Reduce Stress, Metabolic Syndrome, and Health Costs Bruce Cryer, CEO HeartMath LLC

Transforming Stress Workshop Leader’s Notes Problem I would head as The Challenge Dot point three would become Stress is a major contributor (or factor) to many chronic and lifestyle related diseases Stress is accelerating; more complaints; few effective solutions Changing workforce puts organizational productivity, health costs and sustainability at risk Well-demonstrated link between workplace stress, performance and health Slide # 2

Stress and Disease Production One Third of Americans Extremely Stressed. APA Survey 10/07 Workplace stress is as bad for your heart as smoking and high cholesterol. JAMA. 2007;298:1652-1660. Most costly health care expenditures are for stress-related disorders. People with high stress have 46% higher health costs. JOEM, Vol. 40, Number 10, October 1998.

Health Risk Identification

Lurking in the background…. Metabolic Syndrome Blood pressure HDL Triglycerides Blood Glucose Waist Circumference

Impact on Disease Production High Cortisol: Low DHEA Obesity (Marin 1992) Diabetes (Nestler 1992) Hypertension (Shafagoj 1992) Heart Disease (Barrett-Connor 1986) Cancer (Bhatavdekar 1994) Alzheimer’s (Nasman 1995) HIV-related disease (Wisniewski 1993)

Revitalize You! Solution: Video-based online learning program Validated by clinical research into the physiology of optimal function, performance, resilience Results in rapid, sustained behavior and health improvement based on practical tools emWave2® feedback technology engages practice Program can be scaled 24/7 across global populations Way too much for one slide Probably break into two slides: Start new slide at Program can be introduced

Who is HeartMath? Founded 1991, non-profit research center to study links between stress, brain/heart function, health and performance. Developers of award-winning learning and technology solutions with measurable results. 19 years evidence of consistent, sustained reduction of stress and stress-related conditions More than 60 published research studies on mental and emotional well-being, cognitive performance, health care utilization, staff retention, leadership development, PTSD.

Selected Clients

Published Research American Journal of Cardiology Harvard Business Review Wall Street Journal Future Healthcare: The Journal of Medical Innovation Stress Medicine Preventive Cardiology Modern Healthcare Alternative Therapies in Health and Medicine

Interrupting the stress cycle for optimal health and performance Transforming Stress Workshop Leader’s Notes Interrupting the stress cycle for optimal health and performance Perception Brain Function Thoughts & Emotions Physiological Effect Slide # 11 11

Coherence  Creates “Zone Performance” An optimal state in which the heart, mind and emotions are operating in-sync and balanced. Physiologically, the immune, hormonal and nervous systems function in a state of energetic coordination.  Creates “Zone Performance” Slide # 12

Interrupting the stress cycle for optimal health and performance Transforming Stress Workshop Leader’s Notes Interrupting the stress cycle for optimal health and performance ++ Health ++ Performance Perception Coherence Brain Function Thoughts & Emotions Physiological Effect Slide # 13 13

Why Coherence Training is Important Improves effectiveness of other wellness programs Improves both physical and mental categories resulting in reduced costs The state of coherence is a natural state and can be practiced by anyone in any situation It’s an anchor for behavior change that maximizes sustainability. Results indicate improvement in both physical and mental categories. These two categories are the leading causes of illness and prescription drugs used in the US.

Healthcare Cost Reduction: Nonprofit Organization 144 in HeartMath cohort; 343 in control group Positive outcomes in three major areas: Claim Cost Biometrics Well-Being and Quality of Life

Healthcare Cost Reduction Medical Costs: 0% HeartMath Cohort Non-HeartMath Cohort $ 4% Decreased cost $ 9% Increased cost -5% 0% 10% *2007 covered charges vs. 2008 covered charges

Healthcare Cost Reduction Essential Hypertension Costs: 0% HeartMath Cohort Non-HeartMath Cohort $ 22% Decreased cost $ 47% Increased cost -25% 0% 50% *2007 covered charges vs. 2008 covered charges

Healthcare Cost Reduction: 911 Call Center 100 in HeartMath cohort; compared against rest of covered lives Positive outcomes in: Total spend ER visits Rx

Expenditures 11% Decrease 19% Increase 30% Increase 8% Increase Medical Expenditures $77 Decrease $75 Increase 11% Decrease HM Non-Int 19% Increase Total Expenditures The non-intervention pre-program average was $661, significantly lower than the HeartMath pre-program average of $1,115 Non-Int 30% Increase 8% Increase HM = HeartMath = Non-intervention

Utilization 9% Decrease 27% Decrease 17% Decrease 50% Decrease ER Visits / Admissions Non-Int 9% Decrease 27% Decrease HM Office Visits Non-Int 17% Decrease HM 50% Decrease = HeartMath = Non-intervention

Utilization 30% Increase 8% Increase Scripts Non-Int 30% Increase 8% Increase HM While the HeartMath group has a larger average number of scripts per quarter, the percentage growth is significantly lower.  Also, the lower member group size of the HeartMath group will lend itself to causing the few members with a high number of scripts not being averaged as evenly as in the larger non-intervention group. = HeartMath = Non-intervention

Utilization 20% Increase 10% Increase Risk Index Non-Int 20% Increase HM 10% Increase Similar to the Scripts Utilization, the HeartMath has a higher average RI, but the % increase is lower. = HeartMath = Non-intervention

Biometric Improvements Metabolic Syndrome Metabolic Syndrome % Positive

Improvements in Well-Being and Productivity Clinical Stress Risk Reduction Percentage of individuals who responded : often- always Before and six weeks after taking the HeartMath Program (n=5692) 60%6 60%6 44%6 52%6 52%6 61%6

Improvements in Well-Being and Productivity 43%6 44%6 63%6 Hi – Jackie from IHM (where they do the heartmath research) who runs the POQA reports just sent me an updated “all pairs” report – the aggregate of all matching pre / post data we have for POQA – last time they had 3129 people’s data – now they have 5692 - I added two rough slides at the top of this in case you/Catherine want to use. would replace the ones that have n=3129)   Thanks, Sibyl     33%6 44%6 44%6 (n=5692)

Case Study – Sustainability % attendees With no further intervention

Summary: Revitalize You! Outcomes Transforming Stress Workshop Leader’s Notes Summary: Revitalize You! Outcomes Reduced medical costs Reduced self-reported stress, anxiety, depression, fatigue, sleeplessness Reduced Metabolic Syndrome Improved productivity and performance Improved employee engagement and morale Slide # 27

The Science Behind These Results

Inhibits Brain Function (Incoherence) Facilitates Brain Function (Coherence)

The process of shifting into and anchoring a coherent state is facilitated by HeartMath’s award-winning technology — the emWave2.

Revitalize You! Overview Video-based online learning program Five 1-hour sessions teaching more than ten health-promoting HeartMath tools and techniques to build resilience while transforming stress Online application, registration and surveys Individual communication is key to a successful program emWave2 technology for each participant Psychometric measures to validate program effectiveness Five 1-hour sessions teaching more than ten health-promoting HeartMath tools and techniques to build resilience while transforming stress *Delivered through top LMS/Rich internet application platform * Includes worksheets, quizzes, online coaching and alumni program Individual communication is key to a successful program * Multiple messages per session to participants * Health counselors for quality and engagement

Revitalize You! Guided exercises Science Demos Training and Homework

Participants Report 83% say they are healthier Transforming Stress Workshop Leader’s Notes Participants Report 83% say they are healthier 69% say they have more energy and vitality 70% say that it is easier to focus at work 61% say that it is easier to communicate This is the most effective health program I have participated in at my organization. It is phenomenal! This program will be instrumental in improving my health, no doubt about it! Lin Slide # 34

Transforming Stress Workshop Leader’s Notes Participants Report Just want to comment on how great [the Revitalize You! program] is and how much I am learning...  I have a very stressful job and it is great learning how to deal with my stress and reduce it to be more productive.  I use it every night and I am sleeping great.  There are several others in my office on the program and we all have our emWaves on our desk, ready to use at a moment’s notice.  Bottom line, I am very impressed with the program and I would recommend it to anyone. Thanks for the great program.   Margaret Lawrence Team Lead, Travelocity Business Slide # 35

Q&A Bruce Cryer bcryer@heartmath.com