BANNER HEALTH Investor Conference Call
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- Percival Joseph
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1 BANNER HEALTH Investor Conference Call Year Ended December 31, 2012 and Quarter Ended March 31, 2013 May 30, 2013 Dennis Dahlen, Senior Vice President / Chief Financial Officer
2 Banner Health Snapshot 23 Acute Care Hospitals Banner Health Network Banner Medical Group with more than 900 doctors Banner Health Centers and Clinics Behavioral Hospital Outpatient Surgery Medical Education $4.9 billion in revenue, 2012 AA- bond rating $395 million in community benefit including $149 million in charity care,
3 Strong Performance Continues. Operating Income & EBIDA $800 $700 $600 $ % 16.0% 14.0% 12.0% 10.0% $400 $300 $200 $100 $0 5.9% % 6.0% 4.0% 2.0% 0.0% Operating Income Operating EBIDA Operating Margin Operating EBIDA Margin 3
4 ...In Spite Of Considerable Headwinds Uncompensated Care Burden, $500 $450 $400 $350 $300 $250 $200 $150 $100 $50 $ % 10.0% 9.0% 8.0% 7.0% 6.0% 5.0% 4.0% 3.0% 2.0% 1.0% 0.0% } $72 Uncompensated Care % of Revenue 4
5 2012 Operating Performance Consolidated Income Statement Year-Ended December 31 ($ in thousands ) * % Variance Total revenues $ 4,878,172 $ 4,741, % Total expenses 4,588,653 4,499, % Operating income $ 289,519 $ 241, % Investment income $ 285,168 $ 5, % Interest rate swaps 17,681 (227,113) 107.8% Minority interest/other (9,139) (31,821) 71.3% Non-operating income $ 293,710 $ (253,595) 215.8% Excess of revenues over expenses $ 583,229 $ (11,787) % Operating EBIDA margin 14.6% 13.1% Operating margin 5.9% 5.1% Total EBIDA margin 19.5% 8.2% Total margin 11.3% -0.3% * Early adoption of reporting change 5
6 Expense Control Supports Performance Key Performance Indicators Year Ending December % Change Salaries and Benefits % of Revenue 51.1% 52.2% -1.1% Labor Productivity (FTE/AOB) % Hospital Productivity (FTE/AOB) % Average Salary / FTE $66,839 $65, % Supplies % of Revenue 15.6% 16.2% -3.7% Supply Exp per Adjusted Admit $1,780 $1, % Bad Debt & Charity as % of Patient Rev 20.1% 14.9% 35.0% Investment Returns 10.7% 0.4% 2675% Positive Trend Neutral Negative Trend 6
7 Utilization Trends Are Mixed Key Utilization Indicators Year-Ended December 31 Hospital (acute care): Licensed beds 4,155 4,119 Admissions (excl. newborns) 228, ,515 Average length of stay Patient days 870, ,546 Licensed beds occupancy % 57.31% 60.67% Observation days 67,599 38,423 Emergency room visits 733, ,633 Outpatient visits (excl. ER) 932, ,364 Long-term care/behavioral/rehabilitation: Licensed beds Resident days 186, ,830 Licensed beds occupancy % 73.24% 74.86% Banner Medical Group Patient Visits 2,283,011 2,154,298 Banner Health Network Risk Lives 188,192 88,197 7
8 Financial Position Improved by Performance Selected Balance Sheet Ratios Ratio Debt to Capital 43.2% 60.0% 49.1% 44.8% 44.5% 41.0% Days Cash on Hand Cash to Debt 108.7% 50.3% 86.0% 105.0% 112.6% 129.1% Debt Service Coverage
9 Interest Rate Swaps December 2012 Valuation SWAP Notional Amount SWAP Fixed Rates Variable Rates Without SWAP MTM Liability (1) 2005 Floating rate $ 556,100, % 0.43% $(125,067,533) 2006 Interest rate (2) 425,000, % 0.44% (3) (144,712,524) 2007 Floating rate 400,000, % 1.05% (124,873,349) LME Swap 13,516, % 0.21% (4) (1,321,949) Total $1,394,616, $(395,975,355) (1) Mark to Market (MTM) is based on estimated LIBOR rates for remaining life of bond. 30 day LIBOR at 12/31/2012 was 0. 21%. The MTM liability represents the approximate cost to terminate SWAP. (2) 2006 Interest Rate Swap cash flows commenced May 11, (3) 61.80% of 30-day Libor plus 0.31%. (4) 30-day Libor. Note: Posted Collateral at 12/31/2012 was $251 million. 9
10 New value-based models of care 10
11 Pioneer ACO first-year results 8.9% reduction in overall hospital admissions 14.4% reduction in average length of stay 6.0% reduction in avoidable hospital readmissions 6.7% reduction high-tech imaging services 2.53% reduction in CMS paid amount per beneficiary 11
12 Pioneer ACO financial performance 10% 5% 0% Banner Health -5% % 12
13 Focus on Clinical Quality Results 13
14 Ventilator Associated Pneumonia (VAP) Acute Care Patients 50% Reduction Clinical Cost Avoidance of $1 Million Clinical Practices: Ventilator Oral Care CHG Ventilator Management 14
15 Mortality Observed/Expected Acute Care Patients Mortality outcomes are >50% better than predicted Clinical Practice: Severe Sepsis Delirium 15
16 Indwelling Catheters during Labor 80.0% 70.0% 73.8% 69.6% 73.0% 69.8% 60.0% 62.6% 50.0% 40.0% Target of 35% 42.1% 41.9% 44.3% 30.0% 31.3% 23.6% 20.0% 21.3% 10.0% 16
17 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 ED CT Scans Atraumatic Headache 45.0% 40.0% Initiative Started July % 30.0% target stretch 25.0% 20.0% target stretch 15.0% 10.0% 5.0% 0.0% 17
18 Hours Length of Stay in Hours Intensive Care Patients > 24 hours Improvement Clinical Cost Avoidance of $22 Million Clinical Practice: Delirium Identification, Prevention and Treatment 18
19 Quarter Ended March 31,
20 Millions YTD Operating Income By Month $350 $300 $ $200 $150 $ $50 $0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
21 First Quarter Operating Performance Consolidated Income Statement Quarter-Ended March 31 ($ in thousands ) % Variance Total revenues $ 1,246,049 $ 1,316, % Total expenses 1,162,780 1,162, % Operating income $ 83,269 $ 154, % Investment income $ 108,652 $ 143, % Interest rate swaps 40,554 63, % Minority interest/other (6,746) (7,320) 7.8% Non-operating income $ 142,460 $ 199, % Excess of revenues over expenses $ 225,729 $ 353, % Operating EBIDA margin 15.2% 19.7% Operating margin 6.7% 11.7% Total EBIDA margin 23.9% 30.3% Total margin 16.3% 23.3% 21
22 First Quarter Operating Performance (normalized) Consolidated Income Statement Quarter-Ended March 31 ($ in thousands ) % Variance Total revenues $ 1,235,149 $ 1,223, % Total expenses 1,162,780 1,155, % Operating income $ 72,369 $ 68, % Investment income $ 108,652 $ 143, % Interest rate swaps 40,554 63, % Minority interest/other (6,746) (7,320) 7.8% Non-operating income $ 142,460 $ 199, % Excess of revenues over expenses $ 214,829 $ 267, % Operating EBIDA margin 14.4% 14.2% Operating margin 5.9% 5.6% Total EBIDA margin 23.3% 26.2% Total margin 15.6% 18.8% 22
23 Expense Control Supports Performance Key Performance Indicators Three Months Ending March % Change Salaries and Benefits % of Revenue 50.7% 48.1% 2.6% Labor Productivity (FTE/AOB) % Hospital Productivity (FTE/AOB) % Average Salary / FTE $ 67,619 $66, % Supplies % of Revenue 16.0% 15.0% 6.7% Supply Exp per Adjusted Admit $1,841 $1, % Bad Debt & Charity as % of Patient Rev 20.5% 18.7% 9.1% Investment Returns 3.9% 5.7% -31.6% Positive Trend Neutral Negative Trend 23
24 Utilization Indicators Quarter-Ended March 31 Hospital (acute care): Licensed beds 4,148 4,150 Admissions (excl. newborns) 58,989 60,960 Average length of stay Patient days 237, ,142 Licensed beds occupancy % 63.40% 62.46% Observation days 19,971 15,419 Emergency room visits 188, ,304 Outpatient visits (excl. ER) 227, ,683 Long-term care/behavioral/rehabilitation: Licensed beds Resident days 43,234 49,259 Licensed beds occupancy % 72.89% 77.55% Banner Medical Group Patient Visits 712, ,658 Banner Health Network Risk Lives 242, ,083 24
25 Balance Sheet Strength Continues To Improve Selected Balance Sheet Ratios Ratio (S&P AA- Median) First 3 Months 2013 LT Debt to Capital (33.1%) Days Cash on Hand (Excl Bad Debt) (215) Cash to LT Debt (164%) Actual Debt Service Coverage (4.9) 43.2% 60.0% 49.1% 44.8% 44.5% 41.0% 39.0% % 50% 86% 105% 113% 129% 139%
26 Interest Rate Swaps March 2013 Valuation SWAP Notional Amount SWAP Fixed Rates Variable Rates Without SWAP MTM Liability (1) 2005 Floating rate $ 543,000, % 0.44% $(115,003,356) 2006 Interest rate (2) 425,000, % 0.44% (3) (128,048,952) 2007 Floating rate 400,000, % 1.02% (111,150,701) LME Swap 13,335, % 0.20% (4) (1,162,152) Total $1,381,335, $(355,365,161) (1) Mark to Market (MTM) is based on estimated LIBOR rates for remaining life of bond. 30 day LIBOR at 03/31/2013 was 0. 20%. The MTM liability represents the approximate cost to terminate SWAP. (2) 2006 Interest Rate Swap cash flows commenced May 11, (3) 61.80% of 30-day Libor plus 0.31%. (4) 30-day Libor. Note: Posted Collateral at 03/31/2013 was $204 million. 26
27 Questions 27
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