A Personal Call to Action Invest in Yourself 2010 State Agency Wellness Conference:

1. A Personal Call to Action Invest in Yourself 2010 State Agency Wellness Conference: Investing in Health Eduardo Sanchez, MD,MPH,FAAFP Vice President and Chief Medical Officer BlueCross and BlueShield of Texas September 22, 2010

2. Our missionis topromote the health and wellnessof our members and communities through accessible, cost-effective, quality health care.

4. What Employers want from health insurers in 2010: Better information, more value (PwC's Health Research Institute) Employers are looking to their health plan providers for information, technology and strategies to help reduce waste in healthcare spending and better engage employees in managing their health. 4

5. The Healthcare Spectrum Today Understanding the Impact and Opportunity Population Distribution Severe Illness and Complex Disease / End-of-Life Care Acute Conditions Chronic Conditions Healthy At Risk Healthcare Cost Distribution 5 5

6. Causes of Death, United States 2005 26.6% Diseases of the heart 22.8% All cancers 5.9% Stroke 5.3% Chronic lower respiratory disease 4.8% Unintentional injuries Diabetes mellitus 3.1% Alzheimer’s disease 2.9% Influenza and pneumonia 1.8% 1.4% Septicemia 0% 9% 18% 27% 36% Source: cdc.gov

7. The Preventable Causes of Death in the United States:Comparative Risk Assessment of Dietary, Lifestyle, and Metabolic Risk Factors (Danaei,2009) Deaths attributable to individual risk (thousands) in both sexes

8. America's Fattest Cities – Men’s Heath 2010

9. Ready, Willing, And Unable To Serve(Mission: Readiness) The Biggest Reason Why Young Americans Cannot Join the Military: Physically unfit: 27 percent of young Americans are too overweight to join the military.

10. Increasing Prevalence of Diabetes by Age: Burden of Disease or Opportunity Between 2002 and 2006, the prevalence of diabetes has risen among all age groups Diabetes Prevalence by Age Number per 1,000 Population Source: Centers for Disease Control and Prevention, National Center for Health Statistics (2008) National Health Interview Survey (NHIS)

11. Based on claims from 2 million claims, individuals taking medications for at least 3 risk factors associated with Metabolic Syndrome had an annual drug spend more than 4 times that of all other patients. Clinical and Economic Risks of Metabolic Syndrome: Opportunity Working-age individuals with Metabolic Syndrome had significantly higher medical costs compared to those without Metabolic Syndrome: • With Metabolic Syndrome: $626 per member per month (PMPM) • Without Metabolic Syndrome: $367 PMPM • $259 excess medical cost per month • $3108 excess medical cost per year Source: Metabolic Syndrome and Employer Sponsored Medical Benefits: An Actuarial Study, Kathryn Fitch R.N., Med, Bruce Pyenson, FSA, MAA, Kosuke Iwasake, FIAJ, MIAA, Milliman, New York, NY September 2007

12. High cost claims (3 BCBSTX clients)

13. Obesity and Cancer (American Institute for Cancer Research)

14. The Real Problem: The Full Cost of Poor Employee Health Personal Health Costs Medical Care Pharmacy Medical & Pharmacy Costs $3,376 PEPY 25% Productivity Costs Absenteeism Short-term Disability Long-term Disability Health-RelatedProductivity Costs $10,128 PEPY 75% Presenteeism Overtime Turnover Temporary Staffing Administrative Costs Replacement Training Off-Site Travel for Care Customer Dissatisfaction Variable Product Quality Total Costs = $13,504 PEPY Sources: Edington DW, Burton WN. Health and Productivity. In McCunney RJ, Editor. A Practical Approach to Occupational and Environmental Medicine. 3rd edition. Philadelphia, PA. Lippincott, Williams and Wilkens; 2003: 40-152 and Loeppke, R., et al. Health and Productivity as a Business Strategy. Journal of Occupational and Environmental Medicine. Vol 49, No. 7, July, 2007. Pages 712-721 and the 2006 Mercer Employer Annual Survey;

15. Chronic Conditions Health and Productivity as a Business Strategy: A Multiemployer Study Source: “Health and Productivity as a Business Strategy,” JOEM. Vol. 51, No. 4, April 2009 15

16. Total Medical, Pharma & Productivity -- per 1000/FTEs -- (HPBS – Phase 2 Employers) $400,000 $100,000 $200,000 $300,000 16 Source: “Health and Productivity as a Business Strategy,” JOEM. Vol. 51, No. 4, April 2009

17. Co-Morbidity and Lost Time 37.4 29.4 26.5 19.5 14.2 12.7 11.9 7.8 4.9 1.7 17 Source: “Health and Productivity as a Business Strategy,” JOEM. Vol. 51, No. 4, April 2009

18. Estimated Per Capita Health Expenditures,by Age and Sex, 1995 Blue Cross and Blue Shield of Texas 18

19. Healthy aging is dependent on a lifetime of healthy living • Prediction of Lifetime Risk for Cardiovascular Disease by Risk Factor Burden at 50 Years of Age, Lloyd-Jones, et al, Circulation2006;113;791-798. • The absence of established risk factors at 50 years of age is associated with very low lifetime risk for CVD and markedly longer survival. These results should promote efforts aimed at preventing development of risk factors in young individuals. • Given the high lifetime risks and lower survival in those with intermediate or high risk factor burden at 50 years of age, these data may be useful in communicating risks and supporting intensive preventive therapy.

20. Small steps • A recent study of women who had walked 30 minutes a day five days a week at a 20 minute mile pace in their 50’s compared to women who had not: • In their 70’s, the walkers were much less likely to have chronic diseases like heart disease, high blood pressure, or diabetes • The walkers had better mental fitness than non-walkers

21. Life's Simple 7 for personal wellness • Never smoked or quit more than one year ago • Body mass index less than 25 kg/m2 • Physical activity of at least 150 minutes (moderate intensity) or 75 minutes (vigorous intensity) each week • Four to five of the key components of a healthy diet consistent with current American Heart Association guideline recommendations • Total cholesterol of less than 200 mg/dL • Blood pressure below 120/80 mm Hg • Fasting blood glucose less than 100 mg/dL American Heart Association

22. Metabolic Syndrome Program Down Under 10 Australian Aborigines Overweight With diabetes Living a western lifestyle – “la vida loca” Returned to traditional homeland for seven weeks Average weight loss of 18 pounds Blood pressure reduction Normal triglycerides M. Pollan, In Defense of Food 22

23. Diabetes Prevention Program (DPP)Lifestyle works better (and less expensively) than medication The DPP Research Group, NEJM 346:393-403, 2002

24. BCBSTX Employee MetS Program Pilot Results

26. In the clinical setting…

27. The Challenge Engagement

28. “The man who does not read good books has no advantage over the man who can't read.”  - Mark Twain • “Drugs don’t work in patients that don’t take them.” - C. Everett Koop, M.D.

29. Where to engage • The workplace • Away from the workplace • School (for dependents) • Home • Neighborhood/community • Travel • The clinical setting

30. How to engage • By mail • By e-mail • Texting • Web-site • By phone • From the health plan • From the doctor’s office

31. Wellness Options

32. Physical Fitness that’s Affordable, Simple, and Accessible. • Members can mix and match health clubs and locations anywhere in the national network • Just $29 to sign up, then $29 per month – no contract obligation • 1,900 health clubs and growing, including: • Bally (all), 24 Hour Fitness (all), select YMCAs, and many other select fitness centers • Benefits: • Reinforcement of healthy behaviors • Healthier, more productive workforce

33. BCBSTX Strategies to Enhance Quality of Care • Evidence-based measures (EBM) • Performance based reimbursement (PBR) • F-codes           • pregnancy-related         • tobacco use related • Bridges to Excellence (BTE)         • diabetes  50 to 200         • cardiac coming soon • BCBSA Childhood Obesity Clinician’s Toolkit • PCMH pilots in North Texas         • MAC interest • Hospital Acquired infections reduction • EMR financial support for workforce initiative

34. Eduardo’s Wellness tips Eat smart Be active Avoid tobacco Stay connected Sleep plenty See your doctor as advised for age and gender

35. Thank you!