1. Bridges To Excellence 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. Page 2 BTE We created a multi-stakeholder group and designed the program to meet diverse needs 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

3. Page 3 BTE We’re a not-for-profit company with a Board and a Leadership Council  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 Board 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 Leadership Council

4. Page 4 BTE We have three programs that are operational now NCQA Measure set Physician Activation Consumer Activation Physician Office Link (POL) Physician Practice Connections (PPC) Up to $50 pmpy Physician-level report card, and patient experience of care survey Diabetes Care Link (DCL) Diabetes Provider Recognition Program (DPRP) Up to $100 pdppy Diabetes care management tool, and rewards for care compliance Cardiac Care Link (CCL) Heart Stroke Recognition Program (HSRP) Up to $160 pcppy Cardiac care management tool, and rewards for care compliance

5. Page 5 BTE We’re building programs to cover most specialties 200720062005 PPC version 2.0 + All Docs PCPs (IM, FP, Gyn, Ped, etc.) PCP Recognition Program Patient Experience of Care Ortho & RheumMSK RP OncologistsCancer RP EndoDPRP Cardio & NeuroHSRP

6. Page 6 BTE We’ve made great progress in all our pilot markets already Jan 2004July 2005 Recognized Physicians PPC30669 DPRP60384 HSRP029 Employees going to recognized Physicians DPRP1,865 PPC12,668 Rewards paid to-date$1,875K Available Rewards$8,000K

7. Page 7 BTE We’re continuing a rigorous evaluation, but we’ve learned a lot  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

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

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

10. Page 10 BTE The Louisville market has yielded many lessons that can help you 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

11. Page 11 BTE Lessons Learned in each market will help us in all future markets 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.

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

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

14. Page 14 BTE Consumers are also engaged through WebMD 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 Bridges To Excellence, Proprietary & Confidential

15. Page 15 BTE We now have three plan licensees and a strong alliance with NBCH 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

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

17. Page 17 BTE Our efforts have been incorporated in other national initiatives  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

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