2018 Mission Health Partners Value Report

2018 VALUE REPORT

TABLE OF CONTENTS 1 Letter from the Medical Director 2 About Mission Health Partners 6 Our Approach 14 Network Performance 22 Our Work: Targeting Social Determinants 29 Clinical Initiatives 34 Our Team 39 The 2018 MHP Network

LETTER FROM THE MEDICAL DIRECTOR As a Mission Health Partners physician reflecting on the accomplishments of the past year, it’s revealing to click open the MHP mobile application. There you’ll notice the 20 standards of care and the 52 podcasts covering everything from care of the normal newborn to chronic and acute illnesses in adults. There’s the one-touch connections to a care manager, LCSW, pharmacist or a psychiatrist. It becomes clear that our network of providers and team members have made significant contributions by creating the linkages that support a coordinated and accountable system of care. In 2015 we were a network of just 240 Primary Care Physicians (PCPs). Three years later we have grown to almost 300 PCPs and greater than 850 specialists. We continue to strengthen community partnerships and build on the success of a model that focuses on social determinants of health, building a bridge between traditional fee for service and new value based payment models. Evolving health care reimbursement is driving us to adapt. Our work of the future is to be proactive and create the health care system that both we and our patients deserve. The caregivers and administrators at Mission Health Partners (MHP) work quietly and diligently behind the scenes and in the community, helping us to create a new world in health care. Their devotion has shown me that the key to our success is found in the caring that has always been the foundation of our professions, and the strength of this team is what led me to join MHP as Medical Director in 2018. Together we can create a future worth striving for, even if the journey takes a lifetime. Amy Russell, MD Medical Director, Mission Health Partners Family Medicine Faculty, Mountain Area Health Education Center 2018 VALUE REPORT 1

ABOUT MISSION HEALTH PARTNERS Our Vision Provide western North Carolina the best model for quality healthcare by empowering patients to maximize their health and well-being, and through the dedication of physicians, other providers and Mission Health to deliver coordinated and accountable care. MHP will strive to partner with patients to optimize the individual experience of care, improve the health of the community, and make care more affordable. November — Decision Began MSSP Year 1, Addition of by Mission Health formed interprofessional CarePartners, System and the PCC care team 300 total PCPs + to pursue the 855 total Specialists establishment of a Clinically Integrated Network Formation of the Primary April — Mission Health Expansion includes Expansion includes Care Council (PCC), a Partners incorporated Murphy Medical Appalachian Regional group of primary care Center, 275 total PCPs, Healthcare System physicians in western July — Initial primary 550 total Specialists and 18 Skilled Nursing North Carolina who care recruitment yields Facilities came together as a over 240 PCPs reaction to the Affordable Care Act and Includes Mission Health its focus on primary care System, Pardee Hospital, MAHEC, 2 FQHCs, 27 The PCC aimed to independent practices strategically increase collaboration and innovation among primary care providers in the community 2 MISSION HEALTH PARTNERS

Mission Health Partners (MHP) is a Clinically Integrated Network currently serving approximately 93,000 patients in western North Carolina, with an overall goal of improving health outcomes and reducing costs. Over 1,100 physicians spanning the 20 counties of western North Carolina have committed to building a network focused on improving the health of our population, and in just three years the network has seen significant success. MHP’s innovative care coordination model, which focuses on social determinants of health, has received national attention as the population health community has realized that targeting the social and environmental factors that influence a patient’s health outcomes can be just — if not more — effective than focusing only on their clinical care. MHP is continuing to evolve, and it’s exciting to think of what may be accomplished in the coming years. As the network continues to contract with providers throughout the region and moves towards assuming additional lives through managed Medicaid, there are many opportunities to provide expanded services to the patients of western North Carolina. 2018 VALUE REPORT 3

ABOUT MISSION HEALTH PARTNERS Mission Health Partners MHP Provider Footprint 2018 Providers: Strongest When We Work Together Facility PCP Mission Health Partners has spent Pediatrics the last three years developing Specialists a diverse network of providers committed to delivering the highest quality of care to the patients of western North Carolina. Our strength lies in the continued engagement of the physicians in our network, as they recognize that in a quickly-shifting health care environment, there is strength in collaboration and Clinical Integration. Our network includes primary care and specialty providers, both employed and private practice, working together and sharing information with the ultimate goal of arriving at the best possible outcome for each individual patient. With just over 1,100 physicians spanning the 20 counties of western North Carolina, we are well on our way to moving the needle on population health in the region. With just over 1,100 physicians spanning the 20 counties of western North Carolina, we are well on our way to moving the needle on population health in the region. 4 MISSION HEALTH PARTNERS

ABOUT MISSION HEALTH PARTNERS Network Composition The Mission Health Partners network represents a diverse group of physicians — both hospital employed and private practice — spanning 20 counties in western North Carolina. MHP Primary Care and Pediatric Physicians MHP Specialty Physicians Total primary care and pediatric physicians: 287 Total specialty physicians: 831 Private practice physicians: 287 Private practice physicians: 192 Mission-employed physicians: 435 Pardee-employed physicians: Mission-employed physicians: 68 Appalachian Regional Healthcare 61 System physicians: Pardee-employed physicians: 15 48 Appalachian Regional Healthcare 12 System physicians: MHP Primary Care and Pediatric Practices MHP Specialty Practices Total primary care and pediatric practices: 93 Total specialty practice: 192 Private practice primary care and Private practice specialty practices: 74 pediatric practices: 57 Hospital-employed specialty practices: 118 Hospital-employed primary care and 36 pediatric practices: 1,984 Total MHP providers (physicians and advanced practitioners) spanning 20 counties of western North Carolina 2018 VALUE REPORT 5

OUR APPROACH CLINICAL INTEGRATION: ALIGNING TO SUPPORT Components of Clinical Integration access to performance data and enhanced systems to monitor quality and cost goals, as well as training on how A successful clinically integrated network relies on strong to structure quality projects in an office setting, with the leadership, robust data solutions and a clear sense of ultimate goal of establishing a network that encourages community and purpose amongst providers. MHP’s alignment among providers for the good of patients. physician leaders are engaged and innovative, advocating for data transparency and increased collaboration between providers in the region. Network providers have Physician Participation Leadership Criteria Legal COMPONENTS Performance Structure OF CLINICAL Improvement that supports INTEGRATION program objectives Distribution Information Methodology Technology Payor Contracts Source for components of Clinical Integration: Becker’s Hospital Review, “The 7 Components of a Clinical Integration Network,” October 19, 2012 6 MISSION HEALTH PARTNERS

2018 VALUE REPORT 7

OUR APPROACH Physician Engagement Physician engagement has been an important piece of With the network’s addition of skilled nursing facilities MHP’s strategy since its inception, and the MHP team in 2018, MHP has strengthened its commitment to has earned national recognition for their success in facilitating coordination between organizations, providing maintaining a network of providers who are committed introductions and guidance that allows providers to to improving the lives of the at-risk patients of western further collaborate with one another to strategically North Carolina. MHP’s provider relations team focuses expand the continuum of care that is covered by our developing personal relationships with providers and network for the patients of western North Carolina. practice administrators, allowing for a level or trust and collaboration that has been key to the network’s success. Mission Health Partners received a NAACOS Innovation Award in 2018 recognizing achievement in Provider Relations. 8 MISSION HEALTH PARTNERS

OUR APPROACH MHP Connect Mobile App, A successful and ongoing a smartphone app that provides MHP podcast series seamless access to care process featuring western North models, scorecards, and quality Carolina physicians measures, and offers one- across many specialties touch calling to the MHP care sharing ideas and coordination team, clinical referral algorithms in a pharmacists, and LCSWs and conversational setting. telepsychiatry. Quarterly in-person and MHP Provider- Monthly collaborative web-based meetings, Centric Tools webinars/Q&A sessions allowing for discussion targeted towards the and networking amongst MHP utilizes a range of practice administrators and primary and specialty provider-centric tools quality improvement staff for providers. to promote physician primary care, specialty and skilled nursing organizations. MHP Connect, an internal engagement and provider portal linking communication. Weekly email blasts providers with specific to keep providers and information on network and An online population practice managers informed regulatory requirements, health dashboard that about emerging events and clinical guidelines and utilizes several data feeds upcoming deadlines. regional initiatives. to analyze quality, cost and utilization data and identify opportunities to close gaps in care for attributed patients. 2018 VALUE REPORT 9

OUR APPROACH Achieving Population Health Goals through Robust Payor Relationships Mission Health Partners has agreements in place with These successes feel even more impactful as they payors that allow our care coordination team the demonstrate that the social determinants model utilized opportunity to manage patients covered under those by MHP – a relative anomaly among Accountable plans, and provide opportunities for quality incentives Care Organizations – is working, proving that building and shared savings, with distribution models – developed relationships with patients and helping to address social by the physician-led Finance Committee – rewarding determinants and environmental factors is not only the network physicians for improving quality and reducing right thing to do, but it actually saves money and impacts unnecessary costs. overall health outcomes. Mission Health Partners has performed extraordinarily Currently, Mission Health Partners’ attributed lives well under several of these contracts – in 2016 the network represent roughly 10% of the total population of saved just over $11.2 million dollars under the Medicare western North Carolina. As MHP continues to develop Shared Savings Program and $2.3 million dollars under relationships with additional payors – including WellCare the Humana Medicare Advantage contract. In 2017, the which was added in 2018 and Aetna, which will be an network saved $4.1 million dollars as a result of the work addition for 2019 – and grow patient reach throughout done with network management of UnitedHealthcare’s western North Carolina. Certainly as the organization Medicare Advantage population and saved $1.9 million prepares to take on managed Medicaid this number will dollars under the Medicare Shared Savings Program. increase even further, with the ultimate goal of becoming payor agnostic, giving MHP the ability to support all of the patients in our 20 counties. 10 MISSION HEALTH PARTNERS

OUR APPROACH Improving Cost and Quality Performance Using Data Driven Solutions A vital component of “moving the needle” towards Mission Health Partners has partnered with several IT improving quality and lowering costs is actionable data. vendors to create systems to make the best use of the Mission Health Partners has invested in tools to help available information, including a data translation tool translate claims, clinical data, and information on social (allowing clinical data from various EMRs to be compared determinants to help identify the most impactable patients. “apples to apples”), “Big Data” reports with information on social determinants and a comprehensive population health analytics tool that provides risk stratification, care coordination documentation and quality dashboards. EMR Data EMR 1 EMR 2 EMR 3 EMR 4 Claims Lab Partner Big Feed Data Data Translation Tool converts EMR data into one stream (apples to apples) + Lab and ADT Feed • Utilization Information Social Determinants • • Limitied Quality Data • Financial Phase 1 – Phase 2 – Phase 3 – Utilization & Financial Data Quality Dashboard Predictive Analytics Mission Health Partners has partnered with several IT vendors to create systems to make the best use of the available information. 2018 VALUE REPORT 11

OUR APPROACH 12 MISSION HEALTH PARTNERS

OUR APPROACH Well Positioned for Managed Medicaid From the beginning, MHP has committed to provide the best possible care to our community. We are a network of providers in Western North Carolina, for Western North Carolina. Since 2015, MHP has accomplished quite a lot: • Built a network of over 1,100 physicians in primary care, specialties, hospitals and skilled nursing facilities • Improved clinical outcomes year-over-year driven by an annual internal Quality Improvement Plan • Operationalized an innovative, multidisciplinary Care Coordination Team that has curbed avoidable acute care utilization • Deployed a team of CaraMedics and Community Health Workers that extend the reach of clinical providers and become an extension of the telephonic Care Coordination team • Partnered with dozens of community programs to address social determinants of health We now stand poised to utilize this substantive experience to serve our region’s Medicaid population. While the transition to managed Medicaid will be disruptive to both patients and providers, MHP endeavors to provide support and stability. MHP will achieve this through centralized contracting and payer liaison services. We will build upon the successes of our multidisciplinary care management model, across all Prepaid Health Plans, to assess patients, develop care plans, and use community outreach to optimize outcomes. We will enhance our existing community partner relationships and forge new ones to address our Medicaid patient social determinant needs. We will measure the effectiveness of our interventions, with an eye for racial and ethnic disparities and hone our processes to diminish health care disparities. We approach this opportunity to serve our community with humility and purpose. We know that we are no better than our state’s most vulnerable. We stand ready to provide Medicaid beneficiaries the “best model for quality health care”. Period. It’s our mission. Calvin Tomkins, MD MHA Asheville Pediatric Associates Assistant Medical Director, Mission Health Partners 2018 VALUE REPORT 13

NETWORK PERFORMANCE 2017 Quality Performance Mission Health Partners’ overall quality score for 2016 was 96.65%. We achieved significant improvement on several measures, including ACO-13 (Screening for Future Fall Risk) and ACO-18 (Screening for Clinical Depression and Follow-up Plan), two measures that were strategically targeted by the MHP quality improvement team. Additionally, we saw significant improvement on ACO-19 (Colorectal Cancer Screening). Elsewhere we maintained performance and have demonstrated a lifetime increase on all measures. 2017 MSSP Quality Performance Results Patient/Caregiver Experience       Mean 2016 2017 MHP Mean 2017 Measure Measure Name 2016 MHP Number Performance Performance Performance Performance ACO-1 CAHPS: Getting Timely Care, Rate Rate Rate Appointments, and Information Rate 78.35 ACO-2 83.57 (SSP ACOs) 93.11 (SSP ACOs) CAHPS: How Well Your 93.54 80.51 92.05 80.60 ACO-3 Providers Communicate 91.8 93.01 83.06 93.13 ACO-4 92.25 63.75 92.31 ACO-5 CAHPS: Patients’ Rating of 84 83.49 77.77 83.32 ACO-6 Provider 63.08 60.32 72.57 62.30 ACO-7 78.99 75.40 28.05 75.85 CAHPS: Access to Specialists 70.33 72.30 73.05 ACO-34 28.85 26.97   25.68   CAHPS: Health Promotion and   Education   2017 MHP   Mean 2016 Performance CAHPS: Shared Decision Making 2016 MHP Performance Mean 2017 Performance Rate Performance CAHPS: Health Status/ Rate 7.46% Functional Status Rate (SSP ACOs) Rate 5.26% 46.08% (SSP ACOs) CAHPS: Stewardship of Patient 6.40% Resources 48.49% 11.77% 7.93% 39.31% 50.51%   14.38% 70.96% 44.55% 55.18% 18.24% At-Risk Population 67.84% 44.94% 92.94% 16.74% 70.69% 50.37% Measure Measure Name 89.44% 71.47% Number 85.05% ACO-40 Depression Remission at Twelve 86.86% Months Diabetes Diabetes Composite (All or Composite Nothing Scoring) ACO-27 Diabetes Mellitus: Hemoglobin ACO-41 A1c Poor Control ACO-28 Diabetes: Eye Exam ACO-30 Hypertension (HTN): Controlling High Blood Pressure Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic 14 MISSION HEALTH PARTNERS

NETWORK PERFORMANCE Care Coordination/Patient Safety       Mean 2016 2017 MHP Mean 2017 Measure Measure Name 2016 MHP Number Performance Performance Performance Performance ACO-8 Risk Standardized, All Condition Rate Rate Rate ACO-35 Readmission Rate 13.87 ACO-36 13.15 (SSP ACOs) 16.87 (SSP ACOs) ACO-37 Skilled Nursing Facility 16.2 14.69 48.33 15.01 30-day All-Cause Readmission 44.08 66.82 ACO-38 Measure (SNFRM) 64.55 18.17 18.46 53.96 All-Cause Unplanned Admissions 50.97 53.20 53.95 for Patients with Diabetes 75.23 79.16 All-Cause Unplanned 59.81 61.74 Admissions for Patients with Heart Failure All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions ACO-43 Ambulatory Sensitive Condition N/A N/A 1.23 1.93 Acute Composite (AHRQ* Prevention Quality Indicator (PQI #91)) ACO-11 Use of Certified EHR 97.62 82.72% 100.00% 91.17% Technology N/A N/A 77.07% 75.32% 69.54% 82.86% 74.38% ACO-12 Medication Reconciliation 64.04% ACO-13 Falls: Screening for Future Fall Risk ACO-44 Imaging Studies for Low Back Pain N/A N/A 59.18% 67.32%              Preventive Health 2016 MHP     Performance Mean 2016 Mean 2017 Measure Measure Name Performance 2017 MHP Number Rate Performance Performance ACO-14 Preventive Care and Screening: Rate Rate ACO-15 Influenza Immunization (SSP ACOs) Rate (SSP ACOs) ACO-16 Pneumonia Vaccination Status for Older Adults 76.39% 68.32% 78.92% 72.52% ACO-17 Preventive Care and Screening: 78.39% 63.73% 81.30% 72.92% ACO-18 Body Mass Index (BMI) ACO-19 Screening and Follow-Up 73.60% 71.15% 80.54% 70.69% ACO-20 ACO-42 Preventive Care and Screening: 95.36% 90.16% 95.09% 90.48% Tobacco Use: Screening and Cessation Intervention 58.97% 45.25% 79.48% 61.98% Preventive Care and Screening: 68.09% 60.06% 76.59% 64.58% Screening for Clinical 72.79% 67.61% 71.53% 70.05% Depression and Follow-up Plan 76.28% 77.72% 79.31% 79.89% Colorectal Cancer Screening Breast Cancer Screening Statin Therapy for the Prevention and Treatment of Cardiovascular Disease 2018 VALUE REPORT 15

NETWORK PERFORMANCE MSSP Quality Scores 2015-17 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Medication Reconciliation Screening for Future Fall Risk Diabetes Composite Hypertension Ischemic Vascular Disease Depression Remission 2015 Breast Cancer Screening 2016 2017 Colon Cancer Screen Flu Vaccine Pneumo Vaccine BMI Screening Tobacco Screening and Cessation Screening for Clinical Depression Statin Therapy 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 16 MISSION HEALTH PARTNERS

Medicare Shared Savings Program PMPM Data NETWORK PERFORMANCE Efforts to reduce ER visits through patient and provider education surrounding 1.1% appropriate utilization led to a 6% decrease in ER visits from 2015 – 2017. 2-year Metric 2015 2016 2017 increase Office Visits (Events/K) 11,646.0 11,808.8 11,776.9 ER Visits (Events/K) 6.0% Radiology (Events/K) 484.6 447.3 455.7 Lab (Events/K) 2,382.2 2,473.4 2,503.8 2-year Outpatient Observation 3,689.2 3,763.6 3,754.3 decrease (Events/K) Payments (PMPM) 54.6 50.3 54.1 $ 680.77 $ 683.23 $ 704.90 Mission Employee Health Plan PMPM Data During 2017 there were numerous steps outlined for Mission Health System employees and their dependents to encourage wellness. Both employees and spouses were asked to complete a Physical Health Assessment (PHA) that highlighted areas of opportunity to improve wellness. Additionally, employees were required to set a health goal and establish an action that would positively influence the health goal as well as completing a biometric health screening. These steps, along with patient education, helped influence positive behaviors in employees, resulting in an increase in primary care or ambulatory office visits and a decrease in ER utilization. Metric 2016 2017 2.6% Office Visits (Events/K) 4,127.0 4,232.5 ER Visits (Events/K) Annual Radiology (Events/K) 161.8 159.5 Increase Lab (Events/K) 882.0 875.1 Outpatient Observation (Events/K) 1,360.6 1,363.6 1.4% Payments (PMPM) 18.9 19.8 Annual $ 371.10 $ 539.17 Decrease 2018 VALUE REPORT 17

NETWORK PERFORMANCE Humana Medicare Advantage Targeted patient outreach by Mission Health Partners has an established partnership with Humana, allowing the MHP team to manage their Medicare Advantage population in western North Carolina. Part of MHP Pharmacy this partnership focuses on performance measures to promote quality improvement. The Technicians in Q4 measures are tracked and divided into two categories: HEDIS Measures as well as Clinical led to a significant and Strategic Initiatives. MHP has done well meeting targets for the Clinical and Strategic Measures and is strategically working to further improve on the HEDIS Measures. increase in adherence. HEDIS Measures Clinical and Strategic Initiatives Breast Cancer Screening Medication Adhaerence 90% 90% 80% 80% 70% 70% 60% 60% 50% 50% Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Humana PPO Humana PFFS Humana PPO Humana PFFS Colorectal Cancer Screening Chronic Care Management 90% 90% 80% 80% 70% 70% 60% 60% 50% 50% Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Humana PPO Humana PFFS Humana PPO Humana PFFS Targeted gap closure campaigns and strategies as well as strong partnerships with primary care practices have led to significant movement on Medicare Advantage measures. 18 MISSION HEALTH PARTNERS

NETWORK PERFORMANCE United Medicare Advantage Mission Health Partners and United have partnered to strategically focus on comprehensive diabetes care, annual wellness visits, and disease specific lab monitoring to improve health across the attributed population. MHP has exceeded the set targets on many measures, and will continue to focus on areas that most impact the overall health of the population. PCP Visit BMP, CMP, or Renal Panel Nephropathy Screening HbA1c Determination 20.0% 40.0% 60.0% 80.0% 100.0% 0.0% Target Percent of Members As our relationships with payors mature and as our population health efforts continue to advance, the impact on these populations will be significant. 2018 VALUE REPORT 19

NETWORK PERFORMANCE Care Coordination Team Cost Avoidance When working within the social determinants model, which focuses on prevention, the impact of the Care Coordination team can be measured in projected cost avoidance. Below find the estimated cost avoidance related to the Care Coordination Team for 2017. These calculations are specific to the team effort between the multidisciplinary Care Coordination Team and the CaraMedics that allows them to best serve patients and remove social determinant barriers. Healthcare Utilization 6-Months Before/After CaraMedic Initial Visit 250 17.1% 16.1% Projected Projected 200 reduction reduction Annual Annualized 150 192 168 IP Days 100 Avoided: Savings: 160 141 385 $3.3M in gross 50 0 20.8% charges reduction $910K in 53 42 Medicare Savings ED IP Readmit pre-CaraMedic post-CaraMedic Savings estimate based on annualized utilization savings and Mission Hospital FY 2016 average Medicare charges, payments and ALOS. 20 MISSION HEALTH PARTNERS

NETWORK PERFORMANCE Financial Performance Mission Health Partners has seen significant financial success over the past three years. In 2017, MHP saved $1.9 million dollars under the Medicare Shared Savings, Program, meaning that MHP’s attributed Medicare population cost $1.9 million less than the medical cost benchmark as determined by CMS. Additionally, MHP saved $11.2 million under the MSSP in 2016, with a total lifetime savings generated of $13.2 million Medicare dollars. Western North Carolina is already a high-quality, low-cost region – our benchmark is one of the highest in the nation, making it that much more difficult to achieve savings by MSSP standards. Our physicians’ commitment to improving quality and reducing unnecessary costs is evident, and the financial success of the network is a testament to the hard work of the providers and MHP’s clinical and operational teams. MHP’s Care Coordination team targets high utilizer patients to ensure that the care is appropriate and necessary. Many times as they investigate situations of high utilization of health care, they determine the cause of unnecessary utilization to be solved through the social determinates model. If you can solve the most immediate social determinant barrier for a patient, it can free them up to put their time and energy into actually managing their health. $13.2 million Lifetime MSSP savings Mission Health Partners 2017 MSSP Financial Performance 2017 Benchmark $483,924,085 2017 Spending Target per Beneficiary per Year $8,631 Actual Spend per Beneficiary per Year $8,596 Actual Savings $1,965,938 Additionally, MHP has performed well under Medicare Advantage contracts, managing over 13,000 Medicare Advantage patients in the region. With contracts in place that incentivize performance on quality measures as well as cost savings, these agreements allow MHP to expand its scope while also providing financial rewards to physicians for improving quality and reducing costs. Mission Health Partners Medicare Advantage Shared Savings Performance 2016 Humana Medicare Advantage Shared Savings $2.3 million 2017 United Medicare Advantage Shared Savings $4.1 million 2018 VALUE REPORT 21

OUR WORK: TARGETING SOCIAL DETERMINANTS Mission Health Partners’ focus on social determinants — upcoming primary care and specialist appointments the socioeconomic issues that can have a significant effect with patients, and arranges for transportation if needed. on patients’ health — has proven to be incredibly effective Medication changes are also reviewed, assuring the in terms of both clinical outcomes and cost savings. The patient has a plan for filling and taking their medications care coordination team is multidisciplinary, including as prescribed. If cost is a barrier, patients are connected registered nurse (RN) care coordinators, certified pharmacy with medication assistance resources. These calls allow technicians, licensed clinical social workers (LCSWs) the patients an opportunity to ask questions regarding clinical pharmacists, a community resource specialist, the care they received in the hospital or how to monitor and CaraMedics. The team utilizes the Pathways HUB symptoms and manage chronic conditions before their model (more on this below) to collaborate with regional next physician visit. It also allows for social determinant community partners to care for the highest-risk patients. barriers to be identified and resources to be utilized to These relationships with other organizations within overcome these barriers in order for the patient to more western North Carolina allow MHP to expand its scope and clearly focus on health goals. Other parts of the care plan provide local, specialized assistance to patients throughout are also reviewed, such as home health services, therapy, the region, even those in the most rural locations. or medical equipment that may have been ordered during the hospitalization. How Patients Become Engaged in MHP Closing Socioeconomic Gaps Using the Care Coordination Pathways HUB Care Coordination Model Patients engage with MHP care coordination through The Pathways HUB care coordination model addresses the several entry points – they are identified within the socioeconomic drivers of health and relies on partnerships organization’s data analytics tool, which looks at clinical, within the community to institute real change for at-risk cost, and utilization data, or through referrals from patients. The model, which focuses on health, social, and network providers. Additionally, the team connects economic needs, allows MHP care coordinators to identify with patients via transitions of care (TOC). The team is patients who are at-risk and connect them to community telephonically based, and TOC follow up calls typically partners who are able to address the need. The identified occur within 24-48 hours of the patient’s discharge from risk factors, or pathways (e.g. housing, education, behavioral the hospital (both inpatient and emergency room). These health, etc.) are addressed and tracked, and eventually the calls focus on making sure the patient understands their pathways are “closed,” resulting in improved outcomes, care plan and has the support and resources needed lower costs and fewer health disparities. to implement it. The care coordination team reviews Community Care Plan Housing Financial Transportation Legal Behavioral Health 22 MISSION HEALTH PARTNERS

Care Coordination Target Populations Transitions of Care Referrals At Risk • Emergency Department • PCPs • Claims (utilization, diagnoses, cost) • Inpatient Stay • Specialists • No PCP • Skilled Nursing Facility • Hospital Staff • Renal, COPD, CHF • Home Health • Behavioral Health • Community Agencies • COPD + Pneumonia • Hospital & ED high utilizers Once patients are connected to the MHP Care Coordination team, they undergo a comprehensive initial assessment to identify open pathways. cation Conn • Disease Processes • Food • Medications • Housing • Diet • Bills • Self-Care Plan • Transportation ection Coordi Edu unication • PCP Visits • Providers • Medication Access • Community • Insurance Issues Resources nation • Inpatient Staff • Other Care Managers Comm 2018 VALUE REPORT 23

OUR WORK: TARGETING SOCIAL DETERMINANTS MHP Care Coordination: Interventions and Clients Served 2017 The following graph represents the number of unique patient interventions and clients served by the MHP care coordination team.  An intervention can include (but is not limited to) a phone call, home visit, team conference or provider communication. 4500 4000 3500 3000 2500 2000 1500 1000 500 0 Jan Feb Mar Apr May June July Aug Sep Oct Nov Dec 1139 2574 3146 3118 3870 3200 3154 3717 4116 3590 3556 3291 Interventions 332 751 850 725 793 762 727 894 918 985 1044 1067 Clients Served 24 MISSION HEALTH PARTNERS

OUR WORK: TARGETING SOCIAL DETERMINANTS Community Partners MAP Medical Assistance Program CaraMedics Community Paramedics 2018 VALUE REPORT 25

OUR WORK: TARGETING SOCIAL DETERMINANTS Care Coordination Success Story: How One Patient Partnered with MHP to Take Control of Her Health Creating a Powerful Support System The Mission Health Partners care coordination team is just that – a team. In addition to collaborating with our community partners to address the needs of our patients, the MHP clinical team – comprised of RN care coordinators, pharmacy technicians, clinical pharmacists, LCSWs, a community resource specialist and community paramedics – often shares the responsibility of caring for a single patient, each tapping into their own experience and knowledge to create a unique powerful support system. Addressing Social Isolation MHP Pharmacy Tech Jenn Sutton sharing a laugh with M.F. M.F. is 53 years old. She is socially isolated, living in a did significant work addressing her social needs. Jenn mobile home tucked a tree-lined valley in rural Madison Sutton, an MHP Pharmacy Technician, arranged for free County, with very little family support. M.F. was introduced pest control when M.F. was struggling through a flea to the MHP care coordination team through a transitions infestation, and worked with a local auto shop to get of care (TOC) call following a visit to the emergency room her tires replaced at no cost. The relationships that M.F. for advanced COPD and anxiety. Her involvement began has developed with the MHP team have been incredibly with Priscilla Belanger, an RN care coordinator who meaningful to her. As M.F. puts it, “They’ve got my back.” developed a telephonic relationship with M.F., providing much-needed social interaction and clinical guidance. A Big Win! After months spent working with M.F., Priscilla determined that she could benefit from seeing other members of the Between July 2015 and July 2017, M.F. was seen in the MHP team. Soon, M.F. was being seen regularly by Tucker Emergency Room eighteen times for issues related to her Forlines, an MHP “Caramedic” (Community Paramedic) advanced COPD and anxiety. After beginning her work and Katelyn Owensby, a Clinical Pharmacist. with Katelyn and Tucker in July 2017, she has only been seen in the Emergency Room once. This is a huge win, as Before and After: The MHP Team’s Huge Impact M.F. has learned strategies to take control of her health. on Quality of Life With some guidance on who to reach out to for both clinical and social needs, and advice on what to request, The difference in M.F.’s life after becoming involved with M.F. feels empowered to do the things for herself that the MHP team was significant. Katelyn performed a used to cause her anxiety. comprehensive review of her medications, and coordinated with M.F.’s physicians, adjusting her medication and MHP’s work with M.F. is ongoing, and her stability – both working with her on medication adherence. Tucker helped clinically and socially – continues to fluctuate. However, her with smoking cessation and her smoking decreased the impact that the team has had on her life is significant, considerably – at his suggestion, she even began going and M.F. is a great example of the ways in which a through the motions of “smoking” with toothpicks, since collaborative effort can make a real difference in the life of so much of her habit was based on the physical motions a high-risk patient. associated with smoking. While much of the work surrounding M.F. was clinical – for example, getting her medications in order and connecting her with Palliative Care – the MHP team also 26 MISSION HEALTH PARTNERS

OUR WORK: TARGETING SOCIAL DETERMINANTS Combating the Effects of Poverty in Western North Carolina Mission Health Partners has led the charge on assessing The Forgotten Epidemic and addressing social determinants in western North Carolina, working with providers and organizations MHP recently partnered with the Mission Children’s within to community to develop concrete strategies Hospital to host a CME event, “Poverty: The Forgotten to address social issues that have a serious impact on Epidemic.” health outcomes for patients, including but not limited to housing, food insecurity and transportation. In addition to the importance of understanding the utility of addressing select social determinant needs, a more fundamental provider understanding of poverty can enhance the patient provider relationship. The event was attended by regional and pediatric and family medicine providers, and focused on the prevalence of poverty in western North Carolina, as well as the effect that poverty can have on child health and daily life. Additionally, the event presented an opportunity to review state and regional efforts to mitigate the effects of poverty on health outcomes. On a local level, MHP’s strategic initiatives surrounding poverty and, in particular, food insecurity have had some significant successes. Food insecurity affects 1 in 5 to 1 in 3 households in western North Carolina (with variations by county). Food insecurity undermines a patient’s ability to care for their chronic conditions and imposes avoidable stress on all affected families. YMCA’s Mobile Kitchen Collaborating with Community Partners to YMCA’s Distribution Center Address Food Insecurity In 2016, six Mission Health Partners practices partnered with MANNA Food Bank and the YCMA on a food insecurity screening pilot. The pilot supported food insecure families with food stamp application help from MANNA Food Bank, and get access to nutritious food stores through the YMCA’s Mobile Kitchen. The pilot saw an overwhelming demand for fresh, nutritious foods and the YMCA Mobile Kitchen’s distribution volume saw such substantial growth that they needed to build a new distribution center. The 2,000-square-foot space, which opened in July of 2018, serves as home base for the YMCA’s three mobile units. These food markets are free and open to the public at dozens of strategic locations each week, no questions asked. This center was funded in part by personal donations from Mission Health Partners providers. Each month the center distributes more than 16,000 pounds of fresh produce and serve more than 1,200 households across five counties in western North Carolina. 2018 VALUE REPORT 27

OUR WORK: TARGETING SOCIAL DETERMINANTS Community Partner Spotlight: Haywood Street Respite and Downtown Welcome Table The Mission Health Partners care coordination strategy centers around the understanding that the social issues in a patient’s life can have a very serious effect on their ability to get and stay healthy. The homeless population is especially at risk, and the MHP team has partnered with the Haywood Street Respite and Downtown Welcome Table to provide additional resources to this vulnerable population. Haywood Street Respite, located in downtown Asheville, MHP Care Coordinator Deb Beck (far left) checks a patient’s North Carolina, provides a safe place for homeless adults blood pressure at the Downtown Welcome Table. to rest, get three meals a day, and be helped in other ways to “get back on their feet” following discharge from The Mission Health the hospital. It is short-term care in a home-like setting Partners care coordination for patients who are too ill or frail to recover on the streets strategy centers around after surgery or acute illness. The Downtown Welcome the understanding that the Table provides lunch and dinner for homeless and food social issues in a patient’s insecure individuals. The meals are served family style life can have a very serious by an attentive wait staff with cloth napkins, flowers effect on their ability to get on the table and china plates. The Welcome Table is a and stay healthy. communal gathering place, where people can connect and develop friendships. These social interactions can be hugely life-affirming to some, as social isolation can have a significant effect on overall health and wellbeing. The environment at the Welcome Table is meant to counter the notion often held by those living on the streets that handouts and leftovers are all that they deserve. Mission Health Partners has a presence at Haywood Street that allows the clinical team to provide guidance and support to this population. They provide education surrounding blood pressure awareness, nutrition and help navigating the resources that may be available. These conversations often lead to the patient receiving help with housing, medications and finding a doctor. Michelle Bedard, an LCSW on the MHP team, works closely with the director of the Haywood Street Respite, following up on the patients there to help with additional services that they may need. This proactive approach is one way that intervention can occur prior to a health issue becoming catastrophic because of healthcare access issues. 28 MISSION HEALTH PARTNERS

Mission Health Partners’ focus on social determinants — the socioeconomic issues that can have a significant effect on patients’ health — has proven to be incredibly effective in terms of both clinical outcomes and cost savings. 2018 VALUE REPORT 29

CLINICAL INITIATIVES Skilled Nursing Facilities – An Important Piece of the Population Health Puzzle Skilled nursing facilities (SNFs) care for many of our In 2018, Mission Health Partners began building a skilled sickest and highest risk patients. The care provided in nursing facility network to address post-acute clinical this setting is critical to further stabilizing patients after a outcomes, including hospital readmissions. Currently the hospitalization and helping them to regain their optimal network includes 20 skilled nursing facilities that receive level of functioning. The monetary spend on post-acute 55% of Mission Hospital total SNF referrals. As patients services often represents a disproportionate share of admitted into skilled nursing facilities post discharge are total care costs. As a network, our goal is to work towards at higher risk of readmission – MHP has partnered with appropriate utilization of healthcare resources, and Mission Health System to strategically address this risk. creating a network focused on the efficient use of skilled nursing facilities coupled with patient driven transitional care coordination are critical to improving outcomes and reducing unnecessary costs. GOAL 1 GOAL 2 GOAL 3 Decrease hospital Support transitions Identify social/ readmissions from hospital to medical barriers to SNF and SNF to patient’s wellbeing home after discharge MHP Strategies • Network SNFs have a Transitions Care Manager (TCM) assigned to their facility • The TCMs get a daily report of all the high risk patients discharged from Mission Health to the SNF • TCM’s follow and collaborate with the SNF staff to support the needs of these patients 30 MISSION HEALTH PARTNERS

CLINICAL INITIATIVES Advance Care Planning Workshops Advance care planning (ACP) – the process by which a MHP hopes to scale up this type of partnership across patient makes decisions about the care they want to western North Carolina to honor patient wishes and receive if they are unable to speak for themselves – is empower them to approach the end of life on their own well aligned with MHP’s vision for “empowering patients terms. to maximize their well-being.” The ultimate goal of the process is to help patients and families navigate end of UNCA Osher Lifelong Learning life decisions proactively, well in advance of a medical Institute ACP Workshops crisis. Advance care planning is a challenging process, with many obstacles ranging from difficult conversations to the 20 workshops since 2011 appropriate completion of forms and accessibility of the forms when necessary. (occurring every 4 months) MHP and Mission Health System’s IT department have 380 total attendance partnered with the UNCA Osher Lifelong Learning 375 notarized forms Institute’s quarterly Advance Care Planning Workshop to facilitate the electronic storage of the NC ACP “Short Forms.” Once stored, these documents can be easily accessed by hospital staff as appropriate. Additionally, MHP is developing informatics solutions to make those documented decisions readily accessible within the network as needed. 2018 VALUE REPORT 31

CLINICAL INITIATIVES Chronic Condition Management The MyHealthyLife™ Chronic Condition Management MyHealthyLife™ Chronic Condition Management Program is delivered by the Mission Health Partners provides the services above for employees and clinical team. The program offers education, flexible dependents of Mission Health, Healthy State insurance scheduling and innovative programming support for products and several external employers. participants with the following conditions: Taking Control of Type 2 (TCT2), a collaborative • Asthma program between MyHealthyLife™ Chronic Condition Management and the YMCA of Western North Carolina, • Cardiovascular Conditions (including high blood has been effective for individuals with type 2 diabetes. pressure and high cholesterol) The year-long program provides comprehensive diabetes education in a group setting at local YMCA branches. • Chronic Obstructive Pulmonary Disease Participation includes a YMCA family membership along with the benefits included in the MyHealthyLife™ • Depression Chronic Condition Management program. • Diabetes and pre-diabetes Participants who began the TCT2 program in June 2016 have realized improvements in self-management of • Long-term warfarin (Coumadin) therapy diabetes and in their overall health. Hemoglobin A1c and BMI for these participants have continued a sustained Program benefits include: downward trend at 24 months. • $0 co-pay on most disease-related medications • Personalized health coaching and support • Lab work to monitor your conditions • Partnerships with Mission Diabetes Center and the YMCA of Western North Carolina • Education 1:1 and through an online format consistent with behavior change science and shared decision making support MyHealthyLife Chronic Condition Management Diabetes Outcomes Hemoglobin A1c Distribution Rate of Poor Diabetes Control (A1c > 9% – ACO27) 11.2% 25 < 7% 48.7% 20 > 7% -8.9% > 9% 40.1% 15 10 Mission Medical National GPRO Associates data (2017) 5 0 MHL Disease Management 32 MISSION HEALTH PARTNERS

CLINICAL INITIATIVES The following graphs illustrate the success of Taking Control of Type 2 (TCT2), a collaborative program between MyHealthyLife™ Chronic Condition Management and YMCA of western North Carolina. TCT2 A1c Trend 7.2 7.15 7.18 7.1 70.5 7 7.03 7 6.95 24 Month 6.9 6.85 Initial 12 Month TCT2 BMI Trend 37.5 37 37 36.5 36 36.1 35.5 35.7 35 34.5 Initial 12 Month BMI 24 Month BMI Asthma Program Average ACT 22.3 ACT > 20 86% ACT < 19 14% 2018 VALUE REPORT 33

OUR TEAM Mission Health Partners Board of Directors Letter from the Chairman Brian Moore, MD North Buncombe Family Medicine I recently spent a few days in New York City with my friend Dr. Rob Fields, who was instrumental in getting Mission Health Partners off the ground. While enjoying the sites and tastes of the city we had time to reflect on our years together in Asheville. We discussed Mission Health Partners and all the good work and accomplishments of our network. From our beginning – when nothing was certain – to today being one of the largest and most successful Clinically Integrated Networks in the country, it has been an inspiring journey.  At the end of this year I will be yielding to new leadership on or Board of Directors and I feel both pride in our accomplishments and an excitement for the challenges that lie ahead. I’d like to thank you all for the opportunity to serve the last four years. I’ve worked with wonderful people who have accomplished even more than I had optimistically hoped or planned. It has been my great pleasure to work with you all.  Sincerely, Brian Moore, M.D. Chairman, Mission Health Partners Board of Directors 34 MISSION HEALTH PARTNERS

OUR TEAM Brian Moore, MD Jeff Heck, MD John R. Ball, MD, JD Alan Baumgarten, MD Elizabeth Buys, MD Class I Voting Director/ Class I Voting Director/ Class II Voting Director Class I Voting Director Class I Voting Director Chair Vice Chair Medicare Beneficiary The Family Health Mountain Area Health North Buncombe Mountain Area Health Representative Centers Education Center Family Medicine Education Center David Franklin, MD John W. Garrett, MD Jill Hoggard Green Mark Gwynne, MD William Hathaway, MD Class II Voting Director Class II Voting Director Class II Voting Director Class II Voting Director Class II Voting Director Mission Health System Retired, Mission Health Mission Health System Henderson County Mission Health System System Hospital Corporation (Pardee Hospital) Kenneth Kubitschek, MD Scott Love, MD Danielle Mahaffey, MD Marc Malloy Susan Mims, MD Class I Voting Director Class I Voting Director Class I Voting Director Class II Voting Director Class II Voting Director Carolina Internal ABC Pediatrics of Appalachian Regional Mission Health System Mission Health System Medicine Asheville Healthcare System Jeffrey Moreadith, MD Nunzio Pagano, MD Amy Russell, MD Calvin Tomkins, MD Mike Weizman, MD Class I Voting Director Class I Voting Director Class I Voting Director Class I Voting Director Class I Voting Director Asheville Hospital Group Asheville Internal Mission Health System Asheville Pediatric Our Family Doctor Medicine Associates 2018 VALUE REPORT 35

OUR TEAM MHP Staff Operations Team Amanda Gerlach, JD, Amy Russell, MD, Jean Veilleux, JD Calvin Tomkins, MD, MPA, Executive Director Medical Director General Counsel MHA, Assistant Medical Director Angela Bailey Kelly Terry Brittany Kiteley Michelle Kenny Director of CIN Provider Relations Provider Relations Regulatory Operations Representative Representative Administrative Specialist (Primary Care) (Specialists) Ryan Maccubbin, MBA, DeForrest Hipps Samuel Brady Abigail Clarkson Senior Data Analyst Data Architect Data Coordinator Executive Assistant 36 MISSION HEALTH PARTNERS

OUR TEAM Clinical Team Katie Bartholomew, RN, Deb Beck, Rn, ACM Priscilla Belanger, RN, Anna Carter, RN CCM, Manager of Clinical Care Coordinator Care Coordinator Care Coordinator Operations Susan Hester, RN, CCM Ellen Reker, RN, MSN Lisa Swaim, RN, CCM Katelyn Owensby, PharmD Care Coordinator Care Coordinator Care Coordinator Clinical Pharmacist Anna Eldreth, CPHT Jenn Sutton, CPHT Not pictured: Pharmacy Tech Pharmacy Tech Erin Cox, LCSW Clinical Social Worker Kim Nazworth, LCSW, Clinical Social Worker Michele Bedard, LCSW Emergency Department Liaison Lindy Desmarais Community Resource Specialist 2018 VALUE REPORT 37

OUR TEAM MHP Staff Chronic Condition Management Kathryn Higdon, BSN, RD Wendy Billingsley, SCSW Lou Hipps, RN Andrea Yontz, RN Manager, MyHealthyLife CDE, Chronic Condition Chronic Condition Chronic Condition Chronic Condition Manager Manager Manager Management Program Carole Ramsey, CHC Patricia Riddle Timothy Daly, PharmD Population Health Chronic Condition Clinical Pharmacist Coach Coordinator CaraMedics Tucker Forlines, A.A.S, Randy Fugate, A.A.S, Christian Bracket, CP-C, NRP. CP-C, CCEMTP, NRP. CP-C, CCEMTP, CCEMTP PNCCT  PNCCT  38 MISSION HEALTH PARTNERS

2018 Mission Health Partners Network 2018 MISSION HEALTH PARTNERS NETWORK Hospitals Mission Community Primary Care - Highlands Mission Community Primary Care - Spruce Pine Angel Medical Center Mission Family and Internal Medicine Blue Ridge Regional Hospital Mission Family Medicine - Weaverville Charles A. Cannon Jr. Memorial Hospital Mission My Care Plus - Candler Highlands Cashiers Hospital Mountain Docs Family Medicine McDowell Hospital Murphy Group Practice Mission Hospital Nebo Family Medicine Murphy Medical Center North Buncombe Family Medicine Pardee Hospital Old Fort Community Medicine Transylvania Regional Hospital Our Family Doctor Watauga Medical Center Pardee Adult and Family Medicine Pardee Family Medicine - Etowah Family Practice and Internal Medicine Pardee Family Medicine - Fletcher Pardee Family Medicine - Merrell Allan Dale Nash, MD Pardee Family Medicine - Mills River Andrews Internal Medicine Pardee Internal Medicine Associates Angel Medical Center-Angel OB/GYN & Family Park Hill Medicine Angel Primary Care Stewart Trimble, MD Appalachian Mountain Community Health Centers Sylva Family Practice Appalachian Regional Internal Medicine Specialists The Family Health Centers Asheville Family Medicine Toxaway Health Center Asheville Internal Medicine Trillium Family Medicine Asheville Medicine & Pediatrics Vickery Family Medicine Bakersville Community Medical Clinic Vista Family Health Brevard Family Practice Wellspring Family Practice Brie Folkner, MD WNC Internal Medicine Cannon Family Health WNCCHS Carolina Internal Medicine Associates Celo Health Center Pediatrics Chad Smoker, MD Charles E. Baker Jr. MD Center for Primary Care ABC Pediatrics Chatuge Family Practice Angel Pediatrics Community Family Practice Asheville Children’s Medical Center Country Clinic Asheville Pediatric Associates Davant Medical Clinic Blue Sky Pediatrics Dry Ridge Family Medicine French Broad Pediatric Associates East Asheville Family Health Care Haywood Pediatric & Adolescent Medicine Group Elk River Medical Associates Hendersonville Pediatrics Glenwood Family Medicine KidzCare Pediatrics Haywood Family Medicine McDowell Pediatrics Hazelwood Family Medicine Mission Children’s - Bryson City J. Scott Baker Mountain Area Pediatric Associates James J. Caserio, MD Krishna Internal Medicine Acupuncture MAHEC Family Health Center at Biltmore MAHEC Family Health Center at Cane Creek Chinese Acupuncture & Herbology Clinic  MAHEC Family Health Center at Enka/Candler Mission Wellness Center MAHEC Family Health Center at Lake Lure MAHEC Family Health Center at Newbridge Allergy McDowell Internal Medicine Medical Associates of Transylvania Allergy Partners Mission Blue Ridge Medical Center - Yancey Mission Community Primary Care - Burke Anesthesiology Mission Community Primary Care - Cashiers AllCare Clinical Associates Mission Community Anesthesiology Specialists 2018 VALUE REPORT 39

2018 MISSION HEALTH PARTNERS NETWORK Behavioral Medicine Genetics Charles A. Canon Jr. Memorial Hospital Behavioral Health Mission Fullerton Genetics Center Mission Children’s Hospital Olson Huff Center for Child Development Mission Psychiatry Geriatrics October Road, Inc. The Pisgah Institute MemoryCare Watauga Medical Center, Inc. Behavioral Health Infectious Disease Cardiology Mission Infectious Disease Associates Asheville Cardiology Associates Pardee Cardiovascular Services Neonatology Watauga Medical Center, Inc. The Cardiology Center Mission Children’s Hospital Neonatology Chiropractic Nephrology Arpin Chiropractic Back in Balance Mountain Kidney & Hypertension Associates Brevard Chiropractic Center Fairview Chiropractic Center Neurology GreenHands Healing Center Kordonowy Chiropractic Center Mission Neurology Laurel Park Chiropractic Center Pardee Neurology Associates Lawson Chiropractic Mars Hill Chiropractic Center OB/GYN McDowell Chiropractic Merrimon Family Chiropractic Asheville Gynecology & Wellness Vicky M. Scott, DO Phillips Family Chiropractic Asheville Women’s Medical Center River Ridge Chiropractic Biltmore OB/GYN Associates Harmony Center for Women’s Health and Vitality Dermatology Laurel OB/GYN MAHEC OB/GYN Forest Dermatology McDowell OB/GYN Mission Community OB/GYN Emergency/Urgent Care/Walk-in Clinics Mission Women’s Care Murphy Medical Center OB/GYN Angel Urgent Care Pardee Center for Gynecology Carolina Mountain Emergency Medicine Pardee OB/GYN Associates McDowell Urgent Care Rutherford OB/GYN Mission My Care Now Transylvania Women’s Care Western Carolina Women’s Specialty Center Endocrinology Oncology Asheville Endocrinology Consultants Mission Children’s Hospital Pediatric Endocrinology 21st Century Oncology Mountain Diabetes & Endocrine Center Asheville Hematology & Oncology Pardee Diabetes and Endocrine Associates Cancer Care of Western North Carolina Hendersonville Hematology and Oncology at Pardee ENT/Audiology Hope Women’s Cancer Center Mission Children’s Hospital Pediatric Hematology/Oncology WNC Ear, Nose, Throat, Head & Neck Surgeons Mission SECU Cancer Center Mountain Radiation Oncology Gastroenterology New Horizons Women’s Cancer Center Radiation Therapy Associates of WNC Appalachian Gastroenterology Wayne Radiation Oncology Asheville Gastroenterology Associates – Digestive Health Partners Carolina Mountain Gastroenterology and Endoscopy – Digestive Health Partners Digestive Health Partners Endoscopy Center of North Carolina 40 MISSION HEALTH PARTNERS

Opthalmology 2018 MISSION HEALTH PARTNERS NETWORK Asheville Eye Associates Skilled Nursing Facilities Brosnan Eye Associates Carolina Ophthalmology Aston Park Primary Eye Care Associates Autumn Care of Waynesville Steven L. Cahan, MD, PA Autumn Care of Marion Autumn Care of Drexel Orthopedics Autumn Care of Saluda CarePartners PACE Angel Orthopedics Eckerd Living Center Asheville Orthopedic Associates Givens Highland Farms Brevard Orthopedics Givens Estates LLC Carolina Hand & Sports Medicine Pisgah Manor Charles J. DePaolo, MD, PA Pisgah Valley Rehab Hendersonville Orthopedics at Pardee StoneCreek McDowell Orthopedics The Brian Center Health & Rehabilitation Center - Hendersonville Mission Children’s Hospital Pediatric Orthopedics The Brian Center Health & Rehabilitation Center - Spruce Pine Mission Community Orthopedics & Sports Medicine The Brian Center Health & Rehabilitation Center - Weaverville Murphy Medical Center - Orthopedics The Laurels of Greentree Ridge Southeastern Sports Medicine The Laurels of Hendersonville The Laurels of Summit Ridge Pain Management The Lodge at Mills River Transylvania Regional Hospital Skilled Nursing Facility Mission Community Pain Management Surgery Palliative Care Angel Surgical Associates Mission Palliative Care Appalachian Regional Orthopaedic & Sports Medicine Center Blue Mountain Surgery Pathology Carolina Spine and Neurosurgery Center Carolina Vascular Mountain Area Pathology, PA McDowell Surgical Services Pathologist’s Medical Laboratory Mission Surgery Mission Surgical Services - Burke Plastic Surgery Pardee Surgical Associates Tate Clinic Asheville Plastic Surgery James M. McDonough, MD Eric Halvorson, MD, PA Urology Plastic Surgery of Asheville Asheville Urological Associates Podiatry Boone Urology Center Mission Urology Appalachian Foot & Ankle Associates Mission Urology - Burke Asheville Podiatry Associates Murphy Medical Center - Urology Moore Foot & Ankle Specialists, PA Pardee Urological Associates Pisgah Urology Pulmonology Weight Management/Coaching Asheville Pulmonary & Critical Care Associates Mission Children’s Hospital Pediatric Pulmonology Mission Weight Management Radiology Wound Care Asheville Radiology Associates Mission Wound Healing & Hyperbaric Center Watauga Medical Center, Inc. ARHS Wound Care Center Rheumatology Asheville Arthritis and Osteoporosis Center Rheumatology at Pardee 2018 VALUE REPORT 41

1940 Hendersonville Road Asheville, NC 28803 828-213-3250 missionhealthpartners.org