Driving Growth Quality Care Coordination

Quality and Care Coordination
Driving Growth Through Measured Results
DECEMBER 3, 2012

Safe Harbor

Certain statements contained in this presentation may be considered forward-looking as
defined by the Private Securities Litigation Reform Act of 1995. In particular, any statements
made about Accretive Health’s expectations for future financial and operational performance,
expected growth, new services, profitability or business outlook are forward-looking
statements. Investors are cautioned not to place undue reliance on such forward-looking
statements. There is no assurance that the matters contained in such statements will occur
since these statements involve various risks and uncertainties that could cause actual
results to differ materially from those expressed in such forward-looking statements. These
risks and uncertainties include those listed under the heading Risk Factors in the company’s
Quarterly Report on Form 10-Q for the quarter ended September 30, 2012, which is available
on the SEC’s website as well as in the investor relations portion of Accretive Health’s website
at www.accretivehealth.com. The forward-looking statements made in this presentation are
based on the company’s beliefs and expectations as of December 3, 2012 only and should
not be relied upon as representing the company’s views as of any subsequent date. While the
company may elect to update these forward-looking statements at some point in the future,
Accretive Health specifically disclaims any obligation to do so, even if its views change.

Driving Growth Through Measured Results 2

Use of Non-GAAP Financial Measures

In order to provide stockholders with greater insight and to We believe adjusted EBITDA is useful to stockholders in evaluating our
allow for better understanding of how our management and operating performance for the following reasons:
board of directors analyze our financial performance and
• these and similar non-GAAP measures are widely used by investors to
make operational decisions, we supplement our condensed measure a company’s operating performance without regard to items that
consolidated financial statements presented on a GAAP can vary substantially from company to company depending upon financing
basis with the adjusted EB ITDA and adjusted net income and accounting methods, book values of assets, capital structures and the
measures *. methods by which assets were acquired;

Adjusted EBITDA measure has limitations, as noted below, • securities analysts often use adjusted EBITDA and similar non-GAAP
and should not be considered in isolation or in substitute for measures as supplemental measures to evaluate the o verall operating
analysis of our results as reported under GAAP. performance of companies; and

• by comparing our adjusted EBITDA in different historical periods, our
Our management uses adjusted EBITDA:
stockholders can evaluate our operating results without the additional
• as a measure of operating performance, because it does not variations of interest income (expense), income tax expense (benefit),
include the impact of items that we do not consider indicative depreciation and amortization expense and share-based compensation
of our core operating performance; expense.
• for planning purposes, including the preparation of our
We understand that, although measures similar to adjusted EBITDA are
annual operating budget;
frequently used by investors and securities analysts in their evaluation of
• to allocate resources to enhance the financial performance companies, these measures have limitations as analytical tools, and you
of our business;
should not consider it in isolation or as a substitute for analysis of our
• to evaluate the effectiveness of our business strategies; and results of operations as reported under GAAP. To properly and prudently
• in communications with our board of directors and investors evaluate our business, we encourage you to review the GAAP financial
concerning our financial performance. statements included elsewhere in our regulatory filings, including the
Preliminary Prospectus, Form 8-K, and Form 10-K, and not to rely on any
single financial measure to evaluate our business.

*Reconciliations of non-GAAP measures to their most directly comparable GAAP measures are presented, where possible in the Appendix, as well as in the
Company’s financial press releases and related Form 8-K filings with the Securities and Exchange Commission. This information can be accessed for free in
the Investor Relations section of the Company’s website at www.accretivehealth.com


ACCRETIVE HEALTH OVERVIEW


Our Guiding Principles

• Our primary goal is to help our healthcare clients strengthen their financial
stability and deliver better care to the communities they serve

• We use technology to drive best practices and best outcomes

• We work collaboratively with clients to create solutions to existing challenges

• We promote an entrepreneurial culture to encourage innovation and
continuously upgrade our functionality with a focus on value creation


Accretive Health Snapshot

Founded in 2003, headquartered in Chicago

Win – Win Proposition with our Client Partners
• We are paid based on our results; no upfront costs for Quality or Revenue Cycle Services
• We have partnered with some of the most well-respected health systems in the U.S.

We Drive Measured Results for our Partners
• Since inception we have delivered $1.5 billion in cash benefits to clients

Innovation and Operational Excellence is at the Core of What We Do
• Success of our RCM offering is driven by applying technology and innovative process
improvements to drive measurable results
• Seeded Physician Advisory Services in 2009, now a $60 million run-rate business
• Developed unique offerings to improve care quality at lower costs – Intra-Stay Quality and
Population Health Management Infrastructure


Three Distinct Offerings

Revenue Quality and Physician
Cycle Management Care Coordination Advisory Services

Proven end-to-end Utilize physician-driven Compliance services
solution that lowers best practices to that maintain detailed
collection costs and improve care quality at audit trails for claims
reduces yield a lower cost
leakage


Multiple Growth Drivers in Each Business

Revenue Cycle Management
• Large market opportunity, low current penetration
• Proven end-to-end solution with a win-win proposition
• Margin expansion by driving further efficiency and reducing reimbursement leakage

Quality and Care Coordination
• Population Health Management is developing as the next frontier of healthcare
• Lack of provider infrastructure for population health management
• Intra-Stay Quality has broad appeal and could create beachhead into new hospitals

Physician Advisory Services
• Increasing frequency of audits
• Opportunity for continued market share gains
• Expansion into compliance and workflow advisory services


Providers are Getting Squeezed

• Value-based payment models
Health
Reform • Medicaid expansion/State
budget constraints
• Insurance exchanges
• Declining
reimbursement
• Rising bad debt Economic
• Rising costs • ICD-10
from medical Compliance
• RAC Audits
innovation

• Capital constraints • Patient satisfaction scores
Insufficient
• Significant variance Resources • Higher out-of-pocket costs
in provision and Patients
quality of care • Aging population
• Personalized medicine


Market Opportunity

RCM Quality PAS

Market Size $1.0 Trillion $1.6 Trillion $ 710 billion

% to AH 5.0% 6.25% 0.12%
Revenue

Revenue $50 $100 $850
Opportunity Billion Billion Million

Sources: CMS National Healthcare Expenditures, September 2011 and Definitive Healthcare
RCM market scope includes net patient revenue at all hospitals based on CMS 2014 projected expenditures
Quality market scope includes all hospital and physician expenditures
PAS market scope includes all hospitals with >$250 million in net patient revenue


Value Proposition

Revenue Cycle and Quality Require No Upfront Investment from Clients
• Accretive Health is compensated based on Measured Value delivered to clients

Our End-to-End Solution Delivers Superior Results by Combining People,
Process and Technology
• People: Well-trained professionals who work directly with the client
• Process: Market-leading best practices to allow seamless workflow at all stages of the
revenue collection process
• Technology: Comprehensive tools to measure and improve efficiency for clinical and financial
outcomes


A Differentiated Offering

Accretive Health
Operating Partnership

NOT
 Pay for measured results
a consulting firm
 Unparalleled form of
collaboration
NOT
 End-to-end scope
an outsourcing model
 AH makes significant
investment of resources
NOT  Pay for results not input
a software provider

We create operating partnerships that result in distinctly
different outcomes than other models


End-to-End RCM Solution Provides Competitive Advantages

Value
Patient Patient Lost Payor
Compliance Proposition
Advocacy Share Charges Follow-Up
(% revenue lift)

4-6%
(Measured)

SaaS /
Est. 0.5-1%
Technology- (Not Measured)
Supported RCM

Est. 0.5-1%
Consulting (Measured)

IT Outsourcing / Est. 0.5-1.5%
Non-HC BPO (Not Measured)

Note: Based on Accretive Health’s estimates


Partnering with Innovative Leaders


QUALITY AND CARE COORDINATION


TIM BARRY
President, Quality and Care Coordination

DR. WALTER ETTINGER
Chief Medical Officer


Market Overview

Healthcare Spend in the U.S. is Unsustainable…

$9,000 20%
USA OECD $8,223
18%
Healthcare Spend per Capita (USD)

$8,000

Healthcare Spend as a % of GDP
17.6%
16%
$7,000
13.7%
14%
$6,000 12.4%
12%
$5,000 $4,791

9.0% 9.5% 10%
$4,000
7.1% 6.9% $3,265 8%
$2,851 7.8%
$3,000 5.1%
6.6% 6%
$1,888
$2,000 5.1% 4%
$1,102 $1,185
3.8%
$1,000 $628 2%
$356
$148 $78 $187
$- 0%
1960 1970 1980 1990 2000 2010
2009

Source: The Organization for Economic Cooperation and Development (OECD) Health Expenditure Data


Market Overview

...and Care Quality Outcomes are Sub-Optimal

85
JPN
SPA AUS AUT SWI
ISR ITA ICE SWE CAN
Life Expectancy in Years

NZL IRE FRN NOR
KOR GRC
80 GBR BLG GER LUX HOL
SLV FIN
CHL POR
DMK
USA
CZH
POL
MEX
75 EST SLR

TUR HUN

70
$0 $1,000 $2,000 $3,000 $4,000 $5,000 $6,000 $7,000 $8,000 $9,000
Health Spending per Capita (USD)

Source: OECD Health Expenditure Data


“If home building were like healthcare,
carpenters, electricians, and plumbers each
would work with different blueprints, with very
little coordination.”
–Institute of Medicine 2012 Report on Best Care at Lower cost

19

Quality & Care Initiative

Market Drivers
• Shift away from fee-for-service model to population-based accountability
• Provider performance standards tied to total patient quality and cost
• Systems required to provide insight into total patient medical history
• Requires significant investment and expertise for population-based delivery

Accretive Health Solution
• Turn-key accountability-based model that improves quality of patient care
• Strengthens relationship between hospitals and physicians
• Creates aligned interest between payors, hospitals, physicians and Accretive Health
• Generates significant savings for the healthcare system


Quality and Care Initiative

Accretive
Health
Quality &
Care

Optimizing Intra-Stay Population Optimizing quality
Quality Health
quality and and financial
financial results results across all
within each episodes of care
episode of care Physician Engagement

Predictive Analytics

Workflow and Decision Support Technology

Optimal Skill Sets for Execution


End-to-end Infrastructure for Population Health Management

Starting point

Sickest
and most
responsive
patients Continuous care assessment
allows physicians to focus on the
sickest patients and coordinate
care to improve outcomes

Patient-
Real-time specific care
clinical plans and
pathway care
adjustment coordination
workflow


End-to-End Infrastructure for Population Health

Sophisticated Business and
Payor Contracting Model

Proprietary Data and
Technology Platform

Physician Performance and
Change Management

Patient Engagement and
Real-time Care Management

Continuous R&D and Predictive
Performance


Projected Cost and Savings Trend

Cost and Saving Trend Saving ($ in mm)

$290
$1,158

$1,103
$70 To Accretive Health
Market
Trend:
5% $1,050
$1,000 ACO
10% 18% Savings 25% To participating
Efficiency providers and
$945 $220
payors
$904
(splits may vary)
$868

Year 0 Year 1 Year 2 Year 3

Note: Based on Accretive Health’s estimates


Oncology Care: A Complex System for the Patient to Navigate

E/R Oncology
Visit Consult

Imaging
Genetic
Routine Visit/ Testing In-patient
Lab Genetic
Maintenance
stay
Counseling

PCP Imaging

Infusion
Lab
Therapy
Pharmacy Specialist

Psych
Counseling
Palliative
Other Care Counseling
Critical
Trial
Nutritional
Counseling Pharmacy

Radiation
Surgery Oncology

Cancer related Executed at Oncology Clinic
May or may not be executed at Oncology Clinic
Non-Cancer related
Usually not executed at Oncology Clinic


Oncology Care: Significant & Growing Costs

Cost of Care – Cancer v. Non-Cancer (PMPM) ($)* National Health Expenditures – Oncology (US) ($ in bn)**

$10,317.76 $60
2010A

$50 2020E

$40

$30

$2,708.16 $20

$10
$363.64
$0
Cancer Dx + Active Cancer Dx w/o Active All Non-Cancer
Chemo Tx Chemo Tx

% of Membership <1% <1% 99+% Total Expenditures (2010A): $124.5
% of Total Spend 4% 4% 92% Total Expenditures (2020E adjusted): $157.7+

* Source: Milliman, 2010; study of costs for ~14mm commercially-insured lives; assumes 11 mm’s / member; all figures depicted in 2013 $’s
+ Adjusted for recent trends in dx incidence, survival, and cost
** Source: Yabroff, 2011; 2020 figures depicted in 2010 $’s


Simplifying a Complex Process

5 High Impact Interventions to:
• Improve the patient experience
• Manage complexity
• Enhance outcomes
Optimal lab and
• Reduce cost Evidence-based protocols
Development and consistent
Imaging utilization
Application of protocols to remove
application of
unneeded / redundant utilization
best practice treatment protocols

End of life/Palliative Care 24X7 symptom
Consistent approach to
EOL discussions to ensure management
patient fully understands On-call triage helps ensures
treatment / quality of life tradeoffs patient centric, cost effective
solutions to current
In clinic activities symptom(s)
(existing)

In clinic proposed
pilot activities

Outside clinic activities: cancer
Care coordination
related Care coordinator ‘connects
dots’ across full care spectrum
Outside clinic activities: non- to anticipate / respond to care
cancer related gaps to drive triple aim


The Need for Intra-Stay Quality

Many US hospitals do not recoup the cost of care provided for Medicare beneficiaries

Medical Center Potential Future
MedPar FY11 Medicare P/L per Patient Medicare P/L per Patient

$20,000

$16,533
$15,000 $16,533

$10,000
$10,255
Direct Care Cost $5,000
$6,255
$4,749
$0
• Reduced • Wage increases
-$6,278 -$5,000 payments • Investment in new -$6,278
• Readmission technologies
penalties • Aging population
-$10,000
• Penalties for
hospital acquired
-$15,000 conditions

Payment Cost Operating Payment Cost Operating
Income Income

Source: AHD, October 2012 Source: AHA, June 2012


Intra-Stay Quality Timeline

ISQ Solution Today Tomorrow

• Prepare for changes from Health Reform
Align Partners • Establish a shared vision • Administer payment model and disburse
payments

• Analyze DRG and service level
• Introduce real time DRG cost buildup tool
Analytics and performance
• Establish evidence-based plans of care to
Reporting • Establish system/hospital scorecard
reduce variation
and targets

• Establish post discharge relationships and
• Implement defined plan of care communication
Accountability model for high priority patients
Across the • Introduce pre-stay communication, education,
Continuum • Implement tools and technology to and decision support
support efficient through-put
• Integrate care plans with primary care providers

• Identify and implement next wave of enterprise-
Operational • Identify enterprise wide and DRG wide and DRG opportunities
Excellence and specific opportunities and implement
Innovation solutions • Embed CI behaviors and outcomes into
individual performance goals


Our database calculates “avoidable days” opportunity for each DRG

DRG X GMLOS

Facility Avg cases/yr GMLOS AMLOS Median Quartile
Top performer
Sit e 1 7 3. 44 5.04 4 1 3.44
Sit e 2 34 3. 96 4.79 4 1 (shortest LOS)
Sit e 3 27 4. 09 5.06 4 1
Sit e 4 14 4. 22 4.96 4 1
Sit e 5 31 4. 37 5.16 5 1
Sit e 6 35 4. 41 5.77 5 1
Sit e 7 14 4. 48 5.46 4 1
Sit e 8 12 4.49 5.58 4 1 Top quartile 4.49
Sit e 9 40 4.51 5.49 4 2 cut-off (target)
Sit e 10 18 4.56 5.87 5 2
Sit e 11 64 4.58 5.80 5 2
Sit e 12 54 4.63 5.50 5 2
Sit e 13 247 4. 66 5.77 5 2
Sit e 14 128 4. 70 5.61 5 2
“Avoidable days”
Sit e 15 83 4. 84 6.22 5 2
calculated as difference
1.11 days x 88 cases = 98 avoidable
Sit e 16 108 5. 09 6.45 5 2 per case
between client and bottom per year days per year
Sit e 17 35 5. 10 6.11 5 2
of top quartile for DRG (16%
Sit e 18 13 5. 29 6.63 5 3
Sit e 19 129 5. 31 6.34 6 3
reduction)
Sit e 20 64 5. 38 6.55 5 3
Sit e 21 210 5. 38 6.90 5 3
Sit e 22 51 5. 58 6.59 5 3
Sit e 23 43 5.60 6.44 6 3
Client 88 5.60 6.97 6 3 Client 5.60
Sit e 25 55 5.66 6.72 5 3
Sit e 26 32 5.73 6.75 6 3
Sit e 27 54 5. 75 7.16 6 4
Sit e 28 21 5. 86 7.00 6 4
Sit e 29 24 5. 94 7.43 6 4
Sit e 30 68 6. 21 7.85 6 4
Sit e 31 46 6. 50 8.32 7 4
Sit e 32 76 6. 62 8.26 7 4
Sit e 33 64 6. 63 8.60 6 4
Sit e 34 6 6. 79 8.96 9 4 Bottom performer 6.79
Tot al 2264 5. 04 6.33 Database mean 5.04
CM S ( 2011) 5.22 6.61 CMS 5.22
Based on Accretive Health data

ISQ Objectives

Lower Cost of Care
Reduce costs per inpatient encounter due to optimized resource utilization,
correct care setting, and reduced practice variation

Improve Quality
Improve quality metrics (readmissions, core measures, falls, hospital-acquired
infections, pressure ulcers, adverse drug events, serious safety events,
medication management)

Improve Patient Satisfaction
Improve communication with patients about their condition, their care plan, and
expectations for their stay and discharge plan, resulting in higher HCAHPS
scores

Improve Reimbursement
Improve value-based purchasing and affordable care metrics resulting in reduced
hold-backs and increased pay for above-average performance


Maximizing Value in Episodic Care

• Current episodic care environment offers tremendous opportunity to improve
resource utilization, reduce variation in treatment practices and ensure care is
provided in the optimal setting

• Competitors have not driven successful or sustainable results

• Accretive believes it can favorably impact length of stay and improve quality
through:
• Patient care coordination
• Physician engagement
• Optimal care setting
• Proprietary tools and technology

• Quick deployment upon contract execution


Driving Growth Quality Care Coordination

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