Lisa Rasor, Acct Mgr Max Sanchez, SC

1. SYBASE Healthcare SolutionsA Presentation For TheSybase Users' Group of Texas Tuesday, September 16, 2003 Lisa Rasor, Acct Mgr Max Sanchez, SC Catherine SchultenHealthcare Business Development Managercatherine.schulten@sybase.comAugust 6, 2003

2. Agenda • Sybase’s Healthcare Vertical • Overview of Healthcare Issues • Overview of Healthcare Solutions • Q & A

3. The Sybase Healthcare Heritage Sybase, Inc Database, Mobile and Wireless for Hospitals New Era of Networks PaperFree EAI for Payers MicroScript EAI for Hospitals Century Analysis Inc. EAI for Hospitals 1983 1997 1998 1999 2000 2001 2002

4. Sybase Powers Major Healthcare Solutions • Top six U.S. managed-care organizations • 29 of the 47 Blue Cross Blue Shield plans • 1,250 payer and provider organizations worldwide • Sybase teams with more than 95 application partners, offering clinical, financial, administrative and medical management solutions

5. Healthcare Customers Partial Listing

6. MVP Health Care NASCO Nationwide Health Plans OAO Healthcare Ochsner Health Plans Ohio Medicaid Oxford Health Plans PreferredCare Quest Diagnostics Sagamore Health Network Trigon BCBS TriZetto Union Labor Life Wausau Benefits WPS Insurance Healthcare Customers Partial Listing • EDS/Connecticut Medicaid • EDS/EBX • EDS/Indiana Medicaid • EDS/North Carolina Medicaid • EDS/Rhode Island Medicaid • EDS/Vermont Medicaid • Fortis Benefits • Fresenius • Health New England • HealthNow NY • Independence BC • L.A. Care • Mayo • Massachusetts Medicaid • American Medical Security • AmeriGroup • BCBS of Arkansas • BCBS of Arizona • BCBS of Illinois & Texas • BCBS of Minnesota • BCBS of South Carolina • BCBS of Tennessee • CareFirst BCBS (Incl. FEP) • CDPHP • CIGNA • CSC Healthcare Group

7. Tenet Healthcare Corp. Kaiser Permanente HealthNow New York BCBS Minnesota BCBS Michigan BCBS Texas and Illinois NASCO John Muir/Mt Diablo Universal Care University of Colorado Hospital Cole Managed Vision Quest Diagnostics Healthcare Customers Partial Listing • Methodist Hospital Memphis • Baptist Hospital Memphis • Johns Hopkins Health System • Carilian Health System • UCSD Medical Center • Mayo Clinic • Loma Linda University Medical Center • Group Health • Univ. California – San Diego • Hospital Sick For Kids • Arkansas Children's Hospital • Children's Mercy Hospital • Children's Healthcare of Atlanta • Nemours Children's Clinic • Children's Hospital - San Diego • Lee Moffitt Cancer Center • Stanford Medical Center

8. Quest Diagnostics HealthNow New York BCBS Minnesota BCBS Michigan BCBS Texas and Illinois NASCO John Muir/Mt Diablo Universal Care Commonwealth of Massachusetts Oxford Health Plans Healthcare Customers Partial Listing • St. Luke’s Hospital • John Hopkins • Wake Medical Center • Kaiser Permanente • Carilion Health System • UCSD Medical Center • Research Medical Center • Detroit Medical Center • Mayo Foundation • Holy Redeemer • Sutter Health • Catholic Healthcare West • Union Labor Life • Conseco – Bankers Life • Health Alliance • Partnership Health Plan – CA • L.A. Care • LA County

9. Trizetto – Embedded solution for EDI and Process Management HSD/Perot – Embedded EDI solution for Diamond 725/950 OAO MC400 – Embedded EDI solution CSC PowerMHS – Recommended solution Channel Partners Payer Vendors

10. Commitment to the Healthcare Industry • AFEHCT membership, co-chair ASPIRE workgroup(CMS 1500 and UB92 print image gap analysis/demonstration project) • HL7 membership, ASIG workgroup(claim attachments) • WEDI Board of Directors, ’02-’04 • X12N membership, TG3 WG3 (HIPAA Implementation and Modeling)

11. Commitment to the Healthcare Industry • Testified on HIPAA issues to NCVHS • SNIP Transaction workgroups, Co-chair Translations sub-workgroup • NCPDP membership • HIMSS NHII Task Group

12. Healthcare Industry Issues • Costs for healthcare will continue to increase. • Overall efficiency needs to be improved to be in business. • Better customer satisfaction needed. • HIPAA mandate. • Healthcare fraud.

13. Enterprise Application Integration Revenue Cycle Enhancement Solution Sybase Secure Server Solution HIPAA Compliance Solution Sybase / PeopleSoft Solution Business Intelligence Centralized Data Management Solution Sybase Fraud Detection Solution Enterprise Portals HIPAA Security / Privacy Solution Mobile / Wireless Sybase Healthcare Solutions

31. Online Claims Correction • Web-based collaborative case management applications for both payers, providers and service bureaus. Allows processing for: • Fraud investigation • DDE and claims correction • Customer complaints management • Privacy management • Customer service

32. Temporary cache vs. Very long term storage requirements • Operational Data Store used for temporary cache of data needed in order to complete an operational process • Long Term Data Storage Requirements for ongoing analytics, research and to comply with data retention regulations

33. HIPAA Data Repository HIPAA Repository Claim HIPAA R E P O S I T O R Y Maps T R A N S L A T I O N 837 Claim Adjudication System(s) Proprietary File Structure* EDI Map Compliance Map Valid X12 HIPAA Compliant 835 Data Remit Trans

34. Analytical Views of Data Data Acquisition Layer CRM Analytics • Patient Demographics • Effectiveness of Treatments and Procedures • Disease Management • Etc. . . . . IndustryEvents Lab and Testing Applications Patient Encounter Sybase HIPAA Repository Sybase IWS Data Warehouse Sources of Customer Data Customer Automated ETL Business Analytics Insurance Claims and Billing R&D • Fraud Detection • Government Reporting • Claims Analysis • Facilities Mgt • Insurance Risk Mgt • Etc. . . . . Product Industry Warehouse Studiofor Healthcare

35. Fraud Detection • Healthcare fraud is approximately one-seventh of the national economy, or $80 billion annually. Healthcare fraud represents about 10 percent of $1 trillion in annual healthcare revenues. • Types of Healthcare fraud: • Ping-ponging – the use of a single patient ID to generate billings across multiple providers • Unbundling – false inflation of provider billing in which a single patient procedure is represented as a series of separate treatments • Duplicate entrie and the billing of more hours than feasible for patient services • Inappropriate or inapplicable cost center charges • Over-billing, either in man hours or at a higher-than expected rates • Unusual changes in transactions or amounts over short periods of time • Unusual changes in patient activity or care profiles • Unusual provider billing or treatment patterns

36. SYBASE and SPSS:Predictive Fraud Detection for Healthcare • Consists of • SYBASE Adaptive Server IQ Multiplex D/W engine • SPSS Clementine Data Mining Workbench with fraud-specific Clementine Application Templates (CATs) • Enables organizations to • Profile and segment claimants, identifyng those most likely to commit fraud • Predict medical practices among provider base most likely to be subject to fraud • Identify service and product combinations most likely to be out of compliance with claim regulations • Prioritize providers and consumers for enhanced scrutiny and auditing • Detect claim fraud between practices and from region to region within an entire market • Identify duplicate claims, unbundling, and ping-ponging • Take proactive steps to prevent fraud in the claims process

37. Security ServerBusiness Case • Maintaining VPN is expensive and communications via dial-up is slow and unreliable • Remote connection points not technically sophisticated • Large number of connection points • Need to perform data transformation before sending message over the network • Meeting compliance with HIPAA Privacy rules requires that exchanging protected health information (PHI) during transmission between trading partners be secure • Adding, deleting, and modifying trading partner profiles and exchanging data quickly in a secure way is challenging and cumbersome • There is a need to move to a real-time processing environment from batch orientation in order to integrate with the Internet and WWW • To stay competitive, organizations must improve quality of service to their constituents

38. SYBASE Secure Communications Server • Secure bi-directional communications mechanism between you and trading partner • Firewall-supported queuing technology that automatically deploys satellite queues along with the digital certificates • Integrate a new trading partner into a transaction network economically ( low cost of ownership) • Ability to centrally monitor and manage all satellite queues and hosts • Guaranteed Transactional Messaging • Designed for the Internet • Portable – small footprint, pure Java • Only pre-requisite software JVM • Complete and self-contained • Guaranteed Delivery • “Once and Only Once” • Transactional at both client and server • High performance – real-time messaging • Data exchanged between sites are encrypted (RSA Encryption & authentication) • PKI • SSL3 • Automated set-up and administration • Own certificate authority or integrate with trusted third-parties • Integrate a new trading partner into a transaction network economically ( low cost of ownership) • Automated deployment, release management, and un-installation • iMercury • Adapters/applications deployed to the client • Automated installation, configuration and scheduling • Remote client monitoring & management • Automated firewall tunneling

39. Example Configuration Deployment, Integrated Distributed Security, Guaranteed Delivery Hospital SYBASE SCS Client EAI Doctor’s Office SYBASE SCS Client SYBASE EDI Server Adapters I N T E R N E T SYBASE SCS Server Provider SYBASE SCS Client Legacy Systems

49. SYBASE HIPAA Privacy Portal • Business Need: • Per the HIPAA privacy rules, enhance patient’s control over their own protected health information (PHI) • Enhance a covered entitie’s obligation to protect this PHI • SYBASE HIPAA Privacy Portal Value Proposition: • Reduce cost of meeting privacy compliance by automating the implementation of the key requirements • Includes: • SYBASE Enterprise Portal • Pre-Built Portlets for management of • Disclosures • PHI Access • Authorization • Complaints • Notices • BPI Suite for Healthcare (Optional for integration)