34th Annual
J.P. Morgan Healthcare
Conference
San Francisco, California
January 11, 2016
Jim Skogsbergh
President and Chief Executive Officer
Lee B. Sacks, M.D.
Executive Vice President and Chief Medical Officer
Dominic J. Nakis
Chief Financial Officer and Treasurer
The following material and presentation contains information which is forward looking within the meaning of federal securities law. These forward-looking statements are based on the current plans and expectations of Advocate Health
Care Network (“Advocate”) that, although believed to be reasonable, are subject to a number of known and unknown uncertainties and risks inherent in the operation of health care facilities, many of which are beyond Advocate’s control, that could significantly affect current plans and expectations and Advocate’s future financial position and results of operations. These forward-looking statements speak only as of the date made. Investors are cautioned not to unduly rely on such forward-looking statements. This presentation should be reviewed in conjunction with Advocate’s December 31, 2014 and September 30,
2015 continuing disclosure reports.
Jim Skogsbergh
President and Chief Executive Officer
Advocate Health Care
Hospitals (12)
4 teaching
1 children's
1 critical access
5 level 1 trauma centers
Physicians
1,350 employed
5,175 Advocate Physician Partners
6,400 medical staff
Post-acute
Home health, hospice, long-term acute care hospital and palliative care
33,700 associates
$5.7 billion total revenue
Delayed NorthShore Merger
Merger Objective: Increase competition by dramatically changing the way that managed care products are constructed and sold in the Chicago area.
6
• FTC obtained federal court injunction to block merger December 22, 2015
• Judge denied an FTC motion to seal documents
• Hearing date set for April 6, 2016
Recognitions
$783 million community benefit
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Key Market Dynamics
• Provider & health plan consolidation
• Dominant health plan
• Narrow networks emerging
• Revenue pressures – utilization, mix and price
• Cost pressures – labor and drugs
Advocate Well Positioned
• Top decile safety and health outcomes
• Strong brand
• Population health leader
• Narrow network exchange product
• Pluralistic approach to physicians
• Robust ambulatory network & retail clinics
• Financial strength
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10
11
Report Card
Key Result
Area
Measure
Serious Safety Event Rate Change
SAFETY
Safety Event Reporting Rate
QUALITY
SERVICE
GROWTH
FUNDING OUR
FUTURE
COORDINATED
CARE
Health Outcomes Score
Patient Engagement
Associate Engagement
Physician Engagement
Net Revenue Growth
(% vs Prior Year)
System Operating Margin
Hospital Cost per Discharge
Medical Group Cost per Visit
Philanthropy (millions)
AdvocateCare® Index
Target
-20.0%
3.5
100
75
80
75
4.8%
4.0%
$8,010
$115.19
$20.0
100
Actual
-34.0%
5.4
112
59
>90
79
3.9%
5.3%
$7,764
$116.85
$20.7
83
Achieved
12
14,0%
12,0%
10,0%
8,0%
6,0%
4,0%
2,0%
0,0%
Market Share Leader
20,0%
17,8%
18,0%
16,0%
9,2%
8,9%
7,5%
4,8%
Advocate Presence Northwestern Amita NorthShore
RY June 2015
4,6% 4,4% 4,2%
Rush Edward-Elmhurst Trinity
3,6%
Tenet
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Pluralistic Physician Platform
Employed
~1,350
Aligned ~ 3,825
Advocate Physician Partners ~ 5,175
Medical Staff ~ 6,400
Lee B. Sacks, M.D.
Executive Vice President and Chief Medical Officer
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Triple Aim Requires New Business
Model
Five+ years ago, Advocate recognized three ways providers could earn revenue:
1. Maximize unit reimbursement
2. For given unit reimbursement, maximize quantity
3. Take financial risk for managing the health of a population, lowering total costs and serve a greater number of unique patients
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Fee for Service to Value – Shifting
Incentives
2015
1%
Projected 2020
5%
15%
26%
15%
50%
50%
15%
23%
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Current Value-Based Agreements
Contract
Commercial
Medicare ACO
Medicaid ACE
Medicare Advantage
Advocate Associates
Total
Lives
415,000
145,000
100,000
37,000
28,000
725,000
Total Spend
$1.5 B
$1.7 B
$0.2 B
$0.4 B
$0.1 B
$3.9 B
High Performance Network (“HPN”)
Competes on Value
• 2016 BlueCare Direct
® in collaboration with
Advocate
– Public exchange and small group market
– Lowest priced Blue Cross plan
– Projected enrollment: 58,000 lives, $138 million revenue
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• 2017 Market for the product expands:
– SHOP (small business health option program) exchange
– Large employer group market
Co-Marketed HPN
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Medicare Advantage (“MA”)
• Chicago area Medicare population is over 1 million and growing 3% per annum
• 9.5% Advocate MA enrollment growth in 2015
• Turning 65 population represents a market opportunity
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Medicaid is Critical for OB and
Children’s Hospital
• Illinois Medicaid expansion grows managed
Medicaid Lives
• Selective fee for service contracts with Medicaid managed care payers
• Transition to global risk with an insurance partner anticipated mid-2016
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Going Forward…
• Shared Savings is a transition model
• Medicare Advantage is growth opportunity
• Positioned for managed Medicaid
• High Performance Network Products for
Public/Private Exchanges
Dominic J. Nakis
Chief Financial Officer and Treasurer
Intense Focus on Revenue and Cost
Management Driving Margin Performance
Revenue
• Revenue Cycle Standardization/Consolidation
• Clinical Documentation Improvement
• Coding Training and Education
Cost
• Labor Cost and Productivity
• Clinical Effectiveness
• Supply Chain and Purchased Services
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25
Operating Performance Consistently
Strong
$400 10%
6.3%
6.8%
$300
6.5% 6.1% 5.3%
5% $200
$100
$-
$301 $298
2011 2012
Operating Income
$300 $331 $214 //
2013 2014 2015 YTD
Operating Margin
Q3
0%
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Operating Cash Flow is Solid
$700
$600
$500
$400
$300
$200
$100
$-
11.7% 11.6% 11.5%
12.0%
10.9%
15%
10%
5%
$518
2011
$532
2012
Operating Cash Flow
$567
2013
$627 $436
//
2014 2015 YTD
Q3
Operating Cash Flow Margin
0%
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Diversified Investment Portfolio
27
$450
$250 -0.2%
10.6%
7.1%
3.2%
20%
10%
-3.0% 0%
$50
$(34)
$(150)
2011
$439
$343
2012 2013
$188
//
$(145)
-10%
2014 2015 YTD Q3
-20%
Investment Income Investment Yield
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
15%
20%
25%
10%
30%
0%
Target
Expected return of 7.1%
Risk/return ratio at 0.72
15%
25%
21%
7%
32%
Actual Sept 30
Real Assets
Hedge Funds
Fixed Income
Private Equity
Public Equity
27
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Debt Profile is Low, Level and Long*
Tax-exempt debt is $1.6 billion, average annual debt service is generally level through 2038 at $95 million and average life is 19 years.
$100.0
$50.0
$40.0
$30.0
$20.0
$10.0
$90.0
$80.0
$70.0
$60.0
$0.0
2016 2018 2020 2022 2024 2026 2028 2030 2032 2034 2036 2038 2040 2042 2044 2046 2048 2050
* Debt profile as of October 31, 2015
Debt Portfolio Characteristics*
Intermediate
$181,0mm,
11%
Underlying Debt Mix
Synthetic
Fixed,
$321.3mm
20%
Fixed Rate,
$920.8mm
58%
Liquidity Mix
JP Morgan,
$185.4mm, 12%
Wells Fargo,
$49.2mm, 3%
Northern Trust,
$86.6mm, 5%
None,
$920.8mm, 58%
Product Mix
Windows VRDB
$70.0, 4%
Self-Liquidity,
$351.0mm, 22%
Variable Rate
$170mm
11%
Weekly VRDBs
$321.3, 20%
* Debt profile as of October 31, 2015
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Multi-Annual
Tender
$120.3, 8%
Direct Purchase
$100.0, 6%
Annual Tender
$60.6, 4%
Fixed Rate
$920.8, 58%
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Strong Coverage and Capitalization
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12.0
10.0
8.0
6.0
4.0
2.0
0.0
25.9%
24.4%
24.0%
8.7
2011
11.1
2012
Debt Service Coverage Ratio (times)
9.5
2013
23.2%
9.4
2014
//
24.1%
10.5
2015 YTD Q3
Debt as % of Unrestricted Capitalization
40%
35%
30%
25%
20%
15%
10%
5%
0%
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31
Robust Cash to Debt Ratio
280
275
270
265
260
255
250
245
300
295
290
285
265
2011
287
2012
283
2013
296
2014
290 //
2015 YTD Q3
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32
Pension Plans Well Funded
$950
$900
$850
$800
$750
$700
$650
$600
$550
$500
100%
86%
92%
$654 $762
2011
$768 $835
2012
Assets
$840 $838
2013
PBO
96%
94%
$899 $937 $890
2014
Percent Funded
$945
//
2015 YTD Q3
100%
90%
80%
70%
60%
50%
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33
Substantial Liquidity Position
$6,000
$5,000
$4,000
$3,000
$2,000
$1,000
$-
304
$3,211
2011
351
$3,842
2012
386 383 384
$4,518
2013
$4,725
2014
Days Cash and Investments on Hand
//
$4,851
2015 YTD Q3
Dollars
150
100
50
0
300
250
200
450
400
350
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34
Significant Capital Expenditures Past
Three Years
900 250%
212%
196%
750
182% 200%
150%
600 146%
150%
450
100%
300
50%
150
0
$251
2011
$281
2012
$386
2013
$508
2014
$370 //
2015 YTD Q3
0%
Cash Spending Capital Spend Ratio
35
Summary
• National leader in safety, health outcomes and
Population Health Management
• Market share leader and brand strength
• Growth through new risk based products
• Balance sheet strength and solid operating performance
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• AA bond ratings with stable (M/F) and positive
(S&P) outlooks
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