1. QLIANCE Your Primary Care Medical Home Erika Bliss, MD, FAAFP Family Physician, Qliance Medical Group of Washington & Vice President of Medical Care and Quality, Qliance Medical Management Inc. Office: (206) 913-4711 Mobile: (206) 817-5424 Email: ebliss@qliance.com The Impact of Direct Primary Care Medical Homes

2. Can direct primary care save $2.5 trillion over the next 10 years?

3. Strong Primary Care is Essential to a High-Functioning Health Care System Sufficient to address 90% of all health problems Lowers overall health care costs Lowers mortality

4. Nature of Transaction Provider Patient Insurance Admin High FFS Primary Care Admin Cost Promotes Visit Volume vs. Time with Patient

5. Primary Care SpecialistCare($$$) Hospital Care ($$$) Emergency Care ($$$) End of Life Care ($$$) FFS Primary Care Drives Up Healthcare Costs

6. Efficient Direct Primary Care Medical Homes Promote Time with Patients vs. Visit Volume Provider Patient Ins. Admin KEY Schedule Appointment Sees patient Diagnoses Illness Sees patient Diagnoses Illness Take X-ray Onsite Run CBC Onsite Patient goes to pharmacy Dispense Rx Patient recovers Patient has fever and cough Pays cash for Rx Same Day Appointment Patient has fever and cough

7. The Qliance Direct Primary Care Medical Home Preventive Care Wellness Care Chronic Disease Management Specialist Care Coordination Urgent Care Unrestricted office visits Same and next day appointments Unhurried office visits No co-payments Extended weekday hours Weekend office hours Phone and email access Flat monthly fee

8. DPCMH Yields High Patient Satisfaction “ People, it's a miracle. I pay about $45/month for all my primary care needs (their fee is based on age). They can do lab tests on-site for free, or a small fee if it's unusual, and they even have a pharmacy on-site that provides most basic prescriptions for much, much cheaper than you'll get through your insurance. The doctors are all lovely people, and can take the time to get to know you, and - most importantly - LISTEN. They don't have to funnel patients through their office just to make a buck, so they can actually pay attention to what you're saying, which, believe it or not, is mother-flipping crucial for an accurate diagnosis.” “I've had chronic kidney problems since I was 14, and at the time desperately needed a doctor but couldn't afford to go. When I read about Qliance's revolutionary way of approaching medicine I was in complete blissful shock! …the doctors actually listen to the patient and provide feedback and suggestions. Because appointments are 30 minutes to 1 hour long (or longer if needed) the doctors at Qliance can focus on patient education and pay attention to the whole-patient, aiming to solve the problem, not just the immediate symptoms.” “ The level of care, the amount of compassion, and the concept of having a voice in my healthcare is priceless to me. I've sent friends to Qliance when they had complicated issues that other doctors brushed aside (and they got answers!); I've sent friends who didn't have insurance and otherwise couldn't afford care, and I'd suggest to anyone who wants a truly unique and amazing healthcare experience to go to Qliance.” “ Qliance is redefining what good healthcare looks like, and honestly, you have to experience it to believe it...” 1 Yelp Online Reviews, 2008-2010 yelp Net Promoter Score=79%, better than Apple, Google & Amazon

9. Primary Care SpecialistCare($$$) HospitalCare($$$) EmergencyCare($$$) End of Life Care ($$$) The DPCMH Effect on System-wide Costs

10. Qliance DPCMH Decreases Non-Primary Care Utilization Per 1000 members per year Type of Referral Qliance # per year/1000 Regional Benchmark*Difference** ER Visits60158-62% Hospitalizations (in days)136184-26% Specialist Referrals9092000-55% Advanced Radiology414800-48% Surgeries (#/1000/year)33124-73% Surgeries (# days/1000/year)83168-51% *Based on regional benchmarks from Ingenix and other sources. **Based on best available internal data, may not capture all non-primary care claims Source: Qliance Medical Group non-Medicare patients, 2009 (n=2,316)

11. DPCMH Delivers System-wide Savings $268 billion annual savings ($864/person-yr. x 310 million people) Sources: FFS cost data from seven large self-funded groups. Includes both employer and employee payments. Payer transaction cost estimated based on TPA discussions. Qliance DPMH monthly fee based on average age for self-funded groups. Qliance DPMH non-primary care cost based on self-funded pilot impact 2010 which is consistent with Qliance 2009 Impact Study. Excludes cost of prescriptions. Per Capita Monthly Health Care Cost

12. Section 10104 (3) of H.R. 3590, the Affordable Care Act (ACA) Allows direct primary care medical home practices to offer coverage in the exchange in combination with a wrap-around insurance policy that together satisfy exchange requirements.