Joslin Diabetes Center Affiliated Programs HighlightsOctober 27, 2008

Welcome

Medical Directors Center Administrators Dubai Attendees Invited Guests

Disease Burden of Diabetes

• Over 24 million Americans have diabetes• 17.5 million diagnosed

• Cost of Diabetes• $174 billion annually (direct and indirect)• 32% increase over 2002

Affiliates Challenge in the United States

Information from Diabetes Care, March 2008

The Quiet March of the Diabetes Epidemic

“Although six of the seven persons, all head of families…living in three adjoining houses…on a peaceful, elm-lined street….in a country town inNew England…succumbed to diabetes….no one spoke of an epidemic. Consider the measure which would have been adopted to discover the source of the outbreak to prevent a recurrence….if these deaths had occurred from scarlet fever, typhoid fever or tuberculosis…..Because the disease was diabetes, and because the deaths occurred over a considerable interval of time, the fatalities passed unnoticed”.

- Elliott Joslin, 1921

Affiliated Programs - 22nd Year – 2007 Highlights

20 Contracts 30 Sites 170,000 patient visits in 2007 30,000 new patients visits in 2007

11% increase over 2006 13 states 2 International sites 77 Physicians 21 Nurse Practitioners 111 Educators 2 New Partners for Diabetes Specialty Program at

Long-Term Care and Skilled Nursing Facilities (with SUNY & The Hospital of Central Connecticut Affiliate Partners)

Notes: Blue circles indicate multiple sites associated with one umbrella contract.

16

1

13 6

5

10

12

15

43

2

1. New Britain General Hospital - New Britain, CT

2. Lawrence and Memorial Hospital - Mystic, CT

Lawrence and Memorial Hospital - New London, CT

3. Southern NH Medical Center - Nashua, NH

4. SUNY Upstate Medical Univ. - Syracuse, NY

5. Western PA Hospital - Pittsburgh, PA

Forbes Regional Medical Ctr. - Monroeville, PA

Alle-Kiski Medical Center - Natrona Heights, PA

6. Univ. of MD Medical System - Baltimore, MD

Maryland General Hospital - Baltimore, MD

Baltimore Washington Medical Center - Glen Burnie, MD

7. Doctor’s Community Hospital - Lanham, MD

8. St. Mary’s Medical Center - Evansville, IN

9. Floyd Mem. Hosp. & Health Service - New Albany, IN

10. St. Vincent Hospital - Cleveland, OH

11. Southview Hospital - Dayton, OH

12. St. Mary’s Medical Center - Huntington, WV

13. Swedish Medical Center - Seattle, WA

14 UC-Irvine Medical Center - Irvine, CA

15. Frisbie Medical Center – Rochester, NH

16. Providence Medical Center - Novi, MI

Providence Hospital – Southfield, MI

17. Mercy Medical Center – Cedar Rapids, IA

18. Gulf Diabetes Specialist Center, Kingdom of Bahrain

19. Chaleur Regaional Medical Center, Bathurst, NB, Canada

Key

Number of Affiliates as of March 4, 2008:Affiliates in 12 states

29 Total Sites26 Domestic Sites

3 International Sites22 Contracts

Network of Centers

7

14

Joslin Diabetes Center Affiliated Programs

11

18

19

17

2008 Affiliate Domestic Expansion Focus

Network Growth with our existing Affiliate partners

2008 Presentations & Contracts in Negotiation: IllinoisCaliforniaTexasFloridaOhioNew Jersey

December 31, 2008 22 Domestic Contracts 4 International Contracts 32 Domestic Sites 6 International Sites 2 SNF Diabetes Specialty Programs

14

5

9

10

13

3

2

-

INTERNATIONAL SITES Bathurst, NB, CanadaManama, BahrainDubai, UAEChennai, India

Network of Centers-Projected December 2008

7

Joslin Diabetes Center Affiliated Programs

8

17

15

12

16

11 6

22

214

Single siteMultiple sitesUpgrade to multiple sitesUpgrade to additional sitesContracts in negotiation

2008 Affiliate Domestic Expansion Focus

Skilled Nursing Homes and Long Term Care Growth of partnerships between our Affiliates and SNF &

LTC prospective partners

Metro Marketing Campaign Comprehensive Materials being finalized for targeted

campaign to decisionmakers in Major Metropolitan Markets (20 Cities)

Targeted series of cover letters and informational papers discussing Joslin benefits and services

Consulting Services Increased requests for Joslin Boston to conduct consulting

engagements for existing ADA recognized programs throughout the U.S.

- Consulting engagements provide a vehicle for introduction of Joslin team-based approach to prospective Affiliate partners

2008 Affiliate International Projects

Hamed Farooqi, MD, former Medical Director of the Joslin Affiliate in Florida, relocated to Dubai to become Medical Director of the new Joslin Diabetes Center affiliate at the Dubai Health Authority

Agreement has been signed with Agada Health Services in Chennai, India, to begin the process of establishing a Joslin affiliate

Agreement with Partners Harvard Medical International for project in Libya to evaluate current state of care for patients with diabetes

JARS (Joslin Affiliates Reporting System) Mean Results - 2007 Sites Participating

$~9 million annual net revenue per FTE endocrinologist

8% incremental annual net revenue $3,000+ per patient 40% increase in patient population 53% increase in incremental patient

population

ADA Poster Abstract Demonstration JARS (Joslin Affiliates Reporting System) ROI

2007 Joslin Diabetes CenterClinical Performance Summary

Joslin NCQA Target

Boston Affiliate Average

Affiliate Average

Affiliate Average

Affiliate Average

2007 2007 2007 2006 2005 2004 Total # pt charts

N=200

N=1,180 628 465 363

# Sites participating

15 18 16 10

% % % % % A1C > 9.0 <15% 13 14 14 A1C < 7.0 >40% 40 41 40 46 38 BP >140/90 <35% 25 7 BP< 130/80 >25% 51 55 87 86 83 Retinal Screen >60% 73 59 63 65 55 Smoking cessation counseling

>80% 62 96 0 0

LDL > 130 <37% 9 8 LDL <100

>36% 64 57 64

Nephropathy Assessment

>80% 90 85 77 74 61

Foot exam >80% 95 94 88 86 96 NCQA Score

75 -100 90 86

Power of the Brand

The Right Time for Joslin

A Testimonial from the CEO of Frisbee Memorial Hospital - NH

Joslin 50 Year Medalists