Cigna Corporation

DaVita Clinical Scorecard

Q3 2011

Relentless Pursuit of Quality

Q3 2011

DaVita has Achieved Clinical Outcomes that are the best or Among the best in Virtually every Category(1)

A few highlights
DaVita has improved clinical outcomes for 11 consecutive years 98% of affiliated physicians say DaVita meets or exceeds expectations as a clinical partner The DaVita Quality Index (DQI) reflects performance on a range of patient outcomes to measure, rank and improve the clinical performance of each dialysis facility. Improvements in DQI generally translate to longer life and avoided hospitalizations for our patients DaVita Rx reduces the potential for adverse drug interactions and improves patient adherence to prescriptions, lowering the risk of hospitalization by up to 30% Patients with advanced CKD who are in a VillageHealth integrated care program generally experienceslower progression to dialysis, more outpatient than in-hospital dialysis starts, and a higher likelihood ofhaving a fistula in place on the first day of dialysis
1

Based on latest available data; data from 2007-2009

Clinical Trends: Vascular Access

Q3 2011
AV Fistula Rate
66% 64%
Fistula Ind. Avg 54.4%

Catheter Rate
26% 26%
CVC Ind. Avg 24.3%

DaVita leads in fistulas

=

% Of Patients

% Of Patients

62% 60% 58% 56% 54% 52%

26% 25%

Access issues = #1 source of hospitalizations for ESRD pts In 2009, DaVita led the industry in fistula use and day-90 catheter rates
(3)

25% 24%
=

2Q11

3Q11

24%

2Q11

3Q11

In the last quarter of 2009 alone, DaVita gave back 158 years of life to catheter-free patients

2Q11 Fistula 62%

3Q11 64% CVC

2Q11 26%

3Q11 24%

Vascular Access is the patients life line to hemodialysis. Blood for dialysis is pumped from a large arm vessel constructed
from the patients artery and vein (arteriovenous fistula or AVF), or from a catheter placed into a large vein near the heart (central venous catheter or CVC). Patients with CVCs, compared to AVF, suffer higher risk of death and hospitalization from infections and blood clots. Trended data:
= =

CVC: AVF:

percent of prevalent patients(>90 days) with a CVC, based on access used in last treatment of quarter (lower is better) percent of prevalent patients (>90 days) with an AVF, based on access used in last treatment of quarter (higher is better)
3 Among large dialysis organizations

1 2

Average of Large Dialysis Organizations (FMC,DCI,RCG), excluding DVA: as of July 2010 Fistula First Outcomes Dashboard, as of October 2010: excludes DVA data

Q3 2011
Disclaimer: This data is for general information purposes only. The information is provided by DaVita and while we have endeavored to ensure the information up to date and correct, we make no representations or warranties of any kind, express or implied, about its completeness, accuracy, reliability, or suitability for a particular purpose. This data is for DaVitas VA veteran population only. This data is being provided pursuant to the requirements of VA contract # VA-791-P-0079 with DaVita. This data is intended for VA internal use only, and is not intended for external distribution.