Exhibitor Packet - Baylor Scott & White Health

TEST UTILIZATION IN AN ACCOUNTABLEAND INTEGRATED HEALTHCARE SYSTEM:FROM VOLUME TO VALUEBaylor Scott & White HealthPathology and Laboratory Medicine

Welcome to the 2017 Baylor Scott & White Health(BSWH) Workshop: From Volume to Value.We welcome you to our second workshop to rationalize test utilization in aworld of increasing diagnostic complexity and cost. As a large integratedhealth system, we have a duty to actively provide our very best professionaljudgment to patients and their physicians when selecting complexdiagnostic tests in a cost efficient manner.Pathology and Laboratory Medicine must take a central role in testing forthe continuum of care, spanning health maintenance, effective chronicand acute disease management and palliative end-of-life care. We havealready instituted changes in our ordering practices as a result of last year’s discussions, butwe realize that we have a long way to go and much to learn from other systems. In addition,disruptive technologies, including digital health and complex multi-analyte tests, are newchallenges that mandate attention to assessing value prior to implementation. What we learntoday will set and build the framework for rational, caring, and patient-centric diagnostic testingfor years.AgendaMonday, June 12, 2017 Waxahachie Civic Center7:00 – 7:45 amBreakfast & Welcome7:45 – 8:30 amGolden Age of Laboratory Medicine: Value Component of LaboratoryKhosrow Shotorbani, MBAChief Executive Officer, TriCore Reference Laboratories8:30– 9:15 amStephen Sibbitt, MD, Senior VP, CMO, Scott & White Medical CenterRaul Benavides, MD, Baylor University Medical Center at Dallas9:15 – 10:00 amKey Objectives for the day:2. Develop a roadmap for implementation now and data mining for future utilization targets3. C ommunicate the value of utilization management to ordering physicians for all sites of carewith particular focus on oncology testingSincerely,Disruptive Payment Models and the Clinical Laboratory: Anticipatingthe Protecting Access to Medicare Act (PAMA) and Deployment ofAlternate Payment ModelsBradley Brimhall, MD, MPHMedical Director of Integrated Healthcare Analytics & BioinformaticsUniversity of Texas Health Science Center, San AntonioDirector, Medical Analytics, Orchard SoftwareAgain, we hope the outstanding speakers today will spur collaboration and innovation in thecurrent healthcare climate.1. D evelop tactics to best transition from volume-based to value-based testing in laboratorymedicine (i.e., which tests to evaluate for mis/underuse, under what disease states, and howto communicate the desired change in order practice pattern)Utilization Efforts in the Baylor Scott & White System10:00 – 10:15 amQuestions10:15 – 10:30 amBreak10:30 – 11:30 amTesting Strategies for Lung CancerAaron Mansfield, MDMedical Oncologist, Mayo Clinic11:30 – 12:45 pmRound Table: Utilization Efforts in Oncology – DifferentPerspectives Including PayersScott Paulson MD, Michelle Shiller MD, Mark Holguin MD, Maria Juarez MD,Robyn Olney MD, Sheila Dobin PhD, and Richard Reuter, Scott & WhiteHealth PlanErnest Franklin, MDSenior Vice President, Clinical Value and IntegrationBaylor Scott & White Health12:45 – 1:30 pmLunch1:30 – 2:15 pmUtilization Efforts in HematologyCampbell Garland, MDScott & White Medical Center2:15-2:45 pmDiscussion and Wrap Up2:45 pmAdjourn

Test Utilization in an Accountable and Integrated Healthcare System:From Volume to ValueJune 12, 2017Waxahachie, TexasEXHIBITOR REGISTRATIONCompany Name (as itshould appear onacknowledgements)Contact PersonEmail AddressTelephone NumberName ofRepresentative(s)AttendingRegister Online: BSWH.md/UtilizationCMEExhibit 700.00 One Day Exhibitincludes standard exhibit 6 ft table in exhibit hall 300 Additional 6ft table placed with registered exhibitTOTAL DUE:Make check payable toBaylor Scott & White HealthFederal Tax Identification Number: 46-3131350Mail completed formand check to:Baylor Scott & White HealthCTX CME: MS-26-A2292401 South 31st StreetTemple, TX 76508Fax (254) 724-1753Or email tocheryl.massar@bswhealth.orgSignature of authorized company representativeSignature AWRC representativePrinted Name of authorized company representativePrinted Name of AWRC representativeDateDate

May 12, 2017You are invited to exhibit at Baylor Scott & White’s 1st Annual Test Utilization in anAccountable and Integrated Healthcare System: From Volume to Value, to be heldJune 12, 2017 at the Waxahachie Civic Center in Waxahachie, Texas. This activity willhost a wide range of healthcare providers through all disciplines, as well as mid-levelproviders for the Central and North Texas Regions.For full program information, please visit the Test Utilization Conference page on ourCME home page.BSWH.md/CMEThe times available to exhibit will be on June 12 from 11 am until 6:00 pm on Monday,and from 7:00 am – 2:15 pm.The exhibitor fee for this inaugural event is 700, which includes one 6ft table. Pleasesee included exhibitor form for registration or register online at:Please make check payable to Baylor Scott & White Health and mail to the addressbelow:Baylor Scott & White HealthCTX CME: MS-26-A2292401 South 31st StreetTemple, TX 76508Thank you for your continued support of medical education in Texas.Sincerely,Cheryl MassarCME Extramural CoordinatorContinuing Medical EducationCheryl.Massar@bswhealth.org254-724-5470

W-9Form(Rev. December 2014)Department of the TreasuryInternal Revenue ServiceRequest for TaxpayerIdentification Number and CertificationGive Form to therequester. Do notsend to the IRS.1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.Print or typeSee Specific Instructions on page 2.Baylor Scott & White Health2 Business name/disregarded entity name, if different from above3 Check appropriate box for federal tax classification; check only one of the following seven boxes:C CorporationS CorporationPartnershipTrust/estateIndividual/sole proprietor orsingle-member LLCLimited liability company. Enter the tax classification (C C corporation, S S corporation, P partnership) aNote. For a single-member LLC that is disregarded, do not check LLC; check the appropriate box in the line above forthe tax classification of the single-member owner. Other (see instructions) a5 Address (number, street, and apt. or suite no.)Tax Exempt - Non-Profit Corporation4 Exemptions (codes apply only tocertain entities, not individuals; seeinstructions on page 3):1Exempt payee code (if any)Exemption from FATCA reportingcode (if any)(Applies to accounts maintained outside the U.S.)Requester’s name and address (optional)2001 Bryan St., Suite 22006 City, state, and ZIP codeDallas, TX 752017 List account number(s) here (optional)Part ITaxpayer Identification Number (TIN)Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoidbackup withholding. For individuals, this is generally your social security number (SSN). However, for aresident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For otherentities, it is your employer identification number (EIN). If you do not have a number, see How to get aTIN on page 3.Note. If the account is in more than one name, see the instructions for line 1 and the chart on page 4 forguidelines on whose number to enter.Part IISocial security number––orEmployer identification number46– 31 31 350CertificationUnder penalties of perjury, I certify that:1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal RevenueService (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I amno longer subject to backup withholding; and3. I am a U.S. citizen or other U.S. person (defined below); and4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholdingbecause you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgageinterest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), andgenerally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See theinstructions on page 3.SignHereSignature ofU.S. person aDate a1/3/17General Instructions Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T(tuition)Section references are to the Internal Revenue Code unless otherwise noted. Form 1099-C (canceled debt)Future developments. Information about developments affecting Form W-9 (suchas legislation enacted after we release it) is at www.irs.gov/fw9. Form 1099-A (acquisition or abandonment of secured property)Use Form W-9 only if you are a U.S. person (including a resident alien), toprovide your correct TIN.Purpose of FormAn individual or entity (Form W-9 requester) who is required to file an informationreturn with the IRS must obtain your correct taxpayer identification number (TIN)which may be your social security number (SSN), individual taxpayer identificationnumber (ITIN), adoption taxpayer identification number (ATIN), or employeridentification number (EIN), to report on an information return the amount paid toyou, or other amount reportable on an information return. Examples of informationreturns include, but are not limited to, the following:If you do not return Form W-9 to the requester with a TIN, you might be subjectto backup withholding. See What is backup withholding? on page 2. Form 1099-INT (interest earned or paid)3. Claim exemption from backup withholding if you are a U.S. exempt payee. Ifapplicable, you are also certifying that as a U.S. person, your allocable share ofany partnership income from a U.S. trade or business is not subject to thewithholding tax on foreign partners' share of effectively connected income, and Form 1099-DIV (dividends, including those from stocks or mutual funds) Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) Form 1099-B (stock or mutual fund sales and certain other transactions bybrokers) Form 1099-S (proceeds from real estate transactions)By signing the filled-out form, you:1. Certify that the TIN you are giving is correct (or you are waiting for a numberto be issued),2. Certify that you are not subject to backup withholding, or4. Certify that FATCA code(s) entered on this form (if any) indicating that you areexempt from the FATCA reporting, is correct. See What is FATCA reporting? onpage 2 for further information. Form 1099-K (merchant card and third party network transactions)Cat. No. 10231XForm W-9 (Rev. 12-2014)

Make check payable to Baylor Scott & White Health Federal Tax Identification Number: 46-3131350 Mail completed form and check to: Baylor Scott & White Health CTX CME: MS-26-A229 2401 South 31st Street Temple, TX 76508 Fax (254) 724-1753 Or email to cheryl.massar@bswhealth