Eastern Maine Healthcare Systems Non-Profit Health Care Investor Conference

Transcription

1 Eastern Maine Healthcare Systems Non-Profit Health Care Investor Conference May 21, 2014 M. Michelle Hood, FACHE President and Chief Executive Officer Derrick O. Hollings, CPA Senior Vice President, Treasurer/CFO 0

2 OUTLINE System Overview Michelle Hood Leadership Michelle Hood Financials Derrick Hollings 1

3 SYSTEM OVERVIEW Presented by Michelle Hood 2

4 Provider Network EMHS 10,301 employees 8 hospitals located across Maine 621 employed physicians 43 primary care practice locations 4 retail pharmacies 5 emergency transport units 9 nursing homes 5 home health locations integrated EMR freestanding cancer center 1.8 million outpatient visits annually 3

5 EMHS MARKET SHARE EMHS exceeds 30% market share across 2/3 of Maine s geography 70% market share in Bangor service area 25% market share in Portland service area 4

6 LEADERSHIP Presented by Michelle Hood 5

7 Leadership Engine Mission EMHS partners with individuals and communities to improve health and well-being by providing high quality, cost effective services. Vision EMHS will be a nationally recognized model of excellence in healthcare. Values Passion Innovation Integrity Respect Accountability Partnership 6

8 Governance Structure Board Chair: Jim Nicholson, CPA Board Size: At least 15 and not more than 25 directors Board Committee: Representation from across market service area Board Term: 3 year term and maximum of 4 full consecutive terms Committees of the Board of Directors Clinical Coordinating Governance Nomination Strategic Planning Executive Management Performance Finance Audit and Compliance Council of Chairs Investment Function Team 7

9 New Governance Model Joint & Exclusive Initiatory Powers EMHS, acting independently, can initiate action at any level EMHS Board Exclusive System Level Budget Exercise rights as sole member or shareholder Joint Board Initiatory Powers Member actions subjected to EMHS approval EMHS can act after consultation with Member Member Board Exclusive Privileging and credentialing of medical staff Integrated Member Organizations subject to EMHS, can initiate joint strategic deliberation and action EMHS President has management control of all operations EMHS CEO Hiring of Member CEO Hiring of EMHS executive team Member Organization CEO Hiring of Member Organization executive team 8

10 Triple Aim 9

11 State Wide ACO Network Beacon Health Leading Development of High Performing Provider Network 10

12 Beacon Health Pioneer ACP GPRO Benchmark Scores Compared to CMS 5 Star Cut Point Medicare Advantage Plans are graded on a 1-5 star rating by CMS. The 5 star quality rating system is used to measure Medicare beneficiaries experience with their health plans and the health care system. Beacon s Pioneer ACO GPRO Benchmark scores when compared to the CMS 5 Star Cut Point, Beacon s scores were equal to or higher in all but one category CMS 5 Star Cut Point EMHS Beacon Health 11

13 Brand Architecture Reinforce the strategy behind our statewide integrated care delivery system 12

14 Leadership Reinvented Structure Leadership Council Clinical Coordinating Committee Linkage Council Strategic Partner Teams Performance Excellence Steering Committee System Teams Transformation Steering Committee System Teams Growth System Team Enterprise Risk Facilities Finance Human Resources Information Systems Mission Medical Neighborhood Productivity Service Line Integration Share Services Unwarranted Clinical Variation Vendor Value and Supply Chain Business Intelligence Community Health Continuum of Care Patient Pathways Network Partners Research & Development System Policy Task Force Support to Teams from Organizational Effectiveness Group 13

15 Leadership Reinvented Leadership Council Linkage Council Strategy Teams Initiatives 14

16 Human Resources Transformation Future Delivery Model 15

17 Building The IT Foundation The Last Ten Years NHIN Bi Directional Orders Chronic ICU Disease Registries Doc. Document imaging Image Scanning Workflow Task Queue Physician Portal eprescribing Registration Eligibility State HIE Patient Portal evisits Secure Messaging to Physician (referrals, consults, notes) Patient Pharmacy Messaging Appointment Scheduling Enterprise Supply Chain & HRIS Secure Messaging to Physician (referrals, consults, notes) Device Integration (from home) Office Device P4P Reporting OB Oncology PACS Cardiology Integration PQRI / MU Health CPOE/Orders ED Surgery CPOE/orders Maintenance Protocols Patient Automated Faxing Nursing doc. Medical Records Education Scanning Financial Documentation Templates Reporting Billing AR Personal Health Record (PHR) Data Exchange Community Viewer Charge Capture State Immunization Registry Results Review Enterprise Revenue EMPI Interoperability/ Connectivity Enhanced data capture and workflow Foundation and pathways Integration & Interoperability Platform 16

18 Future IT Architecture Delivery Model Network Physician Portal HIEs Patient Portal Medical Economics Patient/Physician Engagement Practice Quality Mgmt Physician Profiling Payer/Contract Analytics Network Mgmt Registry Care Management Research Population Health Data Warehouse Analytics Integration & Interoperability Platform Source Data Future Source Data Single EHR Lab PBM (Rx) Payer PHR Referral Patient Satisfaction EPM Practice Demographics Non-Affiliate EHR Public Health HIEs Medical Devices Data Other Data TBD <Internal Data External Data> 17

19 Real Estate Development Corporation Business Overview Developer services Planning Design Construction Management Regulatory CORPORATE STRATEGY EMHS The Client Steering Committee Landlord and tenant leasing Ongoing property management Acquisition and divestiture Business Overview Healthcare Properties Hospitals Medical office buildings Ambulatory surgery centers CLINICAL STRATEGY The Client Programming Committee SUCCESSFUL REAL ESTATE DEVELOPMENTS FACILITIES SUPPORT The Company Developer CPM Health plexes Free standing urgent cares 18

20 Transforming Payment Models Declining Dollars Entering Healthcare Will Trigger Reallocation of Existing Payments Patient Experience EMHS Today Episodic treatments and reactive approach Employed physicians with very little incentive for population health management EMHS Tomorrow Proactive wellness management, and care coordination for all illnesses Culture of personal accountability with incentives for care management Hospital Role Health Plan Physician Alignment Economics largely inpatient based Disjointed approach to cost reductions Infancy state of reducing variation in clinical care EMHS negotiating individual contracts for hospitals and physicians Reimbursements are based on number of transactions and gross charges Low productivity in physician practices Fragmented medical groups across EMHS Lots of closed physician panels Most care delivery in ambulatory settings Bed utilization management across health system to achieve maximum efficiency Care coordination strategies across patient care continuum Joint ventures with health plans EMHS at greater risk for managing costs in fixed budget arrangements Data collaborations with payers, patients and employers Real time tools tracking and measuring productivity Reduced clinical variations System wide product/service lines 19

21 Treasury Transformation Future Delivery Model Financial Management Centralized Balance Sheet Decentralized Income Statements Business Unit Model Performance Centric Design Cash Management Cash Management Pooling cash into single account at System level Endowment remain aligned with Member Disbursements for payroll and vendors occur at System level Centralized Platform Debt Management All debt issued under single Obligated Group System-wide capital structure that relates to a System-wide risk point of view Allows capital market access for all Members Capital Allocation Invested Asset Cash Investments Assets are managed and controlled at System level Allocation of cash resources occurs across System Invested asset purpose and policies and risk tolerance set and then maintained at System level 20

22 Integrated Planning The whole is greater than sum of its parts Business Plans Demand Strategic Plan Trends rates /1000 populations Clinical capacity Competitive landscape Service offering Environmental impact Fiscal Year 15 Annual Budget Planning Capital Expenditures Combination of System & Member Prioritization Centralized Budgeting Process Annual Budget Fiscal Years Financial Plan Financial Plan 5 Year Plan Driven By Performance Metrics 21

23 Population Health Migration Financial Sustainability Breakeven on Medicare 3%-4% Operating Margin 10% - 12% EBIDA Margin A Credit Ratings Physician Engagement Primary Care Capabilities Specialist Care Re-align Incentives Practice Management Capability Physician Organization Service Distribution Network State Wide Network Hospitalized Care Ambulatory Care Skilled Nursing Facilities Home Health Hospice Long Term Acute Care Rehabilitation Healthplexes Clinical Transformation Clinically Integrated Network Care Redesign Beacon Health Health Exchanges Clinical Variations High Access Care Value Based Purchasing Productivity Standards Reduced Cost of Care Population Health Covered Lives Postal Code Attribution Community-Provider Partnerships Health Plan Partnerships Data Collaborative Agreements Risk-Bearing Models Shared Infrastructures Supply Chain Information Technology Advocacy Business Intelligence Revenue Management Grants/Fundraising Human Resources Medical Quality Finance Insurance/Risk Decision Support Mission Integration SHARED SERVICES INFRASTRUCTURE Branding/Marketing Public Relations Legal Strategic Planning 22

24 FINANCIALS Presented by Derrick Hollings 23

25 Debt Structure Debt Par Outstanding 1 Final Maturity Coupon Enhancement Call Status 2014 Mercy* 8,450, % N/A 3% 2014 Mercy* 61,055, % N/A 3% 2013 EMMC $143,900, %-5% N/A par 2013 SVH* 9,924, %-3.41% N/A 5% 2012A TAMC 5,365, %-5.05 N/A par 2010B BHMH 2,130, %-5.25% N/A par 2010B TAMC 5,065, %-5.25% N/A Non-Callable 2010A Acadia 9,855, %-5.0% N/A par 2010A EMMC 64,730, %-5.25% N/A par 2007B Inland 2,845, %-5.0% FGIC par 2007B Lakewood 6,255, %-5.0% FGIC par 2006A Inland 1,135, %-5.0% MBIA par 2004B SVH 185, %-3.75% Ambac par $320,894, As of June 1, 2014 * - Private Placement Debt 1 24

26 Debt Dashboard Maximum Annual Debt Service Bond Debt Mix Private 25% Inland 4% SVH 2% CA Dean 0% Home Office 7% Mercy 15% Public 75% TAMC 2% BHMH 1% Acadia 2% EMMC 67% Bond Debt Security Variable, 2% Bond Interest Mix Synthetic Fixed, 8% Private Fixed, 28% Non- Obligated Group, 21% Obligated Group, 64% Public Fixed, 62% As of June 1,

27 Obligated Groups SVH TAMC Acadia Hospital Corp. Affiliated Healthcare Systems Beacon Health, LLC Rosscare Blue Hill Memorial Hospital Mercy HS of ME EMHS (Parent) C.A. Dean Memorial Hospital ME Network for Health EMH Real Estate ME Institute for Human Genetics and Health EM HomeCare Inland Hospital EMHS Foundation EMMC Obligated Group Member Potential Obligated Group Member Exclude From Obligated Group 26

28 Revenue Growth 1,400,000 Total Revenue 1,200,000 1,000, , , , , (1) Note 1: Forecast 27

29 Outpatient Visits Growth 1,600,000 Outpatient Visits 1,400,000 1,200,000 1,000, , , , , (1) Note 1: Forecast 28

30 Primary Care Visits Growth 500,000 Primary Care Visits 450, , , , , , , ,000 50, (1) Note 1: Forecast 29

31 Assets Growth $1,600,000 Total Assets $1,400,000 $1,200,000 $1,000,000 $800,000 $600,000 $400,000 $200,000 $ (1) Note 1: as of March 31,

32 Key Performance Indicators Description (1) Debt Position: Debt Service Coverage LTD to Capitalization 29.6% 25.1% 36.8% 36.4% Debt Service as % of Revenue 1.9% 1.8% 1.7% 2.2% Cushion Ratio Liquidity: Cash to Long Term Debt 167% 200% 122% 120% Days Cash on Hand Days in A/R, net Performance: Operating Margin 2.2% 5.9% 3.7% -1.6% EBIDA Margin 7.6% 10.7% 8.6% 2.9% Total Margin 3.1% 6.1% 6.2% -1.3% Note 1: as of March 31,

33 Thank You 32