The EMR Puzzle – Putting the Pieces Together March 10, 2015

Confidential What is Driving Organizations to Adopt or Replace EMR Technology Healthcare reform ―Preparation for bundled payments ―Utilization constraints ―Value-based reimbursement ―Rehospitalization and Length of Stay Rates The IMPACT Act ICD-10 HIEs Patient/resident quality Operational efficiency Analytics and reporting Revenue enhancement 1

Confidential PAC Largest Increases in Medicare Spending 2

Confidential PAC Reform Trends 3 Aging population/demographic trends Growing Medicare enrollment Expanded Medicaid and insurance coverage Rise in prevalence of chronic diseases Reduced reimbursement from Government and private payers Cuts from sequester / deficit reduction Lengths ‐ of- stay continue to fall More concerted effort by ACOs and MCOs to manage PAC utilization SNFs and Home and Community Based Care Needs to Evolve into a Platform for Population Management Increasing need for Home Care capabilities supporting episodic payment Many entities developing “care management” and “population health” capabilities such as MCOs, ACOs, and independent “care management” organizations Episodic care and “bundled” payment methodologies require capabilities to coordinate patient care across care settings into the home Expanding Role for SNFs and Home Health FFS Pricing Pressures will Continue Demand for PAC Services Strong Care Management Across a Post- Acute Episode of Care Managed Care Managed Care Fee For Service (FFS) Fee For Service Hospitals Health Systems Other PAC Providers Current Approximate Payor Mix Potential Future Payor Mix Preparing for Significant Policy and Market Trends

Confidential Preparing for the Future - Today PAC Providers will be forced to bear the brunt of additional costs in the following ways: ―Increased regulatory overhead – will need to demonstrate & quantify quality outcomes ―Better technology infrastructure – configurable, scalable, business processes ―Providers will need to improve efficiency while managing more complex cases Acuity levels will increase for SNFs’ & HHC as CMS shortens the LOS for acute care providers and moves to one Adjusted Case Mix irrespective of location of services in Post Acute Care – Managing the care continuum will be critical to preserving margins New care models: Physician and Care Management is now required vs. Medical Director model of past Reporting requirements will increase ―Analytics that graphically summarize key clinical outcomes & operating metrics daily will be essential to optimize margins and reduce administrative burden Mitigating readmissions will directly impact margins ―CMS proposing up to a 3% reduction in reimbursement for SNF’s with high levels of hospital readmissions starting in PAC providers will play an increasingly important role in reducing system wide healthcare costs

Confidential What to Consider When Selecting an EMR Service Lines Business Structure Flexibility Ease of Use Interoperability ―Referral Partners ―HIE’s Reporting/Analytics Support for Healthcare Reform and Regulatory Changes Physician Engagement Deployment Model Implementation/Training Research Vendors ―KLAS ―Talk to Peers Budget Internal Communication/Planning is Key 5

Interactive Panel Discussion March 10, 2015