Presentation delivered by Bryan Starnes, Chief Financial Officer, Affinity Living Group at the marcus evanc Long-Term Care & Senior Living Central CXO Summit, October 2016, in Chicago.

1. INTEGRATION OF RESIDENT CENTRIC SOFTWARE
TO MAXIMIZE MEDICAID AND MEDICARE REVENUES

2. What is on the Horizon?
• Increasing Federal and State Regulations throughout the Continuum of Care.
• Decreasing number of seniors with sufficient pension income or L-T care plans.
• Recognition for the Need for Solutions to Affordable Long Term Care.
• Increasing Investment in Technology to augment Operational Efficiencies.
• Increased need for qualified professionals in the industry at all levels.
• Outcome Driven Payment Models will replace the current Fee for Service Models.
• Integrated Health Care Delivery Systems will continue to evolve.
• Expect the Medicalization of Assisted Living as a fundamental Health Care Policy
Change.

3. Increased Demand
• Tsunami is coming – a wave of population
• Oldest of 79 million Baby Boomers turn 65 in 2020

4. Demographic Trends
-
2,000,000
4,000,000
6,000,000
8,000,000
10,000,000
12,000,000
14,000,000
16,000,000
18,000,000
20,000,000
2010
2020
2030
2040
2050
5,751,299 6,597,019
8,744,986
14,197,701
19,041,041
85+ US POPULATION GROWTH
85+ US Population

5. Declining Pension and Insufficient Savings
• No pensions
• Workers Enrolled in Pension Plans
• 1979: 28%
• 2012: 3%

6. The Vision of the Future
• Americans will Proactively Choose Senior Living
• There will be a need for Dynamic Senior Living Environments
• Larger range in acuity levels and healthcare needs while keeping costs down
• A growing role for Accountable and Managed Care Organizations
• Increased Need for Healthcare Technology

7. How Will You Manage This Vision of the Future?

8. INTEGRATED HEALTH CARE DELIVERY SYSTEMS
• Integrated health care delivery platforms
• Person-centered care
• Respectful of individual preferences, needs, and values; supported by active involvement of
individuals and their families including clinical treatment decisions.
• Accountable Care Organization (ACO)
• Seeks to tie provider reimbursements to quality metrics and reductions in the total cost for an
assigned population of patients.
• Managed Care Organization (MCO)
• Combines the functions of health insurance, delivery of care, and administration for an
assigned population of patients. These plans provide health care in return for a
predetermined monthly fee and coordinate care through a defined network of physicians and
hospitals (i.e., HMOs, PPOs).
• Coordinated Care Organizations (CCO)
• Networks of all types of health care providers who have agreed to work together in their local
communities for people who receive health care coverage. Each CCO is run by a local board
composed of healthcare providers and community members.

9. Increasing Interest in Affordability and Value
• In the next five to ten years baby-boomers will have less financial
resources available than their parents and affordability will become
increasingly important.
• As our industry grows and evolves, more people are recognizing the
need and the value that affordable senior living provides. When you
compare the cost of trying to offer at home what’s offered in a senior
living community it is nearly impossible to replicate.

10. WHERE ADULT CARE HOMES (“ACH”) FIT IN THE
CONTINUUM
Communities are designed for adults who are no longer able to live on their own safely. Residents require assistance with supervision,
medications, activities of daily living, meals and housekeeping. Three meals per day are provided in a central dining room. Staff is available 24
hours per day for additional safety.
NC ACH communities reside at the inflection point of costly skilled nursing and post-acute care in the continuum.
ACH communities span the intermediate nursing care spectrum of the continuum and are being paid half of what nursing homes are.
ACH Community Overview
Importance in Care Continuum
Unique to North Carolina Only

11. COST OF CARE FOR ACH
Overview Total Cost of Care Per Day
• The cost to care for a resident in an assisted
living facility is less than the cost of
incarceration in the state of North Carolina.
• Skilled nursing by comparison costs more
than 200% per day than caring for a resident
in an assisted living setting.
• The annual cost of one resident being cared
for in skilled nursing setting vs. assisted living
is more than $32,000.
$163.88
$83.92
$75.82
$-
$20.00
$40.00
$60.00
$80.00
$100.00
$120.00
$140.00
$160.00
$180.00
Skilled Nursing Prison Incarceration Assisted Living

12. Higher Acuity in Assisted Living: Risk or Reward?
Keep your staff realistic about their caregiving capabilities
Implement protocols to manage higher acuity residents
Build an Assessment Mentality-know what you are accepting
Partner with other health care organizations
to create the most cost effective setting.
.

13. More Wellness Programs and Preventative Care
• A focus on wellness will help facilities align themselves with the
demands placed on acute care facilities and reduce readmission rates
to Hospitals and Skilled Nursing facilities.
• There is a big opportunity and challenge to keep people healthy and
out of hospitals. Senior Housing Communities will be a vital link in
that chain, through proper planning, they can bridge the gap between
home and the hospital.
• Data collection and predictive analytics will be focused on medication
management, physician and occupational therapy, nutrition, and care
plans. The healthcare industry is quickly shifting to help aging adults
stay on top of their health and keep them out of a hospital bed.

14. Many Different Payment
Models Exist

15. Bundled Payment

16. Medicare Spending

17. PREPARING FOR MANAGED CARE
Keys to Success in a Managed Care Environment:
 Data rather than anecdotes: Using data and
outcomes to drive quality, define performance,
and guide operations.
 Patient Centric Models: Integrating primary
care physicians directly into AL settings via a
patient-centered medical home model.
 Strategic Partnerships: Cultivating well-being
through therapy-driven physical wellness
programming and seamless access to other
services through strategic partnerships and
alliances.
Utilization of technology to
measure and predict outcomes.
Economies of scale and company
footprint in a specific state and/or
region will dictate who is partnered
with and terms of the arrangement.
DATA AND OUTCOMES
SCALE AND FOOTPRINT
NORTH CAROLINA AND OTHER STATES ARE SHIFTING TO A MANAGED CARE MEDICAID MODEL

18. RESIDENT CARE
Resident
Marketing
Leads, Referrals,
Admissions
Census
Medication
Administration
Activities of
Daily Living
Electronic
Medical Record
Government
Mandated
Documentation
& Billing
Revenue Cycle
Management
Business
Intelligence
OVERVIEW
 MatrixCare’s platform provides a full spectrum approach for
a resident-centric care model.
 MatrixCare’s also mitigates risk by delivering consistent and
accurate data, preventing liabilities such as medication error.
MANAGED CARE - ALG PLANNING FOR THE FUTURE
 MatrixCare will be an integral component to obtaining
Managed Care contracts:
 MCO referrals contingent on outcomes
 Reimbursement will rely on data driven initiatives
 Providers with large economies of scale and market
presence will have the most advantageous negotiating
position with MCOs when determining rates

19. CENSUS
ASSESSMENT
 ALG has developed a proprietary assessment tool for evaluating incoming residents
needs and predicting future resident needs.
 MatrixCare’s database of over a million lives will allow Affinity access to predictive
analytics that enables Affinity to not only create care plans based on a resident’s
current condition, but plan for and prepare the resident’s family for what’s to come.
RESIDENT MANAGEMENT
 Automatically create service plans from assessments.
 Customize assessments and sub-assessments to manage state or community specific regulations.
 Schedule, track, and analyze assessments.
 Automate billing changes based on assessment level changes.
 Document and track resident and/or employee related incidents and injuries.

20. MEDICATION ADMINISTRATION
PHARMACY CENTRIC MODEL
 CareAssist helps increase the accuracy of prescriptions and
streamlines communication with your pharmacy using
Pharmacy Centric Order Entry. The intuitive eMAR
functionality increases medication administration
efficiencies while decreasing errors.
Physician Orders
sent directly to
Pharmacy
Pharmacy fills
orders and ships
to the facility
Facility takes
delivery of order
and checks
order
Med-Tech at
facility
dispenses to
resident

21. SMARTLINX – HUMAN CAPITAL
Employee
Complex
Schedules:
Ensure required
staffing
provided
Monitor
overtime with
real time data
Ensure staff
meet
certification &
credentialing
requirements
Find shift
replacement
with the
Schedule
Optimizer
Employee HR
files and record
keeping
Punch-in with
biometric
verification
clocks
Monitor ACA
compliance
Enhance
communication
through APPs
and text
messaging
OVERVIEW
 One of the most important assets in Seniors Housing is
Human Capital.
 Smartlinx simplifies the management of human capital
through an integrated platform.
 Smartlinx assists operators in managing talent, creating
and optimizing schedules, and enables management to
track trends in real time through on-demand access to
effective software.
PURPOSE
 Reduce unnecessary overtime and excess staffing.
 Ensure regulatory compliance with staffing.
 Credentialing and certification checks.
 HR and record keeping.
 Transparency and staff communication.

22. COST MANAGEMENT
OVERVIEW
 DSSI links Senior Living communities to their unique supply
chains, delivering unparalleled procurement cost savings,
supply chain optimization and contract compliance.
FEATURES
 Group Purchasing Organization (“GPO”) – Affinity is a
member of an elite GPO consisting of 25 of the largest
healthcare providers in the country banded together to
leverage lower contracted food costs and other supplies.
 DSSI is a clearing house platform for suppliers and end
users which gives Affinity the capability of controlling food
order guides to match our menus with the lowest costs
possible.
 DSSI allows budget controls for facilities to see real time dashboards of MTD and YTD budgets and expenses by
supply GL codes.
 DSSI feeds approved supplier invoice info directly into our accounting platform (Yardi) for real-time GL posting
and accurate income statements at a fraction of the labor costs of individual accountants.
Compliance
Price Auditing
Automation
Formulary
IT
VALUE PROPOSITION

23. MAINTENANCE SOFTWARE
Scheduling and Tracking Establish, monitor, and execute and meter based preventative maintenance tasks.
Work Order Management
Comprehensive work order management with asset-level tracking capabilities, advanced
routing, and adaptive status reporting.
Inventory
Basic Inventory has records with just the essential fields and consumption tracking.
Automatically link parts used with assets when you close a work order.
Graphical Reporting
Easy to read reports that allow the user to accurately asses how each facility is functioning
and identify improvements and cost savings.
Maintenance Advisor
Dashboards
Create customizable dashboards that allows you to link videos, photos, documents, and
websites to your Dashboard as well.
Mobile App Manage, initiate, and complete work orders wirelessly from a handheld device.

24. MENU PLANNING SOLUTION
OVERVIEW
 Grove Menus is a menu development software company
that comes with a registered dietician. This platform
enables Affinity to produce a 5 week rotational menu
with products in a specific facilities budgeted price
range.
FEATURES
 Menus – specifically written to control costs within a
facility’s budget.
 Ordering lists – allows facility to take delivery on the
exact amounts of food needed for the week, adjusted
for the recipes chosen and production amount.
 Analytics – program gives an estimated cost per serving
for each recipe, and then gives an estimated total for
each meal and each day.
 Prep/Pull Sheet – reminds you what meats to be pulled,
and which items to prepare the day before production.
 Recipes – scale to the resident count and desired
number of servings.
 Compliance – helps to ensure that residents dietary
needs and specifications are met.
Outcome - Affinity Raw Food PRD is below the industry average.

25. • And once the storm is over, you won’t remember how you made it
through, how you managed to survive. You won’t even be sure,
whether the storm is really over