International Plan of Mystery: What Self-Insured Employers Need to Know About Global Health Care Programs PRESENTED BY Victor Lazzaro, Jr. Chief Executive Officer BridgeHealth International, Inc. Tom Emerick President, Emerick Consulting Former VP Global Benefits Wal-Mart Stores, Inc. David Hom Former VP Strategic Initiatives Pitney Bowes October 6, 2008

Presentation Overview Medical Travel and BridgeHealth Overview of Medical Travel Who is BridgeHealth? Destinations, Network, Procedures Care Coordination The Advantage to Employers Examples Myths and Realities Experience as Mythical Patient Popular Myths Witnessed Realities Conclusions What Could It Have Done For Us? US vs. “Peer” Countries Decision Example: Hip Sample Design & Savings Discussion Open Discussion

Medical Travel & BridgeHealth Medical Travel & BridgeHealth The Trusted Bridge to World-Class Healthcare™

Overview of Medical Travel One of the newest, most innovative options for U.S. employers, health plans, third party administrators, and other health benefits administrators. Significant savings Innovative health benefit design Ensures high quality, cost effective medical care Transparent costs Complements consumer-driven programs

Overview of Medical Travel A recent Deloitte study put the number of Americans traveling in 2007 at 750k, and a staggering 15M by 2016 Many players have entered the space on the B2C level, but few qualified on the B2B arena Top criteria to consider: Flexible Benefit Design Simplified Billing Financial Stability Deep Healthcare Experience Solid Infrastructure Quality Care Broad Network and Service Offering Transparent, Cost-Effective Plans Safety Premium Experience

Who is BridgeHealth? BridgeHealth International, Inc. (BridgeHealth) …is the premier service provider in the burgeoning medical travel industry—a real company with infrastructure, expertise, growth capital and industry-specific experience.

…maintains an international network of physicians and accredited hospitals and clinics …offers significant savings …provides a turnkey solution …has sent many Americans abroad for medical travel BridgeHealth…

Destinations BridgeHealth International has selected centers of excellence in the following countries: Brazil, China, Costa Rica, Hong Kong, India, Mexico, Panama, Singapore, South Korea, Taiwan, Thailand, and Turkey. Additional locations in Europe and elsewhere are under evaluation.

Network Just two examples of the high quality network are: Wockhardt Hospital in Bangalore, India – affiliated with Harvard Punta Pacifica Hospital in Panama – affiliated with Johns Hopkins Aftercare Network Our Travel Care Coordinators work individually as needed plus: Over 160 locations in the U.S. for any follow up that their usual physicians might not take. Pre Travel care and consultation The same network is available for discussion and medical review as needed prior to travel

Suite of Procedures BridgeHealth provides prospective patients an all-inclusive, transparent pricing plan which includes: surgery/procedure costs, airfare, lodging, transfers and a 24/7 concierge service. A suite of medical and dental procedures are available, including: Gastroenterology General Surgery Gynecology Internal Medicine Neurosurgery Oncology (selective) Ophthalmology Orthopedics Cardiology Cardiothoracic Chemical Dependency CyberKnife® (cancer) Dental Detox/Rehab ENT Executive Health Physicals Pain Management Pediatrics Plastic and Reconstructive Surgery Urology Male/Female Vascular Weight Loss/Obesity Surgery

Care Coordination Travel Care Coordinators work with client and their needs All U.S. information is treated in HIPAA compliant manner Coordination of Pre travel medical records are made for client to host country hospital and physician Pre travel telephone and/or consultation with client and their host country physician can be arranged Full outcomes data prior to travel is available to client

Care Coordination Post procedure medical records are translated as needed and coordination arranged for the client for their medical records to get to their U.S. physicians Any after care needs can be coordinated Client satisfaction surveys are done Client outcomes are tracked and monitored

What Could It Have Done For Us? The Trusted Bridge to World-Class Healthcare™

Health Care Per Capita Spending (2003) GDP % U.S.$5, Switzerland$3, Canada$2, U.K.$2, Japan$2,2498 Source: OECD Health Data 2006 US Healthcare Spending vs. “Peer” Countries

“One fifth of all countries exceed U.S. in life expectancy.” “Americans are living longer, but not as long as people in 41 other countries.” “The U.S. health care system ranks last compared with five other nations on measures of quality, access, efficiency, equity, and Outcomes.”

Example: Decision for Hip Replacement Hospital AHospital BHospital CLocal US Hospital Underlying Cost of Procedure, including Airfare and Hotel $15,000$12,000$9,000$50,000 Complication Rate for Procedure0.5%1.8%1.1%1.2% Travel time from home (showing flight transfers required.) 4 hrs (0)22 hrs (2)30 hrs (1)0.5 hrs (0) Patient Satisfaction Score (5 point scale) Impact to Employee* Patient co-payment and deductible $500Waived $5000 Incentive paid by ER by EE$0$1500$3000$0 Net benefit to employee with variable incentive $4500$6500$8000-$5000 Assumes a $5000 copay/coinsurance at a US hospital and a variable incentive paid by employer (ER) to employee (EE) based on provider selected.

Sample Benefit Design & Savings Hypothetical Company Example: Current Insurance International Insurance Benefit Savings to Employer*$0$41,000 Deductible$1,000waived Coinsurance80/20waived Max. out of pocket$5,000waived Additional Benefits: Travel Incentive n/a $3,000 Travel costs, air & hotel n/a$4,000 Partner air n/a $2,000 *Hip replacement done in Asia: U.S. cost ~ $50k, Int’l cost ~$9,000 Cost to the Employer: $14,000 ($5k OOP, + $9k incentives & costs) Net Savings to Employer: $27,000.

Pro’s Employees requesting it Lower cost Good quality Con’s Due diligence required Controls important Pros & Cons

Myths & Realities The Trusted Bridge to World-Class Healthcare™

Spent 2 days in Mexico to “feel” the experience as a patient Gained deep understanding of the process Visited several hospitals as a patient Visited a cosmetic surgical center Saw it firsthand and had “bias” pre-visit My Experience as a Mythical Patient

Hospitals are state-of-the-art facilities –Many are newly built with an understanding of patient flow for expedited care Similar principles to just in time production –Visually attractive –High touch service for patients English speaking coordinators and forms are in English Physicians are often US or western trained –Updated on newest procedures and technologies –Typically are English speaking Nursing Staff are trained to handle US patients –Recent graduates with up to date training –English speaking Myth 1: Medical Care is Not Quality Focused Myth 1: Medical Care is Not Quality Focused

Myth 2: Only Cosmetic or Excluded Benefits This is shifting to mainstream care for other conditions such as –Cardiovascular –Pain –Hips and Knees –Optical surgeries Cosmetic surgeries will continue to grow due to the aging of the US population Dental care will expand

Myth 3: Patients Won’t Go Outside the US for Care Access to additional services will continue to be important Options or choices will remain important to patients Individual insurance premiums will continue to increase at high levels Growth of high deductible plans will continue to grow Growth of ethnic populations will continue and willingness to go their home country for care will continue

Myth 4: Medical Travel Won’t Be Sustainable Supply side growth will continue –Hospital beds designated to medical travel will continue to grow –Physician availability for multiple specialties will grow Demand side will grow significantly –Patient volume will grow Under or Un Insured Ethnic Population growth in the US –Employers will begin to adopt these programs as an additional choice for employees –Health plans will need to get active as this will serve as a growth engine for members

Myth 5: Malpractice and Liability Barriers Persist Demand side of health care will force innovative financing of health care malpractice for returning patients in the US Liability coverage will likely move to shared captives by hospitals and other systems or companies Intake processes to manage patients will need to be automated and to improve to manage expectations

Conclusions Growth industry Venture capital is now entering this market to drive adoption and sustainability Health plans will see the need to invest Employers who have specific needs will use these services Employees will demand services over time

Discussion The Trusted Bridge to World-Class Healthcare™

Contact Information The Trusted Bridge to World-Class Healthcare™ Victor Lazzaro, Jr. Chief Executive Officer BridgeHealth International, Inc. O: C: Tom Emerick President, Emerick Consulting Former VP Global Benefits, Wal-Mart Stores, Inc. O: (479) David Hom Former VP Strategic Initiatives, Pitney Bowes O: (203)