1 Brad Bowlus President, CEO PacifiCare Health Plans James Frey President PacifiCare of California.…a health and consumer services company making people’s lives better Contracting Strategies

2.…a health and consumer services company making people’s lives better Contracting Overview Risk Of Conversion Under Control Supporting Claims, Medical Management, Disease Management And Contracting Infrastructure In Place Solid Financial Performance Occurring In Both Capitated And Directly Contracted Models Delegated Model Oversight Enhanced

3.…a health and consumer services company making people’s lives better Delivery System- Commercial Segment / All Products PHS Physician RiskPHS Hospital Risk

4 Can We Manage Risk? Market Leaders In Both States At - Risk Membership As Of 3/31/02

5.…a health and consumer services company making people’s lives better Improving Clinical, Service & Cost Outcomes Integrated Contracting And Medical Management Approach Leverage All Products Into Single Negotiation: “Concentrated Contract Leverage” Target Performance Based Compensation Timely and Accurate Claims Payment In Exchange For Lowest Possible Unit Cost Implement Limited Transplant Network January, 2003 Unique Quality Measurement System Narrow Networks And Tiered Networks Concentrate Penetration Into “High Performing” Providers

6.…a health and consumer services company making people’s lives better Environmental Scan- Delivery System Significant Delivery System Variation Still Exists Around Cost, Quality, And Service Current Products Are Priced To The “Average” The “Average” Is Configured Around 200% + Variation In Cost: –Major Unit Cost Variation –Enormous Utilization Variation –Major Pharmacy Variation Empower Consumers With Information On Cost, Quality, And Service 2001 Hospital Cost Variation: California Source: PHS Internal Data Median

7 PacifiCare Of California Is Both Willing And Prepared To Reimburse Providers With A Full Range Of Capitated And FFS Arrangements Currently 325 Groups Operating Under Delegated Arrangements Amount Of Risk A Group Bears Differs Significantly From One Group To Another Based On Their Financial Capabilities PacifiCare Of California: Philosophy Toward Risk

8 Kaiser Effect Utilization And Unit Cost Data For Delegated Providers Available To Price & Manage Risk DMHC Approach Is To Stabilize Groups Have Strong Commitment To Capitation PacifiCare Of California: Capitation Overview

9 PacifiCare Of California: Delegated Oversight Rigorous Review Processes In Place To Identify & Manage Delegated Risk Process Overview: Step 1: Calculate Liquidity Position For All (Working Capital Vs. Risk) Step 2: Some Providers Go To Level 2 Oversight »Review Financial Statements And Cash Flow Forecasts »Review IBNR Methodology Step 3: Some Providers Go To Level 3 Oversight »Site Visit For Potentially Unstable Providers Step 4: Based On Reviews, Establish Security And/Or Solvency Reserves Or Move To FFS If Necessary