Corporate Healthcare Ideas: Thinking Outside the Box with Employer Sponsored Clinics WAHU

1. Corporate Healthcare Ideas:Thinking Outside the Box withEmployer Sponsored ClinicsWAHU John Neuberger Vice President Operations September 19, 2008

2. The Problem CRISIS Healthcare Cost and Quality

3. A Crisis in Healthcare A Lack of Coordination & Integration Specialist PCP

4. Our Healthcare System • Costs $7,000/person, twice as much as other industrialized countries spend to cover every citizen • 30% of dollars and up to half of doctors and nurses time spent on paperwork • Only 1/3 of time is evidence-based medicine practiced • Healthcare costs to businesses up 140% in the last 10 years, 5x wage growth • But primary care real incomes are down

5. A Crisis in Healthcare Overstressed PCP No Universal EMR No System Integration No Financial Incentives Lack of Care Coordination

6. One Employer’s Solution to the Healthcare Crisis

7. Who is Quad/Graphics? • Founded in 1971 • The world’s largest privately held printer of magazines and catalogs • 10 printing plants in 6 states • International partnerships with printers in Poland, Argentina and Brazil • More than 10,000 employees • $2.0 billion in annual sales

8. A Sample of Quad/Graphics Clients Advertising Age Cargo Entertainment Weekly Elegant Bride Golf Digest Health JC Penney Life National Geographic Newsweek People Self Time Inc. U.S. News & World Report Victoria’s Secret Williams-Sonoma

9. Why Is Quad/Graphics In The Health Care Business? • Control costs by providing a full range of healthcare services • Focus on wellness and preventive medicine • Enhance quality through best practice guidelines and Evidence-Based Medicine • Offer benefits that attract, retain staff • Maintain flexibility in benefit design • Improve patient access with onsite facilities

10. Who Is QuadMed?

11. Quad Med – A Medical Subsidiary of Quad Graphics • Opened first clinic in 1990 • Currently manages 8 clinics • 5 Quad Graphics • 2 Briggs & Stratton (2002 & 2004) • 1 Miller Brewing Company (2005) • In 2007 Quad Med Provided • 120,500 Clinic Visits • 122,100 Prescriptions • 21,800 Dental Visits • 17,600 Rehab Visits • 230,000 Adjudicated Claims

12. Briggs & Stratton Health Center

13. Miller Health & Fitness Center

14. Comprehensive integrated on-site services: Requires balance Medical Management Risk Management Health Transformation/ Population Management Acute care Injuries and Illness Disability Management Primary Care Referral Management Health Advocacy OSHA Reporting Chronic Disease Management Workers Compensation Absence Management Wellness/ Prevention Case Management On-site pharmacy

15. QuadMed Strategy • Provide onsite primary care & selected specialty care • Focus on prevention and wellness • Restructure the delivery of primary care • Focus on patient centered care • Salaried providers, not “production” based reimbursement • Incentives based on quality – customer satisfaction, adherence to guidelines, preventive services, collegiality, committee participation • Provide ample “face time” with patients • Provide resources supporting quality care • Provide specialty care & hospital care through direct contracting “Narrow Networks” • Remove waste and improve quality - LEAN • Integrate workers’ compensation into primary care services

16. Health Plan Design Prevention & Wellness Fitness Centers Data Warehouse TPA Case Management Disease Management Workers Compensation Occupational Health Physical & Occupational Therapy Electronic Medical Record Pharmacy Prepackaged meds EAP & AODA Counseling Direct Contracting High Performance Networks The Power of Integration & Coordination On-Site Primary Care Clinic

17. The Savings of Employer Managed Healthcare

18. QuadMed Track Record Average healthcare cost per employee

19. Actuarial Study Quad/Graphics’ healthcare costs are consistently below the benchmark, when adjusted for demographics and benefit design: • 18% below in 1998 • 19% below in 2000 • 17% below in 2002 • 26% below in 2004 • 32% below in 2006

20. Potential Savings for an On-Site Clinic and Pharmacy Onsite care can provide the following additional savings Lab – 94% Savings Rehab – 54% Savings Pharmacy- 8% Savings Direct Contracting – 11% Savings

21. Average Healthcare Cost Trend 2000-2007 per employee per year 4.9%

22. Briggs & Stratton Per Employee Cost Comparison

23. Steinhafels Experience at Quad PHCS VS Quad shows 16% savings per month per participant Based on 2007 Data

24. The Health Plan

25. Power Of Benefit Design Weekly Premium of $11 per single, $22 per couple, $32 per Family Providers Deductible/Copay Coverage Dollars Spent

26. Quality of Care Measures

27. Satisfaction Surveys Patient Staff Provider Data Warehouse (Ingenix) Key Indicator Report – Comparative Activity Report Evidence-Based Medicine Report Ad Hoc Reports EMR/PM (GE Centricity) Focused EBM Reports – Individually Actionable Quality of Care – Reporting Tools

28. Key Indicator Report – National Experience

29. Evidence-Based Medicine Compliance Ingenix Database

30. Quality of Care Analysis - EMR • Immunizations • Up-to-date on all immunizations at age 2 • QuadMed - 98% • NCQA - 68% • Up-to-date at age 13 • QuadMed - 88% • NCQA - 50%

31. In Summary • QuadMed has developed a program that has been successful in controlling cost and improving quality of care for QuadGraphics. • The program focuses on: • Patient Centered Care • Empowered Primary Care • Wellness and Prevention • Practice of Evidence-Based Medicine • True Integration of Healthcare Across Disciplines • The program can be successfully implemented at a myriad of industries and organizations with similar results.