1. An Electronic Dashboard For Improving the Quality of Health Care and for Decreasing the Cost of health Care Stephen A. Kardos D.O.

2. Stimulus For Dashboard Development  Rising Health care expenditures  Failure of existing methods to stabilize and reduce medical expense Insurance Government programs Doctors and hospitals Limited access provider networks Disease Management Companies  Lack of available information for precise medical interventions to improve health status improvement History

3. Challenge Solution  Disparate systems  Outlier management  Business block management  Care determined by benefits  No leveraging of information  Emphasis on process  Emphasis on network discounts  Single relational database  Population management  Individual client management  Need for care is independent of benefits  Leveraged information  Emphasis on outcome  Emphasis on Care Management History

4.  Logic derived from medical practice standards  Published US standards of care (ADA, AHA, other)  Single flexible software program that allows multiple preventive health and disease states to be managed (“Excel” spreadsheet for Health)  Technology-Driven “Dashboard” Automated Integration of: Claims data Clinical data Pharmacy data Laboratory data Algorithm Evolution

5. Care Management Definition Stratification of medical risk in each population Clinical guidelines Wellness Preventive Disease management Case management Utilization review Predictive modeling Prescription drug management Plan design  Care Management is the convergence of multiple medical tactics properly applied to specific populations including:

6. Drug Dose Doctor Date Cost Diagnosis Procedure Date Cost BP Height Weight Hgba1-c Urine Protein Electrolytes Cost PHARMACY CLAIMLABORATORY DATACLINICAL DATAMEDICAL CLAIM TRIVERIS DOCTORS NURSES STATISTICIANS EPIDEMIIOLOGISTS ADVOCATES TRIVERIS DOCTORS NURSES STATISTICIANS EPIDEMIIOLOGISTS ADVOCATES EMPLOYERS / INSURERS PLAN MEMBERS HEALTH CARE PROVIDERS Computer System Integration of Claims Payment & Care Management Computer System Integration of Claims Payment & Care Management

7. Step 1 Derivation of Wellness Disease Records (WDR) Member Clinical data Claims data Pharmacy data Test results data Wellness WDR 1 Wellness WDR 1 Diabetes Type I WDR 2 Diabetes Type I WDR 2 Care Management Health Improvement Tracking System Other WDR 3 Other WDR 3

8. Eye Exam MQR Eye Exam MQR HgA1c MQR HgA1c MQR BP MQR BP MQR Lipid Control MQR Lipid Control MQR Step 2 Current medical care management compared to Minimum Quality Requirement (MQR) Diabetes Type I WDR Diabetes Type I WDR Clinical data Claims data Pharmacy data Test results data Care Management Health Improvement Tracking System

9. Eye Exam MQR Eye Exam MQR HgA1c MQR HgA1c MQR BP MQR BP MQR Control Lipids MQR Control Lipids MQR Doctor Member Care Management Step 3 Sharing information for action Diabetes Type I WDR Diabetes Type I WDR Care Management Staff

10. Care Management Dashboard Activities  Preventive care  Chronic disease management  Acute and catastrophic case management  Triveris communication to member and doctor

11. Dashboard Demonstration Slides

12. Results

13. Case Study FEHBP Diabetic Patients (01/98-09/2004) Case Study FEHBP Diabetic Patients (01/98-09/2004) 4,838 712 61.1% 71.1 3.6 2,990 2002* 3,932 597 51.2% 70.3 3.5 2,869 2001 6.34.23.63.32.9 Claim PMPM 4,9844,5094,5715,1355,594 Bed days per 1000 member yr 604602706759816 Hospital admissions per 1000 member yr per 1000 member yr 81.0%65.9%48.2%47.8%30.4%HgbA1c Testing 71.671.369.468.868.6 Median Age 2,9793,0783,1553,0902,947Patients 20042003200019991998 * Un-immunized Influenza Epidemic Improved Quality-Less Hospital Use-Lower Expense

14. Case Study FEHBP Hypertension Patients (01/98-09/2004) 127127 2424 3030 0.570.57 71.371.3 7,4267,426 2002*2002* 119119 2323 3535 0.560.56 70.670.6 7,2907,290 20012001 140140157157167167238238220220 Bed days per 1000 member yr Bed days per 1000 member yr 22222626393947474141 Hospital admissions per 1000 member yr Hospital admissions per 1000 member yr 35353737404035353737 ER visits per 1000 member yr ER visits per 1000 member yr 0.620.620.560.560.640.640.590.590.540.54 Office Visits PMPM 72.072.071.471.469.669.668.868.868.168.1 Median Age 7,4337,4337,8087,8088,2148,2148,0998,0998,0248,024PatientsPatients 2004200420032003200020001999199919981998 * Un-immunized Influenza Epidemic Improved Quality-Less Hospital Use-Lower Expense

15. Case Study Chronic Renal Failure Patients (01/98-09/2004) Case Study Chronic Renal Failure Patients (01/98-09/2004) 15,83015,830 1,9631,963 77.677.6 9.19.1 507507 2002*2002* 13,79713,797 1,6261,626 76.476.4 9.09.0 419419 20012001 12.012.013.013.08.28.28.68.66.86.8 Claim PMPM 9714971414,46114,46114,00414,00419,32919,32922,55922,559 Bed days per 1000 members/yr Bed days per 1000 members/yr 1,5481,5481,5071,5071,7321,7322,0582,0582,0632,063 Hospital admissions per 1000 members/ yr per 1000 members/ yr Hospital admissions per 1000 members/ yr per 1000 members/ yr 77.477.477.577.575.675.675.575.574.474.4 Median Age 502502522522370370331331288288PatientsPatients 2004200420032003200020001999199919981998 * Un-immunized Influenza Epidemic Improved Quality-Less Hospital Use-Lower Expense

17. Conclusion  Makes care management possible  Efficient  Bonds doctors and patients and plan sponsors  Improves health status  Lowers plan expense Dashboard