Keynote Presentation delivered by Marvin O’Quinn, Executive Vice President and Chief Operating Officer, Dignity Health at the marcus evans National Healthcare CXO Summit Spring 2018 held in Orlando FL

1. Dignity Health Medicaid Population
Health Strategy
Marvin O’Quinn
Senior Executive VP and
Chief Operating Officer

2. 2
As of March 31, 2017
22 400+ 9,000 62,000 39 993,000
State
Network
Affiliated
Access Points
Affiliated
Physicians
Employees Acute Care
Hospitals
Attributable
Members

3. 3
Growing National Footprint
Providing integrated, patient-centered care to more than six million people annually
Diversified service offerings and partnerships support population health
Hospitals in Arizona, California, and Nevada
As of March 31, 2017

4. 4
Acute Care and Integrated Delivery Networks
39 Acute Care Hospitals
4 – AZ
3 – NV
32 - CA
8 Clinically Integrated Networks
Arizona
Nevada
Inland Empire, CA
Ventura, CA
Redwood City, CA
Bakersfield, CA
North State, CA
San Joaquin, CA
H
HH
H
H
H
H
H
H
H
H
HH
H
H
H
HH
H
H
H H
H
HH
H
H
H
H
H
H
H
H
H
HH
H H
H 400+ Affiliated Care Sites
Primary Care
Medical Foundation Clinics
Specialty Clinics
Ambulatory Surgery Centers
Micro Hospitals
Freestanding Emergency Departments
Urgent Care
Imaging
Home Health

5. 5
Disciplined Approach Produces Results
Volume EBITDARevenue
$17.3B $5.0B 149 92.5% 47.5% $13.0B $933M
Assets Unrestricted
Cash and
Investments
Days Cash Cash to Debt Debt to Cap Annualized
Revenue
Average
Annual
EBITDA*
*Average of last three fiscal years, Q3 2017 annualized
As of March 31, 2017
1.2% 3.6% 8.9%
Fiscal Year End June 30
Improvement
YTD Q3 2017 vs.
YTD Q3 2016
4.2%
Inpatient Outpatient

6. 6
Dignity Health hospitals & aligned physicians provide critical
services to all members of our communities. Our focused
Population Health strategy expands our ability to achieve our
Mission:
We are committed to furthering the healing ministry of Jesus.
We dedicate our resources to:
- Delivering compassionate, high-quality, affordable health
services
- Serving and advocating for our sisters and brothers who are
poor and disenfranchised
- Partnering with others in the community to improve the
quality of life
From Sick Care to Health Services

7. 7
• Dignity Health is committed to
transitioning from the traditional fee for
service environment to fee for value.
• As of December 2017, there are over
1.2M attributable people in Dignity
Health’s VBAs.
• Examples of the VBA’s and Products:
– Commercial ACO
– MSSP ACO and Next Gen Risk
– Bundled payments
– PCMH
– Capitation
– Narrow Network
– Medicaid Risk and Shared Savings
(481kVBA; 7/18 potential 150k new )
– Employer Relations
Population Health - Value Based Agreements
Hospital Acquired
Conditions (HAC)
Mortality
Patient
Satisfaction
Readmissions
Chronic Disease
Management
Best
Practices in:
CHF, COPD,
HTN

8. Leveraging strategies to build a system poised to address the
demands of accountable care
Transforming to Value Based Care
Past
• Episodic Care
• Volume Driven/Fee-For-Service
Payment Systems
• Acute Care Provider
• IT Systems in Silos acute vs.
ambulatory
• Hospital-Physician Centric
Interactions
Current
• Population Management
• Value Based Agreements
• Diversified and Integrated Delivery
System
• Integrated Technology shares data
(Acute, MDs, SNFs, Home Health)
• Collaboration Physicians, Hospitals
Horizon 2020a Strategies
Growth, Cost, Quality, Integration, Connectivity, Leadership
Mission, Vision and Values
3

9. 9
We prioritized 3 critical areas for PHM
Build a Strong Foundation
• Created aligned physician networks: CINs live in 8 markets, 4
additional VBA markets taking risk
• Care Management is integrated across the care continuum
• Implemented standard QA metrics/program across the CINs
Implement Standardized Processes and utilize Best-in-class
Technology to Drive Results
• Launched standard clinical pathways to manage patient health,
satisfaction and risk. 760k members in Athena clinical platform and
all hospitals Curaspan to refer members to post acute providers
• Promoting network keepage with par8o in 4 markets with 2-3 more
planned by July 2018
Measure Success
• Measure results and improve outcomes focused on QA and cost
efficiency
• Physician Practice Transformation: MIPs strategy launched for all
markets
• Improved Contribution margin for risk over FFS for govt. programs

10. Acute
10
Care Management Model Focused Across the Continuum
Post Acute
InpatientEmergency
Outpatient
Common Data Analytics Integrated into Workflows
Integrated Physician, Hospital and Community Partnership
Care Coordination
• Dedicated Care
Managers Multi-
Conditions
Centers
• Advanced
Medical Practice
• Practice
Operations
Coaches
• Care Connect
(PCP)
• Care Coordination
Optimization
• Alternative site of
Care Transitions
• Readmission Risk
Assessment and
Focused
Interventions
• Care Coordination
Redesign for
length of stay
• Transitions to
Post Acute
• Hospital to Home
Coach Program
• Aligned Home
Care Companies
• SNF Care Model
• Palliative Care

11. 11
Specific Focus on Medicaid Risk
• Objective- improve management of Medi-Cal beneficiaries to reduce preventable
admissions, improve quality/patient outcomes and improve operating margins
• End State Deliverable/ goal- Invest in care management infrastructure and
community health integrated network of services to support populations with
complex medical, behavioral health and life needs
• Additional Value
o Incorporate Population Health Management tools and teams to manage network and
clinical programs, risk assessments, clinical pathways, mental health needs, social
determinant interventions, clinical workflows, patient engagement methods, financial
packages and staff training
o Launched a Patient Center Medical Home in Bakersfield to manage the health care
needs of the most complex members in partnership with the largest MediCal payer in
the market. Expanding program to 3 more markets
o Implement an infrastructure to prove value to payers to successfully assume financial
risk
o Partner with state and peers on Public Policy and Advocacy

12. 12
• Strive for total cost of care risk model (closer to the state the
better).
• Will negotiate for Intra-Hospital capitation or full facility risk
• Key is to have Behavioral Health Integration
 Fast-track population health strategy via partnership medical
homes
• Physician recruitment focused on PCPs and key Specialists at
competitive Medicaid rates
• Locating & designing clinics targeted in heavy Medicaid
membership areas
• Coordinating with Community Benefit organizations
• FQHC expansion and participation in CINs
Medicaid Risk Payer and Provider Partnership
Strategies

13. Dignity Health and other systems are partnering with
AVIA and Town Hall Health to accelerate impact for
vulnerable populations
Andy Slavitt is launching a fund and advisory group focused on the development, growth and
adoption of new innovations serving low-access, high-need populations.
• Founded in 2017 with locations in Minneapolis, Washington, D.C., and New York
• Identifying and investing in early-stage innovations in under-served and vulnerable
communities
Deep
dive into
Medicaid,
duals, frail
elderly, and
medically
fragile
populations,
particularly
with high social
support needs
as solutions
Identify
the top
innovations
that can
transform care
delivery for
low-access,
high needs
populations
Focus on
companies with
critical and
proven
intervention
points,
trusted service
models,
re-invented
delivery
locations, and
enabling
technologies that
have national
scale potential
Invest in top
entrepreneu
rs by utilizing
significant
sourcing
advantage;
co-invest
with top
firms
Execute on
a playbook
that
provides
mentoring
and critical
business
advice
Develop and
curate
capabilities
for delivery
system
partners
to
implement
these
offerings
The Medicaid
Challenge

14. 14
3 LA Hospital Capitation Contribution Margins ($ in M)
92
116
104
43
56
50
29
43
48
14 13
24 5 5
34%
24%
4%9% 9%
9%
40%
5%
10%
15%
20%
25%
30%
35%
40%
140
20
40
60
80
100
120
140
FY'16 Medi-Cal FY'17 Medi-Cal FY'18 Medi-Cal
Net Revenue Net Internal Revenue
Variable Expenses Actual Contribution Margin $
Target Contribution Margin $ Actual Contribution Margin %
Target Contribution Margin %
Source: Dignity Health’s Capitation Income Statements and Horizon Business Insights
Note: FY18 is eight months ending 2/28/2018 annualized.

15. 15
Example: 3 LA Hospitals Transfer Center Experience
Since launch of May 2016 have had 4,935 calls to the center and 60% have been repatriated to a Dignity Health facility.
We have lots of opportunities to capture more calls in the Transfer Center.
0
5000
Total Calls Transferred Not
Transferred
Transfers: May 2016-July 2017
0%
20%
40%
60%
80%
Admissions not Transferred
3%
60%
40%
4935
59%
13% 13% 3% 2% 4%
Details of the 13% Admitted
W/O Chance to Transfer
• 55% Missed time limit
• 19% ER referred to admission
• 13% Became unstable
• 3% Direct to OR
• 3% Established MD
• 7% Other
SVS Not Available
• 44% Pediatrics Other
• 16% Pediatric Neuro
• 12% Pediatric Surgery
• 16% Other Adult- other medical
• 3% Burn Unit
• 3% Adult Neurology
• 2% Inpatient Psychiatric
3%

16. 16
In Conclusion
• Dignity Health ‘s Medicaid population is growing rapidly and
becoming a larger percentage of our patient population than our
competitors.
• Fee For Service reimbursement to support our Medicaid patients
is not sufficient for us to maintain our business model. However,
we have shown promising performance improvements in
assuming financial risk for our patients.
• We are committed to building an integrated solution with our
physicians, community partners and our patients that addresses
the clinical and social determinant needs of our Medicaid
patients.

17. 17

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19. Thank you!
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