1. Mobile Integrated Healthcare Program The Opportunities! Presented by: Dixon Marlow, Co-founder, President & CFO Home Physician Care, LLC Reg P James III, Co-founder, CEO Home Physician Care, LLC Michael Colman, Vice President Operations Grady EMS © 2014 All Rights Reserved

2. GRADY EMS Brief Background  Grady Emergency Medical Service  > 125 Years of Service to City of Atlanta  Largest Hospital-based Ambulance Service in State  > 110,000 Emergency Responses per Year  Innovative Leader in Mobile Healthcare Services  Behavioral Health Social Workers in Field  Experience & Lessons Learned from MH Applied to MIH  MIH Program involves  House-calls (‘Rounding’) on High-Risk Discharges  House-calls for “frequent-flyers”  Low-acuity 911 EMS Calls Triaged Omega (& some Alpha)

3. HOME PHYSICIAN CARE Brief Background  Founded in 2008  > 6,000 House-calls over 7 years  First Pilot in NE Georgia - <2% CHF re- admissions  Led to full-time home-visit program for large practice (3 units)  Service Models include:  Physician Practices  Hospital Systems  911 Ambulance Systems  Financially Self-Sustaining Models

4. The Problem …for Emergency Medical Services  Steady increases in non-urgent 911 calls  Non transports = non-payment  Shift in requests to access care through EMS  Requires increase in Ambulances & Personnel  Increase costs of service delivery  Increase in uncompensated care  Cost shifting to insured and tax payers  Increase medic ‘burn-out’ due to system overuse

5. The Problem …for Hospitals  Most expensive method of access to healthcare  911 first response  Ambulance  Emergency Room  Referral  ED Overcrowding  Increased wait times  Increased EMS wall times  Increased costs of service delivery  Increased uncompensated care  No connectivity with PCPs  Frequent Readmissions  Decreased job satisfaction by providers

6. The Solution Mobile Care Teams  Advanced Practice Provider & ‘Enhanced’ Paramedic  1 st Responder Equipped, non-emergency vehicle  Scheduled and episodic response models  Mobile Clinic Outreach for low access areas  Target ‘frequent-flyers’, 30 day readmissions, and 911 requests triaged to be low priority via NAEMD

7. The Benefits For Patients  Improved overall health & wellness  Unequalled Healthcare Customer Service  Right level of care at the right time & place  Mid-level provider evaluation & referral  Avoid costly & ‘scary’ ambulance transport  Avoid lengthy & inconvenient ED visit

8. The Benefits For 911 Providers  Safely & economically shift low-acuity 911 calls to house-calls  Delivers physician-level services remotely/effectively  Enables streamlined, more economical access to the appropriate healthcare services  Frees up limited ALS 911 resources for true emergencies  Begins to integrate healthcare services between field and facilities  Reduce mis-use of resources & costs  Creates new billable events / reduce no-pays

9. The Benefits For Hospitals  Opportunity to take a leadership role in the overall health & welfare of community  Address complications related to:  Frequent 30-day readmissions  Address clinical needs earlier to prevent chronic hospital admissions  Reduce ED overcrowding due to ‘frequent flyers’  Right-size clinical services based on needs  Provide the backbone for integrated healthcare services through collaboration with patients, providers/clinics, & PCPs

10. SummarySummary  EMS Providers have been & continue to be ‘in the gap’  Healthcare delivery costs are rising  Reimbursement is declining  Access is becoming less convenient & more costly causing increased use of 911 & ED entry options  Care is being misappropriated or delayed  Patients’ health & wellbeing may be suffering

11. Summary continued…  Emergency Rooms are no fun  Hospitals may no longer be paid by CMS for frequent readmissions  Deductable requirements on the rise and Payment denials are on the increase  EMS Providers are uniquely positioned to bridge healthcare gaps  Integrating “house-calls” provides safe and effective solutions that benefit patients, providers and payers.

12. Summary continued… Keys to Success  Innovative & Flexible Physician Leaders  Innovative & Flexible EMS Leadership  Innovative & Flexible Hospital Leadership  Innovative & Flexible PCP Community* *(Not required… but would be nice) Common Theme: Innovative & Flexible

13. In Closing…  Requires a major paradigm shift  Can make a positive impact on patients  Can provide right care at right time/place  Can reduce costs of services  Can increase efficiency & effectiveness  Can be done safely & economically  Can be a new source of revenue that was once a cost

14. Questions? & Thank You!