1. 9/1/2015 Developing a Three to Five Year Strategy For Health Promotion/Wellness Philip A. SmeltzerPeter C. Dandalides, MD Senior ConsultantMedical Director

2. Confidential property of OptumHealth. Do not distribute or reproduce without express permission from OptumHealth. 2 Agenda  Key Concepts to Guide Our Strategy  Process Steps that Build Momentum  Critical Components of Successful Programs  How to Measure Success

3. Confidential property of OptumHealth. Do not distribute or reproduce without express permission from OptumHealth. 3 Key Concepts to Guide Our Strategy

4. Confidential property of OptumHealth. Do not distribute or reproduce without express permission from OptumHealth. 4 Healthcare Cost = (Price x Utilization ) - Cost Sharing  oFactor represents efficient consumption and delivery of healthcare resources  Improving the oFactor results in lower care costs and improved worker productivity  The oFactor for the US health care delivery system is 1.25 (reflects 25% waste) Our Focus – “The Optimization Factor”ox Managed Care Consumerism Data Analytics o o Factor Note: Used with permission from Travis Klavohn

5. Confidential property of OptumHealth. Do not distribute or reproduce without express permission from OptumHealth. 5 Cost and Utilization  4.2% Trend Paid PMPM Health Care Cost  52.6 Inpatient admissions/1000 (norm 48)  264 Bed-days/1000 (norm 235) Engagement/Activation  4% Health Management Program Active Engagement Rates –1.37% Case Management –0.72% Disease Management –4.23% Inpatient Care Management  60% of actively engaged members Achieved Health Goal(s) Clinical Quality  EBM Compliance Rates –48% - Diabetes (44%) –42% - CHF (36%) –64% - CAD (63%)  10% Improvement in Health Risk Scores Service Quality  94% program participants satisfied  Vendor performance and guarantees Balanced Scorecard Example Four Critical Performance Domains

6. Confidential property of OptumHealth. Do not distribute or reproduce without express permission from OptumHealth. 6 Optimization Execution Model Solutions are value driven and data based Results are captured across four key metrics domains Primary Data Collection Strategy Health Promotion Total Absence Management Delivery System Value Chain Service Engagement Cost Quality Data Based Decisions Built on Evidence Based Practices Employer-Focused Financial Analysis Optimization Risk Score Reduction Behavior Change Increased Quality of Life

7. Confidential property of OptumHealth. Do not distribute or reproduce without express permission from OptumHealth. 7 Annual Cycles that Continuously Increase Program Intensity Senior Leadership Buy-In Fact- Based Decisions Employee Health Teams With a Champion Network Marketing Evaluate, Modify, Continue Success Plan Your Work Work Your Plan

8. Confidential property of OptumHealth. Do not distribute or reproduce without express permission from OptumHealth. 8 Worksite Climate Values and Beliefs Policies, Benefit Design Organization Website Health Policies Special Promotions Employee Assistance Risk Reduction Activities Low-Risk Maintenance Know Your Numbers Physical Activity Nutrition Awareness Medical Facility Individual (Stratification by Individual) Coaching Sessions Low-Risk Maintenance Disease Management High-Risk Reduction Health Advocate Triage to Resources Health Risk Appraisals Incentives Measurement Worksite Health is a Complex Environment

9. Confidential property of OptumHealth. Do not distribute or reproduce without express permission from OptumHealth. 9 Health Risk Appraisal Health Screenings Self Care Campaigns Monthly Activities Health Literacy Physical Activity Daily Minimum Associate Engagement ( HRA + 1 Program) Health Body Weight Building a Foundation First HRA Campaign Develop Teams Build Wellness Champion Network Organizational Audit Employee Engagement Data Driven Decisions Leadership Engagement Scorecard Distribution Increased Engagement Initial Outcomes Annual Study Partner Summit Incentive & Rewards Accelerating Impact Certification Recognition Full Integration ROI Study Results Wellness Support from Employees 50% 70% 25% 40% 60% 65% 40% 20% 35% 40% 50% 30% Develop a Three to Five Year Plan that Builds Over Time

10. Confidential property of OptumHealth. Do not distribute or reproduce without express permission from OptumHealth. 10 Key Components Health Risk Appraisal Employee Health Teams Wellness Champions Social Networking Organizational Climate Front Line Leader Support Communication Strategy Evaluation Plan

11. Confidential property of OptumHealth. Do not distribute or reproduce without express permission from OptumHealth. 11 Process Steps that Build Momentum

12. Confidential property of OptumHealth. Do not distribute or reproduce without express permission from OptumHealth. 12 Employer Campaigns for Health Promotion Company Size 1 10,000 % Who Promote

13. Confidential property of OptumHealth. Do not distribute or reproduce without express permission from OptumHealth. 13 Cost 0 $ 10,000 Population Distribution 20-30% < $250 90-95% < $ 2,000 Chronic & High Acuity Consumers 1-5% > $10,000 Better Health = Less Expense

14. Confidential property of OptumHealth. Do not distribute or reproduce without express permission from OptumHealth. 14 Cost 0 $ 10,000 Population Distribution The goal is to move a large part of the population to the better health and lower expense side Disease and Case Management Attack the tail Better Health = Less Expense

15. Confidential property of OptumHealth. Do not distribute or reproduce without express permission from OptumHealth. 15 Health Risk Segmentation OptumHealth Normative Data [4-39] [26-58] [15-65]

16. Confidential property of OptumHealth. Do not distribute or reproduce without express permission from OptumHealth. 16 Moderate Risk High Risk Low Risk Net Change 4% 17% 13% [-1%] [+1%] Risk Migration is the Holy Grail!

17. Confidential property of OptumHealth. Do not distribute or reproduce without express permission from OptumHealth. 17 Critical Components of Successful Programs

18. Confidential property of OptumHealth. Do not distribute or reproduce without express permission from OptumHealth. 18 Multiple Sectors of Health & Productivity Health and productivity – the big picture Employee Assistance Health Care Benefits Absenteeism Productivity Presenteeism Workers’ Compensation Disability Turnover

19. Confidential property of OptumHealth. Do not distribute or reproduce without express permission from OptumHealth. 19 Personal Components for a Comprehensive Approach Healthy behavior – the big picture Physical Spiritual Emotional Social Intellectual Occupational

20. Confidential property of OptumHealth. Do not distribute or reproduce without express permission from OptumHealth. 20 Employee Health Team Development Process Health Promotion Success Supply Budget $$ Team Charter Human Resource Oversight Form a Multidisciplinary Team Write Job Descriptions Garner Formal Appointments

21. Confidential property of OptumHealth. Do not distribute or reproduce without express permission from OptumHealth. 21 Lifestyle-related medical costs Schroeder, S. New England Journal of Medicine 2007;357: 1221-8. Determinants of Health Behavioral patterns: 58% Environmental exposures: 7% Health care impact: 14% Social circumstances: 21%

22. Confidential property of OptumHealth. Do not distribute or reproduce without express permission from OptumHealth. 22 Health Action Process Approach ( HAPA) Motivation Decision Maintenance Self Efficacy Action Planning Coping Planning Action Self Efficacy Outcome Expectancies Risk Perception Recovery Self Efficacy Initiative Maintenance Recovery 1 Intention 2 Planning 3 Action Relapse Adapted from R. Schwarzer, Health Psychology 2008

23. Confidential property of OptumHealth. Do not distribute or reproduce without express permission from OptumHealth. 23 USPSTF Guide to Preventive Services. Accessed at http://www.ahrq.gov/clinic/pocketgd09/ http://www.ahrq.gov/clinic/pocketgd09/ Preventive Health is a Foundation Activity Men/Women every 5-10 years

24. Confidential property of OptumHealth. Do not distribute or reproduce without express permission from OptumHealth. 24 Incentive Strategy and Design Program Options

25. Confidential property of OptumHealth. Do not distribute or reproduce without express permission from OptumHealth. 25 How to Measure Success

26. Confidential property of OptumHealth. Do not distribute or reproduce without express permission from OptumHealth. 26 Evaluation of program impact – Short to Long Term  Enrollment  Participation  Completion rates  Participants  Employee team  Leadership  Non- participants  Total  Program area specific  Hard dollars  Soft dollars  Pharmacy  Medical  Productivity set Process metrics Satisfaction scores Outcomes Return on investment

27. Confidential property of OptumHealth. Do not distribute or reproduce without express permission from OptumHealth. 27  Within each age group, as risks increase, costs increase Costs Follow Risks OptumHealth normative data 2010

28. Confidential property of OptumHealth. Do not distribute or reproduce without express permission from OptumHealth. 28 Financial Workplace Productivity Medical Claims Worker’s Comp Disability Claims Absenteeism Productivity Presenteeism -26% -32% -28% -32% -40% 4% Healthier Employees – Work Harder and Cost Less Chapman L. Meta-analysis AJHP. 2005 Program participants are more productive and incur less cost

29. Confidential property of OptumHealth. Do not distribute or reproduce without express permission from OptumHealth. 29 $133 $162 Evaluating Success  Excess costs are defined as those costs associated with medium and high risk individuals over and above the costs associated with low risk status.  The calculation provides a theoretical estimate of potential cost savings assuming every medium and high risk person was reduced to low risk.

30. Confidential property of OptumHealth. Do not distribute or reproduce without express permission from OptumHealth. 30 Develop an Organizational Scorecard for Reporting

31. Confidential property of OptumHealth. Do not distribute or reproduce without express permission from OptumHealth. 31 Health Risk Appraisal Health Screenings Self Care Campaigns Monthly Activities Health Literacy Physical Activity Daily Minimum Associate Engagement ( HRA + 1 Program) Health Body Weight Building a Foundation First HRA Campaign Develop Teams Build Wellness Champion Network Organizational Audit Employee Engagement Data Driven Decisions Leadership Engagement Scorecard Distribution Increased Engagement Initial Outcomes Annual Study Partner Summit Incentive & Rewards Accelerating Impact Certification Recognition Full Integration ROI Study Results Wellness Support from Employees 50% 70% 25% 40% 60% 65% 40% 20% 35% 40% 50% 30% Develop a Three to Five Year Plan that Builds Over Time

32. Confidential property of OptumHealth. Do not distribute or reproduce without express permission from OptumHealth. 32 Summary  Key Concepts to Guide Our Strategy –Continuous Improvement with a Strong Foundation  Process Steps that Build Momentum –Population Health Management with Risk Migration  Critical Components of Successful Programs –Programs to Influence Behavior Change  How to Measure Success –Start with Process Build to Cost Effectiveness

33. 9/1/2015 For more information about Health and Productivity Solutions from OptumHealth, contact your OptumHealth sales executive or visit www.optumhealth.com OptumHealth | Optimizing Health and Well-Being | www.optumhealth.com © 2011 OptumHealth, Inc All Rights Reserved. Philip A. Smeltzer (502)228-6974 Philip.Smeltzer@OptumHealth.com