Transforming Fairview’s Business Model to Accept Risk and Manage the Health of Populations

1. Transforming Fairview’s Business Model to Accept Risk and Manage the Health of Populations Cornell University’s International Health Care Conference May 11th – 12th, 2010

2. Fairview Overview Large integrated health system • Not-for-profit, established in 1906 • Headquartered in Minneapolis, MN • Partnership with University of Minnesota • 22,000+ employees • 2,500 aligned physicians Comprehensive continuum of services • 8 hospitals/medical centers • 42 primary care clinics • 55+ specialty clinics • 28 retail pharmacies • 20+ rehabilitation centers • 26 senior housing locations • Home care and hospice • 2009 data • 4.8 million outpatient encounters • 80,314 inpatient admissions • $333.6 million community contributions • Total assets of $2.4 billion • $2.7 billion total revenue 1

3. Change is coming…Change is here • We are being asked to deliver greater value. • Improved clinical outcomes • Lower cost • Improved experience • We will be asked to care for the health of a population. • Payment systems and methodologies will change, rewarding those who deliver value.

4. The market is changing… Population/ Global Payment Transition Value Market Relevance Global Adoption Today X Payment Methodologies Volume Individual/ Discount Fee For Service Encounter Episode/Lifetime Care Delivery

5. Requiring a new “value chain”… Change Care Creating Value and Outcomes Consumer Provider Value Change Payment Change Experience Employer/ Plan Patient Activation and Consumer Engagement “Global Payment” Enables Performance Rewards Value

6. And a repositioning of our business model Integrated Delivery System Multiple Points of Access (Health Home) Maximize Utilization/ Revenue Growth Internet Multi- Specialty Group Practice TODAY (fee for service) Virtual Clinics Outpatient Ancillaries Incentive to reduce utilization Retail Clinics Sub-Acute Care Employer Clinics FUTURE (global payment) Population Physician Clinics Acute Care Urgent Care Minimize Utilization/ Manage Margin ER Care Management

7. To deliver on today’s and tomorrow’s definition of “value” TodayTomorrow Processes Health & Outcomes Status Encounter Customer Satisfaction Loyalty Cost/ Cost/ Case Member Share of Share of Encounters Covered Lives

8. Creating capabilities and capacity to manage the health of populations Volume Value Fee-for-Service Shared Savings Episode Payment Partial Capitation Global Payment Network Development Fairview Population Population Health Care Delivery Innovation Medical Home Epic Install Integrated Business Intelligence Fairview Medical Group Reorganization Care Packages Physician Compensation Accountable Care Organization Payer Contracting Methodologies Sensor Technology Operating Model/ Infrastructure Virtual Care

9. Today…care for the sick is physician centric

10. Tomorrow…keeping patients healthy with team-based care

11. 2009 CMI results… • Improved quality • Increased access and capacity • promoted virtual care (phone, email, webcam) • created new visit types (nurse only, team visits – n clinicians to one patient) • asked patients for input on length of appointment required when scheduling • Increased patient satisfaction • Migraine example • A real person answered the phone • . . . who knows you

12. Improved quality in CMI clinics

13. Improved access and capacity… Improved Access MD Capacity Increase

14. Successfully shifting care to lower cost & more patient-friendly interactions… Team-Based Care 2008 2009

15. Virtual care…Care Anywhere Average Satisfaction with Online Care By Consumer: 4.69/5 stars By Provider: 4.31/5 stars 49 visits (0 paid extensions) 21 coupons used 1057 enrolled consumers (4.3% with visits) 32 providers (75% with visits) Online Care Rooms 2133 Total Card Swipes 1503 Main 525 RP 105 Virginia Visit Demographics 69.4% Female 30.6% Male Age Time of Day Provider Types Visit Details 12.2% 55-64 94% MD 4% Physician Asst 2% Nurse Practitioner 0% Phone Only 100% Web 0 Disconnects 0 Provider Cancelled/ Provider Declined 49 Completed 28.6% 21-34 32.7% 45-54 26.5% 35-44 Satisfaction with Provider 4.63/5 stars Top Rx • Virtual care prototype with BCBSM: • Fairview providers care for BCBSM employees & family members using web cams in employer clinics and homes • Model and understand virtual care operations • Design for consumerism 18 prescriptions written. No additional detail available Top Diagnoses/Disease Areas • Skin disorders and redness • Behavioral Health • Insomnia • Migraines and other headaches • Hypertension ( November 30, 2009 - January 25, 2010)

16. Payer revenue at risk • Revenue at risk with 3 major commercial payers • Various models • Clinical quality • Clinical quality & total cost of care • Total cost of care • 2010 Revenue at risk $40+M

17. Challenges • Changes in the care models are moving faster than payment & growth models • Living in two worlds is difficult • Change roles

18. Our work requires transformational change in organization focus… Clinical Enterprise Realize value Care Model Innovation Creating new value Operations Global Business Services Creating enabling expertise Design Member Acquisition Connecting to Members Business Model Innovation Recognizing Economic Value

19. Our work requires transformational change in organization focus… Operations Realize value Multi-Specialty Group Outpatient Care Sub-acute Care Acute Care Care Management Design Creating new value Care Model Innovation Business Model Innovation Member Acquisition Goals and Strategies Global Business Services

20. Business model shift New and changing roles will emerge as a “network of capability” forms to deliver on the promise of the new value chain. Payers Individuals Employers Providers Disease Risk Sales Product Development Selection Risk Underwriting Credentialing Credentialing Network Management Network Management Perform- ance Risk Medical Management Medical Management Risk Mitigation Member Services Cash Management Cash Mgmt. Cash Mgmt. Risk Reserves