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Leveraging Analytics Platform for Hospital
Value Based Purchasing (HVBP)
May 22, 2013
Webinar

2. 2
Webinar Presenters
Martin Sizemore
Director
Healthcare Strategy
Perficient, Inc.
Harshad Patil,
CPHIMS, AHIP
Certified
Sr. Consultant
CitiusTech Inc.
Martin Sizemore is Principal in Perficient’s national healthcare practice. Martin is a
healthcare strategist, senior consultant and a trusted advisor to Chief Executive
Officers, COOs, CIOs and senior managers for healthcare organizations including both
payers and providers.
Martin is a specialist in clinical data warehousing, clinical data models and healthcare
business intelligence for improving operational efficiencies and clinical outcomes.
Martin is a TOGAF certified Enterprise Architect with specialized skills in Enterprise
Application Integration (EAI) and Service Oriented Architecture (SOA).
Harshad Patil is part the Healthcare Informatics team at CitiusTech. He has extensive
experience in technology consulting and development for clients worldwide, around
healthcare BI/analytics, clinical quality and performance management.
Earlier, he was lead Business Analyst with Infosys working for a variety of customers
in the payer and provider domains. He has a bachelors degree in Biomedical
Engineering.

3. 3
Background
 The Affordable Care Act (ACA) establishes various programs to reward hospitals
financially for providing higher quality of care
 Once all of the quality programs and regulatory requirements are fully
implemented beginning federal fiscal year 2017, the percentage of Medicare dollars
paid based on quality could be up to approximately 10% for a hospital
 The quality programs and regulatory requirements are: Pay for Reporting, Hospital
Acquired Conditions Reporting, Meaningful Use Reporting, the Readmissions
Reduction Program, and the Hospital Value-Based Purchasing Program.
 The Hospital Value Based Purchasing Program (HVBP) was mandated by Section
3001(a) of the ACA and became Section 1886(o) of the Social Security Act. CMS
published a proposed rule for the Program in January 2011, published in the final
rule on May 6, 2011

4. 4
Agenda
Part 1: HVBP Overview
 Introduction and Timeline
 Measure Coverage
Part 2: HVBP Calculation
 Performance Score and Incentive Calculations
 Achieving Continuous Improvement
Part 3: Live Demo – Health BI HVBP App
Part 4: Summary / Q&A

5. 5
Agenda
Part 1: HVBP Overview
 Introduction and Timeline
 Measure Coverage
Part 2: HVBP Calculation
 Performance Score and Incentive Calculations
 Achieving Continuous Improvement
Part 3: Live Demo – Health BI HVBP App
Part 4: Summary / Q&A

6. 6
Introduction to HVBP
 HVBP rewards acute-care hospitals with incentive payments for the quality of
care they provide to Medicare patients
 The program uses the hospital quality data reporting infrastructure developed
for the Hospital Inpatient Quality Reporting (IQR) Program
 HVBP distributes payment to hospitals for their actual performance on quality
measures rather than just on reporting
 CMS funds the incentive by withholding a small part of regular fees under DRG
payment to Hospitals
 The HVBP incentive payments are based on the hospital scores on HVBP
measures, which are updated annually.

7. 7
How does HVBP work?
Hospital CMS
Report
IQR measures
Score each measure
from 0 to 10
Calculate domain
scores
Calculate Total
Performance Score
for the Hospital
Calculate the
incentive payment /
penalty for the FY
Hospital receives
adjusted DRG
payments
Review
scores, improve
performance
• CMS calculates the scores
based on the existing IQR
reporting framework or
claims or the reported
HCAHPS results
• No additional reporting is
required
• CMS publishes each hospital’s
Actual Percentage Payment
Report on My QualityNet at
the start of the relevant FY
Hospital submits
correction and
appeal, if needed

8. 8
Timeline
2013 2014 2015 2016 2017 ++
1.00% 1.25% 1.5% 1.75% 2.00%
DRG Payments Holdback % by Fiscal Year
NANA
20122011
Reimbursements
adjustment begin
VBP
beginsCMS announces
performance
standards
You are
here!!
The reduction in DRG payments also provides opportunity for hospitals to earn
incentives greater than the holdback!!
* Fiscal year is from 1st Oct to 31st Sep
Financial Impact
of what you do today

9. 9
Important Periods for Performance Calculation
Fiscal Year* Domain Baseline Period Performance Period
2013
Clinical Domain 1-Jul-09 to 31-Mar-10 1-Jul-11 to 31-Mar-12
Patient Experience 1-Jul-09 to 31-Mar-10 1-Jul-11 to 31-Mar-12
2014
Clinical Domain 1-Apr-10 to 31-Dec-10 1-Apr-12 to 31-Dec-12
Patient Experience 1-Apr-10 to 31-Dec-10 1-Apr-12 to 31-Dec-12
Outcome Domain 1-Jul-09 to 30-Jun-10 1-Jul-11 to 30-Jun-12
2015
Clinical Domain 1-Jan-11 to 31-Dec-11 1-Jan-13 to 31-Dec-13
Patient Experience 1-Jan-11 to 31-Dec-11 1-Jan-13 to 31-Dec-13
Outcome
Domain
Mortality 1-Oct-10 to 30-Jun-11 1-Oct-12 to 30-Jun-12
AHRQ 15-Oct-10 to 30-Jun-11 15-Oct-12 to 30-Jun-12
CLABSI 1-Jan-11 to 31-Dec-11 1-Feb-13 to 31-Dec-13
Efficiency 1-May-11 to 31-Dec-11 1-May-13 to 31-Dec-13
* Fiscal year is from 1st Oct to 31st Sep

10. 10
Growth of Domains for HVBP from FY 13 to FY 15
FY 13 FY 14 FY 15
Clinical
Domain
(45%)
Patient
Experience
(30%)
Outcome
Domain
(25%)
Clinical
Domain
(20%)
Patient
Experience
(30%)
Outcome
Domain
(30%)
Efficiency
(20%)
Clinical
Domain
(70%)
Patient
Experience
(30%)
Clinical Measures – 12
HCAHPS Measures – 8
Clinical Measures – 13
HCAHPS Measures – 8
Outcome Measures – 3
Clinical Measures – 12
HCAHPS Measures – 8
Outcome Measures – 5
Efficiency Measure – 1
Over the next few years, eligible hospitals need to build more complex capabilities
around outcome-based processes and clinical efficiency.

11. 11
Measures for FY14
Clinical Measures
1. AMI-7a Fibrinolytic Therapy Received within 30 Minutes of
Hospital Arrival
2. AMI-8 Primary PCI Received within 90 Minutes of Hospital Arrival
3. HF-1 Discharge Instructions
4. PN-3b Blood Cultures Performed in the ED Prior to Initial
Antibiotic Received in Hospital
5. PN-6 Initial Antibiotic Selection for CAP in Immunocompetent
Patient
6. SCIP-Inf-1 Prophylactic Antibiotic Received within One Hour Prior
to Surgical Incision
7. SCIP-Inf-2 Prophylactic Antibiotic Selection for Surgical Patients
8. SCIP-Inf-3 Prophylactic Antibiotics Discontinued within 24 Hours
After Surgery
9. SCIP-Inf-4 Cardiac Surgery Patients with Controlled 6 a.m.
Postoperative Serum Glucose
10. SCIP–Inf–9 Postoperative Urinary Catheter Removal on
Postoperative Day 1 or 2.
11. SCIP-Card-2 Surgery Patients on a Beta Blocker Prior to Arrival
That Received a Beta Blocker During the Perioperative Period
12. SCIP-VTE-1 Surgery Patients with Recommended Venous
Thromboembolism Prophylaxis Ordered
13. SCIP-VTE-2 Surgery Patients Who Received Appropriate Venous
Thromboembolism Prophylaxis within 24 Hours
1. Nurse Communication
2. Doctor Communication
3. Hospital Staff Responsiveness
4. Pain Management
5. Medicine Communication
6. Hospital Cleanliness and
Quietness
7. Discharge Information
8. Overall Hospital Rating
Patient Experience
1. MORT-30-AMI Acute Myocardial
Infarction (AMI) 30-day mortality
rate
2. MORT-30-HF Heart Failure (HF) 30-
day mortality rate
3. MORT-30-PN Pneumonia (PN) 30-day
mortality rate
Outcome Measures

12. 12
Measures for FY15
Clinical Measures
1. AMI-7a Fibrinolytic Therapy Received within 30 Minutes of
Hospital Arrival
2. AMI-8 Primary PCI Received within 90 Minutes of Hospital
Arrival
3. HF-1 Discharge Instructions
4. PN-3b Blood Cultures Performed in the ED Prior to Initial
Antibiotic Received in Hospital
5. PN-6 Initial Antibiotic Selection for CAP in
Immunocompetent Patient
6. SCIP-Inf-1 Prophylactic Antibiotic Received within One Hour
Prior to Surgical Incision
7. SCIP-Inf-2 Prophylactic Antibiotic Selection for Surgical
Patients
8. SCIP-Inf-3 Prophylactic Antibiotics Discontinued within 24
Hours After Surgery
9. SCIP-Inf-4 Cardiac Surgery Patients with Controlled 6 a.m.
Postoperative Serum Glucose
10. SCIP–Inf–9 Postoperative Urinary Catheter Removal on
Postoperative Day 1 or 2.
11. SCIP-Card-2 Surgery Patients on a Beta Blocker Prior to
Arrival That Received a Beta Blocker During the
Perioperative Period
12. SCIP-VTE-2 Surgery Patients Who Received Appropriate
Venous Thromboembolism Prophylaxis within 24 Hours
1. Nurse Communication
2. Doctor Communication
3. Hospital Staff Responsiveness
4. Pain Management
5. Medicine Communication
6. Hospital Cleanliness and Quietness
7. Discharge Information
8. Overall Hospital Rating
Patient Experience
1. AHRQ (PSI-90) Patient Safety for Selected
Indicators (composite)
2. CLABSI Central Line-Associated
Bloodstream Infection
3. MORT-30-AMI Acute Myocardial Infarction
(AMI) 30-day mortality rate
4. MORT-30-HF Heart Failure (HF) 30-day
mortality rate
5. MORT-30-PN Pneumonia (PN) 30-day
mortality rate
Outcome Measures
1. MSPB-1 Medicare Spending Per Beneficiary
Efficiency Measures

13. 13
 Applies to subsection (d) hospital found in
Section 1886(d)(1)(B) of Social Security Act
 Applies to acute care hospitals in the 50 states
and the District of Columbia
 Clinical Process of Care Domain score requires
at least 10 cases for each of at least 4
applicable measures during the Performance
Period
 Patient Experience of Care Domain score
requires at least 100 completed HCAHPS
surveys during the Performance Period
 Outcome 30-Day Mortality requires at least
10 cases and 2 measures during Performance
Period
Eligible and Excluded Hospitals
 Hospitals subject to payment reductions
under Hospital IQR
 Hospitals and hospital units excluded from
the Inpatient Prospective Payment System
(IPPS)
 Hospitals cited for deficiencies during the
performance period that pose immediate
jeopardy to the health or safety of patients
 Hospitals without the minimum number of
cases, measures, or surveys
 Hospitals that are paid under Section 1814
(b)(3) and have received an exemption from
the Secretary of HHS
 Teaching and Children’s Hospitals
Eligible Hospitals Excluded Hospitals
HVBP is mandatory for all eligible hospitals; not reporting the data will attract the
financial penalty by CMS

14. 14
Useful Resources
Hospital Inpatient Quality Reporting Program
 How to Participate
• https://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2
FQnetTier3&cid=1138900291659
 Measures Comparison tables –Calendar Year 2013 Discharges:
• https://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2
FQnetTier3&cid=1138900298473
 FY2013 HVBP Payment Adjustment Factors ( Under Download section)
• http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-
Instruments/hospital-value-based-purchasing/
 Each Hospital’s Value Based Purchasing – Value Based Percentage Payment Summary Report and
the supporting explanatory documents
• https://www.qualitynet.org./

15. 15
Agenda
Part 1: HVBP Overview
 Introduction and Timeline
 Measure Coverage
Part 2: HVBP Calculation
 Performance Score and Incentive Calculations
 Achieving Continuous Improvement
Part 3: Live Demo – Health BI HVBP App
Part 4: Summary / Q&A

16. 16
Threshold and Benchmark
 Hospitals are scored for each measure according to a 10-point scale defined between the
measure’s achievement threshold and a benchmark.
 Achievement threshold is the minimum level of performance to be considered for incentive
payment. The achievement thresholds are set at the 50th percentile of on a given measure
during the baseline period.
 Benchmark is the highest levels of performance among hospitals during the baseline period.
The benchmarks are the mean of the top decile of overall hospital scores
Total Performance Score
0 10050
NumberofHospitals
Threshold (50th Percentile)
Benchmark
(Mean of top decile)
40 95

17. 17
Achievement, Improvement & Total Performance Scores
 The achievement score is based on how a hospital’s current performance compares to the
performance of all other hospitals during the baseline period.
 The improvement score is based on how a hospital’s current performance compares to its
prior performance during the baseline period
Time
My Hospital’s current
performance
compared to All
Hospitals’ Baseline
Period Performance
My Hospital’s current
performance
compared to My
Hospital’s Baseline
Period Performance
Me
MeMe
All

18. 18
Score Calculation: Total Performance
Achievement Score Methodology Improvement Score Methodology
• Hospital will earn 0 to 10 points on where its
performance for the measure falls relative to
the Threshold and the Benchmark
• Formula is [9 * ((Hospital’s performance
period score - Threshold) / (Benchmark -
Threshold))] + 0.5
• All achievement points will be rounded to
the nearest whole number
• Hospital will earn 0 to 9 points on how much
its performance during performance period
improves relative to performance in baseline
period
• Formula is [10 * ((Hospital performance
period score - Hospital baseline period
score) / (Benchmark – hospital baseline
period score))] - 0.5
• All improvement points will be rounded to
the nearest whole number
Total Performance Score = Weighted sum of All the domain scores for that FY
For FY 14:
TPS = 45%(Clinical Score) + 30%(Patient Experience Score) + 25%(Outcome Score)
For FY 15:
TPS = 20%(Clinical Score) + 30%(Patient Experience Score) + 30%(Outcome Score) + 20%(Efficiency
Score)

19. 19
Sample calculations for FY 14 for Hospital ABC for AMI-7a
50% 100%70% 80%60% 90%
Benchmark 99%
79%
Achievement Range
69%
Achievement Threshold  65%
0 2 3 4 5 6 7 8 91
1 2 3 4 5 6 7 8 9
Improvement Range
0
10
Threshold = 65%
Benchmark = 99%
Baseline Score = 69%
Performance Score = 79%
Ach. Score = 4
Imp. Score = 3
= 45% of 40 + 30% of 84 + 25% of 50
= 45% of (52/130 * 100) + 30% of (64 + 20) + 25% of (15/30 * 100)
= 55.7
* Assuming Clinical score for each measure = 4,
Patient Experience score for each measure =8
and Consistency Points = 20
Outcome score for each measure = 5

20. 20
Translating TPS into the VBP Incentive
Estimate each hospital’s total annual base operating DRG payment
amount using Medicare inpatient claims data from MedPAR files
Calculate the total annual estimated base operating DRG
payment amount reduction across all eligible hospitals
Calculate the linear exchange function slope
Calculate each hospital’s incentive percentage (a.k.a.
per cent of base operating DRG earned back)
Compute the net percentage change in the
hospital’s base operating DRG payment
Compute the value-based multiplier
1
2
3
4
5
6
$ $ $
Calculate Net change in
base DRG
7

21. 21
Sample HVPB Incentive Calculation: FY14 vs. FY15
Step Description FY14 FY15
1 Base DRG amount for the hospital $1 Billion $1.1 Billion
2 Total annual estimated base operating DRG payment
amount reduction across all eligible hospitals*
Sum [Base Operating DRG Payment Amount] × 1.25%
$1 Billion $1.2 Billion
3 Linear Exchange Function Slope*
Sum of DRG payment reduction amount for all hospitals) /
(Sum of DRG payment amount for each hospital x that
hospital’s TPS/100)
$1b/$500m
= 2
$1.2b/$600m
= 2
4 VBP Incentive Percentage
Applicable percent Reduction for Program Year × Hospital’s
TPS/100 × Linear Exchange Function Slope
0.0125 X 55.7% X 2
= 1.39%
0.015 X 45% X 2
= 1.35%
5 Net % change for hospital’s base DRG payment for each
discharge
Hospital’s Value-based Incentive Payment Percentage –
Applicable percent Payment Reduction
1.39 – 1.25
= 0.14%
1.35 – 1.5
= -0.15%
6 Hospital’s Value-Based Multiplier
Net % change for Hospitals based DRG payment x Estimate
base DRG amount
1 + 0.14%
= 1.0014
1 – 0.15%
= 0.9985
Net Change in Base DRG ($1b) $1.4m -$1.65m
(Multiplier x Base DRG)-Base DRG
7

22. 22
Agenda
Part 1: HVBP Overview
 Introduction and Timeline
 Measure Coverage
Part 2: HVBP Calculation
 Performance Score and Incentive Calculations
 Achieving Continuous Improvement
Part 3: Live Demo – Health BI HVBP App
Part 4: Summary / Q&A

23. 23
HVBP: Financial Impact on Non-Performing Hospitals
Low
Performance
Score
Loss of market share to
competitors
Non-performing hospitals
stand to lose money to their
regional competitors who
are performing well
Mired in the non-
performance quicksand
The benchmark and threshold
rise each year, making it more
difficult each year to break even
Direct impact on bottom-line
The penalties directly impact hospital’s
bottom-lines and its ability to take on
new efficiency or safety initiatives

24. 24
Compute
periodic measure-
wise performance
scores
Identify
Improvement
areas using
measure /
domain scores
Track
Continuous
Improvement
Continuous Improvement
Predict
Incentives
- Leverage EHR investments by coupling it with analytics solutions to calculate current
performance rates periodically
- Identify at-risk, inefficient and wasteful areas; take corrective actions
- Use analytics to predict your future incentives / penalties today

25. 25
Agenda
Part 1: HVBP Overview
 Introduction and Timeline
 Measure Coverage
Part 2: HVBP Calculation
 Performance Score and Incentive Calculations
 Achieving Continuous Improvement
Part 3: Live Demo – Health BI HVBP App
Part 4: Summary / Q&A

26. 26
Health BI: Overview
OthersEMR PMS/RCM Lab Pharmacy RIS/PACS
 Comprehensive list of Apps for healthcare
BI / analytics – across
hospitals, physician practices, ACOs and
HIEs
 BI-Clinical Rules Engine to address
business critical needs – including
HVBP, ACO analytics, population health
analytics, re-admission and utilization
management
 600+ pre-built measures across
regulatory initiatives -
PQRS, JCAHO/JCI, NCQA HEDIS, PCMH
 Deployment options available on both
on-premise and cloud-based
deployment models
Serving over 1,200 provider sites – most
widely deployed 3rd party ONC-ATCB 2011-
12 certified BI/Analytics platform

27. 27
Health BI HVBP App: Demo
Live Demo

28. 28
Health BI: HEDIS
Status
ABA Adult BMI Assessment PASS
WCC
Weight Assessment and Counseling for Nutrition and Physical Activity for
Children/Adolescents PASS
CIS Childhood Immunization Status PASS
IMA Immunizations for Adolescents PASS
HPV Human Papillomavirus Vaccine for Female Adolescents PASS
LSC Lead Screening in Children PASS
BCS Breast Cancer Screening PASS
CCS Cervical Cancer Screening PASS
COL Colorectal Cancer Screening PASS
CHL Chlamydia Screening in Women PASS
GSO Glaucoma Screening in Older Adults PASS
COA Care for Older Adults PASS
CWP Appropriate Testing for Children With Pharyngitis PASS
URI Appropriate Treatment for Children With Upper Respiratory Infection PASS
AAB Avoidance of Antibiotic Treatment in Adults With Acute Bronchitis PASS
SPR Use of Spirometry Testing in the Assessment and Diagnosis of COPD PASS
PCE Pharmacotherapy Management of COPD Exacerbation PASS
ASM Use of Appropriate Medications for People With Asthma PASS
MMA Medication Management for People With Asthma PASS
AMR Asthma Medication Ratio PASS
CMC Cholesterol Management for Patients With Cardiovascular Conditions PASS
CBP Controlling High Blood Pressure PASS
PBH Persistence of Beta-Blocker Treatment After a Heart Attack PASS
CDC Comprehensive Diabetes Care PASS
ART Disease-Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis PASS
OMW Osteoporosis Management in Women Who Had a Fracture PASS
LBP Use of Imaging Studies for Low Back Pain PASS
AMM Antidepressant Medication Management PASS
ADD Follow-Up Care for Children Prescribed ADHD Medication PASS
FUH Follow-Up After Hospitalization for Mental Illness PASS
SSD
Diabetes Screening for People With Schizophrenia of Bipolar Disorder Who Are Using
Antipsychotic Medications PASS
SMD Diabetes Monitoring for People With Diabetes and Schizophrenia PASS
SMC Cardiovascular Monitoring for People With Cardiovascular Diseases and Schizophrenia PASS
SAA Adherence to Antipsychotic Medications for Individuals With Schizophrenia PASS
MPM Annual Monitoring for Patients on Persistent Medications PASS
MEASURE
Status
MRP Medication Reconciliation Post-Discharge PASS
DDE Potentially Harmful Drug-Disease Interactions in the Elderly PASS
DAE Use of High-Risk Medications in the Elderly PASS
AAP Adults’ Access to Preventive/Ambulatory Health Services PASS
CAP Children and Adolescents’ Access to Primary Care Practitioners PASS
ADV Annual Dental Visit PASS
IET Initiation and Engagement of Alcohol and Other Drug Dependence PASS
PPC Prenatal and Postpartum Care PASS
FPC Frequency of Ongoing Prenatal Care PASS
W15 Well-Child Visits in the First 15 Months of Life PASS
W34 Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life PASS
AWC Adolescent Well-Care Visits PASS
FSP Frequency of Selected Procedures PASS
AMB Ambulatory Care PASS
IPU Inpatient Utilization—General Hospital/Acute Care PASS
IAD Identification of Alcohol and Other Drug Services PASS
MPT Mental Health Utilization PASS
ABX Antibiotic Utilization PASS
PCR Plan All-Cause Readmissions PASS
RDI Relative Resource Use for People With Diabetes PASS
RAS Relative Resource Use for People With Asthma PASS
RCA Relative Resource Use for People With Cardiovascular Conditions PASS
RHY Relative Resource Use for People With Hypertension PASS
RCO Relative Resource Use for People With COPD PASS
ENP Enrollment by Product Line PASS
EBS Enrollment by State PASS
LDM Language Diversity of Membership PASS
RDM Race/Ethnicity Diversity of Membership PASS
WOP Weeks of Pregnancy at Time of Enrollment PASS
TLM Total Membership PASS
CPA CAHPS 5.0H Adult Survey Layout PASS
CPC CAHPS 5.0H Child Survey Layout PASS
CCC Children With Chronic Conditions Layout PASS
MEASURE

29. 29
Agenda
Part 1: HVBP Overview
 Introduction and Timeline
 Measure Coverage
Part 2: HVBP Calculation
 Performance Score and Incentive Calculations
 Achieving Continuous Improvement
Part 3: Live Demo – Health BI HVBP App
Part 4: Summary / Q&A

30. 30
Summary
 The best performing hospitals win the $ share of poor performing hospitals - (e.g. for FY’13
TREASURE VALLEY HOSPITAL earned 83% more & AUBURN COMMUNITY HOSPITAL earned 90%
less than usual MS-DRG payment)
 The incentives / penalties depend not only on your performance, but all the hospitals in the
country; the achievement thresholds and benchmarks may rise every year
 Health BI provides analytics capabilities to help hospitals track their current scores vis-à-vis
thresholds and benchmarks, identify improvement areas and thus maximize future incentives by
continuous improvement.
 Health BI provides What-If capabilities around calculating incentives / penalties; a user can
modify performance / domain scores and see its financial impact
 Being HEDIS 2013 certified gives Health BI a distinct edge; large hospitals could attractively
position their health plans to local employers

31. Business Contacts: Martin Sizemore
Director, Healthcare Strategy, Perficient Inc.
Dennis Swarup
Vice President, BI Practice, CitiusTech Inc.
U: www.citiustech.com
E: Dennis.Swarup@Citiustech.com
Q&AContact us to learn more
about how our Health BI / BI-
Clinical solution can help
your ACO quality reporting
and analytics requirements.
U: www.perficient.com
E: Martin.Sizemore@perficient.com

32. 32
Thank You