Document:

<PAGE>

                                                                   EXHIBIT 10.12

              ----------------------------------------------------

                          REGISTRATION RIGHTS AGREEMENT

                                      among

                       CARE MANAGEMENT SCIENCE CORPORATION

                            J. H. WHITNEY III, L.P.,

                      WHITNEY STRATEGIC PARTNERS III, L.P.,

                        FOUNDATION HEALTH SYSTEMS, INC.,

                                DAVID J. BRAILER,

                                RONALD A. PAULUS,

                                  BRENT MILNER,

                            ZEKE INVESTMENT PARTNERS,

                                       and

                              WILLIAM WINKENWERDER

                          -----------------------------

                          Dated as of December 23, 1998

                          -----------------------------

<PAGE>

                                TABLE OF CONTENTS
<TABLE>
<CAPTION>

                                                                               Page

<S>      <C>                                                                    <C>
1.       Definitions.............................................................1

2.       Securities Subject to this Agreement....................................4

         (a)      Registrable Securities.........................................4
         (b)      Holders of Registrable Securities..............................4

3.       Demand Registration.....................................................5

         (a)      Request for Demand Registration................................5
         (b)      Effective Demand Registration..................................5
         (c)      Expenses.......................................................6
         (d)      Underwriting Procedures........................................6
         (e)      Selection of Underwriters......................................6

4.       Piggy-Back Registration.................................................7

         (a)      Piggy-Back Rights..............................................8
         (b)      Priority of Registrations......................................8
         (c)      Expenses.......................................................8

5.       Holdback Agreements.....................................................9

         (a)      Restrictions on Public Sale by Holders.........................9
         (b)      Restrictions on Public Sale by the Company.....................9

6.       Registration Procedures.................................................9

         (a)      Obligations of the Company.....................................9
         (b)      Seller Information............................................12
         (c)      Notice to Discontinue.........................................12
         (d)      Sale to Underwriter...........................................13

7.       Registration Expenses..................................................13

8.       Indemnification; Contribution..........................................14

         (a)      Indemnification by the Company................................14
         (b)      Indemnification by Holders....................................14
         (c)      Conduct of Indemnification Proceedings........................14
         (d)      Contribution..................................................15

9.       Rule 144; Other Exemptions.............................................16

</TABLE>

<PAGE>

                                TABLE OF CONTENTS
                                   (continued)

<TABLE>
<CAPTION>

                                                                               Page

<S>      <C>                                                                    <C>
10.      Certain Limitations on Registration Rights.............................16

11.      Miscellaneous..........................................................16

         (a)      Recapitalizations, Exchanges, etc.............................16
         (b)      No Inconsistent Agreements; Other Registration Rights.........16
         (c)      Remedies......................................................17
         (d)      Amendments and Waivers........................................17
         (e)      Notices.......................................................17
         (f)      Successors and Assigns........................................18
         (g)      Counterparts..................................................18
         (h)      Headings......................................................18
         (i)      Governing Law.................................................18
         (j)      Jurisdiction..................................................19
         (k)      Severability..................................................19
         (l)      Rules of Construction.........................................19
         (m)      Entire Agreement..............................................19
         (n)      Further Assurances............................................19

</TABLE>

                                      -ii-

<PAGE>

                          REGISTRATION RIGHTS AGREEMENT

                  THIS REGISTRATION RIGHTS AGREEMENT (the "AGREEMENT"), dated as
of December 23, 1998, among CARE MANAGEMENT SCIENCE CORPORATION, a Pennsylvania
corporation (the "COMPANY"), J. H. WHITNEY III, L.P., a Delaware limited
partnership ("JHW"), WHITNEY STRATEGIC PARTNERS III, L.P., a Delaware limited
partnership ("WSP", together with JHW, collectively referred to herein as
"WHITNEY") FOUNDATION HEALTH SYSTEMS, INC., a Delaware corporation ("FHS"),
DAVID J. BRAILER, RONALD A. PAULUS (David J. Brailer and Ronald A. Paulus
collectively referred to as the "MANAGEMENT STOCKHOLDERS"), BRENT MILNER,
WILLIAM WINKENWERDER and ZEKE INVESTMENT PARTNERS, a Pennsylvania partnership
(Brent Milner, William Winkenwerder and Zeke Investment Partners collectively
referred to as the "INDIVIDUAL INVESTORS").

                  This Agreement is made in connection with (i) the Stock
Purchase Agreement (the "PURCHASE AGREEMENT"), dated as of the date hereof,
among the Company, Whitney and the Individual Investors relating to the
acquisition by Whitney and the Individual Investors of an aggregate of 2,366,947
shares of Series C Convertible Preferred Stock, no par value, of the Company
(the "SERIES C CONVERTIBLE PREFERRED") for an aggregate purchase price of
$6,175,000.00 and (ii) the Exchange Agreement, dated as of the date hereof,
between FHS and the Company, pursuant to which FHS has agreed to restructure its
existing investment in the Company in return for 994,000 shares of Series D
Convertible Preferred Stock, no par value, of the Company (the "SERIES D
CONVERTIBLE PREFERRED"), 1,658,004 shares of Series E Convertible Preferred
Stock, no par value, of the Company (the "SERIES E CONVERTIBLE PREFERRED") and
1,560,000 shares of Series G Redeemable Preferred Stock, no par value, of the
Company (the "SERIES G REDEEMABLE PREFERRED").

                  The Company, FHS and the Management Stockholders are parties
to a Registration Rights Agreement, dated September 8, 1995, as amended on
September 6, 1996 (the "1995 AGREEMENT"). In order to induce Whitney to enter
into the Purchase Agreement, (i) the Company, FHS and the Management
Stockholders have agreed, among other things, to terminate the 1995 Agreement
and (ii) the Company has agreed to provide registration rights with respect to
the Registrable Securities (as hereinafter defined) as set forth in this
Agreement.

                  The parties hereby agree as follows:

                  1. DEFINITIONS. As used in this Agreement, and unless the
context requires a different meaning, the following terms have the meanings
indicated:

                     "1995 AGREEMENT" has the meaning assigned such term in the
third paragraph of this Agreement.

                     "ACT" means the Securities Act of 1933, as amended, and the
rules and regulations of the SEC promulgated thereunder.

<PAGE>

                     "APPROVED UNDERWRITER" has the meaning assigned such term
in Section 3(e).

                     "APPROVED UNDERWRITER AMOUNT" has the meaning assigned such
term in Section 3(d).

                     "BUSINESS DAY" means any day other than a Saturday, Sunday
or other day on which commercial banks in the City of New York are authorized or
required by law or executive order to close.

                     "COMMON STOCK" means the Common Stock, no par value, of the
Company, or any other capital stock of the Company into which such stock is
reclassified or reconstituted.

                     "COMPANY UNDERWRITER" has the meaning assigned such term in
Section 4(a).

                     "DEMAND REGISTRATION" has the meaning assigned such term in
Section 3(a).

                     "DESIGNATED HOLDER" means Whitney, FHS, the Management
Stockholders, the Individual Investors and any of their respective transferees
to whom Registrable Securities have been transferred other than the transferee
to whom such securities have been transferred pursuant to a registration
statement under the Act or Rule 144 under the Act; provided, that, for purposes
of Section 3(a) hereof, the transferees of any Designated Holder shall only be
entitled to exercise that Designated Holder's Demand Registration (if not
already exercised by such Designated Holder) as a group.

                     "EXCHANGE ACT" means the Securities and Exchange Act of
1934, as amended, and the rules and regulations of the SEC thereunder.

                     "HOLDER" has the meaning assigned such term in Section
2(b).

                     "HOLDERS' COUNSEL" means (a) with respect to any Demand
Registration that has been requested pursuant to Section 3, the one counsel
selected by the Initiating Holder in such registration and (b) with respect to a
request for registration of Registrable Securities pursuant to Section 4, the
one counsel selected by the Holders holding a majority of the Registrable
Securities held by all Holders being registered in such registration.

                     "INDEMNIFIED PARTY" has the meaning assigned such term in
Section 8(c).

                     "INDEMNIFYING PARTY" has the meaning assigned such term in
Section 8(c).

                                       2
<PAGE>

                     "INITIAL PUBLIC OFFERING" shall mean the sale in an
underwritten offering by the Company of its capital stock pursuant to a
registration statement on Form S-1 or otherwise under the Act.

                     "INITIATING HOLDER" has the meaning assigned to such term
in Section 3(a).

                     "INSPECTOR" has the meaning assigned such term in Section
6(a)(viii).

                     "NASD" has the meaning assigned such term in Section
6(a)(xv).

                     "PERSON" means any individual, firm, corporation,
partnership, trust, incorporated or unincorporated association, joint venture,
joint stock company, government (or an agency or political subdivision thereof)
or other entity of any kind, and shall include any successor (by merger or
otherwise) of any such entity.

                     "PURCHASE AGREEMENT" has the meaning assigned such term in
the second paragraph of this Agreement.

                     "REGISTRABLE SECURITIES" means, subject to Section 2(a),
each of the following: (a) any shares of Common Stock issued or issuable upon
conversion or in exchange for shares of the Series C Convertible Preferred,
Series D Convertible Preferred or Series E Convertible Preferred; (b) any shares
of Common Stock held by the Management Stockholders or any of their respective
permitted transferees; and (c) any shares of Common Stock issued or issuable in
respect of shares of Common Stock issued, issuable or held pursuant to clause
(a) or (b) above by way of a stock dividend or stock split or in connection with
a combination of shares, recapitalization, merger, consolidation or other
reorganization or otherwise.

                     "REGISTRATION EXPENSES" has the meaning assigned such term
in Section 7.

                     "RULE 144" means Rule 144 under the Act (or any similar
rule adopted after the date hereof).

                     "SEC" means the Securities and Exchange Commission.

                     "SERIES C CONVERTIBLE PREFERRED" has the meaning assigned
such term in the second paragraph of this Agreement and is further defined to
include any other capital stock of the Company into which such stock is
reclassified or reconstituted.

                     "SERIES D CONVERTIBLE PREFERRED" means the Series D
Convertible Preferred Stock, no par value, of the Company (or any warrants to
purchase such stock), or any other capital stock of the Company into which such
stock is reclassified or reconstituted.

                     "SERIES E CONVERTIBLE PREFERRED" means the Series E
Convertible Preferred Stock, no par value, of the Company (or any warrants to
purchase such stock), or any other capital stock of the Company into which such
stock is reclassified or reconstituted.

                                       3
<PAGE>

                     "SERIES F REDEEMABLE PREFERRED" means the Series F
Redeemable Preferred Stock, no par value, of the Company (or any warrants to
purchase such stock), or any other capital stock of the Company into which such
stock is reclassified or reconstituted.

                     "SERIES G REDEEMABLE PREFERRED" means the Series G
Redeemable Preferred, no par value, of the Company.

                     "SERIES PREFERRED" means, collectively, the Series C
Convertible Preferred, Series D Convertible Preferred, Series E Convertible
Preferred, Series F Redeemable Preferred and Series G Redeemable Preferred.

                     "SHARES" means the Common Stock, the Series Preferred, any
class of common stock of the Company authorized after the date of this Agreement
and any other class of stock resulting from successive changes or
reclassifications of the Shares.

                     "SHAREHOLDERS' AGREEMENT" means the Shareholders'
Agreement, dated the date hereof, among the Company, Whitney, FHS, the
Management Stockholders and the Individual Investors.

                     "TOTAL SECURITIES" has the meaning assigned such term in
Section 4(a).

                     "UNDERWRITERS" has the meaning assigned such term in
Section 6(d).

                     "VALID BUSINESS REASON" has the meaning assigned such term
in Section 3(f).

                     "WHITNEY DIRECTOR" means a person appointed by Whitney to
the Board of Directors of the Company pursuant to the Shareholders' Agreement.

               2.    SECURITIES SUBJECT TO THIS AGREEMENT.

                     (a) REGISTRABLE SECURITIES. For the purposes of this
Agreement, Registrable Securities will cease to be Registrable Securities when
(i) a registration statement covering such Registrable Securities has been
declared effective under the Act by the SEC and such Registrable Securities have
been disposed of pursuant to such effective registration statement or (ii) the
entire amount of Registrable Securities proposed to be sold in a single sale are
or, in the opinion of counsel satisfactory to the Company and the Holder, each
in their reasonable judgment, may, be distributed to the public pursuant to Rule
144 in compliance with the requirements of paragraphs (c), (e), (f) and (g) of
Rule 144 (notwithstanding the provisions of paragraph (k) of such Rule) (or any
successor provision then in effect) under the Act.

                     (b) HOLDERS OF REGISTRABLE SECURITIES. A Person is deemed
to be a holder of Registrable Securities (a "HOLDER") whenever such Person (i)
is a party to this Agreement (or a permitted transferee of such party that has
become a party hereto) and (ii) owns of record Registrable Securities, or holds
a security convertible into or exercisable or exchangeable for, Registrable
Securities, whether or not such purchase or conversion has actually been
effected and disregarding any legal restrictions upon the exercise of such
rights. If

                                       4
<PAGE>

the Company receives conflicting instructions, notices or elections from two or
more persons with respect to the same Registrable Securities, the Company may
act upon the basis of the instructions, notice or election received from the
registered owner of such Registrable Securities. Registrable Securities issuable
upon conversion of another security shall be deemed outstanding for the purposes
of this Agreement.

               3.    DEMAND REGISTRATION.

                     (a) REQUEST FOR DEMAND REGISTRATION. Subject to Section
3(f) below, at any time after 6 months from the date of the consummation of an
Initial Public Offering, each of the Designated Holders (other than the
Individual Investors who, for purposes of this Section 3, shall be deemed to be
part of any Demand Registration in which Whitney is the Initiating Holder) (each
an "INITIATING HOLDER") shall have the right to make one request in writing that
the Company register Registrable Securities under the Act, and under the
securities or blue sky laws of any jurisdiction designated by such holder or
holders (each such registration under this Section 3(a) that satisfies the
requirements set forth in Section 3(b) is referred to herein as a "DEMAND
REGISTRATION"); PROVIDED, HOWEVER, that the Management Stockholders shall only
be entitled to one demand right as a group. Notwithstanding the foregoing, in no
event shall the Company be required to effect more than three Demand
Registrations. Each request for a Demand Registration by an Initiating Holder in
respect thereof shall specify the amount of the Registrable Securities proposed
to be sold, the intended method of disposition thereof and the jurisdictions in
which registration is desired. Upon a request for a Demand Registration, the
Company shall promptly take such steps as are necessary or appropriate to
prepare for the registration of the Registrable Securities to be registered.
Within fifteen (15) days after the receipt of such request, the Company shall
give written notice thereof to all other Designated Holders and include in such
registration all Registrable Securities held by a Designated Holder from whom
the Company has received a written request for inclusion therein at least ten
(10) days prior to the filing of the registration statement. Each such request
will also specify the number of Registrable Securities to be registered, the
intended method of disposition thereof and the jurisdictions in which
registration is desired. Subject to Section 3(d), the Company shall be entitled
to include in any registration statement and offering made pursuant to a Demand
Registration, authorized but unissued shares of Common Stock, shares of Common
Stock held by the Company as treasury shares or shares of Common Stock held by
stockholders other than the Designated Holders; PROVIDED, that such inclusion
shall be permitted only to the extent that it is pursuant to and subject to the
terms of the underwriting agreement or arrangements, if any, entered into by the
Initiating Holder exercising the Demand Registration rights.

                     (b) EFFECTIVE DEMAND REGISTRATION. The Company shall use
its best efforts to cause any Demand Registration to become effective not later
than ninety (90) days after it receives a request under Section 3(a). A
registration requested pursuant to Section 3(a) hereof shall not count as the
demand to which the Designated Holders are entitled thereunder unless such
registration statement is declared effective and remains effective for at least
the lesser of (i) such time as all Registrable Securities covered by such
registration statement have been disposed of in accordance with such
registration statement or (ii) ninety (90) days.

                                       5
<PAGE>

                     (c) EXPENSES. In any registration initiated as a Demand
Registration, the Company shall pay all Registration Expenses in connection
therewith, whether or not such requested Demand Registration becomes effective.

                     (d) UNDERWRITING PROCEDURES. If the Initiating Holder to
which the requested Demand Registration relates so elects, the offering of such
Registrable Securities pursuant to such requested Demand Registration shall be
in the form of a firm commitment underwritten offering and the managing
underwriter or underwriters selected for such offering shall be the Approved
Underwriter selected in accordance with Section 3(e). In such event, if the
Approved Underwriter advises the Company in writing that, in its opinion, the
aggregate amount of such Registrable Securities requested to be included in such
offering (including those securities requested by the Company to be included in
such registration) is sufficiently large to have an adverse effect on the
success of such offering, then the Company shall include in such registration
only the aggregate amount of Registrable Securities that in the opinion of the
Approved Underwriter may be sold without any such effect on the success of such
offering (the "APPROVED UNDERWRITER AMOUNT"), and (i) all Registrable Securities
that the Initiating Holder proposes to register (including, in the case of
Whitney, Registrable Securities held by the Individual Investors) shall be
included in the registration up to the Approved Underwriter Amount, (ii) to the
extent that the number of Registrable Securities to be included by the
Initiating Holder is less than the Approved Underwriter Amount, securities
proposed to be registered by the Designated Holders (other than the Initiating
Holder) shall be included ratably in the registration based on the amounts of
Registrable Securities sought to be registered by such Designated Holders in
their request for participation in the Demand Registration and (iii) to the
extent that the number of Registrable Securities to be included under clauses
(i) and (ii) above is less than the Approved Underwriter Amount, securities that
the Company proposes to register shall also be included in the registration.

                     If, as a result of the proration provision of this Section
3(d), any Designated Holder shall not be entitled to include all Registrable
Securities in a registration that such Designated Holder has requested to be
included in, such Designated Holder may elect to withdraw his request to include
Registrable Securities in such registration or may reduce the number requested
to be included; PROVIDED, HOWEVER, that (x) such request must be made in writing
prior to the earlier of the execution of the underwriting agreement or the
execution of the custody agreement with respect to such registration and (y)
such withdrawal or reduction shall be irrevocable.

                     (e) SELECTION OF UNDERWRITERS. If any requested Demand
Registration is in the form of an underwritten offering, the Initiating Holder
shall select and obtain an investment banking firm of national reputation to act
as the managing underwriter of the offering (the "APPROVED UNDERWRITER");
PROVIDED that such underwriter shall be reasonably satisfactory to a majority of
the Designated Holders (other than the Initiating Holders) and the Company.

                     (f) LIMITATIONS ON DEMAND REGISTRATIONS. The Demand
Registration rights granted to the Designated Holders in Section 3(a) are
subject to the following limitations: (i) each registration in respect of a
Demand Registration must include Registrable Securities having an aggregate
market value of at least [$5,000,000], which market value shall be determined by
multiplying the number of Registrable Securities to be included in the Demand

                                       6
<PAGE>

Registration by the proposed per share offering price; PROVIDED that the
limitation set forth in this clause (i) shall not be in effect at any time the
Designated Holders' Registrable Securities are not able to be sold under Rule
144 under the Act because of the Company's failure to comply with the
information requirements thereunder, unless at such time, the Company's outside
counsel (which shall be reasonably acceptable to the Designated Holders
requesting such registration) delivers a written opinion of counsel to such
Designated Holders to the effect that such Designated Holders' Registrable
Securities may be publicly offered and sold without registration under the Act;
(ii) the Company shall not be required to cause a registration pursuant to
Section 3(a) to be declared effective within a period of 150 days after the
effective date of any registration statement of the Company effected in
connection with a Demand Registration; and (iii) if the Board of Directors of
the Company, in its good faith judgment, determines that any registration of
Registrable Securities should not be made or continued because it would
materially interfere with any material financing, acquisition, corporate
reorganization or merger or other transaction involving the Company or any of
its subsidiaries (a "VALID BUSINESS REASON"), the Company may (x) postpone
filing a registration statement relating to a Demand Registration until such
Valid Business Reason no longer exists, but in no event for more than ninety
(90) days, and (y) in case a registration statement has been filed relating to a
Demand Registration, if the Valid Business Reason has not resulted from actions
taken by the Company, the Company, upon the approval of a majority of the
Company's Board of Directors, may cause such registration statement to be
withdrawn and its effectiveness terminated or may postpone amending or
supplementing such registration statement. The Company shall give written notice
of its determination to postpone or withdraw a registration statement under
Section 3(f)(iii) and of the fact that the Valid Business Reason for such
postponement or withdrawal no longer exists, in each case, promptly after the
occurrence thereof. Notwithstanding anything to the contrary contained herein,
the Company may not postpone or withdraw a filing under Section 3(f)(iii) hereof
more than once in any twelve-month period.

                     Each Holder of Registrable Securities agrees that, upon
receipt of any notice from the Company that the Company has determined to
withdraw any registration statement pursuant to clause (iii) above, such Holder
will discontinue its disposition of Registrable Securities pursuant to such
registration statement and, if so directed by the Company, will deliver to the
Company (at the Company's expenses) all copies, other than permanent file
copies, then in such Holder's possession, of the prospectus covering such
Registrable Securities that was in effect at the time of receipt of such notice.
If the Company shall give any notice of postponement or withdrawal of a
registration statement, the Company shall, at such time as the Valid Business
Reason that caused such postponement or withdrawal no longer exists (but in no
event later than ninety (90) days after the date of the postponement), use its
best efforts to promptly effect the registration under the Act of the
Registrable Securities covered by the postponed or withdrawn registration
statement in accordance with this Section 3 (unless the Designated Holder(s)
delivering the Demand Registration request shall have withdrawn such request, in
which case the Company shall not be considered to have effected an effective
registration for the purposes of this Agreement), and such registration shall
not be postponed or withdrawn pursuant to clause (iii) above.

               4.    PIGGY-BACK REGISTRATION.

                                       7
<PAGE>

                     (a) PIGGY-BACK RIGHTS. If the Company proposes to file a
registration statement under the Act with respect to an offering by the Company
for its own account of any class of security (other than a registration
statement on Form S-4 or S-8 (or any successor form thereto)) under the Act,
then the Company shall give written notice of such proposed filing to each of
the Holders at least twenty (20) days before the anticipated filing date, and
such notice shall describe in detail the proposed registration and distribution
(including those jurisdictions where registration under the securities or blue
sky laws is intended) and offer such Holders the opportunity to register the
number of Registrable Securities as each such Holder may request. The Company
shall use its best efforts (within ten (10) days of the notice provided for in
the preceding sentence) to permit the Holders who have requested to participate
in the registration for such offering to include such Registrable Securities in
such offering on the same terms and conditions as the securities of the Company
included therein. Notwithstanding the foregoing, if such registration involves
an underwritten offering and the managing underwriters or underwriters (the
"COMPANY UNDERWRITER") shall advise the Holders of Registrable Securities in
writing that, in its opinion, the total amount of securities requested to be
included in such offering (the "TOTAL SECURITIES") is sufficiently large so as
to have an adverse effect on the success of the distribution of the Total
Securities, then the Company shall include in such registration, to the extent
of the number of securities which the Company is so advised can be sold in (or
during the time of) such offering, FIRST, all securities that the Company
proposes to register, and, SECOND the securities proposed to be included in such
registration by all Holders pro rata among them, and, THIRD, all other
securities proposed to be registered. Notwithstanding anything in this Section 4
to the contrary, the Company shall not be required to include any Registrable
Securities in its Initial Public Offering.

                     (b) PRIORITY OF REGISTRATIONS. Subject to the provisions of
Section 3(f)(iii), if the Company proposes to register securities pursuant to
Section 4(a) hereof on the same day that the Designated Holders request a
registration pursuant to Section 3(a) hereof, then the Demand Registration
requested pursuant to Section 3(a) hereof shall be given priority.

                     (c) EXPENSES. The Company shall bear all Registration
Expenses in connection with any registration pursuant to this Section 4.

                     (d) CONDITIONS AND LIMITATIONS ON PIGGYBACK REGISTRATIONS.
If, at any time after giving written notice of its intention to register any
securities and prior to the effective date of the registration statement filed
in connection with such registration, the Company shall determine for any reason
not to register or to delay registration of such securities, the Company may, at
its election, give written notice of such determination to all Holders of record
of Registrable Securities and (i) in the case of a determination not to
register, shall be relieved of its obligation to register the Registrable
Securities in connection with such abandoned registration, without prejudice,
however, to the rights of Holders under Section 3, and (ii) in the case of a
determination to delay the registration of its securities, shall be permitted to
delay the registration of such Registrable Securities for the same period as the
delay in registering such other equity securities.

                     Any Holder shall have the right to withdraw its request for
inclusion of its Registrable Securities in any registration statement pursuant
to this Section 4 by giving the written notice to the Company of its request to
withdraw; PROVIDED, HOWEVER, that (i) such

                                       8
<PAGE>

request must be made in writing prior to the earlier of the execution of the
underwriting agreement or the execution of the custody agreement with respect to
such registration and (ii) such withdrawal shall be irrevocable and, after
making such withdrawal, a Holder shall no longer have any right to include
Registrable Securities in the registration as to which such withdrawal was made.

               5.    HOLDBACK AGREEMENTS.

                     (a) RESTRICTIONS ON PUBLIC SALE BY HOLDERS. To the extent
not inconsistent with applicable law, each Holder agrees not to effect any
public sale or distribution of any Registrable Securities being registered or of
any securities convertible into or exchangeable or exercisable for such
Registrable Securities, including a sale pursuant to Rule 144 under the Act,
during the seven (7) days prior to or the ninety (90) day period beginning on
the effective date of such Demand Registration or Piggy-Back Registration or
other underwritten offering (except as part of such registration), if and to the
extent requested by any other Holder, in the case of a non-underwritten public
offering, or if and to the extent requested by the Company Underwriter, in the
case of an underwritten public offering. To the extent not inconsistent with
applicable law, each Holder also agrees that, during the period of duration (not
to exceed 180 days) specified by the Company and an underwriter of Common Stock
in connection with an Initial Public Offering, following the effective date of a
registration statement of the Company filed under the Act relating to such
Initial Public Offering, it shall not, to the extent requested by the Company
and such underwriter, directly or indirectly sell, offer to sell, contract to
sell (including, without limitation, any short sale), grant any option to
purchase or otherwise transfer or dispose of (other than to donees who agree to
be similarly bound) any securities of the Company held by it at any time during
such period (except Registrable Securities included in such registration).

                     (b) RESTRICTIONS ON PUBLIC SALE BY THE COMPANY. The Company
agrees not to effect any public sale or distribution of any of its securities
for its own account (except pursuant to registrations on Form S-4 or S-8 (or any
successor form thereto) under the Act) during the ninety (90) day period
beginning on the effective date of any registration statement in which the
Holders are participating (except to the extent that such sale or distribution
is made pursuant to such registration).

               6.    REGISTRATION PROCEDURES.

                     (a) OBLIGATIONS OF THE COMPANY. Whenever registration of
Registrable Securities has been requested pursuant to Section 3 or 4 of this
Agreement, the Company shall use its best efforts to effect the registration and
sale of such Registrable Securities in accordance with the intended method of
distribution thereof as quickly as practicable, and in connection with any such
request, the Company shall, as expeditiously as possible:

                         (i) prepare and file with the SEC (in any event not
later than sixty (60) Business Days after receipt of a request to file a
registration statement with respect to Registrable Securities) a registration
statement on any form on which registration is requested for which the Company
then qualifies, which counsel for the Company and Holders' Counsel shall deem
appropriate and which shall be available for the sale of such Registrable
Securities in

                                       9
<PAGE>

accordance with the intended method of distribution thereof, and use its best
efforts to cause such registration statement to become effective; PROVIDED,
HOWEVER, that before filing a registration statement or prospectus or any
amendments or supplements thereto, the Company shall (A) provide Holders'
Counsel with an adequate and appropriate opportunity to participate in the
preparation of such registration statement and each prospectus included therein
(and each amendment or supplement thereto) to be filed with the SEC, which
documents shall be subject to the review of Holders' Counsel, and (B) notify
Holders' Counsel and each seller of Registrable Securities pursuant to such
registration statement of any stop order issued or threatened by the SEC and
take all reasonable action required to prevent the entry of such stop order or
to remove it if entered;

                         (ii) prepare and file with the SEC such amendments and
supplements to such registration statement and the prospectus used in connection
therewith as may be necessary to keep such registration statement effective and
to comply with the provisions of the Act with respect to the disposition of all
Registrable Securities covered by such registration statement until the earlier
of (a) such time as all of such Registrable Securities and other securities have
been disposed of in accordance with the intended methods of disposition by the
sellers thereof set forth in such registration statement and (b) 180 days after
the effective date of such registration statement, except with respect to any
such registration statement filed pursuant to Rule 415 (or any successor Rule)
under the Act if the Company is eligible to file a registration statement on
Form S-3, in which case such period shall be two (2) years;

                         (iii) as soon as reasonably possible, furnish to each
seller of Registrable Securities, prior to filing a registration statement,
copies of such registration statement as it is proposed to be filed, and
thereafter such number of copies of such registration statement, each amendment
and supplement thereto (in each case including all exhibits thereto), the
prospectus included in such registration statement (including each preliminary
prospectus) and such other documents as each such seller may reasonably request
in order to facilitate the disposition of the Registrable Securities owned by
such seller;

                         (iv) use its best efforts to register or qualify such
Registrable Securities under such other securities or blue sky laws of such
jurisdictions as any seller of Registrable Securities may request, and to
continue such qualification in effect in each such jurisdiction for as long as
is permissible pursuant to the laws of such jurisdiction, or for as long as any
such seller requests or until all of such Registrable Securities are sold,
whichever is shortest, and do any and all other acts and things which may be
reasonably necessary or advisable to enable any such seller to consummate the
disposition in such jurisdictions of the Registrable Securities owned by such
seller; PROVIDED, HOWEVER, that the Company shall not be required to (A) qualify
generally to do business in any jurisdiction where it would not otherwise be
required to qualify but for this Section 6(a)(iv), (B) subject itself to
taxation in any such jurisdiction or (C) consent to general service of process
in any such jurisdiction;

                         (v) use its best efforts to obtain all other approvals,
covenants, exemptions or authorizations from such governmental agencies or
authorities as may be necessary to enable the sellers of such Registrable
Securities to consummate the disposition of such Registrable Securities;

                                       10
<PAGE>

                         (vi) notify each seller of Registrable Securities at
any time when a prospectus relating thereto is required to be delivered under
the Act, upon discovery that, or upon the happening of any event as a result of
which, the prospectus included in such registration statement contains an untrue
statement of a material fact or omits to state any material fact required to be
stated therein or necessary to make the statements therein not misleading in
light of the circumstances under which they were made, and the Company shall
promptly prepare a supplement or amendment to such prospectus and furnish to
each such seller a reasonable number of copies of a supplement to or amendment
of such prospectus as may be necessary so that, after delivery to the purchasers
of such Registrable Securities, such prospectus shall not contain an untrue
statement of a material fact or omit to state any material fact required to be
stated therein or necessary to make the statements therein not misleading in
light of the circumstances under which they were made;

                         (vii) enter into and perform customary agreements
(including an underwriting agreement in customary form with the Approved
Underwriter or Company Underwriter, if any, selected as provided in Section 3 or
4; PROVIDED, that the underwriting agreement, if any, shall be reasonably
satisfactory in form and substance to the Company) and take such other actions
as are reasonably required in order to expedite or facilitate the disposition of
such Registrable Securities;

                         (viii) make available for inspection by any seller of
Registrable Securities, any managing underwriter participating in any
disposition pursuant to such registration statement, Holders' Counsel and any
attorney, accountant or other agent retained by any such seller or any managing
underwriter (each, an "INSPECTOR" and, collectively, the "INSPECTORS"), all
financial and other records, pertinent corporate documents and properties of the
Company and any subsidiaries thereof as may be in existence at such time
(collectively, the "RECORDS") as shall be reasonably necessary to enable them to
exercise their due diligence responsibility, and cause the Company's and any
subsidiaries' officers, directors and employees, and the independent public
accountants of the Company, to supply all information reasonably requested by
any such Inspector in connection with such registration statement; PROVIDED,
that such Inspector agrees to keep all such information confidential.

                         (ix) obtain a "cold comfort" letter from the Company's
independent public accountants in customary form and covering such matters of
the type customarily covered by "cold comfort" letters, as Holders' Counsel or
the managing underwriter reasonably request;

                         (x) furnish, at the request of any seller of
Registrable Securities on the date such securities are delivered to the
underwriters for sale pursuant to such registration or, if such securities are
not being sold through underwriters, on the date the registration statement with
respect to such securities becomes effective, an opinion, dated such date, of
counsel representing the Company for the purposes of such registration,
addressed to the underwriters, if any, and to the seller making such request,
covering such legal matters with respect to the registration in respect of which
such opinion is being given as such seller may reasonably request and as are
customarily included in such opinions;

                                       11
<PAGE>

                         (xi) otherwise use its best efforts to comply with all
applicable rules and regulations of the SEC, and make available to its security
holders, as soon as reasonably practicable but no later than fifteen (15) months
after the effective date of the registration statement, an earnings statement
covering a period of twelve (12) months beginning after the effective date of
the registration statement, in a manner which satisfies the provisions of
Section 11(a) of the Act;

                         (xii) cause all such Registrable Securities to be
listed on each securities exchange on which similar securities issued by the
Company are then listed (if any) if the listing of such Registrable Securities
is then permitted under the rules of such exchange or, if no similar securities
are then so listed, cause all such Registrable Securities to be listed on an
exchange on which the Initiating Holders request that such Registrable
Securities be listed, subject to the satisfaction of the applicable listing
requirements of each such exchange;

                         (xiii) keep each seller of Registrable Securities
advised in writing as to the initiation and progress of any registration under
Section 3 or 4 hereunder;

                         (xiv) provide officers' certificates and other
customary closing documents;

                         (xv) cooperate with each seller of Registrable
Securities and each underwriter participating in the disposition of such
Registrable Securities and their respective counsel in connection with any
filings required to be made with the National Association of Securities Dealers,
Inc. (the "NASD"); and

                         (xvi) use its best efforts to take all other steps
necessary to effect the registration of the Registrable Securities contemplated
hereby.

                     (b) SELLER INFORMATION. The Company may require as a
condition precedent of the Company's obligations under this Section 6 that each
seller of Registrable Securities as to which any registration is being effected
furnish to the Company such information regarding such seller and the
distribution of such securities as the Company may from time to time reasonably
request in writing.

                     (c) NOTICE TO DISCONTINUE. Each Holder agrees that, upon
receipt of any notice from the Company of the happening of any event of the kind
described in Section 6(a)(vi), such Holder shall forthwith discontinue
disposition of Registrable Securities pursuant to the registration statement
covering such Registrable Securities until such Holder's receipt of the copies
of the supplemented or amended prospectus contemplated by Section 6(a)(vi) and,
if so directed by the Company, such Holder shall deliver to the Company (at the
Company's expense) all copies, other than permanent file copies then in such
Holder's possession, of the prospectus covering such Registrable Securities
which is current at the time of receipt of such notice. If the Company shall
give any such notice, the Company shall extend the period during which such
registration statement shall be maintained effective pursuant to this Agreement
(including, without limitation, the period referred to in Section 6(a)(ii)) by
the number of days during the period from and including the date of the giving
of such notice pursuant to Section 6(a)(vi) to

                                       12
<PAGE>

and including the date when the Holder shall have received the copies of the
supplemented or amended prospectus contemplated by and meeting the requirements
of Section 6(a)(vi).

                     (d) SALE TO UNDERWRITER. Subject to the limitations on
inclusion of Registrable Securities in a registration under Sections 3(d) and
4(a), in lieu of converting any shares of Series C Convertible Preferred, Series
D Convertible Preferred or Series E Convertible Preferred into Registrable
Securities to be included in a registration under Section 3 or 4 prior to or
simultaneously with the filing or the effectiveness of any registration
statement filed pursuant thereto, the holder of such preferred stock may sell
such stock to the Approved Underwriter or the Company Underwriter, as the case
may be, and any other underwriters of the offering being registered
(collectively, the Approved Underwriter or Company Underwriter, as the case may
be, and such other underwriters, the "UNDERWRITERS") if the Underwriters consent
thereto and if the Underwriters undertake to convert such shares of Series C
Convertible Preferred, Series D Convertible Preferred or Series E Convertible
Preferred into Registrable Securities before making any distribution pursuant to
such registration statement and to include such Registrable Securities among the
Registrable Securities being offered pursuant to such registration statement.
Assuming timely delivery by the Holder of the Series C Convertible Preferred
certificates, Series D Convertible Preferred certificates or Series E
Convertible Preferred certificates to or for the account of the Underwriters,
the Company agrees to cause the relevant Registrable Securities to be issued so
as to permit the Underwriters to make and complete the distribution (including
the distribution of such Registrable Securities) contemplated by the
underwriting.

               7.    REGISTRATION EXPENSES. The Company shall pay all expenses
(other than underwriting discounts and commissions) arising from or incident to
the performance of, or compliance with, this Agreement, including, without
limitation, (a) SEC, stock exchange and NASD registration and filing fees, (b)
all fees and expenses incurred in complying with securities or blue sky laws
(including, without limitation, reasonable fees, charges and disbursements of
counsel in connection with blue sky qualifications of the Registrable
Securities), (c) all printing, messenger and delivery expenses, (d) the fees,
charges and disbursements of counsel to the Company and of its independent
public accountants and any other accounting and legal fees, charges and expenses
incurred by the Company (including, without limitation, any expenses arising
from any special audits incident to or required by any registration or
qualification) and (e) the reasonable fees, charges and expenses of any special
experts retained by the Company in connection with any requested Demand
Registration or Piggy-Back Registration pursuant to the terms of this Agreement,
regardless of whether the registration statement filed in connection with such
registration is declared effective. In connection with each registration
hereunder, the Company shall reimburse the Holders of Registrable Securities
being registered in such registration for the reasonable fees, charges and
disbursements of not more than one Holders' Counsel. All of the expenses
described in this Section 7 are referred to in this Agreement as "REGISTRATION
EXPENSES." Notwithstanding the foregoing provisions of this Section 7, in
connection with any registration hereunder, each Holder of Registrable
Securities being registered shall pay all underwriting discounts and commissions
and any capital gains, income or transfer taxes, if any, attributable to the
sale of such Registrable Securities, PRO RATA with respect to payments of
discounts and commissions in accordance with the number of shares sold in the
offering.

                                       13
<PAGE>

               8.     INDEMNIFICATION; CONTRIBUTION.

                     (a) INDEMNIFICATION BY THE COMPANY. In the event of any
proposed registration of securities of the Company pursuant to Section 3 or
Section 4, the Company agrees to indemnify and hold harmless each Holder, its
directors, officers, partners, employees, advisors and agents, and each Person
who controls (within the meaning of the Act or the Exchange Act) such Holder, to
the extent permitted by law, from and against any and all losses, claims,
damages, expenses (including, without limitation, reasonable costs of
investigation and fees, disbursements and other charges of counsel) or other
liabilities resulting from or arising out of or based upon any untrue, or
alleged untrue, statement of a material fact contained in any registration
statement, prospectus or preliminary prospectus or notification or offering
circular (as amended or supplemented if the Company shall have furnished any
amendments or supplements thereto) or arising out of or based upon any omission
or alleged omission to state therein a material fact required to be stated
therein or necessary to make the statements therein, in light of the
circumstances under which they were made, not misleading, except insofar as the
same are caused by or contained in any information furnished in writing to the
Company by or on behalf of such Holder expressly for use therein. The Company
shall also indemnify any Underwriters of the Registrable Securities, their
officers, directors and employees, and each Person who controls any such
Underwriter (within the meaning of the Act and the Exchange Act) to the same
extent as provided above with respect to the indemnification of the Holders of
Registrable Securities.

                     (b) INDEMNIFICATION BY HOLDERS. In connection with any
proposed registration in which a Holder is participating pursuant to Section 3
or 4 hereof, each such Holder shall furnish to the Company in writing such
information with respect to such Holder as the Company may reasonably request or
as may be required by law for use in connection with any registration statement
or prospectus to be used in connection with such registration and each Holder
agrees to indemnify and hold harmless the Company, any Underwriter retained by
the Company and their respective directors, officers, employees and each Person
who controls (within the meaning of the Act and the Exchange Act) the Company or
such Underwriter to the same extent as the foregoing indemnity from the Company
to the Holders (subject to the proviso to this sentence and applicable law), but
only with respect to any such information furnished in writing by or on behalf
of such Holder expressly for use therein; PROVIDED, HOWEVER, that the liability
of any Holder under this Section 8(b) shall be limited to the amount of the net
proceeds received by such Holder in the offering giving rise to such liability.

                     (c) CONDUCT OF INDEMNIFICATION PROCEEDINGS. Any Person
entitled to indemnification hereunder (the "INDEMNIFIED PARTY") agrees to give
prompt written notice to the indemnifying party (the "INDEMNIFYING PARTY") after
the receipt by the Indemnified Party of any written notice of the commencement
of any action, suit, proceeding or investigation or threat thereof made in
writing for which the Indemnified Party intends to claim indemnification or
contribution pursuant to this Agreement; PROVIDED, that the failure so to notify
the Indemnifying Party shall not relieve the Indemnifying Party of any liability
that it may have to the Indemnified Party hereunder. If notice of commencement
of any such action is given to the Indemnifying Party as above provided, the
Indemnifying Party shall be entitled to participate in and, to the extent it may
wish, jointly with any other Indemnifying Party similarly notified, to assume
the defense of such action at its own expense, with counsel chosen by it and
satisfactory to such

                                       14
<PAGE>

Indemnified Party. The Indemnified Party shall have the right to employ separate
counsel in any such action and participate in the defense thereof, but the fees
and expenses of such counsel (other than reasonable costs of investigation)
shall be paid by the Indemnified Party unless (i) the Indemnifying Party agrees
to pay the same, (ii) the Indemnifying Party fails to assume the defense of such
action with counsel satisfactory to the Indemnified Party in its reasonable
judgment, (iii) the named parties to any such action (including any impleaded
parties) have been advised by the Indemnifying Party's counsel that either (A)
representation of such Indemnified Party and the Indemnifying Party by the same
counsel would be inappropriate under applicable standards of professional
conduct or (B) there may be one or more legal defenses available to it which are
different from or additional to those available to the Indemnifying Party;
PROVIDED, HOWEVER, that the Indemnifying Party shall only have to pay the fees
and expenses of one firm of counsel for all Indemnified Parties in each
jurisdiction, except to the extent representation of all Indemnified Parties by
the same counsel is inappropriate under applicable standards of professional
conduct. In either of such cases the Indemnifying Party shall not have the right
to assume the defense of such action on behalf of such Indemnified Party. No
Indemnifying Party shall be liable for any settlement entered into without its
written consent, which consent shall not be unreasonably withheld. No
Indemnifying Party shall, without the written consent of the Indemnified Party,
effect the settlement or compromise of, or consent to the entry of any judgment
with respect to, any pending or threatened action or claim in respect of which
indemnification or contribution may be sought hereunder (whether or not the
Indemnified Party is an actual or potential party to such action or claim)
unless such settlement, compromise or judgment (A) includes an unconditional
release of the Indemnified Party from all liability arising out of such action
or claim and (B) does not include a statement as to or an admission of fault,
culpability or a failure to act, by or on behalf of any Indemnified Party. The
rights accorded to any Indemnified Party hereunder shall be in addition to any
rights that such Indemnified Party may have at common law, by separate agreement
or otherwise.

                     (d) CONTRIBUTION. If the indemnification provided for in
Section 8(a) from the Indemnifying Party is unavailable to an Indemnified Party
in respect of any losses, claims, damages, expenses or other liabilities
referred to therein, then the Indemnifying Party, in lieu of indemnifying such
Indemnified Party, shall contribute to the amount paid or payable by such
Indemnified Party as a result of such losses, claims, damages, expenses or other
liabilities in such proportion as is appropriate to reflect the relative fault
of the Indemnifying Party and Indemnified Party in connection with the actions
which resulted in such losses, claims, damages, expenses or other liabilities,
as well as any other relevant equitable considerations. The relative faults of
such Indemnifying Party and Indemnified Party shall be determined by reference
to, among other things, whether any action in question, including any untrue or
alleged untrue statement of a material fact or omission or alleged omission to
state a material fact, was made by, or relates to information supplied by, such
Indemnifying Party or Indemnified Party, and the Indemnifying Party's and
Indemnified Party's relative intent, knowledge, access to information and
opportunity to correct or prevent such action. The amount paid or payable by a
party as a result of the losses, claims, damages, expenses or other liabilities
referred to above shall be deemed to include, subject to the limitations set
forth in Sections 8(a), 8(b) and 8(c), any legal or other fees, charges or
expenses reasonably incurred by such party in connection with any investigation
or proceeding.

         The parties hereto agree that it would not be just and equitable if
contribution pursuant to

                                       15
<PAGE>

this Section 8(d) were determined by pro rata allocation or by any other method
of allocation which does not take account of the equitable considerations
referred to in the immediately preceding paragraph. No person guilty of
fraudulent misrepresentation (within the meaning of Section 11(f) of the Act)
shall be entitled to contribution pursuant to this Section 8(d).

               9.    RULE 144; OTHER EXEMPTIONS. If the Company shall have filed
a registration statement pursuant to the requirements of Section 12 of the
Exchange Act or a registration statement pursuant to the requirements of the Act
in respect of Common Stock or securities of the company convertible into or
exchangeable or exercisable for Common Stock, the Company covenants that it
shall file any reports required to be filed by it under the Exchange Act and the
rules and regulations adopted by the SEC thereunder, and that it shall take such
further action as each Holder may reasonably request (including, but not limited
to, providing any information necessary to comply with Rules 144 and 144A under
the Act), all to the extent required from time to time to enable such Holder to
sell Registrable Securities without registration under the Act within the
limitation of the exemptions provided by (a) Rule 144 or Rule 144A under the
Act, as such rules may be amended from time to time, or (b) any other rules or
regulations now existing or hereafter adopted by the SEC. The Company shall,
upon the request of any Holder, deliver to such Holder a written statement as to
whether the Company has complied with such requirements.

               10.    CERTAIN LIMITATIONS ON REGISTRATION RIGHTS. In the case of
a registration under Section 4 if the Company has determined to enter into an
underwriting agreement in connection therewith, no person may participate in
such registration unless such person (a) agrees to sell such person's securities
on the basis provided therein and (b) completes and executes all questionnaires,
powers of attorney, indemnities, lock-up agreements, underwriting agreements and
other documents reasonably required under the terms of such underwriting
agreements.

               11.   MISCELLANEOUS.

                     (a) RECAPITALIZATIONS, EXCHANGES, ETC. The provisions of
this Agreement shall apply, to the full extent set forth herein with respect to
the Shares, to any and all shares of capital stock of the Company or any
successor or assign of the Company (whether by merger, consolidation, sale of
assets or otherwise) which may be issued in respect of, in exchange for or in
substitution of, the Shares and shall be appropriately adjusted for any stock
dividends, splits, reverse splits, combinations, recapitalizations and the like
occurring after the date hereof.

                     (b) NO INCONSISTENT AGREEMENTS; OTHER REGISTRATION RIGHTS.
The Company shall not enter into any agreement with respect to its securities
that is inconsistent with or adversely affects the rights granted to the Holders
in this Agreement other than any lock-up agreement with the underwriters in
connection with an underwritten offering pursuant to which the Company agrees,
for a period not in excess of 180 days if such underwritten offering is an
Initial Public Offering or, for a period not in excess of 90 days if such
underwritten offering is not an Initial Public Offering, not to register for
sale, and not to sell or otherwise dispose of, Common Stock or any securities
convertible into or exercisable or exchangeable for Common Stock. The Company
shall not grant any other Person registration rights without the written

                                       16
<PAGE>

consent of the Designated Holders holding at least a majority of the Registrable
Securities held by all of the Designated Holders. If the Company shall at any
time hereafter provide to any holder of any securities of the Company rights
with respect to the registration of such securities and such rights are provided
on terms or conditions more favorable to such holder than the terms and
conditions applicable to the Designated Holders herein, the Company shall
provide (by way of amendment to this Agreement or otherwise) such more favorable
terms or conditions to the Designated Holders under this Agreement.

                     (c) REMEDIES. The Holders, in addition to being entitled to
exercise all rights granted by law, including recovery of damages, shall be
entitled to specific performance of their rights under this Agreement. The
Company agrees that monetary damages would not be adequate compensation for any
loss incurred by reason of a breach by it of the provisions of this Agreement
and hereby agrees to waive in any action for specific performance the defense
that a remedy at law would be adequate.

                     (d) AMENDMENTS AND WAIVERS. Except as otherwise provided
herein, the provisions of this Agreement may not be amended, modified or
supplemented, and waivers or consents to departures from the provisions of such
section may not be given unless the Company has obtained the prior written
consent of (i) the Designated Holders holding at least a majority of the
Registrable Securities held by all of the Designated Holders and (ii) the
Holders holding at least a majority of the Registrable Securities.

                     (e) NOTICES. All notices, demands and other communications
provided for or permitted hereunder shall be made in writing and shall be by
registered or certified first-class mail, return receipt requested, telecopier,
courier service or personal delivery:

                         (i)   if to Whitney or the Individual Investors:

                                      c/o J. H. Whitney & Co.
                                      177 Broad Street
                                      Stamford, Connecticut 06901
                                      Telecopier No.:  (203) 973-1422
                                      Attention:  Jeffrey R. Jay, M.D.

                                      with a copy to:

                                      Paul, Weiss, Rifkind, Wharton & Garrison
                                      1285 Avenue of the Americas
                                      New York, New York 10019-6064
                                      Telecopier No.: (212) 757-3990
                                      Attention:  Bruce A. Gutenplan, Esq.

                         (ii)  if to FHS:

                                      Foundation Health Systems, Inc.
                                      21600 Oxnard Street, Suite 2000

                                       17
<PAGE>

                                      Woodland Hills, CA 91367
                                      Telecopier No.:  (818) 676-7503
                                      Attention:  Michael E. Jansen

                         (iii) if to the Company:

                                       Care Management Science Corporation
                                       3600 Market Street, 6th Floor
                                       Philadelphia, PA 19104
                                       Telecopier No.:  (215) 387-9406
                                       Attention:  Chief Executive Officer

                              with a copy to:

                                       Morgan, Lewis & Bockius
                                       1701 Market Street
                                       Philadelphia, PA 19103
                                       Telecopier No.:  (215) 963-5299
                                       Attention:  Stephen M. Goodman

                         (iv) if to an Existing Shareholder, to its, his or her
address as it appears on the record books of the Company.

            All such notices and communications shall be deemed to have been
duly given: when delivered by hand, if personally delivered; when delivered by
courier, if delivered by commercial overnight courier service; five Business
Days after being deposited in the mail, postage prepaid, if mailed; and when
receipt is acknowledged, if telecopied.

                     (f) SUCCESSORS AND ASSIGNS. This Agreement shall inure to
the benefit of and be binding upon the successors and assigns of the parties
hereto; PROVIDED, HOWEVER, that the registration rights and the other
obligations of the Company contained in this Agreement shall, with respect to
any Registrable Security, be automatically transferred from a Holder to any
subsequent holder of such Registrable Security (including any pledgee).
Notwithstanding any transfer of such rights, all of the obligations of the
Company hereunder shall survive any such transfer and shall continue to inure to
the benefit of all transferees.

                     (g) COUNTERPARTS. This Agreement may be executed in any
number of counterparts and by the parties hereto in separate counterparts, each
of which when so executed shall be deemed to be an original and all of which
taken together shall constitute one and the same agreement.

                     (h) HEADINGS. The headings in this Agreement are for
convenience of reference only and shall not limit or otherwise affect the
meaning hereof.

                     (i) GOVERNING LAW. This Agreement shall be governed by and
construed in accordance with the laws of the Commonwealth of Pennsylvania,
without regard to the principles of conflicts of law of such State.

                                       18
<PAGE>

                     (j) JURISDICTION. Each party to this Agreement hereby
irrevocably agrees that any legal action or proceeding arising out of or
relating to this Agreement or any agreements or transactions contemplated hereby
may be brought in the courts of the State of New York or of the United States of
America for the Southern District of New York and hereby expressly submits to
the personal jurisdiction and venue of such courts for the purposes thereof and
expressly waives any claim of improper venue and any claim that such courts are
an inconvenient forum. Each party hereby irrevocably consents to the service of
process of any of the aforementioned courts in any such suit, action or
proceeding by the mailing of copies thereof by registered or certified mail,
postage prepaid, to the address set forth in Section 10(e), such service to
become effective 10 days after such mailing.

                     (k) SEVERABILITY. If any one or more of the provisions
contained herein, or the application thereof in any circumstance, is held
invalid, illegal or unenforceable in any respect for any reason, the validity,
legality and enforceability of any such provision in every other respect and of
the remaining provisions hereof shall not be in any way impaired, it being
intended that all of the rights and privileges of the Holders shall be
enforceable to the fullest extent permitted by law.

                     (l) RULES OF CONSTRUCTION. Unless the context otherwise
requires, "or" is not exclusive, and references to sections or subsections refer
to sections or subsections of this Agreement.

                     (m) ENTIRE AGREEMENT. This Agreement is intended by the
parties as a final expression of their agreement and intended to be a complete
and exclusive statement of the agreement and understanding of the parties hereto
in respect of the subject matter contained herein. There are no restrictions,
promises, warranties or undertakings in respect of the subject matter contained
herein, other than those set forth or referred to herein. This Agreement
supersedes all prior agreements and understandings between the parties with
respect to such subject matter.

                     (n) FURTHER ASSURANCES. Each of the parties shall execute
such documents and perform such further acts as may be reasonably required or
desirable to carry out or to perform the provisions of this Agreement.

                                       19
<PAGE>

         IN WITNESS WHEREOF, the undersigned have caused this Agreement to be
executed and delivered by their respective officers hereunto duly authorized on
the date first above written.

                              CARE MANAGEMENT SCIENCE CORPORATION

                              By /S/ DAVID J. BRAILER
                                 ------------------------------------------
                                 Name:    David J. Brailer
                                 Title:   Chief Executive Officer

                              J.H. WHITNEY III, L.P.

                              By    J.H. Whitney Equity Partners III, L.L.C.
                                    Its General Partner

                              By  /S/ DANIEL J. O'BRIEN
                                 ------------------------------------------
                                 Name:   Daniel J. O'Brien
                                         Managing Member

                              WHITNEY STRATEGIC PARTNERS III, L.P.

                              By    J.H. Whitney Equity Partners III, L.L.C.
                                    Its General Partner

                              By  /S/ DANIEL J. O'BRIEN
                                  -----------------------------------------
                                  Name:   Daniel J. O'Brien
                                          Managing Member

                              FOUNDATION HEALTH SYSTEMS, INC.

                              By  /S/ MICHAEL JANSEN
                                  -----------------------------------------
                              Name:  Michael Jansen
                              Title:  V.P., Asst. Gen. Counsel & Asst. Secretary

                                       20
<PAGE>

                              ZEKE INVESTMENT PARTNERS

                              By  /S/ EDWARD N. ANTOIAN
                                  -----------------------------------------
                                 Name:   Ed Antoian
                                         Title: General Partner

                              /S/ DAVID J. BRAILER
                              ---------------------------------------------
                              David J. Brailer

                              /S/ RONALD A. PAULUS
                              ---------------------------------------------
                              Ronald A. Paulus

                              /S/ BRENT MILNER
                              ---------------------------------------------
                              Brent Milner

                              /S/ WILLIAM WINKENWERDER
                              ---------------------------------------------
                              William Winkenwerder

                                       21<PAGE>

                                                                   EXHIBIT 10.13

                        CALIFORNIA HEALTHCARE FOUNDATION
                              CONSULTING AGREEMENT

REFERENCE NUMBER: 99-5063

         THIS CONSULTING AGREEMENT ("Agreement") is entered into and by the
California HealthCare Foundation, a California nonprofit public benefit
corporation ("CHCF"), and Care Management Science Corporation ("Contractor").
Contractor is a for profit organization.

         NOW, THEREFORE, the parties hereto agree as follows:

1.       EFFECTIVE DATE.  This Agreement shall be effective as of October 1,
1999 (the "Effective Date").

2.       ENGAGEMENT FOR SERVICES. CHCF hereby engages Contractor to perform the
services ("Services") set forth in Exhibit B attached hereto.

3.       TERM OF ENGAGEMENT. The term of this Agreement ("Consulting Term")
shall be for a period commencing on the Effective Date and ending on the
earliest of: (i) September 30, 2002; (ii) the completion of the scope of work as
stated in Exhibit B, as amended from time to time (the project described
therein, the "Project"), and (iii) the date on which this Agreement is
terminated pursuant to Section 5 hereof.

4.       PROVISION OF SERVICES.

         a.  CONTRACTOR'S USE OF EMPLOYEES AND CONSULTANTS. Contractor may, at
Contractor's discretion and at Contractor's own expense, use employees or
consultants to perform the Services under this Agreement.

         b.   CHCF REVIEW AND APPROVAL OF ANCHOR AGREEMENT. Contractor shall
prepare and present to CHCF a form of "Generic Anchor Agreement" as contemplated
in Exhibit B, Section 2 hereof. CHCF shall have ten (10) business days after its
receipt of the form of Generic Anchor Agreement to review and approve such form
of Generic Anchor Agreement (or any modification thereof or amendment thereto),
which approval shall not unreasonably be withheld. On and after receiving
approval of the Generic Anchor agreement from CHCF, Contractor may complete and
enter into Anchor Agreements (each such agreement, if and when entered into in
accordance with the terms of this Agreement, a "Final Anchor Agreement") with
each Care Alliance Anchor provided, prior to execution thereof, Contractor
prepares and presents to CHCF a complete and accurate copy of the final form of
such agreement (including, e.g., a description of the scope of work, payments
required thereunder, and payment schedule). CHCF shall have two (2) business
days after its receipt of a proposed Final Anchor Agreement to approve or
disapprove such proposed Final Anchor Agreement, which approval shall not
unreasonably be withheld. CHCF's review of the final agreements will be solely
for the purpose of ensuring that the workscopes contained within the agreements
are generally consistent with

<PAGE>

the overall mission of the project. CHCF's failure to approve or disapprove
within such two (2) business day period shall be deemed approval of such
proposed Final Anchor Agreement.

         c.   ADMINISTRATION OF ANCHOR AGREEMENT. Contractor shall administer
and be fully responsible for the administration of the Final Anchor Agreements,
subject to CHCF's rights to information, accesses, and financial reports as
contained in this Agreement and the Required Provisions (as set forth herein).
CHCF's only obligation with respect to such Final Anchor Agreements shall be to
make payments to the Care Alliance Anchor, which obligation shall arise only (i)
to the extent of the payments expressly set forth in the relevant Final Anchor
Agreement (without regard to any amendment, supplement or other modification
thereto unless approved in advance in writing by CHCF); (ii) after the scheduled
payment date for such payment, and (iii) only on written presentation by
Contractor, signed by an officer, certifying that such Care Alliance Anchor (a)
is not in default or breach under its Final Anchor Agreement, and (b) has met
all conditions to such payment.

5.       TERMINATION.

         a.  TERMINATION. Should either party default in the performance of any
material obligation under this Agreement or breach any material provision
contained in this Agreement and, if the default or breach is deemed curable, not
cure or substantially cure the default or breach within forty-five (45) days
(the "Cure Period") after receipt of written notice by the other party
specifying the nature and extent of the default or breach (a "Claim of
Default"), then in addition to other remedies set forth herein or allowed at
law, the Term of this Agreement may be terminated by the
non-defaulting/non-breaching party. Notwithstanding the foregoing, no Cure
Period shall apply in the event of nonpayment of contract fees by CHCF.

         b.  PAYMENTS ON TERMINATION. If this Agreement is terminated by either
party CHCF shall pay Contractor an amount which, when added to the payments made
by CHCF to date, results in Contractor being paid for the work performed through
the termination, provided that in no event shall CHCF be required to pay more
than the maximum amount payable under this Agreement for the period ended on the
date of termination. Additionally, if this Agreement is terminated by CHCF
pursuant to this Section 5, Contractor may assign to CHCF, and CHCF agrees to
accept, all equipment and real property leases: (i) with third parties unrelated
to the Contractor, (ii) directly related to the Services, (iii) where the third
party acknowledges and agrees that Contractor is not then in default thereunder
and has consented to such assignment. On and after such assignment, if made,
CHCF will be responsible for amounts due and payable after the date of such
assignment, which it shall pay directly to such third parties.

         c.  CESSATION OF OPERATIONS. In the event either party ceases its
business operations or files for bankruptcy protection, then the other party
may, subject to the restrictions imposed by federal bankruptcy law, at its sole
discretion, terminate this Agreement upon giving written notice of termination
to the other party.

                                       2
<PAGE>

6.       COMPENSATION.

         a.  AMOUNT AND DUE DATES. The amount and due dates for all compensation
payable by CHCF to Contractor hereunder is outlined in Exhibit A attached to
this Agreement.

         b.  BOOKS AND RECORDS. Contractor is expected to maintain complete
books and records of revenues and expenditures for the project which should be
made available for inspection at reasonable times if deemed necessary by CHCF.
CHCF, at its expense, will periodically audit a selected number of its grants
and contracts. If Contractor is selected, Contractor will be expected to provide
all necessary assistance in connection with such audit. Records must be kept for
at least three (3) years after completion of the contract.

7.       INDEPENDENT CONTRACTOR.

         a.  INDEPENDENT CONTRACTOR. Contractor enters into this Agreement as,
and shall continue to be, an independent contractor. Under no circumstances
shall Contractor look to CHCF as its employer, or as a partner, agent or
principal. Contractor shall not be entitled to any benefits which may be
accorded to CHCF's employees, including workers' compensation, employee benefit
plans, disability insurance, vacation or sick pay. Contractor shall be
responsible for providing, at Contractor's expense, and in Contractor's name,
disability, workers' compensation or other insurance as well as licenses and
permits usual or necessary for performing the Services.

         b.  CONTRACTOR'S RESPONSIBILITY FOR EMPLOYEES. Contractor shall be
responsible for all wages, withholding, workers compensation and all other
fringe benefits for its employees. Contractor is not an agent of CHCF, nor shall
Contractor possess any right or authority to bind CHCF in any manner without the
prior written consent of CHCF, which may be given or withheld in CHCF's sole
discretion. Neither Contractor nor any of Contractor's employees shall hold
themselves out to third parties to be, or otherwise represent in any manner that
they are, an officer, director or employee of CHCF or its affiliates, or that
such employee of Contractor has authority to bind CHCF or its affiliates.

         c.  CONTRACTOR'S RESPONSIBILITY FOR TAXES. Contractor shall pay, when
and as due, any and all taxes incurred as a result of the amounts paid to
Contractor hereunder, including estimated taxes, and shall provide CHCF with
proof of payment on demand.

         d.  IMMIGRATION STATUS. Contractor hereby represents and warrants to
CHCF that it has verified the immigration status of each of its employees as
required by applicable law and regulations, and is in compliance with all
applicable federal immigration law and regulations with respect to each of its
employees.

         e.  NO PROHIBITION ON OTHER SERVICES. Contractor may represent, perform
services for, or be employed by, any additional persons or entities as
Contractor sees fit.

                                       3
<PAGE>

8.       MUTUAL CONFIDENTIALITY.

         a.  MUTUAL CONFIDENTIALITY. Both parties acknowledge that in the
performance of the Services, either party may have access to information which
is confidential to, or a trade secret of, the other party. Both parties agree
not to disclose any such information, regardless of the form or format in which,
or means by which, either party becomes aware of such information, to any third
party without the specific written authorization from the owning party. For the
purposes of this Agreement, trade secrets and confidential information shall not
include information that (i) is generally available to the public (other than as
a result of a disclosure by a party or its affiliates), or (ii) is available to
such party on a non-confidential basis from a source that is not prohibited from
disclosing such information to such party.

9.       OWNERSHIP AND USE OF INTELLECTUAL PROPERTY.

         a.  "CHCF Intellectual Property" means any and all results and proceeds
of any services heretofore or hereafter rendered by Contractor hereunder or by a
Care Alliance Anchor under a Final Anchor Agreement or otherwise in connection
with the Project and the Services including, without limitation, the business
model, data created or collected by Contractor to the extent not subject to the
ownership rights of another, any newly-created software (in both source and
object code versions), all technical and other documentation developed for or
related to the Project and/or Services, and all other works of authorship or
invention, records, drawings, developments, and trade secrets.

         b.  Contractor acknowledges and agrees, for good and valuable
consideration, including, without limitation, that specified in Sections 6 and
9.f hereof, that all CHCF Intellectual Property and all intellectual property
rights therein are and will be the sole and exclusive property of CHCF.
Contractor further agrees to assign (or cause to be assigned) and does hereby
assign fully to CHCF all of Contractor's rights, if any, worldwide in such CHCF
Intellectual Property and all intellectual property rights thereto including any
copyrights, patents, patent applications, trademarks, and tradenames. CHCF shall
have the right to obtain and hold in its own name copyrights, registrations, or
other such protection as may be appropriate to the subject matter, and any
extensions and renewals thereof. Contractor agrees to give CHCF and any person
designated by CHCF such reasonable assurance and assistance (at CHCF's expense
for all out-of-pocket costs incurred in connection therewith) as is required to
obtain patents, copyrights or otherwise to perfect CHCF's rights in any CHCF
Intellectual Property.

         c.  Contractor acknowledges and agrees that CHCF will at all times have
the right, in its sole and exclusive discretion, to sell, license, or otherwise
exploit in any media now or hereafter known, any of the CHCF Intellectual
Property.

         d.  Contractor agrees that if CHCF is unable because of Contractor's
unavailability, incapacity, or for any other reason, to secure a signature by or
on behalf of Contractor for or to pursue any application for any United States
or foreign patents or copyright registrations covering the CHCF Intellectual
Property assigned to CHCF herein, then Contractor hereby irrevocably designates
and appoints CHCF and its duly authorized officers and agents as Contractor's
agent and attorney in fact, to act for and on Contractor's behalf and stead to
execute,

                                       4
<PAGE>

acknowledge, deliver and file any such applications and to do all other lawfully
permitted acts to further the prosecution and issuance of patents and copyright
registrations thereon with the same legal force and effect as if executed by
Contractor.

         e.  Contractor agrees that, except for the license to be granted
pursuant to Section 9.f hereof, Contractor will not have or be deemed to have
any lien, charge or other encumbrance upon any of the rights conveyed to CHCF
herein, the CHCF Intellectual Property, or any proceeds derived therefrom, and
that no act or omission by CHCF, nor any other act, omission or event of any
kind, will terminate or otherwise adversely affect CHCF's ownership of the
rights conveyed herein.

         f.  Commencing on the project's effective date CHCF shall grant
Contractor a fully-paid, non-exclusive, perpetual, worldwide license to all CHCF
Intellectual Property developed during the course of Contractor's participation
in the project (the "Licensed Intellectual Property"). Contractor may license,
sell, distribute or otherwise use the Licensed Intellectual Property in any way
so long as such use does not violate any applicable law or regulation. As
defined in Section 9.c above, CHCF shall retain the right, exercisable in its
sole and exclusive discretion, to license all or any portion of the CHCF
Intellectual Property at any time, in all or any portion of the world.

10.      INDEMNIFICATION.

         a.  The representations and warranties of the parties contained in
Sections 5, 7, 8, 9, 10, and 12 of this agreement shall survive the termination
of this Agreement. Neither the period of survival nor the liability of a party
hereunder with respect to its representations and warranties shall be reduced by
any investigation or action taken or made at any time by or on behalf of either
party.

         b.  CHCF and its affiliates, officers, directors, employees, agents,
successors and assigns (each, a "CHCF Indemnified Party") shall be indemnified
and held harmless by Contractor for any and all liabilities and obligations
(whether accrued or fixed, absolute or contingent, matured or unmatured,
determined or determinable) ("Liabilities"), losses, damages, claims, costs and
expenses, interest, awards, judgments and penalties (including, without
limitation, attorneys' fees and costs)(collectively, "Losses") suffered or
incurred by them arising out of or resulting from:

         (i)      the breach of any material representation or warranty made by
                  Contractor herein unless such breach is caused directly by
                  CHCF;

         (ii)     the breach of any of its material covenants or agreements
                  contained herein;

         (iii)    any claim by or cause of action brought by any third party
                  resulting from any action or inaction on the part of
                  Contractor in connection with the Project or Services, other
                  than such actions or failures to act specifically directed in
                  writing by CHCF;

                                       5
<PAGE>

         (iv)     the breach by Contractor or any of its affiliates of any other
                  agreement to which it is a party, or of any law, rule, or
                  regulation that would otherwise materially interfere with the
                  performance of this Agreement;

         c.  Contractor and its affiliates, officers, directors, employees,
agents, successors and assigns (each, a "Contractor Indemnified Party") shall be
indemnified and held harmless by CHCF for any and all Losses suffered or
incurred by them arising out of or resulting from:

         (i)      the breach of any material representation or warranty made by
                  CHCF herein unless such breach is caused directly by
                  Contractor;

         (ii)     the breach of any of its material covenants or agreements
                  contained herein;

         (iii)    the breach by CHCF or any of its affiliates of any other
                  agreement to which it is a party, or of any law, rule, or
                  regulation that would otherwise materially interfere with the
                  performance of this Agreement;

         d.  An Indemnified Party shall give Contractor or CHCF, as applicable
(the indemnifying party, the "Indemnifying Party") notice of any matter which an
Indemnified Party has determined has given or could give rise to a right of
indemnification under this Agreement, as promptly as possible. The obligations
and Liabilities of the Indemnifying Party under this Section 10 with respect to
Losses arising from claims of any third party shall also require that the
Indemnifying Party promptly acknowledge in writing its obligations to indemnify
hereunder, after which notice it shall be entitled to assume and control the
defense of such third party claim at its expense and through counsel of its
choice, provided, that if there exists or is reasonably likely to exist a
conflict of interest that would make it inappropriate in the judgment of the
Indemnified Party for the same counsel to represent both the Indemnified Party
and the Indemnifying Party, then the Indemnified Party shall be entitled to
retain its own counsel, at the expense of the Indemnifying Party. In the event
that the Indemnifying Party exercises the right to undertake any such defense
against any such third party claim, the Indemnified Party shall cooperate with
the Indemnifying Party in such defense and make available to the Indemnifying
Party at the Indemnifying Party's expense all witnesses, pertinent records,
material and information in the Indemnified Party's possession or under the
Indemnified Party's control related thereto as are reasonably required by the
Indemnifying Party.

11.      REPRESENTATIONS OF CONTRACTOR.

         Contractor represents and warrants that Contractor has the
qualifications and ability to perform the Services in a professional manner,
without the advice, control, or supervision of CHCF. Contractor represents and
warrants that Contractor possesses any and all licenses and governmental
approvals required in order for Contractor to perform the Services. Failure to
perform the Services in a professional manner shall constitute a material breach
of this Agreement. Contractor shall be solely responsible for the professional
performance of the Services, and shall receive no assistance or control from
CHCF. Contractor shall have sole discretion and control of Contractor's services
and the manner in which performed.

                                       6
<PAGE>

12.      GENERAL PROVISIONS.

         a.  BINDING ON SUCCESSORS. Subject to any restrictions stated in any
other provision of this Agreement, this Agreement shall be binding on and shall
inure to the benefit of the parties and their respective successors and
permitted assigns. None of the provisions of this Agreement is intended to
provide any rights or remedies to any person (including without limitation any
employees or creditors of either of the parties hereto), other than the parties
and their respective successors and permitted assigns.

         b.  PARTIAL INVALIDITY/SEVERABILITY. Should any of the provisions of
this Agreement be held to be invalid or unenforceable, such invalidity or
unenforceability shall not affect the validity or enforceability of any other
provision of this Agreement.

         c.  ENTIRE AGREEMENT. This Agreement contains the entire agreement
between the parties with respect to the subject matter of this Agreement and
supersedes all prior oral or written understandings and agreements including,
but not limited to, any and all consulting or consultancy agreements, promissory
notes, summary of agreements, discharge agreements, non-disclosure agreements,
reduction of debts agreements, and any other document executed between the
parties or their employees, officers, or shareholders.

         d.  AMENDMENTS; WAIVERS. No provision of this Agreement may be changed,
extended, waived, modified, discharged or terminated, except by a written
instrument executed by the parties hereto.

         e.  NOTICE. Any notice, payment, report or any other communication
required or permitted to be given by one party to the other party by this
Agreement shall be in writing, shall be deemed effective upon receipt and shall
be either (a) served personally on the other party, (b) sent by express,
registered or certified first-class mail, postage prepaid, addressed to the
other party by like notice, or (c) delivered by commercial courier to the other
party, at the following address:

         TO CHCF:

                  California HealthCare Foundation
                  476 Ninth Street
                  Oakland, CA  94607
                  Phone:       (510) 238-1040
                  Facsimile:   (510) 238-1388
                  ATTENTION:   SAM KARP, CHIEF INFORMATION OFFICER

         TO CONTRACTOR:

                  Care Management Science Corporation
                  3600 Market Street, 6th Floor
                  Philadelphia, PA  19104
                  Phone:       (215) 387-9401

                                       7
<PAGE>

                  Facsimile:   (215) 387-9406
                  ATTENTION:   DAVID BRAILER, M.D., PH.D., CHAIRMAN AND CEO

         f.  GOVERNING LAW. This Agreement shall be governed by and construed in
accordance with the law of the State of California.

         g.  TITLES AND HEADINGS. Title and headings to sections, subsections
and sub-subsections of this Agreement are for the purposes of reference only and
shall not affect the interpretation of this Agreement.

         h.  COUNTERPARTS. This Agreement may be signed in one or more
counterparts, each of which shall be deemed to be an original, but all of which
together will constitute one and the same instrument.

         i.  TAX MATTERS. Nothing in this Agreement shall be construed to
require CHCF to take any action that would violate any federal or state law,
rules or regulations, including, but not limited to, the rules governing
organizations classified as private foundations as set forth in the Internal
Revenue Code, and any state laws concerning the operation of charitable trusts
or private foundations. CHCF has the authority to report any payments made
hereunder to the Internal Revenue Service, and to make any withholdings as
required by the Internal Revenue Code or any applicable state law.

         j.  SURVIVAL. In the event of any expiration or termination of this
Agreement, provisions hereof which are intended to continue and survive shall so
continue and survive, including, but not limited to, the provisions of Sections
5, 7, 8, 9, 10, 11 and 12.

         k.  ASSIGNMENT. This Agreement and all rights and obligations hereunder
may not be assigned, subcontracted or transferred by either party, except as
permitted pursuant to this Agreement, without the prior written consent of the
other party.

         l.  POLITICAL ACTIVITIES. Funds from this Agreement may not be used for
any of the following purposes: to carry out propaganda, or otherwise attempt to
influence legislation; to influence the outcome of any specific public election
or to carry on directly or indirectly any voter registration drive.

         m.  ACKNOWLEDGMENT AND PUBLICITY. The California HealthCare Foundation
is commissioning this research for its use. If CHCF chooses to publish material
resulting from this project, either in print or electronically, appropriate
acknowledgment of the Contractor will be included. Contractor may not issue any
press release regarding this grant, the Project, or any or the resulting
published material, without the prior written approval of the text of any such
release by the CHCF Communications Department.

Any publication produced by the Contractor that refers to or results from this
research or the Project should include an acknowledgment of CHCF that reads:
SUPPORTED BY THE CALIFORNIA HEALTHCARE FOUNDATION, BASED IN OAKLAND, CALIFORNIA.
THE FOUNDATION IS A NON-PROFIT PHILANTHROPIC ORGANIZATION WHOSE MISSION IS TO
EXPAND ACCESS TO AFFORDABLE, QUALITY HEALTH CARE

                                       8
<PAGE>

FOR UNDERSERVED INDIVIDUALS AND COMMUNITIES, AND TO PROMOTE FUNDAMENTAL
IMPROVEMENTS IN THE HEALTH STATUS OF THE PEOPLE OF CALIFORNIA.

If CHCF disseminates the final research, CHCF's Communications Department will
oversee the dissemination and any resulting publicity activities. In that event,
Contractor will be sent publicity material for final review and approval and
will receive copies of the final product.

         n.  USE OF NAME. Except as otherwise provided for or as contemplated by
this Agreement, neither party shall have the right to, or shall use the other
party's name, trademarks, or tradenames in any form of media, whether written,
visual, audio or otherwise without the prior written consent of the other party.
Further, Contractor cannot authorize CHCF to use and CHCF agrees and
acknowledges that CHCF shall not use, the name of the University of
Pennsylvania, The Wharton School or other similar references under the terms of
this Agreement without the prior written consent of the University of
Pennsylvania.

         o.  FORCE MAJEURE. Neither party shall be liable to the other party for
any delay or non-performance of its obligations under this Agreement arising
from any cause or causes beyond its reasonable control to the extent the effects
of such cause(s) are not capable of being avoided or mitigated through the
reasonable efforts of such party.

         IN WITNESS WHEREOF, this Consulting Agreement has been executed by each
of the parties.

                          CALIFORNIA HEALTHCARE FOUNDATION,
                          a California non-profit public benefit corporation

                          By:__________________________________________________
                          Name:________________________________________________
                          Its:_________________________________________________

                          CONTRACTOR, CARE MANAGEMENT SCIENCE CORPORATION

                          By:__________________________________________________
                          Name:________________________________________________
                          Its:_________________________________________________

                          Tax ID or SS # ____________________________

                          Effective Date: ___________________________

                                       9
<PAGE>

                                    EXHIBIT A

                          CONSULTING AGREEMENT SUMMARY
                            REFERENCE NUMBER: 99-5063

NAME OF PROJECT:

Project Management Office for the Santa Barbara Community-Wide Health
Information Project

CHCF STAFF DIRECTLY RESPONSIBLE FOR THIS AGREEMENT:

Sam Karp, Chief Information Officer

PROJECT SUMMARY:

This project will establish a Program Management Office (PMO) to facilitate the
development and propagation of a local business model for the cooperative
sharing, maintenance and use of clinically relevant health information in Santa
Barbara County.

SCOPE OF WORK TO BE PERFORMED:

A SCOPE OF WORK, WORK PLAN and DELIVERABLES are contained in Exhibit B and is
considered to be a part of this Agreement.

COMPENSATION AND PAYMENT SCHEDULE:

a)       Total project costs: Not to exceed $4,620,574

b)       Payment Schedule:

<TABLE>
<CAPTION>

            YEAR 1:
          -----------
          <S>              <C>
          $ 1,109,328      Within 10 days of the receipt and approval of a
                           signed agreement.

          $   739,552      Within 30 days of receipt and approval (such approval
                           not to be unreasonably withheld) of six-month
                           narrative and financial reports due April 30, 2000
                           (but not payable earlier than May 31, 2000)

</TABLE>

<TABLE>
<CAPTION>

          YEAR 2 (PROJECTED):
          -------------------
          <S>              <C>
          $   692,362      Within 30 days of receipt and approval (such approval
                           not to be unreasonably withheld) of narrative and
                           financial reports and Work Plan,

</TABLE>
                                     10

<PAGE>

<TABLE>
          <S>              <C>

                           Deliverables and Budget for year two, due October 31,
                           2000 (but not payable earlier than November 30, 2000)

          $   692,362      Within 30 days of receipt and approval (such approval
                           not to be unreasonably withheld) of narrative and
                           financial reports due April 30, 2001 (but not payable
                           earlier than May 31, 2001)

</TABLE>

<TABLE>
<CAPTION>
          YEAR 3 (PROJECTED):
          -------------------
          <S>              <C>
          $   693,485      Within 30 days of receipt and approval (such approval
                           not to be unreasonably withheld) of narrative and
                           financial reports and Work Plan, Deliverables and
                           Budget for year three, due October 31, 2001 (but not
                           payable earlier than November 30, 2001)

          $   693,485      Within 30 days of receipt and approval (such approval
                           not to be unreasonably withheld) of narrative and
                           financial reports due April 30, 2002 (but not payable
                           earlier than May 31, 2001)

</TABLE>

         c)  Earned Interest Income. Interest income earned from funds awarded
through this agreement must be used for the purposes of the project. All funds
received from CHCF will be reported as part of the six month financial reports.
A plan for spending any earned interest income on new activities will be
presented with the next six month budget report and must be approved by CHCF.

         d)  Budget Category Transfers. Contractor will be permitted to transfer
of up to 10% of the funds from one budget category to another budget category.
Transfer of funds between budget categories in excess of 10% will need to be
submitted to CHCF for approval as a budget revision. Budget categories are
Salary Expenses, Non Labor Expenses, Capital Expenses and Admin-Finance
Expenses.

TERM OF CONTRACT:

October 1, 1999 through September 30, 2002

REPORTS

Contractor agrees to provide a narrative and financial report every six (6)
months, due April 30, 2000, October 31, 2000, April 30, 2001, October 31, 2001,
April 30, 2002 and October 31, 2002. A Work Plan, Deliverables and Budget for
Year 2 is due October 31, 2000. A Work Plan, Deliverables and Budget for Year 3
is due October 31, 2001.

The narrative report shall address the project's overall progress and the PMO's
success in meeting specific project deliverables. It should identify any risks,
which would threaten meeting specific project deliverables. It should identify
any risks, which would threaten the project's continued success. A final
narrative and financial report is due by January 15, 2003. The narrative report

                                       11
<PAGE>

shall include a summary of the activities and accomplishments of the project;
identify CHCF Intellectual Property including all software applications that
were developed and, if applicable, include the original source code and
documentation; and copies of all articles and publications associated with the
project. The report shall also include the Contractor's recommendations for
additional activities CHCF might consider to further the project's goals.

                                       12
<PAGE>

                                    EXHIBIT B

                            REFERENCE NUMBER: 99-5063

                    SCOPE OF WORK, WORK PLAN AND DELIVERABLES

SCOPE OF WORK

Through the creation of a Program Management Office, Contractor will manage the
Santa Barbara Community-wide Health Care Information Project and will facilitate
the design and implementation of the health care information sharing
infrastructure and decision-making apparatus. Contractor will oversee and manage
the contracts with the Care Alliance Anchor organizations for the operation of
specified project components objectives, and deliverables.

In performance of this agreement, Contractor will provide ongoing support and
training to local health care stakeholders; certify vendors according to
CareStandard criteria; negotiate software and hardware contracts with various
vendors; and seek grants from the Agency for Health Care Policy and Research,
the National Library of Medicine, and others to support evaluation of the
project and to measure the impact of the information-sharing interventions on
quality, efficiency and accessibility of care.

DEFINITIONS

1.       CareStandard is a division of Care Management Science that will be
         responsible for administering the Program Management Office and
         facilitating the work of this project.

2.       Care Exchange is the community-wide membership organization in Santa
         Barbara which will enable community organizations to join together to
         address health care information challenges by developing common
         approaches to information-sharing, communication and decision-making.

3.       Care Exchange Council is the local community governance structure that
         will oversee the Santa Barbara project's decision-making and rule
         setting, resolve data ownership issues, and manage technology
         coordination.

4.       Care Alliance is the team of community health care organizations that
         have agreed to work together to implement a plan to improve the
         clinical and/or administrative exchange of information with their key
         business partners.

5.       Care Alliance Anchor is the lead organization of each Care Alliance
         team.

WORK PLAN

WHEN SIGNED TO APRIL 30, 2000

1.       Draft and Execute Care Exchange Council Accord

                                       13
<PAGE>

         Develop a mutual agreement among all Care Alliance Anchors to summarize
         how the Care Exchange Council will make non-binding decisions regarding
         the use of cross-organizational health care data among health care
         organizations within the community. This agreement is intended to not
         only guide the Care Exchange Council through this project, but to
         survive the three-year time frame and serve as an ongoing forum for
         health data exchange issues.

         --       Review General Policies and Procedures with Care Exchange
                  Council
         --       Draft Care Exchange Council Accord
         --       Review Draft Care Exchange Council Accord with Care
                  Exchange Council
         --       Finalize Care Exchange Council Accord
         --       Sign Off of Care Exchange Council Accord with Care Exchange
                  Participants

2.       Draft and Execute Care Alliance Anchor Agreements

         Prepare a draft agreement with the Care Alliance Anchor organizations
         detailing specific milestones and deliverables that both the Care
         Alliance and CMS agree to complete. Each Care Alliance Anchor will
         effect a separate 'Care Alliance Agreement' with all participating Care
         Alliance organizations to detail more specific data sharing intentions
         and related flow of funds to participating organizations.

         --       Draft Generic Anchor Agreement
         --       Review Generic Anchor Agreement with CHCF
         --       Finalize Generic Anchor Agreement, subject to Section 4(b)
                  of the Agreement
         --       Complete Anchor Agreement with each Care Alliance Anchor,
                  subject to Section 4(b) of the Agreement

3.       Draft and Execute Care Alliance Agreements

         An annual agreement among all members of the Care Alliance detailing
         the scope of work that the Care Alliance will perform. The Care
         Alliance Agreement will also include detail regarding the appropriate
         use of data shared among participating organizations with specific
         business rules and regulatory standards governing the use of data based
         on CALINX rules and HIPAA standards.

         --       Draft Care Alliance Agreement
         --       Review Draft Care Alliance Agreement with Care Exchange
                  Council
         --       Finalize Care Alliance Agreement
         --       Complete Care Alliance Agreement with each Care Alliance

4.       Prepare and Circulate Care Exchange Council and Advisory Committee
         Minutes

         Contractor will attend the Care Exchange Council and Advisory Committee
         meetings. The Care Exchange Council meets monthly. The Clinical and
         Technical Advisory Committees meet quarterly.

                                       14
<PAGE>

5.       Develop and Launch Santa Barbara County Care Exchange Web Site

         A Web site will be developed and made accessible to all Care Exchange
         Members. It will highlight project progress and development,
         disseminate up-to-date information regarding federal, state, and local
         regulations, and provide access to health industry assessments and
         reports that highlight the industry's use of the Internet for health
         information exchange. CareStandard will also publish a list of the
         certified vendors on the site with summary and detailed product
         information.

         --       Draft Web Content and Design
         --       Select Web Developer
         --       Develop Web Site
         --       Launch
         --       Community Roll Out

6.       Develop Roster of Certified Vendors

         Contractor will develop a vendor certification process. The process
         will be vendor neutral and offered to all health care vendors with the
         intent of certifying several competing products for Care Exchange
         selection. Certification is based on the vendors' ability to
         demonstrate the following: product efficacy and proven capability,
         Internet based technology, commitment to industry standards, financial
         viability, and interoperability. Once a vendor is CareStandard
         certified, their company and product information will be available on
         the SBCCE Web site.

         --       Issue RFP to Software Vendors
         --       Evaluate RRP responses according to Certification Criteria
         --       Issue Provisional Certification
         --       Create Final Certification Application
         --       Distribute Certification Application to Software Vendors
         --       Evaluate RRP responses according to Certification Criteria
         --       Announce Certified Vendors and Post on Web site with
                  respective product information

7.       Plan and Hold Vendor Exhibition

         Once a vendor is CareStandard certified, their company and product
         information will be showcased in a Santa Barbara County Vendor
         Exhibition. The Exhibition will be a one-day event, highlighting
         available technology and interoperability. Participants will include
         SBCCE Members, vendor representatives, CareStandard and CHCF staff, and
         other interested community representatives.

         --       Determine Exhibition Format
         --       Plan and Organize Logistics
         --       Prepare Invitation List

                                       15
<PAGE>

         --       Distribute Invitations
         --       Confirm Attendees
         --       Host Vendor Exhibition Day
         --       Summarize Results

8.       Perform Ongoing Communication and Community Facilitation

         CareStandard will routinely provide project updates to the community,
         the media and other interested parties. Project specific communication
         will be co-developed with a public relations firm (to be determined)
         and coordinated with the CHCF. In addition, CareStandard will support
         community dialogue and facilitate multi-organization communication.
         This facilitation will routinely include multi-stakeholder and
         one-on-one meetings, and ongoing electronic communication.

         --       Select Public Relations Firm
         --       Coordinate Press Communication and Project Announcements
         --       Review Press Communication with CHCF
         --       Release Press Communication (On-going)
         --       Facilitate Community Dialogue (On-going)

MAY 1, 2000 TO OCTOBER 31, 2000 (NEW ACTIVITIES)

1.       Plan and Hold Two Day Showcase Conference

         CareStandard will hold an annual two-day conference promoting SBCCE
         progress and opportunities. The conference will provide an opportunity
         to showcase community success, technology innovation and regulation
         awareness. The conference will be geared to health care executives,
         physician and community leaders, and technology vendors.

         --       Determine Conference Format and Speakers
         --       Plan Logistics
         --       Develop Invitation List
         --       Distribute Invitations
         --       Confirm Attendees
         --       Host Conference
         --       Summarize Conference Results

2.       Define and Develop Baseline Outcomes Measures

         Project metrics will be baselined at the start of the project to track
         measurable progress throughout the three-year time frame.

         --       Determine Project Metrics
         --       Measure Baseline Project Metrics
         --       Document Baseline Project Metrics

                                      16
<PAGE>

3.       Identify Academic Research Partner

         CareStandard will conduct research analysis on the benefits to patient
         care across the community and will disseminate success factors for
         broader industry use through scientific conferences. Accordingly,
         CareStandard will seek funds from the Agency for Health Care Policy and
         Research (AHCPR) to involve academic evaluators to assess demonstration
         efforts. AHCPR is a federal agency that supports research designed to
         improve the quality of health care, reduce cost and broaden access to
         essential services.

4.       Prepare and Submit Care Alliance Deliverables Progress Report

         SBCCE progress will be tracked against the milestones and deliverables
         outlined in respective Care Alliance Agreements to be developed.

                                       17
<PAGE>

DELIVERABLES

<TABLE>
<CAPTION>
------------------------------------------  --------------  -------------  ------  -------  -------  ------
                                              04/03/00      10/31/00
------------------------------------------  --------------  -------------  ------  -------  -------  ------
<S>                                         <C>             <C>            <C>     <C>      <C>      <C>
PMO
------------------------------------------  --------------  -------------  ------  -------  -------  ------
Community Web Site Launch                         X
------------------------------------------  --------------  -------------  ------  -------  -------  ------
List of Certified Vendors                         X
------------------------------------------  --------------  -------------  ------  -------  -------  ------
Annual Conference Results                                        X
------------------------------------------  --------------  -------------  ------  -------  -------  ------
Baseline Outcomes Measures                                       X
------------------------------------------  --------------  -------------  ------  -------  -------  ------
Identify Academic Research Partner                               X
------------------------------------------  --------------  -------------  ------  -------  -------  ------
Anchor Agreements                                 X
------------------------------------------  --------------  -------------  ------  -------  -------  ------
Care Exchange Council Accord                      X
------------------------------------------  --------------  -------------  ------  -------  -------  ------
Care Alliance Agreements                          X
------------------------------------------  --------------  -------------  ------  -------  -------  ------
Community Deliverables Progress Report                           X
------------------------------------------  --------------  -------------  ------  -------  -------  ------
Care Exchange Committee and Advisory              X              X
Committee Minutes
------------------------------------------  --------------  -------------  ------  -------  -------  ------
</TABLE>

                                       18

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00010-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00010-of-00352.parquet"}]]