The 12-Criteria of - PowerPoint Presentation

The 12-Criteria of Population Health ManagementBy Dale Sanders

Contact InformationDale Sanders, Senior VP, Strategy, Health Catalyst®dale.sanders@healthcatalyst.com@drsanders www.linkedin.com/in/dalersanders/ Carrie Ivers, The Advisory Board, Crimson Product Lineiversc@advisory.com512-681-2383www.linkedin.com/pub/carrie-ivers-reeuwijk/0/692/824 2 ®

AgendaDale Sanders: 35 minutes Description of the 12 Criteria for Population Health Data ManagementCarrie Ivers: 25 minutes Description of Crimson’s capabilities and strategy related to the 12 Criteria Q&A We will stay online as long as it takes to answer all the questions3 ®

Our Philosophy4 ®

The Supporting White Paper Google: “12-Point Review of Population Health Management Companies”5 ®

Overview Evaluate healthcare IT vendors and their PHM offeringsDevelop internal strategies and roadmaps for Accountable Care Organizations (ACO) Focus is on the data management of Population Health Management Purpose Not the processes of PHM, per se Not on activity based costing and fixed-price (bundled pricing) contract management– that’s a separate webinar ®

Poll QuestionOn a scale of 1-5 where do you feel your organization is in its Population Health maturity?5 – Very high maturity4321 – Little or no maturity 7 ®

Today’s Key Takeaways The ROI of Population Health Management (PHM) is still in debateInvestment is costly, returns are challenging 40% of healthcare is patient lifestyle related Focus on the highest ROI areas of PHM for now Stratifying population risk makes no sense without a strategy for interventionAnd focusing on the highest risk patients might have the lowest ROINo single vendor meets all PHM needs You’ll need a patchwork of solutions to fill the gaps“So you offer PHM, eh? OK, which parts?” 8 ®

True Population HealthManagement 9 Robert Wood Johnson Foundation, 2014 Requires a collaborative strategy between leaders in healthcare, politics, charity, education, and business

Population Health Management The Ordered Checklist for Your 3-5 Year Journey Registries: Evidence-based definitions of patients to include in the PHM registries Attribution & Assignment: Clinician-patient attribution algorithmsPrecise Numerators: Discrete, evidence based methods for flagging patients in the registries that are difficult to manage in the protocol, or should be excluded from the registry, altogether Clinical & Cost Metrics: Monitoring clinical effectiveness and total cost of care (to the system and the patient)Basic Protocols: Evidence based triage and clinical protocols for single disease states Risk Outreach: Stratified work queues that feed care management teams and processes for outreach to patients External Data: Access to test results and medication compliance data outside the core healthcare delivery organization Communication: Patient engagement and communication system about their care, including coordination of benefits Education: Patient education material and a distribution system, tailored to their status and protocol Complex Protocols: Evidence based triage and clinical protocols for comorbid patients Coordination: Inter-physician/clinician communication system about overlapping patients Outcomes: Patient reported outcomes measurement system, tailored to their status and protocol ®

Precise Patient Registries Evidence-based definitions of patients to include in population health registries 1 Must go beyond ICD codes, which are likely to miss 30-40% of the population ®

Patient-Provider Attribution Strategies and algorithms to assign patients to accountable physicians or clinicians 2 Generally accepted options for assigning attribution Patient selection of physician during open enrollment “Most frequently visited” physician over the past two years Random assignment of patients to primary care physicians in the same geographic area Random assignment of patients in an employer group to primary care physicians in the PPO or HMO ®

Precise Numerators in RegistriesDiscrete, evidence-based methods for flagging the patients in the registries that are difficult to manage or should be excluded from PHM, altogether 3 Reasons why a patient may not be able to fully comply with clinical protocols Language barriers Cognitive inability to participate in a care protocol Physical inability to participate in a care protocol Economic inability to participate in a care protocol Willing and informed refusal to participate in a care protocol, e.g. religious reasons Medication contraindications to participating in a care protocol Geographic inability to participate in a care protocol Mortality (it can be surprisingly difficult to identify these patients) ®

Clinical and Cost Metrics Monitoring clinical effectiveness and cost of care to the system and patient 4 Measure practice of medicine against these protocols Measure the variability in care Build dashboards around specific patients and population of patients Must track the total cost of care for specific patients and a per-capita basis across the population Provide quality, outcome, and cost variance feedback to physicians, risk adjusted, at the point of care Ultimately this prepares an organization for fixed-fee contracting in a true value-based system ®

Basic Clinical Practice Guidelines Evidence-based triage and clinical protocols for single disease states 5 Number of patients In the population The Average Total Medical Expenditure (TME) per Capita X ( ) ( ) Measure the practice of medicine against these protocols Current evidence-based medicine lacks applicability outside the specific clinical trial In the future, clinical trials’ “evidence” will be displaced by derived evidence from the analysis of local data sourced by the EDW In the meantime, the industry must make-do with existing evidence and guidelines Many external commercial sources and commercial vendors Health systems need to establish a “Clinical Practice Guidelines” governance body and select their source(s) and processes Start by defining clinical practice guidelines for patient cohorts and process families that offer the highest opportunity for improvement and cost savings High Opportunity = ®

Risk Management Outreach Stratified work queues that feed care management teams and processes 6 First need to stratify and monitor the registry patients Then develop strategies to identify and intervene with high-risk trajectory patients Ultimately need to profile and proactively treat patients before becoming members of the registry Risk stratification enables an organization to analyze and minimize the progression of a disease and the development of comorbidities ®

Be Careful What You Ask For Correlation Patients with the highest satisfaction scores => Higher rate of hospital admissions Prescribed more medications Unpublished, internal data analysis; Northwestern University Medicine Enterprise Data Warehouse, 2008 We were not the first or only organization to see this trend ®

Strategies for PHM Intervention Disease management — Example: Diabetes management programsCatastrophic care management — Example: Programs to reduce risk for individuals with a high risk of developing conditions that lead to catastrophic healthcare costs (e.g., cancer, brain injury) Demand management — Example: Nurse call linesDisability management — Example: Employer-sponsored programs to reduce disability days and costsLifestyle management — Example: Seat belt compliance campaigns, smoking cessation programs, weight management programsIntegrated care management — Example: Programs that integrate other types of interventions (e.g., catastrophic care management,disease management and demand management for cancer patients) with shared outcomes and monitoring over time 18 From Becker’s Hospital Review. Connie Evashwick and Ann Scheck McAlearney , at the American College of Healthcare Executives' 57 th Congress on Healthcare Leadership. ®

Caution of Paradox “…population strategies which focus on reducing the risk of those already at low or moderate risk will often be more effective than strategies which focus on high risk individuals at improving population health in the long run.” 19 Recommended reading: Geoffrey Rose, “Sick Individuals and Sick Populations”, International Journal of Epidemiology 1985;14:32–38. Gordon NormanChief Medical Officer, xG Health Solutions ®

Acquiring External Data Access to clinical encounter data, cost data, laboratory test results, and pharmacy data outside the core healthcare delivery organization 7 Contrary to current national strategy and focus, acquiring external data should be a secondary focus in today’s market It is geometrically more complicated to manage a patient population beyond the core healthcare delivery organization Start with in-house process and data quality first Then, carefully and deliberately expand the data ecosystem HIEs are the most visible technology associated with ACO external data exchanges, but only address a small portion of the data puzzles required for PHM The “A” in M&A will shift from bricks-and-mortar acquisition to data acquisition ®

Communication with Patients Engaging patients and establishing a communication system about their care 8 Current solutions are fragmented and immature but will improve dramatically in the next 3 years Today’s typical patient engagement solution is through a personal health record (PHR) tightly associated with a healthcare delivery organization EMR The future patient engagement solution will be completely patient owned, decoupled from an EMR or single healthcare organization The PHR will evolve into a personal project management system, with a combination of project management, knowledge management and social support. Take advantage of current PHRs, but be prepared to jettison current PHRs for something more informative, customized, collaborative and functionally rich ®

Educating and Engaging Patients Patient education material and distribution system, tailored to the patient’s status and protocol 9 Our current patient education system is hampered by the lack of highly personalized materials and an effective distribution system Often, today’s patients receive no education material about their condition PHRs tend to present generic education information No certified, widely available method of evaluating material quality Widely used vehicles like Twitter, Facebook, Zite , and Amazon have yet to be fully embraced Low-income, preteen girl with type 1 diabetes likely to receive same education material as a middle-aged executive man Materials are not tailored to blend comorbid conditions together ®

ACO vs. ACP: Accountable Care Patient 23 From Eric Topol’s Twitter feed, @EricTopol ®

24 American Journal of Preventive Medicine Volume 46, Issue 3 , Pages 237-248, March 2014 Graph from The Atlantic, March, 2014 Obesity Rates by Occupation

Complex Clinical Practice Guidelines Evidence-based triage and clinical protocols for comorbid patients 10 Establishing protocols for comorbid patients is complicated Few industry sources for clinical protocols for comorbid patients Physicians often left to build their own guidelines, or chain individual disease treatment protocols together Medicare patients on average affected by at least chronic diseases at the same time Organizations that optimize comorbid care will be in a strong position to differentiate themselves in the market, both financially and clinically ®

Care Team Coordination Inter-clinician communication and project coordination 11 We need to treat every patient as if they are at the center of a project plan All members of a patient’s care management team should be able to quickly and easily see the patient’s overall project plan, next milestones, and responsibilities Acute encounters should show recovery milestones and assigned people Chronic diseases should show a lifetime project plan for health The ideal system would function like a project management tool (like Basecamp) ®

Tracking Specific Outcomes Patient-reported outcomes measurement system, tailored to the patient’s status and protocol 12 Patient-reported outcomes data is one of the most important pieces of data missing from our ecosystem today Our best efforts today is assessing patient satisfaction, but that data falls short as an aid for measuring actual clinical outcomes This is also the most culturally and technically difficult criteria to implement Currently, no reasonable options exist in our industry A future patient-reported outcomes system must have a closed-loop data relationship with the EMR, and then exported to the EDW for analytic purposes ®

Vendor Evaluation and Scoring No single vendor today offers an integrated and fully functional population health management solution that meets all 12 criteria How did I come up with these scores? Personal experience as a customer of the vendors’ products Personal experience as an executive in the company (i.e. Health Catalyst)Conversations and interviews with current and past customers of the vendors’ products Market reports from, and conversations with, industry analysts at KLAS, Chilmark, IDC, Gartner, and the Advisory Board Publically available information on the vendors, including their own case studies, white papers, on-line product demos, and product informationConversations with current and past employees of the vendors ®

Focus on the framework & criteria, not the scoresScore these and other vendors yourselves ®

Vendor Evaluation and Scoring Crimson Explorys Health Catalyst Lumeris Optum Humedica Phytel Premier Average Score Criteria #01: Precise Patient Registries 5 5 9 3 3 3 3 4.4 Criteria #02: Precise Patient Attribution 5 5 8 5 6 5 5 5.6 Criteria #03: Precise Numerators in the Patient Registries 0 0 5 0 0 0 0 .7 Criteria #04: Clinical and Cost Metrics 7 7 9 6 5 4 5 6.1 Criteria #05: Basic Clinical Practice Guidelines 0 0 0 3 5 5 0 1.9 Criteria #06: Risk Management Outreach 1 0 0 5 7 5 0 2.6 Sub-Total 18 17 31 22 26 22 13 First tier evaluation scores ®

Vendor Evaluation and Scoring Crimson Explorys Health Catalyst Lumeris Optum Humedica Phytel Premier Average Score Criteria #07: Acquiring External Data 0 5 6 0 4 2 7 3.4 Criteria #08: Communication with Patients 0 0 0 4 5 6 0 2.1 Criteria #09: Educating and Engaging Patients 0 0 0 2 3 4 0 1.3 Criteria #10: Clinical and Cost Metrics 0 0 0 0 0 0 0 0.0 Criteria #11: Complex Clinical Practice Guidelines 0 0 0 0 0 2 0 0.3 Criteria #12: Tracking Specific Outcomes 0 0 0 0 0 0 0 0.0 Second tier evaluation scores ®

Asset Allocation and Timing Recommended asset allocation as the market and organization evolve and mature in population health management ®

Asset Allocation and Timing RecommendationsBuild a population health management roadmap Start as soon as possible with the first six criteria while the latter six develop in the market ®

Poll questionWho do you think will be the most capable to meet the data management requirements of Population Health Management? EMR vendorsAnalytic SpecialistsA combination of both 34 ®

Conclusion Key points to rememberFollow the lead of the IDNs which have been practicing PHM for years Reference this presentation and the CCHIT framework when developing an organizational strategy and evaluating vendors for PHM NQF has a new PHM initiative… keep an eye on that There is no single vendor that can provide a complete PHM solution today Sequencing is important. Focus on the first six criteria over the next three years while the context evolves ®

Other Population Health ResourcesClick to read additional information at www.healthcatalyst.com The Evolution of Care Management to Population Health Management This covers the evolution of the care management market to the population health management, the data needs for effective population health management, and population health business models Why the Solution to Population Health Management Woes Isn’t an EMR Healthcare systems are struggling to figure out how to shift to a value-based model and remain competitive. This will require hospitals to identify and reduce waste in three categories: the variation in 1) the care that is ordered, 2) how efficiently that care is delivered, 3) in care delivery that causes preventable complications .Clearly, EHRs aren’t the answer. The Best Way to Prioritize Your Population Health Management Efforts Effective population health management starts with clearly defining a subset or cohort of patients and determining on which clinical processes to focus improvement efforts. The Health Catalyst Key Process Analysis (KPA) application determines the highest variation and highest resource consumption by integrating and analyzing clinical and financial data. ®

Other Population Health ResourcesClick to read additional information at www.healthcatalyst.com Case Study: Using Data and Reporting in Population Health Efforts How a healthcare system went from manually pulling together reports with varying data to having near real-time data that one executive says, "enables our care coordinators to drive preventive care and ultimately lower our population health costs" Case Study: Using Advanced Analytics to Manage Primary Care Population Health Population health management is largely being driven by the 5 percent of the population accounts for 50 percent of healthcare costs. Being able to identify these patients, provide high-quality care and reduce their utilization is a pressing goal for many of today’s primary care providers (PCPs). Learn how one organization used health care analytics to meet this challenge. Implementing a Successful Population Health Management Strategy A White Paper by Dr. David Burton Based on 25 years of experience, first as a senior executive at Intermountain Healthcare and later as the Chairman of the Board of Health Catalyst, Dr. Burton shares his in-depth learnings about how to systematically implement population health management in a long-term, sustainable way. ®

In Pursuit of ValueCombining Precise Population Risk Analytics with Robust Care Management Support CrimsonPopulation Health

Research Consulting & Talent Development Technology The Advisory Board Helps You Transition to Value-Based Care Optimize Network Performance Engage physicians in performance improvement Reduce cost and care variation Improve quality Manage Financial Outcomes Develop strategy for payment transformation Negotiate risk-based contracts Manage contract performance Crimson Population Health Analytics and workflow technology enabling health systems to manage the clinical and financial outcomes of defined populations. Build the Provider Network Achieve clinical integration Deliver targeted outreach to high-value physicians Reduce referral leakage Transform Care Delivery Prioritize at-risk patients Surface care gaps and intervene Coordinate care across the continuum 350+ accountable care projects across 45 states 75+ Clinical Integration programs developed 45M+ lives in population health benchmark database 100% NCQA PCMH recognition for 50+ members

The Business Case for Change 40 Diverse Motivations for Population Health Source: Health Care Advisory Board interviews and analysis. Strategic Benefits of Transformation Align financial incentives with mission Support investments in better health Clinical Advantage Attract market share of lives Secure attractive purchaser contracts Market Advantage Capture greater share of premium dollar Move away from faltering fee-for-service economics Financial Advantage

41 Two Plausible Transition PathsEnabling Financial Success from Population Health Management Source: Health Care Advisory Board interviews and analysis. Migrating to a Value-Based Business Model Payment Transformation Care Transformation Leading with Care Transformation Invest quickly Prove concept Obtain value-based payment Leading with Value-Based Contracts Meet payer demands for risk Secure share Adapt care model

42 Extremely Challenging to Execute Successfully Four Critical Success Factors, Many Hurdles Along the Way Achieve Data Transparency to Manage Utilization Hard to arm physicians with information due to limited transparency provided by payers Difficult to link and reconcile disparate data sets using data warehouse solutions Internal clinical and financial systems constrains visibility to utilization inside organization Prioritize Patients at Highest Risk of Poor Cost and Quality Outcomes Predictive analytics required to forecast outcomes with accuracy not a core competency of EMR, financial system vendors, or providers Lack of robust benchmarks prevents identification of actionable opportunities based upon gap to benchmark Limited visibility into psycho social factors Focus Interventions on Highest Prioritized Opportunities Lack of integration between analytical and workflow tools prevents effective execution Difficult to quickly identify and engage the appropriate resources for each intervention Limited ability to bring together timely clinical and financial risk data for clinicians at the point of care Measure Impact of Interventions and Continuously Improve Difficulty linking cost and utilization data hinders ability to track and trend PMPM costs Data complexity prevents routine analyses with frequency required for course correction and continuous improvement Difficulty connecting productivity of care managers to outcomes and return on investment CMO CFO 1 2 3 4

43 Managing Three Distinct Populations Essential to Profitability Third-Party Information Valuable But Should Not be Sole Determinant in Segmentation Strategy Source: Health Care Advisory Board interviews and analysis. High- Risk Patients 5%; complex Rising-Risk Patients 15-35%; may have conditions not under control Low-Risk Patients 60-80%; any conditions minor, easily managed 5 Year Margin Projection by Risk Management Level Financial Analysis Indicates Necessity of Managing Rising-Risk Patients Cigna BCBC Aetna UHC Humana Managing high-risk only Managing high-risk and rising-risk patients

44 Prioritize Population-level Improvement Opportunities Proactively Manage Individual Patient Health Evaluate Effectiveness of Interventions Who are my highest-risk patients? Which diagnoses are contributing most to avoidable utilization? Are these patients receiving recommended care? What interventions would decrease avoidable utilization? Did these interventions reduce avoidable utilization? Were our medical homes successful in decreasing PMPM costs? The Crimson Population Health Solution Hardwiring a Critical Feedback Loop New Insights Achieved by Marrying Clinical Data with Total Cost and Utilization Population Risk Management + Care Management Workflow + Care Gap Analysis Functionalities Achieved through Platform Integration Linking clinical values with claims data Enables multivariate analysis of utilization, claims and clinical values for superior population health management Population analytics at the point of care Integrates population-level risk analytics with point-of-care clinical workflow tools, enabling prioritization of high-risk patients for targeted interventions

45 Tailored Data Acquisition Approach Patient Accounting System Hospital Clinical System Practice Management System Ambulatory Clinical System Medical/Rx Claims Processor Third-Party Lab System S ource systems Hospital Data Warehouse Advisory board company data extract Risk contract modeling Population utilization benchmarking Predictive risk algorithms Severity-adjusted physician performance benchmarks Charge normalization Total market referral analysis Multi-source evidence-based care guidelines Point-of-care workflow tools Customizable measure sets Real-time clinical predictive analytics Natural language processing Automated chart review Risk-based contract performance management Avoidable utilization identification Population risk stratification Physician relationship analytics Network leakage analytics Cross-continuum physician performance management Medical home support Patient compliance tracking Patient outreach and engagement Instant patient risk assessment Inpatient and ambulatory clinical risk surveillance Intervention impact tracking insights to Support: Population Risk Management Network Management Care Management Real-Time Risk Identification Best-in-breed Data analytics

46 Common Data Approaches Failing to Deliver a Complete Solution Payer Solutions Data Warehouses EMRs / Clinical Systems Data spanning care settings and delivery network Expertise managing population risk Availability of clinical and financial data spanning care settings Flexibility of analysis Physician and clinician familiarity and engagement with systems Detailed clinical data Conflict of interest when handling data from other payers Limited to claims data Lack of experience with clinical data Lack of experience with provider performance analytics, operations Data and analytics not accessible to clinician end user Potential challenges linking data Difficult to integrate analytics into clinical workflow Lack of benchmarks Not total market Lack of financial data Siloed by care setting D ifficult to extract, aggregate data for analysis Challenges with alert fatigue Hallmarks of a Best-Practice Population Health Management Solution Cross-continuum data Total market data All payer data Clinical and financial data Clinical and financial predictive analytics Customizable performance benchmarks Continuous measurement Analytics embedded in point-of-care work routines Designed to engage providers Accessible across care sites Comprehensive Visibility Insight-Driving Analytics Workflow Support Strengths Deficiencies

47 The Crimson AdvantageData-Driven Insights Enable Proactive and Comprehensive Care Consolidated Data From Multiple Sources Unparalleled Care Transformation Support $2M Potential savings across 1,000 lives 200+ Evidence-based care guidelines and prompts 6M Lives contracted for care management Hardwire Physician Intervention Point-of-care workflow tools to maximize efficiency, effectiveness of patient encounters Proactively identify care gaps using multi-source guidelines, customizable rules engine Manage Total Cost and Quality of Key Populations Identify areas of inappropriate utilization, low compliance to manage network performance Risk stratification algorithms to identify high priority patients requiring timely intervention Measure, manage interventions Analytics Fueled by Research and Insight Payer and Employer Data Medical Claims Prescription Drug Claims Eligibility Files HRA and Biometric Data Physician Practice Data Office-Based PMIS CPT2 Codes Office-based EMR Lab Systems E-Prescribing Systems Direct Entry 45M+ Lives in utilization benchmark database 25+ years of experience researching best practices and identifying areas of opportunity for providers Provider-centric user interface Consolidated view of financial and , clinical performance; robust and customizable benchmarks Extensive cohort services Leading provider of utilization / cost benchmarks and actuarial analytics to the health care industry Benchmarks customizable by geography, plan design, demographics; powered by a database of 45M lives, 2.5B claims Proprietary clinical and financial modeling tools Improve Individual Patient Health Address all levels of patient risk through automated alerts, triggers and care plan development Standardize care manager activities regardless of payer contract or care model to improve overall patient outcomes Increase patient panel size through robust prioritization and automated assignment of tasks across entire care team Hospital Data ADT messages

48 Beyond the TechnologyProviding Extensive Support to Ensure Member Success Additional Services for Crimson Members CXO Affinity Groups Leaders from across The Advisory Board gather with members in our offices or via webinar to problem-solve addressing market and regulatory forces and overcoming implementation challenges as providers migrate toward accountable care. Patient-Centered Medical Homes Bundled Payments Shared Savings Clinical Integration 30+ Years of Best-Practice Research The industry leader for health systems in search of research and insights on the implications of value-based payments and accountable care. Current library includes: Medicare Shared Savings Program Rulebook Succeeding Under Bundled Payments Playbook for Clinical Integration - Building the Performance-Focused Physician Network Blue Print for the Medical Home Clinical Consultants and Coaches Our Medical Directors and Nurse coaches provide insight on how best to improve clinical workflow and leverage data transparency across the collaborative care team Crimson Executive Partners Our most respected executive talent will partner with your leadership team to ensure that our support continually serves your organizational strategy. The EPs bring clinical training, consulting experience, and proven industry depth. Hands-On Support Dedicated Advisors Serve as educator, analyst and counsel identifying care variation, advising on goals and tactics to drive results. Business Analysts Dedicated technical talent who works closely with IT staff, testing data files and formats to ensure seamless site launch and maintenance. Program Managers Our proven project managers serve as a single point of contact managing your technical deployment and ensuring continual implementation progress. Annual Performance Summit Seminal event gathers the entire Crimson cohort to celebrate achievements, share best practices, and highlight successful member case studies. National Webinars Educational intensives focused on current research topics or member case studies including live discussion with Crimson experts and peers. Progressive Peer Network Clinical Advantage Product Advisory Council Participation throughout the year in exclusive meetings with Crimson leaders of product management. These sessions provide an opportunity to preview planned enhancements ahead of Crimson peers, as well as contribute to the near-term product roadmap, and next-generation product capabilities. Unparalleled Services and Resources for Crimson Members

49 A Proven Record Supporting Population Health Management Groundbreaking Technology Capabilities and Assets 140 + At-risk populations supported by Crimson Number of lives managed using Crimson Lives in population health benchmarking database Cost and quality profiles for over 500K physicians Payers sending data to Crimson Payer types supported: Medicare, Medicaid, Medicare Advantage, Commercial, Self-Insured 2.1M + 112+ Depth and Breadth of Expertise Cross-continuum analytics that provide insight into opportunities for improvement by physician, patient and population Risk stratification algorithms with proven predictive superiority Seamless link between population-level analytics and care management work flow to support direct management of high-risk patients Exclusive access to Milliman MedInsight’s customizable benchmarking database of over 2.5B claims and 45M lives Evidence-based guidelines and measures proactively identify gaps in care to facilitate physician and care team workflow Supports tracking for all 33 Medicare ACO metrics and Group Practice Reporting Option submission for identified patients Continuous innovation: member-driven changes , 10 new technology releases per year 5 of 5 A Sampling of Population Health Management Partners Medicare Shared Savings Participants About Covenant Health Partners: Clinical integration program of Covenant Health System in Lubbock, Texas Network of 150 employed. 150 independent physicians Hospital Efficiency Contract for 30K admissions to Covenant Health System, fully at risk for 9K+ lives About MissionPoint Health Partners: Clinically integrated network of St. Thomas Health of Acension Health in Nashville, Tennessee Four major hospitals, over 100 outpatient locations and 1200 physicians participating in network At risk for 40K Medicare and local employer lives About Memorial Hermann Physician Network: Clinically integrated network of Memorial Hermann, a 9 hospital system in Houston, Texas Over 2000+ physicians and 850 independent practices At risk for 60K employee, commercial, Medicare lives 45M 500K +

50 For Additional Information, Infographics and Research visit the following link: www.advisory.com/research/resources/posters/accountable-for-progress You can also email iversc@advisory.com

Thank You Next Educational Webinar The Path to Shared Savings With Population Health Management Applications Laser Focused on Finding Waste, Defining and Monitoring Populations, Accountable Care Organizations and Health Systems Alike Will Learn About The Success of One System Who Reduced Heart Failure ReadmissionsDate : Wednesday, April 9thTime: 1:00-2:00 PM ET Presenter: Eric Just, VP, Technology; Kathleen Merkley , VP, Clinical Engagement By Failing to Prepare, You Are Preparing to Fail Laying the Foundation for Sustainable Change and Success Date: Wednesday, April 16th Time: 1:00-2:00 PM ET Presenter: John Haughom , MD, Senior Advisor, Health Catalyst® Register at http://healthcatalyst.com/ ®