1. June 9, 2005AHRQ Annual Meeting A. John Blair, III, MD President and Chief Executive Officer Taconic IPA, Inc. Fishkill, NY The Taconic Case Study

2. June 9, 2005AHRQ Annual Meeting Taconic IPA  Founded 1989  Mid-Hudson Valley region, New York State  8 counties  2,300 physicians / 500 practices  1 to 70+ physician practice size range  4 physicians – average practice size  Over 1 million covered lives

3. June 9, 2005AHRQ Annual Meeting Taconic IPA  NOT a staff model  Physicians NOT employed by Taconic IPA  NO centralized control  Not an IDN  Not a Clinic  Not a University

4. June 9, 2005AHRQ Annual Meeting Obstacles  Cost  Complexity  Selection  Human Resources  Data  Silos

5. June 9, 2005AHRQ Annual Meeting Strategy: Cost  Internet and ASP model  Leverage IPA size  Aligning incentives  Health plans IHA model Technology focus  Employers Bridges to Excellence

6. June 9, 2005AHRQ Annual Meeting Strategy: Complexity  Incremental approach  Electronic results delivery  Most popular  Electronic signature for transcribed reports  Electronic Prescribing  Document imaging  Full EMR

7. June 9, 2005AHRQ Annual Meeting Strategy: Selection  Independent EMR expertise  Leading annual survey  In-depth knowledge of vendors  Extensive vendor evaluation process  End user group  Health plan / Employer group Medical Directors CIOs

8. June 9, 2005AHRQ Annual Meeting Strategy: Human Resources  MedAllies  Change Management expertise  Planning, Training, Implementation, Support  Hardware / Network Support

9. June 9, 2005AHRQ Annual Meeting Strategy: Human Resources  Industry average 7.5 hours per physician – Year 1 Phone support – Post-implementation  MedAllies 80 hours per physician – Year 1 40 hours per physician – Ongoing 24/7 Help Desk Local support / trainers 1.5 hours maximum onsite response time

10. June 9, 2005AHRQ Annual Meeting Strategy: Data  Physician leadership  Hospital participation  Physician office staff  Laboratory participation  Leverage competing hospitals  Critical mass

11. June 9, 2005AHRQ Annual Meeting Strategy: Silos  Require vendor interoperability  Require standards  Require certification

12. June 9, 2005AHRQ Annual Meeting PharmaciesHospitals Reference Laboratories TRANSLATOR CLINICAL DATA REPOSITORY E- Results E Rx MedAllies Portal EMR 1 EMR 2 MASTER PATIENT INDEX PAYORS PAY-4-PERFORMANCE PMS PHYSICIANS PATIENTS Physician Practice

13. June 9, 2005AHRQ Annual Meeting A. John Blair, III, MD President and Chief Executive Officer Taconic IPA, Inc. Fishkill, NY The Taconic Case Study Thanks for your time!