Joslin Diabetes Center Annual Meeting Debriefing for Center Administrators November 19, 2008

Affiliated Programs - 22 nd Year – 2007 Highlights  20 Contracts  30 Sites  170,000 patient visits in 2007  30,000 new patients visits in 2007  11% increase over 2006  13 states  2 International sites  77 Physicians  21 Nurse Practitioners  111 Educators  2 New Partners for Diabetes Specialty Program at Long-Term Care and Skilled Nursing Facilities (with SUNY & The Hospital of Central Connecticut Affiliate Partners)

2008 Affiliate Domestic Expansion Focus  Network Growth with our existing Affiliate partners  2008 Presentations & Contracts in Negotiation:  Illinois  California  Texas  Florida  Ohio  New Jersey

December 31, Domestic Contracts 4 International Contracts 32 Domestic Sites 6 International Sites 2 SNF Diabetes Specialty Programs INTERNATIONAL SITES Bathurst, NB, Canada Manama, Bahrain Dubai, UAE Chennai, India Network of Centers-Projected December Joslin Diabetes Center Affiliated Programs Single site Multiple sites Upgrade to multiple sites Upgrade to additional sites Contracts in negotiation

2008 Affiliate Domestic Expansion Focus  Skilled Nursing Homes and Long Term Care  Growth of partnerships between our Affiliates and SNF & LTC prospective partners  Metro Marketing Campaign  Comprehensive Materials being finalized for targeted campaign to decisionmakers in Major Metropolitan Markets (20 Cities)  Targeted series of cover letters and informational papers discussing Joslin benefits and services  Consulting Services  Increased requests for Joslin Boston to conduct consulting engagements for existing ADA recognized programs throughout the U.S. -Consulting engagements provide a vehicle for introduction of Joslin team-based approach to prospective Affiliate partners

Topics Identified by Center Administrators for Further Followup  Joslin Boston to send survey questions to Center Administrators to followup on areas of interest:  Center Administrators identified that they want -Analysis of front desk staffing ratios in support of physicians and educators -Further review of how educators are using their time -JARS working group

Topics Identified by Center Administrators for Further Followup (continued)  Update Manuals and materials where appropriate  More engagement with other Center Administrators to share best practices  More conference calls topically focused on areas pertinent to Center Administrators -Business & Operational Planning -Productivity Review -Coding & Compliance review -Billing review and analysis

Topics Identified by Center Administrators for Further Followup (continued)  Multicultural Surveys  How can Center Administrators have a better understanding of cultural competencies and how their patients are impacted?  Affiliates want to collaborate with Joslin Boston on research  Marketing Support from Boston -Center Administrators want marketing templates and support from Joslin Boston so that there is uniformity of message and themes across the network -Joslin Boston advertisements should include affiliate network partners

Topics Identified by Center Administrators for Further Followup (continued)  Joslin Boston discussing new conference call schedule post annual meeting to increase collaboration:  Center Administrator focused calls  Educator focused calls  Physician focused calls  Discussing doing a series of 6 calls for each group  Affiliates to share areas where they want further collaboration for topics

Topics Identified by Center Administrators for Further Followup (continued)  Affiliates want “Why Wait” Lite program  Drs. Jackson and Krishnamurthy to take the lead on developing program content  Structure annual meeting agenda differently next year  Have dinner/reception on Sunday night instead of Monday night  Have physicians attend for just one day  Have parallel track for sessions whereby more time is focused with Center Administrators together and physicians together

More JARS and sharing of results  Have JARS Working Group for engaged affiliate partners  Share below results for 2007:  $~9 million annual net revenue per FTE endocrinologist  8% incremental annual net revenue  $3,000+ per patient  40% increase in patient population  53% increase in incremental patient population  Produce instructions for JARS reports similar to Monthly Report instructions

ADA Poster Abstract Demonstration JARS (Joslin Affiliates Reporting System) ROI