1. QuadMed Innovations in Population Health Management – Delivered On-site Raymond Zastrow, M.D. Chief Medical Officer QuadMed LLC West Allis, Wisconsin

2. We provide innovative, high-value health care solutions to companies, improving the overall health and productivity of their people.

3. QuadMed Clinic Locations MillerCoors Brewing Primary Care Fitness Center Occupational Med Rehab Briggs & Stratton Health Center Primary Care Fitness Center Occupational Med Rehab Northwestern Mutual Health Centers (2) Primary Care Occupational Med Briggs & Stratton Health Center Poplar Bluff, MO Primary Care Rehab QG Lomira, WI Primary Care EAP, AODA Rehab Fitness Center Dental Vision QGWest Allis, WI Primary Care ENT Orthopedics Cardiology Occupational Medicine EAP, AODA Rehab Fitness Center Dental Vision Care QG Sussex, WI Primary Care Surgery EAP, AODA Rehab Fitness Center QG Saratoga Springs, NY Primary Care EAP, AODA Rehab Fitness Center QG Martinsburg, WV Occupational Med Primary Care EAP / AODA Fitness Rehab

4. QuadMed Model Onsite Employer-directed Primary Care Organized as PCMH Self-funded / Self-administered Value-based Benefit Design Our Strategic Directives: Triple Aim / Lean Not Presently Serving Medicare / Medicaid Populations

5. Care Improvement Population Health Management – From a Primary Care Platform Proactive – Across the Care Continuum – Incentivized Wellness – Coaching / Behavior Modification – Chronic Condition Management – Complex Case Management

6. Robust Analytics & Predictive Modeling Plan Design and Incentives Communications and Change Management Integration across the Continuum Integration Population Health Management delivered from a Primary Care Platform Population Care Continuum Preventative Care Short Term Acute Chronic Good Health Complex Catastrophic Fitness Centers HRA Wellness Programming Chronic Condition Management High Performance Network Case Management Patient Centered Primary Care (platform for managing population health ) Lifestyle Coaching

7. Cost Reduction Specialty Care Hospital Inpatient Pharmaceutical Emergency Department Diagnostic Imaging

8. QuadMed Track Record Average healthcare cost per employee Average Cost Trend 1999-2008: 5.6%

9. Regional Collaboration WI Collaborative HC Quality WI Health Information Organization WI Health Information Exchange – ED Linking Project PCMH (WAFP, Jackson Clinic) IHI Triple Aim (Bellin) Lean (Theda)

10. Accountable Community Partnerships Value-based Contracting – Terrific Whitepaper at CHVI site – http://www.vbhealth.org/wp-content/uploads/CHV_OBC-Cover_Text_REV8-30-10c.pdf Narrow, High-Performance Networks – Service Level Agreements QuadMed External to QG – Cost-Plus Contracting – Performance Guarantees Future: Risk-adjusted PMPM?

11. Payer Providers Risk-Adjusted PMPM Fee-For-Service Pay for Performance ACO RVUs Coding Accuracy Chart Completion Schedule Efficiency EBM Patient Satisfaction Salary +

12. Current Challenges Integration of Worldcolor into Quad – Fighting for Transparency e.g. Pharmacy Benefit Design – Extending the QuadMed Model to multiple smaller legacy WC sites Consumer Health IT Telemedicine Paying More for Care Under ACA – Understanding Ramifications of Exchanges heading into 2014

13. Collaboration With CMMI QuadMed has developed a healthcare enterprise that has been successful in controlling cost and improving quality of care for Quad/Graphics and other employers with a focus on: – Accountable / Empowered Primary Care – Wellness and Prevention – Practice of Evidence Based Medicine – Outcomes-based Contracting QuadMed features are applicable to healthcare systems in general and can be successfully implemented at other large organizations with similar results.

14. Contact Information Raymond J. Zastrow, M.D. Chief Medical Officer / QuadMed raymond.zastrow@quad-med.com 414-566-8057

15. Innovations in Health Care Delivery Bruce Nash, M.D., M.B.A. Capital District Physicians’ Health Plan Senior VP, Chief Medical Officer Albany, NY

16. Who We Are Not-for-profit network model health plan Physician-founded and guided for 27 years 350,000+ members in 29 counties in upstate New York Top-ranked plan nationally for Commercial, Medicare Advantage and Managed Medicaid products

17. Practice Reform Payment Reform CDPHP Pilot