1. 1 CONFIDENTIAL “Measuring Quality and Value in the Emergency Department” Alan Channing, President, CEO of Sinai Health System, Chicago Brent Asplen, MD, President, CCO, Catholic Health Partners, Cincinnati John G. Holstein, Director - Zotec Partners May 16, 2014

2. 2 CONFIDENTIAL 130,000,000 Emergency Department Patients That is 356,000 patients/day

3. 3 CONFIDENTIAL 130,000,000 ED patients 250 patients per minute

4. 4 CONFIDENTIAL Overall Description of Your Emergency Departments 4 CONFIDENTIAL

5. 5 How Do You Define Quality in Your EDs? What are the key metrics? How are they obtained? –Coding and billing services –HIM department –EMR

6. 6 CONFIDENTIAL How Do You Define Value in Your EDs? What are the key metrics? How are they obtained? –Coding and billing services –HIM department –EMR

7. 7 CONFIDENTIAL What is the Role and Responsibility of Your ED Physician Directors in Monitoring These Indices? 7 CONFIDENTIAL

8. 8 The emergency department (ED) has been described as the “Nexus of Care” and the “Hub of the Enterprise” both portraying the ED as the center of the care continuum. What are your thoughts on this description of the ED? 8 CONFIDENTIAL

9. 9 Doctor Asplin, last year at the ACEP conference you suggested the emerging ACO world presented a potential shared savings opportunity for Emergency Medicine. In a recent Becker’s Hospital Review article surveying hospital C- Suite executives the following data was reported: 59 percent of attendees indicated that physician groups have been the most important partner over the past three to five years, and 48 percent of attendees are confident this will remain the same in the next five years. 34 percent of attendees, however, indicated insurance companies will emerge as the most important partner. This question is for both of you. What place does emergency medicine and the ED have in these developing arrangements and relationships?

10. 10 CONFIDENTIAL Currently according to the Emergency Department Benchmarking Alliance the ED is responsible for 68% of hospital admissions nationally. CMS is obviously clamping down on readmissions and there certainly appears to be a decided industry push for more outpatient based care. Since hospitals still have to make money to survive, how do each of you see this situation and the role of the ED changing in the future? 10 CONFIDENTIAL

11. 11 CONFIDENTIAL Do you have programs outside the hospital to address patients who frequent your EDs with non-emergent complaints? 11 CONFIDENTIAL

12. Pre-Primary Care 12 Pre-Primary Care Model ©

13. 13 CONFIDENTIAL Do you have now or are you considering the opening an urgent care center for your patients with non-emergent complaints? 13 CONFIDENTIAL

14. 14 CONFIDENTIAL Is there such a thing as a poorly performing emergency department? If “Yes” to the above question, how do you define it? 14 CONFIDENTIAL

15. 15 CONFIDENTIAL Concluding remarks on the future role of the ED in the evolving new world of health care. What will the emergency department look like in 10 years? 15 CONFIDENTIAL

16. 16 CONFIDENTIAL John G. Holstein Director of Business Development Zotec Partners 610-668-6473 jholstein@zotecmmp.com http://www.linkedin.com/in/johngholstein