1. Being Accountable for Healthcare Delivery in Central Ohio
James Dougherty, M.D.
Thomas D. Thompson, M.B.A.
Chief Medical Officer
Vice President, Business Development and CFO

2. The Medical Group of Ohio (MGO)
Demographics
Physicians by County
Physicians 2,036
Groups
56% Solo Practitioners
22% Group of 2-3 Physicians
16% Group of 4-9 Physicians
6% Group of 10 or more Physicians
Primary Care (34%)
Specialists 1,343 (66%)
Growth

3. The Medical Group of Ohio (MGO)
Structure
Independent, Physician Owned and Governed Company
Mission “Improve the Process of Delivering Health Care and Enhance the Professional Satisfaction of its Members”
> 150 Physicians Engaged in Leadership Roles
Services
MGO Contracting, NCQA Certified Credentialing
MGO PR Billing, Group Purchasing, Practice Support Services
PLPP Professional Liability Insurance

4. OhioHealth Hospitals Core Region Referral Columbus
Not-for-Profit, Faith Based Health System
Mission – “Improve the health of those we serve”
Eight Hospitals
Riverside Methodist Hospital
Grant Medical Center
Doctors Hospital
Dublin Methodist Hospital
Grady Memorial Hospital
Marion General Hospital
Hardin Memorial Hospital
Doctors Hospital-Nelsonville
20+ Ambulatory Sites
including home care and long-term care
$ 2.1 billion Operating Revenue
15,000 Associates
Cleveland
Columbus
Cincinnati
Core
Region
Referral 4 4

5. Our Market
Population and Growth Patterns 5

6. SURROUNDING SIX COUNTIES
Physicians
Physicians by Specialty, Central Ohio
SPECIALTY GROUPING
FRANKLIN COUNTY
SURROUNDING SIX COUNTIES
TOTAL
PRIMARY CARE
1,437
468
1,905
SPECIALISTS
2,563
740
3,303
4,000
1,208
5,208
Source: State Medical Board of Ohio; Note that physician location can be defined by
physician’s county of residence, not necessarily their practice location.

7. Health Plans Rank Company Name % Commercial Lives Covered 1
Major Health Insurers, Central Ohio
Rank
Company Name
% Commercial Lives Covered 1
Anthem Blue Cross and Blue Shield
30% 2
United Healthcare
23% 3
Medical Mutual of Ohio
20% 4
Aetna 5
CIGNA 4% 6
All Other 3%
Source: Columbus Business Journal; OhioHealth

8. OhioHealth Group-Products and Services
Physician Hospital Organization + =
The Health4 (Clinically Integrated) Network 8

9. The Journey YEAR 1995 Single Signature Contracting 2001 Messenger
Develop Go-to-Market Strategy
2008
OhioHealth Pilot
2009
Aetna Pilot via Messenger Model
Created Clinical Integration Infrastructure
2010
CIGNA Pilot
FTC Visit
Clinically Integrated Network Goes to Market
2011
Lessons learned and What’s Next: Medical Mutual of Ohio and Aetna contracts
What’s the Plan

10. The OhioHealth Pilot… Goals and Process
Implemented a pilot pay for quality (P4Q) program with OhioHealth’s health plan
Collected Data
Developed Attribution Logic
Developed Clinical Guidelines and Metrics
Goals
Learn / Demonstrate Ability to work with Data
Develop / Implement Effective Communications
Develop / Implement Effective Reports
Determine if we can Produce Meaningful Results
Process
Collected Data
Three years claims data, from multiple payer sources, aggregated into one data warehouse
Developed Attribution Logic
To attribute patients to our PHO (where this network provides the majority of care)
To attribute patients to a physician
Developed Clinical Guidelines and Metrics focused on
Preventive Visits
Cancer Screening
Management of Diabetes and Asthma
Established Baseline Performance
Created / Distributed Actionable Reports to Physicians 10

11. OhioHealth Pilot Results 200811

12. OhioHealth Pilot Results 200812

13. OhioHealth Medical Plan – Financial Impact
Claims Cost Per Associate
$450
$16M Reduction
$375
Total Cost Per Associate
Initiation of OhioHealthy Program
Cost Per Member / Per Month

14. The Journey YEAR 1995 Single Signature Contracting 2001 Messenger
Develop Go-to-Market Strategy
2008
OhioHealth Pilot
2009
Aetna Pilot via Messenger Model
Created Clinical Integration Infrastructure
2010
CIGNA Pilot
FTC Visit
Clinically Integrated Network Goes to Market
2011
Lessons learned and What’s Next: Medical Mutual of Ohio and Aetna contracts
What’s the Plan

15. Health4 Directions Group
Work Groups
INFORMATION
TECHNOLOGY
PERFORMANCE
AND
OUTCOMES
MANAGED CARE
CONTRACTING
LEGAL
OHIOHEALTH
PILOT PROGRAM
OPERATIONS
& TACTICS
ACCOUNTABLE
CARE
ORGANIZATION
COMMUNICATIONS 15

16. Health4 – The New Requirements
A committed, stable, comprehensive network
Required engagement of physicians
Required in-network coordinated care
Required use of point-of-care technology
Engaged physicians
- In development/implementation and ongoing operation of the program and committed to evidence-based standards and guidelines
Coordinated, continuous care
- Via referrals within the Health4 network
Utilizing technology to:
- Gather clinical data for monitoring and improving performance
- Support proper care at the point of care
Infrastructure to provide feedback on performance and address performance deficiencies
- Performance and Outcome Committees
Infrastructure to provide performance feedback 16

17. More Payer Contracts and Lives
Covered Lives
More Payer Contracts and Lives
150,000
OhioHealthy
Aetna
Cigna
MMO
100,000
OhioHealthy
Aetna
Cigna
80,000
OhioHealthy
Aetna
20,000
OhioHealthy
2008
2009
2010
2011
Future 17 17

18. Health4 – Aetna and Medical Mutual of Ohio
Fee Schedule
P4Q
Gain Share
Vs. Payer Trend
Vs. Cost of Other Networks
Discussions with major employers underway 18

19. More Payer Contracts and Rewards
Financial Rewards
More Payer Contracts and Rewards
$8M
OhioHealthy
Aetna
Cigna
MMO
Actual
Potential
$5M
OhioHealthy
Aetna
Cigna
$4.2M
OhioHealthy
Aetna
Proving Performance Means Rewards
$220,000
OhioHealthy 19 19

20. Clinically Integrated Clinical Guidelines and Metrics
Clinical Integration Summary
Clinically Integrated
Health4 Network
in Place
IT Product Chosen
Health4 Contracts
Clinical Guidelines and Metrics
4th
Qtr.
2009 No
None 6
1st Qtr.
2010
YES
When network in place
Valence contract signed in Feb.
(two potential) 8
With an
FTC Visit
Target 1,200 Current 1,600
Aetna and MMO
Near Final
4th Qtr.
2011
YES
and growing
H4 practices
using Valence
Aetna and MMO
FINALIZED
Pursuing Others
12 on and
12 more (24 total)
engaging
90% of MGO Physicians

21. What We Learned Proper infrastructure is important
Provides equal representation between the “P” and the “H”
Engages wider spectrum of key resources
Enhances stakeholder involvement and interest
CI is complex and stakes are too high to overlook issues
No single way of provider communication is optimal. A variety of ways need to be used
Reliance on payer data is a short term strategy for information
Success (P4Q) breeds more interest, less patience
Not every group will want to join immediately
We can effectively collect, analyze, and report data
We can handle multiple data sources
We can attribute patients to the proper physician(s)
Our communication vehicles/processes are effective with physicians and their staffs
They will tell you the types of information they want and how to present it
Actionable Reports positively effect physician performance
We will need many more guidelines and metrics
We will need to report information to physicians more frequently
We can engage physicians in improving performance
Guidelines, when in useful formats, are utilized by physicians
Physicians/practices embrace tools/resources that assist them in their care delivery 21

22. What We Learned. . . Continued
The pace and priorities of the partners vary and can be a challenge to manage
The sooner you can get physicians to talk about value (cost) in the same sentence, the better
“Best Practice Model” resonates with physicians
“ACO” and “bundled payments” get physician’s attention but clinical integration provides the flexibility to pursue
Learning to manage as if you are under risk is not a bad thing because you probably will be soon
We can effectively collect, analyze, and report data
We can handle multiple data sources
We can attribute patients to the proper physician(s)
Our communication vehicles/processes are effective with physicians and their staffs
They will tell you the types of information they want and how to present it
Actionable Reports positively effect physician performance
We will need many more guidelines and metrics
We will need to report information to physicians more frequently
We can engage physicians in improving performance
Guidelines, when in useful formats, are utilized by physicians
Physicians/practices embrace tools/resources that assist them in their care delivery 22

23. Health4 Strategic Priorities 2011-2013
Network serves needs of both owners and purchasers
Measurable cost efficiencies
Valence implementation/ usage/ expansion
Health4 achieves commercial success
Majority of commercial patients cared for by Health4 network
Network serves needs of both owners and purchasers
Maintain minimum number of PCPs/specialists
Identify and contract key specialties/groups/ physicians
Measurable cost efficiencies via guideline design and disease management programs
Any gain share earned (PMPM costs, trends)
Short term economic savings measure
Valence implementation/usage/ expansion
90% of practices using tool for guideline compliance
50% practices using the tool at point-of-care
100% of practices contributing data
Majority of commercial patients cared for by the Health4 network
Health4 contracts with 3 of 4 major payers
Health4 contracts with 4 of 4 major payers
Health4 achieves commercial success
400,000+ covered lives under contract
Population and disease management programs
Proposal for DM plan
Implementation
% of applicable patients engaged in program
ACO Status
Implement comprehensive communication, education and marketing plan
Population and disease management programs
ACO Status
Implement comprehensive communication and education plans

24. The NETWORK OF EXCELLENCE
and
Measurably Improving the Quality and Value of Healthcare, and Being Accountable for Our Results 24