Affirmant valuereport 2017 web

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Value Report Affirmant Health Partners | 1

CONTENTS Message from the CEO Why Affirmant? Our Journey Fueling the Fire for Transformation Data Analytics Clinical Transformation Health Plan Partnerships The Future is Bright Numbers Matter Recognition Board and Committees Collaboration Our Member Systems Affirmant Team

1 2 4 6 8 10 12 14 16 18 20 24 26 32

MESSAGE FROM THE PRESIDENT It is with great pride that we bring you the first-ever Affirmant Health Partners “Value Report.” We have come a long way since our establishment in July of 2015 and it is my pleasure to share with you our journey since then. Affirmant is a network of six leading health systems and participating physicians who are committed to transforming how health care is organized and paid for in Michigan. We have come together for three key reasons: we are all passionate about improving the health of our patients and communities; we want health care to be affordable and sustainable; and we believe we will be more successful together than on our own. In what ways does working together make us more successful? First, it enables us to share in the resources required to provide physicians and patients with more complete, accurate and actionable data on cost and quality at the point of care. Second, it enables us to share best practices for clinical transformation and provide resources and tools to support physicians in the rapid adoption of these best practices. Finally, it provides us with a large enough number of covered lives to influence and partner with health plans, bend the curve for total cost of care, and share in the value we create. Our purpose with this report is to share with you, and all our partners, the progress we are making in achieving our vision of “a healthy Michigan at an affordable cost.” In our first two full years of operation we have laid a strong foundation for success in improving the health of our communities, reducing cost, increasing covered lives and sharing in rewards for the value we create. Together, we have assembled the elements necessary to accomplish these goals through what we call our “Fire Triangle”—data analytics, clinical transformation, and health plan partnerships. What we are doing requires hard work and commitment on the part of all our partners. The greatest challenges we face are aligning our cultures and strategies and engaging our participating physicians as leaders. Fortunately, we can build on the years of trust and collaboration among our Member organizations through their participation in Caymich, a captive medical malpractice insurance company with joint ownership including all Affirmant Members. In addition, we are enabling physicians to lead in the transformation of health care in a way that better reflects why we chose a career in medicine—to improve the health of our patients and communities. If you are already involved in Affirmant, thank you for your engagement and support. If not, I hope you will consider getting involved by connecting with your local Chapter leaders whose contact information can be found on pages 26 - 32. I feel fortunate to be working with you to make these changes happen and am excited to shape the future of health care in Michigan together as Affirmant Health Partners.

Bill Mayer, MD, MPH President and CEO

WHY AFFIRMANT? The rising cost of health care is leading many of our patients to defer or forgo care and employers to drop insurance coverage for employees and their families.

What this means for patients:

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privately insured adults report it is difficult to afford premium costs Medical expenses cause 62% of personal bankruptcies

Among Americans with household income less than 400% of the Federal Poverty Level ($97,200 for a family of four) 40% report concerns about cost having caused them to defer or forgo care.

$18,764 The average premium cost for employer-sponsored family coverage in 2017, up 55% since 2007. The median US household income was $57,617 in 2017

2 of 5 privately insured adults report it is difficult to afford deductibles

In 2017, more than half of all Americans with employer-sponsored health insurance had deductibles of more than

$1,000 per year

What this means for providers: Affirmant gives us the power to take charge of health care for our patients and families and still preserve our independence and accountability to our communities. • Access to patient and practice-level data from across the care continuum • Support for clinical transformation in our practices • Power to increase rewards for improving quality and reducing cost, as well as to reduce our administrative burden Patients and providers have lost control of decisions about what is medically necessary care, who can deliver this care, where it can be delivered, what constitutes quality care, and how it will be paid for. Yet, patients, their families and physicians have the greatest influence over healthcare decisions. Working together as Affirmant Health Partners, patients, their families and physicians can take charge of our health care. 2 | Affirmant Health Partners


[uh-fur-muhnt] noun 1. a person who affirms


[uh-furm] verb 1. to declare to be true; assert positively

ABOUT US Affirmant Health Partners is a Super Clinically Integrated Network – that means we bring thousands of physician leaders from across the state to identify and promote best practices and programs that will have an impact on reducing the cost of health care and improving the health of Michigan residents. Affirmant will create scale but still preserve the independence of our Member organizations and Chapters.

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OUR JOURNEY Our journey began in July 2015 when healthcare leaders across the state, participating in Caymich, assembled to take on lowering cost and improving quality. They committed to partnering as a Clinically Integrated Network according to the rules of the US Federal Trade Commission (FTC). Our first task was to meet FTC requirements to create: • A network of physicians willing to demonstrate a high degree of interdependence and cooperation • A program of initiatives to control costs and ensure quality • An infrastructure that allows physicians to evaluate and modify practice pattern

Committee Structure Affirmant Board of Managers Chapter Operations Committee

Clinical Transformation Committee Evidenced Based Best Practice Subcommittee Measures Development Subcommittee Clinical Priorities Workgroups

4 | Affirmant Health Partners

Federation ACO Board of Managers Communications & Education Committee

Finance & Contracting Committee

Information Technology & Business Intelligence Committee

May 2017 Chapter Participation Agreements signed December 2016 Federation ACO MSSP participation approved; CPC+ participants approved August 2016 Affirmant brand launched

We collaborate with patients, colleagues and community partners to relentlessly improve the quality and cost-effectiveness of health care.

July 2016 Strategy approved June 2016 Inaugural Leadership Retreat May 2016 Federation ACO incorporated March 2016 Henry Ford Health System joins December 2015 CEO hired August 2015 Operating Agreement signed July 2015 Federation Care Network incorporated

1979 Caymich incorporated

Bronson Healthcare Covenant HealthCare Henry Ford Health System Lakeland Health MidMichigan Health Sparrow Health System

Our relationships run deep

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6 | Affirmant Health Partners

With input from our physician and administrative leaders at our first annual leadership retreat in June 2016, we created a roadmap for our journey— known as our Vision, Mission, Goals and Values. Vision A healthy Michigan at an affordable cost. Mission We collaborate with patients, colleagues and community partners to relentlessly improve the quality and cost-effectiveness of health care. Goals Better health and affordable cost through clinical transformation. More covered lives and shared rewards through health plan partnerships.

Values Accountability We are leaders in quality and hold ourselves and our partners to the highest standards of integrity and performance. Compassion We seek to understand and respect our patients, colleagues and community partners. Collaboration We support, empower and leverage our high-performing teams. Knowledge We learn, teach and adopt evidence-based best practices. Transformation We inspire and enable rapid improvement.

The Fire Triangle is a metaphor we are using to describe what we are doing together through Affirmant Health Partners. Just like we cannot light a fire without oxygen, fuel and heat working together at the same time, we cannot transform health care in a meaningful way without data analytics, clinical transformation and health plan partnerships.

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DATA ANALYTICS - Accomplishments


Our data analytics will provide us with ongoing information about where we are and where we’re going. We have developed an information technology and business intelligence strategy for delivering real-time, actionable, cost and quality information at the point of care. Our primary tool will be Epic Constellation. Through data analytics, we will be able to make better informed decision for patients, practices, Chapters and communities.

Our data analytics program began with aggregating and analyzing available data from Medicare, Blue Cross Blue Shield of Michigan (BCBSM) reports, and our Member employee health plan claims reports. This informed the selection of our clinical priorities in July 2016 plan data.

Each Affirmant Chapter authorized Blue Cross Blue Shield of Michigan to transmit and disclose its patient data, encounter data and claims data through an Organized Systems of Care (OSC) agreement.

8 | Affirmant Health Partners

In 2017, our Integrated Analytics Subcommittee produced our first performance scorecards based upon standard measures derived from existing data systems.

Through collaboration with Henry Ford Health System data analytics, we began producing comparative Chapter dashboards based upon Medicare ACO claims data. Our Post-Acute Care Dashboard was critical to informing the development of our Post-Acute Care clinical transformation initiative.

Affirmant signed a contract with Epic to implement Constellation in August 2017. This software leverages the common platform we already have in place (Epic and Epic Healthy Planet) to provide us with dramatically improved population health and physician decision support capabilities. It also realizes the value proposition behind our collaboration - sharing in the cost of population health management - by giving each of our Members and Chapters access to these capabilities at a fraction of the cost of licensing, implementation, maintenance and hosting.

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Our success in delivering the highest quality, most cost-effective care will require us to use the information from data analytics and our health plan partners to transform clinical practice—relentlessly improving care team organization, workflow and key performance measures. Affirmant is focused on improvements in guidelines, provider/patient engagement, care coordination, care team support, and accountability & rewards. Through clinical transformation, we will be able to deliver better quality at a lower cost to our patients.

Guidelines A key component of clinical transformation is identifying the desired state through guidelines and standards of care. For our initial clinical priority of Post-Acute Care, this took the form of developing critical success measures and tactics, as well as discharge disposition criteria for heart failure and total joint replacement.

Care Team Support Chapters have primary responsibility for clinical transformation at the practice and facility-levels. Through our Clinical Transformation System, Affirmant enables and provides support for these local efforts. In 2016 and 2017, Affirmant began best practice sharing as a regular feature of our annual Leadership Retreat. This is now being expanded to an ongoing Best Practice Learning Collaborative, the first subject of which will be care management. Affirmant support is also taking the form of preparing and presenting risk scores and gaps in care to physicians at the point of care through Epic Constellation.

10 | Affirmant Health Partners

Provider/Patient Engagement Clinical transformation requires engagement of patients and the care team. Affirmant has launched a number of communication and training tools to promote such engagement. These include our newsletter, video blog, monthly Management Report, Town Halls, and annual Leadership Retreat. In addition, we leveraged a best practice from Lakeland Health, contracting for and launching COMET (Continuing Online Medical Education and Training) to all Affirmant leaders. COMET gives us the capability to produce and target education and training to our participating physicians and their care teams; track completion and impact with pre- and post-testing; and offer free CME credits. With the help of Lakeland Health, we produced our first training program on what it means to be a Clinically Integrated Network.

Accountability & Rewards Accountability and rewards can increase and accelerate clinical transformation. Affirmant initiated this component of the Clinical Transformation System with Leadership Awards at our annual Leadership Retreat. Also in 2017, our Contracting Committee and Board of Managers approved our first Incentive Distribution Model. The Clinical Transformation Committee has developed scorecards with performance measures and targets in quality, efficiency and utilization, and engagement and citizenship. Our implementation of Epic Constellation includes translating these scorecard measures into dashboards available to all our physicians at the point of care.

Care Coordination In order to effectively coordinate patient care, we need access to a high quality, cost-effective network of care givers, and whenever appropriate, we need to encourage patients to seek care within our network. In our Post Acute Care initiative, this has involved identifying and convening preferred Skilled Nursing Facility (SNF) providers in our Chapter markets. Through our ACO data, we have quantified and compared leakage of care from our Chapters to out-of-network providers and begun efforts to better retain and coordinate this care.

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In order for us to accomplish the data analytics and clinical transformation efforts, we must create a sufficient and sustainable source of funding. This requires us to be able to share in the rewards for reducing the total cost of care and manage financial risk for a large population. Through our health plan partnerships we can reach more lives and earn more money to improve the quality of care in our communities.

Our Approach Through the development and adoption of our “runway to value� we have created a basis for strong partnerships with health plan partners for collaboration for years to come.

Medicare Advantage Over one in three Medicare beneficiaries in Michigan are now enrolled in Medicare Advantage plans and this number continues to grow. Affirmant has identified these plans as a priority opportunity based upon their high utilization and expense, as well as their flexibility to steer patients through in- and out-of-network differences in patient cost-sharing. In December 2017, Affirmant signed our first Medicare Advantage Letter Of Understanding (LOU) with BCBCSM. Effective January 1, 2018, the LOU provides for sharing in total medical cost savings in 2018 and 2019, and for upside and downside risk-sharing of the medical portion of the health plan premium in 2020. It also includes significant BCBSM infrastructure support of Affirmant over the next three years.

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Traditional Medicare The Centers for Medicare and Medicaid Services (CMS) announced on their website the participation of the Federation ACO in the Medical Shared Savings Program (MSSP) starting January 1, 2017. Of the 100,000 beneficiaries, 70,000 come from the Federation ACO, over 24,000 from HFHS Next Generation ACO, and over 6,000 from MidMichigan POM ACO. One billion dollars in healthcare expenses are under these programs.


Affirmant also seized upon this opportunity to build capacity for care coordination, promoting and supporting primary care provider (PCP) participation with outreach, webinars, application support, and formal letters of support. As a result of the combined efforts of our PCPs, Chapters and Affirmant, a total of 335 of our primary care physicians were accepted into the program—2.7 times the number expected based upon the number of beneficiaries attributed to the Federation ACO and POM ACO (Next Generation ACO physicians were not eligible to participate.) In 2017, the first of five years of funding, our participating PCPs received an estimated $8 million in care coordination fees through the CPC+ program.

Commercial/Employee Health Plans In April 2017, Affirmant signed their first letter of agreement (LOA) to partner with a health plan - Physicians Health Plan of Mid-Michigan. This LOA provides for standardizing and simplifying credentialing, formulary, utilization and care management; gain sharing on our clinical priority areas; and creation of custom, competitive products that enable us to successfully share risks and rewards for enhancing cost and quality of care. Affirmant Member health systems are self-insured for employee health benefits covering over 100,000 employees and their families. Applying the benefits of our clinical integration to these employee health plans is critical to leading by example and demonstrating our ability to improve healthcare quality while controlling costs. In 2017, we took an important first step in this process through a collective bid process for employee health plan Third-Party Administration (TPA) and Pharmacy Benefit Management (PBM) services. Affirmant Members who do not own health plans - Bronson, Covenant, Lakeland and MidMichigan invited HAP, PHP, other TPAs and PBMs to submit proposals for assisting us in providing timely claims data for Epic Constellation; implementing gain- and risk-sharing consistent with our runway to value; reducing the burden of prior authorizations, utilization and care management; and saving administrative costs. TPA and PBM finalists have been selected and over $7 million in potential savings have been identified through the process thus far. Affirmant Health Partners | 13

14 | Affirmant Health Partners

THE FUTURE IS BRIGHT 2018 is off to a great start. We look forward to keeping the fire going with our continued focus on all sides of the Fire Triangle. Data Analytics Epic Constellation Go-Live (mid-year); claims integration from BCBSM, POM ACO, and employee health plans; connector with MIHIN for data on admissions, transfers and discharges; connector with PointClickCare—the leading electronic health record in SNFs—and Epic Constellation

Clinical Transformation Post-Acute Care plan implementation; reduction of out-of network leakage; development of pharmacy and chronic disease management plans; launch of our Best Practice Learning Collaborative with initial focus on Care Management

Health Plan Partnerships Execution of contracts with BCBSM and PHP; pursue additional agreements with HAP and others; select employee health plan TPA and PBM vendors and implement for 2019 plan year; ACO/MIPS reporting—successfully completed in the first quarter of 2018

Other Key Supporting Initiatives Growing to include new markets and partners such as rural hospitals, and other providers in the west and north of the state; expanding use of AIMS as our CIN enabling operational software; conducting a strategy review and collaborating with other CINs across the nation Affirmant Health Partners | 15



Health Systems




Governance Committees

Employees and Family Members in Our Employee Sponsored Health Plans


ACOs With Over

100,000+ Medicare Beneficiaries

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Clinical Priorities


Acute Care Hospitals



49 Counties

75% of Lower Michigan Counties Served

6,000+ Independent and Employed Physicians

114 Committee Members

Initial Relationship Started in

1979 Between Bronson and Sparrow

CPC+ Program

$5M Per Year for 5 Years

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RECOGNITION Our founding executive team set the bar high for Affirmant leadership. We thank them for their service!

Dennis Swan Sparrow Health System Chairman

Loren B. Hamel, MD Lakeland Health Vice Chairman

Ray King, MD Henry Ford Allegiance Health Treasurer

Diane Postler-Slattery MidMichigan Health Secretary

On July 1, the Affirmant Board welcomed their new executive team. These outstanding leaders will serve two years as officers for Affirmant Health Partners

Loren B. Hamel, MD Lakeland Health Chairman

Diane Postler-Slattery MidMichigan Health Vice Chairman

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Wright Lassiter, III Henry Ford Health System Treasurer

Michael Slavin, MD Covenant HealthCare Secretary





We are leaders in quality, and hold ourselves and our partners to the highest standards and performance.

We support, empower and leverage our high-performing teams.

We seek to understand We learn, teach and adopt evidence-based and respect our best practices. patients, colleagues and community partners. Henry Ford Health System Lakeland Health Eugene Berezovsky Michael Getty Matt Hussmann Henry Ford Lakeland Health Allegiance Health Tim Grove Dr. Amy Schultz Dr. Lowell Hamel

Bronson Healthcare Human Resources Kristyn Casselman Todd Horst Tara Smith Amy Wright John Hayden Nikki Romence Diane Luyendyk Robin Welch Joe Pant Ian Cooper Sparrow Health System Sandra Denison

Lakeland Health Marketing & Communications Team Megan Yore Cindy Myers Matt Shine Sarah Clemons Christopher Johnson Jessica Springer Kathy Starbuck Lenee Svorec

Transformation We inspire and enable rapid improvement. Sparrow Health System Renee Hoyt Bronson Healthcare Paul Peabody

Thank you

for living our values!

Covenant HealthCare Lary Daly Jamie Jager MidMichigan Health Dr. Thomas Johnson

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BOARD AND COMMITTEES Affirmant Board of Managers

Federation ACO Board of Managers

Chapter Operations Committee

Kevin Albosta Covenant HealthCare Georgia Fojtasek (Advisor), RN Henry Ford Allegiance Health Loren B. Hamel, MD Lakeland Health Ray King, MD Henry Ford Allegiance Health Scott Larson, MD Bronson Healthcare Wright Lassiter, III Henry Ford Health System Madhura Mansabdar, MD MidMichigan Health Bruce Muma (Advisor), MD Henry Ford Health System Harman Nagler, MD Sparrow Health System Ken O’Neill, MD Lakeland Health Diane Postler-Slattery, PhD MidMichigan Health Frank Sardone Bronson Healthcare Michael Slavin, MD Covenant HealthCare Dennis Swan, JD Sparrow Health System

Kevin Albosta Covenant HealthCare Partners Jerry Booth, DDS Jackson Health Network Sharon Deskins, MD Lakeland Care Network Douglas Edema, MD Sparrow Care Network Ron Gonzales, MD Covenant HealthCare Partners David Halsey, MD Jackson Health Network Wynn Hazen Jackson Health Network John Jones, MD Bronson Network Ray King, MD Jackson Health Network Scott Larson, MD Bronson Network William Mayer, MD, MPH Affirmant Health Partners Harman Nagler, MD Sparrow Care Network Ken O’Neill, MD Lakeland Care Network

Gayle Biederman Covenant HealthCare Partners Samantha Fell Lakeland Care Network Mary Greeley, RD MidMichigan Collaborative Care Organization Wynn Hazen Jackson Health Network Ray King, MD Jackson Health Network Melissa Kurtz Henry Ford Physician Network Scott Larson, MD Bronson Network Madhura Mansabdar, MD MidMichigan Collaborative Care Organization Bruce Muma, MD Henry Ford Physician Network Harman Nagler, MD Sparrow Care Network Ken O’Neill, MD Lakeland Care Network Amy Schultz, MD, MPH Jackson Health Network

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Michael Slavin, MD Covenant HealthCare Partners Mike Tobin Sparrow Care Network Nancy Vannest Bronson Network

Communications & Education Committee

Clinical Transformation Committee

Measures Development Subcommittee

Dawn Anderson-Meier Henry Ford Allegiance Health Becca Blanken Henry Ford Health System Kathy Bouchard-Wyant, RN Sparrow Care Network Sacha Crowley Sparrow Health System Larry Daly Covenant HealthCare Rose Glenn Henry Ford Health System Warren Johnson MidMichigan Health Peter May Henry Ford Allegiance Health Sandra Plank, RN Lakeland Health Marijo Snyder, MD Bronson Healthcare Susan Watts Bronson Healthcare Megan Yore, MA, PCMÂŽ Lakeland Health

Karen Bennett, BSN, RN Sparrow Care Network Bethany Charlton Covenant HealthCare Partners Samantha Fell Lakeland Care Network Peter Graham, MD Sparrow Care Network Mary Greeley, RD MidMichigan Collaborative Care Organization Paula Grudt, RN Bronson Network Scott Larson, MD Bronson Network Bruce Muma, MD Henry Ford Physician Network Ken O’Neill, MD Lakeland Care Network Joanna Pease, DO Henry Ford Physician Network Amy Schultz, MD, MPH Jackson Health Network Michael Sullivan, MD Covenant HealthCare Partners Lydia Watson, MD MidMichigan Collaborative Care Organization

Nicole Allen Sparrow Care Network Karen Bennett, BSN, RN Sparrow Care Network Eugene Berezovsky Henry Ford Physician Network Gayle Biederman Covenant HealthCare Partners Dan Cramer Covenant HealthCare Partners Samantha Fell Lakeland Care Network Molly Fleming, MSN, RN Jackson Health Network Michael Getty Lakeland Health Ash Goel, MD Bronson Network Paula Grudt, RN Bronson Network Melissa Kurtz Henry Ford Physician Network Kendall Troyer Lakeland Health Brenda Turner MidMichigan Collaborative Care Organization Kay Wagner, DHA, MSN, RN MidMichigan Collaborative Care Organization Pam Wyatt-Elkins Jackson Health Network

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BOARD AND COMMITTEES Evidence-Based Best Practice Subcommittee Nicole Allen Sparrow Care Network Sharon Deskins, MD Lakeland Care Network Kenneth Edwards, MD Lakeland Care Network Paula Grudt, RN Bronson Network Sean Kesterson, MD MidMichigan Collaborative Care Organization Scott Larson, MD Bronson Network Madhura Mansabdar, MD MidMichigan Collaborative Care Organization Dan Moore, MD Henry Ford Physician Network Harman Nagler, MD Sparrow Care Network Arvind Prabhu, MD Jackson Health Network Furqan Siddiqi, MD Lakeland Care Network Alan Spencer Covenant HealthCare Partners Anish Wadhwa, MD Jackson Health Network Michael Williams, DO Covenant HealthCare Partners

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Post-Acute Care Workgroup Rachel Aultman MidMichigan Collaborative Care Organization Kevin Birchmeier Covenant HealthCare Partners Sue Craft, BSN, RN Covenant HealthCare Partners Lisa Deehan, BSN, RN Jackson Health Network Candace Graham Lakeland Care Network Melinda Gruber, PhD Lakeland Health Morgan Martin Sparrow Care Network Anna Melville Sparrow Care Network Michelle Reed, LMSW Covenant HealthCare Partners Becky Trella, RN Bronson Network Pam Wyatt-Elkins Jackson Health Network

Finance & Contracting Committee Laurie Babinski MidMichigan Collaborative Care Organization Gayle Biederman Covenant HealthCare Partners Lowell Hamel, MD Lakeland Care Network Wynn Hazen Jackson Health Network Melissa Kurtz Henry Ford Physician Network Francine Padgett MidMichigan Collaborative Care Organization Melissa McAfee MidMichigan Collaborative Care Organization Paula Reichle Sparrow Care Network Amy Schultz, MD, MPH Jackson Health Network Kevin Sharp Sparrow Care Network Michael Slavin, MD Covenant HealthCare Partners Nancy Vannest Bronson Network Mary Whitbread Henry Ford Physician Network

Information Technology & Business Intelligence Committee David Allard Henry Ford Physician Network Ken Arnold Covenant HealthCare Partners Eugene Berezovsky Henry Ford Physician Network Thomas Bres Sparrow Care Network Sheila Britney Bronson Network Ken Buechele Bronson Network Meghan Cole Bronson Network Stephen Connellee Bronson Network Dan Cramer Covenant HealthCare Partners Frank Fear Covenant HealthCare Partners Melissa Gerhauser Covenant HealthCare Partners Michael Getty Lakeland Health Ash Goel, MD Bronson Network Michael Grabowski Sparrow Care Network

Tim Grove Lakeland Health Wynn Hazen Jackson Health Network Jason Hunt MidMichigan Collaborative Care Organization Matt Hussmann Henry Ford Physician Network Pankaj Jandwani, MD MidMichigan Collaborative Care Organization Smita Jha Sparrow Care Network Mark Kato MidMichigan Collaborative Care Organization Janet Kummeth MidMichigan Collaborative Care Organization Chris McNees Lakeland Health Gregory Meece Sparrow Care Network Matthew Mitchell MidMichigan Collaborative Care Organization Adam Passig Lakeland Health Ed Patnode Covenant HealthCare Partners Eric Pierce Covenant HealthCare Partners

Robin Sarkar, PhD Lakeland Health Holly Schewe Lakeland Health Kathleen Smith Sparrow Care Network Robert Spitz MidMichigan Collaborative Care Organization Erin Stern MidMichigan Collaborative Care Organization Mindy Stokoszynski Covenant HealthCare Partners Norma Tirado Lakeland Health Sarah Travis MidMichigan Collaborative Care Organization Abbigail Van Andel Jackson Health Network Dan Waltz MidMichigan Collaborative Care Organization Steve Withers Bronson Network Aaron Wootton Jackson Health Network Michael Zaroukian, MD, PhD Sparrow Care Network

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COLLABORATION What is a Clinically Integrated Network? Affirmant Health Partners is a Super Clinically Integrated Network (SCIN). We are connecting Local Clinically Integrated Networks (LCIN) with one another and with value-added, shared services and support—we are a network of networks. Affirmant will create scale while still preserving the independence of our member organizations and chapters. Six leading health systems and their affiliated physicians make Affirmant one of the largest Super Clinically Integrated Networks in the state of Michigan. These leading health systems are: Bronson Healthcare (Kalamazoo), Covenant HealthCare (Saginaw), Henry Ford Health System (Detroit and Jackson), Lakeland Health (St. Joseph), MidMichigan Health (Midland) and Sparrow Health System (Lansing).

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OUR MEMBER SYSTEMS 4 Acute Care Hospitals 812 Licensed Beds 9,000 Employees

Bronson Healthcare Bronson Healthcare is a not-for-profit, community-governed health system serving nine counties in southwest and south central Michigan. With 9,000 employees, four acute care hospitals, more than 1,300 medical staff members, and 812 licensed beds, Bronson is the largest employer in southwest Michigan. Bronson offers a full range of services from primary care to critical care across more than 70 locations. The system provides care in virtually every specialty with advanced capabilities as a Level I trauma center, Joint Commission certified comprehensive stroke center, accredited chest pain emergency center, American College of Surgeons accredited community hospital comprehensive cancer program, and the only high-risk pregnancy center and children’s hospital in southwest Michigan. Bronson Network works directly with independent and employed physicians in southwest Michigan to improve clinical outcomes, cost and quality of care. @bronsonmethodist @BronsonJobs Bronson Healthcare

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643 Licensed Beds 4,800 Employees

Covenant HealthCare From moms-to-be, to babies, to great-grandfathers, the Covenant HealthCare mission is to provide extraordinary care for every generation. Patients can trust Covenant with the healthcare needs of the entire family. The Saginaw-based health system leads in offering a broad spectrum of programs and services for the entire family including high-risk obstetrics, neonatal and pediatric intensive care, acute care, a Level II Adult and Pediatric Trauma Center, cardiology, oncology, orthopaedics, robotic surgery, virtual care and more. Extraordinary care goes beyond outstanding medical services, it’s a compassionate and caring team that makes the difference. The Covenant team lives our WE CARE values—putting patients at the center of every decision. Covenant is proud to work with local physicians and providers to bring world class health care, close to home. Covenant HealthCare Partners provides patients with the extraordinary care they need to stay healthy. Choose a doctor through Covenant HealthCare Partners and get the health care you have been looking for. @CovenantHealthCare @CovenantSaginaw Covenant HealthCare

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5 Acute Care Hospitals 30,000 Employees

Henry Ford Health System As one of the nation’s leading comprehensive, integrated health systems recognized for clinical excellence and innovation, we provide both health insurance and healthcare delivery, including acute, specialty, primary and preventive care services backed by excellence in research and education. Founded in 1915 by auto pioneer Henry Ford, we are committed to improving the health and well-being of a diverse community. Henry Ford Health System is a not-for-profit organization led by President & CEO Wright Lassiter III and governed by a 17-member Board of Trustees, with volunteer-led advisory and affiliate boards providing additional leadership. Henry Ford Physician Network (HFPN), founded in 2010, is a physician-led Henry Ford clinically integrated network (CIN), comprised of the Henry Ford Medical Group, Henry Ford hospital-employed and private practice physicians. The 1,900+ members of this CIN focus on delivering high quality care while reducing medical costs. This is accomplished through collaborative best practices, evidence-based medicine and improved efficiency. Jackson Health Network is a collaboration between healthcare leaders, community leaders and physicians working together to improve patient outcomes and safety, and reduce overall costs through an integrated system of care. @HenryFordHealthSystem @HFHS Henry Ford Health System

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3 Acute Care Hospitals 361 Licensed Beds 4,160 Employees

Lakeland Health Lakeland Health is a not-for-profit, community-owned health system, which includes three hospitals, an outpatient surgery center, rehabilitation services, homecare, hospice and palliative care, long-term care, laboratory services, diagnostic imaging, and a number of primary and specialty physician practices. The history of Lakeland dates back more than a century, when our hospitals first began meeting the needs of southwest Michigan residents. Today, Lakeland continually works to create an integrated system of care that is accessible, affordable, compassionate, and responsible. Lakeland Care Network is a Physician Hospital Organization (PHO) serving the healthcare needs of southwest Michigan communities. Lakeland Care Network includes over 80 primary care physicians, over 150 specialty physicians, all Lakeland hospital services, and a wide range of insurance options. @LakelandHealth @LakelandHealth Lakeland Health

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OUR MEMBER SYSTEMS 7 Medical Centers 773 Licensed Beds 6,000+ Employees

MidMichigan Health True to its leading-edge history, MidMichigan Health was an early pioneer of the health system concept in Michigan. Since its beginning in 1984, MidMichigan has developed into a mature, non-profit health system with a steadfast reputation for clinical expertise, award-winning quality and state-of-the-art technology. MidMichigan Health’s culture of collaboration and focus on quality has been a driving force behind its success as a health system. Headquartered in Midland, Michigan, MidMichigan Health is affiliated with Michigan Medicine, the healthcare division of the University of Michigan. The health system covers a 23-county region with medical centers in Midland, Alpena, Alma, Clare, Gladwin, Mount Pleasant and West Branch. In addition to our medical centers, MidMichigan Health also offers both home health care and physician services, and has a strong commitment to medical education. MidMichigan Physicians Group provides urgent care and medical offices in more than 30 specialties and subspecialties. 7 Medical Centers | 773 MidMichigan Collaborative Care Organization works directly with independent and employed physicians and is committed to connecting people to quality health care. @MidMichigan @MidMichigan MidMichigan Health

30 | Affirmant Health Partners

5 Acute Care Hospitals 820 Licensed Beds 8,300 Employees

Sparrow Health System Sparrow is a not-for-profit, community focused, comprehensive health system and is a major teaching hospital with 24 residency programs. Sparrow was the first health system in Michigan and one of the first five in the country to be selected to join the Mayo Clinic Care Network. The health system also offers dozens of satellite care centers, the new Sparrow Health Center, Lansing, the Sparrow Health Science Pavilion, and the only hospital-based health club in mid-Michigan, the Michigan Athletic Club. Sparrow Hospital, established in 1896, is mid-Michigan’s premier healthcare organization and the region’s largest private employer. Sparrow Care Network In 2014, Sparrow and physician leaders initiated the creation of Sparrow Care Network (SCN), a physician-led Clinically Integrated Organization. Since 2014, SCN has grown to include 650 independent and employed Physicians who care for approximately 112,000 lives across seven mid-Michigan counties. By partnering with eight hospitals, 14 preferred skilled nursing facilities and several community resources, and building on the belief that improving the quality and efficiency of care is most effective when it’s physician-led, SCN is a testament to the power of collaboration and physician leadership. @SparrowHealthSystem @SparrowHealth Sparrow Health System

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TEAM The Affirmant staff is here to: • Support our local Chapters and their efforts in clinical integration. • Bring together subject matter experts from across our network to share best practices. • Negotiate with health plan partners to bend the cost curve and share in the rewards. • Use data from tools such as Epic, to help us make higher value decisions at the point of care.

Bill Mayer, MD, MPH President and CEO

Rose Campbell Blackwood

Erik Pye Executive Assistant

Executive Assistant

Karin Proos, PharmD

Lawrence Green, AM, MBA

Paul Peabody

Katy Velten

Director of Clinical Transformation

Director of Payor Strategy

Information Technology and Business Intelligence Executive

Director of Communications

Meghan Gaertner

Angela Johnson

Business Intelligence Developer

Communications Specialist

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950 Trade Centre Way Suite 200 Portage, MI 49002

(877) 232-3614

@Affirmant Affirmant Health Partners

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