The Qliance Direct Primary Care Medical Home Improving

The Qliance Direct Primary Care Medical Home: Improving Care and Reducing Costs Presented to: CLG Employer Resources Erika Bliss, MD – President & CEO of Qliance August 9, 2012

Current Healthcare Costs: Fiscal Cancer Healthcare Costs (in billions) $80 ü 17% of GDP, projected to be >19% by 2017 Specialty & Other ü 62% of bankruptcies in 2010 were due to medical expenses üPrimary care is severely underfunded (only represents 3% of medical expenditures) $2, 520 Total annual healthcare costs = $2. 6 T ($8047 person per year) üBurdensome fee-for-service insurance billing system undermines potential of primary care Qliance Confidential & Proprietary 2

The Effect of Inadequate Primary Care An ineffective primary care system pushes patients to expensive down-stream care. The result is an increase in health care costs for employers and employees. ($$$) Emergency Care ($$$) Hospital Care Primar y Care ($$$) Specialist Care Qliance Confidential & Proprietary ($$$) End of Life Care

Effective Primary Care Changes the Dynamic… ü Primary care can address 80 -90% of medical issues ($) Emergency Care ü Primary care can catch little problems (hyperglycemia) before they become big problems (diabetes) ü Robust primary care reduces need for expensive downstream care ü But, good primary care requires doctors to spend time with their patients ($) Hospital Care Primary Care ($) Specialist Care Qliance Confidential & Proprietary ($) End of Life Care

The Solution: • Operate outside of traditional insurance – reserve insurance for undesirable, costly events – pay direct for primary care which is desirable and low-cost – eliminate high administrative overhead for primary care practices • Charge a monthly fee – – low-cost: $64 per month eliminates negative incentives of the fee-for-service system incentivizes doctors to focus on holistic care no co-pays or additional charges for visits and services • Provide great access – – – limit patient panel size offer 30 -60 minute appointments multi-modal access, including office, phone, and e-visits extended office hours and weekend hours 24 x 7 physician coverage Qliance Confidential & Proprietary

The Qliance Mission ü Re-establish the direct relationship between doctor and patient, allowing time to develop trust and foster a partnership that promotes and sustains health. ü Dedicate ourselves to providing care that is personal, high-quality, accessible, and most of all, humane. “If you give them enough time, your patients will tell you what is wrong with them. Time to listen to a patient is what is missing in today’s system. ” -Garrison Bliss, MD, Qliance Founder Qliance Confidential & Proprietary

Qliance: All-Inclusive Primary Care Preventive Care Urgent Care Specialist & Hospital Care Coordination Wellness Care Enhance primary care to increase quality & control costs Behavior & Lifestyle Management Qliance Confidential & Proprietary Chronic Disease Management

Qliance Patients Use Less Downstream Care Type of Referral Qliance # per Benchmark** Difference * year/1000 Savings PMPY*** Specialist Visits 670 2000 -66% $199. 50 ER Visits 56 158 -65% $153. 00 Hospitalizations (visits) 34 53 -35% --- Hospitalizations (in days) 105 184 -43% $186. 56 Advanced Radiology 300 800 -63% $400. 00 Surgeries 22 124 -82% $306. 00 3540 1847 +92% $0**** --- --- $1, 245. 06 Primary Care Visits Savings Per Member Per Year * Based on best available internal data, may not capture all non-primary care claims. ** Based on regional benchmarks from Ingenix and other sources. *** Based on average costs in WA State. ****No additional cost for additional primary care visits in the Qliance model. Source: Qliance Medical Group non-Medicare patients, 2010 (n=3, 088) 8

How Does Qliance Improve Member Health? • Gives members the care and resources they need the way they want it. They want: – To feel better – To not feel rushed, with: ü Enough time with their doctor to understand what’s wrong and what they need to do next ü Enough time with their doctor to understand their choices – Appointments when they need them – Convenience (onsite lab, common DME, X-rays, etc. ) – Help over the phone or by email instead of coming in – Expert advice on the best specialists or hospitals to get the best care 9

How Does Qliance Reduce the Overall Cost of Care? • By shifting focus to primary care that includes at no extra cost to the member: – – Longer appointments Basic x-rays and labs onsite First fill drug dispensary Routine DME • Establishing trusting relationship with patients so we can positively influence their decisions and behaviors • Being available when patients need us so they don’t have to go to urgent care or emergency rooms • Reducing self-referral to specialists • Coordinating specialist, ancillary, and hospital care, making sure they get the right care at the right time 10

Plan Integration Examples PPO HDHP • Plan design & contribution can drive participation • High deductible not required • Higher OV copay incorporates well • Provides soft bridge to higher deductible • Can work well with Account Based plans (HRA) • Put Q before HRA to maximize participation and value to employee • Employer gets full benefit from the Qliance claims impact • Can incorporate into plan design (tiered benefit) or just use as a network • Provide claims history for financial analysis to show areas of savings Self-Funded • Utilization reporting provided • New Cigna Level-Funded Partnership with discounted rates

Our Clinics Downtown Seattle Kent Station Mercer Island 509 Olive Way Suite 1607 Seattle, WA 98101 521 2 nd Place North Suite 103 Kent, WA 98032 7707 SE 27 th Street Suite 104 Mercer Island, WA 98040 Mill Creek Guardian Family Care (Qliance affiliated clinic) 805 – 164 th Street SE Suite 100 Mill Creek, WA 98012 Tacoma 2420 S. Union Avenue Suite 100 Tacoma, WA 98405 ! oon s g nin Ope Qliance Confidential & Proprietary in ue v e l l Be