Case Study: Six Straight Years of Declining Healthcare Costs --Presentation and Case Study-- #kyshrmconf Dr. Rick Cartor, Custom Healthcare Designs / BB&T 1 rickcartor.wordpress.com

Dr. Rick Cartor, Custom Healthcare Designs / BB&T AGENDA 1. Our Purpose Today 2. The Company 3. The Summary Statement 4. The Timeline & Results 5. Why it works & Advice #kyshrmconf Dr. Rick Cartor, Custom Healthcare Designs / BB&T rickcartor.wordpress.com

Dr. Rick Cartor, ChD / BB&T Our Purpose Today The purpose of this session is generate ideas that may enhance the value1 of the healthcare benefits your company provides its employees, by sharing the details of one company’s very successful2 health care benefit system. 1. Value: low cost, high quality, accessible care 2. Success: decreasing PEPY spending, improved health, positive reactions, accessible quality care #kyshrmconf Dr. Rick Cartor, ChD / BB&T (502) 489-5972 rickcartor.wordpress.com

Dr. Rick Cartor, ChD / BB&T About the company Description History & Purpose The Mary Byron Foundation Products/Services Awards VP, HR @ 150 Healthcare experience and vision #kyshrmconf Dr. Rick Cartor, ChD / BB&T (502) 489-5972 Page 4 rickcartor.wordpress.com

Dr. Rick Cartor, ChD / BB&T The Summary Statement A long term incremental introduction of an integrated system that engaged employees in primary care by creating a collaborative culture of health awareness by: aligning incentives, analyzing and sharing data (information) contracting for convenient primary care establishing and steering to a narrow network #kyshrmconf Dr. Rick Cartor, ChD / BB&T (502) 489-5972 Page 5 rickcartor.wordpress.com

The “integrated system” Health assessment and promotion “Wellness” with incentives / disincentives Continuum of coaching Contracted accessible care Fixed rate (lower and more predictable) On-site or near site x Solo or shared Data acquisition and analysis Analytics, information and transparency Narrow network and steerage #kyshrmconf Dr. Rick Cartor, ChD / BB&T (502) 489-5972 Page 6 rickcartor.wordpress.com

Biometrics (Eddington) Timeline START: Existing Care plan HDHP/HSA Jan. 1 $1 !? You are here (09/27) Biometrics (Eddington) Drawing: F2T Renewal $ Stop HRA Add Sr+ Committee HRA Coaching 2008 2010 2012 1 2 3 4 2006 2007 2009 2011 2013 Coaching & DM ONSITE CARE Healthcare to HR WELLNESS SELF-FUND ChD BHN EXCLUSIVE NETWORK Incentives (+PCC) for partners Rewards: Participation to ZT to results Free e-cigs Nicotine test to attest Non-smoker reward to smoker fees ½ fitness fees + Steerage #kyshrmconf Dr. Rick Cartor, ChD / BB&T (502) 489-5972 rickcartor.wordpress.com

Dr. Rick Cartor, ChD / BB&T Data  Actions PMPM data Recidivists (biometrics) Targeting repeat high risk factor employees Effects (biometric scores  healthcare costs) Focus wellness programs, activities #kyshrmconf Dr. Rick Cartor, ChD / BB&T (502) 489-5972 Page 8 rickcartor.wordpress.com

Wellness Self Fund On Site PCC 2006 2007 2008 2009 2010 2011 2012 2013 BACK Wellness Self Fund On Site PCC $210 2006 2007 2008 2009 2010 2011 2012 2013 1 2 3 4

Dr. Rick Cartor, ChD / BB&T Data  Actions PMPM data Recidivists (biometrics) Targeting repeat high risk factor employees Effects (biometric scores  healthcare costs) Focus wellness programs, activities #kyshrmconf Dr. Rick Cartor, ChD / BB&T (502) 489-5972 Page 10 rickcartor.wordpress.com

Dr. Rick Cartor, ChD / BB&T Why it Works (1-5 of 11) 01. Primary and preventive care Dr. Barbara Starfield, Johns Hopkins, etc. 02. Transaction costs: doctor visits / meds & pharmacy / lab work 03. Coaching & disease management 04. ER, ICC use 05. Procedures, Inpatient care, Meds #kyshrmconf Dr. Rick Cartor, ChD / BB&T (502) 489-5972 Page 11 rickcartor.wordpress.com

Dr. Rick Cartor, ChD / BB&T Why it Works (6-11 of 11) 06. In Network + Transparency = Lower costs 07. Self-funding: incentive management, steerage 08. Unbundled: transparency, competition, value. 09. Data driven decisions 10. Zero Trend basis (P’MaintainImprove) 11. Integration: system design #kyshrmconf Dr. Rick Cartor, ChD / BB&T (502) 489-5972 Page 12 rickcartor.wordpress.com

Unsolicited Advice (…or free consulting!) 01. Believe. 02. Emphasize primary care, prevention. 03. Stop Idea Whack-a-Mole. 04. Think small / act locally. 05. Use a formal PSDM process. 06. Agree on goals, objectives, criteria. 07. Think > 12 month (Plan & ROI). #kyshrmconf Dr. Rick Cartor, ChD / BB&T (502) 489-5972 Page 13 rickcartor.wordpress.com

Unsolicited Advice (…or free consulting!) 08. Follow up with chronic conditions. 09. Consider exclusive (“narrow”) networks. 10. Insist on acquiring / analyzing data. 11. Align on healthiness. 12. Integrate the system… 13. Stay vigilant: “No victory is final or complete.” #kyshrmconf Dr. Rick Cartor, ChD / BB&T (502) 489-5972 Page 14 rickcartor.wordpress.com