CEO 6 Month Report

MAINE MADE US CONNECTED

CEO Six-Month P ROGR E S S R E PORT

October, 2020

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INTRODUCTION

Northern Light Health will be a national leader in healthcare excellence. Here’s how we are getting there...

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To the Northern Light Health Board of Directors, employees, and members of our community When I was selected as president and CEO of Northern Light Health in April, our health delivery system, like many across the nation, was facing one of the most historic medical challenges of our modern time. Although COVID-19 brought incredible challenges, it also reaffirmed the resiliency, compassion, and strength of Mainers—especially those on the Northern Light Health team. While this global pandemic captured our attention (and will continue to do so for the foreseeable future), we remain committed to our vision to be a national leader in healthcare excellence. At the beginning of my tenure, I outlined a recipe for success in achieving this vision with 12 key components, which you can find at the end of this report. We have already realized exceptional progress in areas such as telehealth, access, population health, and quality while also fostering a culture of caring that will set Northern Light Health apart as a proactive leader in protecting and promoting the rights and equality of all. This progress report captures in brief the enormous amount of work that in the past six months was completed, underway, or ready to launch. I am so impressed with the work your Northern Light Health team does to care for the people of Maine every day. I hope you will be too.

Tim Dentry President & CEO

COVID RESPONSE AND RECOVERY

We have pulled from our collective strengths and risen together to fight the COVID-19 pandemic and continue to safely provide access to care across Maine.

A LOOK BACK • As of August, new cases of COVID-19 were down by 58%; there was one positive case under our care in August. In total, the lives of 13 people who were COVID-19 positive were lost while under our care. • Swab and Go sites were quickly set up in response to Maine’s standing order to expand testing beyond symptomatic individuals. • Supply chain continued working miracles in securing critical supplies and finding new sources in Maine and elsewhere. • In April, we began planning for post-acute COVID-19. The Patient Access to Healthcare Safely program guided member organizations with phased return to service considering realities of each region. • Throughout the summer, Northern Light Health hosted a successful weekly Back to Business forum on Zoom to help leaders of businesses and other organizations reopen safely. • We continued to work with Maine DHHS Commissioner Jeanne Lambrew and other hospitals and health systems to ensure consistency in safety and recovery.

James Jarvis, MD, Senior Physician Executive for Northern Light Health’s COVID-19 Incident Command response, hosts a virtual media press briefing in June. The briefings were live-streamed weekly on social media beginning in April, 2020.

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MOVING FORWARD • Build upon our excellent response and continue development of an adaptable and sustainable Safe Recovery plan. • Continue to improve the care of our communities through new technologies and innovative delivery systems developed in response to COVID-19. • Prepare to administer vaccines for both COVID-19 and Influenza as conveniently and accessibly as possible. • Strengthen Supply Chain contracts to ensure adequate quantity of critical supplies.

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We strive to ensure all Mainers are easily able to receive care when and where they need it regardless of their ability to pay.

GREATER ACCESS

A LOOK BACK • Today’s U.S. shortage of 14,000 primary care physicians is projected to soar to more than 55,000 by 2032. In anticipation of this shortage and competition for scarce resources, we are working with physician leaders to redesign

primary care and develop a primary care strategic plan.

• Telehealth has been a focus in our efforts to provide greater access. Please see more on telehealth in the next section of this report.

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MOVING FORWARD We will further our work toward Northern Light Primary Care to provide user-friendly access. This will include: • Adopting proven best practices for customer experience. • More consistent contact with patients to grow familiarity between provider and individual. • Improved service delivery in assisting patients in the next steps of their care, making the experience easy and simple. • Development of a customer-friendly solution for walk-in-care and same day appointments. • Further development of primary care expertise in population health management. • Development of a universally recommended, effective, and efficient staffing model.

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Northern Light telehealth is creating greater access to care, enhancing provider-patient relationships, and coordinating care among providers.

TELEHEALTH

A LOOK BACK • Before COVID-19, we had more than a dozen telehealth services accounting for about 1% of patient volume. During the peak of the pandemic, our telehealth volume increased to 43%. • In Q1, there were 3,238 telehealth visits throughout the system. By Q3 visits had skyrocketed to 86,787. • In August, we launched around the clock telestroke access at six of our hospitals:

1. CA Dean Hospital 2. Blue Hill Hospital 3. Maine Coast Hospital 4. AR Gould Hospital 5. Inland Hospital 6. Sebasticook Valley Hospital

Northern Light Eastern Maine Medical Center provides telestroke coverage weekdays while our partners at Massachusetts General Hospital covers nights and weekends.

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MOVING FORWARD • Strengthen the telehealth platform and ability of providers to use telehealth in a clinically effective and customer- friendly manner. • Provide regular progress reports (next report expected in December).

Northern Light Health will strengthen the telehealth platform and ability of providers to use telehealth in a clinically effective and customer-friendly manner.

2020 SystemTelehealth Visits

Telehealth Type - All

2020 SystemTelehealth Visits

Telehealth Type - All

100,000

Desktop Computer

Mobile Device

100,000

Desktop Computer

Mobile Device

86,787

86,787

80,000

80,000

14.45%

14.45%

60,000

60,000

40,000

Vi si ts

40,000

Vi si ts

85.55%

85.55%

20,000

9,489

20,000

9,489

3,23

3,238

-

Q1

Q2

Q3

-

Q1

Q2

Q3

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Northern Light Health has reaffirmed its steadfast commitment to quality and is making strides in performance improvement.

QUALITY

A LOOK BACK • Created a multi-disciplinary Quality Planning Council with members from throughout the system. • Added a quality key performance indicator to our annual system goals to ensure a low-risk infection environment. As part of this work we track COVID-19 testing for all hospital admissions. • Quality Intelligence advancements have also been made to: - Expand support to member organizations to include preparation for the Condition of Participation/Joint Commission surveys (these surveys are required as part of our Medicare participation.) - Develop a workplan to ensure maximum earning of quality incentive payments – strong collaboration with delivery system - Initiate onboarding with practices affiliated with Jackson Laboratory and our newest member, Northern Light Mayo Hospital - Develop a new dynamic, patient-centric tool using Cerner’s HealtheIntent platform – initiate pilot, create scorecard - Encourage expansion of quality metrics and dashboards to include performance by demographic - race, ethnicity, and language

- Develop systemwide quality education, including quality programs and reporting, hierarchical condition categories, and performance improvement

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MOVING FORWARD Examine performance data, highlight challenges and successes, implement best practices, and hold members accountable (90-day follow-up) • Implement our performance dashboard by demographic – race, ethnicity, and language. • Publish new dashboards, including women’s health and cardiovascular. • Create a new provider dashboard by combining quality and business metrics. • Establish performance tracking of new Massachusetts General and Northern Light Health tele-stroke partnership. • Explore additional quality incentive programs – Optum and WellCare. • Refine provider attribution.

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Through evidence-based medicine and data analytics, we continue to enhance the care we provide to Maine people.

POPULATION HEALTH

A LOOK BACK • Safely reengaged patients’ preventive care despite the COVID-19 pandemic, including annual wellness visits, screenings, and well-child/vaccination.

- Participated in Maine CDC programs to maintain and recover any missed pediatric vaccinations from the early days of COVID-19

• Began a systemwide population health data analytics platform, HealtheIntent, combining healthcare claims and electronic medical record data. HealtheIntent includes three subsections: HealtheRegistries, HealtheAnalytics, and HealtheCare. Through this platform, we can: - Develop multiple disease and wellness registries - View cost and utilization of Medicare and MaineCare population - Further refine care management through HealtheCare to assist with patients who are: • High utilization • Complex with high disease burden, multiple medications, and/or social needs • Needing transitions of care from inpatient to home • Northern Light Beacon Health continued development of new care standards with multiple electronic medical record-based disease management protocols, preventive screenings, and referral standards. • Coordinated with blood bank/blood management on reaching out to COVID-19 positive patients on plasma donation opportunities.

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MOVING FORWARD • As part of our population health work, we will focus on: - Expansion of ambulatory clinical pathways for harmonized care across primary care (e.g. hypertension, disease screening programs) - Growth of the primary care prevention program with nurse-run annual wellness visits (growth beyond pre-COVID-19 baseline) - Expand Social Determinants of Health screening in conjunction with system team • As part of our care management work, we will focus on: - Evolve the COVID-19 triage program into a sustainable model for the system - Assessment and optimization of HealtheCare use and data analytics

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At Northern Light Health, we firmly believe in a culture of caring—an inclusive culture that cares for all regardless of race, gender, sexual orientation, or religious preferences.

CULTURE OF CARING

A LOOK BACK • To keep a pulse on current activities and address concerns, the president and CEO has regularly attended department and provider team meetings either in-person or by Zoom. • In May, we began our Friday Reflection to provide thoughtful and supportive messages to all employees. The weekly emails have been well received. • We made strides toward understanding, respecting, and strengthening our culture of caring. The efforts below mark only the start of this important work: - Created a Diversity, Inclusion, and Equality Council with members from across the system who help guide social and medical justice initiatives. This council met for the first time August 18. - Since June, at least one Friday Reflection message a month has focused on a topic related to social and/or medical justice. - Senior leaders have conducted Zoom dialog/listening sessions with colleagues as a first step in learning about the varied experiences of people who work within Northern Light Health. By mid-August, we held 43 listening sessions with 475 participants.

- In July, we launched the Tim Talk podcast series to open hearts and minds to diversity, and discuss issues of social and medical justice: www.northernlight.org/podcast

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MOVING FORWARD Identify as many explicit and implicit biases within Northern Light Health as we can by this time next year; embrace and promote ideals that create a system where social and medical justice drives our contributions to society and defines how we make healthcare work for the people we serve. • Prepare quarterly reports for review by the Diversity, Inclusion, and Equality Council, our boards, our employees, and our communities. • Results from our employee survey will help direct the work that will help us reach our goal. • Episodes of Tim Talk podcast will focus on topics surrounding diversity, inclusion, and social and medical justice.

Tim Talk Podcast Data from three episodes in July, 2020 Total Downloads/ Plays/Listens 1,825

Total Unique Pageviews on Website 2,676 Average Completion 57%

Sources of Consumption Google Podcasts 12%

Spotify Apple Podcasts

1% 4%

Website

82%

Other

1%

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Northern Light Health is a strong, united voice for our communities. We continue to advocate in the best interest of Mainers by proactively remaining on the forefront of state and national policy decisions.

COMMUNITY AND STATE LEADERSHIP

A LOOK BACK • Supplied weekly information on COVID-19 response and recovery to local, state, and federal lawmakers; and focused on congressional COVID-19 legislation. • Met weekly with Maine DHHS, the Governor’s office, Maine Hospital Association, and MaineHealth to advance solutions to challenges with COVID-19 related policy issues. • Participated in calls with the American Hospital Association and Government Relations Officers on COVID-19 and other federal policy priorities. • Facilitated multiple discussions with American Hospital Association policy experts on transitioning telehealth waivers into permanent Medicare policy. • Joined many Maine companies to help pass the Yes on 1 referendum to approve a $15M investment to advance broadband infrastructure.

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MOVING FORWARD • We wait to hear more on the next package of COVID-19 federal relief funding and are focused on changing repayment terms for Medicare Advanced/Accelerated Payment Program liability. • We are hopeful Medicare telehealth waivers, which were instituted during the pandemic, will become permanent Medicare policy.

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Despite the challenges of the COVID-19 pandemic, Northern Light Health remains financially strong and ready to care for our Maine communities well into the future.

FINANCIAL STABILITY

A LOOK BACK • Secured a $150M line of credit.

Supply Chain • The Group Purchasing Organization conversion was completed. Initial impact on pricing saving is estimated to be $10M annually. • Executed the first phase of “Plant and Clinical Equipment Obsolescence” Capital Plan. Revenue Cycle • Reduced debit balances more than 90 days old by $29M since January 2020. • Reduced all credit balances by $4.3M since March 2020. • Increased daily average cash collected by $1.3M since May 2020. • Productivity increased by 58% since April 2020. • Quality remains above our 90% target with an average of 93% since January 2020.

• Received $88.1M from the Cares Act to support care delivery during COVID-19. In addition, we continue to pursue funding from other sources (e.g. FEMA). • Received $176.5M of Medicare Advances that will be recouped by Medicare over the next eight to 17 months. • Recovery plans project to bring us to an operating cash flow break-even by the year end. • Received more than $3M from the State of Maine for COVID-19. • Patient revenue continued to increase since April, beating recovery plan estimates. • Through June, achieved a 5.6% savings in the Home Office budget. We are on track to achieve an additional 5% by year-end. • Completed the investment advisor selection process resulting in a significant reduction in fees, and have completed a strategic risk analysis to determine investment portfolio asset allocation.

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MOVING FORWARD • Finalize the FY21 budget and planning for the Integrated Strategic and Financial Plan and Integrated Strategic and Financial Operating Plan (aka COVID-19 Recovery Plan). • Finalize efforts to secure financing for the Mercy transition. • Complete development of Medical Group financial statements and a subsidy analysis. • Within Supply Chain, we are planning for: - Implementation of Group Purchasing Organization supply contracts requiring vendor conversion - Continued diligence on COVID-19 surge planning - Continued enterprise resource planning (ERP) development to fully leverage and make use of our new technology

• As part of Facilities Management, we will: - Implement our consolidation strategy under a Regional Facilities Director model - Join the Maine Solar consortium and work to leverage the current “soft” energy market - The Facilities Safety/Security System Team will assemble system subject matter experts to support all member organizations with regulatory surveys and safety in general - Environmental Services will standardize resources into the COVID-19 new normal cleaning requirements • Food Services will introduce a new method of delivering premier food services called Simple Services. • Laundry will complete a top to bottom assessment of services in conjunction with an expanded agreement with our primary laundry vendor.

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MOVING FORWARD The 12 components of my vision for Northern Light Health

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BRAND Statewide Perception of Northern Light Health

PEOPLE The Growth of Our People

QUALITY Achieve the Highest Standing

Northern Light Health will be known as the greatest organization in Maine, in any field. When Northern Light Health comes up in conversations among the people of Maine, it will be a positive and thankful tone that such an excellent healthcare organization is so readily present to care for the needs of our citizens. Because Northern Light Health seeks to build relationships with other organizations, we will be seen as an excellent partner. Over the course of time, relationships will lead to partnerships which will foster growth opportunities.

Our people matter the most, because it is through people that we fulfill our mission. Colleagues will be proud of working at Northern Light Health, and prospective recruits will seek employment as a means toward career fulfillment and a healthy work-life balance. Northern Light Health will have industry-leading talent development systems. The organization will grow, nurture, and develop the team to the fullest extent possible. Northern Light Health talent development systems will be regarded as world class and other healthcare organizations will view the system as a good partner in thought leadership.

Northern Light Health will achieve the highest standing in quality, safety and service. By all measures, we will show a positive culture of quality and caring. Management, physicians, and staff will be aligned as one in embracing performance improvement and engagement with one another to show the way to excellence. Northern Light Health will be known for consistent, compassionate care; we will reflect this with our colleagues and create an atmosphere for each other and our patients of people caring for others like we care for the ones we love the most.

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04 06 MOVING FORWARD The 12 components of my vision for Northern Light Health 05

ACCESSIBILITY Access to Care

COMMUNITY Making a Difference and Being Truly Involved

HEALTH Population Health and Accountable Care Innovations

Northern Light Health will be the most easily accessible health system in the region. Efficiencies and responsiveness will be exercised to create more accessibility to primary and specialty care practices, diagnostic and treatment services. Telemedicine and smartphones will be a primary portal of entry for many, while the electronic health record will assist care teams in proactively caring for those in greatest need and at highest risk.

Because we serve many unique communities, each community will view Northern Light Health and the services that are delivered as an essential community treasure. Social determinants and community advocacy efforts for essentials such as food security, housing, transportation, etc., will make a demonstrable difference in the health and well-being of the communities we serve. Northern Light Health will be seen as involved, inclusive of other community services, and a problem solver for various community needs.

Northern Light Health will be known as a health system which adds value to the Quality/Cost equation. Fundamentals of population health will allow creative ways to contract with payors, including CMS or Maine demonstration projects and direct-to-employer initiatives. Our patient navigation systems and network of outpatient resources will help our consumers obtain the most appropriate care. The delivery system, coupled with care management expertise and comprehensive care pathways, will allow us to manage population health in a risk-based environment. Through the delivery of high quality, cost effective care, Northern Light Health will develop a reputation as a good steward and other organizations will invite us to manage their healthcare services.

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MOVING FORWARD The 12 components of my vision for Northern Light Health

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PERFORMANCE Stewardship of Resources

EFFICIENCY Digital Transformation

INNOVATION Model for Delivering Solutions

Northern Light Health will strive to be an industry best practice model and will rank in the top quartile or higher for cost efficiency, outcomes and engagement. Successful performance of Northern Light Health in 2019 is correlated with the success of the Operational Excellence initiative; now the next level of performance improvement must be launched, emphasizing access, quality, and coordinated care.

Northern Light Health will build on the initial efforts in telehealth and electronic health records. Stress and workloads will be reduced because of the efficiency and connectivity with other providers of care. Care will be easier to access by consumers. The unit cost and capital requirements to provide Information Services will be reduced, and the clinical informatics database will be used to take population health indicators to a higher level of knowledge.

Northern Light Health will be known for its innovation and will continually seek to build this competency. The Innovation Center will be a well- regarded model for creativity and the delivery of best practice solutions. Northern Light Health colleagues will feel a sense of accomplishment from working together to produce excellent solutions in an inclusive environment. The Innovation Center will tackle pressing problems and facilitate solutions that are thoughtful, consumer- focused and effective. Northern Light Health team members find the Innovation Center is an example of the renewed culture to be free to express creative thinking.

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MOVING FORWARD The 12 components of my vision for Northern Light Health

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CONSUMER-FOCUS Partners in Individual Care

BEHAVIOR Environments of Mutual Accountability

STABILITY Economic Strength

Northern Light Health will be known as a consumer-focused organization that seeks to deliver quality services at an appropriate price. Our services will be seen as the place to go in the communities we serve for health information and healthcare service navigation: a partner in individual care.

Northern Light Health colleagues will work together in an environment of mutual accountability, trust and respect. Since we work as a team, our innovation process and our systematic adoption of best practices will benefit each community that we serve. The organization will be deeply connected, and the broader management team will be aligned around our common vision. The management team will collaborate effectively, providing care and support for one another. Leaders will be active participants in the strategic and operational dialogue of Northern Light Health.

Northern Light Health will produce stable 3% and greater operating margins and will be effective at deploying systems to respond to the changing revenue stream environment. We will move toward an upgraded bond rating and the balance sheet will continue to grow to a minimum of 140 days cash- on-hand and a cash-to-debt ratio of at least 125%. Northern Light Health will lower its operating cost structure to no more than 110% of Medicare reimbursement. We will install state-of-the-art expense- and revenue-management systems to enable us to succeed in any payor environment. All of this will allow us to invest (and reinvest) the capital required to assure safe and modern facilities, technology, and equipment which will enhance every stakeholder’s perception of Northern Light Health quality and safety.

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Northern Light Health Acadia Hospital AR Gould Hospital Beacon Health Blue Hill Hospital CA Dean Hospital Eastern Maine Medical Center Home Care & Hospice Inland Hospital Maine Coast Hospital

Mayo Hospital Mercy Hospital Northern Light Health Foundation Northern Light Laboratory Northern Light Medical Transport & Emergency Care

Northern Light Pharmacy Sebasticook Valley Hospital

northernlighthealth.org