1. Creating a Culture of Health Anne Marie Ludovici-Connolly, M.S.

2. Health Management: a Serious Economic Strategy “Health management is a health strategy, but equally important, health management is a business and economic strategy.” “When risk status changes or when participation in health promotion activity changes, costs follow in the same direction” Dee Edington, PhD., Zero Trends, 2009 2

3. $ Employer health care costs are projected to rise 50% in the next five years (with a “do nothing” approach) 3

4. Return on Investment In a recent study published by Health Affairs, Harvard Economists reported that medical costs fall by about $3.27 for every dollar spent on wellness programs and that absenteeism costs fall by about $2.73 for every dollar spent. Baicker, K., Cutler, D., Song, Z. Workplace Wellness Programs Can Generate Savings. Health Affairs, February, 2010 29:2 4

5. Beyond ROI-Building The Business Case: The Full Cost of Employee Health Personal Health Costs Medical Care Hospitalization Pharmacy Diagnostic Testing Behavioral Health Personal Health Costs Medical Care Hospitalization Pharmacy Diagnostic Testing Behavioral Health Productivity Costs Absenteeism due to Illness and Injury Employee Dissatisfaction Customer Dissatisfaction For each dollar spent on worker medical costs, employers absorb 2 to 4 dollars of health-related productivity costs All Employers Benefit Small-Large, Fully-Self Insured, Application to all Demographics Industries, Goals & Objectives Productivity Costs Turnover Variable Product Quality STD LTD Workers’ Comp Medical Costs Salary Continuation Workers’ Comp Medical Costs Salary Continuation Training Costs Overtime Temporary Staffing Administrative Costs Off-Site Travel for Care Replacement Training 5

6. Best Practice Framework Integrated/Targeted Worksite Wellness Model Health Assessment Biometric Screening Behavior Change Programs Onsite Activities and Campaigns Health & Wellness Portal Engagement Monitoring & Measurement Onsite at the Worksite Identical Virtual Application  Maintain Health  Improve Health  Manage Health Culture of Health Healthier People = Healthier Bottom Line 6

7. The Five Fundamental Pillars 7 Create the Vision Align Workplace with the Vision Create Winners Reinforce the Culture of Health Allow Outcomes to Drive Strategy Dee Edington, PhD., Zero Trends, 2009

8. Create the Vision 8 Leadership Business Strategy Culture of Health Markel Corporation CEO led Long-term commitment to employee health Full time director of health programs

9. Align Workplace with the Vision 9 Branding Policies Employee Engagement Markel Corporation “Live Well” program HR guidelines support vision Healthy food options Fitness Facilities

10. Create Winners 10 Improve Health Stay Healthy Don’t Get Worse! Markel Corporation HDL, Inc. Advanced Lab Testing Clinical Health Consultants Digital tools On-going fitness challenges

11. Reinforce the Culture of Health 11 Incentives Rewards Reinforcement Markel Corporation Incentive Strategy 1) Advanced Lab Testing 2) Clinical Health Consulting 3) Annual physical Reinforcement Associate recognition

12. Allow Outcomes to Drive Strategy 12 Integrate Measure Sustainability Markel Corporation HDL, Inc. Aggregate Report Stratification Claims data & trend