1. WHAT IS MYCATALYST Data Driven Achievement of Optimal Healthcare & Financial Outcomes (case studies) Michigan Purchasers Health Alliance September 23, 2010 Robin F. Foust, PAHM Zoe Consulting, Inc. -- powered by myCatalyst

2. CLIENTS Clients include but not limited to: Physician Practices: Wake Forest Community Physicians, Florida Medical Clinic, Morton Plant Meese Primary Care; United Physicians Inc, Preferred Health Services, etc. Hospital/Hospital Systems: MediCorp Health System, Vanderbilt University Medical Center, St. Mary Medical Center, Oconee Medical Center, HealthEast, Renown (formerly) Washoe Health System, South Texas Health System (McAllen), Vanguard Health Systems, Illinois Hospital Association, SC Hospital Association, The Medical College of Georgia, SELF, Laurens Hospital, Spartanburg Regional Health System, Community Health Systems, and so forth. Universities: Princeton University, The University of South Carolina, Vanderbilt Other Employers: Kone, Inc., Pearlstine Distributors, Ashai Kasai, Cozen O’Connor, DC Consortium, Metropolitan Washington Airports Authority, Boddie-Noell Enterprises, Pilgrim’s Pride, G&P Trucking, Lyondell Equistar, City of Charlotte, Mecklenburg County, State of Delaware, St. Gobain, and many more;

3. POWER OF AWARENESS STOP YIELD

4. FOUNDATION FOR SUCCESS POPULATION HEALTH & PRODUCTIVITY MANAGEMENT (INTEGRATION -- COORDINATION -- EVALUATION) HUMAN – INFORMATION SYSTEM – FINANCIAL

5. EVOLUTION OF DATA INTEGRATION & MANAGEMENT Infrastructure Supports Coordinated Care For Optimal Outcomes BASIC (static) ENHANCED (static) ADVANCED (dynamic) COMPREHENSIVE (dynamic) Population Health and/or Productivity Analysis PHA/PHPA+ PHPA/PHPA+ + GAP ANALYSIS PATIENT CENTERED CARE COORDINATION (PCCC) PHYSICIAN GUIDED CARE COORDINATION (PCGCC) Data Warehouse Data Integration Independent Audit Identifies Cost Drivers & Targets Supporting Analysis Recommendations Retrospective Program Effectiveness Automated Participation Studies Risk Reduction Reports Recommendations Helps with Filling Gaps Documents Outcomes Coordinates All Service Providers (LC/MM/DM/CM) Program Advocate (PA) Optimal Participation Rates Actionable Information Recommendations Prospective Impact on Trend Better Outcomes Physician Coordinates With Medical Neighborhood Patient Advocate (CA) Electronically Connected Physician Led Actionable Information Recommendations Employee Engagement Best Outcomes PHPA+ includes productivity (STD, LTD, Workers Comp, Absence, FMLA) PA = Program Administrator performs ongoing gap analysis on data, CA = Clinical Administrator LC = Lifestyle Coaching, MM = Maternity Management, DM = Disease Management, CM = Case Management Other services available (e.g., nominal groups, RFP management)

6. DATA DRIVEN HEALTH CARE: Healthcare Reform (Refer To Handout) An important element is benefit design… Accountable Care Organizations Clinically Integrated Networks Medical Homes (Multi-Specialty or Primary Care) High performing Networks Narrow Networks Captives “Patient Centered and/or Physician or Clinician Guided Care Coordination = Optimal Outcomes”

7. Other Case Mgmt Maternity Chronic Care Lifestyle Mgmt ????? InterventionsPrograms Weight Loss Smoking Cessation High Risk Pregnancy HRA/Screening Mat Planning & Ed Mat Case Mgmt Wellness Events Other Programs Aggregated Medical Claims HRA & Screenings HRA & Screenings Infant Education Coaching On Line Self Help Diabetes Asthma Other Programs Payroll Incentives EAP Vendor Stratification Data Sources Other Data Sources CLIENT REPORTS Large Case/High Risk CAD/CHF Other Core Cond CLIENT REPORTS THEN: Historically Fragmented and Uncoordinated Wellness Interventions (silos)

8. Consolidated Reporting Population Study Trending/Outcomes Risk Modification Incentive Mgmt Participation Savings (Forecast/Actual) NOW: Program Coordination & Evaluation Integrated Medical & Rx Claims HRA & Screenings HRA & Screenings Other Data Sources: etc., Physicians, Productivity... Assignments, Mediation & Discharges HRA and/or Claims Stratification & Assignment Control HRA and/or Claims Stratification & Assignment Control ID Control & Client Specific Organization Fitness Center Chronic Care Case Mgmt Maternity Care Coordination Transfers Program Administrator/Program Oversight Reporting/Export Interface Other Requests & Discharges Work Life Family Balance Personnel Data Employers Patients Clinicians Employers Patients Clinicians Tasks myCatalyst® -- all rights reserved RTW/SAW Lifestyle Coaching Onsite Health Clinic Onsite Health Clinic Disability Mgmt

9. Disease/Condition Management THEN: Managed Care Condition Management 1985 Employers Where Healthcare Has Been Lack of technology Not able to track patients in between office visits Reimbursement Not Aligned: Fee for Service, Captitation Silo based delivery of care = redundancy, inefficiency Healthcare Costs Continued to Rise

10. Disease/Condition Management NOW: Clinician Guided Patient Centered Care Coordination Outcomes Management 2008 Employers Where Healthcare Is Now Local Clinicians Taking Care of Local People Technology tracks patient outcomes in between office visits (OVs) Payment for Outcomes Coordinated Care = Efficiency and Optimal Outcomes Information systems identify patients who need OVs Condition Management transferred back to physicians Reimbursement is realigned Clinicians can prescribe more intensive intervention (LC/MM/CM)

11. *employers’ employees/covered spouses, carriers’ members Hospital Payer Population* Physicians SUPPORT (data infrastructure, sales support, etc.) Local Healthcare Reform: Cost Containment Opportunities for Employers WIN-WIN-WIN

12. Removing Barriers: why use terms like PGCC/CGCC PGCC vs. Medical Home – The Consumer’s Perspective Focus group participants quoted in a study -- overall equate medical homes to nursing homes and home health care. “First you go to the medical home and then you go to the funeral home,” said one focus group member. Another said the term “just gives me the creeps.” Council of Accountable Physician Practices, an affiliate of the American Medical Group Association and partially funded by the Kaiser Permanente Institute on Health Policy; Winter 2009; Ross, et al Other terms used for medical homes: high performing networks, accountable care organizations/ systems, clinically integrated networks, pay for outcomes, pay for performance networks

13. WHAT IS MYCATALYST THE BUSINESS CASE AAFP study: if every American had a primary physician health manager (medical home), healthcare costs would decrease by ~5.6 %, resulting in national savings of $67 billion per year, with an improvement in the quality of the healthcare provided Employers are seeking solutions to rising healthcare costs; An aging workforce & rising healthcare costs -- require change America’s Health Insurance Plan’s ideal healthcare system includes: “pay for outcomes, disease management, and prevention as core values; with physicians, payers, & patients able to compare treatments to guide clinical decisions.” 77 % of employers offer formal health and wellness programs -- and they are not paying physicians directly but recognize the value of realigning reimbursement to pay physicians for DM and/or outcomes

14. BUSINESS BENEFITS AS LEADERS IN YOUR COMMUNITIES Enhance leadership reputation – show how to achieve healthcare solutions Support employees, members, and community to achieve optimal health outcomes Contribute to fiscal health of your organization and the community you serve Be proactive rather than reactive Prepare for health care reform (local co-ops, take back your health act, accountable care organization/systems, etc.) Transform healthcare locally

15. DATA INTEGRATION SOURCES EMPLOYER PERSONNEL/PAYROLL HEALTH RISK ASSESSMENTS BIOMETRIC VALUES ELIGIBILITY MEDICAL CLAIMS (All Places of Services) PHARMACY CLAIMS PRODUCTIVITY: Employer related Disability Workers Comp Absence OTHER – onsite fitness centers, clinics, seminars, incentive activity; any electronic file Program providers along care continuum – Lifestyle, Condition, Case Management PHYSICIAN PRACTICE MANAGEMENT: (PQRI Codes, other outcome based codes, and other) EMR (if available; but not necessary. Conversion to PQRI outcomes based codes) LABS E-Prescribing

16. Standard Data Warehouses/ Data Mining Companies Combination Approach/ Data Mart Clinical Data Repositories DATA WAREHOUSE: EMPLOYERS YES NO DATA WAREHOUSE: PHYSICIANS/CLINICIANS NOYES DATA INTEGRATION (DI): MEDICAL/PHARMACY YES (DI) HEALTH RISK ASSESSMENT/BIOMETRICS YES NO DATA INTEGRATION: DISABILITY & WORKERS COMPENSATION, ABSENCE (PRODUCTIVITY) MAYBEYESNO (DI) FITNESS CENTER and Health Resource Center NOYESNO Physician Quality Reporting Initiative (PQRI) NOYES COORDINATES CARE BETWEEN ALL SERVICE PROVIDERS ALONG CONTINUUM (Program Integration (PI and Care Coordination (CC) NOYESNO CONSOLIDATED REPORTING MAYBEYESNO REPORTING: FOR EMPLOYERS YES NO REPORTING: FOR PHYSICIANS NOYES MAINTAINS HISTORY OF CLAIMS/OTHER DATA MAYBEYESNO MANAGES INCENTIVES MAYBEYESNO SUPPORTS PHYSICIAN GUIDED CARE COORDINATION NETWORKS (Clinically Integrated, Medical Home, High Performing; and so forth) NOYES SUPPORTS MEDICAL HOMES NOYES SUPPORTS BENEFIT DESIGNS YES MAYBE LOOK FOR COMBINATION APPROACH

17. WHAT PROGRAMS MAY BE COORDINATED PQRI MEASURES (Diabetes Measure #1) #Measure TitleMeasure DescriptionCRMG 1 Diabetes Mellitus: Hemoglobin A1C - Poor Control in Diabetes Mellitus % of patients aged 18 through 75 years with diabetes mellitus who had most recent hemoglobin A1c greater than 9.0% XXX Most Recent Hemoglobin A1c CODE Hemoglobin A1c level > 9.0% 3046F Hemoglobin A1c level 7.0% to 9.0% 3045F Hemoglobin A1c level < 7.0% 3044F If No is checked for all of the above, report 3046F–8P (Hemoglobin A1c level was not performed during the performance period [12 months], reason not otherwise specified.) PQRI = Physician Quality Reporting Initiative

18. HEALTH PROFILE: Works with or without an EMR Different Mart Approach: Supports Acting on Data Stored & Organized at the Individual Level – Aggregate for Reporting

19. Data Integration and Organization Critical for Success (Employer data consistent even if data sources change)

20. HEALTH PROFILE FOR PROVIDERS/CLINICIANS INVOLVED Monitors Programs &/or Physicians Member Has/Is Seeing/Participating In…

21. SERVICE/SYSTEM OPTIONS: combination approach Population OwnersInternal Care Coordination & Population Health Managers Health Management Program Providers Clinicians/ Physician Organizations (IPA, PHO, ACO) Employers, TPAs, Carriers, Captives Hospitals, Health Departments, Internal Wellness Programs, etc. (DM, MM, LM, CM)High Performing Networks, Clinically Integrated Networks, Multi-specialty Medical Homes, ACO, Clinician Guided Care Coordination, etc. Data Integration, Aggregation, Analysis, Reporting. Document Outcomes Health Profiles, Tools for managing to get best outcomes, etc. Care Guidelines and Protocols, Single Focus or Continuum, and other Infrastructure Outcomes Performance Reimbursement Alignment ALL COMBINED

22. SUMMARY REPORTING & RECOMMENDATIONS PRESENTED THROUGH POWER POINT (Samples Follow) Employer Reporting

23. CASE STUDY A

24. SAMPLE BI-ANNUAL REPORTING HEALTH RISK ASSESSMENT TAKERS (IDENTIFY PEOPLE NOT BEING MANAGED WHO SHOULD AND GET THEM INTO PROGRAM) Percentage of High Risk HRA Participants Ever Enrolled in Health Management Programs Composite Risk *HRA ParticipantsManaged Initial Gap Analysis % Managed ~ Without data mart % Managed (Current) Post Acting On Data With data mart Low11997.6%25.4% Moderate129129.3%44.5% Elevated2133315.5%89.9% High971818.6%92.4% Urgent14642.9%94.0% TOTAL572 % Participation56.5% * Composite Risk based on: - Lipid, Weight, Blood Pressure and Blood Sugar - High and Moderate risk are weighted ~ Considered Managed if enrolled in Health Program from 2006 through 2008

25. CASE STUDY B

26. Good News Report an ROI of $3.49 for every $1.00 invested. This is conservative and does not include additional savings associated from gains in productivity Conservatively estimate an additional $74,303 in productivity savings in replacement wage (budget dollars based on STD only and reduction of 4.5 days for replacing 25% of those on disability (197) or 49 employees) Migration to lower health risks = Positive Return on Outcomes. - 155 individuals or 27.1% of HRA takers studied reduced risk - 319 individuals or 55.8% of HRA takers sustained their risk level - 96 individuals or 16.8% of HRA takers increased their risk level Evidence that Lifestyle Coaching influenced reduction in risks

27. Observations (2009) Medical and Pharmacy: 3,867 covered lives during 2009 benefit year compared to 3,783 in 2008 Total Medical Spend (Medical Only – no Rx $) for the 2009 benefit year: $14,411,452 Average medical PMPM over study period: $341.74 lower than forecast Female pmpm rates trending favorably – male pmpm rates are not Overall employees are trending favorably – spouses & dependents aren’t Productivity: Total Productivity Spend for 2009: $1,515,339 (STD, WC). Note: LTD is not included because the data is summarized back to date of disability Total Medical, Pharmacy ($4,132,470), and Productivity: Total Expense with Health and Productivity: $20,059,261 + LTD

28. INTRODUCTION Employer Age Gender Claims Summary for Study Period INTRODUCTION Employer Age Gender Claims Summary for Study Period

29. Females Trending Positive – Focus on Male Participation & Outcomes

30. HRQ Matrix: Risk Modification Scoring methodology for evaluating changes in risk levels for Health Management Program Participants Urgent512 Risk Level Risk Desc Persons % 1st Risk 2.1% High49817.2% Elevated320635.9% Moderate212521.9% Low113122.9% 572 Risk Distribution of Subsequent HRQ 8.3%75.0%16.7%0.0% 543212.0%51.0%34.7%10.2%2.0% 100% First Evaluation 0.0%12.1%56.3%16.5%15.0% 0.0%1.6%22.4%49.6%26.4% 0.0% 12.2%19.1%68.7% 0.5%15.0%22.927.3%34.3%  Health Risk Matrix depicts changes in risk levels over time and the degree of modification  Risk Level cohorts can be related to claims (PMPM) to reflect impact Aggregate Overall Change in risk : All Multiple HRA Takers (572)  Reduced Risk:155 individuals27.1%  Kept risk stable:319 individuals 55.8%  Increased Risk: 96 individuals 16.8%  For all risk levels 47% participated in an intervention  75% urgent risk participated in an intervention  71% high risk participated in an intervention  55% elevated risk participated in an intervention  40% moderate risk participated in an intervention

31. Positive Trend Differential = Net $934,122.60

32. PRODUCTIVITY ANALYSIS Short Term Disability Impact on Core & Complex Chronic Conditions STD Annual Summary: Injury and Illness (2008-2009)Managed STD Start Year STD ClaimantsClaims Benefit Paid DaysSTD CompCond % STD Claimants with C/CCCore [C] Complex [CC] Total Managed Mngd Carrier B Mngd Wellness Vendor 2008171187 7,816 $ 673,3049857.3%96201495 2009197215 8,939 $ 929,62611859.9%11321401329 Only 8% managed in 2008 of those individuals with Core and Complex Chronic Conditions who filed an STD claim. Although an improvement, only 20% with Core and Complex Chronic Conditions & also STD claimants were managed

33. Short Term Disability (STD): Impact by Risks High Risk Productivity Impact: Short Term Disability (2008-2009) Composite Biometric High Risk ClaimantSTD Claimants % of STD ClaimantsSTD Claims STD Benefit Paid DaysSTD Cost % of STD Cost Avg Days Lost/Claimant Obesity308 6719.9% 83 2,798 $ 333,60520.8%41.76 Lipids 424 6820.2% 82 3,417 $ 378,86223.6% 50.25 High BP 124 216.2% 27 997 $ 123,5647.7% 47.48 Glucose 32 72.1% 10 482 $ 83,3235.2% 68.86 Distinct Total560 10029.7% 121 4,652 $ 519,45932.4%46.52 Average Days For STD for 2009 was 45.38 days. Large/Bold Font = above avg. Self Reported Risk Alcohol Risk 262 3610.7% 44 2,039 $ 241,73315.1% 56.64 Depression Risk166 3711.0% 43 1,461 $ 115,6467.2%39.49 Exercise Risk408 6118.1% 66 2,544 $ 287,06117.9%41.70 Stress Risk333 5917.5% 72 2,558 $ 308,99219.3%43.36 Poor Health Perception 260 3811.3% 49 1,901 $ 212,16213.2% 50.03 Sleep Problems 111 247.1% 31 1,254 $ 151,9139.5% 52.25

34. PRODUCTIVITY ANALYSIS Workers Compensation Percent of WC Claimants with Chronic or Core Conditions: 284 or 38.7% Core Conditions 275 or 37.5% Complex Chronic Conditions Worker CompensationManaged WCYear WC ClaimantsWC Claims # Days Lost Work Avg Days Lost/Claimant Total Managed Carrier B - Case Mgmt Wellness Vendor 2006246283474119.27000 200723427219268.23440 200818420214507.88844 20092022165412.681578 Aggregated734973865811.79271512 7.4% Managed in 2009 – opportunity to reduce days if managed Percentage of WC Claimants with Core and Complex Chronic Conditions Conditions28439% Core27538% Complex4142% Total WC Claimants734

35. Savings Potential in Replacement Wages © (myCatalyst ™ ) America Demographics calculates that it costs 150% of an employee’s salary to replace an employee on disability due to salary replacement, training and lower productivity. Based on average wage for individuals out on STD, we calculated the following potential savings for 2009 based on 2008 data (pregnancy related STD is not included). $74,303 conservative savings in replacement wage (budget dollars) by reducing average STD duration by 4.5 days Other savings are available. This only represents payroll replacement saved. PRODUCTIVITY ANALYSIS: Gains in days & dollars

36. CASE STUDY C Physician Guided Care Coordination (PARTICIPATING EMPLOYERS)

37. OBSERVATIONS: Core Conditions FORECAST

38. OUTCOMES: Provider Performance -- Participation Managed Individuals for Core Conditions Claims Data for Calendar 2008 Core ConditionInd w/ ConditionMngd % Mngd T-PdPMPM Un-Mngd Med$ % Un-Mngd Med$ Asthma1885127.13% $1,031,674 $ 492.92 $483,74646.89% CHF261246.15% $930,172 $ 3,000.55 $223,30024.01% CKD291551.72% $412,492 $ 1,185.32 $147,28135.71% COPD2185525.23% $2,407,544 $ 994.03 $1,068,54444.38% CAD2547629.92% $$2,513,329 $ 886.54 $1,213,60948.29% Diabetes2418736.10% 2,505,451 $ 945.81 $1,076,42242.96% PGCC/CLINICAL INTEGRATION Provider Performance – Participation/Drill Down/Refer Physician/Clinical Administrator Ensures Optimal Outcomes

39. WHAT THE DATA IS SAYING: GAP ANALYSIS COMPLEX CHRONIC CONDITIONS (CLAIMS) XYZ: COMPLEX CONDITIONS MED SPEND PMPM (1/1/06 through 12/32/08 with claims paid through 6/30/09)

40. WHAT THE DATA IS SAYING: GAP ANALYSIS Provider Performance – Participation (Poor Performance and Indication of redundancy. Note: This employer implemented PCCC) OUTCOMES: PROVIDER PERFORMANCE (# and % Managed by Complex Chronic Conditions) Chronic Complex Intervention Participation For claimants during 2006 though 2008 Percentage Managed Chronic ComplexClaimantsVendor A Vendor I Vendor H Carrier Case Mgmt Chronic ComplexClaimantsVendor AVendor I Vendor H Carrier Case Mgmt Cystic Fibrosis< 5 Cystic Fibrosis< 50.0% Hemophilia5 2 50.0% 40%0.0% Lupus142 1 Lupus1414.3%0.0%7.1%0.0% Multiple Sclerosis73 2 742.9%0.0%28.6%0.0% Myasthenia Gravis< 5 Myasthenia Gravis< 50.0% Parkinson's Disease< 52 1 Parkinson's Disease< 566.7%0.0%33.3%0.0% Pulmonary Circulation9 3 90.0% 33.3%0.0% Rheumatoid Arthritis272 41 Rheumatoid Arthritis277.4%0.0%14.8%3.7% Total659 131Total6513.8%0.0%20.0%1.5%

41. WHAT THE DATA IS SHOWING (THE DIFFERENCE – ACTING ON THE DATA) Condition Management By Spend Levels: Improvement Overtime (Data shows number of individuals/% proactively coordinating with vendors to enroll -- 2009) MANAGED BY MEDICAL SPEND (BANDS) 200620072008 Medical Spend CategoryPMPMInsured Mngd Insured % MngdPMPMInsured Mngd Insured% MngdPMPMInsured Mngd Insured % Mngd > $0 < $10K$88.33348651615%$93.27339559117%$103.51358266018% > $10K < $25K$1,305.6811438 33% $1,378.3312149 40% $1,303.4014150 35% > $25K < $50K$3,039.37249 38% $2,822.742614 54% $3,088.003512 34% > $50K < $75K$5,166.047< 5 29% $6,548.73< 5 0% $5,905.14147 50% > $75K$21,529.0811< 5 27% $33,638.2510< 5 40% $29,061.25146 43%

42. CASE STUDY E Physician Guided Care Coordination (PARTICIPATING PHYSICIANS) CLINICALLY INTEGRATED NETWORK

43. A LOCAL CARE APPROACH: GAINING MOMENTUM Physician/Clinician Guided Care Coordination (PGCC/CGCC) Medical Neighborhood

44. PHYSICIAN GUIDED CARE COORDINATION (Clinical Integration/Multi-Specialty Medical Home/High Performing Networks) Process: Optimal Patient Outcomes Turns data into actionable information Transitions Condition Management to Local Clinicians Benefit plan incents clinicians/physicians and members Data infrastructure benign to care process but supports outcomes based focus and payments Identifies opportunities and acts on data to get patients into care or into more intensive intervention Physicians can Cx (prescribe) lifestyle coaching (smoking cessation, weight management, stress, and so forth)

45. SANITIZED -- ACTUAL DATA Monthly Updates -- BASELINE OUTCOMES PERFORMANCE – Medicare. Goal is > = 80% Measure Number 114TOBACCO USE INQUIRY Practice NameProvider Eligible Patients Measure Performed% Measured Practice A Physician 11421812.7% Physician 21809854.4% Total31411636.9% Practice B Physician 349331363.5% Physician 419810653.5% Physician 525200.0% Physician 6926570.7% Total94047750.7% Practice C Physician 74679420.1% Physician 81253628.8% Physician 92095526.3% Physician 1058535460.5% Physician 1152020639.6% Physician 123877519.4% Physician 1310600.0% Total197478739.9% Note: Columns may not sum due to patients seeing multiple physicians in the practice

46. SANITIZED -- ACTUAL DATA Monthly Updates – OVER TIME OUTCOMES PERFORMANCE – Medicare. Goal is > = 80% Measure Number 114TOBACCO USE INQUIRY Practice NameProviderReport Period 1Report Period 2Report Period 3Report Period 4 Practice B Physician 353.5%67.5% Physician 40.0%44.2% Physician 570.7%96.0% Physician 650.7%79.6% Total63.5%71.83% Note: Columns may not sum due to patients seeing multiple physicians in the practice

47. LOCATION REP RIGHT CLICK = PATIENT CANDIDATE LIST OUTCOMES PERFORMANCE Measure Number 114TOBACCO USE INQUIRY Practice NameProvider Eligible Patients Measure Not Performed Practice B Physician 3493180 Physician 419892 Physician 5252 Physician 69227 Total940463 LOCATION REPRESENTATIVE Measure # 114TOBACCO USE INQUIRY Practice NameProvider Patient Contact Alert Measure Not PerformedAddress Phone 1 Phone 2Email PATIENT NAME Practice BPhysician 3Patient DAddress##Email Patient EAddress##Email Patient FAddress##Email ∞Address##Email ∞Address##Email ∞Address##Email ∞Address##Email ∞Address##Email ∞Address##Email REMEMBER: Data updated monthly – opportunity to improve performance Location Reps & Physicians only see their patient’s data and patients of their practice peers Columns may not sum due to patients seeing multiple physicians in the practice Mail Merge/Phone List – get patients in so measure(s) met – performance high Act on the data every month before filed in January so outcomes met

48. OPTIONAL LOCATION REP RIGHT CLICK = PATIENT HEALTH PROFILE LOCATION REPRESENTATIVE TOBACCO USE INQUIRY Patient Contact Alert Measure Not PerformedAddress Phone 1 Phone 2Email NAME Patient AAddress##Email Patient BAddress##Email Patient CAddress##Email ∞Address##Email Patient DAddress##Email Patient EAddress##Email Patient FAddress##Email ∞Address##Email REMEMBER: Location Reps & Physicians see only their patient’s data and patients of their practice peers

49. Diabetes By Vendor/Physician/Clinician - Population Count Total Mid Town Internal Medicine Local Family Practice Uptown Medical Clinic Dr Joe Smith, MD Population4622567510328 Indicators HA1c >9%55 12 36 4 3 ><7-996 65 12 17 2 <7118 37 5 55 21 NR193 142 22 27 2 Blood Pressure Sys<130/Dia<8588 56 15 12 5 >< 86-139145 75 21 44 5 >140/>89134 45 37 15 NR95 80 2 10 3 LDL >160mg/dl81 42 21 16 2 ><100-159137 82 14 35 6 <100122 51 37 15 19 NR122 81 3 37 1 PHYSICIAN PRACTICE PERFORMANCE REPORTS

50. Diabetes - Midtown Internal Medicine Population Count Total Michael M. Johnson, MD Sally R. Klipper, MD Dalton C. Benson, MD Hilbert Q. Wiggins, MD Population25650794582 Indicators HA1c >9%12 6 2 1 3 ><7-965 21 15 22 7 <737 3 5 19 10 NR142 20 57 3 62 Blood Pressure Sys<130/Dia<8556 12 8 21 15 >< 86-13975 19 32 15 9 >140/>8945 16 15 8 6 NR80 3 24 1 52 LDL >160mg/dl42 9 5 16 12 ><100-15982 26 25 13 18 <10051 14 13 15 9 NR81 1 36 1 43 PHYSICIAN PERFORMANCE REPORTS

51. HEART FAILURE DATA/PATIENT MONITORING GOALS: Reduction in hospitalizations Reduction in re-admissions Optimal HF management -- ACC/AHA recommendations for optimal HF management DATA MONITORING (Sample Physician Performance Measures): # 5: Patients >18 years old with HF and LVSD who are Rx Ace inhibitor or ARB therapy unless contraindicated # 8: Patients > 18 years old with HF and LVSD who are Rx beta blocker therapy unless contraindicated #115: Advising smokers to quit PCCC/PGCC – VALUE ADD: ACCOUNTABLE FOR OUTCOMES PROVIDER’S PERFORMANCE IS MEASURED and MONITORED BY A COUNCIL OF THEIR PEERS THROUGH CLINICAL INTEGRATION

52. HEART FAILURE DATA/PATIENT MONITORING DATA MONITORING (OTHER): OVs: Patients with 2 or more OV per year Hypertension and lipid management Education on and assessment of Nutrition/Diet compliance Medication compliance Education on and monitoring weight gain – how to react Assessment of ADL Assessment of volume overload Risk readmission assessed following hospitalization OTHER EXAMPLE: IMPROVING OUTCOME PERFORMANCE PCCC/PGCC/CGCC: PROVIDERS MAKE A DIFFERENCE

53. HEART FAILURE DATA/PATIENT MONITORING ACTIONS; if needed and supported by clinical administrator: Physicians: if needed -- consider implementing Minnesota Living with Heart Failure questionnaire Six Minute Walk Test Review and follow ACC/AHA Guideline (2009) Patients; if needed: like writing Rx can order Cx (Cx = more intensive care intervention services) Physician Cx Smoking Cessation Course/Lifestyle Coaching; &/or Physician Cx Heart Failure patient/participant carekit; and/or Physician Cx Case Management; and/or Physician refers to Clinical Administrator for additional help EXAMPLE: IMPROVING OUTCOME PERFORMANCE PCCC/PGCC/PGCC: PROVIDERS MAKE A DIFFERENCE

54. Local delivery compared to remote delivery = best outcomes Coordinating assignment between all service providers/programs along the continuum of care e.g. wellness and prevention, onsite clinical care, lifestyle coaching; maternity, disease, and case management; disability management, employee assistance; etc. Reduce redundancies through patient centered care coordination ensuring most appropriate provider or vendor and timely intervention Manage incentive design Fill in gaps with other services when/if needed Monitor program performance including gains/losses in productivity Audit outcomes independently. Avoid -- “Fox guarding Henhouse”] Soft eligibility audits Leverage consolidated reporting for making more informed decisions Ensure risk reduction in population and cost savings WHAT ARE EMPLOYERS IMPLEMENTING

55. BUSINESS BENEFITS AS EMPLOYERS Manage loss in days and dollars – turn into gains Retain and recruit valued employees Improve overall health of employees and covered lives in population Improve productivity of employee population Reduce risks Reduce or maintain trend Contribute to fiscal health of organization Get the most from your program’s performance through ongoing independent audit and care coordination supported by system infrastructure

56. BUSINESS BENEFITS AS LEADERS IN YOUR COMMUNITIES Enhance leadership reputation – show employers how to achieve healthcare solutions Support employees, members, and community to achieve optimal health outcomes Contribute to fiscal health of your organization and the community you serve Be proactive rather than reactive Prepare for health care reform (local co-ops, captives, take back your own health act of 09, accountable care organizations [ACO]) Transform healthcare locally

57. OPTIMAL OUTCOMES 57

58. AQ&

59. THANK YOU Robin Foust, PAHM rfoust@myCatalyst.com 803-324-8626

60. The Health Risk Quotient is used to stratify populations for program participation and to measure risk changes over time, allowing for control studies to identify program impact. Health Risk Quotient (HRQ) A calculated measure that aggregates critical health risk indicators Biometric measures are selected that support Health Program Goals & Objectives such as Blood Pressure, Blood Sugar, Lipids, Tobacco Use and BMI. These measures are translated into a numeric score to indicate risk level: (3) High, (2) Medium, and (1) Low based on clinically supported guidelines. All participants are scored using the same stratification methodology which allows for a time series analysis without skewing the results. High and Medium risks are given relative weights in order to assure that lower risks do not offset higher risks. The result is a aggregated health risk score that accumulates higher risks. The score is then calibrated into five levels of risk:  0 = Not Scored: Score has not been calculated  1 = Low: Participant only has Low risks  2 = Medium: Participant has Low and Medium Risks  3 = Elevated: Participant has 1 High Risk and an array of Medium and Low risks  4 = High: Participant has 2 High risks and an array of Medium and Low risks  5 = Urgent: Participant has 3 or more High Risks All rights reserved. Do not copy of use any content of this PowerPoint without written permission from Robin Foust