2. EXCEL -Prospective Bundle Payment -One Fee For Entire Episode of Care -One Claim From TCO -Transparent Price -Episode of Care Management -Episodes: Joint Replacement -Outcome Measurements / American Joint Replacement Registry -Commercial Payors -Blue Cross of MN, Medica, HealthPartners, Preferred One -Optum: Center of Excellence Program -Work Comp: case by case

3. Bundle Defined Day of Surgery thru Post-Op -Pre-Op Teaching -Orthopedic Surgeon & Physician Assistant -Surgery Facility & Implant -Anesthesia -Transportation to Care Suites, if needed -Ortho Care Suites -Onsite therapy services- 24 hour RN Care (TCO Staff) -Medications- Lab Fees -Dietary Services -Internal Medicine Physician Management -Therapy -DME -Post-Op Visits

4. Price Transparency ProcedureEXCEL PriceTraditional Model* Total Knee$21,000$33,100 Total Hip$24,000$31,800 Total Shoulder$24,500$33,500 Total Ankle$24,500$41,500 * Source: Metro area commercial healthplan

5. Results Measurement201420152016 – 1 st Qtr Total Procedures10430499 Patient Satisfaction (10 pt scale 10 = Highly Satisfied) 9.979.90 Other Complication Rate* 1.0% (1)1.32% (4)0.00% Total Readmissions002 (hematomas) ED Visits11 (Appendicitis) 1 (Hypotension) * Complications: I&D, post-op pneumonia, incisional infection

6. What We Have Learned -Well Defined Patient Criteria -Addresses Over Utilization Concern -Surgical Optimization -Controls Risk for Physician/Patient/Payor -“Franchise” Model Inside of Practice -Committed Strategic Partners -Increase Practice Financial Risk Level

7. Future -Expand Menu of Bundle Procedures -Spine -Employer Specific -Risk Sharing / Warranties -Additional Layer of Stop Loss Protection

8. Employer Risk

9. Future -Expand Menu of Bundle Procedures -Spine -Employer Specific -Risk Sharing / Warranties -Additional Layer of Stop Loss Protection -Establish Care Suite Facilities -Education to Employers -Claims Data -Self-Insured Work Comp Employers

10. Questions / Comments Troy Simonson Twin Cities Orthopedics troysimonson@tcomn.com 952-512-5639