AvaSure Symposium

Location

Benefis is one of the largesthealth systems in Montana,located in the state’s third

largest city.

Employees

Benefis employs more than3,200 employees, includingnearly half of the physiciansin its primary service area.

Market

Benefis holds 97% marketshare in its primary service

area.

System Overview

2

Acute CareInpatient Beds

Long-Term CareBeds

Inpatient HospiceBeds

64

Assisted LivingApartments

56

Low-IncomeSeniorApartments

25

Rural CriticalAccess Hospital

Beds

Rural ClinicsMedicalGroup Hospitals

SeniorCare

HomeHealth

Hospice

137,000

3,000

6,000

Acute and Long-Term Care

Patient Days

Inpatient Surgeries

Outpatient Surgeries

Comprehensive Continuum Annual Statistics*

474,000 Acute Care Outpatient Visits

295 182 20 30,000 Home Care Visits

Statistical Overview

* Based on year-end 2017 figures, rounded to the nearest thousand.3

67.9% 67.9%73.1% 75.7%

12.8% 13.0%

11.0%10.4%

12.1% 12.0%12.8% 11.2%

7.2% 7.1%3.1% 2.8%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2014 2015 2016 2017

Self Pay

Blue Cross

Other Commercial

GovernmentalPayors

Gross Payor Mix

* First year of Medicaid Expansion in Montana.4

Primary Strategy

Lower-than-

ExpectedCost

GoodOutcomes

BenefisValue

Equation

5

How Benefis Health System is Unique

Medicare Breakeven

Benefis is one of the few health systems in the nation to breakeven on Medicare. We achievedMedicare Breakeven in 2012 and have maintained it each year since then.

Ongoing Financial Success, Annual Raises, and No Layoffs

We have not only been financially successful for each of the last 15 years, we have givenraises each year and had no layoffs during that time, despite our high governmental (morethan 75%) payor mix.

Gift of Life Housing

Benefis offers free housing on two of its campuses for the families of patients receivingtreatment at our health system.

Native American Welcoming Center

We accommodate the needs of our Native American patients through a dedicated center in thehospital where they can spend time together in a group, get a complimentary meal, andpartake in cultural ceremonies.

Low Income Senior Apartments

Our comprehensive continuum of care and robust senior care division are furthercomplemented by a partnership that enables us to offer 56 low income senior apartments toarea residents.

6

Current CMS Compare Star Ratings

Hospital

SpectrumMedical

Senior Services

Teton SeniorServices

7

• Becker’s 150 Great Places to Work in Healthcare (received four years in a row)• Great Falls Area Chamber of Commerce Large Business of the Year• Rural Healthcare Awards:

o Montana Rural Healthcare Performance Improvement Network Quality ImprovementAward

o Benefis Teton Medical Center Emergency Department Transfer Communication QualityAwardo Cardiac RecognitionAward

• HealthGrades Awards:o Pulmonary Care Excellence Award (received six years in a row)

o Stroke Care ExcellenceAwardo Top 10% in the Nation for Overall Pulmonary Services (received six years in a row)o Top 10% in the Nation for Stroke Care (received six years in a row)o Five-Star Treatment of Chronic Obstructive Pulmonary Disease (received six years in a row)o Five-Star Treatment of Sepsis (received 12 years in a row)o Five-Star Treatment of Respiratory Failure (received 12 years in arow)o Five-Star Treatment of Pneumonia (received eight years in a row)o Five-Star for Esophageal/Stomach Surgerieso Five-Star for Colorectal Surgeries (received two years in a row)o Five-Star Treatment of Pulmonary Embolismo Five-Star Treatment of Gastrointestinal Bleedso Five-Star Treatment of Stroke (received two years in a row)

Resulting 2017 Awards

0.7

%

2.6

%

3.6

%

3.4

%

3.3

%

3.4

%

3.5

%

3.3

%

3.4

%

3.2

%

-0.1

%

4.0

%

4.7

%

3.9

%4.1

%

3.7

%3.7

%

3.3

%3.5

%

3.6

%3.8

%

5.9

%

3.2

% 3.6

% 3.9

%

4.1

%

4.1

%

3.3

%3.5

%

6.1

%

5.7

%

5.3

%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

-1.0%2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Operating Margin

Budgeted

Actual

Consistently Better than Budgeted OperatingMargin Every Year Since 2003

9

$2

.9

$3

.1

$7

.5

$9

.8 $1

0.9

$9

.6

$6

.6

$5

.2

$4

.6

Mil

lio

ns

Annual Cost Reduction (totaling over $60.2 million since 2009)

Cost Reduction by Year

$12.0

$10.0

$8.0

$6.0

$4.0

$2.0

$0.02009 2010 2011 2012 2013 2014 2015 2016 2017

10

$7

0.6

$7

0.2 $8

1.9

$8

6.9

$7

6.2

$7

9.6

$8

9.3

$8

7.2

$8

1.1

$30.0

$20.0

$10.0

$0.0

$60.0

$50.0

$40.0

$90.0

$80.0

$70.0

$100.0

2008 2009 2010 2011 2012 2013 2014 2015 2016

Mil

lio

ns

Allowable Cost

MedicareReimbursement

Note: Measurementof Medicarebreakeven is themeasure of totalpayments from:Worksheets E Part A,E Part B, E-3 Part II,E-3 Part III, E-3 PartIV, I-4, HHA D Part II,and the MedicarePS&R PaymentSummary Reportless Worksheets D-1for Hospital andSubproviders IPF,IRF, and SkilledNursing Facility.

* Based on Allowable Cost

$59.6$63.9

$74.9$77.5

$83.3 $82.9

$90.1$93.2

$88.2

Medicare BreakevenFirst Achieved in 2012

ReimbursementPercent of Cost*

84.4% 91.1% 91.4% 89.3% 109.3% 104.1% 100.8% 106.9% 108.7%

11

Together we improve outcomes

FALLS WITHINJURY

ALARM FATIGUE

NURSE FATIGUE

OVERTIME/PREMIUM PAY

BOARDING OFPATIENTS

DRUG USE

BEHAVIOR HEALTHPATIENTS

REMOVED CNAsFROM THE FLOOR

ELOPEMENT

FALLS

SUICIDEIDEATION

CAREGIVER ATRISK OF HARM

LARGE NUMBEROF 1:1s

Our Journey to AvaSys:First the challenges

Researched Best Practice versus being approached

• CNO read articles about AvaSys reducing costs

• Several peer-reviewed articles

• Hot topic at national nursing conferences

Site visit to Sacred Heart Medical Center in Spokane

• Multidisciplinary team

• Looked at it “live”

• Idea to get Foundation funding

Burtson, PL, & Vento, L, Sitter reduction through mobile video monitoring; a nurse-driven protocol and administrative Oversight. The Journal of NursingAdministration, July/August 2015

Cournan, M., Improving safety through video monitoring. Rehabilitation Nursing, Oct. 26, 2016

Votruba, L et al, Video monitoring to reduce falls and patient companion costs for adult inpatients. Nursing Economic$, July/August 2016

Our Journey to AvaSys:Doing our homework

Started with 12 cameras

• Wall mounts versus mobile cart

Relatively easy buy-in• Medical staff

• Nursing staff

Not only used with 1:1 patients but alsowith high risk fall patients

Developed a scorecard for monitoring

Our Journey to AvaSys:The purchase and implementation

Success breeds success

Monitor results

Reported results

• Hospital Quality and Patient Safety Committee

• Board Outcomes Committee

• Benefis Health System Foundation

Our Journey to AvaSys:Monitoring and sharing success

•

Background

The AvaSys Telesitter is a remote

patient observation system that

enables continuous audio and visual

monitoring of patients from a central

station. It allows staff to immediately

and directly intervene when a patient

is at risk of self-harm.

Ability to monitor more patients at a time for falls inattempt to reduced falls and falls with injury.

Improved nurse satisfaction as nurses are spareddisruption of workflow and emotional impact of falls.

Improve staffing efficiencies as nurses can be out on thefloor instead of watching patient one-on-one.

New Technology: AvaSys

53%

Opportunities for use of AvaSys

Benefis (n=742) vs. All Participating Hospitals (n=76,646)

67%

FALL PREVENTION

20%7%

OTHER

3%4%

ELOPEMENT

2%3%

DELIRIUM/RESTLESS

10%4%

SUICIDE PRECAUTIONS

9%13%

SAFETY OF TUBES/LINES

2%2%

ALCOHOL WITHDRAWL

1%1%

AGGRESSIVE/VIOLENT

*Courtesy of ORNA Online Reporting of Nursing Analytics

Example of how data helped target trainingfor Benefis Staff

*Courtesy of ORNA Online Reporting of Nursing Analytics

21 2120

3132.5

30

15

25

23

30.5 31

21.7

JAN MAY

Number of FTEs Reduced or Better Utilized in 2017

Resource Support

FEB MAR APR JUL NOVAUG SEPT OCT DECJUN

259

139145

0

50

100

150

200

250

300

2015 2016 2017

Total Falls

49

20

17

0

10

20

30

40

50

60

2015 2016 2017

Falls with Injury

Outcomes