1. Source: National Association of Health Underwriters Education Foundation Value-based Insurance Design 1

2. Source: National Association of Health Underwriters Education Foundation A New Approach to Benefits: Recognize Clinical Nuance 2 University of Michigan Center for Value-Based Insurance Design

3. Source: National Association of Health Underwriters Education Foundation Value-based Insurance Design ‣ Sets consumer cost-sharing level on clinical ‣ Reduce or eliminate financial barriers to high-value clinical services and providers ‣ Successfully implemented by hundreds of public and private payers 3 University of Michigan Center for Value-Based Insurance Design

4. Source: National Association of Health Underwriters Education Foundation Example: Waiving Co-Pays for Medications after a Heart Attack ‣ Study assessed impact of free access to preventive medications for Aetna members who had a heart attack ‣ Random trial reported in New England Journal of Medicine ‣ “Enhanced prescription coverage improved medication adherence and rates of (heart attacks) and decreased patient spending without increasing overall health costs.” 4

5. Source: National Association of Health Underwriters Education Foundation Implementing V-BID: Connecticut State Employees Health Plan ‣ Participating employees receive a reprieve from higher premiums if they commit to: ‣ Yearly physicals, age-appropriate screenings/preventive care, two free dental cleanings ‣ Employees with certain chronic conditions must participate in disease management programs (which include free office visits and lower drug co-pays) ‣ Early results: ‣ 99% of employees enrolled ‣ Decrease in ER and specialty care ‣ Increase in primary care visits ‣ Increase in chronic disease medication adherence ‣ Medical spending trend declined 5

6. Source: National Association of Health Underwriters Education Foundation Steering Employees to Centers of Excellence ‣ Lowe's eliminates co-pays and pays travel costs if employees use the Cleveland Clinic for elective heart procedures ‣ Cleveland Clinic’s negotiated bundled price beats price of local hospitals 6

7. Source: National Association of Health Underwriters Education Foundation 7 ‣ More than 25% of employers now offer High Deductible Health Plans, many with qualified Health Savings Accounts ‣ The clinical downside: Higher out-of-pocket costs may discourage employees from getting evidence-based medical services ‣ The upshot: There is a movement to changes the rules to encourage enrollees with chronic diseases to get the care they need to manage their conditions HSA-qualified HDHPs: Making Them Work for the Chronically Ill Graphic: Western Health Advantage