1. Driving Down Health Care Costs with Corporate Health Centers CAJPA Conference September 16, 2015 David Zanze, President Pinnacle Claims Management, Inc.1

2. Today’s Agenda  The Cost of Poor Health of Employees  The Evolution of Corporate Health Centers and the Benefits for Both Employers and Employees  Setting Up Your Health Center  Successful Case Studies  Ensuring High Utilization of Your Center  Next Steps  Q&A Pinnacle Claims Management, Inc.2

3. Average Family Premium is $16,834 per year – up 3 percent from last year ** Why are Health Care Costs Still Going Up? Pinnacle Claims Management, Inc.3 **Source: Kaiser Family Foundation 2014 Employer Health Benefits Survey

4. Employees’ Poor Health is Costing the U.S. Economy $576 Billion a Year Pinnacle Claims Management, Inc.4 Source: Based on landmark employee productivity survey conducted by the Integrated Business Institute, a non-profit group. Statistics were drawn using data from the U.S. Bureau of Labor and the institute’s benchmarking data based on 60,000 U.S. employers. $227 billion on lost productivity $117 billion from absences due to illness, workers compensation and short and long-term disability $232 billion from medical treatment and pharmacy- related costs

5. Employee Productivity Levels Affected by Habits Pinnacle Claims Management, Inc.5 Employees with an unhealthy diet were 66% more likely to have a loss of productivity compared to healthy eaters. Employees who rarely ate fruits or vegetables were 93% more likely to have a higher loss of productivity. Employees who had difficulty exercising during the day were 96% more likely to experience a loss of productivity. Unhealthy habits were found to have the most impact on employees between 30-40 years old. Source: Based on a survey of 20,000 employees conducted by Brigham Young University and published in the academic journal, Population Health Management.

6. What Do Chronic Conditions Cost Us? Pinnacle Claims Management, Inc.6 Chronic ConditionAbsenteeism cost per employee with condition How Many People in the United States it Affects Annually COPD$9,82312 million diagnosed Coronary heart disease$7,963375,000 die from it Diabetes$7,90029.1 million (9.3% of population) Congestive heart failure$7,262670,000 diagnosed Depression$3,682One in 10 diagnosed Anxiety$2,38240 million adults 18 and older (18% of population) Chronic Insomnia$2,28040 million Obesity$1,42978.6 million or 34.9% of adults Irritable bowel disorder$1,14725-45 million (10-15% of population)

7. Implementing Wellness Initiatives to Help Manage Health Care Costs Pinnacle Claims Management, Inc.7 Health risk assessments and biometric screenings Discounts to local gyms and weight loss programs Wellness programs including stress management, smoking cessation and walking clubs Chronic disease management Onsite corporate health centers

8. Who is Offering Wellness Programs? According to Kaiser Family Foundation 2014 Annual Employer Health Benefits Survey: Nearly a third of employers who offer health benefits offer a health risk assessment but few make it a requirement to join program. 51% of large employers (200+) are more likely to ask for a risk assessment compared to 32% of small employers. Among large firms that offer a risk assessment, 51% report providing a financial incentive to employees to complete it. 51% of large firms and 26% of smaller offer biometric screenings. Virtually all large employers and most small employers offer at least one wellness program. Pinnacle Claims Management, Inc.8

9. Economic Benefits of Preventing Disease Those who increased their physical activity (2 ½ hours a week) and lost 5-7% of their weight reduced risk of type 2 diabetes by 58% By reducing the average population’s sodium intake to 2,300 milligrams per day, we could save $18 billion in health costs annually For a 1% reduction in weight, blood pressure, glucose and cholesterol risk factors, we would save $83 to $103 in medical costs per person annually. By increasing the use of preventive services to 90% of the recommended levels, we could save $3.7 billion annually in medical costs Source: Surgeon General’s National Prevention Strategy. Pinnacle Claims Management, Inc.9

10. Implementing a corporate onsite or near- site health and wellness center (aka health care clinic) can be an effective tool in driving health care costs down. Pinnacle Claims Management, Inc.10

11. Why are Onsite Health Care Centers Popular Again and Part of a Winning Strategy? Pinnacle Claims Management, Inc.11

12. Pinnacle Claims Management, Inc.12 They Started as Onsite Occupational Clinics

13. Pinnacle Claims Management, Inc.13 Today’s Corporate Health Centers

14. Modern Day Health Centers Look at an Employee’s Whole Health – Not Just One Part Pinnacle Claims Management, Inc.14

15. On-Site Health Center Services Offered Traditional Services Traditional occupational health services/worksite injuries Primary and urgent care needs Promote health and wellness programs Employee Assistance Program, mental health triage Newer type services Referrals to quality specialists and physicians when needed Provide health coaching and care management Dispense commonly prescribed Rx medications Telemedicine Visits to clinic from medical professionals Pinnacle Claims Management, Inc.15

16. Pinnacle Claims Management, Inc.16 Helping Employees Be Compliant with Medications is One of Many Potential Benefits for Employers

17. Many Potential Benefits for Employees Pinnacle Claims Management, Inc.17

18. Success Case Study #1 Pinnacle Claims Management, Inc.18

19. Success Case Study #2 Pinnacle Claims Management, Inc.19

20. Pinnacle Claims Management, Inc.20 Success Case Study #3

21. Setting Up Your Health Care Center Pinnacle Claims Management, Inc.21 Questions to Ask Yourself

22. Setting Up Your Health Care Center Affordable Care Act (ACA) Employee Retirement Income Security Act (ERISA) Consolidated Omnibus Budget Reconciliation (COBRA) Health Insurance Portability and Accountability Act (HIPAA) Americans with Disability Act (ADA) Genetic Information Nondiscrimination Act State Laws Pinnacle Claims Management, Inc.22 Legal Considerations

23. Setting Up Your Health Care Center Pinnacle Claims Management, Inc.23 Factors in Measuring a Center’s Effectiveness

24. Setting Up Your Health Care Center Staffing Services offered Building costs Outside vendor costs Pinnacle Claims Management, Inc.24 Set Up Costs

25. Cost savings from fewer visits to emergency room Reduced employee absenteeism due to less time away when employees receive earlier treatment of illnesses or injuries Cost savings –price tag for visiting a health care center is lower than a traditional doctor visit Improved retention of employees Healthier employees means overall less costs in health care Pinnacle Claims Management, Inc.25 Setting Up Your Health Care Center What to Consider when Measuring your Return on Investment

26. Ensuring High Utilization of Your Center Pinnacle Claims Management, Inc.26

27. Ensuring High Utilization of Your Center Pinnacle Claims Management, Inc.27 Provide Incentives

28. Ensuring High Utilization of Your Center Pinnacle Claims Management, Inc.28 Provide Frequent Communication

29. What Are Your Next Steps? Pinnacle Claims Management, Inc.29

30. Questions? Pinnacle Claims Management, Inc.30