1. RIBGH Quarterly Summit Meeting Using Wellness Incentives to Drive Healthy Choices and Better Outcomes June 14, 2013

2. About Today’s Session 1 Speaker Agenda  Best Practices  Survey Context  Research Insights Robin Bouvier Aon Hewitt, Vice President Certified Wellness Program Coordinator robin.bouvier@aonhewitt.com Resources  Businessgrouphealth.org  Aon.com  Search consumer health mindset  Search 2013 health care survey

3.  A healthy workplace is one in which the organization and its employees collaborate to protect and promote the health and well-being of all workers and the sustainability of the workplace by considering the following: –Incorporate positive health practices into the physical work environment –Make health easy to obtain and sustain through a supportive workplace culture –Provide individual health resources in the workplace and at home –Identify ways of participating in the community to improve the health of workers, their families and other members of the community Create a Healthy & High Performing Workforce Consulting | U.S. Health & Benefits Proprietary & Confidential | June 14, 2013 2

4. 3 Best Practices to Drive a Successful Wellness Program Strategic Planning Disjointed, annual plan Integrated, data-driven, evidence informed, multi-year strategy Leadership Support No buy-in/support All levels buy-in financially and visibly engage Culture of Health Unhealthy environment High performance people, teams, organization considering individuals, environment, culture, and community Program Components No/few programs Programs and services that address the entire health continuum focused on a few areas Program Management No integration; passively offered Fully integrated design leveraging key best practices, focused/targeted programs Engagement No strategy, complicated All stakeholders considered. Culture of health + communications + incentives to drive active participation Measurement No plan, fragmented focus on process Comprehensive strategy, measure process, impact & outcomes Consulting | U.S. Health & Benefits Proprietary & Confidential | June 14, 2013

5. Why Do Employers Think Employees Participate in Wellness Programs? ExtremelySomewhatMinimallyNot ImportantImportantImportantImportant To earn incentives 54.4% 35.3% 6.3% 4.1% To avoid incurring penalties 36.2% 20.8% 11.1% 31.9% To improve their health right now 25.2% 57.0% 17.4% 0.3% To know and understand their biometrics 13.7% 51.4% 30.2%4.7% To make sustainable, healthy lifestyle changes 21.4% 54.3% 22.0% 2.2% To be included in your company’s culture 8.9% 35.8% 38.0% 17.4% To avoid negative perceptions from peers from4.1% 20.2% 40.4% 35.3% not participating Consulting | U.S. Health & Benefits Proprietary & Confidential | June 14, 2013 4 Source: Virgin HealthMiles, April 2013

6. The Business Leader Reality Costs  Continue to rise at unaffordable rates  Most foundational strategies are in place Performance  Real price goes beyond direct costs  Workforce in better health performs at higher levels Behaviors  8 modifiable human behaviors that lead to 15 chronic conditions account for 80% of total costs for all chronic illnesses worldwide  Better behaviors = better health = better outcomes Consulting | U.S. Health & Benefits Proprietary & Confidential | June 14, 2013

7. A lot of good health intentions get sidetracked by real life The Consumer Reality Consulting | U.S. Health & Benefits Proprietary & Confidential | June 14, 2013

8. 7 The Consumer Health Mindset Survey: Profile of Consumers  2,876 consumers ages 23+  Have employer-sponsored health coverage as employee (71%) or dependent (29%) through 1,000+ employee company Source: 2012 Consumer Health Mindset Survey – Aon Hewitt, National Business Group on Health, The Futures Company Consulting | U.S. Health & Benefits Proprietary & Confidential | June 14, 2013

9. Research Insights What’s On Consumers’ Minds?

10. “I know what it takes to be healthy and I really want to do the right things…” 9 Source: 2012 Consumer Health Mindset Survey – Aon Hewitt, National Business Group on Health, The Futures Company Consulting | U.S. Health & Benefits Proprietary & Confidential | June 14, 2013

11. “…but obstacles get in the way.” 10 Source: 2012 Consumer Health Mindset Survey – Aon Hewitt, National Business Group on Health, The Futures Company Consulting | U.S. Health & Benefits Proprietary & Confidential | June 14, 2013 More than half of those who report being in good health are actually overweight or obese.

12. “I’m stressed—particularly with money and work concerns…” 11 Source: 2012 Consumer Health Mindset Survey – Aon Hewitt, National Business Group on Health, The Futures Company Consulting | U.S. Health & Benefits Proprietary & Confidential | June 14, 2013 Nearly 50% of consumers feel their stress level is at least moderately high.

13. “…and most often deal with it in sedentary ways.” 12 Source: 2012 Consumer Health Mindset Survey – Aon Hewitt, National Business Group on Health, The Futures Company Consulting | U.S. Health & Benefits Proprietary & Confidential | June 14, 2013

14. “Pay me to participate in wellness programs.” 13 Younger consumers (ages 25-39) are more likely to need incentives Source: 2012 Consumer Health Mindset Survey – Aon Hewitt, National Business Group on Health, The Futures Company Consulting | U.S. Health & Benefits Proprietary & Confidential | June 14, 2013

15. “I think my employer should reward good health outcomes.” 14 Half the consumers believe their employer should reward them for achieving specific, controllable health outcomes Source: 2012 Consumer Health Mindset Survey – Aon Hewitt, National Business Group on Health, The Futures Company Only 15% of consumers say employers should impose consequences for less-than-healthy outcomes Consulting | U.S. Health & Benefits Proprietary & Confidential | June 14, 2013

16. “If you are going to provide an incentive, I’ll take cash.” 15 Source: 2012 Consumer Health Mindset Survey – Aon Hewitt, National Business Group on Health, The Futures Company Consulting | U.S. Health & Benefits Proprietary & Confidential | June 14, 2013

17. 2013 Aon Hewitt Health Care Survey Results Compendium of Questions & Answers 2013 Aon Hewitt Health Care Survey: New Choices, Better Results

18. 17 Profile of Respondents  837 employer respondents –37% global –36% U.S. multi-state –18% U.S. single state –10% multi-regional (more than one country/region) –7 employers headquartered in Rhode Island  Represent all employer sizes –15% of respondents have fewer than 500 U.S. employees –28% have between 501 and 2,500 U.S. employees –17% have between 2,501 and 5,000 U.S. employees  41% of participating companies have union employees  All industries represented –12% manufacturing –9% health care –7% retail –6% insurance –6% education Source: 2013 Aon Hewitt Health Care Survey Consulting | U.S. Health & Benefits Proprietary & Confidential | June 14, 2013

19. 2013 Desired Outcomes 1. Increase participation in wellness, health improvement and disease management programs 2. Increase participants’ awareness of and decision making related to health issues 3. Lower health risk of population 4. Improve disease management and health improvement program compliance 5. Increase employee use of tools and information on provider price and quality 2013 Current Challenges 1. Motivate participants to promote behavior change 2. Government regulations/ compliance (e.g., health care reform) 3. Maintain participants’ engagement/satisfaction with health plan 4. Understanding employee attitudes toward health and wellness 5. Unpredictability of cost Top Priorities (Next 3–5 Years) 1. Offer incentives or disincentives to motivate sustained health care behavior change 2. Promote a culture of health in the workplace 3. Implement a company wide (or global) wellness policy and guiding principles 4. Move to rewarding improved health results or outcomes 5. Promote other consumer- driven plan tools and resources, including data on provider cost and quality Summary of Results Consulting | U.S. Health & Benefits Proprietary & Confidential | June 14, 2013 18 Source: 2013 Aon Hewitt Health Care Survey

20. Which of the following health and wellness tactics does your organization have in place?  49% have a domestic wellness policy and guiding principles  47% have visible senior and business unit leadership as a champion of health  46% have location-based wellness champions/council that meets regularly  80% have an ongoing wellness communications campaign  59% have unique branding for their wellness program  31% offer flexible policies or schedules to accommodate exercise needs  30% subsidize healthy foods or beverages  27% conduct summit meetings with all health-related vendors to coordinate interventions and data  40% track or report health risks and wellness statistics Consulting | U.S. Health & Benefits Proprietary & Confidential | June 14, 2013 19 Creating a Foundation for Success Source: 2013 Aon Hewitt Health Care Survey

21. Which of the following activities are part of your organization’s 2013 health care strategy?  84% offer tools (health risk questionnaire, biometric screenings) to raise participants’ awareness of their health status and risks  67% reward participants for use of health awareness tools  29% impose consequences on participants if they don’t use tools  21% reward participants (via enhanced plan design, lower premium contribution or other reward) for achieving specific health outcomes (e.g., normal cholesterol or improved BMI)  19% impose consequences on participants for exhibiting unhealthy behaviors (e.g. smoking, high BMI) or not achieving specific health outcomes  34% discourage tobacco use via premium surcharge Consulting | U.S. Health & Benefits Proprietary & Confidential | June 14, 2013 20 Use of Wellness Tools, Rewards & Consequences Source: 2013 Aon Hewitt Health Care Survey

22. Motivating Employees & Family Members to Health Which employees and spouses are eligible for the incentives you offer? Total Responses: 466 Consulting | U.S. Health & Benefits Proprietary & Confidential | June 14, 2013 21 Source: 2013 Aon Hewitt Health Care Survey

23. Incentive Focus and Value Total Responses: 465 Responses represent only employers currently offering incentives *Does not include tobacco use According to the National Business Group on Health, spending on incentives has doubled in the last few years, with an average spend per employee on wellness-based incentives of $521 per year, up from $260 in 2009 Consulting | U.S. Health & Benefits Proprietary & Confidential | June 14, 2013 22 Source: 2013 Aon Hewitt Health Care Survey

24. Build Awareness: Incentive Value Total Responses: 384 Consulting | U.S. Health & Benefits Proprietary & Confidential | June 14, 2013 23 Source: 2013 Aon Hewitt Health Care Survey

25. Build Awareness: Incentive Type Total Responses: 384 Consulting | U.S. Health & Benefits Proprietary & Confidential | June 14, 2013 24 Source: 2013 Aon Hewitt Health Care Survey

26. Take Action: Incentive Value Total Responses: 261 Consulting | U.S. Health & Benefits Proprietary & Confidential | June 14, 2013 25 Source: 2013 Aon Hewitt Health Care Survey

27. Take Action: Incentive Type Total Responses: 261 Consulting | U.S. Health & Benefits Proprietary & Confidential | June 14, 2013 26 Source: 2013 Aon Hewitt Health Care Survey

28. Achieve Outcomes: Incentive Value Total Responses: 113 Consulting | U.S. Health & Benefits Proprietary & Confidential | June 14, 2013 27 Source: 2013 Aon Hewitt Health Care Survey

29. Achieve Outcomes: Incentive Type Total Responses: 113 Consulting | U.S. Health & Benefits Proprietary & Confidential | June 14, 2013 28 Source: 2013 Aon Hewitt Health Care Survey

30. Programs Designed to Address Tobacco Use Total Responses: 463 Does your company offer a surcharge for using tobacco products or a discount for not using tobacco? Total Responses: 217 Consulting | U.S. Health & Benefits Proprietary & Confidential | June 14, 2013 29 Source: 2013 Aon Hewitt Health Care Survey

31. Tobacco Use: Incentive Value Total Responses: 217 Consulting | U.S. Health & Benefits Proprietary & Confidential | June 14, 2013 30 Source: 2013 Aon Hewitt Health Care Survey

32. Tobacco Use: Incentive Type Total Responses: 217 Consulting | U.S. Health & Benefits Proprietary & Confidential | June 14, 2013 31 Source: 2013 Aon Hewitt Health Care Survey

33. RIBGH Quarterly Summit Meeting Panel Discussion June 14, 2013

34. Panel Participants Large Employers  Dr. Susan Andrews, Electric Boat  Tricia Fay, FM Global  Cheryl Kennedy, Hasbro  Howard Dulude, Lifespan  Jean Tapley, Amica Vendors  Dr. David Ahern, Abacus  Heather Provino, Provant Health Solutions  Laura Walmsley, Preventure  Rajiv Kumar, ShapeUp Small Employers  Michael Sullivan, Moran Shipping  Gina DeLuca, RI Dept. of Health Consulting | U.S. Health & Benefits Proprietary & Confidential | June 14, 2013 33

35. 34 Best Practices to Drive a Successful Wellness Program Strategic Planning Disjointed, annual plan Integrated, data-driven, evidence informed, multi-year strategy Leadership Support No buy-in/support All levels buy-in financially and visibly engage Culture of Health Unhealthy environment High performance people, teams, organization considering individuals, environment, culture, and community Program Components No/few programs Programs and services that address the entire health continuum focused on a few areas Program Management No integration; passively offered Fully integrated design leveraging key best practices, focused/targeted programs Engagement No strategy, complicated All stakeholders considered. Culture of health + communications + incentives to drive active participation Measurement No plan, fragmented focus on process Comprehensive strategy, measure process, impact & outcomes Consulting | U.S. Health & Benefits Proprietary & Confidential | June 14, 2013