1. Key Trends Health Advocate1

2. 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.

3. 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

4. Key Trends Employers 4

5. 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

6. 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

7. 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

8. 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

9. Addendum 9

10. 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 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
Sources
1 The United State of Stress 2018 by Maureen Connolly & Margot Slade October 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 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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