C 2003 Premier, Inc.

1. C 2003 Premier, Inc. Improving the health of our biggest community Premier’s Environmentally Preferred Purchasing (EPP) Program

2. The issue • Environmental health and pollution prevention has become • a critical issue in American healthcare • Questions have arisen about the long-term effects of certain products containing mercury, phthalates, and other potential hazards identified by the EPA

3. A call to action • June 24, 1998: Memorandum of Understanding (MOU) between EPA and AHA to address pollution prevention in health care • Goals • eliminate hazardous materials in waste, including mercury and other toxic chemicals • minimize the volume of waste • H2E - Hospitals for a Healthy Environment initiative launched to implement these goals

4. What is H2E? • Joint project of the AHA, EPA, Healthcare Without Harm, and the American Nurses Association • An industry wide collaborative effort to assist hospitals in eliminating mercury and reducing waste and other hazardous and toxic materials in waste. • Voluntary program designed to help hospitals enhance workplace safety and promote environmentally friendly practices • H2E exists to educate healthcare professionals about pollution prevention opportunities in hospitals and healthcare systems

5. H2E Partners • H2E Champions for Change • 43 Organizations that support the H2E goals • Premier designated as a Champion since 2002 • H2E Partners • Health care facilities that commit to making changes to protect community and environmental health • 98 of the 400+ H2E partners are Premier members.

6. Premier an early adopter • Premier’s EPP (Environmentally Preferable Purchasing program) initiated in 2001 • Premier’s EPP program a collaborative effort of Group Purchasing Services and the Safety Institute

7. Premier wins 2003 H2E Champion for Change Award In recognition of its EPP program and leadership role in helping hospitals enhance workplace safety and promote environmentally friendly practices

8. Significance of award • Premier only group purchasing organization in U.S. to receive the prestigious award • Recognized as playing a pivotal role in “greening” the healthcare industry • Promotes Premier’s publicly available environmental and safety resources

9. What is EPP? Environmentally Preferable Purchasing The act of purchasing products and services for which the environmental impacts have been considered and found to be less damaging to the environment and human health than competing products and services that serve the same purpose.

10. What are the goals of Premier’s EPP program? • Enhance the safety and health of patients and healthcare workers and the healthcare environment; • Support and promote efforts to reduce or eliminate products and packaging deemed harmful to the environment; and • Assist members in meeting the EPA/AHA Memorandum of Understanding goal of virtual elimination of mercury containing waste by 2005 and reducing the total volume of waste generated in healthcare by 33% by 2005 and 50% by 2010.

11. Premier’s Position Statement on EPP on public Web site www.premierinc.com/safety • Ongoing input from members to define EPP • Ongoing review of state and national laws, regulations and guidelines • Assist members in product EPP identification to meet national or local requirements • Collaborate with companies with EPP agenda • Special consideration to companies that support EPP products and packaging • Reasonable efforts to help resolve conflicts between member policies regarding reuse of single-use devices (SUDs) and commitment to Premier’s group purchasing policies

12. Premier milestones as H2E ‘Champion for Change’ • Supplier qualification review process to address: • corporate environmental programs • environmental friendliness of products and packaging • EPP resources on Premier supplier Web site • Supplier and member EPP assessment tool on Premier public web site • Premier pledge to eliminate mercury-containing products from group contract portfolio

13. Premier milestones . . • Extensive Web site resources to assist with pollution prevention and environmentally preferable purchasing • www.premierinc.com/safety

14. Premier milestones.. Pharmaceuticals with Mercury List • Only comprehensive list of pharmaceuticals with mercury - available to public • To assist in the identification, management, and/or disposal of these drugs as potentially hazardous waste.

15. Premier milestones . . • Environmental and Safety Product Lists

16. eNews on EPP and Safety Premier milestones . . . . All EPP articles archived on web site

17. Premier milestones . . • Co-sponsoring of Clean Med, international EPP conferences, for three consecutive years • Implementing an internal corporate office program for recycling includes paper, plastic bottles, cans, fax toner, ink/printer cartridges, office supplies (binders) and computers

18. Premier members also named H2E award winners • Champions for Change Award • Catholic Healthcare West (2002-03) • Catholic Healthcare East (2002)

19. Premier members also named H2E award winners • Partners for Change Awards • Given annually to facilities that have made significant progress toward reducing waste, preventing pollution, and eliminating mercury • Baystate Health System • Borgess Medical Center • Detroit Medical Center Health System • Dominican Hospital (CHW) • Fletcher Allen Health Care • Lenox Hill Hospital • St. Elizabeth Community Hospital (CHW)

20. Premier members also named H2E award winners • Partner Recognition Awards • (Given annually to Partner facilities that have met their self-identified H2E goals for the previous year) • Sparrow Health System • Mary Lane Hospital • St. Bernadine Medical Center

21. Premier members also named H2E ‘03 award winners • Making Medicine Mercury Free • (One-time award given to facilities that have met the challenge of becoming “mercury free.” ) • Borgess Medical Center, Kalamazoo, MI • Detroit Medical Center Health System • St. Elizabeth Medical Center, Edgewood, KY

22. Become an H2E partner • As an H2E Champion for Change, Premier encourages member healthcare facilities to become an H2E partners and make changes in their own institutions that support the goals of the H2E program • Apply for H2E partner membership status at • www.h2e-online.org

23. Who is eligible to be a H2E Partner for Change? • The Partners for Change program is open to hospitals, clinics, nursing homes, and any other healthcare facility

24. Why become an H2E partner? • H2E Partners that commit to eliminate toxic materials from their waste stream and reduce overall medical and toxic waste, benefit by: • advancing community health and protecting the environment • reducing healthcare supply and operating costs and liability • gaining recognition in their community

25. 98 Premier members are currently H2E Partners for Change • Fairview Hospital • Fletcher Allen Health Care • Foote Health System • Franklin Medical Center • Glendale Memorial Hospital and Health Center • Hackensack University Medical Center • Harper University Hospital • Henry Ford Hospital • Henry Ford Wyandotte General Hospital • Hospital of Saint Raphael • Huron Valley Sinai Hospital • Hutzel Hospital • Inova Fairfax Hospital/Inova Fairfax Hospital for Children • Inova Mount Vernon Hospital • John T. Mather Memorial Hospital • Kingswood Hospital • Lapeer Regional Hospital • Lenox Hill Hospital • Lexington Memorial Hospital, Inc. • Marian Medical Center • Mary Lane Hospital • McLaren Regional Medical Center • Mercy General Hospital • Mercy Health System • Mercy Hospital • Albert Einstein Healthcare Network • Alexian Brothers Medical Center • Alta Bates Summit Medical Center • Bakersfield Memorial Hospital • Bay Medical Center • Baystate Medical Center • Beth Israel Deaconess Medical Center • Bi-County Hospital • Borgess Medical Center • Bronx-Lebanon Hospital Center • California Hospital Medical Center • Carle Foundation Hospital • Chelsea Community Hospital • Children's Hospital of Michigan • Children's National Medical Center • Christiana Care • Corona Regional Medical Center - Magnolia • Crittenton Hospital in Rochester • Detroit Medical Center Health System • Detroit Recieving Hospital/University Health Center • Dominican Hospital • Duke University • Elliot Hospital • Ellis Hospital • Fairbanks Memorial Hospital & Denali Center As of March 2003

26. 98 Premier members are currently H2E partners for change • Mercy Hospital • Mercy Hospital of Folsom • Mercy Medical Center • Mercy Medical Center Mt. Shasta • Mercy Medical Center Redding • Mercy Southwest Hospital • Mercy Westside Hospital • Metropolitan Hospital • Montgomery General Hospital • NCH Healthcare System • Ogallala Community Hospital • North Broward Hospital District • Northridge Hospital Medical Center - Roscoe • Northridge Hospital Medical Center-Sherman Way • O'Connor Hospital • Our Lady of Lourdes Medical Center • Rehabilitation Hospital of Michigan • Saint Barnabas Hospital • Saint Francis Hospital • Saint James Hospital • Saint Joseph Hospital • Santa Ynez Valley Cottage Hospital • Sequoia Hospital • Seton Medical Center • Seton Medical Center Coastside • .Sibley Memorial Hospital • .South Nassau Community Hospital • .Sparrow Health System • .St. Bernardine Medical Center • .St. Clare Hospital & Health Services • .St. Elizabeth Community Hospital • .St. Elizabeth Hospital • .St. Elizabeth Medical Center • .St. Francis Medical Center • .St. Francis Medical Center • .St. John's Pleasant Valley Hospital • .St. John's Regional Medical Center • .St. John's Riverside Hospital • .St. Joseph Hospital • .St. Joseph Hospital • .St. Joseph's Hospital and Medical Center, CHW • .St. Mary’s Regional Medical Center • .St. Rose Dominican Hospital, CHW • .Thomas Jefferson University Hospital • .Transylvania Community Hospital • .Wagner Community Memorial Hospital • .Wayne Memorial Hospital • Woodland Healthcare • As of March 2003

27. Improve the health of our biggest community Become an H2E Partner for Change www.h2e-online.org