Citizen’s Health Care Working Group Boston, Massachusetts August 17, 2005 Jeffrey R. Hanson, MPH Regional Health Care Ma

1. Citizen’s Health Care Working Group Boston, Massachusetts August 17, 2005 Jeffrey R. Hanson, MPH Regional Health Care Manager, Verizon Communications President, Bridges to Excellence Board Member, Leapfrog Group

2. Mission: Improve care quality through rewards and incentives that (1) encourage providers to deliver optimal care, and (2) encourage patients to seek evidence-based care and self-manage their own conditions Focus: Reengineer office practices by adopting better systems of care Demonstrate the reengineering is working through better outcomes for patients with chronic conditions, starting with diabetes and cardio-vascular diseases We created a multi-stakeholder group and designed the program to meet diverse needs

3. Leadership Council Purpose: Provide broad governance from all BTE stakeholders, issues debating council & working group for Board Participants: Employers (including each GE Business + GH), Plan Licensees, Allied organizations We’re a not-for-profit company with a Board and a Leadership Council Board • BTE Participants & Licensees: • Dale Whitney – 2 years • Jeff Hanson – 3 years • Francois de Brantes – 3 years • Vince Kerr – 2 years • Renee Turner Bailey (through 12-31-2005)Martin Sepulveda (as of 01-01-2006) – 2 years • Other Stakeholders: • Suzanne Delbanco – 3 years • Tom Lee – 3 years • George Isham – 2 years • Andy Webber – 2 years BTE Executive Committee: Jeff Hanson, President Dale Whitney, Secretary Francois de Brantes, Treasurer

4. We have three programs that are operational now

5. We’re building programs to cover most specialties • 2005 • 2006 • 2007 PPC version 2.0 + All Docs Patient Experience of Care PCPs (IM, FP, Gyn, Ped, etc.) PCP Recognition Program Endo DPRP Cardio & Neuro HSRP Ortho & Rheum MSK RP Oncologists Cancer RP

6. We’ve made great progress in all our pilot markets already

7. What we know: DPRP docs are more efficient, by 10% - 15% when looking at diabetes costs alone, by 5% when looking at overall costs The average gross savings per patient is about $250 per year POL docs are more efficient, by 5% to 10% when looking at total costs of care The average gross savings per patient is about What we don’t know: Are DPRP & POL docs more efficient over time? We’re also getting the answer from two sources: Ingenix & Mercer We’re continuing a rigorous evaluation, but we’ve learned a lot

8. DPRP recognized physicians are more efficient and have lower variation in costs

9. POL Recognized PCPs as a group are more efficient, especially Ob-Gyns

10. At launch: 4 recognized physicians, today 36 The Challenge: Physician Philosophy – driven regionally Outside of Norton Healthcare, physicians are not organized into large practices/systems, limited resources Single product market – 63k lives = 3500 diabetics The Lessons: Need both a push and pull approach Basic outreach & follow up increased patient % from 4% to 13% Extraction services supported by grants has increased pipeline to 20-30 physicians for DPRP Public support from multiple sources – all pushing for the same thing Physicians are learning what constitutes guideline care and receiving the tools to support it in lieu of EMR to get them there Patients need to get in the game through incentives The Louisville market has yielded many lessons that can help you

11. Louisville – small independent practices need a lot of hand holding to get them over the hump…even when they have a lot of rewards at stake. Cincinnati – using third party chart extractors is a powerful way to reduce barriers to reporting. Grant funding is available for that process. Boston – engaging large groups and “training the trainer” is critical to getting rapid program uptake. Albany – most IPAs, even smaller ones, are eager to adopt standard processes and welcome the business case that this program brings them to convince their members to make the needed investments. Lessons Learned in each market will help us in all future markets

12. High-level roll-up of physician’s overall performance Distinguishes relative performance of physicians within each level Consumers are engaged through our report card web site Bridges To Excellence, Proprietary & Confidential

13. Effectiveness results come from NCQA, & patient experience of care from employees Bridges To Excellence, Proprietary & Confidential

14. Four-step process Create a profile to establish baseline Use CareGuide with doctor to set long term goals Use CareJournal to track progress Earn CareRewards by answering the self-care questions Consumers are also engaged through WebMD Bridges To Excellence, Proprietary & Confidential

15. Health Plans: UHG – United Health Group has up to ten markets it is focused on, including Omaha, South Florida, Central Florida, St. Louis, Dayton CareFirst BCBS – will be rolling out POL on a limited basis CIGNA – has committed to implementing BTE in AZ, NC and parts of TX NBCH – There are currently four coalition markets ready to start one or more BTE programs Heartland Healthcare (IL) Tri-State Health Care (IL/MO/IA) Employer’s Health Coalition (AR) Colorado Business Group on Health We now have three plan licensees and a strong alliance with NBCH

16. Current BTE Markets Interested Markets: All Programs (DCL/POL/CCL) DCL POL CCL TBD LHRP Additional Interest In Over 30 Markets

17. CMS – we’re working with CMS on three of its programs: CMP, DOQ, DOQ-IT to make sure that our performance measures are synched BTE and CMS will be jointly implementing incentives in MA and Arkansas (through a local NBCH coalition), and possibly Utah Human Resources Policy Association (HRPA) and Care Focused Purchasing (CFP) HRPA has two initiatives – National Affordable & Regional – that are tied to BTE (& Leapfrog) by linking up with plans that use/promote BTE programs. CFP has also agreed to use BTE Program measures in how they evaluate high-performing physicians Our efforts have been incorporated in other national initiatives

18. Contacts and Additional Information • Additional program information: www.bridgestoexcellence.org • Specific questions on regional roll out and BTE programs: bridgestoexcellence@thomson.com