Outcomes Data 1. LOWER READMISSIONS 2. LESS ER USE 3. SATISFACTION Patient Staff 4. IMPROVED BIOMETRICS Diabetes Blood Pressure Weight Loss 5. BEHAVIOR CHANGE 6. STAFF PRODUCTIVITY 7. COST SAVINGS Seven parameters tested in Care Kit studies to date

Statistical reliability: The probability that the results were due to chance is less than 1% An improvement greater than 15%. The American Society of Quality Control says this level of change is breakthrough innovation A validated measurement. When you measure one way, then measure another way and get the same result, your initial measurement is valid. Success where others have failed. If you achieve results where national authorities say results are hardest to achieve What Makes an Outcome Compelling? Results are replicated. When you not only do it once, but over and over and over and over and… >99 % > 15 % ✔ On the outcomes report slides that follow, watch for a Ribbon Symbol to see which of these 5 reasons make that outcome compelling

95% 0 7.4% BEFORE: Vitas Medical Center NJ had used books from the American Lung Association, so clinical accuracy was assured. WITH CARE KITS: Distributing the Care Kits, with no other changes or interventions, More than doubled adherence Eliminated readmissions Reduced ER use by 72% Persistence 6 mo 44% Readmissions 16% Use of the ER 26% Asthma Care Kits alone Eliminated Readmissions BEFORE AFTER EVIDENCE that CLINCAL ACCURACY by itself is not adequate for effective PATIENT COMMUNICATION The probability that the outcome was chance is less than 1%. That means if you adopt Care Kits, it’s 99% likely you’ll see comparable results See Appendix for calculations >99 %

Data collected from each group at 6 months Study designed & conducted by hospital staff BEFORE: Northwest Community Medical Center had failed to change behavior with a year-long Disease Management program Heart Failure Care Kits Changed Behavior Weighing Daily Taking Blood Pressure Medication Compliance 27% 14% 77% 86% 14% 59% BEFORE AFTER IMPROVEMENT 514% 321% 185% EVIDENCE: CARE KITS ARE MORE EFFECTIVE AT ENGAGEMENT BEFORE AFTER The probability that the outcome was chance is less than 1%. That means if you adopt Care Kits, it’s 99% likely you’ll see comparable results See Appendix for calculations >99 %

J Reeves, MD Director Nevada State QIO J Ambulatory Care Management V36, No. 2, pp March 2013 Multiple Conditions in a Medical Home Care Kits saved $1.5 million TOTAL MEDICAL COST Blood pressure Cholesterol Blood sugar Emergency Room visits In-hospital days Health Plan net savings exceeded $56 PMPM $1.5 million / 1000 members Member savings = 30% lower out-of-pocket cost than the alternate PPO plan 54% “Breakthrough Innovation” says the American Society for Quality > 15 % 712 participants 24 months 85% better scores 23% lower 16% fewer visits Imaging services 35% lower use fewer days COMPARED TO BASELINE YEAR Prescription cost per member 18% lower cost

Discharge Teaching Time Care Kits Improve Quality & Productivity 144% improvement in standardization of time spent at discharge “Breakthrough Innovation” says the American Society for Quality > 15 % Care Kits

BEFORE AFTER 17% 0% 92% ER Returns Readmissions in less than 31 days After Prostate Surgery Care Kits eliminated ER Returns and Readmits Control and Intervention Groups were concurrent BEFORE AFTER in less than 31 days St. Joseph Mercy Hospital Ann Arbor Michigan “Breakthrough Innovation” says the American Society for Quality > 15 %

TIME OUT! “These results are not credible. They’re too good.” “There must be flaws in the study designs.” Communication Science researchers shadow hundreds of patients at home, in the workplace and around the community. For each condition, they find the problem preventing adherence and they fix it just as the consumer products industry has done for decades. Observational research increases consumer products sales by giant proportions. Why not health care? The model for fixing adherence is not clinical, where a new treatment may improve a condition by a small percentage. The model is mechanical, where you take a broken machine to the mechanics and they fix it. But let’s not argue. Set up your own study for Care Kits. See for yourself, on your own terms

AFTER BEFORE XX CSI Over 140/90 88% Below 140/80 12% Employer Wellness Initiative: Prior year home visit program had failed Home visit outcome: 12% in control Care Kit outcome: 88% in control All readings confirmed at clinic after six months 6% 88% Hypertension Care Kits performed 6 X better than face-to-face visits Results were measured one way, then confirmed by measuring a different way = valid results ✔

We took them on in South Carolina using outcomes analysis software CMS: “Truckers are the most difficult employee group to effect behavior change.” Multiple Conditions Care Kits are the first to achieve ROI with Truckers Return on Investment For every $1 the trucking company invested, they received $1.79 in savings --to our knowledge, the first successful trucker health intervention Success exceeding levels previously achieved by all others

Diabetes Care Kits could serve well as curriculum for classes P= 97% CARE KIT CLASSES New York City Cleveland, OH Readmissions in 30 days 10.4% <1% 9.6% 5.9% Emergency in 30 days Head-to-Head with Diabetic Education Classes CARE KIT CLASSES Impact after three months A1c Score Care Kits were >90% better at preventing readmits 39% better at preventing ER returns Care Kits brought down A1C numbers after classes had not impacted population Success exceeding levels previously achieved by all others

Success exceeding levels previously achieved by all others Patient Satisfaction Care Kits achieved 33% higher scores “Were you satisfied with the materials for self care?” “Did they help you manage your condition?” Hypertension Yes – 94.9% No – 2.9% Diabetes Yes – 93.6% No – 6.4% CAD Yes –100% University of Pittsburgh Health Plan Press-Ganey national 5-year average = 72% Care Kit UPMC 5-year average = 96% Heart Failure Yes – 97.3% No – 1.8% Asthma Yes – 92.5% No – 2.5%

AMA said getting >33% of the population to comprehend = impossible 154 Patients from Orthopedic and Abdominal Surgery Nurses called one week after discharge, “Were you able to follow your instructions without asking anyone for help or calling back the doctor or the hospital?” Before Care Kits After Care Kits “How satisfied were you with discharge?” Before Care Kits After Care Kits 35% 100% 92% 4% RUSH Medical Center “ Patient Satisfaction” Hospital Peer Review Journal September 2000 Post Surgical Dressings Care Kits outperformed Education Committee Success exceeding levels previously achieved by all others

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 Mercy Hospital, Chicago VA, Ann Arbor MI BEFORE AFTER REDUCED BY 6.4% 4.0% 38% 16.7% 7.7% 54% 13.2% 8.7% 34% 22.2% 6.3% 72% 8.6% 2.2% 73% 23.4% 6.9% 74% >28% 0% 100% 90 days Thompson-Reuters Statistical Analysis Heart Failure Care Kits Reduce or Eliminate Readmissions 58.2% 35.5% 39% 30 days 60 days When you achieve outcomes over and over and over and over again

Summary: Compelling Results Statistical Reliability Breakthrough Innovation Validated Measurement Exceeded authorities’ threshholds for success We have achieved >99% reliability in Diabetes, Hypertension, HF, Asthma, Post-Surgery, et.al. Our worst performance, 34% = more than double the “breakthrough” definition. Many outcomes >70%, even 100% Self-reported confirmed by clinic measurement Self-reported confirmed by software analysis Self-reported confirmed by Thompson-Reuters CMS: Truckers most resistant; achieved ROI National average 72%; Care Kit average 96% AMA prediction = 66%; Care Kit result = 92% “If you were a drug, you’d be approved” --F. I. Orkin, former Corporate Director of Quality and Regulatory, Baxter Healthcare Replicated Results Dozens of studies, all with breakthrough results >99 % > 15 % ✔

√ READMISSIONS P >99% USE OF THE ER Appendix: Statistical Reliability P >99% PERSISTENCE at 6 MONTHS As many times as you repeat a study, statistics says 99% of the outcomes will fall within + or – 3 standard deviations of the initial result. The chance of a result outside ±3Σ is less than 1%

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