1. CONFIDENTIAL A good scalpel makes a better surgeon. Good communication makes a better doctor. - Dr. Josh Umbehr

2. CONFIDENTIAL Agenda How I See Market Developing trends/thesis Patient Engagement via Extensible Patient Relationship Management vs. Limited/Rigid Patient Portals Case studies: Direct Primary Care Medical Home (D-PCMH) Hidden gem in PPACA

3. CONFIDENTIAL Trends/observations driving our thesis Shift to Patient-centered, Accountable, Coordinated World Whos already there? Patients: More than a Vessel to Attach Billing Codes to Communication: The Most Important Medical Instrument Primary Care Renaissance D-PCMH, PCMH, Onsite Nimble Medicine & Fundamentally New Delivery Models Deflationary Economics Will Drive Healthcare Decentralization of Healthcare Delivery (Innovators Prescription + Topol CDoM) Barrier to entry Boat anchor Technology-enabled Services to enable ACOs, PCMH, etc.

4. CONFIDENTIAL Thesis: Impossible to Succeed Without Patient Engagement in New Payment Models Recognize who really makes the decisions influencing outcomes 100 Person/Family The System Key Enabling Technology PRM EMRControl 0 Chronic: 75% of H/C $$ At Home/Low Acuity Hospital/High Acuity Persons Location/Acuity

5. CONFIDENTIAL QUICK DEMO

6. CONFIDENTIAL PPACA SECRET D-PCMH

7. CONFIDENTIAL Only Non-Insurance Solution Authorized in Future Insurance Exchanges Senate Language - H.R. 3590EAS - SEC. 10104 (3). On P. 2068 TREATMENT OF QUALIFIED DIRECT PRIMARY CARE MEDICAL HOME PLANS The Secretary of Health and Human Services shall permit a qualified health plan to provide coverage through a qualified direct primary care medical home plan that meets criteria established by the Secretary, so long as the qualified health plan meets all requirements that are otherwise applicable and the services covered by the medical home plan are coordinated with the entity offering the qualified health plan.

8. CONFIDENTIAL High FFS Primary Care Admin Cost Promotes Visit Volume vs. Time with Patient Nature of Transaction Provider Patient Insurance Admin

9. CONFIDENTIALEfficient Direct Primary Care Medical HomesPromote Time with Patients vs. Visit Volume Patient goes to pharmacy Patient has Patient has Schedule Same Day Sees patient Patient fever and fever and Dispense Rx Appointment Appointment Diagnoses Illness recovers cough cough Run CBC Take X-ray Pays cash Onsite Onsite for Rx KEY Provider Patient Ins. Admin

10. CONFIDENTIALThe Qliance Direct Primary Care Medical Home Preventive Care Unrestricted office visits Extended weekday hours Unhurried office visits Urgent Wellness Care Care Phone and email access Same and next day appointments Weekend office hours No co-payments Flat monthly fee Specialist Chronic Care Disease Coordination Management

11. CONFIDENTIAL 79% (Qliance)

12. CONFIDENTIAL 2x Primary Care Visits & 2-3x Care/Visit 50% Reduction in Downstream Care Utilization Data Qliance Members Under 65 (2010) Qliance # per Benchmark Type of Referral Difference year/1000** * ER Visits 56 158 -65% Hospitalizations (visits) 34 53 -35% Hospitalizations (in days) 105 184 -43% Specialist Visits 670 2000 -66% Advanced Radiology 300 800 -63% Surgeries 22 124 -82% Primary Care Visits 3540 1847 +92% *Based on regional benchmarks from Ingenix and other sources. **Based on best available internal data, may not capture all non-primary care claims Source: Qliance Medical Group non-Medicare patients, 2010 (n=3,088)

13. CONFIDENTIAL Not the Usual Processes Comprehensive assessment and shared care plan Daily huddles with entire team Lots of non visit based care- email, text, video Extensive use of groups- including Stanford Chronic Care Curriculum in 3 languages Integrated Mental health, nutrition Real time data for management, including daily hospital, ER feeds, pharmacy fills Co-management with hospitalists, other specialists Proactive care (DM/CM)- based on registry queries, event triggers

14. CONFIDENTIAL Total spending dropped a net of 12.3%; Driven mostly by large decreases in hospital admissions, ER visits, and outpatient procedures -12.3% Total spending For all SCC patients -37% Hospital days enrolled in 2009, relative -41% Hospital admits to control group created Rx fills 40% using propensity -23% Outpt procedures matching. -48% ER visits -4% Office Visits-60% -50% -40% -30% -20% -10% 0% 10% 20% 30% 40% 50%

15. CONFIDENTIALContact: dave@avado.com