Source: Premier healthcare alliance

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1 Appendix Exhibit 1 Accountable Care Implementation Collaborative Members Aria Health, Philadelphia AtlantiCare, Egg Harbor Township, N.J. Baystate Health, Springfield, Mass. Billings Clinic, Billings, Mont. Bon Secours St. Francis Health System, Inc., Greenville, S.C.; and Bon Secours Richmond Health System, Richmond, Va. - part of Bon Secours Health System Inc. CaroMont Health, Gastonia, N.C. Fairview Health Services, Minneapolis FirstHealth of the Carolinas, Pinehurst, N.C. Geisinger Health System, Danville, Pa. Genesis Health System, Davenport, Ia. Hackensack University Medical Center, Hackensack, N.J. Heartland Health, St. Joseph, Mo. Hoag Memorial Hospital Presbyterian/Greater Newport Physicians, Newport Beach, CA Methodist Medical Center of Illinois, Peoria, Ill. Memorial Healthcare System, South Broward, Fla. North Shore- LIJ Health System, Long Island, N.Y. Presbyterian Healthcare Services, Albuquerque, N.M. Rochester General Health System / GRIPA, Rochester, N.Y. Saint Francis Health System, Tulsa, Okla. Southcoast Hospitals Group, Fall River, Mass. SSM Health Care, St. Louis Summa Health System, Akron, Ohio Texas Health Resources, Arlington, Texas University Hospitals, Cleveland, Ohio WellStar Health System, Atlanta, Ga.

2 Appendix Exhibit 2 ACO Core Components* For an ACO to accept accountability for improved outcomes and efficiencies, it must: Build people- centric systems of care Improve quality and cost for delivery- system components Coordinate care across participating providers Use IT, data and reimbursement to optimize results Build payer partnerships and accept accountability for total cost of care Assess and manage population health risk Be reimbursed based on savings and quality that is, value * ACO model graphic property of the Premier healthcare alliance All rights reserved.

3 Appendix Exhibit 3 Premier s Accountable Care Collaborative Methodology* Premier has developed a proven methodology for collaborative execution. Establish goals and mission: Create a definition of areas to be addressed and what the collaborative will do to fulfill its mission. Define consistent measures: Collaborative members commit to common measures that will be used to improve defined outcomes. Data collection and normalization: The collaborative uses standardized data sets to compare results across participants. Transparency: Participants commit to the open sharing of performance data. In doing so, participants can identify top performers and learn from them to create similar gains in their own organization. Driver analysis and collaborative execution: With transparent data, participants have information to determine the factors that drive inconsistencies or sub- optimal outcomes. Using that analysis, the collaborative can set performance targets, identify opportunities for improvement and establish areas of focus. Share best practices and create pathways to implement innovation: As disruptive ideas are identified and tested, we will create pathways to help members learn what works best and put those ideas into practice as soon as possible. Participants will be able to share new ideas a number of different ways, including educational meetings, resources and materials and knowledge transfer tools. Performance improvement analysis: Premier continually analyzes performance data of the participants as a cohort and individually to pinpoint trends and opportunities that will achieve the goals. Premier will bring together a broad range of stakeholders to guide the design and direction of the ACO Collaboratives. Members of the external Advisory Panel will include national thought leaders from government, patient advocacy groups, providers, payers and academia. * Collaborative methodology is property of the Premier healthcare alliance.

4 DeVore S, Champion RW. Driving population health through accountable care organizations. Health Aff (Millwood). 2011;30(1). Appendix Exhibit 4 Profile: Fairview Health Services Accountable Care Implementation Collaborative member Fairview Health Services is exploring a range of ACO innovations that are having measurable results in the communities they serve. Cultural transformation: Fairview is tackling cultural barriers to change through new primary care team structures that include a physician, nurse practitioner, nurses, medical assistants and schedulers. These teams meet face to face at least once a day to discuss patients and care issues. Culturally this change is significant. Practically, these teams have greatly improved efficiency, reducing the average physician backpack work load (returning messages, review lab results, charting, etc.) from 90 minutes to zero, creating time for physicians to manage more patients and explore care innovations. Technology engagement: Fairview has created an internal networking site called iconnect to help transfer knowledge and develop process improvements. One example comes from Fairview Eagan Clinic, where staff expressed concern on iconnect about inconsistent care protocols for pink eye. By the end of the same day, staff engaged with ideas and enhancements to the process, with the result being a new and improved pink eye protocol that already had buy in from clinical staff. New access points: Since some primary care services don t require in person interaction with physicians, Fairview created new options for patients to access care nurse only visits, virtual care visits, e mail consults and phone and group appointments. One example of this is a unique offering called Online Care Anywhere with Blue Cross Blue Shield of Minnesota, allowing beneficiaries to be diagnosed and treated by a provider over the phone and/or by Web camera. Source: Fairview Health Services

5 Appendix Exhibit 5 ACO Payer Partnership Component, with Related Capabilities, Operating Activities, and Collaborative Deliverables

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