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©2009 PB Healthcare Business Solutions LLC The material contained herein is protected and intended for use by clients and associates of PB Healthcare BusinessPB Healthcare Business Solutions LLC Solutions LLC, and may not be reproduced or distributed without the expressed written consent and permission of PB HealthcareStrategy, Marketing, Management for Health Care® Business Solutions LLC.

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Background 75% of our national health costs are related to chronic conditions that have their origin in lifestyle behaviors In dollar terms, $1.8 trillion of $2.4 trillion spent on health care is due to unhealthy lifestyle behaviors Most of our healthcare delivery is geared toward returning people back to unhealthy lifestyles and not toward changing unhealthy lifestyles PB Healthcare Business Solutions LLC Strategy, Marketing, Management for Health Care® 2

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The Typical Patient/Provider Experience• Average amount of time for a patient/physician visit is 5-7 minutes• Physician determines the patient’s problem within average of 18 seconds• Patients increasingly complain that they do not have enough time to explain things or ask questions; patient is time-pressured and forgets 90% of what was said by the physician• Physician’s focus is on “what is your chief complaint?” rather than “what is happening in your life?” PB Healthcare Business Solutions LLC Strategy, Marketing, Management for Health Care® 3

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What Is Integrative Health Coaching? A whole-person approach to healthy living that promotes on-going engagement (as opposed to episodic interaction) between the provider and the consumer Active planning and accountability on the part of the individual, with rigorous assistance from a highly- skilled coach/advocate PB Healthcare Business Solutions LLC Strategy, Marketing, Management for Health Care® 4

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Why Integrative Health Coaching? A proven approach to changing personal behavioral patterns that have fueled our culture of sick (and not health- promoting) care Puts accountability in the hands of the only party that can make changes to disease-fostering health patterns: the consumer Educates consumers to learn evidence-based treatment guidelines, and to understand treatment options/costs in order to make informed decisions about when, how, and where to utilize healthcare resources PB Healthcare Business Solutions LLC Strategy, Marketing, Management for Health Care® 5

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Clinical Research Unquestionably DemonstratesThe Value Of Health Coaching Cardiovascular Disease Vale MJ et al. Coaching patients On Achieving Cardiovascular Health (COACH): a multicenter randomized trial in patients with coronary heart disease. Archives of Internal Medicine 2003 Dec 8-22;163(22):2775-83. Edelman D et al. A multidimensional integrative medicine intervention to improve cardiovascular risk. Journal of General Internal Medicine 2006 Jul;21(7):728-34. Diabetes Whittemore R et al. A nurse-coaching intervention for women with type 2 diabetes. The Diabetes Educator 2004 Sep-Oct;30(5):795-804. Asthma Fisher EB et al. A randomized controlled evaluation of the effect of community health workers on hospitalization for asthma: the asthma coach. Archives of Pediatrics and Adolescent Medicine 2009 Mar;163(3):225-32. Cancer Pain Oliver JW et al. Individualized patient education and coaching to improve pain control among cancer outpatients. Journal of Clinical Oncology 2001 Apr 15;19(8):2206-12.• Weight Loss Tucker LA et al. Telephone-based diet and exercise coaching and a weight-loss supplement result in weight and fat loss in 120 men and women. American Journal of Health Promotion 2008 Nov-Dec;23(2):121-9. [Note: Coaching and the supplement (made by TriVita), separately and in combination, helped participants lose weight and body fat.] Bone mineral density in adolescent girls DeBar LL et al. Youth: a health plan-based lifestyle intervention increases bone mineral density in adolescent girls. Archives of Pediatrics and Adolescent Medicine 2006 Dec;160(12):1269-76. PB Healthcare Business Solutions LLC Strategy, Marketing, Management for Health Care® 6

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Cardiovascular Clinical Research 3-year study by Duke Integrative Medicine indicated health-coached participants had twice the reduction in inpatient admissions as non-coached participants Coached participants demonstrated positive behavior changes that reduced cardiovascular risk over a ten month period. Biggest improvements were in healthier eating, lost weight, and reduction in smoking. (“A Multi-dimensional Integrative Medicine Intervention to Improve Cardiovascular Risk: Randomized Controlled Trial”, Duke Center For Integrative Medicine/Duke University Medical Center, 2008. Funded by the Centers for Medicare and Medicaid Services) PB Healthcare Business Solutions LLC Strategy, Marketing, Management for Health Care® 7

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Difference Between Wellness Coaching and Well-Being Coaching Traditional Wellness Programs  Integrative Health Coaching  Case Management Orientation  Behavior Modification  Compliance Approach Orientation  Templated Health Planning  Motivational Approach  Focused On Meeting Employer’s  Personalized Health Planning Goals  Focused On Achieving  Disease oriented: manage the Employer and Individual’s symptoms Goals  Lifestyle and behavior oriented: encourage self- health management PB Healthcare Business Solutions LLC Strategy, Marketing, Management for Health Care® 8

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Role of the Integrative Health Coach The integrative health coach :  Guides clients in learning about diagnostic and therapeutic modalities and alternative approaches to management of health issues  Helps clients to navigate the health system  Helps clients to make the right choices and decisions with respect to their total well-being  Operates as a “two-way” member of the medical team PB Healthcare Business Solutions LLC Strategy, Marketing, Management for Health Care® 9

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How Will Contracting With PB HealthcareBusiness Solutions Benefit Your Clients? Clients learn how to effectively navigate the health system, which results in increased client satisfaction Coached clients are more committed to making improvements in their lifestyle behaviors Improvement in the quality of the patient/provider interaction: a more engaged and informed patient and a less-stressed care provider Sustained health improvements and the potential to reduce un- reimbursable hospital re-admissions (e.g. 30 day post-discharge) Provides clients with continuity before, during, and after engagement with the health system; can keep clients from leaving the system due to fragmented and disjointed coordination Strengthens loyalty of consumer to using your healthcare offerings as opposed to those offered by other providers PB Healthcare Business Solutions LLC Strategy, Marketing, Management for Health Care® 10

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Different Phases Of CoachingPre-health system engagement Health system engagement and Post-system engagement 1. Client/Coach 2. Client/Provider/Coach 3. Client/Hospital/Coach Pre-visit Pre-admission Group or assistance in health individual assistance in assessment, preparing for motivational preparing key interviewing hospitalization questions, internet research In-hospitalization Educate on CAM resources assistance Post-visit assistance in Post- preparing hospitalization personalized health assistance plan Weekly, bi- Monitoring plan weekly, and adherence through monthly coaching weekly, bi-weekly, and monthly coaching PB Healthcare Business Solutions LLC Strategy, Marketing, Management for Health Care® 11

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Pilot Program: How Approach?  Choose specialty like general internal medicine, oncology, or cardiovascular care  Controlled trial of usual care vs. care utilizing integrative health coaching  Minimum of 6 months  Measure effectiveness on both qualitative and quantitative parameters  Client and physician satisfaction  Productivity  Gains in biometric measures e.g. cholesterol reduction, blood pressure  Adherence to personalized health planPB Healthcare Business Solutions LLCStrategy, Marketing, Management for Health Care® 12

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PB Healthcare Business Solutions LLC Strategy, Marketing, Management for Health Care SM 773-458-8662 www.pbhealthbiz.com 14