1 Data source: Hospitals/Systems Digest Managed Care Digest Series ® 2009 © 2009 sanofi-aventis U.S. LLC US.NMH Hospitals/Systems Digest

2 Data source: Hospitals/Systems Digest Managed Care Digest Series ® 2009 © 2009 sanofi-aventis U.S. LLC US.NMH Hospital Industry Overview  Of the 5,035 short-term, acute-care, nonfederal hospitals tracked in the SDI database in 2007, 2,665 (52.9%) were part of a multihospital system (MHS), up from 52.4% in 2006, and from 51.8% in  The number of short-term, acute-care, nonfederal hospitals owned by or contracted to highly integrated systems rose another 5% in 2008, to 1,914 from 1,822 the year before.  Total facility average length of stay (ALOS) fell, between 2006 and 2007, for hospitals in MHSs, regardless of HMO ownership.

3 Data source: Hospitals/Systems Digest Managed Care Digest Series ® 2009 © 2009 sanofi-aventis U.S. LLC US.NMH Average HMO Utilization, 2007

4 Data source: Hospitals/Systems Digest Managed Care Digest Series ® 2009 © 2009 sanofi-aventis U.S. LLC US.NMH Hospital Outpatient Surgery Volumes Outpatient Surgeries as a Percentage of Total Surgeries

5 Data source: Hospitals/Systems Digest Managed Care Digest Series ® 2009 © 2009 sanofi-aventis U.S. LLC US.NMH Multihospital System Utilization All Hospitals in MHSs All Non-MHS Hospitals Utilization Measure Inpatient Surgeries per Staffed Bed Outpatient Surgeries per Day Outpatient Visits per Day Emergency Dept. Visits per Day

6 Data source: Hospitals/Systems Digest Managed Care Digest Series ® 2009 © 2009 sanofi-aventis U.S. LLC US.NMH Average ICU Occupancy Average ICU Patient-days per Hospital Multihospital System ICU Utilization

7 Data source: Hospitals/Systems Digest Managed Care Digest Series ® 2009 © 2009 sanofi-aventis U.S. LLC US.NMH MHS Pharmaceutical Expenses, 2007 PHARMACEUTICAL COSTS/DISCHARGE FOR MULTIHOSPITAL SYSTEMS PHARMACEUTICAL COSTS/STAFFED BED FOR MULTIHOSPITAL SYSTEMS Expenses per Discharge Expenses per Staffed Bed

8 Data source: Hospitals/Systems Digest Managed Care Digest Series ® 2009 © 2009 sanofi-aventis U.S. LLC US.NMH Hospital Costs, 2007

9 Data source: Hospitals/Systems Digest Managed Care Digest Series ® 2009 © 2009 sanofi-aventis U.S. LLC US.NMH Major Trends: Chronic Disease  In 2007, average inpatient charges per case of hypertension were $14,430 in 2007, lowest of the 10 diseases profiled in the Digest.  Of hospital inpatient cases that treated patients diagnosed with atrial fibrillation in 2007, more than three- quarters (76.3%) were paid for by Medicare, down slightly from 78.7% in 2006, but still the highest Medicare payer share, by disease state, by a notable margin.  Of the 10 disease states listed in this section of the Digest, the average length of stay (ALOS) per hospital inpatient case was longest for peripheral artery disease (PAD) in 2007, at 6.6 days.

10 Data source: Hospitals/Systems Digest Managed Care Digest Series ® 2009 © 2009 sanofi-aventis U.S. LLC US.NMH Hospital Procedure/Diagnoses Overall Number of Inpatient Cases per Hospital per Year Atrial Fibrillation Diabetes Mellitus1,263.41,259.4 Hypertension2,150.72,100.0 Neoplasms Stroke

11 Data source: Hospitals/Systems Digest Managed Care Digest Series ® 2009 © 2009 sanofi-aventis U.S. LLC US.NMH Hospital Procedure/Diagnoses Average Hospital Inpatient Charges per Deep Vein Thrombosis Case, by State Average Hospital Inpatient Charges per Peripheral Artery Disease Case, by MSA Average Charges

12 Data source: Hospitals/Systems Digest Managed Care Digest Series ® 2009 © 2009 sanofi-aventis U.S. LLC US.NMH ACS, by ICD-9 Code Diabetes Mellitus, by ICD-9 Code Hospital Procedure/Diagnoses Most Common Concomitant Diagnoses for Patients with a Primary Diagnosis of: Percentage of Patients

13 Data source: Hospitals/Systems Digest Managed Care Digest Series ® 2009 © 2009 sanofi-aventis U.S. LLC US.NMH Highly Integrated Health Systems Definition The systems defined by this Digest as highly integrated either own or contract with three or more components of health care delivery, including at least one acute-care hospital, at least one physician component, and at least one other component of care. They also have at least one systemwide contract with a payer.

14 Data source: Hospitals/Systems Digest Managed Care Digest Series ® 2009 © 2009 sanofi-aventis U.S. LLC US.NMH Universe of Integrated Health Systems * Labs and diagnostic imaging centers are not counted among the major components of care for any of the system categories shown.

15 Data source: Hospitals/Systems Digest Managed Care Digest Series ® 2009 © 2009 sanofi-aventis U.S. LLC US.NMH Facilities in Integrated Systems, The first number represents the total number of facilities tied to highly integrated systems. The second number represents the share of all facilities accounted for by a particular facility type. For example, in 2008, the 2,170 hospitals in highly integrated systems accounted for 16.5% of all system facilities. 2 Diagnostic Imaging Center 3 Freestanding Outpatient Surgery Center 8,397 (63.9%) 163 (1.2%) 457 (3.5%) 513 (3.9%) 520 (4.0%) 929 (7.1%) 2,170 (16.5%) 2 3

16 Data source: Hospitals/Systems Digest Managed Care Digest Series ® 2009 © 2009 sanofi-aventis U.S. LLC US.NMH * Systems that indicated more than one initiator are included only in the “Combination” category. ** Includes systems initiated by universities, clinics, and local, state and federal governments. Initiators of Integrated Systems, 2008*

17 Data source: Hospitals/Systems Digest Managed Care Digest Series ® 2009 © 2009 sanofi-aventis U.S. LLC US.NMH Hospitals in Integrated Systems, 2007* * Hospital data are based on all short-term, acute-care, nonfederal hospitals. Average occupancy and average length of stay represent only the acute-care portion of the hospitals’ occupancy. All data are as of December 31, ** Includes system hospitals that were not part of highly integrated systems and hospitals that were not part of any system.

18 Data source: Hospitals/Systems Digest Managed Care Digest Series ® 2009 © 2009 sanofi-aventis U.S. LLC US.NMH HMO Hospital Utilization, 2007

19 Data source: Hospitals/Systems Digest Managed Care Digest Series ® 2009 © 2009 sanofi-aventis U.S. LLC US.NMH HMO Pharmacy Characteristics, 2007

20 Data source: Hospitals/Systems Digest Managed Care Digest Series ® 2009 © 2009 sanofi-aventis U.S. LLC US.NMH Medical Group Practices in Systems Number of Medical Groups NOTE: SDI defines medical group practices as those with five or more FTE physicians whose primary business is seeing regularly scheduled patients for nonsurgical services other than imaging. Physicians must have a share in the practice and offer outpatient care, and the practice must be physically separate from a hospital. Anesthesiology and pathology groups are excluded.