T H E A C T I V A T E D P A T I E N T Integrating Self-Direction with Provider Support Shirley Grey RN MSN RESULTS

XX CSI Low-Income Latinos—Sanofi Aventis COMPREHENSIVE PROGRAM Ethnographic Research Patients at home and in doctor appointments SelfCareKit IVR and Dashboard Continuing Medical Education Three sessions in three cities Outcomes: Diabetes Average A1c score after SIX months 99.7% Confidence Level AFTER BEFORE B a r c l a y B l v d B u f f a l o G r o v e, I L

3 Data collected from each group at 6 months Study designed & conducted by hospital staff Suburban Medical Center DM program had failed Multiplied compliance rates Patient Adherence Results: Heart Failure Weighing Daily Taking Blood Pressure Medication Compliance 27% 14% 77% 86% 14% 59% BEFORE AFTER IMPROVEMENT 514% 321% 185% EVIDENCE: MORE EFFECTIVE AT ENGAGEMENT BEFORE AFTER B a r c l a y B l v d B u f f a l o G r o v e, I L

4 We took them on in South Carolina! LOWER CLAIMS COST Challenge: CMS said, "Truckers are the most difficult employees to influence for healthy change.” Outcome: For every $1 invested, the company saved $1.79--to our knowledge, the first trucker health success! Evidence It Works : BETTER SCORES Challenge: Employer said, “We only brought 12% of our hypertensives into normal range after a year of live coaching” Outcome: 88% of employees reduced their BP scores below the threshold in six months! AFTER BEFORE Over 140/90 88% Below 140/80 12% 6% 88% Clinic confirmed BP after six months Increased medication compliance EVIDENCE SELF REPORTING IS RELIABLE We took them on in Illinois!

5 Before After 95% 0 7.4% Medical Center NJ previously used instructions from the American Lung Association OutcomeAdvantage program more than doubled the medication compliance rate Persistence 6 mo 44% Readmissions 16% Use of the ER 26% Evidence Our Program Works: Asthma EVIDENCE CLINCAL ACCURACY IS NOT ADEQUATE COMMUNICATION B a r c l a y B l v d B u f f a l o G r o v e, I L

St. Joseph, Lexington KY St. Joseph, Elgin IL NWC, Arlington Hts. IL DRG 127 ONLY NWC, Arlington Hts. IL ALL CHF-RELATED DRGs Aurora, Milwaukee WI Great Plains, Elk City OK VA, Ann Arbor MI Mercy Hospital, Chicago IL 6.4% 4.0% 38% 16.7% 7.7% 54% 22.2% 6.3% 72% 8.6% 2.2% 73% 23.4% 6.9% 74% 54.5% 33.3% 38% 13.2% 8.7% 34% BEFORE AFTER REDUCED BY 38% 54% 34% 74% 72% 73% 38% 100% >28% 0% BEFORE AFTER At Mercy only: N = insufficient for highest level of statistical significance, but indicative, especially given overall trend Reduce 30-day Heart Failure Readmission Rates

Results : Satisfaction “Did the program help you manage your condition?” Hypertension Yes – 94.9% No – 2.9% Diabetes Yes – 93.6% No – 6.4% CAD Yes –100% 5-year kit average = 96% Press Ganey 5-year average = 72% Heart Failure Yes – 97.3% No – 1.8% Asthma Yes – 92.5% No – 2.5% UPMC Health Plan B a r c l a y B l v d B u f f a l o G r o v e, I L

“ After 24 months, for 712 participants, total medical costs were 23% lower than the baseline year Blood pressure, cholesterol, and blood sugar improved more than 85% ER visits decreased by 16% and hospital days decreased by 54% There were substantial reductions in imaging services (-35%), procedure services (-10%), and average prescription costs per member (-18%). Physician office visits increased by 19%. The net savings at two years exceeded $56 PMPM Members had 30% lower out-of-pocket cost compared to the alternate PPO plan.” TESTIMONY TO THE NEVADA STATE LEGISLATURE RE: KITS AND CONNECTION PROGRAM B a r c l a y B l v d B u f f a l o G r o v e, I L C O N F I D E N T A L FINANCIAL RESULTS: LONG TERM ROI