Wellness in the Workplace

1. Wellness in the Workplace Benefits Forum 2005 Atlanta Association of Health Underwriters February 17, 2005 William Burke Capital Health Associates, LLC James Price HispaniCare, a division of DrTango

2. Agenda • Common issues regarding “wellness” • Defining a wellness program • Critical Success Factors • Logic for investing in wellness • What’s different today from 1995 • An interesting client example • Lessons learned

3. Corporate CFOs expect that healthcare costs will be the biggest cost increase for their company. Health Benefits: Top Management Concern Top Three ConcernsFor 1,482 CFOs at companies with revenue of $500,000 to $1 billion Employee healthcare plans 45% Technology spending 20% Employee recruitment/training 11%Source: Robert Half Management Resources survey, USA Today, January 25, 2005, p. B-1)

4. Typical Issues • How Do You Invest in a Wellness Program That Provides Return? • What Is the Best Allocation of Wellness-type Resources? • What Is the Timeframe Most Suited for an Effective Wellness • Program to Produce Return on Investment? • What Company Profile Is Best Suited for a Wellness Program? • What Is the Best Step Taken in Implementing a Wellness • Strategy That Establishes Buy-in and Results?

5. Our Assumptions Companies do not want to • Invest in extending the life of a 20-year old Companies do want to • Provide resources to prevent unnecessary health care costs • Provide resources to prevent individuals from developing costly medical conditions • Educate their employees as responsible health care purchasers and users • Help employees with a chronic condition optimize their wellness

6. How Does It Work Really? Providing programs and tools that empower People with information that encourages and supports them to take a more active role in their health care Incentives • Financial • Non-financial Directives Cultural Motivators Benefit Plan Design

7. Mod. To Severe Chronically Ill Mild Chronically Ill Sick, Not Yet Diagnosed Worried Well Ideal Health Segmenting your Covered Lives and Addressing each Segment’s Needs Prevention (for well people) Disease Management Awareness Compliance Population Health Management/Wellness

8. Different Approach, Different Results Health Maintenance VS Risk Management • Have a problem, Fix It • Minimal organizational commitment • Standard Plan Design • Willingness to allow benefit plan design to control costs • Assume there is Risk – Find It, Fix It • Organizational Dedication • Wellness Integrated into Plan Design

9. Program Complexity Cost/Impact Less More Claims Analysis Invasive HRAs Non-invasive HRAs Self Assess Guides Health Library Predictive Modeling Group Programs Individualized Programs Nutrition & Exercise Evaluators News Letters Health Coaching Disease Management Health Fairs Self- reporting Tools/Programs Workshops

10. Factors affecting Investment in Wellness • Industry Segment • Budget • Employee Turnover • Workforce Composition • Worker’s Compensation Claims • Employee communications culture • Medical claims • Current benefit plan design • Centralized Workforce

11. Critical Success Factors • Understand Client’s Goals and Objectives on Cost & Impact • Willingness to Invest and Timeframe for ROI • Get Management’s Sponsorship • Develop a Communication Plan • Measure the Program Participation and the Outcomes • Reporting on the Aggregate and for the Individual • Aggressive Follow-up on High-cost & chronically ill enrollees • Choice-oriented Programs • Strong Linkage to Health Benefits • Privacy, Privacy, Privacy

12. Changes over past 10 years • Real healthcare costs per employee have tripled….so dollar value of 10% savings has tripled • Realization that chronic conditions drive healthcare costs • Realization that behavior change is required • Behavior change is hard to effect • Current health outcomes (awareness, status, process) are poor • The nation’s workforce is becoming very multi-cultural • Most people access the Internet • Explosion of Internet-based health/wellness applications…at very low costs

13. People with Chronic Conditions: 31% of total population have 64% of costs Enrollee Cost by Age 35–44, 1992 Group Health Coop., Puget Sound Chronic Conditions Distribution of: Enrollees 100% 69% 23% 8% Health Care Costs 100% 36% 36% 28% Source: Fishman, et al, “Chronic Care Costs in Managed Care,” Health Affairs, May/June 1997, page 243

14. Chronic Conditions Accumulate with Age, Driving Costs Enrollee Cost by Age, 1992 Group Health Coop., Puget Sound People with 1+ condition Source: Fishman, et al, “Chronic Care Costs in Managed Care,” Health Affairs, May/June 1997, page 243

15. Importance of Weight Management for Employers Prevalence of Weight Status, Adults with Commercial Insurance Increase in Adult per Capita Medical Spending Attributable to Weight (Commercial) $12-15 PMPM cost for typical commercial plan Source: Health Affairs, May 2003 Total Medical Expenditures due to Overweight/Obesity: 8.2%

16. Relative risk of Selected Obesity-Related Diseases Source: Oster et al, “The Clinical and Economic Burden of Obesity in a Managed Care Setting,” The American Journal of Managed Care, June 2000.

17. Probability of diabetes, newborns: • 33% all American • 50% for Hispanics • More than most other issues diet & health driven by culture and language

18. Self-Management by Diabetics, NYC (2002): Currently Very Poor Blood Sugar Control (A1c) Blood Pressure Well Controlled: 2% Normal & High-Normal: 11% Poorly controlled & Don’t know: 98% High & Don’t Know: 89% Cholesterol Weekly Exercise Normal: 7% High & Don’t Know: 93% Source: NYC Vital Signs, January, 2003

19. “Minorities”: Driving population growth with Employer-Sponsored Insurance Total U.S. Population with Employer-Sponsored Insurance (in millions) Source: Census data; HispaniCare analysis

20. Percent of ALL Adults who have sought health information online Source: Harris Interactive, 2003 (Feb 2003 survey)

21. Smoking Cessation Program Highlights Web-based Smoking Cessation Program • Online Quit Program, including • 11 dynamic exercises • Results stored in personal Glove Compartment • Quit Diary to track progress • Quit Stats: money saved, cigarettes not smoked, life gained • 11-week Outbound Motivational Email Campaign • Printable Dependency Test • Follow-up email at 1, 6 and 12 months to assess abstinence • Expert-moderated chat rooms • Public Pledges • Gallery of Quitting Tips • Anniversary Celebrations

22. Consumer-Directed Healthcare Objective: Help members make informed decisions, appropriately use providers, and self-manage

23. Example Page from Lab-Test Driven HRA Links to targeted content (driven by lab value) within health portal

25. Diet & Exercise Self-Management Diet & Exercise Evaluation E-mail Newsletter (encourage change) Food Shopping List Wellness Management (Menu & Exercise Planner)

26. Member-Personalized Weekly Newsletter

27. What We Don’t Know Yet: • Net present value to the employer of each wellness “success”: • 35-year old whose BMI is reduced from 30 to 25 • 45-year old who stops smoking • 50-year old diabetic who becomes compliant • 40-year old depressive who responds well to treatment • Value of Health Insurance with a distinctive wellness component to the typical employee (for whom minimal claims are incurred in a given year), in terms of recruitment, retention, sick days, “presenteeism” • Incremental return of adding human counseling to web-based tools

28. Robert Wood Johnson Health e_Technologies Research Project Overall Goal: Rigorously evaluate the ability of the MiDieta™ (MyDiet) eHealth portal to facilitate improved diets, increased fitness-levels, and weight-loss among U.S. Hispanics. Settings: Managed care (AtlantiCare, BCBS-FL) and Hospitals (Tenet, CHRISTUS) Design: * Formative Research (6 m) * Randomized Trial (12 m) * n = 500 among four groups (at least) Subjects: Overweight online Hispanics attending clinic / enrolled in managed care plan Currently recruiting 2-5 employers by March 31

29. As a former VP-HR, I would: • Provide my employees with information to understand healthcare, increase awareness/interest, and help them make better decisions • Offer an inexpensive (but extensive-looking) basic wellness program/portal with: • Diet and exercise planner • Smoking cessation • Depression support • Stress/anxiety • Guides for common chronic conditions • Increase awareness via: • Web-based Health Risk Assessment • Personalized weekly health newsletter • Health fairs • Incentives

30. As a former VP-HR, I would: • Explore: • Lab-test based Health Risk Assessment • Intensive support/tools for employees with chronic conditions • Offering employees (particularly those at high-risk or already with a chronic condition) a Personal Health Record • On-site primary care • Document all outcomes, for future ROI discussions with the CFO

31. Questions Contacts Bill Burke (770) 579-8323 WBurke@Cap-Health.com Jim Price (678) 242-6778 JPrice@HispaniCare.com

32. Appendix • Slides we couldn’t delete

33. The Importance of Language Number of People in U.S. that Speak at home…. ? Source: Census data; HispaniCare analysis

34. Number of People in U.S. that Speak at home…. Spanish! Source: Census data; HispaniCare analysis

35. Language and culture are particularly relevant for health issues INSURED Hispanics Very sick, did NOT seek medical care Percent Source: Commonwealth Fund, Feb 2003

36. Language and culture are particularly relevant for health issues INSURED - Easily understands instructions on prescription bottle Percent Source: Commonwealth Fund, Feb 2003

37. …results in Sub-optimal utilization of medications by Hispanics Of 100Sick, insuredSpanish-speaking Hispanics: 70%go to doctor, and of these, only 55%adequately understand English Instructions on the bottle. Thus, due to these two factors alone, Just 39* of the original 100 are getting and properly understanding the medications they need *(100 x 0.7 x 0.55 = 39)

38. “Go Online” by race Pew Internet Study, 2004.

39. Percent of ALL Adults who have sought health information online Harris Interactive 2003

40. HispaniCare Mission Provide healthcare organizations with online: • Communications, • Marketing, • Health improvement solutions Strategy • Best of breed solutions • Culturally & linguistically adapt each solution • Integrate & customize