1.  Presenters  David Reyes, Principal, AEC Consulting, An Altitude Edge Company  Wayne Olson, Senior Vice, President of Operations, Volunteers of America National Services

2.  Deficit Reduction Act of 2005 – Rural PACE Provider Grant Program  Purpose – to promote the development of PACE in rural service areas.  Provided $7.5 million for up to 15 sites (each grant not to exceed $750K)  Also provided $10 million for risk sharing with rural sites (outlier protection funds)

3.  Volunteers of America was 1 of 14 organizations awarded approximately $500k to develop PACE in Montrose and Delta Counties, Colorado  Two PACE Centers were opened on August 1, 2008 – Eckert & Montrose, Colorado

5.  Demographic Analysis to determine for the existence of PACE target population in Montrose, & Delta Counties  Definition of PACE eligible target population – 65+, self reporting two or more ADL disabilities, Medicaid eligible

6. County Projected PACE Market 10% Market Penetration 15% Market Penetration 20% Market Penetration 25% Market Penetration Delta5875988117147 Montrose6576699131154 Total1,244125187248301

7. A National Organization Serving Local Needs

9. Healthcare and Housing focused division formed in 1970

10. Healthcare Map

11.  11 Nursing Homes  202’s  7 Assisted Living Sites  4 Market Rate Senior Housing  1 CCRC  Adult Day Programs  Home Health Certified and HCBS  Senior Meals Programs  PACE  Minnesota  Colorado  Ohio  North Carolina  Florida  Arizona  Nevada  Virginia

12. There are no limits to caring.® Montrose Delta Skilled Nursing Housing Meals Assisted Living Home Health PACE 70 Grand Junction 25 Colorado Springs Eckert

14.  Montrose County population 41,400 population over 65 5,500 rural - agriculture, some industrial  Delta County population 31,000 population over 65 6,200 very rural - agriculture, mining

15.  1980 a SNF  1984 a SNF  1995 a 202  1998 a 202  2000 a 202  2001 Home Health  2002 a Assisted Living  2003 a 202  2009 assumed senior meals services In 2007 we operated  220 low income apartments -202 funded  170 SNF beds  60 unit Assisted Living  HH service base 60  Serving 470 per day

16.  We were Solutions orientated- without any new solutions  A belief that change in healthcare funding and accountability would come  That our continuum was full on housing and residential services, but light and certainly not dominate in HCBS  Many competitors in the spaces of residential care – little differentiation

17.  We continued to focus on core business – we always planned to be additive to the base  We explored a variety of approaches to have a broader touch Technology HCBS PACE  Looked for ways to build brand and relationships  Our goal is RELAVANCE in our markets

18.  If you are not at the Table, you are on the menu  Solutions are not singular any more, they are comprehensive.  Less (in number of partnerships) is more …. when it comes to those that organizations wish to partner with

19.  Years of observing PACE program development nationally  Attended intro NPA programs on the model  Explored States friendly to PACE  In 2006 - the Rural PACE opportunity became available, we applied and became one of the pilot programs

20.  Facilities – we re-purposed  Staff – more on the next slide  Money - the process is not cheap  Finding good council – we found AEC  Explaining the model We needed, and had, a “Johnny Appleseed” of PACE”- and his name was John  Thinking different – negotiated risk and care

21.  With PACE added, the region became more internally competitive  Residents….Staff ……Reputation  Leadership culture needed to evolve  A shared understanding of 1+1+1+1=6 for Referrals, Reputation, Staff Enrichment The trigger was sustainability of Mission, and continuation of their Jobs

22. Did we increase service volume? Did we improve care? Did we find a more stable financial model? Did we become more relevant in our market?

23. Operation 2007CurrentVariance SCC 0285 Valley 90 71 -19 Horizons 57 62 5 Homestead 44 47 3 HHWC 68164 96 Senior Apts202242 40 Total461851410

24. 25% penetration rate Clinical outcomes, hospital readmission rates Expense controls Reputational/brand strengthening Filled in our continuum

25. 2007 2015  $21,000,000 annual income  3.5% NI  $42,000,000 annual income  6% NI  Increased management fee

27.  Find and create solutions for health care needs of the area. ACO Opportunity West End – solutions needed Medicaid Clinic/Care Management options Post Acute Medicare stay reduction  Focus on Human Resources  Expand on Brand and Reputation  Reinvest in legacy programs physical plants  Invest in technology

28.  If not us, someone, would have done what we did in Western Colorado --- if not us, then we would have been out of business  Change required commitment and focus  We needed to be ready to act when the rural PACE grant developed… we had done our homework  Board needed to be prepared for change, but not impatient until we found our solutions  It wasn’t easy, cheap or risk free to pursue

29.  We have a window into Comprehensive Care – population management  We have experience with true Capitated Care  The credibility and respect of the community has created a differentiated Perception of all of our programs.  The Board, with the success has greater faith in Staffs strategic growth plans and ability to execute on plans focused on Collaboration

30. We have created a “different” presence in the market, we are now at the Table…. every time.

31.  Contact Information:  David Reyes  303-748-6762  dreyes@altitudeedge.com dreyes@altitudeedge.com  Wayne Olson  952-941-0305  wolson@voa.org wolson@voa.org