Virginia Health Care Conference Engaging Consumers to Purchase Value June 6, 2013

Who We Are  ValueOptions is a health improvement company that specializes in mental and emotional wellbeing and recovery  Singular focus on behavioral health  Serves 32 million members 2  Three major market segments: Commercial market featuring national employers, labor and trust funds and health plans State and local governments managing Medicaid populations The Federal government, on behalf of the U.S. military, veterans, employees and their families

Prevalence of Behavioral Health  25% of all U.S. adults are affected by mental illness in a given year  Nearly 50% of U.S. adults will develop at least one mental illness in their lifetime  In 2010, 15% of the U.S. population met criteria for addiction  Last month, the CDC released a report on childhood mental illness with data showing 20% of U.S. children are affected by mental health issues  Mood disorders such as depression are the third most common cause of hospitalization in the U.S.  Although military members comprise less than 1% of the U.S. population, veterans represent 20% of suicides nationally 3

Economic Impact of Behavioral Illness Businesses experience direct and indirect costs due to mental illness:  217 million business days of work loss and work impairment are due to behavioral health disorders  Serious mental illness costs American businesses $193 billion in lost earnings annually  Substance abuse issues cost more than $400 billion in government spending annually  One third of all hospital costs is attributable to addictive illness 4

Depression Management Case Study (Virginia-Based Employer)  Members identified either through referral by health plan or through ValueOptions’ internal analysis: 73% Female; 27% Male Average age was 51 (range of 22 yrs – 72 yrs)  All referrals, whether engaged or not, received relevant information highlighting the importance of integrated care, specific to the individual’s identified medical condition  High-touch engagement by intensive case manager  Engagement dependent upon member willingness to participate 5

Depression Severity 6

Effectiveness of Participation 7 PHQ-9 Score Change 3-6 month Pre-Post results PHQ-9 Score Change by Severity 3-6 month Pre-Post results

Cost Savings 8 Comparison of Average Claims Cost Six Months Before and After Referral for Depression Disease Management: Intervention vs. No Intervention Key findings of this evaluation: The intervention program is associated with a $1.27 million reduction in total claims costs (medical and behavioral) Claims cost savings totaled $2.38 for every $1 expended on the program

Member Engagement Case Study #1 9  His last PHQ-9 score was 3, indicating no depression The Challenge: The Solution:  52-year-old male  Depression, anxiety and comorbid diabetes, CAD, hypertension and obesity  Limited connection to medical provider  Initial PHQ-9 was 9, one point away from moderate depression  Outpatient support  Parenting group  Phone consultation  Ongoing education and support  Access to a dietician  EAP Legal/Financial services The Result:

Member Engagement Case Study #2 10 The Challenge: The Solution: The Result:  Improved blood sugar levels  Weight loss and regular exercise  Reduced pain level  The final PHQ-9 resulted in a score of 6, indicating mild depression  48-year-old female  Comorbid depression, history of PTSD, diabetes, chronic pain, obesity and gum disease  First PHQ-9 was 16, indicating severe depression  Outpatient therapy and psychiatrist visits  Psychotropic medications adjusted  Self-care support medical conditions  Consult with program dietician

Stamp Out Stigma Campaign  Raise awareness about the high prevalence of mental illness, the need to seek help and the hope for recovery  Launched internally with green wristbands and pledge  Focuses on the three R’s: Recognize, Reeducate, Reduce  Developed client toolkit to assist customers in launching their own S.O.S programs  Visit to view employee stories, learn more about mission and take the S.O.S. pledgewww.stampoutstigma.com 11