SCL Health 2018 Report to the Community

Advancing Person-Centered Care 2 0 1 8 R E P O R T TO T H E CO M M U N I T Y

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Patients are looking for empowerment.

They want us to provide connected and coordinated care, tools, services and information, where and when they want it.

Our new campaign, Power to the Patient, highlights all the ways that we put power into patients’ hands so they can find the care they need.

2018 Report to the Community | 3

From Our Board Chair and Our President and CEO It is a true blessing and a privilege to be part of an organization that continues to fulfill a mission of healing dating back 160 years. Today, through our associates and caregivers, SCL Health remains committed to meeting the health and wellness needs of hundreds of thousands of individuals in Colorado, Kansas and Montana.

Looking back at 2017, it is astonishing to reflect on all we accomplished in a year marked by change and uncertainty. We made tremendous progress in each of our strategic priorities: • To be person-centered in all we do.

• To pursue ministry excellence in operations, quality, safety, financial strength and community benefit.

• To develop accountable healthcare models.

• To deepen provider partnership.

• To invest in smart and strategic growth.

• To leverage skill, scale and learning.

• To create a culture that is associate-empowered.

We’ve also repositioned ourselves to adapt to changing dynamics in our industry and the markets in which we

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operate. We continue to welcome new members to the SCL Health family through new partnerships, clinics and providers. And based on our commitment to financial stewardship, we were able to once again increase our investment in community benefit, contributing $259 million toward programs and relationships that improve the health of the people and communities we serve, especially those who are poor and vulnerable.

We made significant progress in many of our quality and safety metrics by identifying, sharing and replicating clinical best practices. This work helped us reduce hospital-borne infection rates, improve outcomes for our patients and reduce waste. In October, we began laying the foundation for the next evolution in our patient-centered journey: Clinical Integration. This dedication to further integrate our care models and best practices represents how we will achieve more connected and coordinated care, the best health outcomes and zero harm for patients and associates. Clinical Integration is one of our top strategic priorities in 2018, and much tangible progress is underway, as evidenced by the many national quality awards bestowed on SCL Health care sites, ranking them among the nation’s leading hospitals.

Kate Paul and Lydia Jumonville

Finally, a word on innovation. We launched our first-ever Innovation Challenge in 2017, harnessing the creativity and expertise of our associates and medical staff to identify viable new models of care, address social determinants of health, enhance our patient journey and drive revenue to reinvest in our ministry. And because SCL Health has evolved and the programs and services we offer extend beyond our hospitals and clinics, we took steps to more intentionally promote the SCL Health brand. To support this, we introduced a bold new advertising campaign, Power to the Patient. This innovative campaign highlights how we are providing access and convenience — increasingly through virtual and telehealth programs — to accommodate the needs of today’s healthcare consumer.

None of this would be possible without the support of our Board of Directors, our Sisters of Charity of Leavenworth sponsors, our associates, providers and our communities.

We hope you will enjoy reading some of the highlights from what can only be described as a truly banner year for our ministry. We look forward to continuing to serve our patients and communities in 2018, and bringing our legacy of healing to those who need it most.

CONTENTS Section 1 – Strategic Imperatives . . . . . . . . . . . . . . . . . . . . .6 Our Strategic Imperatives. . . . . . . . . . . . . . . . . . . . . . . . . .7 Person-Centered. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Operational Excellence . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Clinical Integration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Provider Alignment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Growth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Associate-Empowered . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Section 2 – How We Give Back to Our Communities . . 22 Community Benefit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Addressing Social Determinants of Health . . . . . . . . . . . 26 Impact of Philanthropy . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Ensuring a Safety Net for the Most Vulnerable . . . . . . . . 30 Mount Saint Vincent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 International Ministries . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Section 3 – About SCL Health . . . . . . . . . . . . . . . . . . . . . 34 Our Mission, Vision and Values . . . . . . . . . . . . . . . . . . . . 35 Leadership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Kate Paul SCL Health Board Chair

Lydia Jumonville President and CEO

Where We Serve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Financial Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

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Section 1 Strategic Imperatives

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Our Strategic Imperatives The way to reach a challenging goal is to set clear priorities and stay true to them. At SCL Heath, our ministry is continually improving and growing because we establish specific strategic imperatives and deliver on them. These priorities are shared and achieved by people at all levels of our organization.

STRATEGIC IMPERATIVES

FOR

MINISTRY EXCELLENCE

PERSON-CENTERED Keep the patient at the forefront of all that we do OPERATIONAL EXCELLENCE Achieve performance excellence

CLINICAL INTEGRATION Deliver safe, reliable, high-quality, cost-effective care to every patient, every time

PROVIDER ALIGNMENT Enhance provider alignment to provide greater value to our patients

GROWTH Expand the reach of our healing ministry

ASSOCIATE-EMPOWERED Create an environment where our associates find meaning and purpose in their work

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Person-Centered Personalized care to every patient, every time The SCL Health brand represents the sum of all our parts.

Each and every aspect of our ministry contributes to who we are and to our shared mission to help and to heal. Whether it is a technician at one of our hospitals, a provider in one of our physician clinics, a nurse providing care in patients’ homes, or a virtual visit — each associate and each of our care sites are committed to compassion and excellence.

SCL Health continued advancing our brand during 2017, from creating new patient-care programs to adding more than 55 physicians and advanced practice providers to our Medical Group.

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In 2017, we asked consumers what they wanted from healthcare systems. They told us they value receiving all of their care from one healthcare brand, and they perceive value in their local doctor or hospital belonging to a larger network. And we listened! We took steps to build better awareness for the SCL Health brand and range of services, and made it much easier to find and engage with us. We elevated SCL Health in our visual identity while maintaining the strong legacy, culture and identity of our care-site brands in each community we serve. This collaborative work is having the effect of creating a more coordinated and connected experience for our patients, no matter the setting. n

Creating a tailor-made digital experience We know that most people search online for information about us and how to access care for themselves or their family. As part of our transformative brand journey, we reimagined our online healthcare experience to match the needs of our customers — empowering them to manage their health virtually, right from their personal device. Since we’ve relaunched our website, the number of people requesting or scheduling appointments online, or registering for classes, has grown significantly. It’s now

27

%

#

SCL Health’s employed providers rank first in Google name search results.

11K

easier and faster than ever for patients to find a doctor or a service, as our website is performing faster than many of the biggest healthcare brands in the country. We also continue to roll out enhancements to MyChart — our patient portal — to empower patients to easily access their medical information and communicate with their providers.

Through all of these digital experiences, we’re providing personalized engagements at every turn to give patients information they need, when and where they need it. n

increase in online scheduled appointments and class registrations in 2017.

People who made online video visits to Doctor on Demand last year.

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Operational Excellence Quality, safety and patient experience highlights At SCL Health, we aspire to provide every patient with the kind of extraordinary care and compassion we expect for our own families. Zero harm is the standard by which we hold ourselves accountable in everything we do. The best possible clinical outcomes and a positive patient experience every single time are not just aspirations — they are expectations.

We’re relentlessly focused on improving our quality of care and patient experience, and we’re proud to say those efforts have received national recognition. From our work to reduce hospital-associated infections to our passion and commitment to continuously enhance our patient experience in our care sites and clinics, we’re delivering award-winning care across our ministry. n

Saint Joseph Hospital receives Magnet accreditation Since 2013, Saint Joseph Hospital has been on a journey to receive its Magnet accreditation, and in May 2017, their hard work and persistence paid off. Magnet status represents the highest national honor a hospital can receive for nursing excellence and quality patient care, and only 7 percent of U.S. hospitals have this designation.

The Magnet Commission unanimously voted to credential Saint Joe’s as a Magnet hospital.

In their report, the commission noted several areas of work that are considered “Exemplars,” meaning that the hospital demonstrated examples of a concept, practice or program worthy of imitation, and it exceeds the expectations of an organization designated as Magnet.

Some of the Exemplars were: • Daily Safety Huddle, which embraces a high level of communication and a multidisciplinary approach to patient care.

• Reduction in the Serious Event Rates.

• Increase in Patient Satisfaction and Associate Engagement scores.

• Consistent instances of nurses partnering with patients and their families to involve them in their care plan.

• The Patient and Family Advisory Council’s “Through the Eyes of our Patients” program • Door to diagnostic evaluation times in our Emergency Department, which outperformed national data.

We are incredibly proud of the Saint Joseph Hospital team — nurses, physicians, technicians, dietitians, support staff and many others — as this recognition requires the hard work and support of every team member to make it happen. Achieving Magnet status is a true reflection of our focus on outstanding patient care and demonstrates our commitment to operational excellence. Bravo! n

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Recognized for award-winning care SCL Health has three of America’s 100 Best Hospitals in 2018 — more than any other healthcare system in Colorado.

• Lutheran Medical Center, Good Samaritan Medical Center and Saint Joseph Hospital were named in Healthgrades 2018 Distinguished Hospital Awards for Clinical Excellence.

• Saint Joseph Hospital and Lutheran Medical Center have achieved the Healthgrades 2018 America’s 50 Best Hospitals Award™.

• Good Samaritan Medical Center has achieved the Healthgrades 2018 America’s 100 Best Hospitals Award™.

• Platte Valley Medical Center and Saint Joseph Hospital received the Outstanding Patient Experience Award™ from Healthgrades.

SCL Health care sites are earning high marks for quality, safety and patient experience across all regions.

The Leapfrog Group recently announced the spring 2018 Leapfrog Hospital Safety Grades, focused on how safe hospitals keep their patients from errors, injuries, accidents and infections.

• Lutheran Medical Center, St. Mary’s Medical Center and Saint Joseph Hospital all received “A” grades.

• Good Samaritan Medical Center, Platte Valley Medical Center and St. Vincent Health all received “B” grades.

• St. James Healthcare was recognized as a Top 100 Rural and Community Hospital in the Nation by The Chartis Center for Rural Health.

• Holy Rosary Healthcare was recognized as a Top 100 Critical Access Hospital in the Nation by The Chartis Center for Rural Health. n

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Clinical Integration The next frontier of our ministry’s evolution — Clinical Integration Each year in the spring and fall, we bring together executives from around SCL Health for shared learning and to focus on our biggest strategic priorities. In fall 2017, we dedicated our leadership event to one topic — Clinical Integration. Clinical integration is one of the major initiatives we have underway at SCL Health to ensure we are consistently identifying and replicating clinical best practices to support our healing mission and commitment to safe, reliable, high-quality, effective care to every patient, every time.

Summit participants developed new ways to integrate all of our clinical functions to ensure that we bring safe, reliable, high-quality, effective care to every patient, every time.

What does that mean for our patients? It means that we are relentlessly focused on continuous improvement and high-quality care to ensure each patient the best possible outcome. It also means we are reducing costs and waste associated with variation. All of our work around clinical integration is designed to help us meet our goal of zero harm for our patients and associates. n

SCL Home Health celebrates recognitions and milestones One of our goals within clinical integration is to find and fill gaps in clinical care and community services to ensure that we’re meeting patients where they are and delivering care the way they need it.

Increasingly, patients wish to stay in their homes when managing recovery or chronic conditions. SCL Home Health provides medical care in the privacy and comfort of your own home from experienced healthcare professionals.

In 2017, SCL Home Health received a number of accolades, showing just how far we’ve come in a relatively short time with our home health services.

These achievements and recognitions reflect our Home Health team’s constant focus on innovation and improvement, including some of our latest developments, like remote monitoring of patients at home. This program has been recently implemented in 10 homes and is already making a difference. In just a few weeks, the monitoring 12 | SCL Health

system alerted our health professionals to medical complications from a patient’s home, enabling nurses to provide care that day, before their condition became worse. The program is a hit with patients, who can also request a call or video chat with nurses as needed. After such strong initial success, the SCL Home Health team is looking at expanding the program.

Further integration of home health continued in November, when after months of hard work and preparation, our Front Range Home Health team went live on Epic, our shared electronic medical record. This brings tremendous benefits to our patients, as it provides the ability for home health encounters and information about your home care to be shared easily among our healthcare providers in all settings. These are just a few examples of how we’re focusing on integrating patient care beyond the walls of our hospitals and clinics through our growing home health strategy. n

Watch an online video to learn more about Home Health Initiatives and Epic: visit sclhealthreport.org

During 2017, our Home Health team had much to celebrate, including being recognized as a 2017 HomeCare Elite organization. Now in its 12th year, this market-leading review by ABILITY Network names the top 25 percent of agencies nationally-based on performance measures such as quality of care, quality improvement, etc.

SCL Home Health is one of 15 Denverarea agencies named to the list and one of only 35 in Colorado. There are 175 home health agencies statewide.

We are also proud to share that SCL Home Health has earned a 4.5-star rating from the Centers for Medicare and Medicaid Services (CMS) for quality, and it maintains a 4-star rating from CMS for patient satisfaction.

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Provider Alignment 2017 was a transformative year for SCL Health provider practices as we continued building a high-performing Medical Group that delivers high-quality care and service to patients and communities.

In our journey to high performance, we have focused on four key areas: clinical quality, patient experience, operational excellence and financial performance. This year, we made significant advances in our ability to measure, report and improve our performance in these domains. New members of our ministry and regional leadership teams have brought external expertise and new ideas to help us advance the work.

And for the first time since our Medical Group was formed, we met our budget.

All of this work was made possible by the tremendous efforts of our providers and associates. n

2017 Patient Care 254,408

PAT I E N T S S E R V E D

70,957

N E W PAT I E N T S

90.3%

Likely to recommend

91.8%

Office staff quality

92%

Physician communications

484,222

PRIMARY CARE VISITS

364,516

S P E C I A LT Y C A R E V I S I T S

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Patient experience ratings

Provider star ratings SCL Health is committed to providing patients with the information they need to make informed decisions about their care. Our new star-ratings program enables us to proactively provide patient satisfaction data via provider profiles at SCLHealth.org. This data provides accurate information to patients who are selecting healthcare providers, and helps clinicians improve overall outcomes in patient care and experience.

Results of our pilot program showed increased traffic to our website and an average 4.82 out of 5 stars for participating providers, consistently placing them at the top of Google searches. We are excited to expand this program across our Medical Group in 2018. n

We offer tools that simplify patients’ access to high-quality care.

Care Coordinators Quality Dashboards eConsults Provider Reports Electronic Medical Records Provider Finder Referral Module

In 2017, close to 1,400 associates worked in our clinics serving our communities.

Provider Profiles MyChart Patient Portal Online Provider Ratings Online Scheduling Online Bill Pay Appointment Availability Alerts Ly Ridesharing Collaboration

We offer tools that make accessing care simple and providing high-quality care 2018 easy.

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Growth At SCL Health, our priority and purpose for growth is to expand the reach of our healing ministry in order to bring our healing mission to those who need it most.

CV groundbreaking in Grand Junction St. Mary’s Medical Center launches new initiatives Several exciting partnerships and programs are underway at St. Mary’s Medical Center. The Grand Junction care site broke ground on a $48.5 million cardiovascular surgical suite expansion that will transform care for some of our most critically ill patients in Western Colorado, enabling them to get the care they need close to home.

Breaking ground for a new heart center at St. Mary’s in Grand Junction, home to a new structural heart program for the Western Slope.

St. Vincent’s Kindred Alliance Billings healthcare providers team up to tackle brain injuries St. Vincent Healthcare has teamed up with Kindred Healthcare Inc., and Billings Clinic to construct and operate a 34-bed inpatient-rehabilitation hospital in Billings for patients who are recovering from conditions such as stroke, traumatic brain injury and spinal cord injury. This is a great example of collaborating around a common cause for the benefit of the community. n

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National trends show an increasing demand for the very services this expansion will support. The new, innovative facility will allow us to grow and expand our services, leveraging the latest state-of-the-art technology, and deliver an outstanding patient experience in a beautiful, modern space.

It will also help to attract talented new providers, who will no doubt be drawn to the beauty and culture in Western Colorado. n

Successful go-live partnership with Platte Valley produces results Our partnership with Platte Valley Medical Center continues to produce positive results. Last summer, Platte Valley Medical Center (PVMC) successfully transitioned to SCL Health’s business and clinical systems, a significant milestone in our integration efforts. The go-live was a proud moment for both PVMC and System Services associates, who spent months preparing and training for the big moment. After earning its Level III trauma designation, PVMC emergency department visits are increasing. Inpatient admissions are up as well, and a new ambulatory center is driving an increase in service capacity and new programs. n

Since becoming a Level III Trauma Center, Platte Valley Medical Center has experienced historic growth.

2018 Report to the Community | 17 17

Growth Plans for new Denver birth center unveiled

Saint Joseph birth center is a first for Colorado and a milestone in person-centered care.

When it comes to childbirth, person-centered care often looks different than other service lines. It’s less about the latest technology and interventions, and more about the experience and value. Women desire for safety and great care for themselves and their babies, and they also want to customize their birth plan based on what they want their birth experience to be in a non-clinical setting. For example, the center offers options such as birth balls, birth slings and large tubs to support a natural approach to birth. In addition to childbirth, Birth Center of Denver will provide prenatal care, educational classes, and postpartum and newborn care provided by certified nurseAssociates at Saint Joseph Hospital

midwives, nurses and clinical educators. n

Saint Joseph Hospital announced they will open the first freestanding, hospital-owned, accredited birth center in Colorado. While many hospitals refer to their labor and delivery departments as birth centers, Saint Joseph Hospital will be the first to establish a freestanding birth center outside the hospital setting. Birth Center of Denver will offer another childbirth option for families looking for fewer interventions and lower costs.

A team of certified nurse-midwives will provide comprehensive care from prenatal through labor and delivery, and will follow up with patients to check in on how they are doing after they’ve given birth and gone home.

donned pink hard hats to commemorate the construction of Colorado’s first freestanding, hospital-owned birth center.

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As Colorado’s top baby hospital for over a century, Saint Joseph will offer another childbirth option for families looking for fewer interventions and lower costs that come with being outside a hospital setting.

The birth center model honors pregnancy and childbirth as a healthy and normal part of life.

Birth Center of Denver will offer customized care to empower families to make healthy decisions that fit a philosophy of low-risk pregnancy and birth.

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Associate-Empowered Our associates have big ideas about how to tackle healthcare challenges.

SCL Health believes that the best solutions to today’s toughest healthcare challenges come from within. So we launched an Innovation Challenge to leverage the creative ideas of our associates in order to create the ideal patient journey, both within and outside our hospitals and clinics.

Eighty-one semifinalists were selected, and SCL Health associates were able to cast votes to narrow the finalists.

Eleven winners out of 288 submissions were then selected after a “Shark Tank� style contest.

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The winners then had the opportunity to put those ideas into action, with funding to launch their ideas. Ideas ran the gamut, ranging from providing educational videos to help patients avoid post-operative problems after total knee replacement to a successful Meds to Beds program that delivers prescriptions from the outpatient pharmacy to patients before they leave the hospital. SCL Health leaders fully supported the challenge, and the challengers were diligent, creative and forward thinking in their approaches. n

Person-centered care inspires and guides everything we do at SCL Health.

To ensure that our patients receive the very best care, SCL Health starts by providing a supportive and caring environment for its associates with a wide range of careintervention programs. Ensuring that our associates have the resources to proactively manage their care and stay well is one of our top priorities, and we’re thrilled that many associates are proactive in managing their health and wellness.

• Redbrick Health , our health and wellness incentive program, reached 55 percent associate engagement, 25 percent higher than its average client associate engagement.

• Our Employee Assistance Program (EAP) annualized case utilization rate is 2 percent higher than the national average.

• Lantern, an app-based benefit we offer free to associates and family members to help ease and manage stress and anxiety through a variety of research-backed techniques and personal coaching, saw 217 new registrations since

opening enrollment. More than 60 percent stayed engaged for more than 12 weeks.

• Noom, our personalized, easy-to-use mobile app that provides SCL Health medical plan enrollees access to tools and resources to help reach personal health goals, has helped 56 percent of all users lose more than 5 percent of their initial body weight. A full 91 percent of the active users have been in the program for at least 17 weeks.

• Doctor on Demand offers immediate online video visits with doctors for non-emergent healthcare needs. More than 1,000 SCL Health member visits led to high associate satisfaction scores with a 4.7 out of 5 rating.

• Recognizing YOU — an associate program providing recognition to associates who go above and beyond to support our Mission, Vision and Values, and who demonstrate our caring spirit and take action to inspire person-centered care — led to 13,097 leader-to-associate and peer-to-peer recognitions. n

Helping our associates stay well is important to ensuring that our patients receive the very best care.

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Section 2 How We Give Back to Our Communities

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Community Benefit Inspired by our faith, SCL Health addresses the most important healthrelated needs of those who are poor and vulnerable.

Through our Community Needs Assessments, we identify the biggest obstacles facing our communities and develop programs to address them. We remain faithful to the charitable spirit of our founding sisters by providing free and discounted healthcare services. And we are leading the way in our communities through health education, preventive healthcare and chronic-condition management that will provide lasting and meaningful change for generations to come. n

$259.4 M

in charity care & community program spending

10¢ of every dollar is reinvested in our communities

Charity Care and Community Benefit Spending 2017 expenditures shown in millions

$149.4

Government Shortfalls

$37.9

Subsidized Health Services

$29.3

Health Professions Education Financial Aid & Charity Care

$28.7

$6.8 Community Health Improvement Services $3.6 In-Kind Contributions

241,145 lives touched* * This summarizes the number of people reached in 2017 through all Community Benefit activities — health services, education, research, screenings, etc.

$2.7 Community Building $0.9 Other Means-Tested Government Programs $0.1 Research

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How We Give Back to Our Communities SCL Health mobilizes to support mental health When Community Health Needs Assessments revealed that mental health is a priority concern for all of the communities we serve, SCL Health set out to offer mental health training to 1,500 individuals throughout all our regions during 2017.

Care sites from across our ministry participated.

To meet the distinct training needs of various groups and locations, four classes were offered, including: • Mental Health First Aid (MHFA) — how to identify signs of mental illness and addiction and how to offer appropriate support, including during an emergency.

• How to recognize the signs of a suicide crisis and how to question, persuade and refer someone to help.

• Suicide-prevention skills and awareness for the work­place, including signs to be aware of, what and what not to say.

• Understanding, recognizing and responding to the effects of all types of trauma.

Mental Health First Aid courses give our associates and the public the knowledge, confidence and tools to offer appropriate support, including during an emergency.

Many people with behavioral health issues don’t seek treat­ment due to social stigma or because they don’t know warning signs; so our goals included increasing awareness and redu­cing stigma around seeking help. SCL Health exceeded our goal and trained 1,651 individuals in Colorado, Kansas and Montana, including adults, youth, seniors, public safety officers and veterans.

Our program to mobilize support for mental health will continue to grow and have impact, in part through training more MHFA instructors and continuing to expand partnerships with employers and community organizations to raise awareness and reduce stigma. n

“A population well trained in Mental Health First Aid can be as effective as a population well trained in CPR.” — National Council of Behavioral Health

[Insert Graphics for the following statistics] Behavioral health conditions affect 1 in 5 Americans each year.

More than 50% of people in the U.S. will be diagnosed with a mental illness or disorder at some point in their lifetime.

During 2017, SCL Health trained 1,651 individuals in Mental Health First Aid

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Community Crisis Center Mental health is a health priority in many counties in Montana including Yellowstone County, where 13 percent of adults report their overall mental health as fair or poor, and 25 percent of adults have been diagnosed with depression.

St. Vincent Healthcare provides financial assistance to the Community Crisis Center in Yellowstone County, which provided integrated mental health, substance abuse and social-service-related healthcare services to more than 10,500 clients in 2017, regardless of their ability to pay.

SCL Health’s Chief Medical Officer in Montana, Dr. Michael Bush, serves on the crisis center’s board of directors.

Open 24 hours per day, 7 days a week, the center has a “no wrong door” philosophy. It triages clients and refers them to appropriate services at the point in a person’s life when it is most needed. The center provides mental health assessments, case management, addiction counseling, chemical dependency evaluations, groups, referrals, and stabilization services to individuals in crisis, including an 18-bed stabilization area for those most at risk, but who do not need hospitalization. The center also provides crisis intervention team training for law enforcement.

The center plans to continue its approach to accessible, affordable, collaborative care and to add programming to meet the needs of its clients and local communities. n

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Addressing Social Determinants of Health Improving the health of our communities is both a driving force and a call to action embedded in our organization’s mission.

Wrapped within this call to action is a need to deliver exceptional clinical care at lower costs and address underlying drivers of poor health.

Increasingly, Social Determinants of Health are becoming a focus of strategic community benefit investment as health systems recognize that many environmental factors affect overall health. They include economic stability, education, social and community context, and neighborhood and built environments.

In their research and reporting, these assessments often include data and profiles of social-determinant needs. While addressing these environmental influences sits outside the traditional healthcare-delivery model, considering these issues is already showing benefits to patients and communities, especially among those who are most vulnerable.

For example, in clinical settings social determinants of health are being integrated into patient care through intake screenings, the discharge planning process and by making referrals to services such as transportation, housing assistance and chronic-disease management classes. This partnership between clinical and social services supports whole-person care and Catholic faith traditions to care for those who are poor and vulnerable.

Hea lthc are

on ati uc Ed

Sy st e

During 2017, SCL Health made gains to expand investments Improving the health of diverse groups of people and the into the social determinants of health, focusing on three environmental conditions in which they live requires focused areas: increasing food security; securing housing for at-risk goals and involvement with many community stakeholders. populations; and providing hands-on training to medical To identify and prioritize pressing community health issues, professionals in all of our care sites. nonprofit hospitals are required to complete a community health needs assessment every Gaye Woods, System Director of mic Stability Econo three years and to develop corresponding Community Benefit, summed improvement strategies. During our up the health system’s work m assessments, SCL Health invites input during 2017: “We’ve been Employment, Income, from diverse community segments, focusing on innovation, Expenses, Debt, Medical Bills, such as public health, faith commudriving the idea that Support Literacy, Language, Health Coverage, nities, educators, law enforcement Early Childhood Education, helping patients to solve Provider Availability, Quality Vocational Training, of Care, Provider Linguistic and local residents. This shared Higher Education challenges to their health & Cultural Competency thought process leverages their often involves getting knowledge of community health outside of our clinics needs and financial resources to and hospitals to work Community Engagement, Hunger, Access to Social Integration, Healthy Options help correctly identify priority health on solutions with other Support Systems, Discrimination concerns and develop strategically community stakeholders.” n Housing, Safety, sound potential solutions.

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Transportation, Walkability

t N ei g h b o r h o o d & t P h y si c al E n v ir o n m e n

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Support of senior housing

Giving our patients a Lyft

We are increasingly moving outside the walls of our care sites to impact the lives of the people in our communities. In the future, our efforts will involve securing affordable housing on the campus of Saint Joseph Hospital in Denver. Last year, Saint Joseph and SCL Health sold Tammen Hall to a local real estate development company and committed to making a substantial financial investment to redevelop the historic building as affordable independent senior housing. Housing in general, and especially affordable housing, is scarce in Denver — particularly in the city center. So the 49 one- and two-bedroom rental apartments that will fill the building will be a boon to the 62-and-older population who qualify based on income.

The building will maintain its historical designation but will be updated to address this critical shortage.

Getting to a healthcare appointment is something we could easily take for granted. We might simply assume that our patients have transportation to our care sites and clinics, but that’s not always the case. So in 2017, we decided to begin a collaboration with the ridesharing company Lyft to make non-emergency transportation services available to patients facing transportation barriers. The service was first offered at our four Front Range hospitals and physician clinics, and expanded to St. Vincent Healthcare in Billings, Montana, in 2018. We hope to expand the service to other areas in the future. Care teams at our sites are able to identify patients who are eligible for a Lyft and arrange a ride for them, either on demand or in advance.

“We are delighted to have identified a solution, as well as experienced development partners, to effectively reuse the space to meet a glaring need in our community — affordable living space for seniors on fixed incomes,” said Saint Joseph Hospital President Jamie Smith. n

We have provided more than 400 rides through this service and have seen an 840 percent increase in its use from its launch in November 2017 through February 2018. n

“ Helping patients get to or from our clinics and hospitals is a simple and critical step in improving health outcomes,” said Peter Kung, Vice President of Innovation and Virtual Health for SCL Health. “This initiative furthers our mission and our efforts to create an exceptional experience at an affordable cost.

We’re excited to work with Lyft to help the patients and communities that need it most.”

2018 Report to the Community | 27

Impact of Philanthropy The SCL Health Philanthropy team is a boundless source of heartwarming stories of generosity, and 2017 was no different in this regard. A Billings couple made a $1 million donation to the St. Vincent Spiritual Care program. Associate giving campaigns at multiple care sites raised hundreds of thousands of dollars. The St. Mary’s Foundation had its second highest fundraising year ever. Our foundations collaborated with police departments, hockey teams and more.

Montana care sites united around behavioral health and secured nearly $700,000 in grant money.

And these are just a few of the accomplishments from the past year.

St. Vincent $1 million donation Two pillars of the Billings healthcare community made a staggering donation to the St. Vincent Healthcare Foundation in 2017. John Moseley, MD, a retired neurosurgeon, and his wife, Cheryl, a retired registered nurse, donated $1 million to support the care site’s spiritual care program. The couple’s relationship, spirituality and charitable work have spanned several decades. Cheryl worked with Mother Teresa nine times over the span of 20 years, providing end-of-life care in India. Dr. Moseley over the course of his entire career has provided surgical care to those who couldn’t afford it. They also have contributed a combined 86 years of care to SCL Health. Cheryl would often assist Dr. Moseley while performing brain surgery, and the two worked together for 14 years before they got married in 1993. Dr. Moseley moved his practice to St. Vincent that same year.

The Moseleys’ gift supports the work of St. Vincent’s spiritual care team, including Chaplain John Jamison.

21.4 million

$

raised by our foundations

28 | SCL Health

While they spent their careers primarily providing physical healing, they were always cognizant of their patients’ mental and spiritual needs. “You can only do physically so much,” says Dr. Moseley. “You can fix parts of them but you can’t necessarily fix all of them, and that’s where the spiritual side of life comes in.” n

$

9.1 12.2 million million secured as grants

transferred to our care sites

Supporting Maternal Mental Health Perinatal mood and anxiety disorders are a common complication of pregnancy and the postpartum period; approximately one in seven women experience them. To help address this reality, the Saint Joseph Hospital Foundation secured a three-year, $820,000 grant from ZOMA Foundation for its Denver-Area Continuum of Maternal Mental Health (Denver CMMH) project.

SCL Health and Saint Joseph Hospital have also invested in the work through physician and staff time to advise the project’s development and create training and other resources using the system’s electronic health record to ensure efficient screening and referral services.

The funding will support the development and implementation of an evidence-based maternal mental health screening and treatment program for women at Saint Joseph Hospital throughout pregnancy, delivery and one-year postpartum. This approach, which helps to detect and treat perinatal

mental health disorders such as depression and anxiety, is based on groundbreaking work by Dr. Camille Hoffman, a maternal-fetal medicine provider at Saint Joseph Hospital and Lutheran Medical Center.

“We are grateful for SCL Health and Saint Joseph Hospital’s commitment to being a Colorado leader in the integration of mental and physical health to support the best outcomes for mothers, parents, and their children,” said Lucy Ana Walton, co-founder of ZOMA Foundation. “The opportunity to screen consistently and connect women to a continuum of care is a great step forward. It is our hope that innovative work in this area will yield results that can be widely replicated.”

This initiative will begin at Saint Joseph Hospital and will extend to SCL Health’s other three Front Range hospitals by the conclusion of the project. n

To help the one in seven women experiencing mood and anxiety disorders, we launched innovative screening and treatment programs.

2018 Report to the Community | 29

Ensuring a Safety Net for the Most Vulnerable Our three safety-net clinics in Kansas reflect our mission to reveal God’s healing love by improving the health of the individuals and communities we serve, especially those who are poor and vulnerable. Marian Dental Clinic in Topeka offers dental care to uninsured or underinsured patients. Duchesne Clinic and Saint Vincent Clinic provide primary healthcare, optical care and management of chronic illnesses to adult patients, among other services.

8K

Marian Dental Clinic Number of patients in Topeka, Kansas, to whom we provided non-emergency dental exam­ inations, treatments and restorative care.

6%

Caritas Clinics (Saint Vincent and Duchesne) Increase in patients served, compared to the prior year.

Of these 12,365 visits to 1,839 patients, 63% of the patients were women, mostly between the ages of 45 and 64.

1,000+

Caritas Clinics Number of unique prescriptions filled. The clinics dispensed another 1,154 medication samples to patients at no cost. The medications were purchased through philanthropic grants and the Kansas Unused Medication Program.

Marian Dental Clinic The Marian Dental Clinic had a year of growth and transformation, starting with the hiring of a new executive director, Krista Hahn, who stepped into the role in January.

For example, the clinic expanded its services to offer comprehensive dental care versus emergency-only services. During the year, more than 8,000 patients received dental examinations, treatment plans, and restorative care to support better oral health. SCL Health continued to assist the clinic to invest in projects that directly benefit patients, including education to expand providers’ expertise, updating equipment, implementing electronic patient charting, expanding clinic space, and hiring more dentists and staff.

The clinic also began a partnership with Baker University School of Nursing and with social workers at Stormont Vail Health to support a Dentistry for Diabetics program and further medical and dental integration. The partnership offers patients a brief medical history update, blood pressure checks, blood sugar checks, primary care referrals, and social service interventions. This provides patients with expanded care and allows the dental team to collaborate across disciplines to provide “whole person” care. n Our team members strive to care for the “whole person” who is sitting in the dental chair. We have expertise that allows us to provide services often found in private dental practice, and our spirits shine when patients leave with renewed, healthy smiles.

– Krista Hahn, Executive Director

30 | SCL Health

Watch an online video to learn more about Marian Dental Clinic: visit sclhealthreport.org

Saint Vincent Clinic When a nurse practitioner noticed that some patients were suffering from not having anyone to talk to when dealing with difficult issues in their lives, the team at Saint Vincent Clinic in Leavenworth, Kansas, took the initiative to develop a “listening ministry.” Two Sisters of Charity of Leavenworth volunteers who have experience in this type of ministry, Sister Nancy Bauman and Sister Marie Michael, provide the service to patients two days per week. To create a place for these conversations, team members painted and decorated the end of a hallway and added furniture donated by the Sisters of Charity of Leavenworth Motherhouse.

The ministry started in December and has been well received.

The clinic plans to expand the service by recruiting more volunteers from among local clergy. n

Saint Vincent Clinic’s “listening ministry” provides support for patients dealing with difficult issues in their lives.

Duchesne Clinic At Duchesne Clinic in Kansas City, Kansas, a bilingual English-Spanish diabetes education program, operated in partnership with Riverview Health Services, has had great success during the past three years. All of the participating patients live below 150 percent of the federal poverty level. More than 75 percent of the patients participating in the program now have their diabetes in control, according to measurements of their A1c levels.

Also, a $10,000 grant was received from the Order of Malta to replace a procedure table at Duchesne Clinic with a wider table that can hold patients weighing up to 650 pounds. The existing table will be installed at Saint Vincent Clinic, which does not have such a table. n Watch an online video to learn more about Caritas Clinics: visit sclhealthreport.org

2018 Report to the Community | 31

Mount Saint Vincent TheInternational Goodbye Tunnel Ministries The Goodbye Tunnel at Mount Saint Vincent in Denver is an emotional and time-honored ritual. At this provider of mental health treatment, foster care and education services operated by SCL Health, staff and caregivers gather to say goodbye to a child who is leaving the residential or day treat­ment programs. It’s a huge, celebratory step for these kids who have suffered trauma or neglect in their lives and often arrive at Mount Saint Vincent one or more grade levels behind their peers.

In its 134th year, Mount Saint Vincent accomplished much and impacted many lives. For example, the organization:

• Was awarded accreditation by the Council of Accreditation, signifying that it meets or exceeds best practice standards in all programs.

• Served 234 children.

• Provided 3,300 therapy hours and 41,000 meals.

• Served 71 children through its Foster Care program, a 51% increase over 2016.

• Helped improve literacy for 82 percent of students in its K-8 school.

• Trained 1,862 adults in its trauma-informed course.

• Released 91 percent of children in its short-term stabilization program to less restrictive settings. n

32 | SCL Health

In 2017, Mount Saint Vincent provided therapy, educational support, meals and more for hundreds of children — and changed lives forever.

International Ministries Bringing clinical teaching and technology to Tanzania hospitals It’s a good year when we can make two mission trips to help the people of Arusha, Tanzania. 2017 was a good year. It started with a January trip made by 10 associates that featured a lot of teaching and a lot of equipment — a 40-foot container full of equipment, to be exact. It ended with a December trip to address some critical needs at Arusha Lutheran Medical Center (ALMC), our sister hospital that serves Eastern Tanzania.

SCL Health associates provided training and technology assistance to two hospitals in Tanzania.

Our first trip, to Selian Lutheran Hospital, focused on bringing technology improvements to the hospital.

We replaced a 40-year-old X-ray machine with a newer machine donated from Saint Joseph Hospital and installed servers so caregivers could store images for more than eight weeks, which was their previous limit. Our team also installed a medical air system that supports mixedgas therapy for the ICU, NICU and surgical services, and donated computers to a local girls’ school.

During our December trip to ALMC, our caregivers hosted a skills fair about treating cardiac and respiratory patients, including showing the hospital’s staff how to do a bronchoscopy using new equipment.

Our team from SCL Health also provided physical therapy education for a new spine and back clinic at ALMC and shared suggestions to improve patient care in the emergency department and outpatient clinics.

We look forward to continuing this partnership into 2018 and beyond. n

2018 Report to the Community | 33

Section 3 About SCL Health

34 | SCL Health

MISSION

VALUES

We reveal and foster God’s healing love by improving the health of the people and communities we serve, especially those who are poor and vulnerable.

Caring Spirit

VISION Inspired by our faith, we will partner with our patients and communities to exceed their expectations for health.

We honor the sacred dignity of each person.

Excellence We set and surpass high standards.

Good Humor We create joyful and welcoming environments.

Integrity We do the right thing with openness and pride.

Safety We deliver care that seeks to eliminate all harm for patients and associates.

Stewardship We are accountable for the resources entrusted to us.

2018 Report to the Community | 35

Leadership From our sponsor to our board of directors and our senior executives, SCL Health leaders are dedicated to fulfilling our mission and vision, and to living our shared values.

Seated, left to right: Scott J. Keller President/CEO/Co-founder, Dynamis Advisors Inc. Vinod Sahney, PhD Retired Senior Vice President/ Chief Strategy Officer, Blue Cross Blue Shield of Massachusetts, Founding Member of Institute for Healthcare Improvement Lydia Jumonville President and CEO, SCL Health Kathryn A. Paul, Chair Retired President & CEO, Delta Dental Plan of Colorado

SCL Health Board of Directors

Gordon Howie, MBA Retired Managing Director, Bank of America Securities

Standing, left to right: Donna J. King, BSN, MBA, RN Retired Chief Nurse Executive, Advocate Illinois Masonic Medical Center Constance Phelps, SCL Community Director, Sisters of Charity of Leavenworth Alan R. Yordy, MBA, FACHE President/CEO, The Infinity Group J. Paul Solverson SVP/Chief Information Officer, Cape Cod Healthcare

36 | SCL Health

Paul Hughes-Cromwick, MA Co-director, Center for Sustainable Health Spending, Altarum Institute Knute Knudson, Past Chair Retired President, Dixson, Inc. Robert E. Wilson Retired SVP/Chief Finance Officer, Phoenix House, Brooklyn Steven D. Huebner, CPA, Vice Chair Retired Audit Partner, KPMG Michael Salem, MD President and CEO, National Jewish Health

D. Lynn Casey, SCL Retired Chancellor, Diocese of Great Falls – Billings Maureen Hall, SCL Former Community Director, Sisters of Charity of Leavenworth Not pictured: Pamela Federbusch Consultant, Healthcare Finance and Credit Consulting

System Services Executive Team

Standing, left to right: Tajquah Hudson SVP, Chief Strategy Officer Steven Chyung SVP, Supply Chain and Real Estate Lydia Jumonville President and CEO James P. (J.P.) Valin, MD EVP, Chief Clinical Officer Janie Wade EVP, Chief Financial Officer

Shawn Dufford, MD SVP, Chief Medical Officer and Acute Care Operations Geri Towndrow, RN SVP, Chief Nursing Officer

Seated, left to right: Tamara Saunaitis SVP, Chief Human Resources Officer David Pringle SVP, Mission Integration

Leaven Ministries

Rosland Fisher McLeod SVP, Chief Legal Officer Christine Woolsey SVP, Chief Communications & Marketing Officer Michael Taylor EVP, Chief Operating Officer, Hospital Operations

Left to right: Charlotte White, SCL, Vice Chair Amy Willcott, SCL Rita Turley Michael DeFreece Maureen Hall, SCL, Chair Constance Phelps, SCL

Not pictured: Louis Capponi, MD Interim Chief Information Officer

2018 Report to the Community | 37

Care Site Presidents

Brian Davidson, MD

Jay Doyle

St. Mary’s Medical Center

St. James Healthcare

John Hicks

Steve Loveless

Paul Lewis

Platte Valley Medical Center

St. Vincent Healthcare

Holy Rosary Healthcare

Jamie Smith

Saint Joseph Hospital

38 | SCL Health

Jennifer Alderfer

Good Samaritan Medical Center

Grant Wicklund

Lutheran Medical Center

Where We Serve The heart of our ministry is to provide compassionate, safe, person-centered care for every patient, every time. We focus on taking care of those who need it most.

COLORADO – WESTERN COLORADO REGION

MONTANA REGION 3 Hospitals

1 Hospital

Holy Rosary Healthcare – Miles City St. James Healthcare – Butte St. Vincent Healthcare – Billings

St. Mary’s Medical Center – Grand Junction

1 Outpatient Imaging Center

MONT

ANA

1 Accountable Care Organization

20+ Physician Clinics

COLORADO – FRONT RANGE REGION 7 Hospitals Good Samaritan Medical Center – Lafayette

1 Long-Term Care Facility 35+ Physician Clinics COLORA

DO

KA NS AS

KANSAS REGION

Lutheran Medical Center – Wheat Ridge

3 Safety-Net Clinics

Saint Joseph Hospital1 – Denver Platte Valley Medical Center – Brighton SCL Health Community Hospital – Northglenn2 SCL Health Community Hospital – Southwest 2 – Littleton SCL Health Community Hospital – Westminster 2

1 Community Clinic Emergency Center SCL Health Emergency Center – Aurora 2

1 Home Health Agency 1 Hospice Center 2 Mental Health Centers 9 Outpatient Imaging Centers 3

Where we serve communities as of 12/31/17 Joint operating agreement with National Jewish Health Joint venture with Emerus 3 Joint venture with Touchstone Imaging

1

50+ Physician Clinics

2

2018 Report to the Community | 39

2017 Financial Summary

Healthcare is rapidly changing, in ways both evolutionary and revolutionary. In this time of great change and uncertainty in healthcare, SCL Health had one of the best years in our history for financial performance. We attained steady improvement in our operating margin and maintained strong operating cash flow well above rating agency and Catholic healthsystem benchmarks.

We also continued and slightly improved our Community Benefit investment, reinvesting 10 cents of every dollar into our SCL Health communities.

Hospital Utilization* Acute Admissions Acute Average Length of Stay Births Emergency Visits Inpatient Surgeries Outpatient Surgeries *2017 figures. Continuing operations only.

40 | SCL Health

Clinic and Outpatient Facilities 80,072 4.7 days 13,146 297,992 23,487 29,139

Clinic Locations Outpatient Visits (Including Observation)

209 848,378

Affiliates and Other Ministries Children’s Mental Health Treatment Center

1

Utilization SCL Health sponsors ministries in Colorado, Kansas and Montana.

Affiliates and Other Ministries Children’s Mental Health Treatment Center

1

*Continuing operations only.

2017 Financial Summary

Net operating revenue* . . . . . .

$2.6 billion

* NET OPERATING REVENUE Total operating expenses* ....

$2.5 billion

. . . . . . . . $137.4 million

$2.5 billion

2015 Capital expenditures* . . . . . . . . $185.2 million

$2.3 billion

2014

$2.2 billion

2016 Earnings reinvested*

*2017 figures. Continuing operations only.

TOTAL OPERATING EXPENSES*

2015

$2.4 billion NEED 2017 NUMBERS $2.2 billion

2014

$2.1 billion

2016

EARNINGS REINVESTED IN OUR COMMUNITIES* 2016

$117.7 million

2015

$101.7 million

2014

$80.3 million

2016 TOTAL CAPITAL EXPENDITURES

$189.8 MILLION

*Continuing operations only.

*Continuing operations only.

2018 Report to the Community | 41

160 years ago, a band of nuns stepped off a steamboat onto the banks of the Missouri River at Leavenworth, Kansas, to lay the foundation for a ministry of faith and service. Dedicated to serving the sick and poor, the sisters financed our first hospitals through fundraising events, loans, donations from benefactors, and pocket change they collected from miners and teamsters in local taverns. Over the next 100 years, the Sisters of Charity of Leavenworth went on to establish or assume responsibility for 18 hospitals from Kansas to California.

Today, as we negotiate a challenging and ever-changing healthcare landscape, we’re still inspired by our founding sisters. They taught us what’s possible with faith and hard work. And like them, 160 years later we’re still looking forward every day.

Look forward to the good that is yet to be.

— Mother Xavier Ross, Founder Sisters of Charity of Leavenworth

42 | SCL Health

Detail of an oil painting by Ernst Ulmer depicting the arrival of the little band of sisters at Leavenworth after a trip up the ice-clogged Missouri River in November, 1858.

2018 Report to the Community | 43

500 Eldorado Boulevard | Suite 4300 | Broomfield, CO 80021 303-813-5190 | SCLHealth.org

in Š2018 Sisters of Charity of Leavenworth Health System, Inc. All rights reserved.