Appendix: Complementary Solutions

Engage Employees in Their Health and Well-Being

Health Advocacy Personal Health Advocates help members navigate healthcare and insurance-related issues, quickly and efficiently Personal Health Advocates are typically registered nurses, supported by medical directors, benefits and claims specialists Single, ongoing contact available for, direct dial phone number and email Increases employee productivity, satisfaction and retention; maximizes benefits utilization Available to members and their eligible family members including spouses/domestic partners, dependents, parents and parents-in-law. Reduces grievances and appeals; improves administrative efficiencies; alleviates burden on HR staff Reduces medical costs; improves health outcomes; saves everyone time and money

Wellness Program Highly personalized program to help employees reach health goals Unlimited health coaching by phone, email or secure web messaging Key focus areas include weight management, fitness/exercise, nutrition/diet, stress management, tobacco cessation, self care of chronic conditions NCQA-certified Health Risk Assessment and personalized report Robust online resources support coaching Innovative engagement programs, campaigns, wellness competitions Comprehensive, turnkey communications and educational materials Individual and aggregate management reporting Full suite of complementary add-on solutions Seamless integration with Health Advocacy service and all other Health Advocate solutions

EAP + Work/Life Licensed Professional Counselors provide confidential, short-term assistance with personal, family and work issues Counseling focuses on coping strategies In-person, telephonic and online video counseling available Referrals to appropriate professionals for more long-term support Work/Life specialists locate support services and local resources for help with childcare, eldercare, legal and financial counseling Work/Life website, webinars and onsite seminars Unlimited telephonic consultation for management and supervisors for help with critical incidents, employee conflicts and sensitive cases Medical Bill Saver™ service features skilled negotiators for help lowering non-covered medical/dental bills Personal Concierge service Reduces need for more costly mental health services and ER utilization

EmpoweredHealth™ Strategic alliance of key programs and services into one seamless offering Single, toll-free number, no matter what the issue Delivered by a select team of interdisciplinary experts in one location Advanced systems architecture analyzes health data from multiple sources; enables powerful targeting risk stratification and customized coaching Integrated Dashboards provide consolidated view of benefits utilization, gaps in care, health/wellness measures and engagement opportunities Promotes unprecedented level of collaboration around each individual Targeted, multi-format communications Robust management reporting Improves health outcomes/productivity; decreases medical costs; maximizes benefits utilization

Chronic Care Solutions Fully customizable to meet each client’s specific needs Advanced data analysis identifies and stratifies employees by risk level (high, average, low) and co-morbidities Ongoing, customized prevention and condition-specific communications increase compliance with recommended care Unlimited access to a Registered Nurse for personalized coaching Flexible communications including telephonic and email Reduces utilization and costs associated with avoidable complications Improves health outcomes and quality of life; lowers medical costs Fully integrated with Health Advocacy service and all other Health Advocate programs

Onsite Biometric Screenings Customizable onsite health screenings available nationwide Complete program management from start to finish Wide selection of screening options and packages Delivered by trained Health Advocate registered nurses, EMTs and health educators Easy-to-use online scheduler Immediate results Turnkey educational and promotional materials Seamless integration with Health Risk Assessment (HRA), wellness and incentive programs Individual and aggregate year-over- year reporting

Health Cost Estimator+ Health Advocate’s proprietary pricing transparency solution Supported by leading-edge technology and data analytics Provides key information to help select the highest-value providers Multiple data sources including client’s paid medical claims supplemented by our national database Cost comparisons for hundreds of medical services by ZIP code Real-time out-of-pocket estimates and user benefits status Quality indicators, safety scores and patient reviews Proactive employee awareness and engagement program Empowers more cost-effective decision-making Available on multiple platforms including mobile, tablet and PC Employees can call a Personal Health for added pricing support

Personalized Health Communications Personalized preventive and chronic care reminders focused on gaps in care Data-driven using eligibility and claims data matched to evidence-based guidelines Reaches 100 percent of members with preventive and chronic care services due Promotes compliance with important tests, medications and other screenings Addresses the most costly conditions such as heart disease, diabetes and asthma Directs members to their personal physician, Personal Health Advocates and Nurse Coaches Comprehensive management reports Fully-integrated with all Health Advocate solutions

Incentive Management Participation-Based Outcome-Based Engage with a Wellness Coach Complete a workshop Complete a PHP Track activities + participation on Wellness website Communications support WPC/Consultation and planning Added fees Outcome-Based Outcome-based associated with health-contingent program Behavior change Improve screening results Quit tobacco Eligibility file generation Incentive tracking + reporting WPC/Consultation and planning

Healthy Baby Personalized program focused on education, support and helping members have healthy pregnancies and babies Identifies risk factors (e.g., smoking) and supports members in reducing health risks Ongoing, regular outreach throughout pregnancy and after delivery During pregnancy: Ensures women get prenatal care, understand maternity benefits, and have a resource for any complications After delivery: Ensures that the baby gets newborn care; screen mom for post-partum depression; offers benefits and claims support Improves health outcomes and reduces medical costs

Outbound Calling, Text and Email Employs a variety of communication methods to fully support your need Product adoption, adherence and retention Increased revenue and market share Proven customer satisfaction & loyalty CSAT Customer Satisfaction rate of 97% Enhanced patient engagement Improved health & wellness

Tobacco Cessation Program Comprehensive solution helps employees successfully quit tobacco and stay tobacco-free 12-week, evidence-based program Personalized, one-on-one coaching Engages spouse in Coaching for additional support Coordinates with employer or health plan-paid Nicotine Replacement Therapies Integration with Wellness incentive program Promotion and reinforcement materials

NurseLine 24/7 hotline staffed by experienced Registered Nurses Supported by a state-of-the-art clinical information database Addresses questions about symptoms, medications and treatments for acute health issues Provides easy-to-understand self-care measures for non-urgent issues Directs callers to appropriate care in emergency situations (urgent care, 911) Ongoing communications support Integrates seamlessly with Health Advocacy service

MedChoice Support™ Self-directed comparison tool guides employees through key health decisions about treatments, tests and medications Combines authoritative medical information with practical personal assessments 150 decision-making topics cover costly and high-prevalence health choices such as surgery, diagnostic tests and medications Downloadable summary to share with healthcare team Helps employees choose appropriate care that may be less risky, complicated and costly

Cleveland Clinic MyConsult ® Online Second Opinion Program Special arrangement with Cleveland Clinic for access to electronic second opinions through their MyConsult Online Medical Second Opinion program Designed for employees with serious and life-threatening medical diagnosis Provides access to the Cleveland Clinic’s expert specialty physicians Eliminates time and expense of travel Helps confirm diagnosis or a treatment plan or offers alternatives; provides recommendations Convenient and secure; all personal health information is kept confidential Maximizes employee engagement in their care Improves health outcomes and reduces medical costs

Reduce Medical Costs – Save Money

Data Analytics Comprehensive selection of analytics and reporting services Flexible, customizable and scalable solutions available to self-insured groups of all sizes Provides key insight into the cost and quality of health benefits programs Helps monitor success of disease management and wellness programs Measures the cost of absenteeism and lost productivity Completely objective; no affiliation with specific carries or plans Proven performance measurement methods to facilitate data acquisition/consolidation Customized reporting with multiple end-user views

PreVent/Claim Overpayment Recovery Complete post adjudication, pre-payment identification/validation solution supplements auto-adjudication and traditional pre-pay tools Combines analytics with the human touch to identify areas of incorrect payment before the payment is made to the provider Uses predictive, data-driven, integrated code edits and clinical aberrancy rules to identify potential mis-payments Increases recoveries and reduces costs immediately

Cost Containment Solutions State-of-the-art data analytics, combined with expert knowledge, to pinpoint claims payment errors and identify areas of waste Highly-trained staff works to recover mis-paid claims and implement processes to protect future incorrect payments Skilled recovery specialists provide complete case management Supported by expert legal team and resources Clients pay only if our services can save them money Ongoing, comprehensive client reporting

HealthInsights Dashboards Helps employee benefits organizations transform aggregate claims, pharmacy and enrollment data into a series of understandable web- based dashboards and reports Predictive modeling based on evidence-based medicine cost and utilization history Quickly identify and track spending Track, measure and forecast enrollee health and wellness benefits costs Select and manage insurers and health plans; monitor financial and clinical performance Eliminate redundant costs and improve product offerings

Subrogation/Overpayment Recovery Proprietary subrogation identification model and advanced analytics identify third-party liability and claims with the greatest likelihood of recovery Applies specialty subrogation tools (property/casualty database searches, federal/state online records) to maximize identification and recovery Validators manually calculate and verify that the claim is truly overpaid Regular, detailed reporting of claims recovery status and results You only pay us if we save you money

Third Party Liability Proprietary software, combined with expert team, analyzes claims to identify when other sources for healthcare coverage may be liable for claim payments Software uses ICD-9 trauma and E-series codes to identify and accumulate paid claims Code library contains codes that most often represent accidents that result in settlement; library is updated annually Minimizes member abrasion and use of client’s internal resources, and can be incorporated into any payer’s workflow

Survey Services Coordination of Benefits (COB) Recovery. Experienced survey team collects, manages and reports other insurance coverage information for member populations; results uploaded to payers’ systems so claims can be processed accurately according to the primary sequence. Employer Group Size Verification. Helps payers maintain compliance with Medicare Secondary Payer (MSP) requirements to ensure accurate claim payments and avoid fines/penalties. Social Security Number Capture. Survey services ensure compliance with ACA mandate to capture Social Security numbers of members who carry minimal essential coverage.

Medical Bill Saver™ Negotiates non-covered, out-of-network, and/or exceeding the benefit maximum medical or dental bills over $400, regardless of benefit status Highly experienced negotiating unit Offers “safety net” for employees to reduce out-of-pocket expenses Track record of achieving significant savings

Medicare Advantage Stars Program Fully integrate 6-part program helps plans meet quality-based objectives Provides opportunity to earn 5-star rating required to secure millions in bonuses and ability to market the plan year-round Combines personalized, telephonic, healthcare help, clinical coaching, data- driven communications and Dashboard technology to increase compliance and improve outcomes

Telemedicine Licensed MeMD physicians available 24/7, 365 No waiting rooms, no closed offices, no waiting weeks for an appointment Receive answers and treatment within 30-60 minutes via phone or video No limitations on use Significantly less expensive than typical office, urgent care or ER visits Saves on out-of-pocket expenses, i.e., deductibles, co-pays Less time off from work for doctor appointments

Support Streamlined Administration

Benefits Gateway™ Benefits experts connect employees to all benefits through a single 800# (e.g., medical, dental, EAP, pharmacy) Flexible design; client dictates which benefits/vendors to include Health Advocate development team coordinates intra-vendor setup and processes Supported by the latest information/telephonic technology Turnkey communications program Smooth transition to Health Advocacy service for help resolving healthcare and insurance-related issues

FMLA Support Staffed by a team with experience working with providers, health benefits, medical issues and FMLA review Reviews employees’ medical leave requests, including contacting the certifying physician when necessary Helps determine whether the condition meets the FMLA definition of “serious medical condition” Fully complies with HIPAA privacy regulations to protect health information

External Appeals Administration Independent, turnkey solution to meet federal regulations for external appeals Seasoned healthcare and insurance experts manage complete external appeals process Contracts with qualified Independent Review Organizations for unbiased reviews Develops required member notices, in accordance with NAIC model communications Facilitates expedited reviews where member’s life or health is at risk Coordinates relevant medical and benefits information Tracks progress; provides required reports including certification of outcomes

Enrollment Advocate Serves as primary resource for all benefit-related questions Supports HR staff and strategic initiatives Enhanced support to make presentation of benefits run smoothly Supports all aspects of communication program Employees can call any time; no limit on call duration and call-backs Seamlessly integrates with Health Advocacy service

Independent Appeals Administration Supports self-funded organizations who have fiduciary responsibility for the appeals process Experienced appeals administration and review team performs objective analyses for accurate appeals decision Researches appeals to ensure fair and consistent treatment and avoid costly mistakes Manages the entire process; provides unbiased evaluations Ensures compliance with state and federal regulations and timelines

Improve Quality of Care

Integrated Data Repository Customizable services include patient outreach, administrative assistance and data analytics to help health organizations maximize revenue, optimize patient engagement and build brand loyalty Personalized service from trained Personal Health Advocates Administrative and clinical help for patients and staff; personal outreach to patients via telephone and mail Advanced data analytics and reporting helps identify risk and pinpoint spending Frees physician and administrative schedules Maximizes performance on quality metrics and revenue retention Fully integrated with all Health Advocate programs

Disease Stratification and Predictive Modeling Identifies and risk stratifies patients with chronic diseases using proprietary clinical indicators adapted from nationally-recognized standards of care and evidence-based medical guidelines Creates member-level risk scores, broken down by service category and 2,000+ clinical classifications Actuarial forecasting uses industry- leading predictive models, customized to include multiple data sources Comprehensive concurrent and prospective healthcare cost and utilization analysis

Provider Performance Analytics Tailored approach to managing performance, quality and cost efficiency among provider populations Flexibility—client decides how strict or loose the methodology Analyzes episodes of care to rate providers on effectiveness and cost Identifies unnecessary medical interventions Analysis based on peer-reviewed preventive and recommended care metrics Data is refreshed annually and presented in actionable formats to promote behavior change Results can be used to develop preferred networks to control costs and improve outcomes Detailed, easy-to-understand reporting package

Population Risk Tailored approach to managing performance, quality and cost efficiency among provider populations Flexibility—client decides how strict or loose the methodology Analyzes episodes of care to rate providers on effectiveness and cost Identifies unnecessary medical interventions Analysis based on peer-reviewed preventive and recommended care metrics Data is refreshed annually and presented in actionable formats to promote behavior change Results can be used to develop preferred networks to control costs and improve outcomes Detailed, easy-to-understand reporting package