1. Leveraging Integrated Hospital Care to Revenue Cycle Management PHARMACIST ENABLED CHRONIC CARE CYCLE MANAGEMENT

2. Foreword 1.Care cycle management of patients in the Meridian system require more integrated foundation and experience in order to increase total reimbursement mix. 2.Forward looking innovation coupled with risk minimization can drive cultural change and increase adoption speed towards market changes. 3.Drawing value and delivering accountable management techniques will decreas oeperational friction to improves outcomes, reduces waste and increase efficiency.

3. Objectives 1.Finalize current pilot initiative to expand, grow and leverage pharmacy operations to optimize HCAHPs scores. 2.Explore, pilot and demonstrate capabilities of pharmacist interventions at inpatient and outpatient setting aligned to hospital revenue goals of HCAHPs, Readmissions, Costs and Revenue generation. 3.Evaluate, initiate, develop and prepare processes for outpatient pharmacy program management including medication reconciliation and adherence, HCAHPs pull through, Annual Wellness Exam enrollment and Transition of Care Management initiation.

4. Overview 1.Cost Savings and Revenue Generation Options 1.All Unit HCAHPs Program 2.Transition of Care Management (TCM) 3.Medication Adherence (iMPAK Health Customer Validation) 4.Medication Reconciliation Process Change 2.Inpatient Program Expansion 1.Program Overview 2.Timeline 3.Implementation Keys 4.Process

5. Strategic Hospital and Corporate Value Service additions and program management leads to growth in operating margins Revenue & Care Cycle Enhancements 1. Improved Operating Costs & Efficiencies 2. Cash Conversion Cycle Optimization 3. Improved Outcomes & Revenue Generation 4. Staff Accountability & Cultural Shift 5. Community Brand Enhancement

6. 6 Strategic Value & Importance Weight of value predominantly relies on timing, location, benefit upside and immediacy of margin improvement High Low Current Level Of Strategic Value & Importance iMPAK Health ED Pharmacist TCM Program Outpatient Pharmacy HCAHPs Program Annual Wellness Exam/CLIA Waived Exams HCAHPs Program Roll Out Medication Adherence Pilot and Validation Medication Reconciliation Process Change Transition of Care Management Service Role & Billing

7. Program Roll Out Overview 5 Key Programs lead incremental improvements in operating margins and efficiency aligned to outcomes, talent management and patient journey improvement Program Approval, Expansion and Roll out iPAD Usage and Discussion with Nursing 1. HCAHPs Training and Continuous Monitoring Training, Change & Change (iPAD Face:Face Counseling) Program Exploration and Development Facilitate discussion with managed care, billing and physician groups 2. Initiate TCM Program Implementation Services, Roles, Billing Program Approval, Support and Meridian BD Validation Pilot launch with Meridian Business Development March 1 st 3. Medication Adherence Pilot iMPAK Health Process Change Approval and Error Prevention ED Pharmacist Opportunity Discussion 4. Medication Reconciliation Admission – Discharge Process Change Full Business Opportunity Discussion Service business model exploration 5. Outpatient Pharmacy Maximization Annual Wellness Exams/CLIA Waived Tests & Checkup

8. 1. HCAHPs Nursing Unit Program Overview 10 week comprehensive program enables nursing to own patient experience with ‘as needed’ interventions Seminar and Training (HCAHPS) – (1 Unit/Time) Best practice and activity breakouts Unit specific discussion and focus points* 1. Program Onboarding (2 wks) 4 Week Service Execution and Monitoring Face-Face Accountability Checking and Reporting 2. Program Roll Out (4 wks) Tight Feedback Loop and Monitoring *Pharmacist enabled face-face video enrollment and sessions 3. Transition Improvement (4 wks)

9. 2. Transition of Care Program Overview CMS (CPT) Billing codes of transition of care management can be explored for enhanced discharging and profitability Program billing discussion and exploration Service role creation and nomination Process and documentation development Cross functional group discussion and meetings* Program Exploration (2 wks) Unit process development, training and documentation creation Review of billing, CMS rejections, outcomes and patient feedback Assessment of program potential, staff operating changes Cross functional evaluation of expansion Program Initiation (4 wks) Post Evaluation Discussion Program Expansion (Ongoing)

10. 3. Med. Adherence Program Pilot Overview 10 Week Program focuses on medication adherence and follow up validates iMPAK Health product acquisition value Nominate and enroll patients previously identified Begin process and enrollment Adjust program ongoing as needed Program Initiation (1 wk) Follow up post discharge adds additional HCAHPs touch points Product investigation of safety and effectiveness claims Product branding and positioning evaluation Program Enrollment & Follow up (4 wks) Data gathering and adherence monitoring Patient follow up phone calls and device collection *Additional CRM enrollment (Outpatient) Tracking & Outcomes (4 - 6 wks)

11. 4. Med. Reconciliation Program Overview Program shifts work burden to pharmacy owned med rec upon admission and oversight of stay and discharge med rec ED Pharmacist Proposal Review Process review and medication reconciliation committee onboarding Talent recruitment and/or FTE shifting to ED Program Initiation (2 wk) ED Department documentation and process optimization KPI development and results tracking Save costs by encouraging patient’s specialty /non formulary med use Program Development & Growth (4 wks) Quarterly reporting and med reconciliation meetings Cost savings by selectively encouraging patient’s own medications Tracking & Outcomes (4 - 6 wks)

12. 5. Outpatient Pharmacy Optimization Riverview Outpatient Pharmacy preparation and diligence are key to maximizing future hospital revenue and value Explore Outpatient Business Models including MTM/TCM/AWVs Optimize Outpatient Pharmacy Dispensing Flow Partner with Physician Business Development and Managed Care to discuss billing capabilities Program Initiation (1 wk) Create model, roles and P&L depending on potential Create Trackable CRM Program Liaise with HCPs on pilot initiative and process development Program Business Model Development & Discussion (4 – 8 wks) Implement and pilot initiative process Track billing, patient outcomes and adjust program as necessary Improve design and implementation Tracking & Outcomes (4 - 6 wks)

13. Initiate Execute 1234 May 1234 April 341 2 MarchJune 123Q1 J - S Assess TCM Program HCAHPs Program Med Adherence (iMPAK Health) Program Medication Reconciliation Program Timelines Exploration & Discussion Training Discussion Pilot Enrolment Accountability iPad Program Pilot Report 1 Report 2 KPI Assessment Program Development (HCP Partnership) Report 1 Monitoring Monitoring Ends Product Assessment Report 2 Role fulfilment Employment Program Begin

14. Implementatio n Process & Strategy As ACO models continually shift against CMS changes for reimbursement, it has become more clear a team-based care approach would improve outcomes and reimbursement. Key Execution Points 1.Individual practitioners require more conscious use of talent including knowledge of skill set building and enhancements. 2.‘Group think’ surrounding feedback transparency with accountability reporting towards results will induce sentiment change. 3.Employee sentiments require increased desire to align towards results. (Multifaceted Drivers*) 4.Technology surrounding information and communication can optimize fluidity and continuity of care for patient satisfaction. 5.Partnership with commercial cross functional departments can leverage increased value to hospital stakeholders and carve out Riverview’s niche amongst future competition. Objectives: 1.Review future pharmacy outlook and evolution. 2.Understand potential upside and exploration points to enhance community perception. 3.Align on program next steps and initiate communication needed.

15. ER Admission Unit Admission Continued Stay DischargeLTC/ALF Outpatient Pharmacy Self/CaregiverObservationDischarge 1.Med Reconciliation2. Nursing Continuity3. Elective Medication Counseling Pharmacist InitiationNursing Owned and Trained Touch Point Addition and Medication Reconciliation Q/A Pharmacy Follow upPharmacy Oversight and ‘PRN Intervention’ *Outpatient Pharmacy, Med Adherence, iPad Med Records, CRM Enrollment Minimize ErrorsIncrease Accountability and Culture ChangeEnhance Patient Outcomes and Experience Pharmacist Enabled Care Cycle Management 1. ER Pharmacist 2. Pharmacy Oversight 3. Video: Pharmacist 4. CRM Contact *