1. 3M Health Information Systems, Inc. 3M provides these slides to better understand 3M's software and/or services. These slides contain 3M confidential information and are for customer’s internal review only. Innovating Health Language of the Innovating Health Language of the Dryer Medical Group Thomas C Kravis MD © 3M 2013 - 3M Confidential - For Customer's Internal Review Only. Further use or disclosure requires prior approval from 3M.

2. 2 3M Health Information Systems © 3M 2013. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. Impact of Accurate Complete Documentation Profiling Risk Management Accountable Care Critical Pathways Case Management Quality Management (CQI, TQM) Core Measures Regulatory Compliance Validating LOS Reimbursement ICD-9-CM ICD-10 Present-on- Admission Indicators RAC Audits 2 Midnight Medicare Advantage

3. 3 3M Health Information Systems © 3M 2013. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. Skilled Nursing Facility Hospital - Outpatient Urgent Care Day Surgeries Emergency Clinic visits Observation Aancillary services Outpatie nt Ambulatory Hospital Out of Hospital Post Acute Care Home Hospice Inpatient Psych Rehab Home Healthcare ASC Hospic e Population at Risk Dryer documentation: All Payers Across the Continuum of Care Physician Office Clinic Physician E&M Documentation and Coding FFS>>RISK Plan Payer Physician Office Clinic Med/Surger y

4. 4 3M Health Information Systems © 3M 2013. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. Skilled Nursing Facility Hospital - Outpatient Urgent Care Day Surgeries Emergency Clinic visits Observation Aancillary services Outpatie nt Ambulatory Hospital Out of Hospital Post Acute Care Home Hospice Inpatient Psych Rehab Home Healthcare ASC Hospic e Population at Risk Dryer impact on services of All Payers Across the Continuum of Care Dryer Dryer Dryer Dryer Physician Office Clinic Physician E&M Documentation and Coding FFS>>RISK Plan Payer Physician Office Clinic Med/Surger y

5. 5 3M Health Information Systems © 3M 2013. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. 5 © 3M 2015 All Rights Reserved. Payer Financial Opportunity @ 75% Realization SOI variance ROM variance MedPAR (2013)$3,210,367-5.80%19.40% Medicaid (3M Compare)$2,800,45014%-24% All Payer (3M Compare)$2,100,000-10%-14% Payer Financial Opportunity$8,110,817 ROI TypeROI Amount Reduced Cost of Readmissions $ 23,564 Reduced Cost of HACs $ 1,390,269 Increased revenue due to better PSI scores $ 1,374,080 Increased revenue due to better SOI/ROM $ 785,469 Quality Indicators Financial Opportunity $ 3,573,382 Total Opportunity: $14,697,083 Total Financial Opportunity IssueNumber Financial Opportunity Medical Necessity Edits 11.026 $268,871 IP Only Procedure Edits6 $123,190 CCI Edits984 $91.088 Medically Unlikely Edits1,077 $2,128,644 Edit Financial Opp $2,611,793 Ineffective Modifiers (no change in outcome)76 Inappropriate Modifiers3223 Possible Missing Modifiers4897 Modifier Financial Opp$193,720 Observation to IP Opp29$207,371 Outpatient Financial Opp$3,012,884

6. 6 3M Health Information Systems © 3M 2013. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. Physician Driven Solutions Assess Goals Strategy Metrics Physician and staff training Queries> Feedback Reports Reengage Retrain - Engage  Assess  Engage Stakeholders  Strategy: Goals Metrics Quality Measures  Target service lines ICD 9/10  High volum  Physician profiles: in patient & out patient  Training: specialties midlevel, house staff  Physician Champion / Advisor  Identify barriers to Physician workflow  Reassess  Modify to meet goals

7. 7 3M Health Information Systems © 3M 2013. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. 3M™ Clinical Documentation Improvement Assure all conditions are documented in the medical record  To promote the appropriate assignment of  S everity O f I llness (SOI) & R isk O f M ortality (ROM)  Based on CMS’s rules  Documentation Specialists  “Real Time”  Continuum of care Physicians Medical Record Professionals Clinical Doc. Specialists 360

8. 8 3M Health Information Systems © 3M 2013. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. Liver failure, renal failure, resp failure Respiratory failure : “ Acute, due to……” Hypotension, “ Shock, septic due to…..” Dehydration, hypovolemia Ventricular tachycardia Simple UTI Hypokalemia LLL pneumonia Acute or Chronic Blood Loss Anemia Dementia, Coma, Encephalopathy Protein Calorie Malnutrition Diagnostic TermClinical Statement Multi-system organ failure Severe respiratory distress Hemodynamically unstable Will rehydrate Rhythm stable today “Urosepsis” ↓ K = 2.0, will give KCL LLL infiltrate ↓ HgB 5.2, Transfuse Altered Mental Status Emaciated, weight loss,↓ Albumin ↓BMI Unable to Code Able to Code

9. 9 3M Health Information Systems © 3M 2013. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. General and Internal Medicine 1 Clinical Terms (Documentation needs clarification) Diagnostic Statement (Accurate code may be assigned) Continue home medications such as furosemide, HCTZ, ACE inhibitor Document specific diagnosis such as chronic systolic/diastolic heart failure, CAD, atrial fibrillation, angina, HTN History of CHF, will continue home medsSpecify acuity (chronic, acute, acute on chronic); specify type (systolic, diastolic, combined systolic and diastolic) Cardiac enzymes elevated, elevated troponin, EKG positive Acute myocardial infarction (specify type such as STEMI or NSTEMI; document specific artery involved such as LAD, left circumflex; exact date of any recent AMI) Acute coronary syndrome (ACS)Clearly document intended diagnosis such as intermediate/insufficiency syndrome, unstable angina, coronary slow flow syndrome, myocardial infarction Cardiac history Clearly document specific diagnoses such as CAD, angina, old MI (document date when MI occurred) Atrial fibrillationSpecify type such as paroxysmal, persistent, chronic Atrial flutterSpecify type such as typical (type I) or atypical (type II) BP 70/40, ordered norepinephrine or dopamine for support Shock (specify type such as cardiogenic septic, hypovolemic) A code may not be assigned based on abnormal laboratory results or diagnostic report findings alone. The physician must document the corresponding diagnosis in the body of the medical record.

10. 10 3M Health Information Systems © 3M 2013. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. Specificity and Severity of Illness DiagnosisExtremeModerateMinor Acute systolic and/or diastolic heart failureX Congestive heart failureX Decubitus ulcer Stage III or IVX Decubitus ulcer (site not specified)X COPD with acute exacerbationX COPDX Acute renal failure secondary to ATN or ESRDX Acute renal insufficiencyX Acute blood loss anemiaX Chronic blood loss anemiaX Severe protein-calorie malnutritionX MalnutritionX

11. 11 3M Health Information Systems © 3M 2013. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. When do I document “other” diagnoses …………. in the inpatient setting? “ additional conditions that affect patient care in terms of requiring at least one of the following”: ― Clinical evaluation ― Therapeutic treatment ― Diagnostic procedures ― Extended length of hospital stay ― Increased nursing care and/or monitoring

12. 12 3M Health Information Systems © 3M 2013. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. 3M™ APR DRG : All Patient Refined DRGs Severity of Illness (SOI) and Risk of Mortality (ROM ) MDC/APR MDC Subdivide each APR DRG into subclasses Severity of Illness Subclasses 1.Minor 2.Moderate 3.Major 4.Extreme Risk of Mortality Subclasses 1.Minor 2.Moderate 3.Major 4.Extreme 316 APR DRGs 1,258 Subclass Cells

13. 13 3M Health Information Systems © 3M 2013. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. SOI and ROM are Independent ROM = 1 Low risk of mortality Major severity of illness SOI = 3 Acute Cholecystitis The 4 severity of illness and risk of mortality subclass are calculated separately and may be different from each other.

14. 14 3M Health Information Systems © 3M 2013. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. Underlying Principle of 3M™ APR DRGs Severity Of Illness (SOI) and Risk Of Mortality (ROM) are dependent on the patient’s underlying problems. High SOI and ROM are characterized by: (a) multiple serious diseases and (b) the interaction among those diseases.

15. 15 3M Health Information Systems © 3M 2013. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. Principal Diagnosis : "XYZ" example illustration only Impact of Secondary Diagnosis © 3M 2012 - 3M Confidential - For Customer's Internal Review Only. Further use or disclosure requires prior approval from 3M.

16. 16 3M Health Information Systems © 3M 2013. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. Diabetic Neuropathy ICD-10  “ Diabetic neuropathy” = nonspecific code ―If known or suspected, document : Diabetic mononeuropathy Diabetic polyneuropathy Diabetic autonomic neuropathy Diabetic amyotrophy ― Type of diabetes as Type 1 or Type 2 ― control status Document : “inadequately controlled,” “ out-of-control,” or “ poorly controlled” and Type with hyperglycemia.

17. 17 3M Health Information Systems © 3M 2013. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. Medicare Severity Index Comparisons System Hospitals Higher Than Expected (Favorable) Lower Than Expected (Unfavorable) Source:3M TM APR DRG Classification System and MEDPAR 2012 17 © 3M 2014 - 3M Confidential - For Customer's Internal Review Only. Further use or disclosure requires prior approval from 3M. State Average

18. 18 3M Health Information Systems © 3M 2013. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. Medicare Risk-Adjusted Mortality Analysis System Hospitals Higher Than Expected (Unfavorable) Lower Than Expected (Favorable) Source:Risk Adjustment – by the 3M TM APR DRG Classification System and MEDPAR 2012; Expected deaths are based on the State of Illinois’s average death rate, risk adjusted by the 3M APR DRG Classification System. Data based on all cases using selection criteria. No inference is made or conclusion can be drawn about the significance of actual to expected mortality variance without further study. 18 © 3M 2014 - 3M Confidential - For Customer's Internal Review Only. Further use or disclosure requires prior approval from 3M. State Average

19. 19 3M Health Information Systems © 3M 2013. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. Data based on all cases using selection criteria. No inference is made or conclusion can be drawn about the significance of actual to expected mortality variance without further study. Target Variances in ROM By Service Line Analysis: Example Cardiac

20. 20 3M Health Information Systems © 3M 2013. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. RISK OF MORTALITY APR DRG 194, HEART FAILURE Quality Documentation or Coding

21. 21 3M Health Information Systems © 3M 2013. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M.  Acuity Acute, chronic, acute on chronic/exacerbation  Type Systolic and/or diastolic heart failure  Etiology If known or suspected:  Collaboration and clinically effective: Core measure ;Potential Preventable Readmission (PPR);continuum ―Ischemia ―Anemia ― Kidney failure ―Hypertension ―Myocarditis ―Structural heart disease ―Supraventricular tachycardia ―Cardiomyopathy : Alcoholic congenital, congestive, constrictive, dilated, endomyocardial, idiopathic hypertrophic sub aortic stenosis,nonobstructive hypertrophic, obstructive hypertrophic, restrictive Heart Failure Common Impacts all specialties Driver of SOI ROM Quality (PPR)

22. 22 3M Health Information Systems © 3M 2013. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. ―Acute renal “insufficiency” SOI 1; ROM 1 ―Acute kidney injury (AKI) SOI 3; ROM 3 ―Acute kidney failure SOI 3; ROM 3 Versus ― Acute kidney failure “ due to” Acute tubular necrosis SOI 4; ROM 4 Cortical necrosis SOI 4; ROM 3 Medullary (papillary) necrosis SOI 4; ROM 3 Acute Kidney Failure Documentation Impact of Appropriate Documentation on SOI and ROM and Physician Scorecard

23. 23 3M Health Information Systems © 3M 2013. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. Heart Failure  Sample Physician: SOI less than Peers  Target for Training/guidance Learning objective:  Respond to request for clarification  Document the drivers of SOI  Treat underlying cause: clinical effectiveness  Lower SOI

24. 24 3M Health Information Systems © 3M 2013. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. "Probable" "Possible" "Suspected" "Unable to Rule Out"  Inpatient application: ―Code these conditions as though they exist – applies to hospital setting only ―If condition is ruled out, it may not be coded  Dryer Outpatient application: ―Must code signs/symptoms, not the suspected condition

25. 25 3M Health Information Systems © 3M 2013. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. Chest Pain Alternatives GERD Gastritis MS-DRGs 391/392 RW = 1.1903 Chest Pain MS-DRG 313 RW = 0.5992 Anterior CP Pleuritic CP Chest Wall Pain MS-DRG 204 RW = 0.6780 Costochondritis Tietze’s Disease MS-DRGs 205/206 RW = 1.3935 Pulmonary Embolism MS-DRGs 175/176 RW = 1.5346 Cardiac Arrhythmia MS-DRGs 308/309/310 RW = 1.2088 Angina MS-DRG 311 RW = 0.5649 CAD MS-DRGs 302/303 RW = 1.0287 Shingles MS-DRGs 595/596 RW = 1.5958 Pleurisy MS-DRGs 193/194/195 RW = 1.4550 Psychogenic Angina or Pericarditis MS-DRGs 314/315/316 RW = 1.8941 Anxiety MS-DRG 880 RW = 0.6388 Biliary Colic MS-DRGs 444/445/446 RW = 1.6060 Cardiac Cath MS-DRGs 286/287 RW = 2.1058 Aortic Stenosis MS-DRG 306/307 RW = 1.3659

26. 26 3M Health Information Systems © 3M 2013. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M.  Document acuity: ― Acute ― Chronic ― Healed/old  Specify meaning of “history of PE” ― Chronic PE continuing to be treated, is being prophylactically treated ― or patient no longer has the condition ― “chronic pulmonary embolism” vs. “healed PE” or “old PE”  Specify type: ― Saddle ― Septic ― Postprocedural or due to a vascular device  Specify if related to any other condition such as: ― Atrial fibrillation ― DVT (specify site and laterality) ― Hypercoagulable state ― Malignancy/Orthopedic surgery/Sepsis/Trauma ― Not POA and after an operative episode is considered a patient safety indicator (PSI 12) ― A hospital acquired condition (HAC) when following certain orthopedic procedures  Document presence of cor pulmonale (acute /chronic) Documentation for Pulmonary Embolism

27. 27 3M Health Information Systems © 3M 2013. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. ACS or “acute ischemic heart disease” translates in ICD-10-CM to a nonspecific code Document a diagnosis which may more accurately describe the patient's condition: Intermediate or insufficiency coronary syndrome Unstable angina Coronary slow flow syndrome Myocardial infarction Other condition? Acute Coronary Syndrome (ACS) – A Nonspecific Code in ICD-10

28. 28 3M Health Information Systems © 3M 2013. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. Myocardial Infarction Myocardial infarction documentation and coding will need to include: Type of infarction STEMI NSTEMI Age of infarction If within 4 weeks coded as initial If older than 4 weeks coded as “old” Specific site of myocardium involved Anterior wall Inferior wall Coronary artery involved ICD-10-CM Myocardial Infarction 9 5 9 codes for initial (I21) and 5 codes for subsequent (I22) © 3M 2014. All Rights Reserved.

29. 29 3M Health Information Systems © 3M 2013. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. Drug Underdosing  New clinical terminology in ICD-10  Identifies intentionally or unintentionally taking less of a medication than prescribed  Document intentional versus unintentional or accidental ―Intentional For example, due to financial hardship ―Unintentional or accidental For example, due to age related disability –Age-related dementia –Rheumatoid arthritis of hands

30. 30 3M Health Information Systems © 3M 2013. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. Clarification impact Impact w/ Response to Query  RW = 2.9797  GLOS = 8.98  SOI = 3 Major  ROM = 2 Moderate Impact w/o Response to Query  RW = 2.9797  GLOS = 8.98  SOI = 2 Moderate  ROM = 2 Moderate Query: “ Patient had a magnesium level of 1.6 and received magnesium sulfate. Please provide a corresponding diagnosis for the treatment provided.” ** CDI seeks documentation of “ hypomagnesemia “ Cardiac Procedure

31. 31 3M Health Information Systems © 3M 2013. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M.  Bacteremia – nonspecific laboratory finding of bacteria in the blood with no signs of illness  Septicemia – systemic disease associated with the presence of pathogenic microorganisms in the blood*  Sepsis – SIRS due to an infection.* An infection-induced syndrome in the presence of two or more manifestations of SIRS without organ dysfunction. Septicemia that has advanced to involve two or more manifestations of SIRS.  Severe sepsis – sepsis with associated acute organ dysfunction*  Septic shock – severe sepsis in which the cardiovascular system begins to fail, blood pressure drops, and vital organs are deprived of adequate blood supply* *Definitions per NCHS/CDC Definitions

32. 32 3M Health Information Systems © 3M 2013. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. Sepsis Continuum  Sepsis is classified in ICD-10 as: ―Streptococcal Sepsis (group A, group B, Streptococcus pneumoniae, other streptococcal) or ―Other Sepsis (e.g., MRSA, Pseudomonas)  Severe sepsis ―Document any associated organ dysfunction and ―Document presence of septic shock

33. 33 3M Health Information Systems © 3M 2013. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. 3M  APR DRG Classification System Risk-Adjusted Mortality Example APR-DRG 139 - OTHER PNEUMONIA Data based on all cases using selection criteria. No inference is made or conclusion can be drawn about the significance of actual to expected mortality variance without further study. Data Source: 3M APR DRG Classification System utilizing MEDPAR 2012 data Improved documentation may have increased the ROM to a higher level

34. 34 3M Health Information Systems © 3M 2013. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. Pneumonia: Complex vs. Simple  Complex Pneumonia Higher SOI; consume more resources RW = 1.9934 ―Anaerobic pneumonia ―Aspiration pneumonia ―Gram-negative pneumonia, which includes: E. coli pneumonia Hemophilus parainfluenzae pneumonia Legionnaires’ disease Moraxella catarrhalis Proteus pneumonia Serratia marcescens pneumonia Xanthomonas pneumonia ―Klebsiella pneumonia ―Pseudomonas pneumonia ―Staphylococcus pneumonia MRSA MSSA  Simple Pneumonia Lower SOI weight; consume less resources RW = 1.4550 ―Chlamydia ―Gram-positive pneumonia ―Hemophilus influenzae pneumonia ―Mixed bacterial pneumonia ―Mycoplasma pneumonia ―Pneumococcal pneumonia ―RSV Pneumonia ―Streptococcus pneumonia ―Vancomycin resistant Enterococcus (VRE) ―Viral pneumonia ―Unspecified pneumonia, CAP, HAP

35. 35 3M Health Information Systems © 3M 2013. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. 35 Neoplasms Admit for Chemotherapy vs. Malignancy  Document all reasons for admission: ―Chemotherapy/radiotherapy/immunotherapy ―Pain control/management ―Symptoms/conditions related to malignancy (e.g., weakness, ascites, cachexia, malnutrition, anemia [specify type], dehydration) ―Staging

36. 36 3M Health Information Systems © 3M 2013. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. Syncope Alternatives Arrhythmia MS-DRGs 308/309/310 RW = 1.2188 Syncope MS-DRG 312 RW =.7215 Stroke or CVA MS-DRGs 64/65/66 RW = 1.8258 Anemia MS-DRGs 811/812 RW = 1.2431 Dehydration MS-DRGs 640/641 RW = 1.0896 Heart Failure MS-DRGs 291/292/293 RW = 1.4609 Hypotension MS-DRGs 314/315/316 RW = 1.7589 Dig Poisoning MS-DRGs 917/918 RW = 1.4449 Alcohol Abuse MS-DRGs 896/897 RW = 1.4155 Note: In Quick Reference Guide

37. 37 3M Health Information Systems © 3M 2013. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. Documentation Opportunities ICD-10 for TIA Document specific known or suspected cause: Vertebro-basilar artery syndrome ―Carotid artery syndrome ―Precerebral artery syndrome ―Amaurosis fugax ―Transient global amnesia ―Other cerebral ischemic attacks and syndromes  Document the cause and effect ―Link the patient’s TIA to a specific precerebral artery disease (e.g., occlusion, stenosis) ―Document possible probable or suspected ( if diagnosis TIA or CVA/cerebral infarction)

38. 38 3M Health Information Systems © 3M 2013. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. ICD-10 Cerebral Infarction  What remains the same ICD-9 ? Etiology = thrombosis or embolism  What’s new ― Site = precerebral, cerebral, or cerebellar arteries If precerebral :  Vertebral, basilar, carotid, or other ― Laterality = right or left, when applicable ― Intraoperative or ― post procedural cerebral infarction occurring ― during cardiac surgery or ― another type of surgery If cerebral :  Middle, anterior, or posterior

39. 39 3M Health Information Systems © 3M 2013. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. ICD-9 vs. ICD-10 Structural Changes  ICD-9 (Diagnoses) 3-7 characters a a # # a/# Category etiology, site, manifestation extension a/# ICD-10 (Diagnoses) # # # # # # # # # # Category etiology, site, manifestation 3-5 characters t

40. 40 3M Health Information Systems © 3M 2013. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. Potentially Preventable Events 3M TM Potentially Preventable Readmissions (PPRs) 3M TM Potentially Preventable Initial Admissions (PPAs) 3M TM Potentially Preventable Visits (PPVs) 3M TM Potentially Preventable Complications (PPCs) 3M TM Potentially Preventable Services (PPSs) © 3M 2015 - 3M Confidential - For Customer's Internal Review Only. Further use or disclosure requires prior approval from 3M.40 Population Focused Preventable Events

41. 41 3M Health Information Systems © 3M 2013. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. MD Statewide Experience: PPC Cost Savings Source: Health Affairs December 2012 Source: Health Affairs, December 2012 31:12; doi: 10.1377/hlthaff.2012.0357

42. 42 3M Health Information Systems © 3M 2013. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. Potentially Preventable Emergency Department Visits (PPVs) by Enhanced Ambulatory Patient Group (EAPG)

43. 43 3M Health Information Systems © 3M 2013. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. Manage Potentially Preventable Admissions (PPAs) by APR-DRG

44. 44 3M Health Information Systems © 3M 2013. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. Example: post acute care coordination Recommendations for Dryer Outpatient Care: PPRs 17

45. 45 3M Health Information Systems © 3M 2013. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. Reduce Potentially preventable costs Potentially preventable ICU Days/Costs

46. 46 3M Health Information Systems © 3M 2013. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. Documentation and Data Quality Extracted and Codified Data Compliance and Quality Analytics Interfaces 3M 360 Encompass processes EHR for codes, documentation improvement and Quality metrics. 3M 360 Encompass processes EHR for codes, documentation improvement and Quality metrics. 3M 360 Encompass Natural Language Processing (NLP) Inpatient > Outpatient Tests Labs Scanned Physician Workflows EHR Physician EHR Workflow Integration Physician EHR Workflow Integration Coder CAC Workflow Application Coder CAC Workflow Application CDI Reviewer Workflow Application CDI Reviewer Workflow Application Daily Hospital Workflows

47. 47 3M Health Information Systems © 3M 2013. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. Case Study: Specificity Query Impact Principal Diagnosis Secondary Diagnoses MS DRG APR DRG Severity of Illness Risk of Mortality National Mortality Rate Acute Kidney Failure Sepsis Acute systolic heart failure Chronic Kidney Disease, Stage IV Old myocardial infarction Acute Kidney Failure Urosepsis (UTI) Heart Failure Chronic Kidney Disease Old myocardial infarction 683: Renal Failure with CC 460: Renal Failure 3: Major 2: Moderate 0.7% Patient OverviewOriginal SummaryImproved Specificity 682: Renal failure with MCC 460: Renal Failure 3: Major 3 Major 3.9% Unspecified Diagnoses Improved Specificity and Quality report Improved Specificity and Quality report

48. 48 3M Health Information Systems © 3M 2013. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. Case Study: Impact of ICD-10 Requirements Principal Diagnosis Secondary Diagnoses MS DRG Weight APR DRG Weight Severity of Illness Risk of Mortality Acute on Chronic Diastolic Heart Failure Diabetes Type 2 Un-codable in ICD-10 Acute on Chronic Diastolic Heart Failure Diabetes Type 2 Urosepsis 292: Heart Failure0.9938 194: Heart Failure0.6127 2: Moderate Patient Overview 293: Heart Failure0.6723 194: Heart Failure0.4868 1: Minor Unspecified Diagnoses In ICD-9 “urosepsis” = UTI ICD-9 SummaryICD-10 Summary In ICD-10 “urosepsis” not codeable

49. 49 3M Health Information Systems © 3M 2013. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. Case Study: Specificity Query Impact Principal Diagnosis Secondary Diagnoses MS DRG Weight APR DRG Weight Severity of Illness Risk of Mortality National Mortality Rate Severe sepsis Acute Respiratory Failure Influenza with Pneumonia Acute on Chronic, Diastolic CHF Sepsis fever dx infiltrate RR access muscles pO2 60 Acute Respiratory Failure Influenza with Pneumonia CHF 871: Septicemia1.8803 720: Septicemia1.3272 3: Major 7.9% Patient Overview 871: Septicemia1.8803 720: Septicemia3.0499 4: Extreme 30% Unspecified Diagnoses Patient Outcome Patient expired in hospital Accurate capture SOI and ROM More appropriate Reflects clinical condition Accurate capture SOI and ROM More appropriate Reflects clinical condition Original SummaryImproved Specificity Improves hospital and physician quality and outcomes reporting

50. 50 3M Health Information Systems © 3M 2013. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. Medicare Advantage HCCs Care is Delivered to the Member (face-to-face encounter) CMS Calculates MA Risk Adjustment ICD-9 CM codes are submitted on Claims based on the face-to-face encounter clinical findings Claims data diagnosis codes are converted to HCC codes Plan & Providers can Deliver better care And reimbursement is received Care and Diagnoses are Documented in the Chart / Progress Notes HCC codes data is submitted to CMS 50

51. 51 3M Health Information Systems © 3M 2013. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. Medicare Advantage and HCCs.  A member is “flagged” with an HCC if an ICD-9 diagnosis code has been submitted to CMS for the prior year that maps to the HCC.  For example, ICD-9 code 250.00 (diabetes mellitus without mention of complication) maps to HCC 19. commercial??  If a member has this ICD-9 code submitted (and has no other diabetes- related ICD-9 code), then that member’s risk score would increase by 0.162.  This would result in an additional payment to a typical MA plan of about $100 per member per month (PMPM).

52. 52 3M Health Information Systems © 3M 2013. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. Analytics

53. 53 3M Health Information Systems © 3M 2013. All Rights Reserved. 3M Confidential – for customer's internal review only. Further use or disclosure requires prior approval from 3M. From Value Based Purchasing to Accountable Care- The PPR Roadmap Prospective Payment Pay for Performance Pay for Outcomes Risk Sharing Contracts Bundled payments/ACO s Risk Adjustment for IP and OP Retrospective PPR Complete and Accurate coding Process Improvement PPR Integration of Clinical and Data Quality Quantifying PPR costs Quality Outcome Measurement Concurrent PPR PPR Benchmark Improvement and Analytics Integrated AlertsImprove efficienciesPredictive PPR Predicting Costs PPR in Patient Focused Episodes ( Population Risk) Preventable Events Cost efficiency across the continuum or care Predicting Bundle risks Preventables have full integration in Physician/EHR workflow Automate data quality