1. Taking Health Care Consumer Engagement to the Next Level: The Employer’s Role Paul Landgraf Guardian Industries plandgraf@guardian.com

2. About Guardian Industries  Headquartered in Auburn Hills, Michigan  Privately held companies with 19,000 employees  60 work locations in 21 countries, on five continents  Large manufacturer –World’s largest mirror manufacturer –World’s 2nd largest manufacturer of flat glass –Tier 1 supplier of auto glass and body trim –One of the largest manufacturers and distributors of fiberglass and building materials  Unique culture –Accountability extends to personal health –Significant leadership support

3. The Challenge: Guardian’s Largest Expenses  Raw Materials  Labor, Administration, Payroll Taxes  Freight  Depreciation  Maintenance and Repair  Furnace Energy  Electricity/Utilities  Health Care  Packaging  Guardian Management point of view:  “Employee health and productivity are business issues”

4. The Ongoing Problem  1 plant, 374 employees, average age = 40 –87% participated in screenings and HRA –42% classified as obese (BMI over 30) –30% had blood pressure over 140/90 –32% have never had complete physical –26% reported tobacco use –63% seldom or never exercise –59% had 5 or more health risks –68% reported their own health as either good or excellent

5. Reinventing HealthGuard  Started in 1984 -- “Seven Steps For Better Living” –1. Exercise –2. Diet –3. Limiting alcohol use –4. Avoidance of smoking and illegal drugs –5. Blood pressure awareness and control –6. Use of seat belts –7. Developing positive attitudes.  It may sound dated today, but the expectations were clear  Today our focus has changed –It is not about turning joggers into marathoners; the problem is getting members off the couch –Not a traditional “wellness” perspective; now much more clinical, outcomes driven, we talk about health

6. What Do We Want Folks to DO?  Health screenings and physicals  Health risk assessments  Exercise, “Winner’s Circle” participation  HealthGuard activities and education  Preventive care  No tobacco on U.S. property  Respond to Care Considerations and participate in Disease Management if contacted

7. AHA/ ACC Guideline CONFIDENTIAL- May not be copied, reprinted or redistributed without prior written approval. Guardian Health Risks N =1,581

8. AHA/ ACC Guideline SOLVD study: ACEI reduces CHF mortality by 11.3% and hospitalization by 18% CONFIDENTIAL- May not be copied, reprinted or redistributed without prior written approval. CareEngine: Identifying Gaps in Care

9. AHA/ ACC Guideline CONFIDENTIAL- May not be copied, reprinted or redistributed without prior written approval. Who is Spending the Money?

10. Condition Management – Where’s the Savings?  Fendrick and Chernow will be releasing a review of the current literature, critical of most study protocols  Need to “separate the dolphins from the tuna”  Target well – ROI is greatest when you –Identify the highest risk patients –Availability of effective services, real clinical value –Services have low current use –Price responsive so people will readily comply  ROI is lost when lower risks are swept in, patient would have done intervention anyway, or will not do the intervention; look at copays, reach rates, opt-ins  We focus on the chronically and acutely ill

11. The Problem  Wanted to improve engagement in Condition Management, especially in higher risk groups  Strategy – the carrot or the stick?  We wanted to address two issues  How to increase engagement in Condition Management, and  How to improve drug therapy adherence  Willing to consider Value Based Insurance Design approach, but dolphins v. tuna problem  Use Condition Management and VBID, by usingCM engagement to trigger drug cost incentive

12. Finding a Solution - CM Simulation  What drug classes should be subject to incentives?  How much benefit incentive did we need to provide?  What would the savings be from improved drug adherence?  Did we expect overall savings from adherence, minus the cost of the incentives?  How does the PBM provide the incentive?  How will this be communicated?

13. Clinical opportunity scenarios used to model savings CLINICAL RISK SCENARIOSMEDICATIONS APPLICABLE Related care considerations Lipid-lowering agents (e.g., statins) CAD or Cerebrovascular disease or Peripheral arterial disease or Diabetes On RX but not in a specific clinical scenario Related care considerations Inhaled corticosteroids Respiratory (Asthma, COPD) Related care considerations ACE inhibitors or ARBs CAD or Cerebrovascular disease or peripheral arterial disease or Diabetes CHF Chronic kidney disease plus Hypertension Refractory hypertension* On RX but not in a specific clinical scenario Related care considerations Beta-blockers CAD CHF Chronic kidney disease plus Hypertension Refractory hypertension* On RX but not in a specific clinical scenario Related care considerations Injectable, inhaled, and oral meds for diabetes Diabetes

14. A Final Thought – Health and Your Culture Questions?