Health IT Panel Discussion John McCandlish, Director–CGI National Healthcare Team 7/29/14 Updated March 2014

Industry insights Government health agencies Industry trends Extreme fiscal pressures Increased citizen engagement and expectations – patients act as consumers Much higher visibility of citizen facing programs Pay-for-value vs fee-for- service culture increases with outcome based model Compliance with health reform mandates and legislative oversight Contain costs and manage budgets Adapt systems to meet new mandates and legislative changes; ICD-10 and ACA Develop services around the citizen, with a focus on self-service capability Increase the transparency of quality and outcomes data Engage with complex stakeholder groups – payers/providers/citizens Increase in pay-for- performance / value models Business implications Modern interaction models for public health services using web, social media and direct communication - Telemedicine Enterprise analytics to inform policy and detect fraud/waste Agile (aka Cloud) infrastructures Mobility for citizens More “real-time” transaction ecosystem Legacy systems to be harmonized, extended or replaced IT priorities Market insights: Government health agencies At CGI, we take seriously what we hear from our clients. A key pillar of our management framework is focused on the client with a process regularly seeks direct feedback from those we are serving. Additionally, as part of our annual planning cycle, we reach out through an interview process to gain further client insights. These are reviewed and collated. In discussion with various analysts, our own industry experts and leveraging our international industry working groups, we paint the picture described in this slide reflecting the market trends, business implications and IT priorities. When talking with our government health agency clients: Health reform driven by the dual imperatives of cost control and quality improvement are creating rapidly changing requirements in business processes and the IT systems to support those processes. Given the political pressures and high visibility, the time to implement these changes is relatively short given the magnitude of the tasks, but also because of the political stakes and the importance of the problem, there is a pervasive notion that “failure is not an option” as governments move in transformative directions. Engagement of the government in shaping the market place is an increasing trend. With the transformative nature of these major changes (UK in largest reform since 1948) new ideas and innovative thinking are welcome. Whether in the U.S. or in the Nordics, meaningful engagement of the citizen is an significant trend and this entails availability and transparency of information that will make them more a part of their health care. The demand for effective agile development of these new systems; ability to incorporate the CRM environment of citizen/patient engagement some of the business and IT implications of these government initiatives. Speed of effective delivery is an imperative in this politically charged environment. A big picture ability to cross information/system silos is a competitive advantage (example, it is the internal revenue system that will pay the health premium support; not the government health system itself). Big data and the analytics around them are increasingly important and access to those results for decision makers and the public at large are government imperatives. Open data and transparency is an increasing trend and will support the trend of citizen self service and patient engagement in their own health care decisions. While there has been some reluctance in the adoption of cloud in health care in general, the ability to create solid security and the cost savings and efficiencies will support cloud adoption and further the government intentions of providing meaningful analytics and transparent information to industry and consumers alike. The short window for these IT systems implementation is a challenge for our government customers. A trend is that some of the initial requirements are mitigated to meet the short time … but there is the expectation that the first deliveries will be iterated and improved upon. The partnership approach with quality delivery and bringing the best ideas to the table will result in long-term and recurrent work as our government customers drive to meet the critical cost containment and quality improvement objectives in a highly political environment. It is an environment that CGI understands and is a proven partner.

Industry insights Healthcare Business Intelligence/Analytics Industry trends Move to accountable care and managed care Move from FFS to Episode – based model. Increase use of big data in healthcare Move to incentives or penalties for achieving or not achieving health outcomes High healthcare $$$$ Meaningful use of information to improve care and to measure performance Need for new data sources and pooling of data Increased transparency Increased movement of clients between payers Merging/acquiring providers Pay-for-performance means new measures for cost, quality and outcomes Better alignment needed between payers, clients and providers Business implications Big data opportunity still largely unharnessed Data Integration, Interoperability & Infrastructure Data Quality, Management & Transformation Business Intelligence & Advanced Analytics Agile development to speed product to market IT priorities Market insights: Government health agencies At CGI, we take seriously what we hear from our clients. A key pillar of our management framework is focused on the client with a process regularly seeks direct feedback from those we are serving. Additionally, as part of our annual planning cycle, we reach out through an interview process to gain further client insights. These are reviewed and collated. In discussion with various analysts, our own industry experts and leveraging our international industry working groups, we paint the picture described in this slide reflecting the market trends, business implications and IT priorities. When talking with our government health agency clients: Health reform driven by the dual imperatives of cost control and quality improvement are creating rapidly changing requirements in business processes and the IT systems to support those processes. Given the political pressures and high visibility, the time to implement these changes is relatively short given the magnitude of the tasks, but also because of the political stakes and the importance of the problem, there is a pervasive notion that “failure is not an option” as governments move in transformative directions. Engagement of the government in shaping the market place is an increasing trend. With the transformative nature of these major changes (UK in largest reform since 1948) new ideas and innovative thinking are welcome. Whether in the U.S. or in the Nordics, meaningful engagement of the citizen is an significant trend and this entails availability and transparency of information that will make them more a part of their health care. The demand for effective agile development of these new systems; ability to incorporate the CRM environment of citizen/patient engagement some of the business and IT implications of these government initiatives. Speed of effective delivery is an imperative in this politically charged environment. A big picture ability to cross information/system silos is a competitive advantage (example, it is the internal revenue system that will pay the health premium support; not the government health system itself). Big data and the analytics around them are increasingly important and access to those results for decision makers and the public at large are government imperatives. Open data and transparency is an increasing trend and will support the trend of citizen self service and patient engagement in their own health care decisions. While there has been some reluctance in the adoption of cloud in health care in general, the ability to create solid security and the cost savings and efficiencies will support cloud adoption and further the government intentions of providing meaningful analytics and transparent information to industry and consumers alike. The short window for these IT systems implementation is a challenge for our government customers. A trend is that some of the initial requirements are mitigated to meet the short time … but there is the expectation that the first deliveries will be iterated and improved upon. The partnership approach with quality delivery and bringing the best ideas to the table will result in long-term and recurrent work as our government customers drive to meet the critical cost containment and quality improvement objectives in a highly political environment. It is an environment that CGI understands and is a proven partner.