Outsourcing Rehabilitation: A Pragmatic Approach to Opportunities and Strategies

Alliance Rehab-SRA/SRA Mission and Vision Mission: Strive to develop and deliver innovative products and services designed to optimize the effectiveness of organizations servicing seniors Vision: To be an integral part of the future success of the organizations we serve Innovation In Ohio: New Model of Rehab Delivery (Physiatrist-guided with Best Practices)

Alliance Rehab Company Profile First alliance-owned and managed rehab and fitness company established in response to PPS employees providing services in 11 states 100+ client facilities; 16 in Ohio area All SNF clients are quality and mission-driven organizations 87 SeniorFITness™ Program sites 26 In-House conversions to outsourced over the past two years

Alliance Rehab Company Profile Local Management structure includes full-time, on- site Rehab Program Managers, Two Rehab Account Managers, Corporate Regional Director of Operations, and Corporate VP Rehab Best Practices Committee of 17 therapists across multiple states and chaired by Dr. Stambolis of Marianjoy Rehab Hospital Corporate Quality Management oversight Benchmarking and Outcomes focus Advanced clinical programming models for improved rehab outcomes and facility differentiation

What Differentiates Alliance Rehab? First integrated Rehab and Fitness Model Assist facility in efforts relating to CMS’s Quality Initiative via enhanced clinical outcomes to targeted Quality Measures and Quality Indicators using advanced rehab technology Physiatrist-guided rehabilitation and fitness model utilizing Rehab Best Practices First rehabilitation company to offer innovative fitness programs specifically designed for the senior population using “Certified Senior Fitness Exercise Specialists” with integration into rehab Unique contract with UDS to certify, implement, and measure rehab outcomes using the FIM Instrument™ Benchmarking from eleven states of rehab operations Proprietary Web-Based Rehab Information Software (ARIS 2.0)

Alliance Rehab-SRA Strategic Initiatives Advanced Rehab Programming Model, Non-Invasive Rehab for IncontinenceAdvanced Wound Care Contracture Management, Diabetes/Peripheral Neuropathy Rehab ProgramsPain Management Implementation of Rehab Best Practices for Subacute/Post Acute Rehab and Long Term Care/Outpatient (inc.ALF and ILF) Dementia Initiative (Allen Cognitive) SeniorFITness™ Program to Create Rehab and Wellness Model Fitness Best Practices for Seniors FIM Instrument™ Certification, Implementation, and Outcome Reporting Development of state-of-the-art Outpatient Rehab and Fitness Centers Electronic Rehab Auditing and Compliance Patient Satisfaction Initiative

RUGs Utilization Pre and Post AR Operations (4 States) Rugs Cat. HVA Pre ARPost AR (3 rd Qtr’03) RU0%22.6% RV11%37.6% RH51%32.6% RM38%7.3% RL1%0% Rugs Cat. CT Pre ARPost AR (3 rd Qtr’03) RU2.2%18% RV23.6%40% RH58%31.3% RM14.2%8.6% RL.2%1% Rugs Cat. AZ Pre ARPost AR (3 rd Qtr’03) RU2%30% RV20%49% RH71%18% RM9%3% RL.1%.03% Rugs Cat. OH Pre ARPost AR (4 4d Qtr’04) RU3.7%21% RV29.5%53% RH47.2%20% RM18.2%6% RL0%

Outpatient Rehab Center Opportunities Non-Invasive Rehab for Incontinence (ACP) Functionally-Based Pain Management Center (ACP/Anodyne/Low Beam Laser Therapy) Diabetic Neuropathy Clinic (Anodyne) Advanced Wound Care Center (ACP/Anodyne) Advanced Orthopedic Rehab (ACP) Early Stage Dementia Clinic (Allen Cognitive)

Senior FITness  Program Participant sessions are supervised and tracked Programming emphasis on improving: –Strength –Stability –Flexibility –Mobility –Cardiovascular Health SeniorFITness is a senior focused wellness program Staff is degreed in Exercise Science and certified as SeniorFITness Exercise Specialists Fitness equipment utilized is senior friendly and designed to improve ability to perform activities of daily living

Rehab and Fitness Pricing Rehabilitation Services - Full Risk Arrangement Part A : RUGs per diem pricing based on a “per minute” pricing model Part B : Payment based on % of Fee Screen MCO: Payment based on “per minute” or % of MCO payment per visit SeniorFITness Option - Pricing Components: Equipment - purchase, lease Monthly fee for E.P.salary/benefits and management of SeniorFITness Program Initial Fitness Assessment fee Participant incentives