Martin Pearson President Troy Gautier Managing Director YOUR

Martin Pearson, President Troy Gautier, Managing Director YOUR LOGO

Accountable Care Organizations (ACO) ACOs are the future of integrated collaborative Health Care solutions and provide the best opportunity to improve services and reduce costs. Alliances Progress and Revcon Alliances are professional consulting firms specialized in designing and implementing ACOs. Our service offering provides the support and expertise to ensure successful delpoyment of your ACO and the quickest return on investment in the healthcare industry. Major workstreams include: Design – people, process, technology and lean operating models Build – health care team, payer-provide relations, shared best practices Optimize – assist physicians and adminsitrative staff to obtain & measure results The following pages provide an overview of our approach and credentials. Managment consultants and business/technology process specialists Alliance professionals with hundreds of projects building succesful ecosystems HC IT speicalists to carry-out package selction and implement solutions Page 2 YOUR LOGO

ACO Presentation Index 1 History and Context 2 Legislation – Affordable Care Act 3 ACO Examples 4 How to build an ACO 5 6 Roles & Responsabilities 7 Next Steps 8 Contact Us Page 3 Rev. Con Alliances and Alliances Progress YOUR LOGO

History - background for ACOs Better health care solutions are a moral and economic imperative ! Accountable Care Organizations ACOs were created as a result of the Affordable Care Act (ACA) that was signed into law March 23, 2010. CMS and the Congressional Budget Office agree the purpose of ACOs is to ensure quality service and reduce costs. Also, to ensure that the Medicare budget grows no faster than the rate of growth of the economy in general. Hospital specific index of costs has historically grown at a rate double that of the consumer price index. This growth rate is unsustainable given the arrival of Baby Boomer patients in the coming years. The ACA created a demonstration period that runs between 2012 and 2014. As of 12/31/2012 close to 200 ACOs have been established and this number is expected to double or triple by 2014. Full implementation begins 2015 and runs to 2020 when it’s expected that virtually all Medicare payments to providers will flow through ACOs. Page 4 YOUR LOGO

Context - for ACOs Better health care solutions are a moral and economic imperative ! Context All ACOs have a common objective built around three core tenets: 1. Patient Satisfaction 2. Improved Outcomes 3. Affordability An ACO’s success requires thinking about all collaboration of stakeholders and patient-centricty in a seamless care continuim. ACOs can be considered a preferred procurement program where by Medicare only reimburses for services to its beneficiaries to providers adhearing to this program. ACO design, build and optimization is greatly enhanced by the use of alliance professionals and consultants who understand how to make the complexities of advanced collaborative solutions work. Page 5 YOUR LOGO

Legislation - Affordable Care Act (ACA) Incentive Payments and Autorization • Under the ACA, the Secretary of Health and Human Services established ACOs to promote best practices and funnel incentive payments to healthcare providers. • Two ways to authorize an ACO: 1. Physician only with minimum of 5, 000 Medicare enrollees where physicians own and control the network. 2. Hospital sponsorship as long as there is physician cosponsorship with a minimum of 5, 000 Medicare enrollees. Page 6 YOUR LOGO

ACO Requirements ACA requirements to form an ACO under Medicare Shared Savings Program • Define processes to promote the practice of evidence-based medicine and provide data to evaluate quality and cost measures. • Build a management and leadership structure that includes administrative and clinical systems. • Develop a formal legal structure that allows the organization to receive payments and distribute shared savings among participating providers. • Have enough primary care providers to provide care to a minimum of 5, 000 Medicare beneficiaries. • Provide the Centers for Medicare & Medicaid Services with a list of participating primary care practitioners and specialists. • Contract with a core group of specialist physicians. • Agree to participate in the program for a minimum of three years. Page 7 YOUR LOGO

ACO Examples in Georgia Well. Star Health Network, LLC Located in Marietta, Georgia, is comprised of partnerships between hospitals and ACO professionals, with 1, 203 physicians. It will serve Medicare beneficiaries in Georgia. Piedmont Physicians Group launched a pilot ACO with Cigna in July 2010. The ACO covers about 10, 000 people in Cigna health plans. Under the pilot, Cigna pays the providers of Piedmont Physicians Group — which includes more than 100 primary care physicians — as usual for medical services, along with an additional fee for care coordination and medical home services. Physicians also get bonus payments if they meet targets for better quality and lower costs. Accountable Care Coalition of Greater Athens Georgia The Coalition of Athens Area Physicians partnered with Collaborative Health Systems to form the ACC of Greater Athens Georgia, which is participating in the Medicare Shared Savings Program. The Coalition includes more than 230 independent physicians. Approximately 8, 500 Medicare beneficiaries are covered by this ACO. Page 8 YOUR LOGO

Challenges to ACO Formation and Optimization Capital Investment ACO require significant up-front capital. The development of a strong IT framework alone requires a sizable capital investment. Access to capital may be challenging for some organizations but can be obtained. • Physician buy-in Some physicians may have concerns about relinquishing autonomy and may resist shared-payment arrangements. There is a cultural challenge to obtain agreement. Alliance professionals and facilitating consultants may be necessary at this stage. Patient buy-in Patients likely will be assigned to an ACO, but they also will be allowed to see providers outside of the ACOs will need to educate consumers about their role in reducing costs and improving quality. Organizational Sharing Strategies ACOs require the coalescing of diverse provider groups to develop a new system of care with the aim of improving quality and reducing costs. The move from a “fee for service” to a “fee for outcome” system requires creative collaborative solutions: physician alignment is key. Page 9 Source: H&HN research 2011 YOUR LOGO

Design, Build and Optimize an ACO Five crucial steps to implementing an ACO • • Create legal entity Assess capital strategy • • Conduct gap analysis Analyze market and assess ACO position Formalize & Funding Page 10 • • Patient-centered processes Patients involved in own care and decision-making • Performance improvements • Quality improvements Quality reporting Primary care model refined • Patient education Physician buy-in Patient buy-in Shared EMR Change Mgmt • Develop plan for physician integration • Develop IT investment plan • Design strategic partnerships • Design & implement EHR and HIE • Structure comp for ACO -oriented culture • Real-time access of clinical data YOUR LOGO

Stages of ACO Development – where are you today? Early Adapter – ACO has been launched These organizations will have the funding, the physician support, the talented leadership to make decisions, and the confidence to move before their competitors. They will have first mover advantage. Join Up – Partner with an existing ACO These organizations will watch the first movers, save their own cash, and simply join by contract with what they perceive to be the dominant local ACO. Wait and see – join an ACO at the 11 th hour Many organizations choosing to stay outside the process for ideological reasons will be sorry once the new Medicare juggernaut gets rolling. CMS encourages this group to find ways to connect to larger organizations. Next wave - ACO 2. 0 In this approach regional competitor systems might come together with the blessing of the antitrust watchdogs to create large networks to serve regional populations more effectively. . Page 11 YOUR LOGO

Roles and Responsibilities and Services Provided by Consultants Provider Organizations Patient centered primary care model Patient education Gather key decisionmakers together Agree to a governance model Agree to operating principals Establish a strong communications plan Gain buy-in from key stakeholders Page 12 Alliance professionals/consultants Executive leadership and oversight Clinical managerment systems Physician leadership and synergy developement Quality recording and reporting Drive and contract relationships with other service and technolgy providers Robust IT infastructure Prepare and facilitate meetings Assist in implementation strategies Operationalize decisions Source: H&HN research 2011 Governance Relations with governement entities Relations with adminsitrative staff Planning – short and long term Formal reporting YOUR LOGO

Alliances Progress and Rev. Con Alliances Progress: • Experts in creative collaborative solutions and ecosystem development • 20+ years in major global consultancy • Strong network of HC and IT providers Rev. Con Alliances: • 15+ year management level with high tech companies in the healchcare sector • Expertise in health IT, physician alignment and relationships with community providers along the continuum Page 13 YOUR LOGO

Martin Pearson, CPA, President Rev. Con Alliances 2402 River Green Drive NW Atlanta, GA 30327 O: 404 -842 -1215 C: 404 -374 -9565 martinp@revconalliances. com Twitter: revconalliances website: www. revconalliances. com Troy J Gautier, Managing Director Alliances Progress 1085 Richmond Glen Cir Alpharetta, GA 30004 Tel: 678 -644 -2533 Troy. Gautier@Alliances. Progress. com http: //alliancesprogress. com/strategic-alliances/what-is-an -accountable-care-organization-aco/ Page 14 YOUR LOGO