Dr.

Raymond Zastrow
President

555 S. 108th St.

West Allis, WI
53214-1145
tel 414.566.3000
888.700.7633
December 4, 2009 fax 414.566.3866
raymond.zastrow@quad-med.com

US Senate
Washington DC 20015

Dear Senators:

We offer this letter of support for the proposed Freshman Cost Containment Package of
Amendments to the Patient Protection and Affordable Care Act currently under consideration in
the US Senate. We speak for Quad/Graphics, an employer with significant experience not only
funding but delivering care for employees and their dependents on-site, placing a special
emphasis on primary care, prevention and chronic condition management. In many ways
Quad/Graphics’ QuadMed story is that of one employer deciding to mange health-care in a
fashion similar to other aspects of its supply chain, and with staggeringly positive results. We
can attest to the power of value-based purchasing when married to a patient-centered care
delivery model that emphasizes financial stewardship and accountability for quality outcomes.

Therefore, we strongly support broader delivery system reforms such as the Accountable Care
Organization (ACO) model that will move the US away from paying for the provision of units of
health-care delivery, and that instead incentivizes hospitals and doctors to drive towards healthy
populations. We believe this will be as applicable to the Medicare population as it will be to all
sectors of the health-care market. Finally, we strongly support modernizing the health-care
information infrastructure including Tele-health applications built upon a robust national Health
Information Exchange (HIE) backbone that incorporates interoperable Electronic Health Records
(EHRs), as this will significantly break down barriers to access, especially in rural and other
under-served settings.

Sincerely,

Joel Quadracci.
President and CEO
Quad/Graphics

Raymond J. Zastrow, M.D.

President
QuadMed

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