Ascension Health NCCCP Pilot Sites Overview

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Ascension Health’s Mission, Vision and Values

Our Mission . . . Directs us to serve all persons, particularly those poor and vulnerable, toward improving the health of individuals and communities.

Our Vision . . .Propels us to contribute to the building of a strong, vibrant Catholic health ministry in the U.S.

Our Values . . .We are called to: Service of the Poor, Reverence, Integrity, Wisdom, Creativity and Dedication.

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Fiscal Year 2006 Systemwide Statistics

• Discharges 660,341• Inpatient Malignant Neoplasm Cases

82,805• Available beds 16,788• Number of births 74,942• Total surgical visits 531,938• Emergency visits 2,073,619• Physician office visits 3,530,176• Total outpatient visits 14,884,007• Employees 105,000

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Lourdes Health NetworkPasco, WA

Carondolet Health NetworkTucson, AZ

NCCCP Pilot Sites

St.Vincent Indianapolis HospitalIndianapolis, Ind.(Lead Clinical)

Brackenridge HospitalAustin, Texas(Lead Access)

Columbia St. Mary’sMilwaukee, Wis.

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NCCCP Pilot Sites

Early Stage Comprehensive Cancer Care

Later Stage Comprehensive Cancer Care

Later Stage Access Model

Early Stage Access Model

BrackenridgeHospital

Austin, TX

ColumbiaSt. Mary’s

Milwaukee, WI

St.VincentHospital

Indianapolis, IN

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Importance of NCCCP Project

• The best care available to all• Making sure that our

understanding of the value of new treatments is determined from their evaluation in all

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Importance of NCCCP Project

“Consistent with our Mission, this initiative will allow Ascension Health to open the doors to thousands of cancer patients – including many who are poor and vulnerable – who otherwise would not have access to the excellent clinical care and cancer trials they need and deserve. This work supports our Strategic Direction in which we promise Healthcare That Works, Healthcare That Is Safe, and Healthcare That Leaves No One Behind, for Life.”

– Anthony R. Tersigni, EdD, FACHEPresident and Chief Executive OfficerAscension Health

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Challenges and Opportunities

Clinical• Offers the highest

quality cancer care – including clinical trials and end-of-life care – to those who need it

• Clinical trials must include all patients

Disparities• Breaks down

barriers to care for thousands of cancer patients – including many who are poor and vulnerable – who otherwise would not have access to the care they need and deserve

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Ascension Health’s Call to Action

Healthcare That Works• Consistent, exceptional Ascension Health

Experience and strive to achieve absolute satisfaction by 2020

Healthcare That Is Safe• Zero preventable injuries and deaths by 2008• “A clinically obligated group”

Healthcare That Leaves No One Behind• 100% Access in every community by 2020

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Spreading Clinical Practices Across Ascension Health

• The Strategy – •8 priorities for action directly

address outcomes•5 challenges in how we work

together change the environment to make rapid and sustained change possible

• 369 days from July 08

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2,027 Ascension Health System Mortalities

Avoided from Baseline

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Systemwide Spread -- Perinatal Safety

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Ascension HealthBirth Trauma Rate

14Hospital ID

[103

][0

59]

[007

][0

12]

[069

][0

11]

[051

][0

48]

[047

][0

16]

[046

][0

33]

[027

][0

24]

[026

][0

55]

[057

][0

32]

[031

][0

62]

[061

][0

09]

[005

][0

36]

[066

][0

65]

[004

][0

35]

[014

][0

02]

[054

][0

03]

[001

][0

17]

[042

][0

30]

[021

][0

64]

[067

][0

18]

[053

][0

68]

Ob

serv

ed R

ate

per

100

0 L

ive

Bir

ths

0

2

4

6

8

10

30.2

1.7

Priority For Action - Perinatal Safety Birth Trauma1/1/2006 - 12/31/2006

System Average

National Average6.5

National Rate is 6.5 birth traumas per 1000 live births.System Average is 1.7 birth traumas per 1000 live births.Comparison to National Rate: We are 74% lower than the national rate (favorable).

Hospital ID

Ob

serv

ed R

ate

per

100

0 L

ive

Bir

ths

0

2

4

6

8

0.0

1.53

Priority For Action - Perinatal SafetyNeonatal Mortality1/1/2006 - 12/31/2006

System Average

Neonatal Mortality is a death during the first 28 days prior to discharge in a live born inborn infant ≥ 24 weeks of gestational age without lethal malformation or abnormality.National Rate is 4.7 neonatal mortalities per 1000 live births.Goal is 0 (zero) neonatal mortalities per 1000 live births.System Average is 1.53 neonatal mortalities per 1000 live births.Comparison to National Rate: We are 67% lower than the national rate (favorable).Interpreting the Graph: Data points (dots or ministry lines) that are below the System average line indicate a neonatal mortality rate that is lower than the System average.

4.7National Average

Hospital ID

Ob

serv

ed

Rate

pe

r 10

00 I

np

ati

en

t D

ays

0

2

4

6

1.4System Average

Priority For Action - Pressure UlcerFacility Acquired Pressure Ulcer Incidence1/1/2006 - 12/31/2006

no data avaliable

21.1718.14

National Avearge

National Rate is 18.1 to 21.2 facility acquired pressure ulcers per 1000 inpatient days.System Average is 1.4 facility acquired pressure ulcers per 1000 inpatient days.Comparison to National Rate: We are 92% lower than the national rate (favorable).average.

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Ascension Health System Performance 2006

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2020 Goal of Healthcare That LeavesNo One Behind = 100% Access

What, and For Whom, is 100 Percent Access?

100% access means that all persons, particularly those persons who are uninsured or underinsured, receive healthcare services that:

1. Create, and support the best journey to improved health outcomes for each individual, and

2. Are funded in an adequate and sustainable fashion.

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Principles

1. We are committed to access for all. 2. Healthcare is a right required for human dignity.3. We reject a “two-tiered” health system that separates those

who can pay for services from those who cannot pay for services.

4. A comprehensive solution to finance the care of the uninsured and underinsured is the shared responsibility of public and private partners at the local, state and national levels.

5. Healthcare systems must redesign care to achieve safe, accessible care for the uninsured.

6. To achieve access to healthcare for all, a new model of access leadership involving inclusive, “ego-less” collaboration is required.

Discussion Draft from Ascension Health Board of Trustees – March 14, 2007

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Setting/Defining a Broad 2020 Goal of 100% Access:Defined as Linking Improved Health Outcomes and Achieving Sustainable Funding

Showcasing Health Ministry Leadership by Initiating Pilot Access Models:Sites Catalyzed by the Federal Grant Funding from the Healthier Communities Access Program (HCAP)

Learning Together by Crafting the 5-Step Access Model: Synthesis of Learnings from Pilot Access Model Sites

Measuring Success Through Outcome Measures: Tracking Results of Access Models

Rewarding Health Ministries for Access Work:One Year System Incentive Rating Leadership Participation in Access Models’ Collaborative Work

Initiating Implementation Planning Through the Access Leadership Program:Translating the 5-Step Access Model to 18-Month Health Ministry Access Plans

Broadening the Impact of Health Ministry Leadership Through Influencing Community-Wide Systems’ Change Versus Episodic Hospital- Based Programs

Expanding Funding Sources: Seeking National Collaborative Partners and Local Partners to Match System Endowment Grants

Investing Local Resources to Access Work: Access Leadership Plans Integrated into ISFPs* and Health Ministry Organizational Structures

Engaging All Health Ministries in Access Work:Setting an At-Risk Compensation Plan for 28 Health Ministries to Complete Access Leadership Plans

Effective Systems / Models of Care for the Uninsured/Underinsured:Redesigning the Care Journey to Improved Health Outcomes

Outcome Measures:Measuring Improved Health Outcomes as Success

Sustainable Funding:Achieving Solutions for 100% Access

Incentives: Tied to Improving Health Outcomes for Uninsured/Underinsured and Achieving Sustainable Funding

New Model of Leadership Achieved:Integrating 100% Access Work into Health Ministry Operations

Access Models: From Strategy to Operations

Where We Have Been Where We Are Today Where We Want to Be

*Integrated Strategic and Financial Plans Revised 10/25/06

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2007Access Model Collaboratives

Lourdes Health NetworkPasco, WA

Carondolet Health NetworkTucson, AZ

*Daughters of Charity ServicesSan Antonio, TX

*Seton Family of HospitalsAustin, TX

Daughters of Charity ServicesNew Orleans, LA

*Our Lady of LourdesMemorial HospitalBinghamton, NY

*St. Vincent HealthIndianapolis, IN

Saint Thomas Health ServicesNashville, TN

*St. Vincent’s HealthCareJacksonville, FL

*Lourdes Health NetworkPasco, WA

*Carondelet Health NetworkTucson, AZ

Borgess HealthKalamazoo, MI

*Daughters of Charity Services of Arkansas Dumas, AR

Saint Mary’sof MichiganSaginaw, MI

*St. JosephHealth SystemTawas City, MI

Genesys Health SystemFlint, MI

*St. John Health Detroit, MI

*Sacred Heart Health SystemPensacola, FL

*Seton HealthTroy, NY

*St. Vincent’s Health Svcs.Bridgeport, CT

Good Samaritan Reg. Med. Ctr.Pottsville, PA

*Carondelet HealthKansas City, MO

*Columbia St. Mary’sMilwaukee, WI

* Access Leadership Planning Program Participant

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Michael’s 3-month Healthcare Journey ---Without Insurance

2/20/04 Acute Upper Respiratory Infection Brackenridge Hospital ER (Ascension Health)

2/20/04 Bronchitis St. David ER

3/9/04 Backache St. David ER

3/11/04 Lumbago, Hypertension St. David ER

3/11/04 Skin Disturbance Brackenridge Hospital ER (Ascension Health)

4/1/04 Lumbago Seton McCarthy (Ascension Health)

4/13/04 Neuritis Austin Travis County FQHC

5/12/04 Joint Pain Austin Travis County FQHC

5/13/04 Lumbago Brackenridge Hospital Outpatient (Ascension)

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SYSTEMIC CHANGE = 100%

ACCESS

Ascension Health’s5-Step Model to 100% Access

© Ascension Health

5. Sustainable Funding is Achieved for Care (State/local government; business; community partnerships)

4. Private Physicians Volunteer as Medical Homes/Specialists for the Uninsured and Underinsured

3. Care Models Achieve Improved Health Outcomes

2. Community Service Gaps Filled(Dental/Pharmaceutical/Mental Health)

1. Develop Community-wide Formal Infrastructure•Leadership Coalitions•Shared Information Systems•Catalyst Funding

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National Access Outcome Measures Initiative (NAOMI)*

* Work is underway to complete health outcome measures related to asthma and hypertension.

Access

1 Demonstrate an increase in the number of individuals in the targeted population with funded healthcare by increasing enrollment in public funded healthcare programs such as Medicaid, SCHIP, existing State and Local coverage initiatives.

2 Demonstrate an increase in the number of individuals in the targeted population with funded healthcare by increasing enrollment in private funded healthcare programs such as New Plan for the uninsured.

3 Demonstrate access and assignment to a medical home as evidenced by a documented visit to a primary care physician.

4 Demonstrate the impact of Pharmaceutical Assistance Programs by the percentage of unduplicated people who receive pharmaceutical assistance.

5 Demonstrate the impact of Pharmaceutical Assistance Programs by the retail cost of drugs obtained.

6 Demonstrate a reduction in unnecessary emergency room visits in the targeted population.

7 Demonstrate a reduction in unnecessary hospitalizations in the targeted population.

Health*

1 Diabetes: Demonstrate an improved health status of diabetic clients who are enrolled in care management programs.

Financial

1 Demonstrate a reduction in the cost of unnecessary emergency room visits in the targeted population.

2 Demonstrate a reduction in the cost of unnecessary hospitalizations in the targeted population.

3 Demonstrate achievement of material, sustainable funding for the care of the targeted population.

*Approved by Board Executive Compensation Committee December 8, 2006

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Cumulative Number of Adult Medicaid Enrollees, April 2005 – December 2006

0

2000

4000

6000

8000

10000

Apr.-Dec. 05 Jan.-June 06 July-Dec. 06

Through December 2006, 8,011 (33%) obtained coverage.