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HomeMy WebLinkAbout2020-06-11 PAG FinalPARTNERSHIP ADVISORY GROUP JUNE 11, 2020 MEETING PAGE 1 ASSEMBLY The Partnership Advisory Group met to hold a virtual meeting on Thursday, June 11, 2020, at 5:30 p.m. in Wilmington, North Carolina. Members present via roll call: Co -Chair Barbara Biehner; Co -Chair Spence Broadhurst; Vice Co -Chair Bill Cameron; Vice Co -Chair Dr. Joseph Pino; Members: Dr. Virginia Adams; Evelyn Bryant; Robert Campbell; Chris Coudriet; Cedric Dickerson; Hannah Gage; John Gizdic; Dr. Sandra Hall; Tony McGhee; Dr. Michael Papagikos; Dr. Mary Rudyk; Dr. Rob Shakar; and Meade Van Pelt. Members absent: Brian Eckel; Jack Fuller; Jason Thompson; and David Williams. Staff present: County Attorney Wanda Copley; Clerk to the Board Kymberleigh G. Crowell; Assistant County Manager Tufanna Bradley; Chief Financial Officer Lisa Wurtzbacher; Chief Communications Officer Jessica Loeper; Budget Officer Sheryl Kelly; Intergovernmental Affairs Coordinator Tim Buckland; New Hanover Regional Medical Center (NHRMC) Director of Marketing and Public Relations Carolyn Fisher; NHRMC Chief Legal Officer Lynn Gordon; NHRMC Chief Strategy Officer Kristy Hubard; NHRMC Executive Vice -President and Chief Financial Officer Ed 011ie; Joseph Kahn, Shareholder with Hall Render and outside counsel for NHRMC; Bryan Burgett, Director with Guidehouse; David Burik, Managing Director with Guidehouse; Greg Van Alstyne, Senior Strategy Consultant with Guidehouse; Karl Henkel, Associate with Ponder & Company; Eb LeMaster, Managing Director with Ponder & Company; and Robert Jaeger, Vice President with Ponder & Company. Atrium Health members present via roll call: Dr. Tony Asher; William Cannon; Anthony Defurio; Brett Denton; Jim Dunn; Terry Hales; Ken Haynes; Carol Lovin; Dr. Brent Matthew; Dr. Stacy Nicholson; Dr. Scott Rissmiller; Dr. Geoffrey Rose; Dr. Rasu Shrestha; and Gene Woods. Co -Chair Broadhurst called the meeting to order and thanked everyone for participating in the virtual format. This meeting is being held as a permissible virtual meeting with public access to open session components in accordance with state law. As with all other meetings, the public can hear the open session portion of the meetings, but is not participating in the meeting discussion, and there will be no questions from the public in this forum. When the PAG moves into closed session, the public access will have a placeholder slide of "Closed Session Portion" and no audio; this slide will close and audio will be turned back on as the PAG goes back into the open session portion of the meeting. ATRIUM HEALTH PRESENTATION Co -Chair Biehner welcomed representatives from Atrium Health and thanked them for taking the time to address members of the public and the PAG. Everyone looks forward to hearing further about Atrium Health's proposed strategic partnership with NHRMC and the communities NHRMC serves. As a reminder, PAG members will be put on mute and are asked to hold any questions until the closed session portion of the meeting has begun. She then asked Gene Woods, Atrium Health President and Chief Executive Officer, to begin the presentation. Gene Woods, Atrium Health President and Chief Executive Officer, in review of slides 1 — 3, expressed appreciation for the opportunity to talk about being better together. He and his team understand this has been a long process for the PAG members and the work they have done is a tribute to each member's commitment to the health and well-being of this community. It is also a credit to NHRMC that it has three reputable organizations that are interested in having a long term partnership and he thinks it speaks to the quality of the organization and is a tribute to what it has done for this community. The goal tonight is to describe what makes Atrium Health different, what it means specifically for NHRMC, and how the community will be better. He feels Atrium Health has the best board and the best leadership team in the country. The team that is participating tonight is the team that NHRMC would be engaging with directly on the ground if Atrium Health were privileged to be selected as a partner. In review of slide 3, Mr. Woods reviewed how the goal of the next hour was to answer the following questions: What makes us different? What does a partnership with Atrium Health mean for NHRMC and the community? What does day one look like, what does year one look like, what does 10 years from now look like? He then asked William Cannon, Vice Chairman of the Atrium Health Board of Commissioners, to discuss what Atrium Health calls "connect to purpose". William Cannon, Vice Chairman of the Atrium Health Board of Commissioners, stated it was literally 13 years ago that he sat in NHRMC's shoes. It was June of 2007, and he was serving as a member of the board of Northeast Healthcare system and it needed a partner. Based on what his hospital had always done, provided care for all of God's children, that was part of their mission and part of their soul and they wanted that to continue. Northeast Medical Center had a dominant market share in Cabarrus County and was the largest non-governmental employer. The board felt that it must put in place comprehensive, long term solutions. A critical factor in their decision was the fact that in 2006 in Mecklenburg County Atrium Health, known then as Carolina's Healthcare, provided 83% of the Medicare and uninsured care while they were there and in -county competition provided 17%. Today, Atrium Cabarrus and Atrium Health stand together for health, hope, and healing for all. Personally, he is very proud to have been a part of including the "for all" in that statement. Atrium Cabarrus strives to live up to that goal every day and is thriving today, just as was hoped for in 2007. Mr. Woods continued the presentation in review of slide 5, which starts the discussion about what Atrium Health thinks makes it different. One of the things that is thought to make Atrium Health different is not just its mission statement, which is to improve health, to elevate hope, and to advance healing for all. It's not just that Atrium Health has a mission; everyone has a mission. It's how Atrium Health lives that mission that he thinks is PARTNERSHIP ADVISORY GROUP JUNE 11, 2020 MEETING PAGE 2 something that differentiates it and its vision is to be the first best choice for care. The desire would be for NHRMC to always be the first and best choice for care. In regard to community benefit, Atrium Health is the largest provider of community benefit in this state, both in absolute terms of $2 billion on an annual basis and as a percentage of operating expense, 20.7%. This provides a sense of how it lives its "for all" mission. However, it is not just about the numbers, but also about how they live. For example, one of the things Atrium Health knows is that mental health issues are very prevalent in its communities. It is known that is also very important to NHRMC. He and his team also know that black men will tell their barbers things that they will not tell their loved ones and that a lot of good communication sometimes happens there. As Atrium Health was talking to the barber shops in the communities, one of the things heard was that these men were telling stories about their mental health and challenges, and the barbers didn't know what to do with that. Atrium Health partnered with a number of barbershops throughout North Carolina, called No Grease, and trained barbers to really be sort of an extension of its mental health providers so that when they're talking to someone who has suicidal ideations or just needs some help, they can connect them directly with Atrium Health. Atrium Health staff also lives the "for all" mission. It joined with other organizations and the Attorney General in North Carolina on the statewide coalition and the opioid epidemic. Atrium Health knows this is a very important issue in Wilmington. In North Carolina, there are 41 counties that are at high risk for opioids. Some years ago it partnered with the Centers for Disease Control on an algorithm to help its physicians when they're in the office what the warning signs are, and then they could really get those patients the help that they needed. Atrium Health is the only health system in this state and actually one of the few in the entire country, that has its own laboratory equipment that could do its own COVI D-19 tests. When it was looking at Mecklenburg County in April, what was realized was that there is a population of about 25% African-Americans and seven percent Hispanics, and that there is a disparity in testing. Atrium Health has nine mobile sites, but realized the challenge with transportation to get to the sites was preventing those communities from actually getting the test. Atrium Health developed two roving mobile vans, put its testing capabilities on the vans, and worked with the churches and community leaders to launch an initiative with communities to issue the tests. In a very short period of time, the disparities in testing were reduced or eliminated. In review of slide 9, Mr. Woods stated that even though Atrium Health provides more community benefit than anyone in the state, it has maintained its double A ratings and its strong balance sheet. It knows that healthcare is going to be challenging for the next decade and beyond. Atrium Health has a history of strong and stable operating performance and cash flow, highly liquid balance sheet, volume growth in terms of what S&P says about it, service line demands, favorable fundamentals, coupled with considerable geographic reach. The rating agencies are telling Atrium Health that not only is it living in terms of its community mission, it is also doing it in a disciplined manner to have a very strong balance sheet to support partners and also to deal with the headwinds ahead. Atrium Health also has a track record of national excellence. In looking at the seven U.S. News and World Report shields, there are children's recognitions. Atrium Health is the most recognized in the state as well one of the top children's hospitals in the country, notjust for the clinical excellence. It also treats the highest number of Medicaid children in the entire state. Atrium Health is also different in that it has been by NHRMC's side since 2009 caring for the community together. The physicians at NHRMC are part of Atrium Health's medical group. It started back in 2009 with 17 physicians and it has grown to 207 and it is believed it will continue to grow in the future. Mr. Woods hopes discussions have been had with those physicians to learn what it's like to be part of Atrium Health. He thinks Atrium Health has a phenomenal relationship with the medical group in Wilmington and it is really excited by the care that has been provided together to the community. It is not just about the relationships with medical groups that are employed, Atrium Health also has very strong relationships with independent groups. You would not be able to distinguish whether a doctor was employed or not employed by Atrium Health in the facilities. They are part of the family and all work together to do the best they can for the community together. Atrium Health also has a very successful track record of partnerships in the state such as the one with Atrium Healthcare Cabarrus. It also had a very successful couple of decades of relationship in Atrium Health Union, where it is in the process of building another hospital in that county. Mr. Woods stated that the commitment made in Atrium Health's investing in Union County is significantly north of what it had in the paper that was initially signed in terms of what it meant to have a lease relationship. The only other relationship he would point out is Anson County, which is one of the poorest counties in the entire state. Some years back it was an old Hill Burton Hospital and it was losing about $8 - $9 million a year. Everyone has read that many other systems when they have had small rural hospitals that are struggling, the hospitals are closed or sold. Atrium Health did not do that. It tore down the old hospital and built a new one based on asking the community what do they need most. They needed dental care, medical homes, behavioral health, and chronic care services. If someone were to ask anyone in the community about whether that community is better now than they were before the partnership, Mr. Woods thinks the answer would be yes. Atrium Health's most recent partner is Navicent Health who joined the family in 2019. He provided a brief overview of the achievements made in the first year of the integration. He noted that all of it was done was with zero layoffs. The integration was about synergies, about how they work together, about deploying clinical programs such as cancer, and also networking with their children's hospital. While being the largest organization in North Carolina and one of the largest in southeast, the goal is for Atrium Health to feel like a small organization. In review of slide 14, Mr. Woods described how Atrium Health helped speed up the processing of COVID- 19 tests for patients here and the efforts of its mobile hospital that was deployed during Hurricane Florence. He thinks these efforts in this community are one of the things that really differentiates Atrium Health. It is felt that only the surface has been scratched on what potentially could be accomplished together. In addition to growing the physician network, Atrium Health has saved since 2015 about $32 million through its group purchasing organization supply chain partnership. That is $32 million that did not go to vendors outside of the state that actually were PARTNERSHIP ADVISORY GROUP JUNE 11, 2020 MEETING PAGE 3 reinvested in the New Hanover community. It has also improved care locally in this community through its clinical affiliation with Carolinas Rehab, which was recognized by the American Hospital Association. Dr. Scott Rissmiller, Executive Vice -President and Chief Physician Executive with Atrium Health, stated in review of slides 17 — 24, that he has been with Atrium Health for 23 years and during that time a lot has changed. What has not changed over the 23 years is Atrium Health's commitment to quality and its commitment to communities. It is something he is proud of, it is the mission, and is lived by staff every day. He knows that a lot of healthcare systems say that and claim that and he would ask that everyone look behind the words and the slogans and look at track records, look at Atrium Health's track records of what it has done in the communities that it has partnered with and how it has improved care and partnership with those health systems. Atrium Health partners knowing that care is local, and everything that it does is targeted at allowing that patient to stay within their community and receive the high level care that they need within their community and sometimes within their home. It also knows that leadership and decision making needs to be as close to the care as possible, so Atrium Health allows and sets up the system so that decisions are made at the local level, and there is a great deal of autonomy around that. Finally, Atrium Health partners with humility and enters these relationships with a high degree of confidence because they have done it before. It is part of Atrium Health's DNA, it has a long track record of doing it, and knows in partnership with NHRMC it can do it again. He then provided an overview of Atrium Health's services that it believes can really partner and help elevate the care within this community, noting that not all are listed on slide 18. Atrium Health has a wide array of services from primary care to super -subspecialty, under the umbrella of a program that it started called Atrium Health Excellence led by Dr. Derek Raghavan. It is taking service lines that it believes have the ability to not only attract patients in its communities, but beyond its region across the country, and potentially across the world by investing in research and investing in talent in those specific areas. In review of slide 19, Dr. Rissmiller provided an overview of how Dr. Derek Raghavan has developed the Levine Cancer Institute. The Levine Cancer Institute was started in 2010 and was an affiliation of 12 cancer centers at that time, and it has grown to 25. The key goal and vision of the Levine Cancer Institute is to bring high level expertise, but deliver care local within the communities. Over the past decade, Dr. Raghavan has been successful in recruiting talented physicians who have national and international recognition, and have brought with them cutting edge phase one trials and research to really elevate the care to patients in its communities. Atrium Health is really excited about the opportunity of partnering with NHRMC's Zimmer Cancer Center to bring access to these expanded trials, genetic counseling, the virtual tumor boards, and the incredible evidence based protocols that the team has built that ensures that no matter where you receive your care, you have access to cutting edge research and evidence based care, no matter if it's in a rural community or in a metropolitan city. The Levine Children's Hospital, as shown on slide 20, is recognized by the U.S. News and World Report within seven specialties. Atrium Health is incredibly proud of its success in a relatively short time with its commitment to its children, and is also the largest medical provider for Medicaid patients within North Carolina. The children's hospital is viewed as an academic medical center, but with a keen focus on providing the absolute highest quality of care to children entrusted to Atrium Health's care. The best of academics is taken and used to serve Atrium Health's clinical mission and it does not do academics just for academic sake. Atrium Health believes that culturally it and NHRMC are very aligned in using academics to further the clinical mission and it feel like it is a good fit there. Atrium Health is incredibly excited to partner with the Betty H. Cameron Women's and Children's Hospital, bringing innovative new care models and a full spectrum of specialty services to the community. In review of slide 21, Dr. Rissmiller provided an overview of the Musculoskeletal Institute led by Dr. Moorman, who Atrium Health grabbed from Duke Health three years ago and has done an amazing job building the Musculoskeletal Institute. The vision is to create the largest and most comprehensive program across the entire southeast and Atrium Health wants NHRMC to be a part of that through a partnership. The unique thing about this is the alignment model and how it is accomplished. The majority of the physicians within the Musculoskeletal Institute come from independent practices, one being the second largest independent orthopedic group in the nation and the second being the largest independent neurosurgery group. It is independent physicians partnering with employed physicians around a unified vision strategy to improve care. Atrium Health believes that its experience in partnering with independent groups, and doing so with groups like EmergeOrtho in this community, where Dr. Moorman already has a relationship with the physicians and leadership, that there can be success in elevating musculoskeletal care in the community. Dr. Rissmiller reviewed slide 22 concerning behavioral health noting that all know that there is a huge need across this state and the country for behavioral health services. One in five individuals, at some point in their life, will have a mental health issue and there is a scarcity of resources and providers to provide that. Atrium Health has doubled down on behavioral health because it is aligned with the mission. It owns two psychiatric hospitals, has 51 integrated practices, and is integrated virtually into its primary care offices. It also integrated virtually into its hospitals taking this precious resource of its psychiatrists and behavioral health team to allow them to see a much larger number of patients through the virtual tools. It has paid off in terms of seeing a significant decrease in admissions to its hospitals and the ability to intervene earlier and to meet patients where they live, often in their homes, and in their primary care office through the virtual technology. Atrium is excited to partner to serve the community and bring this expertise and commitment to behavioral health to NHRMC. Ten years ago, Atrium Health made a decision as an organization to invest significantly in its own virtual care platform and it has paid off significantly over the past decade, particularly with the COVID-19 surge. It was able to, in three weeks, set up a virtual at-home hospital where it is caring for over five hundred patients who were diagnosed with COVID-19 in the comfort of their home. These are patients who would most likely be in an observation unit or a med surge unit in the hospitals. Atrium Health was able to give the patients wearables/at-home PARTNERSHIP ADVISORY GROUP JUNE 11, 2020 MEETING PAGE 4 devices that could monitor their blood pressure, pulse, oxygen levels, and they were in constant communication with the care team. The team was able to send paramedics into homes to give IV fluids, IV antibiotics if needed, and this was able to be setup within three weeks because of the investment. It is not just the acute care setting that Atrium Health excels in, it believes in virtual health across the entire care continuum, whether it be from primary care virtual visits to in -school visits for elementary school children so that the parents don't have to leave work and they can get the help they need, all the way to virtual care at home and virtual critical care services. Atrium Health is excited to bring this capability to this community to allow it to bring experts, subspecialists, behavioral health specialists, and everything else virtually to this community to allow patients to stay local. Dr. Rissmiller reviewed slide 24 noting that together, through a partnership, the commitment is to keep care local. Atrium Health means this and it is not a patient acquisition strategy for Charlotte. Atrium Health is far enough away that it would be next to impossible to do anyways, but it is not part of its DNA. Its DNA is to set up the community to be able to receive care locally to stay within the comfort of their home, the comfort of their support system, and within their community. Together, specialty care will be expanded in Wilmington. Atrium Health has a proven track record growing from 14 positions to over 200 and it is just getting started and is excited to bring other specialists to communities such as pediatrics, pediatrics subspecialists, cancer care, orthopedics, etc. New care models will continue to be developed together as well as service lines. Healthcare is changing rapidly, the needs and wants of our patients are changing rapidly. New care models have to be developed to meet them where they are, as well as developing lower cost options. Atrium Health will also bring a nationally leading approach to health equity. Atrium Health is excited at the possibility of continuing the work that it has done in partnership with NHRMC, to continue down this journey to elevate care for this community. Terry Hales, Vice -President of Academic Administration and Operations and Executive Vice -Dean of Wake Forest School of Medicine, expressed appreciation for the opportunity to provide an overview about the academic enterprise and specifically medical education to create the next generation of academic healthcare system through a partnership. In review of slides 27 — 32, Mr. Hales noted that Atrium Health has a rich history of 80 years of being involved in both medical education and research. He has had the opportunity over the last year or so to get to know the team and to engage in many in-depth conversations. He has been so impressed with Atrium Health's depth of commitment to education and research despite it not having a four-year formal medical school presence in Charlotte. As shown on slide 27, it is incredible to see what Atrium Health has grown and done in regard to residencies and fellowships, having a substantial presence in education. He is excited to the think of the power of Wake Forest School of Medicine and Atrium Health coming together and the future of medical education. It is believed unequivocally that with the combination of Atrium Health and Wake Forest School of Medicine, they would not only be a phenomenal choice, but the best choice for medical education and academics with NHRMC. Atrium Health has also operated a regional campus in Charlotte for many years. When you combine the accredited regional campus in Charlotte with the four-year presence that Wake Forest School of Medicine (WFSM) currently has in Charlotte, again, it is tremendous experience. Mr. Hales feel that experience will be really critical in thinking more deeply about medical education in this region and how that can be expanded moving ahead. In an overview about the next generation school of medicine, Mr. Hales stated that in slide 29 you see a building and while a building is incredibly important, he is excited about space, how space is evolving, and what it will look like. More important than that is the program itself. There have been many discussions about what the next generation education looks like. When talking about next generation medical education and/or a school of medicine, the first thing that comes to mind, to him, it is learners that are actively connected and engaged in the environment where they are at both in the school and in the communities they are serving. That is a critical component of providers in the future, their engagement and the community's existence. That is a part of looking and thinking about the future. In regard to population health focused, it was mentioned Atrium Health and WFSM don't just do education and research for the sake of doing it. They do it because they believe that optimal care in the future will require a tremendous amount of knowledge and depth of insight about the population. Everything they do in the academic enterprise, both education and research, is now slanting to having that population health focus. Maybe the more important point as mentioned earlier is the application of both the education and the research to the care that is provided. It's great to be in the education business. It's great to be in the research world. However, if we're not appropriately connecting that to the care and being very purposeful to make that insight that we gained today in the classroom or tomorrow in the lab and apply it to improve care, then we're missing a huge opportunity to be uniquely focused on that as we think about the next generation. As to leadership, both are committed to and would be together training the next generation of not only providers, but scientists as well. Mr. Hales reviewed slide 30 noting WFSM as it applies to research, has made a conscious decision over the last six to seven years to evolve from very much a shotgun approach to research to a very tailored, focused research. It asked what it was going to take to be doing research that, again, is impactful in the care that is being providing in the areas of: cancer, neurosciences, brain aging, Alzheimer's, cardiovascular, and regenerative medicine. The goal is to do research that ultimately changes and impacts patient care. He gets excited thinking about the power of the collective and is equally excited about what it can be in terms of thinking about education and growing research at NHRMC. In review of slide 31, he noted that between the combination of WFSM and Atrium Health there will be a combination of over 1,200 residents and fellows, one medical school with two locations with the potential for more, one of the most selective schools of medicines in the nation that currently has over 11,000 applications a year for less than 500 spots, almost 2,000 full time and part time faculty, and over 3,500 active clinical studies and trials between the two. That is the key to translation into the care environment and they are excited about expanding that in this part of the state. Mr. Hales concluded his portion of the presentation reviewing slide 32 stating that he wants NHRMC to know, understand, and really get excited about the strong experience that Atrium Health and WFSM has together both in operating a regional campus and in a full four-year medical school. The combination of those two knowledge PARTNERSHIP ADVISORY GROUP JUNE 11, 2020 MEETING PAGE 5 sets and experiences puts them in a really powerful position to be impactful in the NHRMC region. They want to bring their expertise to help drive appropriate growth and when combined with the academic team that exists at NHRMC today, there is an opportunity to really do something special in the academic space. The combination of both community focus and academic depth, he thinks is a powerful combination. They believe wholeheartedly that for a health system to be as high performing health system as it needs to be, it needs to have an appropriate level of academics and so both the current academics that exist today and thinking aggressively about what the future can look like, that combination is powerful. Carol Lovin, Atrium Health Executive Vice -President and Chief Integration Officer and System Chief of Staff, reviewed slides 33 — 47, stating that she would provide an overview of about the integration, day one, and beyond. There's really very little mystery about day one because if you're prepared, then it's almost a non-event. What Atrium Health does is to really develop a playbook for integration, which it started doing a few years ago. As it brought organizations on, it has gotten better every time and changed the playbook every time because every single organization molds and shapes it just a little bit. It knows that the driving force is culture, which makes or breaks any partnership. To Atrium Health, culture is it principles that it holds dear in its mission, vision, and values, and it's really manifested in how the teams work. This is what makes Atrium Health excited to potentially be at the next level with NHRMC, because each already knows a lot about both cultures and Atrium Health thinks it is poised for the next step. In review of slide 35, she stated that the failure rate of 71% for healthcare mergers and acquisitions is really important to know because overall it is a staggering statistic and is measured by the ability to meet integration goals. Atrium Health has a track record and experience to, every single time, meet or exceed the integration goals that have been established. She stated it actually does not start with day one. 90 days before closing, before day one, it starts building an integration team of teams and the concept works very well here. There is an executive team, an integration management office, and 20 to 30 functional teams. The real engines of integration are those functional teams like a pharmacy team or a revenue cycle team. One of the differentiators for Atrium Health within integration is the fact that those enterprise functional teams become really strong and add a huge voice in the success of the enterprise itself. It also brings more details to the vision. What Atrium Health will be doing, it will be doing with NHRMC, because it has made some pretty bold big statements out there saying that, yes, it wants NHRMC to be the cornerstone, the leader of the network, and of its enterprise in the southeastern part of the state. What that really means the two are going to define together. In review of slide 40, Ms. Lovin stated that Atrium Health does organize for value and as shown on the slide it is called their next generation network architecture. In the middle, the tree of life is very important. Atrium Health is the enterprise, Charlotte is not the enterprise, and it takes that very seriously. The slide shows southeastern North Carolina as one of the regions and the markets under it, which will be developed more. One thing that Atrium Health likes is the McKinsey & Company (McKinsey) framework. The model shown on slide 41 has been borrowed from McKinsey and it is their four S's: scale, scope, structure, and skill. What these functional teams do is look for value and there are high level integration targets that are bottom up and top down. The bottom line is the way they find that is by looking across scale, scope, structure, and skill, because it's a reminder that synergy is not just about cost, it's about revenue, and being able to look at more than only economies of scale, but also at scope, structure, and skill. There is no question that Atrium Health and NHRMC can be better together. Once day one arrives, it's a pretty proud day for all because a lot of work has been done in the prior 90 days to get there. The structure is all in place, they have day one plans, and do the checkboxes. The day -100 plans are also ready, and then you pass forward, and it's the end of the first year. In the meantime, the most important thing being done is executing on those plans for year one, and tracking and measuring over and over again, and pivoting and adjusting. Once year one has arrived, it positions the organization for the rest of the time and while integration is generally a few years a long, every year there's such significant progress made and it's amazing. Ms. Lovin stated that slide 44 is probably one of the most important slides in the section on integration. Atrium Health has one fundamental question that it asks repeatedly all through the year and even before that, and the bottom line is, by coming together, is the community better off? If it's not, then something is not being done right and further work has to be done. If Atrium Health has the privilege of coming together in a deeper way with NHRMC, it will answer yes and both will challenge each other along the way to do that. In review of slides 45 and 46, Ms. Lovin highlighted parts of the proposal noting that one question being why, when Atrium Health has proposed a long term lease, would it do installment payments? She reviewed the five reasons listed on slide 46 noting Atrium Health understood at one point what NHRMC wanted to do, but was intrigued by that and set out asking what could it do to make a difference; it was a creative approach. It was thought this kind of approach would be keeping everyone, the County, NHRMC, and Atrium Health aligned for many years. It aligns incentives, goals, etc. and provides an ongoing revenue stream for the County to invest in economic development and other things. It also provides, basically, benefits for the County in the form of margin sharing. That provision was incorporated into the proposal along with the ability for NHRMC to choose to sell anytime. It was felt it was a flexible structure in which to propose. Ms. Lovin concluded her presentation providing an overview of slide 47 regarding governance and noting she feels the teal bar at the top of the slide says at all. Atrium Health thinks of local governance in that there is not going to be any major decision made, any impact on healthcare in southeastern North Carolina in the region that NHRMC serves, without the approval of the regional board that is overseeing that. It is just the way Atrium Health works and it believes that is what local governance is. Mr. Woods concluded the presentation reviewing slides 48 — 50 stating that Atrium Health is excited about this possibility as the missions are aligned and both start with very similar humble beginnings. Atrium Health knows PARTNERSHIP ADVISORY GROUP JUNE 11, 2020 MEETING PAGE 6 NHRMC's culture and has been in this community for many years and has also worked with the management and leadership team. Atrium Health comes into this with humility, understanding that NHRMC has some phenomenal quality there that it can learn from. It also looks forward to sharing the clinical excellence that it has achieved as well. Atrium Health respects the leadership team and they are very talented. He hopes what has been shared during this time helps to answer the questions of "Why Atrium?" It certainly has a proven track record of successful partnerships, the highest number of community benefit and is committed and nationally recognized for health equity. It has a track record of expanding care in this area through the medical group and the different specialties and how it connects with the community. This proposal will not negatively impact Atrium Health's credit rating. In fact, when it did announce the partnership with WFSM, S&P just on the announcement itself elevated their credit rating. He thinks Atrium Health has a track record of bringing that level of financial strength to its partners. It also has experience, independent of WFSM, with having 300 medical students, 490 residents, and together this partnership will be the most comprehensive medical education system health system in the state. He then reviewed the potential future headlines as a result of the partnership. Atrium Health looks forward to working with NHRMC if it has the privilege of being selected. As stated earlier, should it be selected, Atrium Health would immediately engage in the question of what does this community desire, it would talk to all individually and collectively, what do you want this community to look like 10 years from now, how can health be better, what do we need to do, and what investments do we have to make to really achieve that. Mr. Woods expressed appreciation for the opportunity for him and his team to make the presentation. Co -Chair Broadhurst thanked Mr. Woods and his team for the presentation and the public for joining the meeting and for being involved and engaged in this important process for our community. CLOSED SESSION Co -Chair Broadhurst announced that the meeting would move into closed session for confidential discussion and review of confidential information, pursuant to North Carolina General Statute (NCGS) 143- 318.11(x)(1), NCGS 143-318.11(a)(3), and NCGS 131E-97.3. These protect competitive healthcare activities and attorney-client matters. He asked for a motion to move into Closed Session. Motion: Member Papagikos MOVED, SECONDED by Member Dickerson to enter into a Closed Session pursuant to NCGS 143-318.11(a)(1), NCGS 143-318.11(a)(3), and NCGS 131E-97.3. These protect competitive healthcare activities and attorney-client matters. Upon vote the MOTION CARRIED UNANIMOUSLY. Co -Chair Broadhurst excused the public participants and convened to closed session at 6:32 p.m. CONVENE TO OPEN SESSION AND ADJOURNMENT Co -Chair Broadhurst called the meeting back to order at 8:11 p.m. and thanked the members for their discussion and work during the closed session and expressed appreciation to public who remained on the line during that time. There being no further business, Co -Chair Broadhurst adjourned the meeting at 8:12 p.m. Respectfully submitted, /Kymberleigh G. Crowell/ Kymberleigh G. Crowell Clerk to the Board Please note the above minutes are not a verbatim record of the Partnership Advisory Group meeting. Meeting materials associated with this meeting are included as attachments to these minutes for reference. 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