1. © 2012 Wells Fargo Bank, N.A. All rights reserved. Confidential. Population Health Management Strategy Wells Fargo Insurance Services Chesapeake Health Strategies Practice McLean, Virginia Wells Fargo Insurance Services Confidential. © 2010 Wells Fargo Insurance Services. All rights reserved.

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3. MBP Wellness Mission Our mission is to provide information and opportunities for team members and their families to develop healthier lifestyles by supporting the adoption of healthy habits and attitudes that contribute to personal and professional productivity, as well as their positive physical and mental well-being now, and in the future 3 Baltimore 2011 & 2012 Greater Charlotte 2011 Greater Washington 2011 & 2012

4. MBP Wellness Program Goals  Short Term Improve health awareness of team members and their families Create excitement for wellness Educate team members and their families about healthier living Improve team cohesiveness and morale  Long Term Create a culture of wellness Decrease absenteeism and enhance productivity Improve recruitment and retention Decrease medical care costs 4

5. Biometric Screening Event Program Summary  Biometric screenings completed onsite by CIGNA Onsite Health during MBPs Annual Business Meeting  Screenings included a 10 question self-reported questionnaire as well as the following clinical measurements: Height Weight Blood pressure Total cholesterol HDL cholesterol Glucose Body mass index Waist circumference  Results (in aggregate) were prepared and reported to MBP in May 2012 by CIGNA 5

6. Participation Statistics Program Summary 6 Biometric Screening Participation Summary Total Screenings Performed107 Male Screenings Performed53 Female Screenings Performed54 Age 10-191 Age 20-2916 Age 30-3928 Age 40-4929 Age 50-5925 Age 60-698 Note: According to the National Business Group on Health, industry average for participation in biometric screenings is 14.3% and 50% participation is considered “high” and potentially leads to cost trend reductions of 1.5%

7. Population Health Risks Summary  Top 3 health risks reported include Blood Pressure – 55% of participants were identified as “At-Risk” while an additional 10% had results which were abnormal Body Mass Index – 41% of participants were identified as “At-Risk” while an additional 24% of participants had results which were abnormal Cholesterol – – 20% of participants were identified as “At-Risk” – 39% of participants had “Abnormal” HDL levels 7

8. Population Health Risks Blood Pressure 8 Definition – The amount of blood the heart pumps and the amount of resistance to blood flow in the arteries Risks – Uncontrolled HBP increases and individual’s risk of heart attack, stroke, heart failure, and kidney disease National Norms – According to the Centers for Disease Control (CDC) approximately 28% of American adults have pre-hypertension and 1 in 3 Americans have hypertension. Normal Hypertension Pre-Hypertension 35% 55% 10%

9. Population Health Risks High Density Lipoprotein 9 Definition – HDL “Good Cholesterol” carries excess cholesterol to the liver to remove it from the body. Risks – Low HDL (< 50 mg/dL for women and < 40 mg/dL for men) is considered a cardiac risk factor which coupled with additional risk factors increases risk of arteriosclerosis, heart attack, and stroke National Norms – Approximately 17% of adult Americans have a total cholesterol level of greater than 240 according to the CDC. Desirable Undesirable 61% 39%

10. Population Health Risks Blood Glucose – Non-Fasting 10 Definition - Diabetes is a group of diseases characterized by high blood glucose levels that result from defects in the body's ability to produce and/or use insulin. Risks – Uncontrolled high blood sugar levels are associated with increased risk of serious complication such as heart disease, stroke, high blood pressure, blindness, kidney disease, nervous system damage and others. National Norms – According to the CDC, Diabetes affects 25.8 million people, 8.3% of the US population. 18.8 million people are diagnosed. 7.0 MILLION PEOPLE ARE CURRENTLY UNDIAGNOSED. Normal < 140 Abnormal > 140 86% 14%

11. Population Health Risks Body Mass and Weight 11 Definition – BMI (Normal = 18.5-24.9; Overweight = 25 – 29.5; Obesity 30 or greater), Waist Circumference (Men: Desirable < 40”; Women: Desirable < 35”. Risks – Coronary heart disease, Type 2 Diabetes, Cancers (endometrial, breast, colon), Hypertension, High Cholesterol, Stroke, Liver and Gallbladder Disease, Sleep Apnea and Respiratory Disease, Osteoarthritis. National Norms – More than 1/3 of adults are obese (72 million people) according to the CDC. Recommended Obese Overweight 35% 40% 19% Extreme Obesity 5%

12. Metabolic Syndrome Syndrome X Criterion3 or More Criteria Abdominal Obesity Men Women > 40 inches > 35 inches High Triglycerides> 150 mg/dL Low HDL Men Women < 40 mg/dL < 50 mg/dL Hypertension> 130/85 mm Hg Impaired Fasting Glucose> 110 mg/dL 12 Risks – Increased long-term risk for development of cardiovascular disease and Type 2 diabetes

13. So What???? Help??? 13

14. Recommendations For Individuals  Develop your personal wellness team: Engage family members Engage peers  Engage your Primary Care Physician Get your annual exam Get your age and gender based screenings Be compliant with your medication usage 14

15. Recommendations For Individuals  Engage in regular physical activity Assess your current fitness level Design your fitness program – Consider your goals – Create a balanced routine, include a variety of activities you enjoy and put it on paper – Go at your own pace – Allow time for recovery, listen to your body – Reward yourself and be flexible 15

16. Recommendations For Individuals  Implement a healthy eating plan Limit fat intake at or below 30% for total daily calories Limit saturated fats to less than 10% of total fat calories Keep cholesterol intake at 300 milligrams per day or less Eat diet high in complex carbohydrates Maintain a moderate protein intake (12% of total calories) Eat a variety of foods, stretch your pallet Avoid too much sugar Limit sodium to no more then 2,400 milligrams per day Maintain an adequate calcium intake 16

17. Recommendations Within the MBP  Participate in Woohoo Wellness Activities  Seek information about “Healthy Horizons: A Wealth of Health” Program Keep an eye out for and compete in weekly activities Get your biometric screening done Participate in Cigna health coaching 17

18. 18 Thank you Questions and answers Kevin Cowden Health Strategies Practice Lead Wells Fargo Insurance Services USA, Inc. o – 703-760-6947 / c-703-927-7518 Kevin.cowden@wellsfargo.com