1. Overview Health Statistics ACA Framework for wellness Employer Strategies Wellness Bill and California Climate

2. U.S. Healthcare Facts While 70% of healthcare costs are preventable, only 1% of healthcare costs are invested in prevention & wellness. U.S. accounts for only 5% of the world’s population yet we consume 1/2 of all the prescription drugs manufactured world wide! Nearly one-third (31%) of us are clinically obese (body mass index of 30% or more). Obesity leads to lots of ills, from heart attacks, strokes and diabetes. The annual costs for treating diabetes alone exceed $200 billion.

3. Obesity Trends* Among U.S. Adults BRFSS, 1985 (*BMI ≥30, or ~ 30 lbs. overweight for 5 ’ 4 ” person) No Data <10% 10%–14% BRFSS, Behavioral Risk Factor Surveillance System http: //www.cdc.gov/brfss

4. Obesity Trends* Among U.S. Adults BRFSS, 1990 (*BMI ≥30, or ~ 30 lbs. overweight for 5 ’ 4 ” person) No Data <10% 10%–14%

5. Obesity Trends* Among U.S. Adults BRFSS, 1995 (*BMI ≥30, or ~ 30 lbs. overweight for 5 ’ 4 ” person) No Data <10% 10%–14% 15%–19%

6. Obesity Trends* Among U.S. Adults BRFSS, 2000 (*BMI ≥30, or ~ 30 lbs. overweight for 5 ’ 4 ” person) No Data <10% 10%–14% 15%–19% ≥20%

7. Obesity Trends* Among U.S. Adults BRFSS, 2005 (*BMI ≥30, or ~ 30 lbs. overweight for 5 ’ 4 ” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

8. Obesity Trends* Among U.S. Adults BRFSS, 2008 (*BMI ≥30, or ~ 30 lbs. overweight for 5 ’ 4 ” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

9. Framework Health Insurance/Wellness Copays http://www.healthcare.gov/prevention/index. htmlhttp://www.healthcare.gov/prevention/index. html Provider Reimbursements Spurring innovation

10. Startup Incubators & Open Data Initiatives Quantify self New EMR Provider/Patient R/ships Self-Diagnosis Mental Health Enhanced Care Delivery Get in shape Food Q&A Find/Rate a Doctor Paying Bills Cost Transparency Clinical Trials Children healthdatapalooza.org hhs.gov/digitalstrategy/open-data

11. Employer strategies (small business <50) Tiered contribution structures tied to: Financial (or other) incentives Annual physical exam Biometric screening Team contests; Walk-a-thons Healthy Snacks

12. Wellness in California Insurance Market Rating (providing discounts) for smokers vs. non-smokers (allowed in ACA) was disallowed in California under AB 1083 last year. SB 189 (Monning) in Senate Health committee review now will greatly restrict wellness initiatives allowed by Federal ACA. Good intentions: avoid discrimination Bad law: wrong approach