The Qliance Direct Primary Care Medical Home: Improving Care and Reducing Costs Presented to: CLG Employer Resources Erika Bliss, MD – President & CEO of Qliance August 9, 2012

Current Healthcare Costs: Fiscal Cancer Qliance Confidential & Proprietary2 17% of GDP, projected to be >19% by % of bankruptcies in 2010 were due to medical expenses Primary care is severely underfunded (only represents 3% of medical expenditures) Burdensome fee-for-service insurance billing system undermines potential of primary care Total annual healthcare costs = $2.6T ($8047 per person per year)

The Effect of Inadequate Primary Care ($$$) Emergency Care ($$$) Hospital Care ($$$) Specialist Care ($$$) End of Life Care Primary Care Qliance Confidential & Proprietary An ineffective primary care system pushes patients to expensive down-stream care. The result is an increase in health care costs for employers and employees.

Effective Primary Care Changes the Dynamic… ($) Emergency Care ($) Hospital Care ($) Specialist Care ($) End of Life Care Primary Care Primary care can address 80-90% of medical issues Primary care can catch little problems (hyperglycemia) before they become big problems (diabetes) Robust primary care reduces need for expensive downstream care But, good primary care requires doctors to spend time with their patients Qliance Confidential & Proprietary

The Solution: Operate outside of traditional insurance – reserve insurance for undesirable, costly events – pay direct for primary care which is desirable and low-cost – eliminate high administrative overhead for primary care practices Charge a monthly fee – low-cost: $64 per month – eliminates negative incentives of the fee-for-service system – incentivizes doctors to focus on holistic care – no co-pays or additional charges for visits and services Provide great access – limit patient panel size – offer minute appointments – multi-modal access, including office, phone, and e-visits – extended office hours and weekend hours – 24x7 physician coverage Qliance Confidential & Proprietary

The Qliance Mission Re-establish the direct relationship between doctor and patient, allowing time to develop trust and foster a partnership that promotes and sustains health. Dedicate ourselves to providing care that is personal, high-quality, accessible, and most of all, humane. Qliance Confidential & Proprietary “If you give them enough time, your patients will tell you what is wrong with them. Time to listen to a patient is what is missing in today’s system.” -Garrison Bliss, MD, Qliance Founder

Qliance: All-Inclusive Primary Care Preventive Care Wellness Care Chronic Disease Management Urgent Care Specialist & Hospital Care Coordination Behavior & Lifestyle Management Enhance primary care to increase quality & control costs Qliance Confidential & Proprietary

Qliance Patients Use Less Downstream Care 8 Type of Referral Qliance # per year/1000 * Benchmark ** Difference Savings PMPY *** Specialist Visits %$ ER Visits %$ Hospitalizations (visits) %--- Hospitalizations (in days) %$ Advanced Radiology %$ Surgeries %$ Primary Care Visits %$0 **** Savings Per Member Per Year --- $1, * Based on best available internal data, may not capture all non-primary care claims. ** Based on regional benchmarks from Ingenix and other sources. *** Based on average costs in WA State. ****No additional cost for additional primary care visits in the Qliance model. Source: Qliance Medical Group non-Medicare patients, 2010 (n=3,088)

How Does Qliance Improve Member Health? Gives members the care and resources they need the way they want it. They want: – To feel better – To not feel rushed, with: Enough time with their doctor to understand what’s wrong and what they need to do next Enough time with their doctor to understand their choices – Appointments when they need them – Convenience (onsite lab, common DME, X-rays, etc.) – Help over the phone or by instead of coming in – Expert advice on the best specialists or hospitals to get the best care 9

How Does Qliance Reduce the Overall Cost of Care? By shifting focus to primary care that includes at no extra cost to the member: – Longer appointments – Basic x-rays and labs onsite – First fill drug dispensary – Routine DME Establishing trusting relationship with patients so we can positively influence their decisions and behaviors Being available when patients need us so they don’t have to go to urgent care or emergency rooms Reducing self-referral to specialists Coordinating specialist, ancillary, and hospital care, making sure they get the right care at the right time 10

Plan Integration Examples PPO Plan design & contribution can drive participation High deductible not required Higher OV copay incorporates well HDHP Provides soft bridge to higher deductible Can work well with Account Based plans (HRA) Put Q before HRA to maximize participation and value to employee Self-Funded Employer gets full benefit from the Qliance claims impact Can incorporate into plan design (tiered benefit) or just use as a network Provide claims history for financial analysis to show areas of savings Utilization reporting provided New Cigna Level-Funded Partnership with discounted rates

Our Clinics Downtown Seattle 509 Olive Way Suite 1607 Seattle, WA Kent Station nd Place North Suite 103 Kent, WA Mercer Island 7707 SE 27 th Street Suite 104 Mercer Island, WA Mill Creek Guardian Family Care (Qliance affiliated clinic) 805 – 164 th Street SE Suite 100 Mill Creek, WA Tacoma 2420 S. Union Avenue Suite 100 Tacoma, WA Opening soon in Bellevue! Qliance Confidential & Proprietary