Post Acute Integration Strategies as we care for more individuals with higher acuity

1. The Case for Post-Acute Partnerships Kindred Healthcare William M. Altman, Senior Vice President of Strategy & Public Policy

3. Why Develop a Post Acute Strategy? Demand for Post-Acute Services Aging Demographics Post-Acute Utilization Payment Reform Value Based Purchasing Readmission Penalties Episodic / Bundled Payment Increased Competition Customer Satisfaction Care Coordination Reducing Hospital Readmissions

4. Positioned to Take Advantage of a Changing Healthcare and Payment Environment “ Continue The Care ” Patient Service Intensity Patient Illness Severity HOME SKILLED NURSING FACILITIES HOSPICE HOME HEALTH CARE OUTPATIENT REHAB ASSISTED LIVING ACUTE CARE HOSPITALS TRANS CARE ICU IN-PATIENT REHAB LTACs FREESTANDING/ HIH SAU TCC & TCU ADULT DAY CARE

5. 35% of Medicare beneficiaries are discharged from acute hospitals to post-acute care (1) Source: RTI, 2009: Examining Post Acute Care Relationships in an Integrated Hospital System Tremendous Opportunities Exist to Better Manage Patient Care for Patients Discharged to Post-Acute Medicare Patients’ Use of Post-Acute Services Throughout an “Episode of Care” (1) Patients’ first site of discharge after acute care hospital stay Patients’ use of site during a 90 day episode SHORT-TERM ACUTE CARE HOSPITALS Intensity of Service LONG-TERM ACUTE CARE HOSPITALS Lower Higher INPATIENT REHAB SKILLED NURSING FACILITIES OUTPATIENT REHAB HOME HEALTH CARE 37% 2% 10% 11% 41% 52% 9% 21% 2% 61%

6. Positioned to Help Determine the Most Appropriate Setting for Patients as they Continue Their Care Throughout a Patient Episode 35% 25% 5% Skilled Nursing and Rehab Centers (1) Source: Kindred Internal Data, 2010 data. Home * (16% with Home Health) Inpatient Rehab Facility Patients Discharged From Kindred Long Term Acute Care Hospitals 13% 77% Skilled Nursing and Rehab Centers Home * (45% with Home Health) Patients Discharged from Kindred Inpatient Rehabilitation Facilities 50% Home* (31% with Home Health) Patients Discharged Kindred Nursing and Rehabilitation Centers

7. Operational Imperatives with Payment Reform PREPARING FOR SHARED RISK Stakeholders Physicians Providers Patients Payors Clinicians Improve Patient Quality Reduce Hospital Readmissions Provide Greater Transparency Be More Efficient / Grow Volumes Aligned Incentives Information Sharing Care Management Models Physician Engagement Key Enablers Operational Imperatives

10. Options for Developing a Post-Acute Strategy Develop Internally Establish and develop internal post-acute care capacity – deploying limited capital and clinical resources Outsource Manage relationships with multiple providers for all levels of post-acute care Partner Partner with progressive post-acute providers to fulfill patient needs

13. Positioned to Take Advantage of a Changing Healthcare and Payment Environment “ Continue The Care ” Patient Service Intensity Patient Illness Severity HOME SKILLED NURSING FACILITIES HOSPICE HOME HEALTH CARE OUTPATIENT REHAB ASSISTED LIVING ACUTE CARE HOSPITALS TRANS CARE ICU IN-PATIENT REHAB LTACs FREESTANDING/ HIH SAU TCC & TCU ADULT DAY CARE

14. Coordinating Clinical Services & Programs Across Service Lines to Improve Outcomes and Prevent Readmissions Long-Term Acute Care Hospitals Hospital Based Sub-Acute Units Inpatient Rehabilitation Facilities Skilled Nursing & Rehabilitation Centers Rehabilitative Therapy Kindred Long-Term Acute Care Hospitals: 28,766 (64%) patients went home or to a lower level of care in 2010 after an average length of stay of 30 days Kindred Inpatient Rehabilitation Facilities 34,960 (76%) patients returned home after an average length of stay of 12 days in 2010 Kindred Rehabilitative Therapy Patient functional improvement from evaluation to discharge was 76.4% in 2010 Kindred Nursing and Rehabilitation: 39,836 (50%) patients returned home after an average length of stay of 32 days in 2010. Home Health & Hospice Services Services Services Specialty Programs Therapies Respiratory & Pulmonary Care Cardiac Care Pulmonary Care Intensive Short-Term Complex Rehabilitation Cardiac Care Pulmonary Care Cardio-Pulmonary and Medically Complex Complex Wound Care IV antibiotic Therapy Clinically Complex Care Reconditioning Wound Care Severe Stroke, Brain, Spinal Cord, and Other Neurological Impairment Wound Care Wound Care Therapies for Complex Wounds Short-Term Rehabilitation Intensive Short –Term & Orthopedic Rehabilitation Complex Cognitive, Physical Rehabilitation Orthopedic and Neurological Rehabilitation Orthopedic Rehab Neurological / Stroke Rehabilitation Dialysis Pain Management IV Therapy Dialysis, Wound Care, Pulmonary Therapy Long-term Chronic Care Palliative & Hospice Care Palliative & Pain Programs Services Skilled Nursing Care w/ Specialty Programs Wound Care, CHF, Methadone Dosing, Med Management, Safety Assessments, IV Therapy Physical, Occupational & Speech Therapy Psychiatric Nursing

15. Increased Focus on Developing Market Specific Integrated and Coordinated Care Delivery Models With Focus On Developing Cluster Market Service Offerings LTACHs (121) Inpatient Rehab Hospitals (5) Nursing and Rehabilitation Centers (224) Acute Rehabilitation Units (113) RehabCare External Customers (1,563) Home Care and Hospice (19) Existing Cluster Market Potential New Cluster Market (as of June 1, 2011)

17. Key Attributes for Successful Collaboration Information Sharing Communication mechanisms - Joint Operating Committees Information Technology Linkage Inclusion of stakeholders Care Transitions Post-acute clinical programs designed fit hospital need Coordinated staffing, training, and nurse competencies Shared clinical protocols; Care pathways Physician Engagement Physician leadership and buy-in Medical privileges across sites of care Awareness of practice patterns, confidence in partners Quality & Outcomes Shared quality and operating measures Established baseline performance and agreed targets Focus on high impact outcomes (e.g., re-hospitalizations)

19. Kindred is Actively Engaged with Hospitals, Health Systems, and Managed Care Organization in Piloting Integrated Care and Payment Models (ACOs, Bundling, Rehospitalization Pilots, Etc.)