1. Join the Movement! 10th Caribbean Health Financing Initiative Conference October 28, 2015 Dr. Kester J. Nedd Chairman and CEO, JIPA Network

2. A Noble Ideal “The Value of a Nation is determined by the health of its people” - Franklin D. Roosevelt

3. National Health Challenges: Consumers Relatively sick population with lifestyle illnesses (associated high cost of care) Retirees have limited and high-cost coverage Consumers are more focused on property & casualty than health care insurance High out-of-pocket expenses for health care services Populations are limited and scattered across multiple nations - not operating as a unit (fragmented, higher acquisition costs)

4. National Health Challenges: Health Care Providers Relatively small population with small number of specialists (high turnover of specialists) Few training programs (fear of training the competition) Blending of the public and private sector – compensation system not reasonable Specialists work independently Provider network not organized until now!

5. National Health Challenges: Payers Focus on profits not coverage Only 40-50% of insurance premiums spent on actual health care compared to the United States: 71-82% Laws governing health coverage and insurance are antiquated and favor insurance companies, not consumers or health care providers Premiums not adequate to cover the benefits members want Health care coverage focused on the wealthy Small insured population with fragmented pools of covered lives - competition is both regional and international Provider network not organized Blending of the public and private sector

6. Caribbean people should have Access to High Quality, Coordinated, Affordable Care where they need it and when they need it.

7. Challenges & Opportunities Health care is seen as a Cost Center rather than an opportunity for growing the economy Expats want to come home but choose not to because of the limited health care services Flight of health care dollars: South Florida USD $600 million – 20% We need a way to pay for health care

8. What will work in the Region? A new model to pay for and provide health care Federated organization across country, political divide and economic status Consolidation and concentrated Collective bargaining arrangements

9. Introducing JIPA Network A Global Multi-Provider Association

10. JIPA’s Strategy Health Care Providers Payers Consumers Consolidate and Collectively Bargain on behalf of:

11. We connect patients to world-class, affordable health care through our integrated family of global health care providers.

12. JIPA Network, A Provider Organization Physician-driven and operated Mutual company: Investor/ownership with health care providers and payers Providers contracted to provide care: Primary care Specialty physicians Hospitals Ancillary providers of health care services Concierge providers

13. Provider Organization Focus Organize providers across countries to create Centers of Excellence Organize care coordination and triage of patients to allow for timely access and cost- effective care between network providers Utilize collective bargaining methods to make health care affordable Group purchasing power to keep cost down

14. Regional access to over 300,000 providers and National (USA) and international Access to over 1 Million providers through Aetna First Health Network and other Network Partners Scope and Reach of JIPA’s Provider Network

15. Payer Strategy - JIPA’s Clients: Payers Employer Groups Consumers: Self-Pay Traveling Public Travel for Health Care: Destination Medicine Assistance Companies Cruise Industry Self-Funded Organizations High-Deductible Insureds Union Members Workers Compensation Government Workers National Health Insurance Plan Non-Governmental Agencies Insurance Companies and Reinsurance Companies

16. Stratified Pooled Risk Coverage (SPRC) Additional Premium Paid Above Second Tier Highest Coverage Limits Local, Regional and International Payers Additional Premium Paid Above First Tier Benefit Limits Higher Local, Regional and International Payers Lower Cost Premium and Benefits Local Plan or Self-Funded Large Population will Have Access JIPA’s Three-Tiered Stratified Risk Program Third Tier Second Tier First Tier

17. Payer Organization Focus Local coverage for basic and basic+ coverage that is focused on wellness and prevention (broader population can now buy health insurance) Catastrophic coverage pooled across many countries and groups to spread risk and lower insurance cost Care provided through a network of credentialed providers Lower administrative costs with more dollars available for patient care Stratified Pooled Risk Coverage allows for the following:

18. Self-Funded and Self-Administered Allows for financial, administrative and care risk up to a certain level TPA and Provider Network maintains the following capabilities: Administer benefits Manage and coordinate care Collect and distribute premiums Adjudicate claims Case management Utilization management

19. Stratified Pooled Rick Coverage (SPRC ) Allocate less premium to administration and marketing More premiums utilized on health care Lower cost administration Can offer richer benefits Must structure benefits to protect plan and members Conglomerated Risk: Work with other entities and membership to purchase catastrophic coverage including stop-loss, reinsurance and major medical coverage

20. JIPA’s Architecture Integrated Care Utilizing a Continuum of Care Model with Technology and Incentives as the Focus of Integration Ancillary Providers Specialty Physicians Inpatient Outpatient Services Primary Care Therapies International Patients High Deductible Self Funded Insurance PPO Self Pay PSA Admin Services Clinical Providers Payers Third Party Administrator JIPA Pain Management

21. Instant Benefits No Sign-Up or Membership Fees Harold Martin PT12711 PT12711 2015 Membership Benefits Access to network of world-class doctors, facilities and service providers Free complex case review by clinical specialists Competitive pricing for health care services Free quotes for medical services and cost negotiation on your behalf Customized care plans developed by medical specialists Patient Care Coordinators and complimentary hospitality services 24/7 emergency care coordination and medical evacuation Access to Discounts Travel, health and air ambulance insurance Medications, supplies and medical equipment Hotel arrangements U.S. Toll Free: 1.877.749.5472 Int’l: 1.954.331.6530 This is not an insurance card

22. JIPA’s Three Fundamental Pillars Follow the Care: Triage and Care Coordination Follow the Information: Plan of Care Document Follow the Money: Collect & Make Payments, We Pay Up-Front

23. JIPA NETWORK, LLC (Discounted Case Sampling - Actual Claims/Negotiations) Service LocationTreatment SummaryService ProviderTotal ExpensesDiscount Write-OffAmount PaidDiscounted % Hialeah, FLAdenocarcinoma-Ovary; TAH,BSO+Facility/Professional $122,070$94,070$28,00077% Miami, FLTBI, Surgery and RehabFacility/Professional $710,894$615,803$95,09187% Miami, FLPubic Symphysis Dislocation, Rt Sacroiliac Joint Dislocation, Left Acetabulum Fracture Facility/Professional $288,515$165,016$123,49957% Miami, FLMalignant Neoplasm - Breast; Biopsy/ Diagnostics, Surgery, Chemo and Radiation Therapies Facility/ Professional $388,000$290,000$98,00075% Miami, FLHeart TransplantFacility/ Professional $461,243$182,643$278,60040% Service LocationTreatment SummaryService ProviderTotal ExpensesDiscount Write-OffAmount to PayDiscounted % ColombiaLumbar Herniated Disc L4-5, L5-S1 with Subluxation of L4 on L5; Discectomy with instrumentation fusion and interbody cage Facility/ Professional/ Air Ambulance $62,475$25,592$36,88341% PanamaMalignant Neoplasm - Breast; Presurgical, Surgical (bilateral mastectomy / reconstructive) and Chemo and Radiation therapies Facility/ Professional $119,890$58,985$60,90549% Trinidad ESRD on hemodialysis, Infective endocarditis, Klebsiella UTI, Myelodysplastic Syndrome with Anemia, Hypertension, Gastric Polyp - Tunneled left internal jugular vein Permacath, left brachio-basilic vein transposition AVF, upper/lower endoscopies with gastric polyp biopsy (24 days admit) Facility/ Professional $91,650$42,937$48,71347% ColombiaAneurysm Posterior Cerebral ArteryFacility/ Professional $46,119$14,297$31,82231% Colombia Male Newborn, Complex Cyanotic Hearth Disease, Malposition of Great Arteries, Pulmonary Atresia. Air Ambulance x2, Ground Ambulance, 12 ICU days, 18 regular days, Heart surgeries Facility/ Professional $200,000$80,000$120,00040%

24. Health Care as a Commodity Accessibility Quality Price

25. Health Care as a Commodity Accessibility Quality Price

26. Coronary Artery Bypass Surgery Cost vs Outcome CostComplications Miami $70,0004% Panama $40,0003% Colombia $20,0001.8%

27. Increasing Patient Traffic Through JIPA Network Over 2,200 Patients Served in 3.5 Years Patients from 44 Countries Average Payment US $41,000 Estimated Financial Impact of over US $89 Million

28. JIPA Network IS… A Provider Network Promoting Centers of Excellence An Administrator (TPA) An Enabler of Information Technology A Risk Manager A Triage and Care Coordination A Payer Syndicator A Consumer Consolidator An Association Company – Member Ownership

29. JIPA Network IS NOT 1. An Insurance Company 2. A Broker 3. A Health Care Provider 4. A Risk-Bearing Entity 5. A Bank or Financial Services Company

30. JIPA’s Caribbean Focus The identification of and development of “Centers of Excellence” in the Caribbean Improving access and quality of health care by promoting care coordination and appropriate triaging of patients Organizing a heath care syndication to increase affordable health care coverage for Caribbean citizens utilizing the SPRC model Organize consumers as a large buying group utilizing the JIPAconnect card system Promote information technology, education, managed care principles and wellness in the Caribbean

31. Join the Movement!