1. LeadingAge PA Grounds for EHR adoption in LTC 06/19/2015

2. Agenda The LTPAC Environment Partnerships Across the Continuum Interoperability to Improve Quality of Care and the Bottom Line

3. LTPAC Business Challenges Financial Squeeze Penalties for Hospital Readmissions Penalties for Hospital Readmissions Reimbursement Changes Reimbursement Changes o Lower medication costs and nursing overtime hours o Increase reimbursement without adding staff o Improve care delivery by reducing variability o Reduce hospitalizations by improving care o Improve care coordination through interoperability o Appeal to ACOs through improved quality measures

4. Pennsylvania Medicare Hospitalization Rates ( 7/1/2013- 6/30/2014) o Rehospitalizations with a diagnosis of CHF, MI, or Pneumonia that were re-admitted within 30 days of hospital discharge: Source: SigmaCare Claims-Based Analytics Discharged To Care Setting#% No Care in between Admissions 779055.44% Skilled Nursing 349924.90% Home Health 266018.93% Hospice 1010.72%

5. LTPACs and the Complex Web of Data Exchange What percentage of the document volume is received/shared from/with the following provider types?

6. Partnerships Across the Care Continuum Are Hindered by Paper-Based Methods Source: IDC

7. Impact on LTPAC Organizations 7 Source: IDC

8. Reducing Variability in Care Delivery Through Standardization & Optimization Phase I Paper Phase II Automation with EHR Phase III Operational Excellence Higher Costs Inconsistent Quality Costs Reduced Quality Improved Lower Costs Higher Quality Reduced Hospitalizations Low Standardization Results in High Variability Low Standardization Results in High Variability Increased Standardization Reduces Variability Increased Standardization Reduces Variability Improved Standardization and Ability to Sustain Best Practices Further Drives Down Variability Improved Standardization and Ability to Sustain Best Practices Further Drives Down Variability Standardization & Optimization Programs Compliance & Efficiencies Financial Outcomes Disease Management Standardization & Optimization Programs Compliance & Efficiencies Financial Outcomes Disease Management

9. EHR Interoperability Platform 9 Assisted Living Discharge Data Flow Patient Flow EHR Platform ALF EHR Home Health & Hospice EHR Referral Source Management (RSM) SNF EHR Enterprise Analytics Rehabilitation & Hospice

10. EHR: Interoperability Features & Benefits InteroperabilityFeaturesBenefits EHR to Pharmacy Medication order information sent electronically to pharmacy dispensing system through an electronic interface Electronic orders eliminates faxing by facility Reduces calls to facility from pharmacy related to legibility and document imaging issues Pharmacy to EHR Dispensed medication information automatically updates resident MAR Refill requests with real-time status notifications are available with bidirectional interface Eliminates manual reconciliation at drug delivery since dispensed medication information is posted automatically to paper or electronic MAR/TAR Laboratory & Radiology Results Lab and Radiology results stored in resident’s electronic chart through an interface with the vendor Dashboard alerts notify clinicians when results are panic abnormal, abnormal, not reviewed and not signed Improves compliance and patient safety by providing lab results during order entry Increases adoption of order entry and sign-off compliance by physicians HIE/RHIOs/HISPs Exchange resident demographic and clinical information with HIEs, RHIOs, and HISPs (i.e. hospitals) Accurate and timely sharing of resident information with outside providers reduces the risk of data omissions and possible rehospitalizations Hospital Discharge Clearinghouses Electronic notification from hospital discharge clearinghouses (e.g. ECIN, eDischarge) when there is a pending patient discharge Optimizes access to possible referrals due to real-time hospital discharge notification Captures residents not selected/selected for trending and reporting Reduces errors associated with manual entry

11. Bernie Mangano Senior Vice President of Sales Office: 212-268-4242 ext. 170 Mobile: 201-446-9467 Email: bmangano@sigmacare.combmangano@sigmacare.com Confidential This document contains proprietary ideas, concepts, and other information which belong exclusively to eHealth Solutions. Information disclosed herein should be considered proprietary and confidential. This document is the property of eHealth Solutions and may not be disclosed, distributed, or reproduced without the express written consent of eHealth Solutions. © 2014 eHealth Solutions, Inc. All rights reserved. SigmaCare® and SigmaCare logo are registered trademarks of eHealth Solutions, Inc.

12. APPENDIX

13. Appendix