Robert Margolis, M.D. Chairman & CEO HealthCare Partners

1. ACO’s – Getting from Here to There Benefits / Risks / Opportunities Robert Margolis, M.D. Chairman & CEO HealthCare Partners

2. National Delivery System California HealthCare Partners LLC HealthCare Partners Medical Group HealthCare Partners IPA Florida JSA Nevada Pinnacle Health Care Systems Summit Medical Group Fremont Medical Group Rainbow Medical Group In Patient Physician Network (IPN)

3. HealthCare Partners HealthCare Partners and its physician networks nationally serve over 1,000,000 patients including over 168,000 Medicare Advantage and over 500,000 commercially insured members primarily through global capitation. The pre-eminent physician-owned, professionally managed, patient-centered coordinated care system in the nation and an important delivery system in the many communities we serve.

4. Proactive Population Management The continuous ‘Virtuous Cycle’ of Improved care and outcomes is at the heart of HCP’s proactive population management. Continuous improvement to drive: • Better Care • Better Quality • Better Efficiency • Better Patient Experience

5. Target Patient Population Risk Stratification PMPM Costs

6. Stratifying Patients into the Appropriate Program $250 - $260 High PMPM Hospice/Palliative Care Home Care Management Provides in-home medical and palliative care management by Specialized Physicians, Nurse Care Managers and Social Workers for chronically frail seniors that have physical, mental, social and financial limitations that limits access to outpatient care, forcing unnecessary utilization of hospitals Level 4 Home Care Management $220 - $200 $130 - $140 High Risk Clinics and Care Management intensive one-on-one physician /nurse patient care and case management for the highest risk, most complex of the population. As the risk for hospitalization is reduced, patient is transferred to Level 2. Physicians and Care Managers are highly trained and closely Integrated into community resources and Physician offices or clinics. Level 3 High Risk Clinics ESRD Medical Home Complex Care and Disease Management Provides long-term whole person care enhancement for the population using a multidisciplinary team approach. Diabetes, COPD, CHF, CKD, Depression, Dementia Level 2 Complex Care and Disease Management Level 1 Self-Management & Health Education Programs Self Management, PCP Provides self-management for people with chronic disease. $ 50 - $100 Low PMPM

7. The HCP Care Team Approach Interactive and collaborative teams of clinicians support HCP clinical programs. • High Risk Programs: • Home Care • ESRD • Comprehensive Care Center • Post-Acute Comprehensive Care • Disease Management Programs: • Diabetes • CAD • CHF • COPD • Dementia

8. Clinical Data, Clinical Tools Disease Registries for every HCP physician to better understand the make up of his or her patient panel • Web-based, Self-Serve, Disease Registries: • Diabetes • COPD • CHF • CKD • Dementia • CAD • Asthma • Depression

9. Outreach / Compliance OpportunitiesCustom Registries Based on Specific Interventions

10. Results – Medicare Patients • Acute Bed Days ~ 1/3 national average @ 800 days 1K • Readmission – all cause 30 days ~ ½ national average @ 12% (including elective readmissions) • Terminal in hospital care ~ ½ national average @ < 20% • Quality / HEDIS metrics ≥ national statistics • Patient Satisfaction (“very” and “completely satisfied”) > 90%

11. CMMI Opportunity • Embrace Medicare FFS ACO’s • The Quality Improvement and Savings Opportunities are Enormous • Population Based Payment Incentives Work!

12. Clinica Family Health Services Pete Leibig, CEO WWW.CLINICA.ORG

13. Underserved population Continuity If one thing… TEAM Based Way to be evidenced based Care Space Design Patient Centered Population Health Management

14. Patient Centered Population Health Management Group Care Space Design Alternative Visits • Lower A1c • Lower LBW • Higher Satisfaction Advanced Access

15. Information Systems Partnering Community Health Record EHR Templates Evidence based Registries Outcome Reports

16. Self Management - Patient Activation

18. CMMI Help! www.clinica.org • Colorado cutting Clinica’s FQHC payments as a way to reduce Medicaid expenses. DRAT!!! • Quality up – outcomes improving • Compensation down $3 million (23%) • HRSA wants more users at same cost to them – 22% of total • Need demonstration of FQHC QI Investment payoff to 3rd parties • Share FQHC savings impact with Governors and Medicaid Directors in a meaningful way –they are trying to save money by cutting what we’re paid.