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Forming Care Partnerships Lessons Learned 2

Our Call to Action Virtually all of our residents experience transitions in care Care coordination between sites was not always optimal Arbor Upon discharge from the hospital, at least 30% of patients have at least one medication discrepancy Medical appointment follow up is critical post discharge Hospitalizations 1 in 5 U.S. patients discharged from the hospital to home experienced an adverse event within 3 weeks of discharge Opportunity 3

Opportunities for Improvement Medical follow up on site Medication reconciliation Home Health Hospice, Rehab Better clinical outcomes Increased LOS 4

Our goals became clear… Decrease hospitalizations Increase access to top quality providers Generate a powerful referral base Educate staff on top clinical diagnosis related to hospitalizations Interventions started at first sign of clinical red flags Partner with the strongest third party providers in each market Improve physician access at each community Become a transitional care provider Fill a void for ER/SNF/Hospital patients that are discharged to home 5

Hospital readmissions Part of the problem Part of the solution 6

Considerations Operational Impact Marketing & Sales Impact Clinical Impact 7

Interdisciplinary team Operations Executive Director involvement is key Bottom line impact on referrals, census and resident retention Clinical Clinical capabilities and state regulatory restrictions Ability to implement practice changing programs and processes Marketing Market specific impact analysis Packaging and naming our program 8

Gathering internal & external intelligence “Community Readiness Assessment” Exploratory conversations with hospital CEO’s, CFO’s and Director’s of Case Management Assessed current third party relationships, explored new opportunities 9

What we learned… 10 Common Goals Redefining Assisted living Opportunity Overlap with key diagnosis and clinical outcomes hospitals were looking at There was a lack of understanding about the care and services we could provide and support in an AL setting New opportunities to be selective with our partnerships Align with those that were most progressive and had started their own care transitions plan

Sales/Marketing Tool box Branded our program Transitional Living Care Admission criteria Formation of community market consortiums TLC Discovery tool Presentation materials including our capabilities and partner affiliations ACO/Hospital Diagnostic fact sheets for key diagnosis Staffing and clinical support in each community Clinical information 11

Clinical Tool Box Training materials, care paths, charting tools, stop and watch for all care staff Monitoring for key conditions/diagnosis Staff training Medication reconciliation after hospitalization Closer monitoring of critical meds, insulin, Coumadin, cardiac, blood pressure Medication management Streamline physician communication on condition changes Weekly risk meetings with third party providers Care partners 12

Wesley Woods Domiciliary Program 13 Access to quality medical care is important to our residents Follow up with the physician post hospitalization is key Physician access Wesley Woods is a geriatric acute care hospital that is part of the Emory University Health System Partnered with us to bring Board Certified Geriatricians to our Atlanta communities Emory Affiliation Our residents and families responded overwhelmingly to the introduction of the program They are pleased with the Concierge type medicine available to their loved ones within the community Customer satisfaction

Opportunities realized Gaps in care communication can be reduced by coordination of information among all parties Use of an Electronic Health Record (EHR) for each resident eases transfer of information throughout the health system Diagnostics, labs and medications as well as MD notes are all electronically accessible to any Emory provider 14

Benefits realized Decrease in time to treat symptoms result in fewer delays with interventions, avoiding hospitalizations Reduction of duplication of tests and referrals and medication errors upon return from the hospital Improved coordination and referral to third party providers with access to the physician in person 15

Outcomes 16 Communities participating in the Domiciliary program avg. 10 hospitalizations vs. 14 in all other Arbor communities (Q1 2012) Reduce Hospitalizations 3of 4 communities participating in the Domiciliary program have increased the avg. LOS from last year to 4 months longer than all other Arbor communities Length of stay We have successfully launched partnerships in some markets with acute care hospitals, rehab companies, home health, hospice and care management firms Healthcare consortiums