Key Trends Health Advocate 1

Health Advocate Trends in 2019 Key Findings… Health Advocate has seen a significant increase in employers purchasing our health concierge service (Benefits Gateway) as well as our fully integrated solution (Empowered Health)! In effort to personalize and simplify their healthcare offering. In 2019: Integration is on the rise, 54% of clients purchased more than one product believing that the integration of services will drive more engagement. Integration of EAP with Advocacy continues to be leading trend with 10% of our clients offering the combined service. Over 100 new clients (160,000 employee lives) purchased our Concierge or fully Integrated Empowered Health Model.

Health Advocate Trends in 2019 Key Findings… 25% increase in clients purchasing Health Advocate’s Data Solutions to facilitate: Gaps in Care Coaching Overall Population Health Management (dashboards) 551 unique organizations providing data 8.1 M Members Significant increase in employers using Health Advocate's Digital Navigation Platform as an engagement keystone. Making healthcare easier for 325 unique organizations and 1.5M employee lives

Key Trends Employers 4

Trends in 2019 What employers want… Product “Must Haves” Advocacy Health coaching EAP Tobacco Cessation Disease management Telemedicine “Total Well-being” approach to benefits More niche “point solutions” (diabetes, financial wellness, mental health, stress relief, etc.) Mobile apps/ Digital navigation HUBs/ one number to call to reach ALL benefits Benefits integration Customization Concierge-level Service Biometrics, health assessments, healthy challenges Multiple touchpoints/ outreach Source: Shortlister Well-being Industry Prospectus, 2018

Employer Benefit Trends in 2019 Medical decision support or second opinion services have increased from 66% in 2018 to 71% in 2019. Employers continue to add high-touch concierge services—up to 39% from 28% just two years ago Employers are dialing back on the move to CDHPs as their only health plan option and adding other health plan choices back into the mix. They see investments in employee health and well-being as an important element of their overall workforce strategy Half of large employers stated that implementing more virtual care solutions is their top initiative in 2019 The use of centers of excellence has grown from 79% in 2016 to 88% in 2019 Source: National Business Group on Health, 2019 Large Employers’ Health Care Strategy and Plan Design Survey, September 2018

Employer Benefit Trends in 2019 Engagement Platforms Employers are most optimistic about their potential value as a single place for employees to access all resources, for the personalization of services and for concierge/navigation services In 2018, 31% of employers were using engagement platforms, and another 9% will be adding one in 2019 By 2021, two-thirds of employers could be working with an engagement platform Source: National Business Group on Health, 2019 Large Employers’ Health Care Strategy and Plan Design Survey, September 2018

Employer Benefit Trends in 2019 Expanding Resources for Mental and Behavioral Health More companies are offering on-site behavioral health counseling beyond what is typically offered through their EAPs Opioid epidemic is a big concern There has been a significant jump from 2018 (18% to 30%) in the number of large employers that will conduct anti-stigma campaigns in 2019 Other expanded resources: Self-directed online resources (apps, articles, videos, webinars) Flexible work schedule Online therapy Employee training Source: National Business Group on Health, 2019 Large Employers’ Health Care Strategy and Plan Design Survey, September 2018

Addendum 9

2018 Health Advocate EAP Utilization & Industry Trends 2018 Health Advocate EAP Call Volume was up 25% over 2017 Stress has become a national epidemic for all ages and genders 1 More than half of working adults and 47% of all Americans are concerned with the amount of stress in their lives 2 Health Advocate managed over 1,680 Critical Incident cases in 2018 – 20% of these were suicide related Suicide is the 10th leading cause of deaths in the U.S. and second leading cause at worksite behind industrial accidents 3 Suicide Rate is increasing: From 2000 – 2016, suicide rate among adults ages 16-64 rose 34%, from 12.9 deaths for every 1000,000 people in the population to 17.3 per 100,000 4 Two disturbing industry trends in mental health care: Increase in demand and growing shortage of qualified providers to meet the demand A 2016 report released by Health Resources and Service Administration projected the supply of workers in behavioral health professions to be approximately 250,000 workers short of the project demand in 2025. 5 Sources 1 The United State of Stress 2018 by Maureen Connolly & Margot Slade October 31. 20182 Everyday Health 2 Stressed Out Nation – American Psychological Association April 2006, Vol 27 3 American Foundation for Suicide Prevention, November 2018 Survey 4 Centers for Disease Control and Prevention (CDC), November 16, 2017 Morbidity and Mortality Weekly Report 5 What is the Answer to the Shortage of Mental health Care Providers? U.S. News - May 25, 2018 Sources 1 The United State of Stress 2018 by Maureen Connolly & Margot Slade October 31. 20182 Everyday Health 2 Stressed Out Nation – American Psychological Association April 2006, Vol 27 3 American Foundation for Suicide Prevention, November 2018 Survey 4 Centers for Disease Control and Prevention (CDC), November 16, 2017 Morbidity and Mortality Weekly Report 5 What is the Answer to the Shortage of Mental health Care Providers? U.S. News - May 25, 2018

Employer Benefit Trends in 2019 Health Advocacy and Navigation Tools Medical decision support or second opinion services have increased from 66% in 2018 to 71% in 2019. Employers continue to add high-touch concierge services—up to 39% from 28% just two years ago Other important navigations tools: Employee advocacy tools/services for claims assistance Self-directed online decision support tools Source: National Business Group on Health, 2019 Large Employers’ Health Care Strategy and Plan Design Survey, September 2018

Employer Benefit Trends in 2019 Benefit Offerings Employers are dialing back on the move to CDHPs as their only health plan option and adding other health plan choices back into the mix. The number of employers offering CDHPs as the only option will drop by 9% Increase in the use of value-based benefit design to steer employees toward: Telehealth (29% in 2019 compared to 18% in 2018) COEs (20% compared to 14%) HPNs (12%) Disease management programs (10%) Source: National Business Group on Health, 2019 Large Employers’ Health Care Strategy and Plan Design Survey, September 2018

Employer Benefit Trends in 2019 Healthcare Costs Employers see health care as having broader implications for their workforce beyond cost They see investments in employee health and well-being as an important element of their overall workforce strategy High-cost claimants are the top cost driver Other drivers: Specialty pharmacy Specific diseases/conditions Inefficient use of the health care system Hospitalization Behavior health Source: National Business Group on Health, 2019 Large Employers’ Health Care Strategy and Plan Design Survey, September 2018

Employer Benefit Trends in 2019 Pharmaceuticals 49% Believe the model needs to be overhauled and simplified 75% Do not believe drug manufacturer rebates are an effective tool for helping to drive down pharmaceutical costs 91% Would welcome an alternative to the rebate-driven approach to managing drug costs Source: National Business Group on Health, 2019 Large Employers’ Health Care Strategy and Plan Design Survey, September 2018

Employer Benefit Trends in 2019 Virtual Care/ Artificial Intelligence Half of large employers stated that implementing more virtual care solutions is their top initiative in 2019 The majority of large employers believe virtual care will play a significant role in how health care is delivered in the future, and nearly as many believe A.I. will have a similar impact More than three-quarters (78%) provide behavioral health services to employees virtually 65% provide health and lifestyle coaching services virtually Musculoskeletal and physical therapy, sleep, diabetes management, prenatal care and coaching, and emotional and behavioral health show the greatest potential for growth over the next several years Source: National Business Group on Health, 2019 Large Employers’ Health Care Strategy and Plan Design Survey, September 2018

Employer Benefit Trends in 2019 Engagement Platforms Emerging engagement platforms show promise to deliver significant value They are most optimistic about their potential value as a single place for employees to access all resources, for the personalization of services and for concierge/navigation services In 2018, 31% of employers were using engagement platforms, and another 9% will be adding one in 2019 By 2021, two-thirds of employers could be working with an engagement platform Source: National Business Group on Health, 2019 Large Employers’ Health Care Strategy and Plan Design Survey, September 2018

Employer Benefit Trends in 2019 Centers of Excellence Employers are turning to COEs for more than transplants: Bariatric surgery, musculoskeletal, cancer, fertility The use of COEs has grown from 79% in 2016 to 88% in 2019 COEs for cancer (up 10%) and fertility treatments (up 7%) will experience the greatest growth in 2019 Between 25% and 45% of COE contracts have been structured as bundled payments rather than fee-for-service Source: National Business Group on Health, 2019 Large Employers’ Health Care Strategy and Plan Design Survey, September 2018

Employer Benefit Trends in 2019 Onsite Health Centers More than half (56%) of employers will have on-site (or near-site) health centers in at least one of their larger sites. 12% are considering doing so by 2021 Some employers are now offering on-site employee assistance program (EAP) and/or chronic care management services Top services provided: Acute care Health improvements/ Biometric screenings Primary care Occupational health EAP Chronic care management Pharmacy Source: National Business Group on Health, 2019 Large Employers’ Health Care Strategy and Plan Design Survey, September 2018

Employer Benefit Trends in 2019 Expanding Resources for Mental and Behavioral Health More companies are offering on-site behavioral health counseling beyond what is typically offered through their EAPs Opioid epidemic is a big concern There has been a significant jump from 2018 (18% to 30%) in the number of large employers that will conduct anti-stigma campaigns in 2019 Other expanded resources: Self-directed online resources (apps, articles, videos, webinars) Flexible work schedule Online therapy Employee training Source: National Business Group on Health, 2019 Large Employers’ Health Care Strategy and Plan Design Survey, September 2018