DY 6 Year-End Report

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					                                              DSRIP Semi-Annual Reporting Form

CA 1115 Waiver - Delivery System Reform Incentive Payments (DSRIP)
Reporting Form Instructions
Dates Reports are Due

DPH systems submit this report to the State twice a year:

         DY 6 (6-month)                                       March 2, 2011
        DY 6 (year-end)                                        May 15, 2011
         DY 7 (6-month)                                       March 31, 2012
        DY 7 (year-end)                                     September 30, 2012
         DY 8 (6-month)                                       March 31, 2013
        DY 8 (year-end)                                     September 30, 2013
         DY 9 (6-month)                                       March 31, 2014
        DY 9 (year-end)                                     September 30, 2014
        DY 10 (6-month)                                       March 31, 2015
        DY 10 (year-end)                                    September 30, 2015


Use of This Reporting Form

All DPH systems must use this reporting form template for reports starting May 15, 2011.
For the year-end report, DPH systems will include the year-end narrative, the year-end report, and reattach the
  previously submitted 6-month report.
DPH systems should follow the instructions at the top of each tab for completing the form. DPH systems should
  complete information for items marked "*" for each project tab and milestone being reported.




5/25/2012                                                       Instructions                                      1 of 173
                                                                     DSRIP Semi-Annual Reporting Form


CA 1115 Waiver - Delivery System Reform Incentive Payments (DSRIP)
* DPH SYSTEM:                    Arrowhead Regional Medical Center
* REPORTING YEAR:                DY 6
* DATE OF SUBMISSION:           5/12/2011
Total Payment Amount            0

This table sums the eligible incentive funding amounts. Please see the following pages for the specifics.
* Instructions for DPH systems: Please input the DPH System Name, Reporting DY & Date. Everything else on this
tab will automatically populate.
Category 1 Projects - Incentive Funding Amounts
Expand Primary Care Capacity                                                                            $        -

Increase Training of Primary Care Workforce                                                             $        -

Implement and Utilize Disease Management Registry Functionality                                         $        -

Enhance Interpretation Services and Culturally Competent Care
Collect Accurate Race, Ethnicity, and Language (REAL) Data to Reduce Disparities
Enhance Urgent Medical Advice
Introduce Telemedicine
Enhance Coding and Documentation for Quality Data
Develop Risk Stratification Capabilities/Functionalities
Expand Capacity to Provide Specialty Care Access in the Primary Care Setting
Expand Specialty Care Capacity                                                                          $        -

Enhance Performance Improvement and Reporting Capacity
TOTAL CATEGORY 1 INCENTIVE PAYMENT:                                                                     $        -

Category 2 Projects
Expand Medical Homes                                                                                    $        -

Expand Chronic Care Management Models                                                                   $        -

Redesign Primary Care                                                                                   $        -

Redesign to Improve Patient Experience
Redesign for Cost Containment
Integrate Physical and Behavioral Health Care
Increase Specialty Care Access/Redesign Referral Process
Establish/Expand a Patient Care Navigation Program
Apply Process Improvement Methodology to Improve Quality/Efficiency
Improve Patient Flow in the Emergency Department/Rapid Medical Evaluation
Use Palliative Care Programs
Conduct Medication Management
Implement/Expand Care Transitions Programs
Implement Real-Time Hospital-Acquired Infections (HAIs) System
TOTAL CATEGORY 2 INCENTIVE PAYMENT:                                                                     $        -

Category 3 Domains
Patient/Care Giver Experience (required)
Care Coordination (required)
Preventive Health (required)
At-Risk Populations (required)
TOTAL CATEGORY 3 INCENTIVE PAYMENT:                                                                     $        -

Category 4 Interventions
Severe Sepsis Detection and Management (required)                                                       $        -

Central Line Associated Blood Stream Infection Prevention (required)                                    $        -

Surgical Site Infection Prevention
Hospital-Acquired Pressure Ulcer Prevention                                                             $        -

Stroke Management                                                                                       $        -

Venous Thromboembolism (VTE) Prevention and Treatment
Falls with Injury Prevention
TOTAL CATEGORY 4 INCENTIVE PAYMENT:                                                                     $        -

TOTAL INCENTIVE PAYMENT                                                                                 $        -




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                                                DSRIP Semi-Annual Reporting Form

CA 1115 Waiver - Delivery System Reform Incentive Payments (DSRIP)
DPH SYSTEM:                     Arrowhead Regional Medical Center
REPORTING YEAR:                 DY 6
DATE OF SUBMISSION:             5/12/2011
Year-End Narrative
This narrative summarizes the DSRIP activities performed in the reporting demonstration year.
* Instructions for DPH systems: Please complete the narrative for year-end reports. The narrative must include
a description of progress made, lessons learned, challenges faced, other pertinent findings and participation in
shared learning.
Summary of Demonstration Year Activities
ARMC's DSRIP team members and Administrative Leadership are fully engaged in the hospital's DHCS approved DSRIP plan and the
projects are underway. The DSRIP team and subcommittees meet on a regular basis to ensure progress is being made towards the
prescribed milestones and to address any obstacles as they arise. Below we have detailed progress for each Category:

Category 1 – Expand Primary Care Capacity - We were able to analyze patient volume by primary residence zip code. We compared
this to current clinic locations allowing us to identify areas needing a clinic location, current clinics that need more primary care
practitioners and current clinics that could better serve our patients if moved to a different location. Plans have been developed to move
two clinics to a larger more accessible location: Internal Medicine Primary Care Clinic and ARMC Westside Family Health Center. Earlier
this year, the San Bernardino County Board of Supervisors approved a contract with a new provider to see patients in one of the County’s
underserved zip codes. Plans are being created to allow for additional capacity expansion as it will be necessary in the following years.
The vast size of the County, including numerous isolated areas, poses a challenge to expanding primary care capacity to the entire County
population. ARMC plans to address these issues by utilizing contracted providers when it wouldn’t be feasible for ARMC to operate its
own clinic in these impacted areas.

Category 1 – Increase Training of Primary Care Workforce - ARMC sponsors an 18 resident American Osteopathic Association
accredited Internal Medicine Residency Program (a three year program with 6 residents enrolled in each year). We have committed to
funding an increase from 6 to 8 residents a year. We formally submitted a request for an increase of two positions per year to allow us to
recruit eight incoming residents in the fall of 2011. Once this process has begun we will be able to add two residents each year to a total
of 6 new primary care trainees.

Category 1 – Implement and Utilize Disease Management Registry Functionality - ARMC chose the Chronic Disease Electronic
Management System (CDEMS) for our diabetes registry. A physician and dedicated clinic assistant have been identified to implement use
of this registry at our pilot clinic. Lessons learned include the necessity of clinic assistant protected time for appropriate data management.
A few years ago, ARMC implemented the use of registry at one of its Family Health Centers. Through this implementation, we did not
allocate a dedicated staff member to oversee the registry. Because of this, not all patients were entered into the registry and data wasn’t
updated or utilized in an efficient manner. ARMC commits to adding FTEs in DY7 and DY8 to accomplish this.


Category 1 – Expand Specialty Care Capacity - ARMC receives anecdotal evidence of prolonged waits for some specialty care clinic
appointments. Using our referral management information system (ARM) we ran reports on request volumes and wait times for several
specialty clinics. We also determined the no-show rate for each clinic. One additional FTE with management and information technology
experience was appointed to oversee this initiative as a special project. Through a detailed analysis of the information extracted from the
ARMC system, we have learned that although the no-show report is accurate the other two measures are suspect. A redesign of the
entire process is now underway. ARMC is committed to adding resources to the referral department as well as specific impacted clinics to
accomplish the necessary increased capacity in subsequent DY years.

Category 2 – Expand Medical Homes - ARMC has achieved “buy-in” from the physician and nurse management leadership of our
licensed but off-site primary care clinics. A physician champion has been identified at our pilot clinic. This physician is using information
from Institute for Healthcare Improvement, the American Academy of Family Practice and the family medicine graduate medical education
community to develop a McKee FHC specific medical home plan and enrollment strategy. We will begin with preventive medicine
measures and add chronic disease measures as feasible.
Category 2 – Expand Chronic Care Management Models - A physician and a clinic nurse manager champion with a particular interest in
diabetes have been identified at the pilot primary care clinic. The ARMC Comprehensive Care Management Program for Diabetes has
been drafted and will serve as a roadmap for implementation of the Chronic Care Model. Biweekly meetings with the project champions
and the Associate Medical Director for ARMC Ambulatory Services are ongoing. This group has identified the necessary skill set for a new
position to be added to primary care clinics called Ambulatory Chronic Care Case Manager. ARMC has committed to establishing and
filling these positions in DY7 and DY8.

Category 2 – Redesign Primary Care - ARMC remains committed to improving the patient experience in our primary care clinics. Patient
complaints most often revolve around wait times and poor choice in specific appointment time availability. In the past ARMC had
successfully redesigned some of our ambulatory clinics to increase the amount of time a patient was directly interacting with a member of
the healthcare team and decrease the amount of time waiting during the appointment. We also implemented “open-access scheduling” of
some providers to allow improved choice of appointment times. In addition, ARMC has determined the baseline for cycle times and no
show rates for its Family Health Centers. ARMC is currently working on its formal bid process to contract with a vendor/consultant to
oversee the redesign process at the pilot FHC in DY7.




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Category 4 - Improve Severe Sepsis Detection and Management - During DY 6, ARMC made the following progress towards improving
severe sepsis detection and management: (1) The current tool used for medical record review has been revised to include all the elements
of the Sepsis IHI Bundle; (2) Reinstated the hospital-wide multi-disciplinary Performance Improvement Team; (3) Applied for membership
to the Surviving Sepsis Campaign; (4) Currently revising the pre-printed Physician Order for Care of the Patient with Sepsis and Septic
Shock form; (5) Developing the curriculum for hospital-wide education for physicians, residents and nursing staff on the Sepsis IHI Bundle;
and (6) Selecting a software system to assist with data collection, data analysis and benchmarking for all DSRIP quality measures. In
order to be successful and compliant with all the new quality measures, education for all staff involved is imperative, including the financial
impact of reaching our goals.


Category 4 - Central Line-Associated Bloodstream Infection Prevention - During DY 6, ARMC made the following progress towards
Central Line-Associated Bloodstream Infections Prevention: (1) Developed training materials and began initial training to critical care
nursing staff on the requirements and elements of the IHI Bundle for CLABSI Prevention - Full training to be rolled out during DY 7; (2)
Currently building a documentation tool in Medi-Tech (ARMC's hospital information system) to facilitate collection of data and accuracy of
findings; and (3) Selecting a software system to assist with data collection, data analysis and benchmarking for all DSRIP quality
measures. Through initial development of the CLABSI Prevention measures, we have decided to assign one individual per unit to collect
(daily) the data for CLABSI Prevention. This will ensure that the data collected is consistent and that there is always a contact person for
follow-up. Challenges we will face are; (1) Developing a process to ensure that 100% of all new residents receive training on the IHI
CLABSI Bundle as part of their initial hospital orientation; and (2) "Hardwiring" to care teams that, Nursing staff must collaborate with
Physicians on a daily basis to determine if the catheter is still necessary.


Category 4 - Hospital-Acquired Pressure Ulcer Prevention - During DY 6, ARMC has made the following progress towards Hospital-
Acquired Pressure Ulcer Prevention: (1) Developed training material and began initial training to nursing staff and attending physicians on
the IHI Bundle for Pressure Ulcer Prevention - Full training to be rolled out during DY 7; (2) Developed protocols and began piloting
weekly skin rounds by a trained registered nurse; (3) Created a tool to track daily compliance with applying all elements of the IHI Bundle
to the appropriate patients for prevention of pressure ulcers. Our goal is to build the daily skin assessment tool in the computer Meditech
database; (4) Developing a business agreement to join CalNoc; (5) Performance improvement data analysis and data reporting tool
revised to reflect all data elements of the IHI Bundle for Pressure Ulcer Prevention; and (6) Nursing policy and procedures revised to
ensure all components of the IHI Bundle for Pressure Ulcer Prevention are clearly defined.

Category 4 - Stroke Management - During DY 6, ARMC has made the following progress towards Stroke Management: (1) Revised data
collection tool for stroke patients to include all required elements for DSRIP; (2) Education completed to all members of the hospital-wide
Stroke Committee on new Quality Measures for DSRIP; (3) Established a process for Patient Accounts and Medical Records to capture
total cost of each patient admission related to acute onset of stroke; and (4) Selecting a software system to assist with data collection, data
analysis and benchmarking for all DSRIP quality measures. During DY 6 ARMC has learned the importance of including the coding and
Medical Records Leaders to ensure that the Medical Records Department identified for data analysis are 100% appropriate and accurate.
In addition, we have learned that when a change affects a "physician preference", it is always best to be prepared with regulatory
standards and evidence-based results to support the changes.




Summary of DPH System's Participation in Shared Learning
Category 1 – Expand Primary Care Capacity - The data for this analysis was developed in coordination with ARMC, the San Bernardino
County Public Health and Department of Mental Health. Based on this analysis, these departments are also evaluating their existing
resources based to determine where services are necessitated within the County.

Category 1 – Increase Training of Primary Care Workforce - ARMC’s DSRIP team members will participate in programs/sessions led
by CAPH/SNI to help facilitate connecting members with CAPH/SNI and each other on general DSRIP work, for the following purposes: 1)
ensure consistency in measurement; 2) share progress and lessons learned; and, 3) exchange effective approaches as well as
troubleshoot around challenges.
Category 1 – Implement and Utilize Disease Management Registry Functionality - ARMC members participated in a Panel
Management Workshop with other California public and safety net hospitals. In addition, ARMC’s Information Management department
head forged an ongoing information exchange with his counterpart at Riverside County Department of Public Health which also will be
using the CDEMS registry.
Category 1 – Expand Specialty Care Capacity - ARMC’s DSRIP team members will participate in programs/sessions led by CAPH/SNI
to help facilitate connecting members with CAPH/SNI and each other on general DSRIP work, for the following purposes: 1) ensure
consistency in measurement; 2) share progress and lessons learned; and, 3) exchange effective approaches as well as troubleshoot
around challenges.
Category 2 – Expand Medical Homes - ARMC members participated in a Panel Management Workshop with other California public and
safety net hospitals allowing us to share with these organizations. In addition the physician champion is a member of a regional family
medicine residency program exchange so that lessons learned particularly with primary care resident providers will be shared.




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Category 2 – Expand Chronic Care Management Models - ARMC’s DSRIP team members will participate in programs/sessions led by
CAPH/SNI to help facilitate connecting members with CAPH/SNI and each other on general DSRIP work, for the following purposes: 1)
ensure consistency in measurement; 2) share progress and lessons learned; and, 3) exchange effective approaches as well as
troubleshoot around challenges.
Category 2 – Redesign Primary Care - ARMC does participate in a redesign collaborative; through which ARMC DSRIP team members
receive periodic patient redesign updates.
Category 4 - Improve Severe Sepsis Detection and Management - Participated in a conference call with the Surviving Sepsis
Campaign; will be involved in on-going collaborative information sharing.
Category 4 - Central Line-Associated Bloodstream Infection - ARMC is a member of the Southern California Patient Safety
Collaborative for networking and continued education on CLABSI prevention All education sessions, webinars, etc. are free of charge to
members.
Category 4 - Hospital-Acquired Pressure Ulcer Prevention - ARMC's hospital-wide Wound and Skin Care Committee meets monthly
to share data, new evidenced based practices, results, etc. In addition ARMC networks with Quality Improvement Organization (QIO)
through CMS, as well as the Southern California Patient Safety Collaborative for clinical updates, education, creative documentation tools,
etc.
Category 4 - Stroke Management - ARMC collaborates with the American Heart Association (AHA) for guidelines, protocols, policies,
best practices, outcome data, etc. on our Acute Stroke patients. In addition, we have access to education opportunities for the Physicians
and the Nursing Staff regarding care for our Acute Stroke Patients. AHA also provides data for benchmarking our organization with other
hospitals that have Certified Stroke Centers.




5/25/2012                                                   Year-End Narrative                                                       5 of 173
                                                  DSRIP Semi-Annual Reporting Form

CA 1115 Waiver - Delivery System Reform Incentive Payments (DSRIP)
DPH SYSTEM:                     Arrowhead Regional Medical Center
REPORTING YEAR:                 DY 6
DATE OF SUBMISSION:             5/12/2011
Category 1 Summary Page

This table is the summary of data reported for the DPH system. Please see the following pages for the specifics.
* Instructions for DPH systems: Do not complete, this tab will automatically populate.
     The black boxes indicate Milestone achievements, either "yes/no", or the actual achievement # or %.
     The blue boxes show progress made toward the Milestone ("Achievement Value") of 1.0, 0.75. 0.5, 0.25 or 0.
     The red boxes indicate Total Sums.

Category 1 Projects
Expand Primary Care Capacity
 Process Milestone: Develop a plan to establish additional primary care clinics for the County’s current MIA population
                                                                                                           Yes
    Achievement Value                                                                                                 1.00
  Process Milestone: Develop a plan to establish additional/expand primary care clinics for the County’s targeted FHC population
                                                                                                            Yes
    Achievement Value                                                                                                 1.00
  Process Milestone: Increase (contract) primary care locations by one (MIA clinic)                        Yes
    Achievement Value                                                                                                 1.00

  Process Milestone: ________________________________                                                      N/A
    Achievement Value

  Process Milestone: ________________________________                                                      N/A
    Achievement Value
  Improvement Milestone: ________________________________                                                  N/A
    Achievement Value
  Improvement Milestone: ________________________________                                                  N/A
    Achievement Value

  Improvement Milestone: ________________________________                                                  N/A
    Achievement Value
  Improvement Milestone: ________________________________                                                  N/A
    Achievement Value
  Improvement Milestone: ________________________________                                                  N/A
    Achievement Value

  DY Total Computable Incentive Amount:                                                                   $   6,060,207.00

  Total Sum of Achievement Values:                                                                                    3.00

  Total Number of Milestones:                                                                                         3.00

  Achievement Value Percentage:                                                                                      100%

  Eligible Incentive Funding Amount:                                                                      $   6,060,207.00

  Incentive Funding Already Received in DY:                                                               $   6,060,207.00

  Incentive Payment Amount:                                                                               $               -




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Category 1 Summary Page
Increase Training of Primary Care Workforce
                                                                                                        Yes
  Process Milestone: Expand primary care residency training programs by applying to AOA to increase primary care residency training programs (IM
    Achievement Value                                                                                             1.00
  Process Milestone: ________________________________                                                   N/A
    Achievement Value
  Process Milestone: ________________________________                                                   N/A
    Achievement Value
  Process Milestone: ________________________________                                                   N/A
    Achievement Value
  Process Milestone: ________________________________                                                   N/A
    Achievement Value
  Improvement Milestone: ________________________________                                               N/A
    Achievement Value
  Improvement Milestone: ________________________________                                               N/A
    Achievement Value

  Improvement Milestone: ________________________________                                               N/A
    Achievement Value
  Improvement Milestone: ________________________________                                               N/A
    Achievement Value
  Improvement Milestone: ________________________________                                               N/A
    Achievement Value

  DY Total Computable Incentive Amount:                                                                $   6,060,207.00

  Total Sum of Achievement Values:                                                                                1.00

  Total Number of Milestones:                                                                                     1.00

  Achievement Value Percentage:                                                                                   100%

  Eligible Incentive Funding Amount:                                                                   $   6,060,207.00

  Incentive Funding Already Received in DY:                                                            $   6,060,207.00

  Incentive Payment Amount:                                                                            $            -




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Category 1 Summary Page
Implement and Utilize Disease Management Registry Functionality
  Process Milestone: Develop a plan to re-implement disease registry at ARMC’s Family Health Centers   Yes
    Achievement Value                                                                                             1.00
  Process Milestone: ________________________________                                                  N/A
    Achievement Value
  Process Milestone: ________________________________                                                  N/A
    Achievement Value
  Process Milestone: ________________________________                                                  N/A
    Achievement Value
  Process Milestone: ________________________________                                                  N/A
    Achievement Value
  Improvement Milestone: ________________________________                                              N/A
    Achievement Value
  Improvement Milestone: ________________________________                                              N/A
    Achievement Value

  Improvement Milestone: ________________________________                                              N/A
    Achievement Value
  Improvement Milestone: ________________________________                                              N/A
    Achievement Value
  Improvement Milestone: ________________________________                                              N/A
    Achievement Value

  DY Total Computable Incentive Amount:                                                                $   6,060,207.00

  Total Sum of Achievement Values:                                                                                1.00

  Total Number of Milestones:                                                                                     1.00

  Achievement Value Percentage:                                                                                   100%

  Eligible Incentive Funding Amount:                                                                   $   6,060,207.00

  Incentive Funding Already Received in DY:                                                            $   6,060,207.00

  Incentive Payment Amount:                                                                            $            -




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Category 1 Summary Page
Enhance Interpretation Services and Culturally Competent Care
 Process Milestone: ________________________________                             N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value

  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value

  DY Total Computable Incentive Amount:                                          $     -

  Total Sum of Achievement Values:                                                     -

  Total Number of Milestones:                                                          -

  Achievement Value Percentage:

  Eligible Incentive Funding Amount:

  Incentive Funding Already Received in DY:                                      $     -

  Incentive Payment Amount:




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Category 1 Summary Page
Collect Accurate Race, Ethnicity, and Language (REAL) Data to Reduce Disparities
 Process Milestone: ________________________________                               N/A
    Achievement Value
  Process Milestone: ________________________________                              N/A
    Achievement Value
  Process Milestone: ________________________________                              N/A
    Achievement Value
  Process Milestone: ________________________________                              N/A
    Achievement Value
  Process Milestone: ________________________________                              N/A
    Achievement Value
  Improvement Milestone: ________________________________                          N/A
    Achievement Value
  Improvement Milestone: ________________________________                          N/A
    Achievement Value

  Improvement Milestone: ________________________________                          N/A
    Achievement Value
  Improvement Milestone: ________________________________                          N/A
    Achievement Value
  Improvement Milestone: ________________________________                          N/A
    Achievement Value

  DY Total Computable Incentive Amount:                                            $     -

  Total Sum of Achievement Values:                                                       -

  Total Number of Milestones:                                                            -

  Achievement Value Percentage:

  Eligible Incentive Funding Amount:

  Incentive Funding Already Received in DY:                                        $     -

  Incentive Payment Amount:




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Category 1 Summary Page
Enhance Urgent Medical Advice
 Process Milestone: ________________________________                             N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value

  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value

  DY Total Computable Incentive Amount:                                          $     -

  Total Sum of Achievement Values:                                                     -

  Total Number of Milestones:                                                          -

  Achievement Value Percentage:

  Eligible Incentive Funding Amount:

  Incentive Funding Already Received in DY:                                      $     -

  Incentive Payment Amount:




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Category 1 Summary Page
Introduce Telemedicine
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value

  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value

  DY Total Computable Incentive Amount:                                          $     -

  Total Sum of Achievement Values:                                                     -

  Total Number of Milestones:                                                          -

  Achievement Value Percentage:

  Eligible Incentive Funding Amount:

  Incentive Funding Already Received in DY:                                      $     -

  Incentive Payment Amount:




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Category 1 Summary Page
Enhance Coding and Documentation for Quality Data
 Process Milestone: ________________________________                             N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value

  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value

  DY Total Computable Incentive Amount:                                          $     -

  Total Sum of Achievement Values:                                                     -

  Total Number of Milestones:                                                          -

  Achievement Value Percentage:

  Eligible Incentive Funding Amount:

  Incentive Funding Already Received in DY:                                      $     -

  Incentive Payment Amount:




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Category 1 Summary Page
Develop Risk Stratification Capabilities/Functionalities
 Process Milestone: ________________________________                             N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value

  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value

  DY Total Computable Incentive Amount:                                          $     -

  Total Sum of Achievement Values:                                                     -

  Total Number of Milestones:                                                          -

  Achievement Value Percentage:

  Eligible Incentive Funding Amount:

  Incentive Funding Already Received in DY:                                      $     -

  Incentive Payment Amount:




5/25/2012                                             Category 1 Summary                   14 of 173
                                              DSRIP Semi-Annual Reporting Form

Category 1 Summary Page
Expand Capacity to Provide Specialty Care Access in the Primary Care Setting
 Process Milestone: ________________________________                             N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value

  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value

  DY Total Computable Incentive Amount:                                          $     -

  Total Sum of Achievement Values:                                                     -

  Total Number of Milestones:                                                          -

  Achievement Value Percentage:

  Eligible Incentive Funding Amount:

  Incentive Funding Already Received in DY:                                      $     -

  Incentive Payment Amount:




5/25/2012                                             Category 1 Summary                   15 of 173
                                              DSRIP Semi-Annual Reporting Form

Category 1 Summary Page
Expand Specialty Care Capacity
 Process Milestone: Collect baseline for wait times, backlog and no-show rates in the specialty clinics.   Yes
    Achievement Value                                                                                                 1.00
  Process Milestone: Expand the ambulatory care medical specialties referral mgmt dept by adding 1 FTE Yes
    Achievement Value                                                                                                 1.00
  Process Milestone: ________________________________                                                      N/A
    Achievement Value
  Process Milestone: ________________________________                                                      N/A
    Achievement Value
  Process Milestone: ________________________________                                                      N/A
    Achievement Value
  Improvement Milestone: ________________________________                                                  N/A
    Achievement Value
  Improvement Milestone: ________________________________                                                  N/A
    Achievement Value

  Improvement Milestone: ________________________________                                                  N/A
    Achievement Value
  Improvement Milestone: ________________________________                                                  N/A
    Achievement Value
  Improvement Milestone: ________________________________                                                  N/A
    Achievement Value

  DY Total Computable Incentive Amount:                                                                    $   6,060,206.00

  Total Sum of Achievement Values:                                                                                    2.00

  Total Number of Milestones:                                                                                         2.00

  Achievement Value Percentage:                                                                                       100%

  Eligible Incentive Funding Amount:                                                                       $   6,060,206.00

  Incentive Funding Already Received in DY:                                                                $   6,060,206.00

  Incentive Payment Amount:                                                                                $            -




5/25/2012                                                Category 1 Summary                                                   16 of 173
                                              DSRIP Semi-Annual Reporting Form

Category 1 Summary Page
Enhance Performance Improvement and Reporting Capacity
 Process Milestone: ________________________________                             N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value

  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value

  DY Total Computable Incentive Amount:                                          $     -

  Total Sum of Achievement Values:                                                     -

  Total Number of Milestones:                                                          -

  Achievement Value Percentage:

  Eligible Incentive Funding Amount:

  Incentive Funding Already Received in DY:                                      $     -

  Incentive Payment Amount:




5/25/2012                                             Category 1 Summary                   17 of 173
                                                    DSRIP Semi-Annual Reporting Form

CA 1115 Waiver - Delivery System Reform Incentive Payments (DSRIP)
DPH SYSTEM:                    Arrowhead Regional Medical Center
REPORTING YEAR:                DY 6
DATE OF SUBMISSION:            5/12/2011
Category 2 Summary Page

This table is the summary of data reported for the DPH system. Please see the following pages for the specifics.
* Instructions for DPH systems: Do not complete, this tab will automatically populate.
     The black boxes indicate Milestone achievements, either "yes/no", or the actual achievement # or %.
     The blue boxes show progress made toward the Milestone ("Achievement Value") of 1.0, 0.75. 0.5, 0.25 or 0.
     The red boxes indicate Total Sums.

Category 2 Projects
Expand Medical Homes
 Process Milestone: Expand and redefine the roles and responsibilities of primary care team members       Yes
    Achievement Value                                                                                               1.00
  Process Milestone: ________________________________                                                     N/A
    Achievement Value
  Process Milestone: ________________________________                                                     N/A
    Achievement Value
  Process Milestone: ________________________________                                                     N/A
    Achievement Value
  Process Milestone: ________________________________                                                     N/A
    Achievement Value
  Improvement Milestone: ________________________________                                                 N/A
    Achievement Value
  Improvement Milestone: ________________________________                                                 N/A
    Achievement Value
  Improvement Milestone: ________________________________                                                 N/A
    Achievement Value
  Improvement Milestone: ________________________________                                                 N/A
    Achievement Value
  Improvement Milestone: ________________________________                                                 N/A
    Achievement Value

  DY Total Computable Incentive Amount:                                                                   $ 8,334,391.00

  Total Sum of Achievement Values:                                                                                  1.00

  Total Number of Milestones:                                                                                       1.00

  Achievement Value Percentage:                                                                                    100%

  Eligible Incentive Funding Amount:                                                                      $ 8,334,391.00

  Incentive Funding Already Received in DY:                                                               $ 8,334,391.00

  Incentive Payment Amount:                                                                               $          -




5/25/2012                                                       Category 2 Summary                                         18 of 173
                                              DSRIP Semi-Annual Reporting Form

Category 2 Summary Page

Expand Chronic Care Management Models
 Process Milestone: Develop a comprehensive care management program for diabetes patients   Yes
    Achievement Value                                                                                 1.00
  Process Milestone: ________________________________                                       N/A
    Achievement Value
  Process Milestone: ________________________________                                       N/A
    Achievement Value
  Process Milestone: ________________________________                                       N/A
    Achievement Value
  Process Milestone: ________________________________                                       N/A
    Achievement Value
  Improvement Milestone: ________________________________                                   N/A
    Achievement Value
  Improvement Milestone: ________________________________                                   N/A
    Achievement Value
  Improvement Milestone: ________________________________                                   N/A
    Achievement Value
  Improvement Milestone: ________________________________                                   N/A
    Achievement Value
  Improvement Milestone: ________________________________                                   N/A
    Achievement Value

  DY Total Computable Incentive Amount:                                                     $ 8,334,391.00

  Total Sum of Achievement Values:                                                                    1.00

  Total Number of Milestones:                                                                         1.00

  Achievement Value Percentage:                                                                      100%

  Eligible Incentive Funding Amount:                                                        $ 8,334,391.00

  Incentive Funding Already Received in DY:                                                 $ 8,334,391.00

  Incentive Payment Amount:                                                                 $          -




5/25/2012                                              Category 2 Summary                                    19 of 173
                                                DSRIP Semi-Annual Reporting Form

Category 2 Summary Page

Redesign Primary Care
 Process Milestone: Establish baseline data for patient appt ‘no-show’ rates and primary care visit cycle times.
                                                                                                             Yes
    Achievement Value                                                                                                 1.00
  Process Milestone: ________________________________                                                       N/A
    Achievement Value
  Process Milestone: ________________________________                                                       N/A
    Achievement Value
  Process Milestone: ________________________________                                                       N/A
    Achievement Value
  Process Milestone: ________________________________                                                       N/A
    Achievement Value
  Improvement Milestone: ________________________________                                                   N/A
    Achievement Value
  Improvement Milestone: ________________________________                                                   N/A
    Achievement Value
  Improvement Milestone: ________________________________                                                   N/A
    Achievement Value
  Improvement Milestone: ________________________________                                                   N/A
    Achievement Value
  Improvement Milestone: ________________________________                                                   N/A
    Achievement Value

  DY Total Computable Incentive Amount:                                                                     $ 8,334,391.00

  Total Sum of Achievement Values:                                                                                    1.00

  Total Number of Milestones:                                                                                         1.00

  Achievement Value Percentage:                                                                                      100%

  Eligible Incentive Funding Amount:                                                                        $ 8,334,391.00

  Incentive Funding Already Received in DY:                                                                 $ 8,334,391.00

  Incentive Payment Amount:                                                                                 $          -




5/25/2012                                                   Category 2 Summary                                               20 of 173
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Category 2 Summary Page

Redesign to Improve Patient Experience
 Process Milestone: ________________________________                             N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value

  DY Total Computable Incentive Amount:                                          $     -

  Total Sum of Achievement Values:                                                     -

  Total Number of Milestones:                                                          -

  Achievement Value Percentage:

  Eligible Incentive Funding Amount:

  Incentive Funding Already Received in DY:                                      $     -

  Incentive Payment Amount:




5/25/2012                                             Category 2 Summary                   21 of 173
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Category 2 Summary Page

Redesign for Cost Containment
 Process Milestone: ________________________________                             N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value

  DY Total Computable Incentive Amount:                                          $     -

  Total Sum of Achievement Values:                                                     -

  Total Number of Milestones:                                                          -

  Achievement Value Percentage:

  Eligible Incentive Funding Amount:

  Incentive Funding Already Received in DY:                                      $     -

  Incentive Payment Amount:




5/25/2012                                             Category 2 Summary                   22 of 173
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Category 2 Summary Page

Integrate Physical and Behavioral Health Care
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value

  DY Total Computable Incentive Amount:                                          $     -

  Total Sum of Achievement Values:                                                     -

  Total Number of Milestones:                                                          -

  Achievement Value Percentage:

  Eligible Incentive Funding Amount:

  Incentive Funding Already Received in DY:                                      $     -

  Incentive Payment Amount:




5/25/2012                                             Category 2 Summary                   23 of 173
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Category 2 Summary Page

Increase Specialty Care Access/Redesign Referral Process
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value

  DY Total Computable Incentive Amount:                                          $     -

  Total Sum of Achievement Values:                                                     -

  Total Number of Milestones:                                                          -

  Achievement Value Percentage:

  Eligible Incentive Funding Amount:

  Incentive Funding Already Received in DY:                                      $     -

  Incentive Payment Amount:




5/25/2012                                             Category 2 Summary                   24 of 173
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Category 2 Summary Page

Establish/Expand a Patient Care Navigation Program
 Process Milestone: ________________________________                             N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value

  DY Total Computable Incentive Amount:                                          $     -

  Total Sum of Achievement Values:                                                     -

  Total Number of Milestones:                                                          -

  Achievement Value Percentage:

  Eligible Incentive Funding Amount:

  Incentive Funding Already Received in DY:                                      $     -

  Incentive Payment Amount:




5/25/2012                                             Category 2 Summary                   25 of 173
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Category 2 Summary Page

Apply Process Improvement Methodology to Improve Quality/Efficiency
 Process Milestone: ________________________________                             N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value

  DY Total Computable Incentive Amount:                                          $     -

  Total Sum of Achievement Values:                                                     -

  Total Number of Milestones:                                                          -

  Achievement Value Percentage:

  Eligible Incentive Funding Amount:

  Incentive Funding Already Received in DY:                                      $     -

  Incentive Payment Amount:




5/25/2012                                             Category 2 Summary                   26 of 173
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Category 2 Summary Page

Improve Patient Flow in the Emergency Department/Rapid Medical Evaluation
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value

  DY Total Computable Incentive Amount:                                          $     -

  Total Sum of Achievement Values:                                                     -

  Total Number of Milestones:                                                          -

  Achievement Value Percentage:

  Eligible Incentive Funding Amount:

  Incentive Funding Already Received in DY:                                      $     -

  Incentive Payment Amount:




5/25/2012                                             Category 2 Summary                   27 of 173
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Category 2 Summary Page

Use Palliative Care Programs
 Process Milestone: ________________________________                             N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value

  DY Total Computable Incentive Amount:                                          $     -

  Total Sum of Achievement Values:                                                     -

  Total Number of Milestones:                                                          -

  Achievement Value Percentage:

  Eligible Incentive Funding Amount:

  Incentive Funding Already Received in DY:                                      $     -

  Incentive Payment Amount:




5/25/2012                                             Category 2 Summary                   28 of 173
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Category 2 Summary Page

Conduct Medication Management
 Process Milestone: ________________________________                             N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value

  DY Total Computable Incentive Amount:                                          $     -

  Total Sum of Achievement Values:                                                     -

  Total Number of Milestones:                                                          -

  Achievement Value Percentage:

  Eligible Incentive Funding Amount:

  Incentive Funding Already Received in DY:                                      $     -

  Incentive Payment Amount:




5/25/2012                                             Category 2 Summary                   29 of 173
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Category 2 Summary Page

Implement/Expand Care Transitions Programs
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value

  DY Total Computable Incentive Amount:                                          $     -

  Total Sum of Achievement Values:                                                     -

  Total Number of Milestones:                                                          -

  Achievement Value Percentage:

  Eligible Incentive Funding Amount:

  Incentive Funding Already Received in DY:                                      $     -

  Incentive Payment Amount:




5/25/2012                                             Category 2 Summary                   30 of 173
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Category 2 Summary Page

Implement Real-Time Hospital-Acquired Infections (HAIs) System
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Process Milestone: ________________________________                            N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value
  Improvement Milestone: ________________________________                        N/A
    Achievement Value

  DY Total Computable Incentive Amount:                                          $     -

  Total Sum of Achievement Values:                                                     -

  Total Number of Milestones:                                                          -

  Achievement Value Percentage:

  Eligible Incentive Funding Amount:

  Incentive Funding Already Received in DY:                                      $     -

  Incentive Payment Amount:




5/25/2012                                             Category 2 Summary                   31 of 173
                                                  DSRIP Semi-Annual Reporting Form

CA 1115 Waiver - Delivery System Reform Incentive Payments (DSRIP)
DPH SYSTEM:                     Arrowhead Regional Medical Center
REPORTING YEAR:                 DY 6
DATE OF SUBMISSION:             5/12/2011
Category 3 Summary Page

This table is the summary of data reported for the DPH system. Please see the following pages for the specifics.
* Instructions for DPH systems: Do not complete, this tab will automatically populate.
     The black boxes indicate Milestone achievements, either "yes/no", or the actual achievement # or %.
     The blue boxes show progress made toward the Milestone ("Achievement Value") of 1.0, 0.75. 0.5, 0.25 or 0.
     The red boxes indicate Total Sums.

Category 3 Domains
Patient/Care Giver Experience (required)
 Undertake the necessary planning, redesign, translation, training and contract
 negotiations in order to implement CG-CAHPS in DY8 (DY7 only)                                           N/A
    Achievement Value

  Report results of CG CAHPS questions for “Getting Timely Appointments, Care,
  and Information” theme to the State (DY8-10)                                                           N/A
    Achievement Value

  Report results of CG CAHPS questions for “How Well Doctors Communicate With
  Patients” theme to the State (DY8-10)                                                                  N/A
    Achievement Value

  Report results of CG CAHPS questions for “Helpful, Courteous, and Respectful Office
  Staff” theme to the State (DY8-10)                                                                     N/A
    Achievement Value

  Report results of CG CAHPS questions for “Patients’ Rating of the Doctor”
  theme to the State (DY8-10)                                                                            N/A
    Achievement Value

  Report results of CG CAHPS questions for “Shared Decisionmaking”
  theme to the State (DY8-10)                                                                            N/A
    Achievement Value

  DY Total Computable Incentive Amount:                                                                  $         -

  Total Sum of Achievement Values:                                                                                 -

  Total Number of Milestones:                                                                                      -

  Achievement Value Percentage:

  Eligible Incentive Funding Amount:

  Incentive Funding Already Received in DY:                                                              $         -

  Incentive Payment Amount:




5/25/2012                                                     Category 3 Summary                                       32 of 173
                                              DSRIP Semi-Annual Reporting Form

Category 3 Summary Page
Care Coordination (required)
 Report results of the Diabetes, short-term complications measure to the State
 (DY7-10)                                                                        N/A
    Achievement Value

  Report results of the Uncontrolled Diabetes measure to the State (DY7-10)      N/A
    Achievement Value

  Report results of the Congestive Heart Failure measure to the State (DY8-10)   N/A
    Achievement Value

  Report results of the Chronic Obstructive Pulmonary Disease measure
  to the State (DY8-10)                                                          N/A
    Achievement Value

  DY Total Computable Incentive Amount:                                          $     -

  Total Sum of Achievement Values:                                                     -

  Total Number of Milestones:                                                          -

  Achievement Value Percentage:

  Eligible Incentive Funding Amount:

  Incentive Funding Already Received in DY:                                      $     -

  Incentive Payment Amount:

Preventive Health (required)
  Report results of the Mammography Screening for Breast Cancer
  measure to the State (DY7-10)                                                  N/A
    Achievement Value

  Reports results of the Influenza Immunization measure to the State (DY7-10)    N/A
    Achievement Value

  Report results of the Child Weight Screening measure to the State (DY8-10)     N/A
    Achievement Value

  Report results of the Pediatrics Body Mass Index (BMI) measure to the State
  (DY8-10)                                                                       N/A
    Achievement Value
  Report results of the Tobacco Cessation measure to the State (DY8-10)          N/A
    Achievement Value

  DY Total Computable Incentive Amount:                                          $     -

  Total Sum of Achievement Values:                                                     -

  Total Number of Milestones:                                                          -

  Achievement Value Percentage:

  Eligible Incentive Funding Amount:

  Incentive Funding Already Received in DY:                                      $     -

  Incentive Payment Amount:




5/25/2012                                              Category 3 Summary                  33 of 173
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Category 3 Summary Page
At-Risk Populations (required)
  Report results of the Diabetes Mellitus: Low Density Lipoprotein
  (LDL-C) Control (<100 mg/dl) measure to the State (DY7-10)                     N/A
    Achievement Value

  Report results of the Diabetes Mellitus: Hemoglobin A1c Control (<9%)
  measure to the State (DY7-10)                                                  N/A
    Achievement Value

  Report results of the 30-Day Congestive Heart Failure Readmission Rate
  measure to the State (DY8-10)                                                  N/A
    Achievement Value

  Report results of the Hypertension (HTN): Blood Pressure Control
  (<140/90 mmHg) measure to the State (DY8-10)                                   N/A
    Achievement Value

  Report results of the Pediatrics Asthma Care measure to the State (DY8-10)     N/A
    Achievement Value
  Report results of the Optimal Diabetes Care Composite to the State (DY8-10)    N/A
    Achievement Value
  Report results of the Diabetes Composite to the State (DY8-10)                 N/A
    Achievement Value

  DY Total Computable Incentive Amount:                                          $     -

  Total Sum of Achievement Values:                                                     -

  Total Number of Milestones:                                                          -

  Achievement Value Percentage:

  Eligible Incentive Funding Amount:

  Incentive Funding Already Received in DY:                                      $     -

  Incentive Payment Amount:




5/25/2012                                                Category 3 Summary                34 of 173
                                                        DSRIP Semi-Annual Reporting Form

CA 1115 Waiver - Delivery System Reform Incentive Payments (DSRIP)
DPH SYSTEM:                     Arrowhead Regional Medical Center
REPORTING YEAR:                 DY 6
DATE OF SUBMISSION:             5/12/2011
Category 4 Summary Page

This table is the summary of data reported for the DPH system. Please see the following pages for the specifics.
* Instructions for DPH systems: Do not complete, this tab will automatically populate.
     The black boxes indicate Milestone achievements, either "yes/no", or the actual achievement # or %.
     The blue boxes show progress made toward the Milestone ("Achievement Value") of 1.0, 0.75. 0.5, 0.25 or 0.
     The red boxes indicate Total Sums.

Category 4 Interventions
Severe Sepsis Detection and Management (required)
 Compliance with Sepsis Resuscitation bundle (%)                                                         N/A
    Achievement Value

   Sepis Mortality (%)                                                                                    N/A
    Achievement Value

  Optional Milestone: Begin to collect data on Sepsis Bundle for purposes of establishing the baseline    Yes
    Achievement Value                                                                                               1.00
  Optional Milestone: ________________________________                                                    N/A
    Achievement Value
  Optional Milestone: ________________________________                                                    N/A
    Achievement Value

  Optional Milestone: ________________________________                                                    N/A
    Achievement Value

  Optional Milestone: ________________________________                                                    N/A
    Achievement Value
  Optional Milestone: ________________________________                                                    N/A
    Achievement Value

  DY Total Computable Incentive Amount:                                                                   $ 1,089,000.00

  Total Sum of Achievement Values:                                                                                  1.00

  Total Number of Milestones:                                                                                       1.00

  Achievement Value Percentage:                                                                                    100%

  Eligible Incentive Funding Amount:                                                                      $ 1,089,000.00

  Incentive Funding Already Received in DY:                                                               $ 1,089,000.00

  Incentive Payment Amount:                                                                               $          -




5/25/2012                                                            Category 4 Summary                                    35 of 173
                                                   DSRIP Semi-Annual Reporting Form


Category 4 Summary Page
Central Line Associated Blood Stream Infection Prevention (required)
 Compliance with Central Line Insertion Practices (CLIP) (%)                          N/A
    Achievement Value

  Central Line Bloodstream Infection (Rate per 1,000 patient days)                    N/A
    Achievement Value
  Optional Milestone: Begin to collect data on CLABSI Bundle                          Yes
    Achievement Value                                                                           1.00
  Optional Milestone: ________________________________                                N/A
    Achievement Value

  Optional Milestone: ________________________________                                N/A
    Achievement Value

  Optional Milestone: ________________________________                                N/A
    Achievement Value

  Optional Milestone: ________________________________                                N/A
    Achievement Value
  Optional Milestone: ________________________________                                N/A
    Achievement Value

  DY Total Computable Incentive Amount:                                               $ 1,089,000.00

  Total Sum of Achievement Values:                                                              1.00

  Total Number of Milestones:                                                                   1.00

  Achievement Value Percentage:                                                                100%

  Eligible Incentive Funding Amount:                                                  $ 1,089,000.00

  Incentive Funding Already Received in DY:                                           $ 1,089,000.00

  Incentive Payment Amount:                                                           $          -




5/25/2012                                                      Category 4 Summary                      36 of 173
                                                    DSRIP Semi-Annual Reporting Form


Category 4 Summary Page
Surgical Site Infection Prevention
 Rate of surgical site infection for Class 1 and 2 wounds (%)                                   N/A
    Achievement Value

  Optional Milestone: ________________________________                                          N/A
    Achievement Value
  Optional Milestone: ________________________________                                          N/A
    Achievement Value
  Optional Milestone: ________________________________                                          N/A
    Achievement Value

  Optional Milestone: ________________________________                                          N/A
    Achievement Value

  Optional Milestone: ________________________________                                          N/A
    Achievement Value

  Optional Milestone: ________________________________                                          N/A
    Achievement Value

  DY Total Computable Incentive Amount:                                                         $          -

  Total Sum of Achievement Values:                                                                         -

  Total Number of Milestones:                                                                              -

  Achievement Value Percentage:

  Eligible Incentive Funding Amount:

  Incentive Funding Already Received in DY:                                                     $          -

  Incentive Payment Amount:

Hospital-Acquired Pressure Ulcer Prevention
 Prevalence of Stage II, III, IV or unstagable pressure ulcers (%)                              N/A
    Achievement Value
  Optional Milestone: Develop a plan to establish a baseline on HAPU Incidence and Prevalence   Yes
    Achievement Value                                                                                     1.00
  Optional Milestone: ________________________________                                          N/A
    Achievement Value
  Optional Milestone: ________________________________                                          N/A
    Achievement Value

  Optional Milestone: ________________________________                                          N/A
    Achievement Value
  Optional Milestone: ________________________________                                          N/A
    Achievement Value

  Optional Milestone: ________________________________                                          N/A
    Achievement Value

  DY Total Computable Incentive Amount:                                                         $ 1,089,000.00

  Total Sum of Achievement Values:                                                                        1.00

  Total Number of Milestones:                                                                             1.00

  Achievement Value Percentage:                                                                          100%

  Eligible Incentive Funding Amount:                                                            $ 1,089,000.00

  Incentive Funding Already Received in DY:                                                     $ 1,089,000.00

  Incentive Payment Amount:                                                                     $          -




5/25/2012                                                       Category 4 Summary                               37 of 173
                                                            DSRIP Semi-Annual Reporting Form


Category 4 Summary Page

Stroke Management
` Discharged on Antithrombotic Therapy                                                                  N/A
    Achievement Value
  Anticoagulation Therapy for Atrial Fibrillation/Flutter                                               N/A
    Achievement Value
  Thrombolytic Therapy                                                                                  N/A
    Achievement Value
  Antithrombotic Therapy by End of Hospital Day 2                                                       N/A
    Achievement Value
  Discharged on Statin Medication                                                                       N/A
    Achievement Value
  Stroke Education                                                                                      N/A
    Achievement Value
  Assessed for Rehabilitation                                                                           N/A
    Achievement Value
` Stroke mortality rate                                                                                 N/A
    Achievement Value
                                                                                                         Yes
  Optional Milestone: Develop a plan to report data collection on the 7 stroke management process measures
    Achievement Value                                                                                             1.00
  Optional Milestone: ________________________________                                                  N/A
    Achievement Value
  Optional Milestone: ________________________________                                                  N/A
    Achievement Value
  Optional Milestone: ________________________________                                                  N/A
    Achievement Value

  Optional Milestone: ________________________________                                                  N/A
    Achievement Value

  Optional Milestone: ________________________________                                                  N/A
    Achievement Value

  DY Total Computable Incentive Amount:                                                                 $ 1,089,000.00

  Total Sum of Achievement Values:                                                                                1.00

  Total Number of Milestones:                                                                                     1.00

  Achievement Value Percentage:                                                                                  100%

  Eligible Incentive Funding Amount:                                                                    $ 1,089,000.00

  Incentive Funding Already Received in DY:                                                             $ 1,089,000.00

  Incentive Payment Amount:                                                                             $          -




5/25/2012                                                           Category 4 Summary                                   38 of 173
                                                          DSRIP Semi-Annual Reporting Form


Category 4 Summary Page
Venous Thromboembolism (VTE) Prevention and Treatment
  VTE Prophylaxis (%)                                                                        N/A
    Achievement Value
  Intensive care unit VTE prophylaxsis (%)                                                   N/A
    Achievement Value
  VTE patients with anticoagulation overlap therapy (%)                                      N/A
    Achievement Value
  VTE patients receiving unfractionated heparin with dosages/platelet count monitoring (%)   N/A
    Achievement Value
  VTE discharge instructions (%)                                                             N/A
    Achievement Value
  Incidence of potentially preventable VTE (%)                                               N/A
    Achievement Value
  Optional Milestone: ________________________________                                       N/A
    Achievement Value
  Optional Milestone: ________________________________                                       N/A
    Achievement Value
  Optional Milestone: ________________________________                                       N/A
    Achievement Value

  Optional Milestone: ________________________________                                       N/A
    Achievement Value

  Optional Milestone: ________________________________                                       N/A
    Achievement Value
  Optional Milestone: ________________________________                                       N/A
    Achievement Value

  DY Total Computable Incentive Amount:                                                      $     -

  Total Sum of Achievement Values:                                                                 -

  Total Number of Milestones:                                                                      -

  Achievement Value Percentage:

  Eligible Incentive Funding Amount:

  Incentive Funding Already Received in DY:                                                  $     -

  Incentive Payment Amount:




5/25/2012                                                            Category 4 Summary                39 of 173
                                                           DSRIP Semi-Annual Reporting Form


Category 4 Summary Page
Falls with Injury Prevention
  Prevalence of patient falls with injuries (Rate per 1,000 patient days)                     N/A
    Achievement Value
  Optional Milestone: ________________________________                                        N/A
    Achievement Value
  Optional Milestone: ________________________________                                        N/A
    Achievement Value
  Optional Milestone: ________________________________                                        N/A
    Achievement Value

  Optional Milestone: ________________________________                                        N/A
    Achievement Value

  Optional Milestone: ________________________________                                        N/A
    Achievement Value

  Optional Milestone: ________________________________                                        N/A
    Achievement Value

  DY Total Computable Incentive Amount:                                                       $     -

  Total Sum of Achievement Values:                                                                  -

  Total Number of Milestones:                                                                       -

  Achievement Value Percentage:

  Eligible Incentive Funding Amount:

  Incentive Funding Already Received in DY:                                                   $     -

  Incentive Payment Amount:




5/25/2012                                                               Category 4 Summary              40 of 173
                                                      DSRIP Semi-Annual Reporting Form

CA 1115 Waiver - Delivery System Reform Incentive Payments (DSRIP)
DPH SYSTEM:                    Arrowhead Regional Medical Center
REPORTING YEAR:                DY 6
DATE OF SUBMISSION:            5/12/2011
                                                                               REPORTING ON THIS PROJECT:          * Yes
Category 1: Expand Primary Care Capacity

Below is the data reported for the DPH system.
* Instructions for DPH systems: Please select above whether you are reporting on this project. If 'yes',
please type in all of your DY milestones for the project below and report data in the indicated boxes (*).
*     The yellow boxes indicate where the DPH system should input data
      The black boxes indicate Milestones and will automatically populate and flow to summary sheets
      The blue boxes show progress made toward the Milestone ("Achievement Value") and will automatically
      populate and flow to summary sheets

Expand Primary Care Capacity

    DY Total Computable Incentive Amount:                                                                          * $ 6,060,207.00

    Incentive Funding Already Received in DY:                                                                      * $ 6,060,207.00

    Process Milestone: Develop a plan to establish additional primary care clinics for the County’s current MIA
    population
    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                                    *
    Denominator (if absolute number, enter "1")                                                                    *
      Achievement                                                                                                      Yes
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                        * Yes
    (1) ARMC performed gap analysis to determine current MIA patient volume vs. primary care clinics
    (document on file with ARMC) (2) ARMC will release a Request for Proposals to seek additional contract
    providers to meet the needs of: Victor Valley - needs 3 more clinics, West Valley - needs 4 more clinics,
    Rialto/Fontana - needs 4 more clinics, and San Bernardino/Redlands - needs 3 more clinics, based on a
    750:1 patient/provider ratio. (3) Primary care clinic volume (baseline) for ARMC's current MIA population is
    22,165 (numbers per clinic are on file with ARMC).


    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                              * Yes
      Achievement Value                                                                                                        1.00


    Process Milestone: Develop a plan to establish additional/expand primary care clinics for the County’s targeted FHC
    population
    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                                    *
    Denominator (if absolute number, enter "1")                                                                    *
      Achievement                                                                                                      Yes
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                        * Yes
    (1) ARMC performed a gap analysis to identify our current patient volume vs. primary care clinics (document
    of file with ARMC) (2) ARMC has developed a plan to add and expand its primary care clinics, including a
    new primary care clinic in the hospital's Medical Office Building and to move/expand Westside Family Health
    Center to a new location which will expand exam rooms from 14 to 21. A floorplan has been drafted for the
    Westside expansion and an RFP will be perfomed to obtain the necessary bidding/contract process (full plan
    on file with ARMC). (3) ARMC's (FHC) primary care clinic volume is 65,592 (numbers per clinic are on file
    with ARMC).
    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                              * Yes
      Achievement Value                                                                                                        1.00




5/25/2012                                                      Expand Primary Care Capacity                                           41 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 1: Expand Primary Care Capacity

  Process Milestone: Increase (contract) primary care locations by one (MIA clinic)
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                                  *
  Denominator (if absolute number, enter "1")                                                                  *
    Achievement                                                                                                    Yes
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                      * Yes
  On 1/11/2011, the County of San Bernardino Board of Supervisors approved Agreement No. 11-21 between
  ARMC and the Medical Clinic of Redlands to provide primary care services to County Medical Service Plan
  Program patients (Medically Indigent Adults) for the period 1/1/2011 through 12/31/2013, with an option to
  extend the term for two addtion one-year periods. The new clinic is located at 255 Terracina Blvd, #101,
  Redland, CA 92373. As of 3/2/2011, 780 of ARMC's MIA patients have been assigned to this clinic for their
  primary care services. The clinic schedules appointments Mon-Fri, 9:00AM to 6:45PM, Sat 10:00AM-3:45PM
  . (Documents on file with ARMC.)
  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                            * Yes
    Achievement Value                                                                                                    1.00


  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                                  *
  Denominator (if absolute number, enter "1")                                                                  *
    Achievement                                                                                                    N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                      *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                            *
    Achievement Value


  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                                  *
  Denominator (if absolute number, enter "1")                                                                  *
    Achievement                                                                                                    N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                      *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                            *
    Achievement Value




5/25/2012                                                   Expand Primary Care Capacity                                        42 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 1: Expand Primary Care Capacity

  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                   Expand Primary Care Capacity                        43 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 1: Expand Primary Care Capacity

  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                   Expand Primary Care Capacity                        44 of 173
                                                      DSRIP Semi-Annual Reporting Form

CA 1115 Waiver - Delivery System Reform Incentive Payments (DSRIP)
DPH SYSTEM:                    Arrowhead Regional Medical Center
REPORTING YEAR:                DY 6
DATE OF SUBMISSION:            5/12/2011
                                                                               REPORTING ON THIS PROJECT:             * Yes
Category 1: Increase Training of Primary Care Workforce

Below is the data reported for the DPH system.
* Instructions for DPH systems: Please select above whether you are reporting on this project. If 'yes',
please type in all of your DY milestones for the project below and report data in the indicated boxes (*).
*     The yellow boxes indicate where the DPH system should input data
      The black boxes indicate Milestones and will automatically populate and flow to summary sheets
      The blue boxes show progress made toward the Milestone ("Achievement Value") and will automatically
      populate and flow to summary sheets

Increase Training of Primary Care Workforce

    DY Total Computable Incentive Amount:                                                                             * $ 6,060,207.00

    Incentive Funding Already Received in DY:                                                                         * $ 6,060,207.00

    Process Milestone: Expand primary care residency training programs by applying to AOA to increase primary care
    residency training programs (IM)
    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                                       *
    Denominator (if absolute number, enter "1")                                                                       *
      Achievement                                                                                                         Yes
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                           * Yes
    On 2/15/2011, ARMC completed and sent in an, "Application for Increases in Residency/Fellowship Training
    Programs" to the American Osteopathic Association. This application requested a program increase of an
    additional 6 resident positions for the Internal Medicine specialty. The application was received on 2/16/2011
    in Chicago, Illinois, American Osteopathic Association, Division of Postdoctoral Training. (Copy of application
    on file with ARMC.)



    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                                 * Yes
      Achievement Value                                                                                                           1.00


    Process Milestone: ________________________________
                                 (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                                       *
    Denominator (if absolute number, enter "1")                                                                       *
      Achievement                                                                                                         N/A
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                           *




    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                                 *
      Achievement Value




5/25/2012                                                    Training Primary Care Workforce                                             45 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 1: Increase Training of Primary Care Workforce

  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                 Training Primary Care Workforce                       46 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 1: Increase Training of Primary Care Workforce

  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                 Training Primary Care Workforce                       47 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 1: Increase Training of Primary Care Workforce

  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                 Training Primary Care Workforce                       48 of 173
                                                       DSRIP Semi-Annual Reporting Form

CA 1115 Waiver - Delivery System Reform Incentive Payments (DSRIP)
DPH SYSTEM:                    Arrowhead Regional Medical Center
REPORTING YEAR:                DY 6
DATE OF SUBMISSION:            5/12/2011
                                                                               REPORTING ON THIS PROJECT:              * Yes
Category 1: Implement and Utilize Disease Management Registry Functionality

Below is the data reported for the DPH system.
* Instructions for DPH systems: Please select above whether you are reporting on this project. If 'yes',
please type in all of your DY milestones for the project below and report data in the indicated boxes (*).
*     The yellow boxes indicate where the DPH system should input data
      The black boxes indicate Milestones and will automatically populate and flow to summary sheets
      The blue boxes show progress made toward the Milestone ("Achievement Value") and will automatically
      populate and flow to summary sheets

Implement and Utilize Disease Management Registry Functionality

    DY Total Computable Incentive Amount:                                                                              * $ 6,060,207.00

    Incentive Funding Already Received in DY:                                                                          * $ 6,060,207.00

    Process Milestone: Develop a plan to re-implement disease registry at ARMC’s Family Health Centers
                                 (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                                        *
    Denominator (if absolute number, enter "1")                                                                        *
      Achievement                                                                                                          Yes
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                            * Yes
    (1) We have identified that we will need one additional FTE (Clinic Assistant) per FHC in order to support data
    entry and maintenance into the Chronic Disease Electronic Management System (CDEMS) (2) Workshops
    have been developed and will begin in April to train all staff at the Fontana FHC. Training materials have
    been adapted from the Safety Net Institute/Chronic Care Learning Communities. (3) We identified Dr. Brown
    and Doris Sanchez to be the project champions to re-implement the disease registry at Fontana FHC. A
    robust plan has been developed including, data entry, tracking, element extraction, report validity and training
    (documents/plan on file with ARMC).
    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                                  * Yes
      Achievement Value                                                                                                            1.00


    Process Milestone: ________________________________
                                 (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                                        *
    Denominator (if absolute number, enter "1")                                                                        *
      Achievement                                                                                                          N/A
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                            *




    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                                  *
      Achievement Value




5/25/2012                                                          Registry Functionality                                                 49 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 1: Implement and Utilize Disease Management Registry Functionality

  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                       Registry Functionality                          50 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 1: Implement and Utilize Disease Management Registry Functionality

  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                       Registry Functionality                          51 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 1: Implement and Utilize Disease Management Registry Functionality

  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                       Registry Functionality                          52 of 173
                                                     DSRIP Semi-Annual Reporting Form

CA 1115 Waiver - Delivery System Reform Incentive Payments (DSRIP)
DPH SYSTEM:                    Arrowhead Regional Medical Center
REPORTING YEAR:                DY 6
DATE OF SUBMISSION:            5/12/2011
                                                                             REPORTING ON THIS PROJECT:      * No
Category 1: Enhance Interpretation Services and Culturally Competent Care

Below is the data reported for the DPH system.
* Instructions for DPH systems: Please select above whether you are reporting on this project. If 'yes',
please type in all of your DY milestones for the project below and report data in the indicated boxes (*).
*     The yellow boxes indicate where the DPH system should input data
      The black boxes indicate Milestones and will automatically populate and flow to summary sheets
      The blue boxes show progress made toward the Milestone ("Achievement Value") and will automatically
      populate and flow to summary sheets

Enhance Interpretation Services and Culturally Competent Care

    DY Total Computable Incentive Amount:                                                                    *

    Incentive Funding Already Received in DY:                                                                *

    Process Milestone: ________________________________
                                (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                              *
    Denominator (if absolute number, enter "1")                                                              *
      Achievement                                                                                                N/A
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                  *




    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                        *
      Achievement Value


    Process Milestone: ________________________________
                                (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                              *
    Denominator (if absolute number, enter "1")                                                              *
      Achievement                                                                                                N/A
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                  *




    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                        *
      Achievement Value




5/25/2012                                                        Interpretation Services                               53 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 1: Enhance Interpretation Services and Culturally Competent Care

  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                      Interpretation Services                          54 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 1: Enhance Interpretation Services and Culturally Competent Care

  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                      Interpretation Services                          55 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 1: Enhance Interpretation Services and Culturally Competent Care

  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                      Interpretation Services                          56 of 173
                                                     DSRIP Semi-Annual Reporting Form

CA 1115 Waiver - Delivery System Reform Incentive Payments (DSRIP)
DPH SYSTEM:                    Arrowhead Regional Medical Center
REPORTING YEAR:                DY 6
DATE OF SUBMISSION:            5/12/2011
                                                                             REPORTING ON THIS PROJECT:      * No
Category 1: Collect Accurate Race, Ethnicity, and Language (REAL) Data to Reduce Disparities

Below is the data reported for the DPH system.
* Instructions for DPH systems: Please select above whether you are reporting on this project. If 'yes',
please type in all of your DY milestones for the project below and report data in the indicated boxes (*).
*     The yellow boxes indicate where the DPH system should input data
      The black boxes indicate Milestones and will automatically populate and flow to summary sheets
      The blue boxes show progress made toward the Milestone ("Achievement Value") and will automatically
      populate and flow to summary sheets

Collect Accurate Race, Ethnicity, and Language (REAL) Data to Reduce Disparities

    DY Total Computable Incentive Amount:                                                                    *

    Incentive Funding Already Received in DY:                                                                *

    Process Milestone: ________________________________
                                (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                              *
    Denominator (if absolute number, enter "1")                                                              *
      Achievement                                                                                                N/A
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                  *




    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                        *
      Achievement Value


    Process Milestone: ________________________________
                                (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                              *
    Denominator (if absolute number, enter "1")                                                              *
      Achievement                                                                                                N/A
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                  *




    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                        *
      Achievement Value




5/25/2012                                                              REAL Data                                       57 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 1: Collect Accurate Race, Ethnicity, and Language (REAL) Data to Reduce Disparities

  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                            REAL Data                                  58 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 1: Collect Accurate Race, Ethnicity, and Language (REAL) Data to Reduce Disparities

  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                            REAL Data                                  59 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 1: Collect Accurate Race, Ethnicity, and Language (REAL) Data to Reduce Disparities

  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                            REAL Data                                  60 of 173
                                                     DSRIP Semi-Annual Reporting Form

CA 1115 Waiver - Delivery System Reform Incentive Payments (DSRIP)
DPH SYSTEM:                    Arrowhead Regional Medical Center
REPORTING YEAR:                DY 6
DATE OF SUBMISSION:            5/12/2011
                                                                             REPORTING ON THIS PROJECT:      * No
Category 1: Enhance Urgent Medical Advice

Below is the data reported for the DPH system.
* Instructions for DPH systems: Please select above whether you are reporting on this project. If 'yes',
please type in all of your DY milestones for the project below and report data in the indicated boxes (*).
*     The yellow boxes indicate where the DPH system should input data
      The black boxes indicate Milestones and will automatically populate and flow to summary sheets
      The blue boxes show progress made toward the Milestone ("Achievement Value") and will automatically
      populate and flow to summary sheets

Enhance Urgent Medical Advice

    DY Total Computable Incentive Amount:                                                                    *

    Incentive Funding Already Received in DY:                                                                *

    Process Milestone: ________________________________
                                (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                              *
    Denominator (if absolute number, enter "1")                                                              *
      Achievement                                                                                                N/A
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                  *




    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                        *
      Achievement Value


    Process Milestone: ________________________________
                                (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                              *
    Denominator (if absolute number, enter "1")                                                              *
      Achievement                                                                                                N/A
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                  *




    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                        *
      Achievement Value




5/25/2012                                                        Urgent Medical Advice                                 61 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 1: Enhance Urgent Medical Advice

  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                      Urgent Medical Advice                            62 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 1: Enhance Urgent Medical Advice

  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                      Urgent Medical Advice                            63 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 1: Enhance Urgent Medical Advice

  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                      Urgent Medical Advice                            64 of 173
                                                     DSRIP Semi-Annual Reporting Form

CA 1115 Waiver - Delivery System Reform Incentive Payments (DSRIP)
DPH SYSTEM:                    Arrowhead Regional Medical Center
REPORTING YEAR:                DY 6
DATE OF SUBMISSION:            5/12/2011
                                                                             REPORTING ON THIS PROJECT:      * No
Category 1: Introduce Telemedicine

Below is the data reported for the DPH system.
* Instructions for DPH systems: Please select above whether you are reporting on this project. If 'yes',
please type in all of your DY milestones for the project below and report data in the indicated boxes (*).
*     The yellow boxes indicate where the DPH system should input data
      The black boxes indicate Milestones and will automatically populate and flow to summary sheets
      The blue boxes show progress made toward the Milestone ("Achievement Value") and will automatically
      populate and flow to summary sheets

Introduce Telemedicine

    DY Total Computable Incentive Amount:                                                                    *

    Incentive Funding Already Received in DY:                                                                *

    Process Milestone: ________________________________
                                (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                              *
    Denominator (if absolute number, enter "1")                                                              *
      Achievement                                                                                                N/A
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                  *




    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                        *
      Achievement Value


    Process Milestone: ________________________________
                                (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                              *
    Denominator (if absolute number, enter "1")                                                              *
      Achievement                                                                                                N/A
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                  *




    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                        *
      Achievement Value




5/25/2012                                                        Introduce Telemedicine                                65 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 1: Introduce Telemedicine

  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                      Introduce Telemedicine                           66 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 1: Introduce Telemedicine

  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                      Introduce Telemedicine                           67 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 1: Introduce Telemedicine

  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                      Introduce Telemedicine                           68 of 173
                                                     DSRIP Semi-Annual Reporting Form

CA 1115 Waiver - Delivery System Reform Incentive Payments (DSRIP)
DPH SYSTEM:                    Arrowhead Regional Medical Center
REPORTING YEAR:                DY 6
DATE OF SUBMISSION:            5/12/2011
                                                                             REPORTING ON THIS PROJECT:      * No
Category 1: Enhance Coding and Documentation for Quality Data

Below is the data reported for the DPH system.
* Instructions for DPH systems: Please select above whether you are reporting on this project. If 'yes',
please type in all of your DY milestones for the project below and report data in the indicated boxes (*).
*     The yellow boxes indicate where the DPH system should input data
      The black boxes indicate Milestones and will automatically populate and flow to summary sheets
      The blue boxes show progress made toward the Milestone ("Achievement Value") and will automatically
      populate and flow to summary sheets

Enhance Coding and Documentation for Quality Data

    DY Total Computable Incentive Amount:                                                                    *

    Incentive Funding Already Received in DY:                                                                *

    Process Milestone: ________________________________
                                (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                              *
    Denominator (if absolute number, enter "1")                                                              *
      Achievement                                                                                                N/A
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                  *




    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                        *
      Achievement Value


    Process Milestone: ________________________________
                                (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                              *
    Denominator (if absolute number, enter "1")                                                              *
      Achievement                                                                                                N/A
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                  *




    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                        *
      Achievement Value




5/25/2012                                                       Coding & Documentation                                 69 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 1: Enhance Coding and Documentation for Quality Data

  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                     Coding & Documentation                            70 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 1: Enhance Coding and Documentation for Quality Data

  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                     Coding & Documentation                            71 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 1: Enhance Coding and Documentation for Quality Data

  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                     Coding & Documentation                            72 of 173
                                                     DSRIP Semi-Annual Reporting Form

CA 1115 Waiver - Delivery System Reform Incentive Payments (DSRIP)
DPH SYSTEM:                    Arrowhead Regional Medical Center
REPORTING YEAR:                DY 6
DATE OF SUBMISSION:            5/12/2011
                                                                               REPORTING ON THIS PROJECT:    * No
Category 1: Develop Risk Stratification Capabilities/Functionalities

Below is the data reported for the DPH system.
* Instructions for DPH systems: Please select above whether you are reporting on this project. If 'yes',
please type in all of your DY milestones for the project below and report data in the indicated boxes (*).
*     The yellow boxes indicate where the DPH system should input data
      The black boxes indicate Milestones and will automatically populate and flow to summary sheets
      The blue boxes show progress made toward the Milestone ("Achievement Value") and will automatically
      populate and flow to summary sheets

Develop Risk Stratification Capabilities/Functionalities

    DY Total Computable Incentive Amount:                                                                    *

    Incentive Funding Already Received in DY:                                                                *

    Process Milestone: ________________________________
                                (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                              *
    Denominator (if absolute number, enter "1")                                                              *
      Achievement                                                                                                N/A
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                  *




    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                        *
      Achievement Value


    Process Milestone: ________________________________
                                (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                              *
    Denominator (if absolute number, enter "1")                                                              *
      Achievement                                                                                                N/A
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                  *




    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                        *
      Achievement Value




5/25/2012                                                            Risk Stratification                               73 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 1: Develop Risk Stratification Capabilities/Functionalities

  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                         Risk Stratification                           74 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 1: Develop Risk Stratification Capabilities/Functionalities

  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                         Risk Stratification                           75 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 1: Develop Risk Stratification Capabilities/Functionalities

  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                         Risk Stratification                           76 of 173
                                                     DSRIP Semi-Annual Reporting Form

CA 1115 Waiver - Delivery System Reform Incentive Payments (DSRIP)
DPH SYSTEM:                    Arrowhead Regional Medical Center
REPORTING YEAR:                DY 6
DATE OF SUBMISSION:            5/12/2011
                                                                             REPORTING ON THIS PROJECT:      * No
Category 1: Expand Capacity to Provide Specialty Care Access in the Primary Care Setting

Below is the data reported for the DPH system.
* Instructions for DPH systems: Please select above whether you are reporting on this project. If 'yes',
please type in all of your DY milestones for the project below and report data in the indicated boxes (*).
*     The yellow boxes indicate where the DPH system should input data
      The black boxes indicate Milestones and will automatically populate and flow to summary sheets
      The blue boxes show progress made toward the Milestone ("Achievement Value") and will automatically
      populate and flow to summary sheets

Expand Capacity to Provide Specialty Care Access in the Primary Care Setting

    DY Total Computable Incentive Amount:                                                                    *

    Incentive Funding Already Received in DY:                                                                *

    Process Milestone: ________________________________
                                (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                              *
    Denominator (if absolute number, enter "1")                                                              *
      Achievement                                                                                                N/A
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                  *




    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                        *
      Achievement Value


    Process Milestone: ________________________________
                                (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                              *
    Denominator (if absolute number, enter "1")                                                              *
      Achievement                                                                                                N/A
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                  *




    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                        *
      Achievement Value




5/25/2012                                                    Spec Care Access in Primary Car                           77 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 1: Expand Capacity to Provide Specialty Care Access in the Primary Care Setting

  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                  Spec Care Access in Primary Car                      78 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 1: Expand Capacity to Provide Specialty Care Access in the Primary Care Setting

  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                  Spec Care Access in Primary Car                      79 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 1: Expand Capacity to Provide Specialty Care Access in the Primary Care Setting

  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                  Spec Care Access in Primary Car                      80 of 173
                                                      DSRIP Semi-Annual Reporting Form

CA 1115 Waiver - Delivery System Reform Incentive Payments (DSRIP)
DPH SYSTEM:                    Arrowhead Regional Medical Center
REPORTING YEAR:                DY 6
DATE OF SUBMISSION:            5/12/2011
                                                                              REPORTING ON THIS PROJECT:            * Yes
Category 1: Expand Specialty Care Capacity

Below is the data reported for the DPH system.
* Instructions for DPH systems: Please select above whether you are reporting on this project. If 'yes',
please type in all of your DY milestones for the project below and report data in the indicated boxes (*).
*     The yellow boxes indicate where the DPH system should input data
      The black boxes indicate Milestones and will automatically populate and flow to summary sheets
      The blue boxes show progress made toward the Milestone ("Achievement Value") and will automatically
      populate and flow to summary sheets

Expand Specialty Care Capacity

    DY Total Computable Incentive Amount:                                                                           * $ 6,060,206.00

    Incentive Funding Already Received in DY:                                                                       * $ 6,060,206.00

    Process Milestone: Collect baseline for wait times, backlog and no-show rates in the specialty clinics.
                                (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                                     *
    Denominator (if absolute number, enter "1")                                                                     *
      Achievement                                                                                                       Yes
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                         * Yes
    ARMC has identified the baseline for wait times, backlogs and no-shows by specialty clinic. Specialty clinics
    include: General Surgery, Neurosurgery, Urology, Ear, Nose and Throat, Eye, GI, Hepatitis C, Gynecology,
    Obstetrics, Cardiac, Rheumatology, Neuromedicine, Endocrine, Orthopedic and Oral Surgery. Average rates
    among clinics are 34.46% for no-shows; 135 days from referral request to speciality appointment; and 273
    new patients waiting to be seen (Full report by speciality clinic on file with ARMC)



    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                               * Yes
      Achievement Value                                                                                                         1.00


    Process Milestone: Expand the ambulatory care medical specialties referral mgmt dept by adding 1 FTE
                                (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                                     *
    Denominator (if absolute number, enter "1")                                                                     *
      Achievement                                                                                                       Yes
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                         * Yes
    Effective 2/28/11, Cindie Watkins will be assigned to ARMC's Referral Center to complete a full analysis and
    revamp of the current referral system. The goal of this assignment is to complete a gap analysis of current
    operating procedures, recommend processes and technology solutions to streamline the referral process and
    specialty care. Specific deliverables include; volume of referrals received; existing volumes; identifying
    referring practitioners; volume per referring practitioner; volume per designated specialty; procedures for
    processing referrals; technology needs; personnel production capacity; scheduling timeframes; wait times by
    specialty; process improvement.
    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                               * Yes
      Achievement Value                                                                                                         1.00




5/25/2012                                                    Expand Specialty Care Capacity                                            81 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 1: Expand Specialty Care Capacity

  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                  Expand Specialty Care Capacity                       82 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 1: Expand Specialty Care Capacity

  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                  Expand Specialty Care Capacity                       83 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 1: Expand Specialty Care Capacity

  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                  Expand Specialty Care Capacity                       84 of 173
                                                     DSRIP Semi-Annual Reporting Form

CA 1115 Waiver - Delivery System Reform Incentive Payments (DSRIP)
DPH SYSTEM:                    Arrowhead Regional Medical Center
REPORTING YEAR:                DY 6
DATE OF SUBMISSION:            5/12/2011
                                                                             REPORTING ON THIS PROJECT:      * No
Category 1: Enhance Performance Improvement and Reporting Capacity

Below is the data reported for the DPH system.
* Instructions for DPH systems: Please select above whether you are reporting on this project. If 'yes',
please type in all of your DY milestones for the project below and report data in the indicated boxes (*).
*     The yellow boxes indicate where the DPH system should input data
      The black boxes indicate Milestones and will automatically populate and flow to summary sheets
      The blue boxes show progress made toward the Milestone ("Achievement Value") and will automatically
      populate and flow to summary sheets

Enhance Performance Improvement and Reporting Capacity

    DY Total Computable Incentive Amount:                                                                    *

    Incentive Funding Already Received in DY:                                                                *

    Process Milestone: ________________________________
                                (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                              *
    Denominator (if absolute number, enter "1")                                                              *
      Achievement                                                                                                N/A
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                  *




    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                        *
      Achievement Value


    Process Milestone: ________________________________
                                (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                              *
    Denominator (if absolute number, enter "1")                                                              *
      Achievement                                                                                                N/A
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                  *




    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                        *
      Achievement Value




5/25/2012                                                    Perf Improvement & Reporting                              85 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 1: Enhance Performance Improvement and Reporting Capacity

  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                  Perf Improvement & Reporting                         86 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 1: Enhance Performance Improvement and Reporting Capacity

  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                  Perf Improvement & Reporting                         87 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 1: Enhance Performance Improvement and Reporting Capacity

  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                  Perf Improvement & Reporting                         88 of 173
                                                       DSRIP Semi-Annual Reporting Form

CA 1115 Waiver - Delivery System Reform Incentive Payments (DSRIP)
DPH SYSTEM:                    Arrowhead Regional Medical Center
REPORTING YEAR:                DY 6
DATE OF SUBMISSION:            5/12/2011
                                                                               REPORTING ON THIS PROJECT:             * Yes
Category 2: Expand Medical Homes

Below is the data reported for the DPH system.
* Instructions for DPH systems: Please select above whether you are reporting on this project. If 'yes',
please type in all of your DY milestones for the project below and report data in the indicated boxes (*).
*     The yellow boxes indicate where the DPH system should input data
      The black boxes indicate Milestones and will automatically populate and flow to summary sheets
      The blue boxes show progress made toward the Milestone ("Achievement Value") and will automatically
      populate and flow to summary sheets

Expand Medical Homes

    DY Total Computable Incentive Amount:                                                                             * $ 8,334,391.00

    Incentive Funding Already Received in DY:                                                                         * $ 8,334,391.00

    Process Milestone: Expand and redefine the roles and responsibilities of primary care team members
                                 (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                                       *
    Denominator (if absolute number, enter "1")                                                                       *
      Achievement                                                                                                         Yes
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                           * Yes
    In concert with other DSRIP milestones ARMC is undertaking which focus on expanding our primary care
    capacity and adopting the medical home model, it has been necessary to reassess current roles and
    responsibilities as assigned to the various members of the clinic health care team. Redefined roles will affect
    medical assistants, clinic assistants, licensed vocational nurses (new to ARMC's medical homes), registered
    nurses, residents, physicians and clinic supervisors. In addition, ARMC is studying pilot projects from other
    institutions and coordinating training sessions with SNI to better define the role of our new "Panel Managers".
    (Documents on file with ARMC)
    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                                 * Yes
      Achievement Value                                                                                                           1.00


    Process Milestone: ________________________________
                                 (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                                       *
    Denominator (if absolute number, enter "1")                                                                       *
      Achievement                                                                                                         N/A
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                           *




    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                                 *
      Achievement Value




5/25/2012                                                         Expand Medical Homes                                                   89 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 2: Expand Medical Homes

  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                      Expand Medical Homes                             90 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 2: Expand Medical Homes

  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                      Expand Medical Homes                             91 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 2: Expand Medical Homes

  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                      Expand Medical Homes                             92 of 173
                                                      DSRIP Semi-Annual Reporting Form

CA 1115 Waiver - Delivery System Reform Incentive Payments (DSRIP)
DPH SYSTEM:                    Arrowhead Regional Medical Center
REPORTING YEAR:                DY 6
DATE OF SUBMISSION:            5/12/2011
                                                                              REPORTING ON THIS PROJECT:           * Yes
Category 2: Expand Chronic Care Management Models

Below is the data reported for the DPH system.
* Instructions for DPH systems: Please select above whether you are reporting on this project. If 'yes',
please type in all of your DY milestones for the project below and report data in the indicated boxes (*).
*     The yellow boxes indicate where the DPH system should input data
      The black boxes indicate Milestones and will automatically populate and flow to summary sheets
      The blue boxes show progress made toward the Milestone ("Achievement Value") and will automatically
      populate and flow to summary sheets

Expand Chronic Care Management Models

    DY Total Computable Incentive Amount:                                                                          * $ 8,334,391.00

    Incentive Funding Already Received in DY:                                                                      * $ 8,334,391.00

    Process Milestone: Develop a comprehensive care management program for diabetes patients
                                (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                                    *
    Denominator (if absolute number, enter "1")                                                                    *
      Achievement                                                                                                      Yes
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                        * Yes
    ARMC developed a Comprehensive Care Management Program for Diabetes. This program focuses on the
    six fundamental elements as identified by the Chronic Care Model developed by Ed Wagner, MD, MPH,
    Director of MacColl Institute for Health Innovation; (1) self-management; (2) decision support; (3) clinical
    information system; (4) delivery system design; (5) organization of health care; and (6) community. Within
    these elements there are specific concepts ("change concepts") that teams will use to direct their
    improvement efforts. This program will be implemented in one of ARMC's FHCs during DY 7. (Complete
    program manual is on file with ARMC.)
    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                              * Yes
      Achievement Value                                                                                                        1.00


    Process Milestone: ________________________________
                                (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                                    *
    Denominator (if absolute number, enter "1")                                                                    *
      Achievement                                                                                                      N/A
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                        *




    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                              *
      Achievement Value




5/25/2012                                                      Chronic Care Management                                                93 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 2: Expand Chronic Care Management Models

  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                    Chronic Care Management                            94 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 2: Expand Chronic Care Management Models

  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                    Chronic Care Management                            95 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 2: Expand Chronic Care Management Models

  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                    Chronic Care Management                            96 of 173
                                                     DSRIP Semi-Annual Reporting Form

CA 1115 Waiver - Delivery System Reform Incentive Payments (DSRIP)
DPH SYSTEM:                    Arrowhead Regional Medical Center
REPORTING YEAR:                DY 6
DATE OF SUBMISSION:            5/12/2011
                                                                             REPORTING ON THIS PROJECT:          * Yes
Category 2: Redesign Primary Care

Below is the data reported for the DPH system.
* Instructions for DPH systems: Please select above whether you are reporting on this project. If 'yes',
please type in all of your DY milestones for the project below and report data in the indicated boxes (*).
*     The yellow boxes indicate where the DPH system should input data
      The black boxes indicate Milestones and will automatically populate and flow to summary sheets
      The blue boxes show progress made toward the Milestone ("Achievement Value") and will automatically
      populate and flow to summary sheets

Redesign Primary Care

    DY Total Computable Incentive Amount:                                                                        * $ 8,334,391.00

    Incentive Funding Already Received in DY:                                                                    * $ 8,334,391.00


    Process Milestone: Establish baseline data for patient appt ‘no-show’ rates and primary care visit cycle times.

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                                  *
    Denominator (if absolute number, enter "1")                                                                  *
      Achievement                                                                                                    Yes
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                      * Yes
    ARMC reports an average "no-show" rate of 30% for all three Family Health Centers (FHC) for the period
    1/1/2010 - 12/31/2010, specifically, 38% for McKee, 23% for Westside, and 30% for Fontana. Utilizing
    Coleman & Associates cycle time calculations, ARMC had an average primary care cycle time of 72 minutes,
    specifically, 76 minutes for McKee, 73 minutes for Westside, and 68 minutes for Fontana. These will be the
    established baselines in which ARMC will measure progress towards future milestone goals.



    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                            * Yes
      Achievement Value                                                                                                      1.00


    Process Milestone: ________________________________
                                (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                                  *
    Denominator (if absolute number, enter "1")                                                                  *
      Achievement                                                                                                    N/A
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                      *




    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                            *
      Achievement Value




5/25/2012                                                        Redesign Primary Care                                              97 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 2: Redesign Primary Care

  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                      Redesign Primary Care                            98 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 2: Redesign Primary Care

  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                      Redesign Primary Care                            99 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 2: Redesign Primary Care

  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                      Redesign Primary Care                            100 of 173
                                                     DSRIP Semi-Annual Reporting Form

CA 1115 Waiver - Delivery System Reform Incentive Payments (DSRIP)
DPH SYSTEM:                    Arrowhead Regional Medical Center
REPORTING YEAR:                DY 6
DATE OF SUBMISSION:            5/12/2011
                                                                             REPORTING ON THIS PROJECT:      * No
Category 2: Redesign to Improve Patient Experience

Below is the data reported for the DPH system.
* Instructions for DPH systems: Please select above whether you are reporting on this project. If 'yes',
please type in all of your DY milestones for the project below and report data in the indicated boxes (*).
*     The yellow boxes indicate where the DPH system should input data
      The black boxes indicate Milestones and will automatically populate and flow to summary sheets
      The blue boxes show progress made toward the Milestone ("Achievement Value") and will automatically
      populate and flow to summary sheets

Redesign to Improve Patient Experience

    DY Total Computable Incentive Amount:                                                                    *

    Incentive Funding Already Received in DY:                                                                *

    Process Milestone: ________________________________
                                (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                              *
    Denominator (if absolute number, enter "1")                                                              *
      Achievement                                                                                                N/A
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                  *




    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                        *
      Achievement Value


    Process Milestone: ________________________________
                                (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                              *
    Denominator (if absolute number, enter "1")                                                              *
      Achievement                                                                                                N/A
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                  *




    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                        *
      Achievement Value




5/25/2012                                                          Patient Experience                                  101 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 2: Redesign to Improve Patient Experience

  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                        Patient Experience                             102 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 2: Redesign to Improve Patient Experience

  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                        Patient Experience                             103 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 2: Redesign to Improve Patient Experience

  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                        Patient Experience                             104 of 173
                                                     DSRIP Semi-Annual Reporting Form

CA 1115 Waiver - Delivery System Reform Incentive Payments (DSRIP)
DPH SYSTEM:                    Arrowhead Regional Medical Center
REPORTING YEAR:                DY 6
DATE OF SUBMISSION:            5/12/2011
                                                                             REPORTING ON THIS PROJECT:      * No
Category 2: Redesign for Cost Containment

Below is the data reported for the DPH system.
* Instructions for DPH systems: Please select above whether you are reporting on this project. If 'yes',
please type in all of your DY milestones for the project below and report data in the indicated boxes (*).
*     The yellow boxes indicate where the DPH system should input data
      The black boxes indicate Milestones and will automatically populate and flow to summary sheets
      The blue boxes show progress made toward the Milestone ("Achievement Value") and will automatically
      populate and flow to summary sheets

Redesign for Cost Containment

    DY Total Computable Incentive Amount:                                                                    *

    Incentive Funding Already Received in DY:                                                                *

    Process Milestone: ________________________________
                                (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                              *
    Denominator (if absolute number, enter "1")                                                              *
      Achievement                                                                                                N/A
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                  *




    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                        *
      Achievement Value


    Process Milestone: ________________________________
                                (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                              *
    Denominator (if absolute number, enter "1")                                                              *
      Achievement                                                                                                N/A
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                  *




    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                        *
      Achievement Value




5/25/2012                                                    Redesign for Cost Containment                             105 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 2: Redesign for Cost Containment

  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                  Redesign for Cost Containment                        106 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 2: Redesign for Cost Containment

  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                  Redesign for Cost Containment                        107 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 2: Redesign for Cost Containment

  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                  Redesign for Cost Containment                        108 of 173
                                                     DSRIP Semi-Annual Reporting Form

CA 1115 Waiver - Delivery System Reform Incentive Payments (DSRIP)
DPH SYSTEM:                    Arrowhead Regional Medical Center
REPORTING YEAR:                DY 6
DATE OF SUBMISSION:            5/12/2011
                                                                             REPORTING ON THIS PROJECT:      * No
Category 2: Integrate Physical and Behavioral Health Care

Below is the data reported for the DPH system.
* Instructions for DPH systems: Please select above whether you are reporting on this project. If 'yes',
please type in all of your DY milestones for the project below and report data in the indicated boxes (*).
*     The yellow boxes indicate where the DPH system should input data
      The black boxes indicate Milestones and will automatically populate and flow to summary sheets
      The blue boxes show progress made toward the Milestone ("Achievement Value") and will automatically
      populate and flow to summary sheets

Integrate Physical and Behavioral Health Care

    DY Total Computable Incentive Amount:                                                                    *

    Incentive Funding Already Received in DY:                                                                *

    Process Milestone: ________________________________
                                (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                              *
    Denominator (if absolute number, enter "1")                                                              *
      Achievement                                                                                                N/A
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                  *




    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                        *
      Achievement Value


    Process Milestone: ________________________________
                                (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                              *
    Denominator (if absolute number, enter "1")                                                              *
      Achievement                                                                                                N/A
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                  *




    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                        *
      Achievement Value




5/25/2012                                                     Integrate Physical Behavioral                            109 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 2: Integrate Physical and Behavioral Health Care

  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                   Integrate Physical Behavioral                       110 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 2: Integrate Physical and Behavioral Health Care

  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                   Integrate Physical Behavioral                       111 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 2: Integrate Physical and Behavioral Health Care

  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                   Integrate Physical Behavioral                       112 of 173
                                                     DSRIP Semi-Annual Reporting Form

CA 1115 Waiver - Delivery System Reform Incentive Payments (DSRIP)
DPH SYSTEM:                    Arrowhead Regional Medical Center
REPORTING YEAR:                DY 6
DATE OF SUBMISSION:            5/12/2011
                                                                             REPORTING ON THIS PROJECT:      * No
Category 2: Increase Specialty Care Access/Redesign Referral Process

Below is the data reported for the DPH system.
* Instructions for DPH systems: Please select above whether you are reporting on this project. If 'yes',
please type in all of your DY milestones for the project below and report data in the indicated boxes (*).
*     The yellow boxes indicate where the DPH system should input data
      The black boxes indicate Milestones and will automatically populate and flow to summary sheets
      The blue boxes show progress made toward the Milestone ("Achievement Value") and will automatically
      populate and flow to summary sheets

Increase Specialty Care Access/Redesign Referral Process

    DY Total Computable Incentive Amount:                                                                    *

    Incentive Funding Already Received in DY:                                                                *

    Process Milestone: ________________________________
                                (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                              *
    Denominator (if absolute number, enter "1")                                                              *
      Achievement                                                                                                N/A
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                  *




    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                        *
      Achievement Value


    Process Milestone: ________________________________
                                (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                              *
    Denominator (if absolute number, enter "1")                                                              *
      Achievement                                                                                                N/A
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                  *




    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                        *
      Achievement Value




5/25/2012                                                         Specialty Care Access                                113 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 2: Increase Specialty Care Access/Redesign Referral Process

  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                       Specialty Care Access                           114 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 2: Increase Specialty Care Access/Redesign Referral Process

  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                       Specialty Care Access                           115 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 2: Increase Specialty Care Access/Redesign Referral Process

  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                       Specialty Care Access                           116 of 173
                                                     DSRIP Semi-Annual Reporting Form

CA 1115 Waiver - Delivery System Reform Incentive Payments (DSRIP)
DPH SYSTEM:                    Arrowhead Regional Medical Center
REPORTING YEAR:                DY 6
DATE OF SUBMISSION:            5/12/2011
                                                                             REPORTING ON THIS PROJECT:      * No
Category 2: Establish/Expand a Patient Care Navigation Program

Below is the data reported for the DPH system.
* Instructions for DPH systems: Please select above whether you are reporting on this project. If 'yes',
please type in all of your DY milestones for the project below and report data in the indicated boxes (*).
*     The yellow boxes indicate where the DPH system should input data
      The black boxes indicate Milestones and will automatically populate and flow to summary sheets
      The blue boxes show progress made toward the Milestone ("Achievement Value") and will automatically
      populate and flow to summary sheets

Establish/Expand a Patient Care Navigation Program

    DY Total Computable Incentive Amount:                                                                    *

    Incentive Funding Already Received in DY:                                                                *

    Process Milestone: ________________________________
                                (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                              *
    Denominator (if absolute number, enter "1")                                                              *
      Achievement                                                                                                N/A
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                  *




    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                        *
      Achievement Value


    Process Milestone: ________________________________
                                (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                              *
    Denominator (if absolute number, enter "1")                                                              *
      Achievement                                                                                                N/A
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                  *




    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                        *
      Achievement Value




5/25/2012                                                        Patient Care Navigation                               117 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 2: Establish/Expand a Patient Care Navigation Program

  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                      Patient Care Navigation                          118 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 2: Establish/Expand a Patient Care Navigation Program

  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                      Patient Care Navigation                          119 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 2: Establish/Expand a Patient Care Navigation Program

  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                      Patient Care Navigation                          120 of 173
                                                     DSRIP Semi-Annual Reporting Form

CA 1115 Waiver - Delivery System Reform Incentive Payments (DSRIP)
DPH SYSTEM:                    Arrowhead Regional Medical Center
REPORTING YEAR:                DY 6
DATE OF SUBMISSION:            5/12/2011
                                                                             REPORTING ON THIS PROJECT:      * No
Category 2: Apply Process Improvement Methodology to Improve Quality/Efficiency

Below is the data reported for the DPH system.
* Instructions for DPH systems: Please select above whether you are reporting on this project. If 'yes',
please type in all of your DY milestones for the project below and report data in the indicated boxes (*).
*     The yellow boxes indicate where the DPH system should input data
      The black boxes indicate Milestones and will automatically populate and flow to summary sheets
      The blue boxes show progress made toward the Milestone ("Achievement Value") and will automatically
      populate and flow to summary sheets

Apply Process Improvement Methodology to Improve Quality/Efficiency

    DY Total Computable Incentive Amount:                                                                    *

    Incentive Funding Already Received in DY:                                                                *

    Process Milestone: ________________________________
                                (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                              *
    Denominator (if absolute number, enter "1")                                                              *
      Achievement                                                                                                N/A
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                  *




    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                        *
      Achievement Value


    Process Milestone: ________________________________
                                (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                              *
    Denominator (if absolute number, enter "1")                                                              *
      Achievement                                                                                                N/A
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                  *




    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                        *
      Achievement Value




5/25/2012                                                  Process Improvement Methodology                             121 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 2: Apply Process Improvement Methodology to Improve Quality/Efficiency

  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                Process Improvement Methodology                        122 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 2: Apply Process Improvement Methodology to Improve Quality/Efficiency

  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                Process Improvement Methodology                        123 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 2: Apply Process Improvement Methodology to Improve Quality/Efficiency

  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                Process Improvement Methodology                        124 of 173
                                                     DSRIP Semi-Annual Reporting Form

CA 1115 Waiver - Delivery System Reform Incentive Payments (DSRIP)
DPH SYSTEM:                    Arrowhead Regional Medical Center
REPORTING YEAR:                DY 6
DATE OF SUBMISSION:            5/12/2011
                                                                             REPORTING ON THIS PROJECT:      * No
Category 2: Improve Patient Flow in the Emergency Department/Rapid Medical Evaluation

Below is the data reported for the DPH system.
* Instructions for DPH systems: Please select above whether you are reporting on this project. If 'yes',
please type in all of your DY milestones for the project below and report data in the indicated boxes (*).
*     The yellow boxes indicate where the DPH system should input data
      The black boxes indicate Milestones and will automatically populate and flow to summary sheets
      The blue boxes show progress made toward the Milestone ("Achievement Value") and will automatically
      populate and flow to summary sheets

Improve Patient Flow in the Emergency Department/Rapid Medical Evaluation

    DY Total Computable Incentive Amount:                                                                    *

    Incentive Funding Already Received in DY:                                                                *

    Process Milestone: ________________________________
                                (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                              *
    Denominator (if absolute number, enter "1")                                                              *
      Achievement                                                                                                N/A
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                  *




    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                        *
      Achievement Value


    Process Milestone: ________________________________
                                (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                              *
    Denominator (if absolute number, enter "1")                                                              *
      Achievement                                                                                                N/A
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                  *




    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                        *
      Achievement Value




5/25/2012                                                            ED Patient Flow                                   125 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 2: Improve Patient Flow in the Emergency Department/Rapid Medical Evaluation

  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                          ED Patient Flow                              126 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 2: Improve Patient Flow in the Emergency Department/Rapid Medical Evaluation

  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                          ED Patient Flow                              127 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 2: Improve Patient Flow in the Emergency Department/Rapid Medical Evaluation

  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                          ED Patient Flow                              128 of 173
                                                     DSRIP Semi-Annual Reporting Form

CA 1115 Waiver - Delivery System Reform Incentive Payments (DSRIP)
DPH SYSTEM:                    Arrowhead Regional Medical Center
REPORTING YEAR:                DY 6
DATE OF SUBMISSION:            5/12/2011
                                                                             REPORTING ON THIS PROJECT:      * No
Category 2: Use Palliative Care Programs

Below is the data reported for the DPH system.
* Instructions for DPH systems: Please select above whether you are reporting on this project. If 'yes',
please type in all of your DY milestones for the project below and report data in the indicated boxes (*).
*     The yellow boxes indicate where the DPH system should input data
      The black boxes indicate Milestones and will automatically populate and flow to summary sheets
      The blue boxes show progress made toward the Milestone ("Achievement Value") and will automatically
      populate and flow to summary sheets

Use Palliative Care Programs

    DY Total Computable Incentive Amount:                                                                    *

    Incentive Funding Already Received in DY:                                                                *

    Process Milestone: ________________________________
                                (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                              *
    Denominator (if absolute number, enter "1")                                                              *
      Achievement                                                                                                N/A
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                  *




    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                        *
      Achievement Value


    Process Milestone: ________________________________
                                (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                              *
    Denominator (if absolute number, enter "1")                                                              *
      Achievement                                                                                                N/A
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                  *




    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                        *
      Achievement Value




5/25/2012                                                     Use Palliative Care Programs                             129 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 2: Use Palliative Care Programs

  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                   Use Palliative Care Programs                        130 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 2: Use Palliative Care Programs

  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                   Use Palliative Care Programs                        131 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 2: Use Palliative Care Programs

  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                   Use Palliative Care Programs                        132 of 173
                                                     DSRIP Semi-Annual Reporting Form

CA 1115 Waiver - Delivery System Reform Incentive Payments (DSRIP)
DPH SYSTEM:                    Arrowhead Regional Medical Center
REPORTING YEAR:                DY 6
DATE OF SUBMISSION:            5/12/2011
                                                                             REPORTING ON THIS PROJECT:      * No
Category 2: Conduct Medication Management

Below is the data reported for the DPH system.
* Instructions for DPH systems: Please select above whether you are reporting on this project. If 'yes',
please type in all of your DY milestones for the project below and report data in the indicated boxes (*).
*     The yellow boxes indicate where the DPH system should input data
      The black boxes indicate Milestones and will automatically populate and flow to summary sheets
      The blue boxes show progress made toward the Milestone ("Achievement Value") and will automatically
      populate and flow to summary sheets

Conduct Medication Management

    DY Total Computable Incentive Amount:                                                                    *

    Incentive Funding Already Received in DY:                                                                *

    Process Milestone: ________________________________
                                (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                              *
    Denominator (if absolute number, enter "1")                                                              *
      Achievement                                                                                                N/A
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                  *




    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                        *
      Achievement Value


    Process Milestone: ________________________________
                                (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                              *
    Denominator (if absolute number, enter "1")                                                              *
      Achievement                                                                                                N/A
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                  *




    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                        *
      Achievement Value




5/25/2012                                                  Conduct Medication Management                               133 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 2: Conduct Medication Management

  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                Conduct Medication Management                          134 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 2: Conduct Medication Management

  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                Conduct Medication Management                          135 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 2: Conduct Medication Management

  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                Conduct Medication Management                          136 of 173
                                                     DSRIP Semi-Annual Reporting Form

CA 1115 Waiver - Delivery System Reform Incentive Payments (DSRIP)
DPH SYSTEM:                    Arrowhead Regional Medical Center
REPORTING YEAR:                DY 6
DATE OF SUBMISSION:            5/12/2011
                                                                             REPORTING ON THIS PROJECT:      * No
Category 2: Implement/Expand Care Transitions Programs

Below is the data reported for the DPH system.
* Instructions for DPH systems: Please select above whether you are reporting on this project. If 'yes',
please type in all of your DY milestones for the project below and report data in the indicated boxes (*).
*     The yellow boxes indicate where the DPH system should input data
      The black boxes indicate Milestones and will automatically populate and flow to summary sheets
      The blue boxes show progress made toward the Milestone ("Achievement Value") and will automatically
      populate and flow to summary sheets

Implement/Expand Care Transitions Programs

    DY Total Computable Incentive Amount:                                                                    *

    Incentive Funding Already Received in DY:                                                                *

    Process Milestone: ________________________________
                                (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                              *
    Denominator (if absolute number, enter "1")                                                              *
      Achievement                                                                                                N/A
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                  *




    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                        *
      Achievement Value


    Process Milestone: ________________________________
                                (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                              *
    Denominator (if absolute number, enter "1")                                                              *
      Achievement                                                                                                N/A
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                  *




    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                        *
      Achievement Value




5/25/2012                                                            Care Transitions                                  137 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 2: Implement/Expand Care Transitions Programs

  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                         Care Transitions                              138 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 2: Implement/Expand Care Transitions Programs

  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                         Care Transitions                              139 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 2: Implement/Expand Care Transitions Programs

  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                         Care Transitions                              140 of 173
                                                     DSRIP Semi-Annual Reporting Form

CA 1115 Waiver - Delivery System Reform Incentive Payments (DSRIP)
DPH SYSTEM:                    Arrowhead Regional Medical Center
REPORTING YEAR:                DY 6
DATE OF SUBMISSION:            5/12/2011
                                                                             REPORTING ON THIS PROJECT:      * No
Category 2: Implement Real-Time Hospital-Acquired Infections (HAIs) System

Below is the data reported for the DPH system.
* Instructions for DPH systems: Please select above whether you are reporting on this project. If 'yes',
please type in all of your DY milestones for the project below and report data in the indicated boxes (*).
*     The yellow boxes indicate where the DPH system should input data
      The black boxes indicate Milestones and will automatically populate and flow to summary sheets
      The blue boxes show progress made toward the Milestone ("Achievement Value") and will automatically
      populate and flow to summary sheets

Implement Real-Time Hospital-Acquired Infections (HAIs) System

    DY Total Computable Incentive Amount:                                                                    *

    Incentive Funding Already Received in DY:                                                                *

    Process Milestone: ________________________________
                                (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                              *
    Denominator (if absolute number, enter "1")                                                              *
      Achievement                                                                                                N/A
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                  *




    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                        *
      Achievement Value


    Process Milestone: ________________________________
                                (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                              *
    Denominator (if absolute number, enter "1")                                                              *
      Achievement                                                                                                N/A
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                  *




    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                        *
      Achievement Value




5/25/2012                                                        Real-Time HAIs System                                 141 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 2: Implement Real-Time Hospital-Acquired Infections (HAIs) System

  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Process Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                      Real-Time HAIs System                            142 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 2: Implement Real-Time Hospital-Acquired Infections (HAIs) System

  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                      Real-Time HAIs System                            143 of 173
                                                   DSRIP Semi-Annual Reporting Form

Category 2: Implement Real-Time Hospital-Acquired Infections (HAIs) System

  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Improvement Milestone: ________________________________
                              (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                      Real-Time HAIs System                            144 of 173
                                                DSRIP Semi-Annual Reporting Form

CA 1115 Waiver - Delivery System Reform Incentive Payments (DSRIP)
DPH SYSTEM:                     Arrowhead Regional Medical Center
REPORTING YEAR:                 DY 6
DATE OF SUBMISSION:             5/12/2011
Category 3: Patient/Care Giver Experience (required)

Below is the data reported for the DPH system.
 * Instructions for DPH systems: Please type in all of your DY milestones for the project below and report data
in the indicated boxes (*). Note: for DY8, data from the last 2 quarters shall suffice.
*     The yellow boxes indicate where the DPH system should input data
      The black boxes indicate Milestones and will automatically populate and flow to summary sheets
      The blue boxes show progress made toward the Milestone ("Achievement Value") and will automatically
      populate and flow to summary sheets

Patient/Care Giver Experience (required)

    DY Total Computable Incentive Amount:                                                                 *

    Incentive Funding Already Received in DY:                                                             *

    Undertake the necessary planning, redesign, translation, training and contract
    negotiations in order to implement CG-CAHPS in DY8 (DY7 only)

    Provide an in-depth description of how the milestone was achieved:                                    *




      Achievement                                                                                             N/A
      Achievement Value


    Report results of CG CAHPS questions for “Getting Timely Appointments, Care,
    and Information” theme to the State (DY8-10)
    Top-box score composite of all questions within this theme from all returned surveys:
    Enter the percentage of responses that fell in the most positive response category                    *
      Achievement                                                                                             N/A
      Achievement Value


    Report results of CG CAHPS questions for “How Well Doctors Communicate With
    Patients” theme to the State (DY8-10)
    Top-box score composite of all questions within this theme from all returned surveys:
    Enter the percentage of responses that fell in the most positive response category                    *
      Achievement                                                                                             N/A
      Achievement Value


    Report results of CG CAHPS questions for “Helpful, Courteous, and Respectful Office
    Staff” theme to the State (DY8-10)
    Top-box score composite of all questions within this theme from all returned surveys:
    Enter the percentage of responses that fell in the most positive response category                    *
      Achievement                                                                                             N/A
      Achievement Value



5/25/2012                                                PatientCaregiver Experience                                145 of 173
                                               DSRIP Semi-Annual Reporting Form

Category 3: Patient/Care Giver Experience (required)

  Report results of CG CAHPS questions for “Patients’ Rating of the Doctor”
  theme to the State (DY8-10)
  Top-box score composite of all questions within this theme from all returned surveys:
  Enter the percentage of responses that fell in the response categories 9 and 10         *
    Achievement                                                                               N/A
    Achievement Value


  Report results of CG CAHPS questions for “Shared Decisionmaking”
  theme to the State (DY8-10)
  "Yes" rating composite of all questions within this theme from all returned surveys:
  Enter the percentage of responses indicating "yes"                                      *
    Achievement                                                                               N/A
    Achievement Value




5/25/2012                                               PatientCaregiver Experience                 146 of 173
                                                    DSRIP Semi-Annual Reporting Form

CA 1115 Waiver - Delivery System Reform Incentive Payments (DSRIP)
DPH SYSTEM:                    Arrowhead Regional Medical Center
REPORTING YEAR:                DY 6
DATE OF SUBMISSION:            5/12/2011
Category 3: Care Coordination (required)

Below is the data reported for the DPH system.
 * Instructions for DPH systems: Please type in all of your DY milestones for the project below and report data
in the indicated boxes (*).
*     The yellow boxes indicate where the DPH system should input data
      The black boxes indicate Milestones and will automatically populate and flow to summary sheets
      The blue boxes show progress made toward the Milestone ("Achievement Value") and will automatically
      populate and flow to summary sheets

Care Coordination (required)

    DY Total Computable Incentive Amount:                                                      *

    Incentive Funding Already Received in DY:                                                  *

    Report results of the Diabetes, short-term complications measure to the State
    (DY7-10)
    Data Collection Source                                                                     *
    Numerator                                                                                  *
    Denominator                                                                                *
      Rate
      Achievement                                                                                  N/A
      Achievement Value


    Report results of the Uncontrolled Diabetes measure to the State (DY7-10)
    Data Collection Source                                                                     *
    Numerator                                                                                  *
    Denominator                                                                                *
      Rate
      Achievement                                                                                  N/A
      Achievement Value


    Report results of the Congestive Heart Failure measure to the State (DY8-10)
    Data Collection Source                                                                     *
    Numerator                                                                                  *
    Denominator                                                                                *
      Rate
      Achievement                                                                                  N/A
      Achievement Value


    Report results of the Chronic Obstructive Pulmonary Disease measure
    to the State (DY8-10)
    Data Collection Source                                                                     *
    Numerator                                                                                  *
    Denominator                                                                                *
      Rate
      Achievement                                                                                  N/A
      Achievement Value




5/25/2012                                                            Care Coordination                            147 of 173
                                                DSRIP Semi-Annual Reporting Form

CA 1115 Waiver - Delivery System Reform Incentive Payments (DSRIP)
DPH SYSTEM:                     Arrowhead Regional Medical Center
REPORTING YEAR:                 DY 6
DATE OF SUBMISSION:             5/12/2011
Category 3: Preventive Health (required)

Below is the data reported for the DPH system.
 * Instructions for DPH systems: Please type in all of your DY milestones for the project below and report data
in the indicated boxes (*).
*     The yellow boxes indicate where the DPH system should input data
      The black boxes indicate Milestones and will automatically populate and flow to summary sheets
      The blue boxes show progress made toward the Milestone ("Achievement Value") and will automatically
      populate and flow to summary sheets

Preventive Health (required)

    DY Total Computable Incentive Amount:                                                     *

    Incentive Funding Already Received in DY:                                                 *

    Report results of the Mammography Screening for Breast Cancer
    measure to the State (DY7-10)
    Data Collection Source                                                                    *
    Numerator                                                                                 *
    Denominator                                                                               *
      Rate
      Achievement                                                                                 N/A
      Achievement Value


    Reports results of the Influenza Immunization measure to the State (DY7-10)
    Data Collection Source                                                                    *
    Numerator                                                                                 *
    Denominator                                                                               *
      Rate
      Achievement                                                                                 N/A
      Achievement Value


    Report results of the Child Weight Screening measure to the State (DY8-10)
    Data Collection Source                                                                    *
    Numerator                                                                                 *
    Denominator                                                                               *
      Rate
      Achievement                                                                                 N/A
      Achievement Value




5/25/2012                                                     Preventive Health                                   148 of 173
                                           DSRIP Semi-Annual Reporting Form

Category 3: Preventive Health (required)

  Report results of the Pediatrics Body Mass Index (BMI) measure to the State
  (DY8-10)
  Data Collection Source                                                        *
  Numerator                                                                     *
  Denominator                                                                   *
    Rate
    Achievement                                                                     N/A
    Achievement Value


  Report results of the Tobacco Cessation measure to the State (DY8-10)
  Data Collection Source                                                        *
  Numerator                                                                     *
  Denominator                                                                   *
    Rate
    Achievement                                                                     N/A
    Achievement Value




5/25/2012                                           Preventive Health                     149 of 173
                                                DSRIP Semi-Annual Reporting Form

CA 1115 Waiver - Delivery System Reform Incentive Payments (DSRIP)
DPH SYSTEM:                     Arrowhead Regional Medical Center
REPORTING YEAR:                 DY 6
DATE OF SUBMISSION:             5/12/2011
Category 3: At-Risk Populations (required)

Below is the data reported for the DPH system.
 * Instructions for DPH systems: Please type in all of your DY milestones for the project below and report data
in the indicated boxes (*). For the last two measures, which are both diabetes composite measures, please
follow the instructions on specifically how to calculate the composite measures (available based on NQF
endorsement).
*     The yellow boxes indicate where the DPH system should input data
      The black boxes indicate Milestones and will automatically populate and flow to summary sheets
      The blue boxes show progress made toward the Milestone ("Achievement Value") and will automatically
      populate and flow to summary sheets

At-Risk Populations (required)

    DY Total Computable Incentive Amount:                                                     *

    Incentive Funding Already Received in DY:                                                 *

    Report results of the Diabetes Mellitus: Low Density Lipoprotein
    (LDL-C) Control (<100 mg/dl) measure to the State (DY7-10)
    Data Collection Source                                                                    *
    Numerator                                                                                 *
    Denominator                                                                               *
      Rate
      Achievement                                                                                 N/A
      Achievement Value


    Report results of the Diabetes Mellitus: Hemoglobin A1c Control (<9%)
    measure to the State (DY7-10)
    Data Collection Source                                                                    *
    Numerator                                                                                 *
    Denominator                                                                               *
      Rate
      Achievement                                                                                 N/A
      Achievement Value


    Report results of the 30-Day Congestive Heart Failure Readmission Rate
    measure to the State (DY8-10)
    Data Collection Source                                                                    *
    Numerator                                                                                 *
    Denominator                                                                               *
      Rate
      Achievement                                                                                 N/A
      Achievement Value




5/25/2012                                                   At-Risk Populations                                   150 of 173
                                       DSRIP Semi-Annual Reporting Form

Category 3: At-Risk Populations (required)

  Report results of the Hypertension (HTN): Blood Pressure Control
  (<140/90 mmHg) measure to the State (DY8-10)
  Data Collection Source                                                        *
  Numerator                                                                     *
  Denominator                                                                   *
    Rate
    Achievement                                                                     N/A
    Achievement Value


  Report results of the Pediatrics Asthma Care measure to the State (DY8-10)
  Data Collection Source                                                        *
  Numerator                                                                     *
  Denominator                                                                   *
    Rate
    Achievement                                                                     N/A
    Achievement Value


  Report results of the Optimal Diabetes Care Composite to the State (DY8-10)
  Data Collection Source                                                        *
  Numerator                                                                     *
  Denominator                                                                   *
    Rate
    Achievement                                                                     N/A
    Achievement Value


  Report results of the Diabetes Composite to the State (DY8-10)
  Data Collection Source                                                        *
  Numerator                                                                     *
  Denominator                                                                   *
    Rate
    Achievement                                                                     N/A
    Achievement Value




5/25/2012                                          At-Risk Populations                    151 of 173
                                                      DSRIP Semi-Annual Reporting Form

CA 1115 Waiver - Delivery System Reform Incentive Payments (DSRIP)
DPH SYSTEM:                     Arrowhead Regional Medical Center
REPORTING YEAR:                 DY 6
DATE OF SUBMISSION:             5/12/2011
Category 4: Severe Sepsis Detection and Management (required)

Below is the data reported for the DPH system.
 * Instructions for DPH systems: Please type in all of your DY milestones for the project below and report data
in the indicated boxes (*).
*     The yellow boxes indicate where the DPH system should input data
      The black boxes indicate Milestones and will automatically populate and flow to summary sheets
      The blue boxes show progress made toward the Milestone ("Achievement Value") and will automatically
      populate and flow to summary sheets

Severe Sepsis Detection and Management

    DY Total Computable Incentive Amount:                                                                 * $     1,089,000.00

    Incentive Funding Already Received in DY:                                                             * $     1,089,000.00

    Compliance with Sepsis Resuscitation bundle (%)
    Numerator                                                                                             * N/A
    Denominator                                                                                           *
      % Compliance                                                                                            N/A
    DY Target (from the DPH system plan)                                                                  *
      Achievement Value


    Sepis Mortality (%)
    Numerator                                                                                             * N/A
    Denominator                                                                                           *
      % Mortality                                                                                             N/A
    DY Target (from the DPH system plan)                                                                  *
      Achievement Value

    Optional Milestone: Begin to collect data on Sepsis Bundle for purposes of establishing the baseline
                                 (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                           *
    Denominator (if absolute number, enter "1")                                                           *
      Achievement                                                                                             Yes
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:               * Yes
    ARMC began to collect data on the Sepsis Resuscitation Bundle for the purposes of establishing the
    baseline/benchmark. The reporting period is for December 2010; Compliance with Sepsis Resuscitation
    Bundle is 76%; Sepsis Mortality Rate is 29%. (Full report on file with ARMC)




    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                     * Yes
      Achievement Value                                                                                                  1.00


    Optional Milestone: ________________________________
                                 (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                           *
    Denominator (if absolute number, enter "1")                                                           *




5/25/2012                                                              Sepsis                                                    152 of 173
                                                    DSRIP Semi-Annual Reporting Form

Category 4: Severe Sepsis Detection and Management (required)
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Optional Milestone: ________________________________
                               (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Optional Milestone: ________________________________
                               (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                            Sepsis                                     153 of 173
                                                    DSRIP Semi-Annual Reporting Form

Category 4: Severe Sepsis Detection and Management (required)

  Optional Milestone: ________________________________
                               (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Optional Milestone: ________________________________
                               (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                            Sepsis                                     154 of 173
                                                       DSRIP Semi-Annual Reporting Form

CA 1115 Waiver - Delivery System Reform Incentive Payments (DSRIP)
DPH SYSTEM:                     Arrowhead Regional Medical Center
REPORTING YEAR:                 DY 6
DATE OF SUBMISSION:             5/12/2011
Category 4: Central Line Associated Blood Stream Infection (CLABSI) (required)

Below is the data reported for the DPH system.
 * Instructions for DPH systems: Please type in all of your DY milestones for the project below and report data
in the indicated boxes (*).
*     The yellow boxes indicate where the DPH system should input data
      The black boxes indicate Milestones and will automatically populate and flow to summary sheets
      The blue boxes show progress made toward the Milestone ("Achievement Value") and will automatically
      populate and flow to summary sheets

Central Line Associated Blood Stream Infection

    DY Total Computable Incentive Amount:                                                                                * $   1,089,000.00

    Incentive Funding Already Received in DY:                                                                            * $   1,089,000.00

    Compliance with Central Line Insertion Practices (CLIP) (%)
    Numerator                                                                                                            *
    Denominator                                                                                                          *
      % Compliance                                                                                                           N/A
    DY Target (from the DPH system plan)                                                                                 *
      Achievement Value


    Central Line Bloodstream Infection (Rate per 1,000 patient days)
    Numerator                                                                                                            *
    Denominator                                                                                                          *
      Infection Rate                                                                                                         N/A
    DY Target (from the DPH system plan)                                                                                 *
      Achievement Value

    Optional Milestone: Begin to collect data on CLABSI Bundle
                                  (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                                          *
    Denominator (if absolute number, enter "1")                                                                          *
      Achievement                                                                                                            Yes
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                              * Yes
    ARMC began to collect data on: (1) compliance with optimal catheter site selection, with avoidance of using the
    femoral vein for central venous access in adult patients, and (2) evidence of daily review of line necessity; with
    prompt removal of unnecessary lines. For the period December 2010, Compliance with Central Line Insertion
    Practices was at 88%; and Central Line Bloodstream Infection rate was 4.5. (Full report of file with ARMC).
    From this initial data collection period it has been determined that the Intensive Care Units need to be more
    compliant with daily review of central line necessity. Education is being scheduled.


    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                                    * Yes
      Achievement Value                                                                                                               1.00




5/25/2012                                                                CLABSI                                                               155 of 173
                                                    DSRIP Semi-Annual Reporting Form

Category 4: Central Line Associated Blood Stream Infection (CLABSI) (required)

  Optional Milestone: ________________________________
                               (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Optional Milestone: ________________________________
                               (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Optional Milestone: ________________________________
                               (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                            CLABSI                                     156 of 173
                                                    DSRIP Semi-Annual Reporting Form

Category 4: Central Line Associated Blood Stream Infection (CLABSI) (required)

  Optional Milestone: ________________________________
                               (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Optional Milestone: ________________________________
                               (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                            CLABSI                                     157 of 173
                                                          DSRIP Semi-Annual Reporting Form

CA 1115 Waiver - Delivery System Reform Incentive Payments (DSRIP)
DPH SYSTEM:                     Arrowhead Regional Medical Center
REPORTING YEAR:                 DY 6
DATE OF SUBMISSION:             5/12/2011
                                                                                  REPORTING ON THIS PROJECT:   * No
Category 4: Surgical Site Infection Prevention

Below is the data reported for the DPH system.
* Instructions for DPH systems: Please select above whether you are reporting on this project. If 'yes',
please type in all of your DY milestones for the project below and report data in the indicated boxes (*).
*     The yellow boxes indicate where the DPH system should input data
      The black boxes indicate Milestones and will automatically populate and flow to summary sheets
      The blue boxes show progress made toward the Milestone ("Achievement Value") and will automatically
      populate and flow to summary sheets

Surgical Site Infection Prevention

    DY Total Computable Incentive Amount:                                                                      *

    Incentive Funding Already Received in DY:                                                                  *

    Rate of surgical site infection for Class 1 and 2 wounds (%)
    Numerator                                                                                                  *
    Denominator                                                                                                *
      % Infection Rate                                                                                             N/A
    DY Target (from the DPH system plan)                                                                       *
      Achievement Value

    Optional Milestone: ________________________________
                                 (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                                *
    Denominator (if absolute number, enter "1")                                                                *
      Achievement                                                                                                  N/A
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                    *




    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                          *
      Achievement Value




5/25/2012                                                                         SSI                                    158 of 173
                                                        DSRIP Semi-Annual Reporting Form


Category 4: Surgical Site Infection Prevention

  Optional Milestone: ________________________________
                               (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Optional Milestone: ________________________________
                               (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Optional Milestone: ________________________________
                               (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                                       SSI                             159 of 173
                                                        DSRIP Semi-Annual Reporting Form


Category 4: Surgical Site Infection Prevention

  Optional Milestone: ________________________________
                               (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Optional Milestone: ________________________________
                               (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                                       SSI                             160 of 173
                                                       DSRIP Semi-Annual Reporting Form

CA 1115 Waiver - Delivery System Reform Incentive Payments (DSRIP)
DPH SYSTEM:                     Arrowhead Regional Medical Center
REPORTING YEAR:                 DY 6
DATE OF SUBMISSION:             5/12/2011
                                                                                  REPORTING ON THIS PROJECT:               * Yes
Category 4: Hospital-Acquired Pressure Ulcer Prevention

Below is the data reported for the DPH system.
* Instructions for DPH systems: Please select above whether you are reporting on this project. If 'yes',
please type in all of your DY milestones for the project below and report data in the indicated boxes (*).
*     The yellow boxes indicate where the DPH system should input data
      The black boxes indicate Milestones and will automatically populate and flow to summary sheets
      The blue boxes show progress made toward the Milestone ("Achievement Value") and will automatically
      populate and flow to summary sheets

Hospital-Acquired Pressure Ulcer Prevention

    DY Total Computable Incentive Amount:                                                                                  * $   1,089,000.00

    Incentive Funding Already Received in DY:                                                                              * $   1,089,000.00

    Prevalence of Stage II, III, IV or unstagable pressure ulcers (%)
    Numerator                                                                                                              *
    Denominator                                                                                                            *
      Prevalence (%)                                                                                                           N/A
    DY Target (from the DPH system plan)                                                                                   *
      Achievement Value

    Optional Milestone: Develop a plan to establish a baseline on HAPU Incidence and Prevalence
                                  (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                                            *
    Denominator (if absolute number, enter "1")                                                                            *
      Achievement                                                                                                              Yes
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                                * Yes
    ARMC has develop a robust plan for data collection on hospital-wide acquired pressure ulcer incidence and
    prevalance, including; education for nurses and medical staff; annual HAPU competencies; revised policies
    and procedures; develop a tool for daily monitoring of compliance with the Bundle; a designated Wound
    Resource Nurse on every Medical/Surgical, Telemetry, and Intensive Care Unit; development of a visual cue to
    identify patients at risk of pressure ulcers; revision of the computerized Patient Care Plan; development of
    software infrastructure to assist with data collection; and data reporting to hospital committees (full plan on file
    with ARMC).
    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                                      * Yes
      Achievement Value                                                                                                                 1.00




5/25/2012                                                                  HAPU                                                                 161 of 173
                                                    DSRIP Semi-Annual Reporting Form

Category 4: Hospital-Acquired Pressure Ulcer Prevention

  Optional Milestone: ________________________________
                               (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Optional Milestone: ________________________________
                               (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Optional Milestone: ________________________________
                               (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                             HAPU                                      162 of 173
                                                    DSRIP Semi-Annual Reporting Form

Category 4: Hospital-Acquired Pressure Ulcer Prevention

  Optional Milestone: ________________________________
                               (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Optional Milestone: ________________________________
                               (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                             HAPU                                      163 of 173
                                                  DSRIP Semi-Annual Reporting Form

CA 1115 Waiver - Delivery System Reform Incentive Payments (DSRIP)
DPH SYSTEM:                     Arrowhead Regional Medical Center
REPORTING YEAR:                 DY 6
DATE OF SUBMISSION:             5/12/2011
                                                                              REPORTING ON THIS PROJECT:     * Yes
Category 4: Stroke Management

Below is the data reported for the DPH system.
* Instructions for DPH systems: Please select above whether you are reporting on this project. If 'yes',
please type in all of your DY milestones for the project below and report data in the indicated boxes (*).
*     The yellow boxes indicate where the DPH system should input data
      The black boxes indicate Milestones and will automatically populate and flow to summary sheets
      The blue boxes show progress made toward the Milestone ("Achievement Value") and will automatically
      populate and flow to summary sheets

Stroke Management

    DY Total Computable Incentive Amount:                                                                    * $   1,089,000.00

    Incentive Funding Already Received in DY:                                                                * $   1,089,000.00

    Discharged on Antithrombotic Therapy
    Numerator                                                                                                *
    Denominator                                                                                              *
      % Compliance                                                                                               N/A
    DY Target (from the DPH system plan)                                                                     *
      Achievement Value


    Anticoagulation Therapy for Atrial Fibrillation/Flutter
    Numerator                                                                                                *
    Denominator                                                                                              *
      % Compliance                                                                                               N/A
    DY Target (from the DPH system plan)                                                                     *
      Achievement Value


    Thrombolytic Therapy
    Numerator                                                                                                *
    Denominator                                                                                              *
      % Compliance                                                                                               N/A
    DY Target (from the DPH system plan)                                                                     *
      Achievement Value


    Antithrombotic Therapy by End of Hospital Day 2
    Numerator                                                                                                *
    Denominator                                                                                              *
      % Compliance                                                                                               N/A
    DY Target (from the DPH system plan)                                                                     *
      Achievement Value




5/25/2012                                                            Stroke                                                       164 of 173
                                                    DSRIP Semi-Annual Reporting Form

Category 4: Stroke Management

  Discharged on Statin Medication
  Numerator                                                                                                         *
  Denominator                                                                                                       *
    % Compliance                                                                                                        N/A
  DY Target (from the DPH system plan)                                                                              *
    Achievement Value


  Stroke Education
  Numerator                                                                                                         *
  Denominator                                                                                                       *
    % Compliance                                                                                                        N/A
  DY Target (from the DPH system plan)                                                                              *
    Achievement Value


  Assessed for Rehabilitation
  Numerator                                                                                                         *
  Denominator                                                                                                       *
    % Compliance                                                                                                        N/A
  DY Target (from the DPH system plan)                                                                              *
    Achievement Value


  Stroke mortality rate
  Numerator                                                                                                         *
  Denominator                                                                                                       *
    Mortality Rate                                                                                                      N/A
  DY Target (from the DPH system plan)                                                                              *
    Achievement Value

  Optional Milestone: Develop a plan to report data collection on the 7 stroke management process measures
                               (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                                       *
  Denominator (if absolute number, enter "1")                                                                       *
    Achievement                                                                                                         Yes
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                           * Yes
  ARMC has developed a robust plan to report data collection on the 7 stroke management process measures
  for purposes of establishing a baseline and setting benchmarks, including; adding the following two measures
  to data collection (1) 30-day readmissions and (2) cost of care per inpatient case; Performance Improvement to
  collaborate with the Fiscal Services Department to obtain cost per inpatient case; revised current tool used to
  report stroke data to include 2 new measures; identifying a software system to facilitate data collection; and
  data reporting to select hospital committees (i.e. Stroke Committee, Quality Management Committee). Full
  report of file with ARMC.
  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                                 * Yes
    Achievement Value                                                                                                         1.00




5/25/2012                                                            Stroke                                                          165 of 173
                                                    DSRIP Semi-Annual Reporting Form

Category 4: Stroke Management

  Optional Milestone: ________________________________
                               (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Optional Milestone: ________________________________
                               (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Optional Milestone: ________________________________
                               (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                            Stroke                                     166 of 173
                                                    DSRIP Semi-Annual Reporting Form

Category 4: Stroke Management

  Optional Milestone: ________________________________
                               (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Optional Milestone: ________________________________
                               (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                            Stroke                                     167 of 173
                                                       DSRIP Semi-Annual Reporting Form

CA 1115 Waiver - Delivery System Reform Incentive Payments (DSRIP)
DPH SYSTEM:                     Arrowhead Regional Medical Center
REPORTING YEAR:                 DY 6
DATE OF SUBMISSION:             5/12/2011
                                                                         REPORTING ON THIS PROJECT:          * No
Category 4: Venous Thromboembolism (VTE) Prevention and Treatment

Below is the data reported for the DPH system.
* Instructions for DPH systems: Please select above whether you are reporting on this project. If 'yes',
please type in all of your DY milestones for the project below and report data in the indicated boxes (*).
*     The yellow boxes indicate where the DPH system should input data
      The black boxes indicate Milestones and will automatically populate and flow to summary sheets
      The blue boxes show progress made toward the Milestone ("Achievement Value") and will automatically
      populate and flow to summary sheets

Venous Thromboembolism (VTE) Prevention and Treatment

    DY Total Computable Incentive Amount:                                                                    *

    Incentive Funding Already Received in DY:                                                                *

    VTE Prophylaxis (%)
    Numerator                                                                                                *
    Denominator                                                                                              *
      % Compliance                                                                                               N/A
    DY Target (from the DPH system plan)                                                                     *
      Achievement Value


    Intensive care unit VTE prophylaxsis (%)
    Numerator                                                                                                *
    Denominator                                                                                              *
      % Compliance                                                                                               N/A
    DY Target (from the DPH system plan)                                                                     *
      Achievement Value


    VTE patients with anticoagulation overlap therapy (%)
    Numerator                                                                                                *
    Denominator                                                                                              *
      % Compliance                                                                                               N/A
    DY Target (from the DPH system plan)                                                                     *
      Achievement Value


    VTE patients receiving unfractionated heparin with dosages/platelet count monitoring (%)
    Numerator                                                                                                *
    Denominator                                                                                              *
      % Compliance                                                                                               N/A
    DY Target (from the DPH system plan)                                                                     *
      Achievement Value


    VTE discharge instructions (%)
    Numerator                                                                                                *
    Denominator                                                                                              *
      % Compliance                                                                                               N/A
    DY Target (from the DPH system plan)                                                                     *
      Achievement Value




5/25/2012                                                                VTE                                           168 of 173
                                                        DSRIP Semi-Annual Reporting Form


Category 4: Venous Thromboembolism (VTE) Prevention and Treatment

  Incidence of potentially preventable VTE (%)
  Numerator                                                                                           *
  Denominator                                                                                         *
    Incidence (%)                                                                                         N/A
  DY Target (from the DPH system plan)                                                                *
    Achievement Value

  Optional Milestone: ________________________________
                               (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Optional Milestone: ________________________________
                               (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Optional Milestone: ________________________________
                               (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                                       VTE                             169 of 173
                                                        DSRIP Semi-Annual Reporting Form


Category 4: Venous Thromboembolism (VTE) Prevention and Treatment

  Optional Milestone: ________________________________
                               (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Optional Milestone: ________________________________
                               (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Optional Milestone: ________________________________
                               (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                                       VTE                             170 of 173
                                                      DSRIP Semi-Annual Reporting Form

CA 1115 Waiver - Delivery System Reform Incentive Payments (DSRIP)
DPH SYSTEM:                     Arrowhead Regional Medical Center
REPORTING YEAR:                 DY 6
DATE OF SUBMISSION:             5/12/2011
                                                                                  REPORTING ON THIS PROJECT:   * No
Category 4: Falls with Injury Prevention

Below is the data reported for the DPH system.
* Instructions for DPH systems: Please select above whether you are reporting on this project. If 'yes',
please type in all of your DY milestones for the project below and report data in the indicated boxes (*).
*     The yellow boxes indicate where the DPH system should input data
      The black boxes indicate Milestones and will automatically populate and flow to summary sheets
      The blue boxes show progress made toward the Milestone ("Achievement Value") and will automatically
      populate and flow to summary sheets

Falls with Injury Prevention

    DY Total Computable Incentive Amount:                                                                      *

    Incentive Funding Already Received in DY:                                                                  *

    Prevalence of patient falls with injuries (Rate per 1,000 patient days)
    Numerator                                                                                                  *
    Denominator                                                                                                *
      Prevalence Rate                                                                                              N/A
    DY Target (from the DPH system plan)                                                                       *
      Achievement Value



    Optional Milestone: ________________________________
                                 (insert milestone)

    Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                                *
    Denominator (if absolute number, enter "1")                                                                *
      Achievement                                                                                                  N/A
    If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
    menu, and (if "yes") provide an in-depth description of how the milestone was achieved:                    *




    DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                          *
      Achievement Value




5/25/2012                                                          Falls with Injury                                     171 of 173
                                                    DSRIP Semi-Annual Reporting Form

Category 4: Falls with Injury Prevention

  Optional Milestone: ________________________________
                               (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Optional Milestone: ________________________________
                               (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Optional Milestone: ________________________________
                               (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                        Falls with Injury                              172 of 173
                                                    DSRIP Semi-Annual Reporting Form

Category 4: Falls with Injury Prevention

  Optional Milestone: ________________________________
                               (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value


  Optional Milestone: ________________________________
                               (insert milestone)

  Numerator (if N/A, use "yes/no" form below; if absolute number, enter here)                         *
  Denominator (if absolute number, enter "1")                                                         *
    Achievement                                                                                           N/A
  If "yes/no" as to whether the milestone has been achieved, select "yes" or "no" from the dropdown
  menu, and (if "yes") provide an in-depth description of how the milestone was achieved:             *




  DY Target (from the DPH system plan) or enter "yes" if "yes/no" type of milestone                   *
    Achievement Value




5/25/2012                                                        Falls with Injury                              173 of 173

				
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