1. CIA Annual Meeting Session 3203 Measuring Wellness: The Issues? Tom Brogan President June 28 th, 2005

2. Ever evolving environment Labour shortages Changes to retirement law Two-tier health care ­ Court decision ­ Public opinion ­ Journalistic bias

3. Health & Wellness Health is a state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity. World Health Organization Constitution, 1948

4. Wellness Perception Survival Freedom from disease Ability to perform daily activities Quality of Life Shift away in viewing health From QUANTITY to QUALITY Measures: Infant mortality Life expectancy

5. Wellness Perception Survival Freedom from disease Ability to perform daily activities Quality of Life Shift away in viewing health From QUANTITY to QUALITY Measures: Prevalence Rates Incidence rates Clinical outcomes

6. Wellness Perception Survival Freedom from disease Ability to perform daily activities Quality of Life Shift away in viewing health From QUANTITY to QUALITY Measures: Productivity Loss Absenteeism Disability

7. Wellness Perception Survival Freedom from disease Ability to perform daily activities Quality of Life Shift away in viewing health From QUANTITY to QUALITY Subjective Measures obtained through questionnaires

8. Measuring Quality of Life Quality of life measurements through structured questionnaires Various instruments developed: ­ World Health Organization: WHOQOL ­ EuroQol ­ SF-36, etc.

9. Measuring Wellness: Conditions do apply Current state of health ­ The ill - need treatment ­ The healthy - need prevention

10. Top 10% = 56% of Cos t Cost Concentration Cost per Claimant PDP: $3,866 ODB: $8,446 From most expensive to less expensive claimants Source: BROGAN INC. Private Drug Plans Database

11. Defining Wellness: Conditions do apply Current state of health ­ The ill - need treatment ­ The healthy - need prevention Age Economic status Location

12. Is health care providing wellness? Drugs ­ Can improve wellness ­ Reduce morbidity, mortality ­ Provide economic benefits ­ Not the sole answer (perhaps not the most important solution)

13. Reduced Mortality, HIVAIDS Source: BROGAN INC. Ontario Drug Plan

14. Reduction in Hospital Utilization for Asthma 1990-2000 Source:Innovation Crossroads – The health and economic value of new medicines, GSK

15. Age Standardized Mortality Rate per 100,000 Men, Canada, 1969-1997 Source: The Changing Face of Heart Disease and Stroke in Canada, 2000

16. Reduced Risk with 1% Reduction in Blood Glucose Levels Source:Innovation Crossroads – The health and economic value of new medicines, GSK

17. Age-standardized breast cancer incidence and mortality rates, Canada, 1985 to 1999 Source: Statistic Canada, Health Reports Vol. 15, No. 2

18. Wellness… Why should we care? Cost to clients, employers, society ­ Lost work time ­ Premature mortality, morbidity

19. Burden of Illness Selected Medical Conditions Source: Health Canada, 1998

20. Wellness… Why should we care? Cost to clients, employers, society ­ Lost work time ­ Premature mortality, morbidity Business opportunity Social obligation Urgent need ­ Cannot count on government

21. Measuring Wellness… It’s all a matter of perspective Employee Employer Insurer/Third Party Administrator Public sector health care system Recipient/Beneficiary: ­ Age ­ Current health status ­ Socio-economic status, etc.

22. Given From Insurer Perspective How can you influence health? Biological factors Lifestyle choices Environmental conditions Health care system ­ Prevention ­ Treatment Determinants of Health, Page 9, Romanow Report

23. Health care components ~ all as important ~ Each condition requires different actions: Life-style choices: ­ Healthy living, smoking, obesity, etc. Physicians/Testing: ­ Compliance, early detection (ex. PSA) Drug therapy: ­ Ex. Diabetes, RA, High-Cholesterol etc. Hospitals: ­ Injuries, surgeries, etc.

24. Role of Insurers Break cost containment philosophy, silo thinking: move to economic value Health & Wellness = more costs: ­ Tests, drugs, treatments, monitoring, etc. ­ More aggressive treatment Results hard to measure, benefits hard to quantify

25. Role of Insurers Promote aggressive treatment Incentives for healthy living Incentives for prevention and early action Incentives for compliance More member education

26. Wellness… answering the basic questions Wellness - operational definition required Philosophical issues ­ Investment or cost ­ Degree of intervention Wellness has economic benefits Innovative programs required - courage and persistency demanded