TRUTH EXPOSING THE & EMPOWERING CHOICE Starmark® PROTECT PATIENTS BY Healthcare Bluebook is not an affiliate of Starmark or Trustmark® Life Insurance Company.

HUGE PRICE & QUALITY $ VARIATIONS ADDRESSING 10X 3X tt Middle 33% FAIR PRICE $ ADDRESSING HUGE PRICE & QUALITY VARIATIONS Middle 33% Orthopedic Many consumers don’t realize there is a huge variance in price and quality. Healthcare Bluebook highlights the highest value for both cost as well as quality to assist consumers in making smarter choices   I’d like to start out with some background of Healthcare Bluebook. There’s a common misconception about provider pricing. Consumers are in the dark about the large variance that exists in the price and quality for procedures. There can be a 300-1000% variance in provider pricing. Can you think of a time when you were willing to pay 10x more for a product? You wouldn’t spend 500% more for gas when you have other viable options, so why would you make the same decision in healthcare. Top 33% Cardiac Surgery Lower 33% Cancer Care

STRATEGIC DIFFERENCE OUR Simple 1 Practical 2 Outcomes-Driven 3 tt PHYSICIAN FACILITIES BASE 26% 58% YEAR 1 67% 33% 0% 20% 40% 60% 80% 100% OUR STRATEGIC DIFFERENCE Simple 1 Practical 2 When you are solving a problem, it is important to have a sound strategy. Healthcare Bluebook stands out from other transparency vendors with three key strategic differences.   We have found that there are two key reasons why employees don’t use transparency solutions: ACTION: Click on Simple The first is that the site or app is not easy to use. This simplicity also applies to the implementation and account management process. ACTION: Click on Practical The second reason that employees don’t use a transparency solution is that many solutions don’t offer much value – they mislead patients into thinking they are shopping, but they miss the big opportunities to save. A good example of this is shopping for a doctor versus shopping for the right place to have the procedure done. Employees don’t want to spend time shopping for an office visit only to save $1.18 and then be sent to a facility where they overpay by hundreds or thousands of dollars. From a practical standpoint, you have to make sure patients know to ask their doctor for referrals to cost-effective facilities. ACTION: Click on Outcomes-driven We are outcomes-driven because we are saving money and improving the quality of care for employees. Healthcare Bluebook is the only transparency vendor using a claims-driven approach to measure improved consumerism and actual savings. ACTION: When ready to move to the next slide, click anywhere on the slide (other than on the words Simple, Practical, Outcomes-Driven). Outcomes-Driven 3

SOLUTION Savings Opportunity OUR EMPLOYERS EMPLOYEES tt Save up to 12% of medical costs Save ~$1,400 per event Savings Opportunity With Healthcare Bluebook, employers can typically see between 4-6% savings. For employees, there is a $1400 savings every time they move from red to green.   *Healthcare Bluebook’s data analytics findings from 2008 to 2015 – across multiple third-party administrators and hundreds of employer clients – confirm savings opportunities of up to 12 percent of employers’ total medical spend.

ShopSmartTM Procedures High Volume Non-Emergent Schedulable High Price Variance High Quality Variance ShopSmart are the procedures that will drive savings and better outcomes. This is a term you will hear throughout Healthcare Bluebook. ShopSmart refers to a procedure that is elective or non-emergent, schedulable, has high price and quality variance, and occurs with high frequency. For these procedures, you will be able to find provider listings in the area ranked in accordance with the Fair Price color bar. An example of a ShopSmart procedure would be a colonoscopy. Here you can see the large price variance that exists for this procedure within the selected zip code. These are procedures that have a significant variance and will allow us to move the needle to better savings and better outcomes.

PRICE VARIABILITY FOR COLONOSCOPY (NO BIOPSY) It’s not the physician, it’s the facility… PRICE VARIABILITY FOR COLONOSCOPY (NO BIOPSY) Fair Price $1,200 UNIQUE CASES Here I want to show the analytics that will help us understand the excess costs. This chart is showing you the total cost for a colonoscopy with no biopsy. While this example is specific to colonoscopy, this is a standard chart that we see for every procedure in every market. The vertical axis represents unique individual cases. The horizontal axis represents cost per procedure. The blue portion of the bar is the physician cost. The green segment is the facility cost. As you can see on the horizontal axis, the colonoscopy ranges in price from just under $1000 to almost $4000 depending on where you go.   Now by breaking down the cost, you can see that the bulk is not the physician cost. As you can see, they are nearly the same across the board. There is very little price variability for their portion of the cost. However facility costs vary greatly, as you can see here. Facility is where the variance lies. It matters where you go, not who you see. You can go to whomever you like but get involved. The vertical green line represents the Fair Price. This phrase is what we have determined to be the price that you should pay for the procedure. It is determined by procedure by market. It typically falls between 33rd and 55th percentile. In this case it is $1,200. Fair Price is another common term you will hear. $0 $500 $1000 $1500 $2000 $2500 $3000 $4000 TOTAL COST PHYSICIAN FACILITY

PRICE VARIANCE REPORT Market | Chicago MARKET BASKET OF COMMON PROCEDURES LOW PRICE HIGH PRICE VARIANCE 1 Screening Colonoscopy $769 $5,660 736% 2 Sleep Study $732 $3,938 538% 3 Shoulder MRI (with contrast) $514 $3,245 631% 4 Knee Arthroscopy $1,887 $23,935 1268% 5 Cholecystectomy (laparoscopic) $2,195 $18,073 823% 6 Carpal Tunnel Surgery $1,722 $8,398 488% 7 Ear Tube Placement (tympanostomy) $1,890 $8,775 464% 8 Hysteroscopy (with biopsy) $2,431 $23,162 953% 9 Chest CT (no contrast) $257 $1,899 739% 10 Abdominal Ultrasound $115 $480 417% Average Market Variance 706% Here is a report showing the price variance for 10 procedures in Chicago. Look at Knee Arthroscopy, where a member can pay anywhere from $1800 to almost $24000 and often have the procedure done by the same physician. We have laid out the market variance for these procedures in comparison with a gallon of gas. If you knew gas cost $21.17/gallon at one gas station but $3/gallon across the street, what would you do? You wouldn’t spend 500% more for gas when you have other viable options, so why would you make the same decision in healthcare.   Does any of this information surprise you? EQUIVALENT VARIANCE IN A GALLON OF GAS $3.00 $21.17 706% What gas would cost per gallon with the same price variance * All healthcare procedure costs are derived from claims amounts after network discounts were applied

Outpatient Procedures QUALITY VARIANCE COST VARIANCE Transplants Office Visits Outpatient Procedures Imaging / Labs Inpatient Procedures SOMETIMES YOU ARE A CONSUMER YOU ARE A PATIENT This slide is important and will set the stage for the rest of the presentation.   Sometimes your employees are consumers and sometimes they are patients. Quality is very important for transplants and inpatient procedures, but is not as large of a factor for office visits and procedures like imaging. Likewise, cost is very important for inpatient and outpatient procedures and imaging, but is not very relevant for office visits or transplants. Healthcare Bluebook was intentionally designed to make it easy for employees to understand the difference and then find the information that they need to be good consumers of healthcare. Q: Does this make sense? Any questions or comments? (PAUSE AND LET THEM ANSWER)

Hospitals may do everything but are not great at everything CANCER CARE 57th percentile CARDIAC SURGERY 99th percentile JOINT REPLACEMENT 8th percentile A key differentiator with Healthcare Bluebook comes into play with the quality piece. Not every hospital is great at every procedure they perform. It is important that the patient understand the idea that quality varies. This ensures that they choose a hospital facility that provides the best outcomes. Our quality ratings compare each hospital against all other hospitals in the nation in the specific clinical area.

Quality Rating Check rating indicates hospital rank among all hospitals in the US for the selected clinical category Facilities for inpatient procedures will be ranked by quality rating first. For common procedures such as Total Hip Replacement, we are able to include cost rating at the facility level. The ideal high-value facility is a high-quality facility at a low price. The data shows that expensive doesn’t always mean highest quality.

Quality Data that is High Quality Objective, Reliable Data Risk Adjusted By Procedure Multi-dimensional Scoring Volume Adjusted Relative Ranking NOTES: Our data comes from CMS MedPar data, that includes all hospitals across the US with the exception of VA hospitals, required from all hospitals   Q: How important is it to you that the quality data you give to employees is accurate and reliable? (PAUSE TO LET THEM ANSWER) With Healthcare Bluebook, your COVERED employees are getting the most accurate and reliable hospital quality data available. Most health plan tools don’t have any real quality data for members and most other transparency solutions have quality data that is not accurate. There are six criteria to consider when selecting a source of hospital quality data: The underlying quality data must be objective and audited. All of the data must be risk-adjusted – accounting for demographic and condition differences. Hospitals must be given credit for treating sicker or riskier patients. Results must be broken down by procedure. An overall score for a hospital is dangerous and misleading. Hospitals must be scored on multiple dimensions of care. We use complications, patient safety events, mortality and core process compliance. Most other sources only use a single dimension of care. Results must be volume-adjusted. The results for a hospital that does five procedures in a year is not as credible as the results for a hospital that does 2,000 procedures per year. The quality results must rank all hospitals nationally relative to each other. We think that it is critical that any source of inpatient quality data needs to meet these six criteria. Most quality discussions other transparency vendors tend to stay on the surface and not cover the important pieces.

Member Access Single Sign On via Starmark portal at www.starmarkinc.com No additional login information required to access tool – user will be automatically signed on

Mobile accessibility for iPhone and Android The Healthcare Bluebook site is mobile optimized Healthcare Bluebook app is available via Apple or Android app Members can access information on the mobile app by entering STARMARK into the mobile app Free mobile app available to smartphone users Same green, yellow, red icons displayed Ability to change market by entering a new zip code Valuable point of access when used at the time of referral

PriceFinder Support Healthcare Bluebook is available for PriceFinder Support M-F, 8am to 5pm CST 800-341-0504 pricefinder@healthcarebluebook.com Healthcare Bluebook will respond to requests in one to two business days Staffed by specially trained representatives with healthcare experience

REWARDS How Does It Work? Optional program selected by the employer Employees and their eligible dependents receive rewards for select procedures when using a Fair Price provider All rewards are paid to the employee No forms to submit Administered by Healthcare Bluebook The Healthcare Bluebook Rewards program is an optional program, selected by the employer, and is available for groups with a Starmark® self-funded major medical plan design with an effective date of 12/1/17, and later. When using Healthcare Bluebook, employees that are eligible for the Rewards program will see a Go Green to Get Green tile displayed on the site for reward-eligible procedures. Employees and their eligible dependents earn rewards by using a Bluebook "Green" provider for reward-eligible services. The employee receives a check in the mail for the Reward amount. Employers can select the optional Rewards program at no additional cost, except that the employer is responsible for funding all rewards. Employers are responsible for all applicable payroll taxes and withholdings, and are encouraged to consult their financial advisor.

$ Reward Program Reward checks are issued monthly Rewards are issued on a monthly basis. No forms are necessary. Rewards are paid out when the claims data shows the employee or their eligible dependent went to a green provider for the Reward-eligible procedure. The Reward amounts range from $25 to $100. Reward checks are issued monthly Rewards are based on actual utilization as documented in claims data Reward amounts range from $25 to $100

Rewards $100 $50 $25 Colonoscopy Ear Tube Placement Lithotripsy CT Scans Upper GI Endoscopy Cataract Surgery Sleep Study Transthoracic Echocardiogram Shoulder/Knee Arthroscopy Tonsil/Adenoid Removal Cholecystectomy MRI Heart Perfusion Imaging Here are the procedure categories in the Rewards program.

REWARD LETTER Sample The employee will receive a letter of explanation with the Reward check. This letter will also encourage continued use of Bluebook for additional savings.

Reward Taxation Employers are responsible for funding all rewards, and for all applicable payroll taxes and withholdings. Consult your financial advisor. Employers are responsible for funding all rewards, and for all applicable payroll taxes and withholdings, and are encouraged to consult their financial advisor.

Confidentiality This presentation and the information contained in it is Confidential Information of CareOperative/Healthcare Bluebook. Please do not further share this information without contacting Healthcare Bluebook. Healthcare Bluebook is included with Starmark® major medical plan designs with an effective date of 12/1/2016, or later. Healthcare Bluebook is not an affiliate of Starmark or Trustmark® Life Insurance Company. Before receiving care, verify your coverage and cost for services. Additionally, if you have a PPO plan design, or a provider network for specific services such as transplants and specialty drugs, verify the provider participates in your network. HCB3-er (12-1-17)