Martin Pearson, President Troy Gautier, Managing Director

1. Martin Pearson, President Troy Gautier, Managing Director

2. ACOs are the future of integrated collaborative Health Care solutions and provide the best opportunity to improve services and reduce costs. Alliances Progress and Revcon Alliances are professional consulting firms specialized in designing and implementing ACOs. Our service offering provides the support and expertise to ensure successful delpoyment of your ACO and the quickest return on investment in the healthcare industry. Major workstreams include: Design – people, process, technology and lean operating models Build – health care team, payer-provide relations, shared best practices Optimize – assist physicians and adminsitrative staff to obtain & measure results The following pages provide an overview of our approach and credentials. Managment consultants and business/technology process specialists Alliance professionals with hundreds of projects building succesful ecosystems HC IT speicalists to carry-out package selction and implement solutions Accountable Care Organizations (ACO) Page 2

3. ACO Presentation Index 1 History and Context 2 Legislation – Affordable Care Act 3 ACO Examples 4 How to build an ACO 5 Roles & Responsabilities 6 RevCon Alliances and Alliances Progress 7 Next Steps 8 Contact Us Page 3

4. History - background for ACOs Better health care solutions are a moral and economic imperative ! Accountable Care Organizations • ACOs were created as a result of the Affordable Care Act (ACA) that was signed into law March 23, 2010. • CMS and the Congressional Budget Office agree the purpose of ACOs is to ensure quality service and reduce costs. Also, to ensure that the Medicare budget grows no faster than the rate of growth of the economy in general. • Hospital specific index of costs has historically grown at a rate double that of the consumer price index. This growth rate is unsustainable given the arrival of Baby Boomer patients in the coming years. • The ACA created a demonstration period that runs between 2012 and 2014. As of 12/31/2012 close to 200 ACOs have been established and this number is expected to double or triple by 2014. • Full implementation begins 2015 and runs to 2020 when it’s expected that virtually all Medicare payments to providers will flow through ACOs. Page 4

5. Context - for ACOs Better health care solutions are a moral and economic imperative ! Context • All ACOs have a common objective built around three core tenets: • Patient Satisfaction • Improved Outcomes • Affordability • An ACO’s success requires thinking about all collaboration of stakeholders and patient-centricty in a seamless care continuim. • ACOs can be considered a preferred procurement program where by Medicare only reimburses for services to its beneficiaries to providers adhearing to this program. • ACO design, build and optimization is greatly enhanced by the use of alliance professionals and consultants who understand how to make the complexities of advanced collaborative solutions work. Page 5

6. Legislation - Affordable Care Act (ACA) Incentive Payments and Autorization • Under the ACA, the Secretary of Health and Human Services established ACOs to promote best practices and funnel incentive payments to healthcare providers. • Two ways to authorize an ACO: • Physician only with minimum of 5,000 Medicare enrollees where physicians own and control the network. • Hospital sponsorship as long as there is physician co-sponsorship with a minimum of 5,000 Medicare enrollees . Page 6

7. ACO Requirements ACA requirements to form an ACO under Medicare Shared Savings Program • Define processes to promote the practice of evidence-based medicine and provide data to evaluate quality and cost measures. • Build a management and leadership structure that includes administrative and clinical systems. • Develop a formal legal structure that allows the organization to receive payments and distribute shared savings among participating providers. • Have enough primary care providers to provide care to a minimum of 5,000 Medicare beneficiaries. • Provide the Centers for Medicare & Medicaid Services with a list of participating primary care practitioners and specialists. • Contract with a core group of specialist physicians. • Agree to participate in the program for a minimum of three years. Page 7

8. ACO Examples in Georgia WellStar Health Network, LLC • Located in Marietta, Georgia, is comprised of partnerships between hospitals and ACO professionals, with 1,203 physicians. It will serve Medicare beneficiaries in Georgia. Piedmont Physicians Group Piedmont Physicians Group launched a pilot ACO with Cigna in July 2010. The ACO covers about 10,000 people in Cigna health plans. Under the pilot, Cigna pays the providers of Piedmont Physicians Group — which includes more than 100 primary care physicians — as usual for medical services, along with an additional fee for care coordination and medical home services. Physicians also get bonus payments if they meet targets for better quality and lower costs. Accountable Care Coalition of Greater Athens Georgia The Coalition of Athens Area Physicians partnered with Collaborative Health Systems to form the ACC of Greater Athens Georgia, which is participating in the Medicare Shared Savings Program. The Coalition includes more than 230 independent physicians. Approximately 8,500 Medicare beneficiaries are covered by this ACO. Page 8

9. Challenges to ACO Formation and Optimization Capital Investment • ACO require significant up-front capital. The development of a strong IT framework alone requires a sizable capital investment. Access to capital may be challenging for some organizations but can be obtained. Physician buy-in • Some physicians may have concerns about relinquishing autonomy and may resist shared-payment arrangements. There is a cultural challenge to obtain agreement. Alliance professionals and facilitating consultants may be necessary at this stage. Patient buy-in • Patients likely will be assigned to an ACO, but they also will be allowed to see providers outside of the ACO. ACOs will need to educate consumers about their role in reducing costs and improving quality. • ACOs require the coalescing of diverse provider groups to develop a new system of care with the aim of improving quality and reducing costs. The move from a “fee for service” to a “fee for outcome” system requires creative collaborative solutions: physician alignment is key. Organizational Sharing Strategies Page 9 Source: H&HN research 2011

10. Formalize & Funding Physician buy-in Patient buy-in Shared EMR Change Mgmt Design, Build and Optimize an ACO Five crucial steps to implementing an ACO • Create legal entity • Assess capital strategy • Conduct gap analysis • Analyze market and assess ACO position • Patient-centered processes • Patients involved in own care and decision-making • Primary care model refined • Patient education • Performance improvements • Quality improvements • Quality reporting • Develop plan for physician integration • Design strategic partnerships • Structure comp for ACO-oriented culture • Develop IT investment plan • Design & implement EHR and HIE • Real-time access of clinical data Page 10

11. Stages of ACO Development – where are you today? Early Adapter – ACO has been launched These organizations will have the funding, the physician support, the talented leadership to make decisions, and the confidence to move before their competitors. They will have first mover advantage. Join Up – Partner with an existing ACO These organizations will watch the first movers, save their own cash, and simply join by contract with what they perceive to be the dominant local ACO. Wait and see – join an ACO at the 11th hour Many organizations choosing to stay outside the process for ideological reasons will be sorry once the new Medicare juggernaut gets rolling. CMS encourages this group to find ways to connect to larger organizations. Next wave - ACO 2.0 In this approach regional competitor systems might come together with the blessing of the antitrust watchdogs to create large networks to serve regional populations more effectively.. Page 11

12. Roles and Responsibilities and Services Provided by Consultants Provider Organizations Alliance professionals/consultants Governance • Patient centered primary care model • Patient education • Gather key decision-makers together • Agree to a governance model • Agree to operating principals • Establish a strong communications plan • Gain buy-in from key stakeholders • Executive leadership and oversight • Physician leadership and synergy developement • Drive and contract relationships with other service and technolgy providers • Prepare and facilitate meetings • Assist in implementation strategies • Operationalize decisions • Clinical managerment systems • Quality recording and reporting • Robust IT infastructure • Relations with governement entities • Relations with adminsitrative staff • Planning – short and long term • Formal reporting Source: H&HN research 2011 Page 12

13. Alliances Progress and RevCon Alliances • Alliances Progress: • Experts in creative collaborative solutions and ecosystem development • 20+ years in major global consultancy • Strong network of HC and IT providers • RevCon Alliances: • 15+ year management level with high tech companies in the healchcare sector • Expertise in health IT, physician alignment and relationships with community providers along the continuum Page 13

14. Martin Pearson, CPA, PresidentRevCon Alliances2402 River Green Drive NWAtlanta, GA 30327O: 404-842-1215C: 404-374-9565martinp@revconalliances.comTwitter: revconallianceswebsite: www.revconalliances.com Troy J Gautier, Managing DirectorAlliances Progress1085 Richmond Glen CirAlpharetta, GA 30004Tel: 678-644-2533TroyGautier@AlliancesProgress.com http://alliancesprogress.com/strategic-alliances/what-is-an-accountable-care-organization-aco/ Page 14