1. Convenient Care Center River Health System Vikas Singh 02/14/2007

2. Convenient Care Center Recommendations to the Board What is “Convenient Care Center”? Market forces behind the phenomenon of convenient care clinics Market analysis Proposal – management, operational, financial and staffing recommendations Key issues Alternatives Restatement of the recommendations

3. Recommendations Opening four – River Health System “Convenient Care Center”, at strategic locations across the state of Arkansas at Wal-Mart and Walgreen's stores Negotiating contracts with large and small employers to provide these services through our insurance plan or to open up more clinics on their premises Media campaign targeted at uninsured, underinsured, low and high income group and hispanic population to promote use of our convenient care clinic Total estimated cost of the project is $ 984,000

4. What is a Convenient Care Center Convenient Care Centers are health care kiosks, operating in retail or grocery store or super centers like Wal-Mart and Target and are less expensive and more convenient than the visit to the physician’s office or other health care facilities Staffed by NP or PA Provide care for a very limited range of services In store prescription and rapid testing Requirement to have some degree of physician oversight and referral mechanism to ensure continuity of care

5. Market forces behind emergence of Convenient Care Centers Everyday increasing number of uninsured population (~47 million) in US Shifting of cost on consumer through higher co- payments, deductibles and co-insurance Consumer Driven Health Plans and Health Savings Account Double digit rise in insurance premiums Accessibility issues and long waiting hours in physician offices

6. Market forces behind emergence of Convenient Care Centers Low fees for the services, convenient location, open access, convenient operating hours In-house routine diagnostics, pharmacy and optometrist on site And many more factors make it more appealing for consumers for minor illnesses like sore throat, flu shot, sports physicals, bowel upset, superficial infection, minor injuries, etc.

7. Market Analysis First clinic was opened in Minneapolis MSA in year 2000 – QuickMedex (Minute Clinic) ~90 clinics all across US by 2005 ~200 clinics all across US in 2006 and several hundreds of store openings planned in 2007

8. Market Analysis They are also in the process of being endorsed by consumer driven health plans, managed care plans, HMO’s and insurance companies to lower their cost. Employers and stores also evaluating it as a method to lower their employee healthcare expenditure, increase in productivity and satisfaction and lower absenteeism

9. Market Overview – Major Players

10. Source: Drew Sullivan, Retail Health Clinics are Rolling Your Way, Journal of Family Practice Management, May 2006.

11. Market Overview – Major Players Source: Drew Sullivan, Retail Health Clinics are Rolling Your Way, Journal of Family Practice Management, May 2006.

12. Market Overview – Arkansas Only two retail health clinic in Arkansas till date – in NW Arkansas Operated by Interfit Health (Redi Clinic) at Wal-Mart super centers in Rogers and Fayetteville. Wal-Mart is negotiating with Solantic and Med point Express to open more retail health clinics in Arkansas

13. Proposal Open four – River Health System “Convenient Care Clinics” in Arkansas at: Little Rock Fayetteville EL Dorado Jonesboro

14. River Health System “Convenient Care Center” Management Nurse practitioner will be responsible for administration of the clinic and deliver of care PCP of our nearest medical practice/hospital will provide supervision and support Practice management administrator of the physician clinic providing support will oversee the functioning of that convenient care center

15. Scope of Services Get Well services Source: Adapted from RediClinic website (http://www.rediclinic.com/services/services.asp)

16. Scope of Services Stay Well services Source: Adapted from RediClinic website (http://www.rediclinic.com/services/services.asp)

17. River Health System “Convenient Care Center” Operational Issues Nurse practitioner will do check-in, registration, examination/diagnosis/testing, fill in medical records and give prescription Hours of operation – Mon-Fri (8Am to 8PM), Sat(8AM to 6 PM), Sun(10Am to 5 PM) Triage of the patients as required Transmission of records Management and IT support

18. River Health System “Convenient Care Center” Financials – Fee Structure

19. River Health System “Convenient Care Center” Financials – Fee Structure

20. River Health System “Convenient Care Center” Financials – Expenses

21. River Health System “Convenient Care Center” Sensitivity Analysis – Net revenue

22. River Health System “Convenient Care Center” Key Issues Relevance to River Health System M/V/V Physician apprehension Quality of care Conflict of interest Regulatory – Healthcare, Financial, Corporate Physician oversight and referral mechanism

23. River Health System “Convenient Care Center” Quality of Healthcare at Retail Health Clinics Limited number of services Peer review, physician oversight, medical board review, use evidence based medicine software Source: The Wall Street Journal Online

24. River Health System “Convenient Care Center” Alternatives Urgent Care Centers Improving the management and operation of our own clinics Expanding coverage/service area by opening more clinics

25. River Health System “Convenient Care Center” Reasons for opening Convenient Care Center To be proactive and maintain our market position To serve the M/V/V and purpose of organization Financial issues Strategic issues

26. Recommendations Opening four – River Health System “Convenient Care Center” at strategic locations across the state of Arkansas in Wal-Mart and Walgreen's stores Negotiating contracts with large and small employers to provide these services through our insurance plan or to open up more clinics on their premises Media campaign targeted at uninsured, underinsured, low and high income group and hispanic population to promote use of our convenient care clinic Total estimated cost of the project is $ 984,000

27. Questions?