From: Marsha FretwellTo: Kay ZwanSubject: letterDate: Wednesday, April 22, 2015 6:31:56 PM

Dear Ms Hogans, It is with great pleasure that I write you this letter of recommendation in support of Kay Zwan's application for the position of Senior Manager, Patient Advocacy at Molnlycke Health Care. I recruited and worked closely with Ms. Zwan from 2011- 2014, the entire time she was the PACE Program Director and Center Manager at Elderhaus PACE in Wilmington, NC. What makes her stand apart is the very powerful combination of heart and mind that she brings to every situation. The position title: Senior Manager, Patient Advocacy indicates that you are looking for a very special individual who has effectively integrated organizational and communication skills with a focused but creative vision and always operates from a fundamental loving concern for others, especially those who are vulnerable or suffering. That is exactly how I want to describe Kay Zwan.

I first met Kay in 2008 when she was out in the community recruiting volunteers to work with her for national health care reform. We traveled to the Capitol in Washington DC and together lobbied all of our representatives from NC and many others. I came to reform as a physician specializing in medical care of frail older folks; her experience was closer, as she had directly experienced the health care system through the life threatening illnesses of her husband and son. They are both thriving today, I believe, because they had Kay Zwan as their patient advocate.

At the PACE site, she managed the Day Center where frail older nursing home eligible patients came daily instead of being placed in a nursing home. From the participants, their families, the nursing aides , dietary aides, transportation drivers up to and including the professionals who made up the clinical interdisciplinary team, she was unfailingly supportive, honest and fair. Yet, she in fact was the only person on the leadership staff who actually held everyone accountable for their responsibilities. Her first management task was to cut back hours of service to families over utilizing hours of home care. She, understanding quickly the functional model I had established at the Program, made a groundbreaking suggestion. Why not use the functional measures we were already collecting to create a Homecare Functional Assessment Tool that we could objectively apply to each participant to determine how many hours they actually needed. Using this Tool, she had conversations with each family, educating them on this approach to assigning hours of care and everyone cooperated with the reduction in hours without appealing the decision to the State.

In addition to her skills at patient and staff advocacy, she demonstrated an extraordinary ability to work with surveyors, regulators, health governing bodies and payers. She quickly moved to a leadership position in the NC PACE Association (includes all 10 of the PACE sites in NC) as the "go-to" person when there needed to be some difficult negotiation with the groups mentioned above. She was able to operate from a place of respect and true understanding that these individuals had a job to do. This thoughtful posture allowed her to negotiate some important changes in policy.

From my perspective as the Medical Director and based on 30 years in solo practice caring for older folks, I strongly feel that trusting relationships are the true unit of production

in our health care industry. It is through trusting relationships that people begin to take responsibility for their health rather than expecting others to create health for them. The interdisciplinary team functions optimally through trust especially as they are making cost effective resource decisions with participants and their families. And, of course, the leadership and finance team must trust the clinical team as they distribute costly resources. Kay, more than anyone on the management team actively demonstrated trust as she worked with every other employee in the Program. Though not a clinician herself, her respect and active listening skills enabled her to problem solve around social and medical issues as if she were a clinician. In fact, she came to understand the theory and practice of Patient Centered Functional Care Plans better than almost anyone that I have mentored in the last 30 years.

I believe Kay Zwan can and will effectively build and execute MHC's strategy for engaging Patients, Patient Advocacy organizations, Provider Associations and all other stakeholders. Most importantly, she will do so with integrity. She has demonstrated unmatched effectiveness in her compassionate advocacy, an empowering style of leadership for her staff and a trustworthy,collegiate style when negotiating with her peers. She is creative, always looking for the possibility in the situation that is not obvious. I am honored to give her my highest recommendation and would be pleased to speak with you if other information is needed.

Sincerely yours,Marsha D. Fretwell, MDPACE Medical Director, Emeritus78 Charlyn DriveAsheville, NC 28803910-262-4347