnoses

7.2% reduction from baseline for Heart Failure Readmissions

Catheter-associated

urinary tract

infection, ICU

28% decrease

Colon surgery --

surgical site infection Complex 30-day

8.9% decrease

Abdominal hysterectomy --

surgical site infection

standardized infection ratio, complex 30-day

37% decrease

Clostridium difficile

13.2% decrease

Methicillin-resistant Staphylo-

coccus aureaus

bacteremia

5% decrease

Knee Surgical

Site Infection

13% decrease

Overall Catheter

Associated UTI

9.2% decrease

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One Ascension Journey: Decreasing Insurance Costs

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3. Advocacy and Services for Those Most Vulnerable

One Ascension Journey

• Focus on eliminating preventable disparities in care

• Socially just minimum wage

• Speaking out in support of 100% access/coverage, Medicaid expansion, and mental and behavioral health reform

• Addressing human trafficking through advocacy and service

• Ascension Medical Missions At Home

• Veterans Choice

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Ascension’s Principles in Analyzing Healthcare Reform Proposals

One Ascension Journey: Advocacy

• Legislation must preserve a strong safety net

• Legislation should not reduce access or coverage; it should expand it

• Legislation must strengthen and stabilize the individual market to make insurance more accessible and affordable

• Legislation must push the pace of transformation to a system based on value, not volume

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Ascension is called to improve health and healthcare through sustainable, values-inspired innovation

Two Divisions

Delivery

Be a Mission-focusedmulti-market health

delivery system with a demonstrated ability

to deliver high-quality,low-cost, personalized and

compassionate care

Solutions

Continue to innovate, incubate and acquire

new solutions and capabilities to strengthen

our national health ministry in a rapidly changing

environment

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Ascension

Healthcare Division

Ministry Markets

Ascension Living

Ascension Medical Group

Ascension Community

Clinics

Ascension Clinical

Holdings

Ascension At Home

Solutions Division

Ascension Information

Services

AscensionMinistry

Service Center

Ascension Care

Management

Ascension Investment

Management

Ascension Global

Mission

Ascension Ventures

Ascension Holdings

Ascension Leader

Institute

• Ascension Leadership Academy

• The Resource Group

• Medxcel Facilities Management

• Ascension Holdings International

Ascension SmartHealth

Solutions

One Mission.One Integrated Ministry.One Ascension.

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Ascension Ventures

Solutions Division

• Strategic healthcare venture funds focused on the medical device, technology and service sectors

• Four funds and more than $800 million in assets under management

• Limited partners include several prominent Catholic and nonprofit health systems representing:

• 474 acute care hospitals

• $88 billion in combined annual operating revenue

• 500+ adoptions by LPs of solutions referred by Ascension Ventures

• Provides financial and strategic returns, including key insights into emerging technologies, products and services

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Ascension

Healthcare Division

Ministry Markets

Ascension Living

Ascension Medical Group

Ascension Community

Clinics

Ascension Clinical

Holdings

Ascension At Home

Solutions Division

Ascension Information

Services

AscensionMinistry

Service Center

Ascension Care

Management

Ascension Investment

Management

Ascension Global

Mission

Ascension Ventures

Ascension Holdings

Ascension Leader

Institute

• Ascension Leadership Academy

• The Resource Group

• Medxcel Facilities Management

• Ascension Holdings International

Ascension SmartHealth

Solutions

One Mission.One Integrated Ministry.One Ascension.

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Virtually Enabled Care

Ascension Holdings

Making Care Available Anywhere, and Deploying New Technologies to Support It

Direct to Consumer(D2C)

Specialty Consults(B2B)

@Home Monitoring

• Portfolio of services including contracting, operations and logistics, integrated change management, and implementation services

• Operates a group purchasing organization that benefits members by leveraging their contract portfolio to increase efficiency, decrease waste and reduce costs for participants and suppliers

The Resource Group

Ascension Holdings

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Results Driven: $1.0B+ Annual Expense Reduction

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Supply Chain Global Reach

Ascension Holdings International

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International Value Creation Platforms

The Resource Group’s international offering is only the first step of international expansion. In the future, other offerings could include other Solutions subsidiaries, quality-safety consulting, system consulting and hospital management consulting.

Now

System Consulting

Future Ascension International Offerings

Next

Future

Quality/Safety Consulting

Biomedical Engineering

Hospital Management

System Readiness And Processes

System Readiness And Processes

System Readiness And Processes

Food Services

Facilities Management

System Consulting

Quality/Safety Consulting

Biomedical Engineering

Food Services

Facilities Management

The Resource Group Global Solution

The Resource Group Global Solution

The Resource Group Global Solution

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1999INDIA20152012 2014

EUROPE2018

SINGAPORE2017

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Up-close learning from a high-quality, low-cost international model

Health City Cayman Islands

• A public-private partnership leveraging Narayana Health’s model for strategies and operational approaches that can be applied within Ascension while bringing care to an underserved population

• Opened in 2014 as a 104-bed cardiac and orthopedic specialty hospital

Accomplishments:• Built facility at ½ U.S. cost• Deliver procedures at ½ U.S. cost• Expanded service lines

HealthCityCaymanIslands.com

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“The U.S. healthcare industry has been

slow to adopt innovations developed

in other geographies.”─ Anthony R. Tersigni, EdD, FACHEPresident and Chief Executive Officer

Ascension

“The future cannot be just an extension of

the past. It must embrace new technology,

implement innovative approaches and aim

higher than people thought possible before.”

─ Dr. Devi Prasad ShettyChairman, Narayana Health

Board Chair, Health City Cayman Islands

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• Embracing the rapidly changing healthcare landscape

• Investing in innovation

• Developing partnerships that advance our Mission and Vision

• Supporting population-based economic models that reward value

Ascension is…

Maintaining our Vital Presence

“Do not conform to the pattern of this world, but be transformed by the renewing of your mind. Then you will be able to test and approve what God’s will is—his good, pleasing and perfect will.

“For just as each of us has one body with many members, and these members do not all have the same function, so in Christ we, though many, form one body, and each member belongs to all the others.”

A Vital Presence

Romans 12:2, 4-5

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Strategic Direction

Our Future Vision

Our outward

promise to those

we serve

Enabled by focused

inner strengths

ONE MissionIntegratedMinistryAscension

Strengthening Catholic healthcare

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Questions and Conversation