PCD PARTNERS introduction TO HEALTHCARE ATTORNEYS

1. PCD PARTNERS introduction TO HEALTHCARE ATTORNEYS

2. Who is PCD Partners? PCD Partners is comprised of world class physicians, academics, and entrepreneurs who have decades of experience with collaboration in medical quality and practice improvement systems for large scale practice management and clinical practice improvement. The founders and principals of PCD Partners have devoted their careers to establishing themselves as leaders in the healthcare field as physicians, academics, senior administrators, entrepreneurs, and lawyers. Their collective wisdom and experience is a critical component of every PCD Partners offering. PCD Partners was formed to bring together the combined experience and intellect of our principals to apply towards solving many of the challenges that physicians and hospitals are facing. Our partners are committed to playing an active role in improving the efficiency, quality and consistency of healthcare delivery. We have the clinical, administrative, quality, and systems acumen to help any healthcare delivery system. Align Measure Improve

3. PCD Core Competencies • PCD Delivers Expertise And Experience In Dealing With Complex Organizational Challenges: • Data Process & Capture, • Governance, • Complex System Integration and Implementation; • Deep And Broad Clinical Expertise And Experience • Extensive Vascular, Cardiology and Orthopedic, • Operation “Reboot”, • Risk Adjusted Outcomes; • Thoroughly Trained In Quality Standards And Process Redesign • Lean Six Sigma in Clinical Healthcare Applications, • ISO 9001 Quality System, • System-wide Quality Initiatives, • Process Redesign And Optimization. Align Measure Improve

4. Align, Measure and Improve • PCD’s methods are grounded in a simple framework: • Alignco-dependent healthcare stakeholders (physicians, hospitals, payers and patients) using common metrics, structured relationships and financial incentives • Measurethe right quality and efficiency variables, ensure excellent data governance and buy-in, and make the data transparent to stakeholders • Improveoperations to reduce defects and increase efficiency using standardized tools in a way that reinforces the underlying stakeholder alignment

5. Align What is it? There are a myriad of alignment structures that are used to create different levels of integration between hospitals and physicians; some are more effective than others depending upon the specific objectives of creating the alignment. A CMA can provide a structure to ensure that physicians and the hospitals that they practice in have their incentives aligned. The formation of an alignment structure requires input from all involved parties to determine physician and management roles and responsibilities, service line governance and CMA fees and compensation. How does a CMA help with Alignment? PCD’s clinical, operational and data experience enables us offer input into developing the right alignment structure. The CMA structure is the only structure that provides on-going financial rewards; it is also the only structure that requires the use of data to improve quality, and it can co-exist with any other alignment structure. How can PCD add value? What are the implications for a system wide quality initiative? CMAs are typically implemented within a service line; once the initial service line has been implemented additional service lines can be added quickly. Having the right alignment structure that is repeatable across service lines can facilitate a facility wide quality initiative.

6. Measure What is it? To be useful, the right data needs to be in the right format in the right place at the right time. Data is required to be able to measure anything in a meaningful way; without data there is no knowledge. CMAs require that quality and efficiency performance objectives and metrics, data management, training and operations plans, and valuation must be defined. Incentive bonuses are earned by producing data to demonstrate measurable quality improvements over specified time periods. How does a CMA help with Alignment? PCD can help define quality and efficiency performance objectives and metrics, structure a data management plan, develop and deliver training and operations plans, and provide an independent 3rd party Valuation Fairness Opinion. Our real time dashboards will help you to transform data into knowledge that is meaningful for all parties. How can PCD add value? Having the right data available and in a useful format is the key to optimizing quality across a healthcare delivery system. The majority of data required to produce an effective system wide quality system comes from outside of the EMR. In order to effectively identify, collect and transform all of the data required into useful knowledge requires experience skill and the right tools. What are the implications for a system wide quality initiative?

7. Improve What is it? Improvement can come in many forms: increased throughput, reduced costs, reduced defects, improved efficiency and most importantly, improved patient outcomes. Realization of these improvements is the result analyzing and optimizing processes using best practice methodologies. CMA quality incentive bonuses are structured to provide an incentive payment that is commensurate with measurable and demonstrable improvements that can be proven through the data in the quality system. How does a CMA help with Alignment? PCD’s clinical skills, operational know-how and data expertise will combine to develop the process improvements that ensure that you achieve optimal results. PCD’s consultants are Lean Six Sigma and ISO 9001 trained to identify and reduce waste, reduce defects and develop processes and procedures that are tracked by an exception and corrective action tracking tool to ensure compliance and visibility to quality performance. How can PCD add value? Having the right alignment structure and measurement capabilities are pre-requisitesto realizing meaningful improvement, but do not assure improvement on their own. The addition of Lean Six Sigma principles does not guarantee process improvements without the role definition, process standardization and reporting infrastructure that ISO 9001 compliance assures. What are the implications for a system wide quality initiative?

8. Why Should an Attorney Consider a CMA? • The health care industry’s increasing emphasis on quality of care and improving outcomes has created a need for innovative business models that align the interests of physicians and hospitals without conflicting with fraud and abuse laws. • Hospital/Physician alignment is a prerequisite for hospitals to be able to realize meaningful change. • There are many alignment structures that can be used depending on the goals of the alignment. • The CMA is a very versatile and effective structure because: • It can co-exist with any other alignment structure, • It provides on-going financial rewards for the physicians, • It’s flexible and adaptable, • It can provide a first step towards accountable care , and • It leads to improved patient outcomes and establishes a process for continuous improvement. Align Measure Improve

9. A CMA has Structural and Operational Components

10. When Is It Advantageous To Use a CMA? • CMAs can add significant value when: • An entity is acquiring hospitals, • A hospital desires to be acquired, • A hospital desires to elevate a service line to a “center of excellence” or an “institute”, • A hospital in a competitive market wants to differentiate itself by allowing physicians to remain independent, • A hospital needs help retaining and recruiting physicians, • A hospital wants to build a foundation for ACO, and/or • Existing quality initiatives not delivering desired results. Align Measure Improve

11. How Can a CMA Help? X

12. What is the Result of a Properly Implemented CMA? • Patients get the benefit from a system that is working closely together to achieve a common set of objectives. • A common plan and vision that was created jointly by the physicians and the hospital; • Financial incentives for physicians for measuring and improving quality and efficiency; • Physicians having greater impact on achieving operational and process improvements; • Joint implementation of quality and safety standards by the physicians and the hospital;

13. What Are PCD Partners’ Deliverables? PCD can help define quality and efficiency performance objectives and metrics, structure a data management plan, develop and deliver training and operations plans, and act as an independent 3rd party to the arrangement. Our real time dashboards will help to transform data into knowledge that is meaningful for all parties. PCD can help to maximize quality improvements by leveraging our experience in gathering meaningful clinical data and transforming it into evidence based treatment protocols to improve patient outcomes. PCD has the clinical skills, operational know-how and the data expertise to help to develop the process improvements that ensure the realization of measurable and meaningful results. PCD’s consultants are trained in Lean Six Sigma and ISO 9001 to identify and reduce waste, reduce defects and develop processes and procedures that are reinforced by a variance reporting and corrective action tracking tool to ensure compliance and visibility to quality improvements. Align Measure Improve

14. PCD Partners Value Add Considerations

15. World Class Partners CHARLES HUTCHINSON, PhD Chairman Co-founder and CEO, GlycoFi, Inc. (acquired by Merck in 2006), Founder, M2S, Inc. and SustainX, Inc., Dean Emeritus, Thayer School of Engineering at Dartmouth, Ph.D., Stanford M. WESTON CHAPMAN CEO Chairman, President & CEO, M2S (acquired by AIG affiliate), Managing Director, Oppenheimer & Co. and Donaldson, Lufkin & Jenrette, Adjunct Professor, ISO medical quality systems, Dartmouth Medical School, A.B. Dartmouth, M.B.A. Tuck GRANT BAGLEY, MD, JD Partner Past Managing Partner, Healthcare Practice, Arnold & Porter, Past Director, Coverage and Analysis, Centers for Medicare & Medicaid Services DONALD S BIALEK MD MPH Partner Managing Director, Huron Consulting Group; SME, CSC Global Health Services; Physician Executive, Dearborn Advisors; CEO, Alliance Medical Practices; CEO, Paradigm Medical Teams; Faculty, Harvard University; NLM Informatics Fellow, Harvard/MIT; BSc, Univ of MD; MD, Univ of MN; MPH, Harvard University COLIN C. BLAYDON, AM, PHD Partner Director, Center for Private Equity & Entrepreneurship Dean Emeritus, Tuck School of Business at Dartmouth Professor, Harvard Business School Dept. Of Defense, OMB BEE Univ. of Virginia, AM Harvard, PhD Harvard

16. World Class Partners MICHAEL A. CHOUKAS Partner President and CEO, Oncopartners, EVP United Biosource Corp., Chairman & CEO, Scirex Corp., Chairman & CEO Springborn Laboratories (Now STRI,NYSE),Partner, Bain & Company, Legislative Director, US Senator Patrick Leahy, B.A. Dartmouth, M.B.A. Harvard Business School JOHN C. COLLINS, MPH, JD Partner Chair and President, Hampden Assurance Co. Ltd., Chief Executive Officer, Dartmouth-Hitchcock Clinic, Dartmouth-Hitchcock Medical Center Director BCBS of Vermont Assist. Prof. Dartmouth Medical School BS Cornell, MPH Michigan, JD Georgetown JACK CRONENWETT, MD Partner, Chief Medical Officer Chair Emeritus, Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center Medical Director, Vascular Study Group of New England, Professor of Surgery, Dartmouth-Hitchcock Medical Center, B.S. Michigan, M.D. Stanford ADAM GROFF, MD, MBA Partner Division Director, Bayada Nurses, Inc., Hospitalist, Dartmouth-Hitchcock Medical Center, Assistant Professor, Dartmouth Medical School and The Dartmouth Institute for Health Policy & Clinical Practice, A.B. Dartmouth, M.D. Penn, M.B.A. Wharton MARK ISRAEL, MD Partner, Chairman of the Medical Advisory Board Director, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Professor, Pediatrics and Genetics, Dartmouth Medical School, B.A. Hamilton, M.D. Albert Einstein

17. World Class Partners  DR. GERRY O’CONNOR, PhDConsultant, Design and Implementation of Clinical Quality Programs, Principal Investigator, National Quality Program, Cystic Fibrosis Foundation Partner, Quality Program Director Research Director, Northern New England Cardiovascular Disease Study Group, Corporate, Professor, Dartmouth Medical School and The Dartmouth Institute for Health Policy & Clinical Practice, B.S. Columbia, Ph.D. Union, Sc.D. BU, M.P.A Harvard Staff PAUL CARREIRO, PA Corporate Consultant Medical Staff Officer, U.S. Merchant Marine Consultant, New England Center for Emergency Preparedness, Dartmouth Medical School Board of Advisors, Franklin Pierce University Physician Assistant Program A.B. Harvard, B.S. University of Texas, JFK Special Warfare Center for Low Intensity Conflict, Flight Surgeon - School of Aviation Medicine, U.S. Army VEKRAM JENARTHANAN Project Manager Vekram has previously worked in the fields of data analytics and information management in the banking and insurance verticals. His experiences and interests in project management and TQM make him an ideal fit for PCD. His work at PCD involves the technical design and implementation of quality management systems.  B.E. (Electrical and Electronics Engineering) College of Engineering Guindy - Chennai, India M.E.M. Duke University JON LEET Director of Sales & Marketing Jon brings 25+ years of sales and marketing accomplishments with both large companies (Oracle, IBM) and startup companies across a variety of technologies and industry verticals. Jon is responsible for working with PCD management to implement a structured sales process and develop a focused marketing plan. B.A. Colorado College.