Transforming Health Care Delivery

One of Society’s Most Pressing Issues

20% 30% $1.6T

of US GDP

by 2025

of health care cost

is waste

wasted cost

by 2025

Wide Variation in Utilization/Treatment Rates of PSA Screening for Males

65+

Prostatectomy per 1,000 male Medicare

beneficiaries 75 & under with prostate cancer

480 Munster, IN

72 Tulsa, OK

Rates of Cardiac Stenting

29x regional variation

Back Procedures

4% Lebanon, NH

58% Miami, FL

87% ↑ Nat. avg.

Wyoming

58% ↓ Nat. avg.

Hawaii

Wide Variation in Price for Same Service

$0

$10,000

$20,000

$30,000

$40,000

ACL Repair Knee Arthroscopy

Louisville

4X 3X

$0

$10,000

$20,000

$30,000

$40,000

ACL Repair Knee Arthroscopy

San Francisco

3X 3X

$0

$10,000

$20,000

$30,000

$40,000

ACL Repair Knee Arthroscopy

Columbus

5X 6X

$0

$10,000

$20,000

$30,000

$40,000

ACL Repair Knee Arthroscopy

New York

5X 4X

HOSPITAL ASC

Wide Variation in Site of Service Cost

Urgent Care and Walk-In

Clinics

ASCs

Practice-Based Imaging

Emergency Room

Inpatient Surgery

Hospital-Based Imaging ~50% less

60-70% less

~50% less

Independent Physician Hospital-Employed Physician ~60% less

Lower Cost Alternative Hospital-Based Lab ~70% less

Resulting in Above Average Costs – Below Average Outcomes

Longevity vs. Cost

76

78

80

82

84

86

88

0 2 4 6 8 10

Life E

xpe

cta

ncy

Health Care Cost per Capita ($K)

Source: The Journal of the American Medical Association

Health Care Spend (% of GDP)

0%

5%

10%

15%

20%

19

60

19

63

19

66

19

69

19

72

19

75

19

78

19

81

19

84

19

87

19

90

19

93

19

96

19

99

20

02

20

05

20

08

20

11

OECD Average U.S. over Average

If We Eliminated Wasted Cost by 2025

We could more than double

the current level of funding for public education

We could increase our investment in

clean energy by 5x

We could increase global aid to

developing countries by 58x

TRADITIONAL

FEE FOR SERVICE

VALUE-

BASED CARE

Visit length 15 min. 45 min.

Panel size 2,000+ <500

Preventative care Less More

Referrals Patient-directed Tightly

coordinated

Reimbursement Volume x Rate Outcomes

Utilization Volume Evidence

Revenue Rate Risk

99% PATIENTS IN 4+ STAR PLANS

82 PATIENT NPS

30% LOWER TOTAL

COST OF CARE*

50%+ REDUCTION IN

COST TREND

*relative to fee-for-service Medicare

Achieving the Triple Aim through Value-based Care

Achieving the Triple Aim through Value-based Care

Physician leadership

Evidence-based clinical programs

High-value ancillary services

Alignment with health plans

Consumers Served

>14M >37K Clinics

1.1K Payers

80 Aligned Physicians

LEADING CLINICAL RESEARCH

“BENCH”

STANDARD CARE MODELS

“BEDSIDE”

Grounded in Physician-Led

Clinical Governance

FULFILLING THE

TRIPLE AIM

Powerfully Integrating Evidence-Based Medicine

Embedded in Culture

Integrated into Workflow and

Point of Service

Aligned Incentives

Improved Outcomes

Better Patient Experience

Lower Total Cost of Care

OptimalCare Applied Broadly

Gleason & prostate cancer active

surveillance

Colon polyp

surveillance

Barrett’s screening

Epidural steroid

injections

Nuclear stress test for stable CAD

Vertebro-plasty

84% 28% 68% 47% 94% 54%

CONTRACTED PHYSICIANS &

PARTNERS

Lab

Pathology

MEDICAL

GROUPS

Home Health Care

Skilled Nursing Facilities

Pharmacy

Home Infusion

Urgent

Care Ambulatory

Surgery Centers

House Calls

Local Care Delivery Ecosystem

Behavioral Health

Powered by Data & Analytics

Nevada Market Example

36 Locations

6 Urgent Care Centers

375+ Providers

2 Surgery Centers

16 Specialty Departments

7 Convenient Care Locations

99.6% 80% generic RX

substitution rate

telehealth users

directed to lower

site of care

20% 12.5% better HEDIS

measurements

lower health care cost

for PCP patients

Hospice

and

palliative

care

Tele-health

Conven-

ient care

Urgent

care

Online

visits Mobile

medicine

Provider

network

OB/GYN

and Peds

Lifestyle

centers

Integrated EMR and care coordination

Primary

and

specialty

care

Nevada Market Example

New Jersey Market Example

21 Neighborhood Care Centers

14 Surgery Centers

210 Physicians

11% lower inpatient

hospital admits/1000

35% lower ER

visits/1000

lower total

PMPM cost

50%

Massachusetts Market Example

$0 $2,000 $4,000 $6,000

Reliant

Umass Medical Center

Lahey Health

Beth Israel Deaconess Care Org.

South Shore Health System

Boston Medical Center

Partners HealthCare

Variation in Spending Among Mass. Providers

500 providers

320K patients served

90% OF EMERGENCY

ROOM

SERVICES AT

ASC HOPD

Example: Total Cost of Rotator Cuff Surgery

2x 10% OF THE COST

Urgent Care Surgical Care

High Value Ancillary Services

A Transformative Model of Care

BETTER

QUALITY

IMPROVED

EXPERIENCE

MEANINGFULLY LOWER

TOTAL COST OF CARE