1 Gaston Regional Chamber Healthcare Summit Leading edge wellness strategies for your organization (4/08) Are you ready for the future of wellness?

Wellness matters 70 – 90 percent of health care costs are due to unhealthy choices and preventable risks 1 In 2008, employers are projected to spend 46% more for health care costs than in 2003, an average of $9,312 per employee 2 Chronic diseases cost businesses more than $1 trillion in lost productivity 3 U.S. companies lose nearly $63 billion in lost work and productivity each year due to employee injuries and illnesses 4 1 Health Care Statistics, Prevent Disease.com, Towers Perrin Health Care Cost Survey 3 “An Unhealthy America: The Economic Burden of Chronic Disease,” The Milken Institute, October Journal of Occupational and Environmental Medicine, July 2007

Wellness programs may save organizations $900/person/year in direct medical costs 1 Most employers can expect a $3 to $1 return on investment for preventive services and health promotion 2 Employers can save $1.65 in health care expenses for every dollar spent on a comprehensive health care program 3 Wellness programs save money through:  Lower health care costs  Greater productivity  Reduced absenteeism 4 Wellness works 1 Wellness Councils of America (WELCOA) Absolute Advantage: ROI Bullseye; Building a First ClassWorkforce by David R. Anderson, Healthcare Cost Trends for 2008, PricewaterhouseCoopers, Journal of Occupational and Environmental Medicine, February Purdue University, February 2007

Gather information to understand needs and develop strategies Solutions that drive meaningful change and make your vision a reality Celebrate your successes and refine your strategies for the future The plan sponsor’s journey to wellness… embracing change and developing a supportive culture

 Assess your workplace culture, environment, business and benefit strategies  Review claim information to understand utilization and health risks  Understand your employees, preferences, health status and behaviors  Identify the behaviors you want to change  Determine how wellness programs will contribute to your benefit strategy  Define how you will measure and determine success  Review current plan designs; align with defined goals and objectives  Choose wellness programs and incentives that will meet your needs  Identify other workplace changes, cafeteria food, smoke-free environment  Ensure leadership commitment and support  Create a detailed implementation plan and timeline  Develop a comprehensive communications plan  Measure outcomes against goals and objectives  Gather feedback about how well your strategy is working  Celebrate successes and refine your strategy Gather and analyze information The plan sponsor’s journey to wellness… Five steps to creating an effective wellness strategy Design wellness strategy Evaluate outcomes and refine strategy Define goals and objectives Develop implementation plan

Supporting members with wellness solutions that span the continuum of care Provide structured programs to support return to health and productivity Manage medical care Manage disability Stay well (mind and body) Identify and manage health risks to prevent disease and disability Reduce absenteeism and on-the-job productivity loss Manage/mitigate disease impact Identify and manage those most at risk for disability Access to Quality Care Health/low risk At risk for disease/injury Managing a chronic disease Major health events

Aetna Health Connections SM The suite of programs & services that enables wellness solutions * Availability may vary by location, product, group size Staying Healthy Changing Lifestyles Managing Conditions Simple Steps To A Healthier Life ® Health Assessment Personal Health Record MedQuery Health Fairs and On-site Screenings * Lifestyle Coaching * Tools and Informational Resources Discount Programs, Natural Products and Services Advocacy Programs * Integrated Solutions Worksite Clinic Services * Well Visits & Screenings Informed Health Line Disease Management Case Management Aetna Healthy Actions SM Incentives Capabilities Communications Campaigns and Toolkits Major Health Events

A plan sponsor’s multi-year wellness strategy Simple Steps To A Healthier Life ® Disease Management Incentives Simple Steps To A Healthier Life ® Disease Management Incentives More health assessments Lower absenteeism Increase in physical activity Reduction in medical costs Increase in productivity Reduction in medical costs YEAR 1YEAR 2YEAR 3 (Illustrative only) Fitness and weight management programs Simple Steps To A Healthier Life ® Incentives Lifestyle coaching or wellness counseling Integrated Health Solution Disease Management

Overall trends in Aetna employee population The Aetna Experience Medical Trend Engagement (chronically ill) Results of Simple Steps Healthy Lifestyles Program Participation Illness Burden (chronically ill) 2007 trend is 3.3% A compared to 5.9% as of 11/06 and 15.9% as of 11/05 Engaged and Engageable population increased from 64.3% in 2005 to 72.7% in 2006 Participation in Healthy Living Programs climbed 111% from 2005 to 2007 Participation increased from 10,939 in 2006 to employees in 2007, a 56% increase Retrospective Risk Score shows chronically ill population became less sick over last 2-1/2 years Please note: Trend is the result of plan design, medical management and wellness interventions. Today we are talking about wellness interventions, but all interventions should be used to get the trend in line. Illness burden measures the breadth and intensity of diseases in a population. A Dec month rolling trend Aetna Confidential may not be copied or reproduced without prior written approval Going down Going up

Your employees and their families are fully engaged in their health and take responsibility for health care decisions The benefits experience they receive is personalized to meet their needs, based on experienced clinical knowledge and analysis All benefits seamlessly work together to enhance your bottom line and the well-being of your employees We’re creating a future where… 10

Your employees and their families are fully engaged in their health and take responsibility for health care decisions The benefits experience they receive is personalized to meet their needs, based on experienced clinical knowledge and analysis All benefits seamlessly work together to enhance your bottom line and the well-being of your employees Seamless Linking HRA to PHR to Wellness Programs We’re creating a future where… 11

The journey to optimal health starts with the health assessment… Simple Steps to a Healthier Life Know your: Numbers Health status Modifiable risks Wellness resources … and continues with the right programs and services Preventive Screenings Well Visits Improve Nutrition Increase Physical Activity Medical Adherence Care Plan Care Management Managed Disability Managing Conditions Staying Healthy Lifestyle ChangesMajor Health Events

Our industry-leading PHR is really like a personal health assistant  All patient information in one place  A dynamic system for interactivity based on our patented CareEngine ® technology  Integrated patient and health care information to support higher quality, cost- effective care  A unique decision aid for health care providers, providing up-to-the-minute information on the patient Aetna Personal Health Record goes well beyond a static claim history

Your employees and their families are fully engaged in their health and take responsibility for health care decisions The benefits experience they receive is personalized to meet their needs, based on experienced clinical knowledge and analysis  Value Based Benefits - Rx/DM incentive: Copay relief for medication adherence for specific drug classes All benefits seamlessly work together to enhance your bottom line and the well-being of your employees Seamless Linking HRA to PHR to Wellness Programs We’re creating a future where… 14

Evidence-based strategies are built into our: Improving care for members at all stages of health Evidence- Based Care Effective application of evidence-based care is key to improving outcomes Evidence-based care relies on research evidence to enhance patient care  Strategies for collaborating with members and physicians to improve health  Clinical coverage decisions  Strategies to identify care improvement opportunities  Overall medical care management approach

22% of U.S. patients take less of the medication than is prescribed American Heart Association: Statistics you need to know. Accessed November 21, Aetna Pharmacy Management Medication adherence

Aetna Pharmacy Management Why adherence matters Results of failure to adhere to prescribed medications:  Increased hospitalization  Poor health outcomes  Increased costs  Decreased quality of life  Patient death Benner JS, Glynn RJ, Mogun H, Neumann PJ, Weinstein MC, Avorn J. Long-term persistence in use of statin therapy in elderly patients. JAMA 2002;288: “Of all medication-related hospital admissions in the United States, 33 to 69 percent are due to poor medication adherence, with a resultant cost of approximately $100 billion a year.”

The Logical Next Step Several sources of data: 1. Surveys of self-reported underuse and pill-splitting 2. Comparisons of people with less and more generous drug insurance 3. Longitudinal studies of the introduction of payment caps Reducing or eliminating cost- sharing (at least for some conditions or for some levels of risk) may increase adherence to efficacious medications In fact, the cost of paying for increased drug costs may be (more than) offset by the cost-savings from averted clinical events

Aetna Pharmacy Management Overcoming barriers to adherence Health plan pays member copay  Reduces member out-of pocket costs  Emphasizes the importance of continuing therapy Education and outreach  Explains the need for medication therapy  Breaks down complex therapies into manageable parts  Offers strategies for coping with side effects Benner JS, Glynn RJ, Mogun H, Neumann PJ, Weinstein MC, Avorn J. Long-term persistence in use of statin therapy in elderly patients. JAMA 2002;288:

Aetna Pharmacy Management Investment in medication adherence can lead to dramatic reductions in overall cost of care Sokol M et al. Impact of Medication Adherence on Hospitalization Risk and Healthcare Cost. Medical Care. Volume 43, Number 6, June 2005 Outcome is significantly higher than outcome for % adherence group (P<0.05). Differences were tested for medical cost and hospitalization risk. Rx $ Medical $

Sensitivity Analysis: Time Horizon Health Affairs 2007; 26: 186

Benefit Design Research Study Aetna / Harvard Proposal Aetna to participate with Harvard in a study to formally test the hypothesis that by removing financial barriers (co-pay, co- insurance and deductibles) for certain conditions we would: –Increase medication adherence –Improve clinical quality –Decrease medical costs

Your employees and their families are fully engaged in their health and take responsibility for health care decisions Work Site Clinics: Brings wellness to the worksite The benefits experience they receive is personalized to meet their needs, based on experienced clinical knowledge and analysis  Value Based Benefits - Rx/DM incentive: Copay relief for medication adherence for specific drug classes All benefits seamlessly work together to enhance your bottom line and the well-being of your employees Seamless Linking HRA to PHR to Wellness Programs We’re creating a future where… 23

What is engagement? Engagement is an individual’s ownership of and active participation in his or her journey to optimal health and wellness JOIN US

Engagement matters Up to 50% of health care costs are due to unhealthy choices and preventable risks 1 In 2008, employers are projected to spend 46% more for health care costs than in 2003, an average of $9,312 per employee 2 Chronic diseases cost businesses more than $1 trillion in lost productivity 3 U.S. companies lose nearly $63 billion in lost work and productivity each year due to employee injuries and illnesses 4 1 NAHU’s Healthy Access Briefing Report: Constraining Medical Costs, 2006, Towers Perrin Health Care Cost Survey 3 “An Unhealthy America: The Economic Burden of Chronic Disease,” The Milken Institute, October Journal of Occupational and Environmental Medicine, July 2007

Your organization may already be paying Increased productivity has been noted as a key reason plan sponsors adopt an onsite health center* Onsite programs using face-to-face coaching and motivational interviewing techniques result in higher engagement levels than telephonic only delivery of programs Worksite health services create and support an effective wellness strategy by helping to create and maintain a culture of wellness © 2007 Aetna Inc. * Watson Wyatt “Realizing the Potential of Onsite Health Centers” 2008 Study Lost productivity and a lack of focus on wellness can cost your organization We know…

Our worksite health solution: Expands and extends our Aetna Health Connections overall health and wellness solutions portfolio Initial offering includes onsite delivery of: –Selected Aetna Health Connections programs already delivered telephonically –Biometric screenings. Aetna Health Connections Direct2you Our future vision of Direct2you solutions:  Part-time clinical staff  Community-based centers  Remote outreach and engagement

Aetna Health Connections The program includes face-to-face delivery of any combination of these programs:  Disease Management  Wellness Counseling  Behavioral Health (BH) Assessment and Counseling  Employee Assistance Program (EAP) Assessment and Counseling  Biometric Screenings available through Summit Health or Quest Diagnostics Available beginning 1/1/2009 Direct2you

Your employees and their families are fully engaged in their health and take responsibility for health care decisions Work Site Clinics: Brings wellness to the worksite The benefits experience they receive is personalized to meet their needs, based on experienced clinical knowledge and analysis Value Based Benefits - Rx/DM incentive: Copay relief for medication adherence for specific drug classes All benefits seamlessly work together to enhance your bottom line and the well-being of your employees Seamless Linking HRA to PHR to Wellness Programs We’re creating a future where… 29