Are you ready for the future of wellness?

Gaston Regional Chamber Healthcare Summit

Leading edge wellness strategies for your organization

1 00.25.910.1 (4/08)

Wellness matters

70 – 90 percent

of health care costs are due to unhealthy choices and preventable risks 1 In 2008, employers are projected to spend

46% more

than in 2003, an average of $9,312 per employee 2 for health care costs Chronic diseases cost businesses

more than $1 trillion

in lost productivity 3 U.S. companies lose nearly

$63 billion

in lost work and productivity each year due to employee injuries and illnesses 4 1 2 3 4 Health Care Statistics, Prevent Disease.com, 2006 2008 Towers Perrin Health Care Cost Survey “An Unhealthy America: The Economic Burden of Chronic Disease,” The Milken Institute, October 2007 Journal of Occupational and Environmental Medicine, July 2007

Wellness works

Wellness programs may save organizations

$900/person/year

in direct medical costs 1 Most employers can expect a

$3 to $1 return on investment

and health promotion 2 for preventive services Employers can

save $1.65

in health care expenses

for every dollar

comprehensive health care program 3 spent on a Wellness programs

save money

through:    Lower health care costs Greater productivity Reduced absenteeism 4 1 2 3 4 Wellness Councils of America (WELCOA) Absolute Advantage: ROI Bullseye; Building a First ClassWorkforce by David R. Anderson, 2003 Healthcare Cost Trends for 2008, PricewaterhouseCoopers, 2008 Journal of Occupational and Environmental Medicine, February 2008 Purdue University, February 2007

The plan sponsor’s journey to wellness…

embracing change and developing a supportive culture

Gather information to understand needs and develop strategies Solutions that drive meaningful change and make your vision a reality Celebrate your successes and refine your strategies for the future

The plan sponsor’s journey to wellness…

Five steps to creating an effective wellness strategy

Gather and analyze information Define goals and objectives Design wellness strategy    Assess your workplace culture, environment, business and benefit strategies Review claim information to understand utilization and health risks Understand your employees, preferences, health status and behaviors    Identify the behaviors you want to change Determine how wellness programs will contribute to your benefit strategy Define how you will measure and determine success    Review current plan designs; align with defined goals and objectives Choose wellness programs and incentives that will meet your needs Identify other workplace changes, cafeteria food, smoke-free environment Develop implementation plan    Ensure leadership commitment and support Create a detailed implementation plan and timeline Develop a comprehensive communications plan Evaluate outcomes and refine strategy    Measure outcomes against goals and objectives Gather feedback about how well your strategy is working Celebrate successes and refine your strategy

Supporting members with wellness solutions that span the continuum of care

Health/low risk

Stay well (mind and body)

At risk for disease/injury Managing a chronic disease Major health events

Identify and manage health risks to prevent disease and disability Reduce absenteeism and on-the-job productivity loss Manage/mitigate disease impact Identify and manage those most at risk for disability Provide structured programs to support return to health and productivity Manage medical care Manage disability

Access to Quality Care

Aetna Health Connections SM

The suite of programs & services that enables wellness solutions

Staying Healthy Changing Lifestyles Managing Conditions Major Health Events Integrated Solutions Disease Management Lifestyle Coaching * Advocacy Programs * Worksite Clinic Services * Personal Health Record MedQuery Health Fairs and On-site Screenings * Informed Health Line Simple Steps To A Healthier Life ® Health Assessment Discount Programs, Natural Products and Services Well Visits & Screenings Communications Campaigns and Toolkits Tools and Informational Resources Case Management Aetna Healthy Actions SM Incentives Capabilities

* Availability may vary by location, product, group size

A plan sponsor’s multi-year wellness strategy

(Illustrative only)

More health assessments Lower absenteeism Incentives Simple Steps To A Healthier Life

®

Disease Management YEAR 1 Increase in physical activity Reduction in medical costs Fitness and weight management programs Incentives Simple Steps To A Healthier Life

®

Disease Management YEAR 2 Increase in productivity Reduction in medical costs Lifestyle coaching or wellness counseling Incentives Simple Steps To A Healthier Life

®

Disease Management YEAR 3

The Aetna Experience

Overall trends in Aetna employee population

Medical Trend Engagement (chronically ill) Results of Simple Steps Healthy Lifestyles Program Participation Illness Burden (chronically ill) 2007 trend is 3.3% compared to 5.9% as of 11/06 and 15.9% as of 11/05 A Engaged and Engageable population increased from 64.3% in 2005 to 72.7% in 2006 Participation in Healthy Living Programs climbed 111% from 2005 to 2007 Participation increased from 10,939 in 2006 to 17.085 employees in 2007, a 56% increase Retrospective Risk Score shows chronically ill population became less sick over last 2-1/2 years Please note: Trend is the result of plan design, medical management and wellness interventions. Today we are talking about wellness interventions, but all interventions should be used to get the trend in line. Illness burden measures the breadth and intensity of diseases in a population. A Dec 2007 12 month rolling trend

Aetna Confidential may not be copied or reproduced without prior written approval

We’re creating a future where…

Your employees and their families are fully

engaged

health and take responsibility for health care decisions in their The benefits experience they receive is

personalized

to meet their needs, based on experienced clinical knowledge and analysis All benefits seamlessly

work together

line and the well-being of your employees to enhance your bottom 10

We’re creating a future where…

Your employees and their families are fully

engaged

health and take responsibility for health care decisions in their The benefits experience they receive is

personalized

to meet their needs, based on experienced clinical knowledge and analysis All benefits seamlessly

work together

line and the well-being of your employees to enhance your bottom

Seamless Linking HRA to PHR to Wellness Programs

11

The journey to optimal health starts with the health assessment…

Know your:

Numbers Health status Modifiable risks Wellness resources Simple Steps to a Healthier Life

Staying Healthy Lifestyle Changes Managing Conditions Major Health Events

Preventive Screenings Well Visits Improve Nutrition Increase Physical Activity Medical Adherence Care Plan Care Management Managed Disability

… and continues with the right programs and services

Aetna Personal Health Record goes well beyond a static claim history

Our industry-leading PHR is really like a personal health assistant

 All patient information in one place  A dynamic system for interactivity based on our patented CareEngine ® technology  Integrated patient and health care information to support higher quality, cost effective care  A unique decision aid for health care providers, providing up-to-the-minute information on the patient

We’re creating a future where…

Your employees and their families are fully

engaged

health and take responsibility for health care decisions in their The benefits experience they receive is

personalized

to meet their needs, based on experienced clinical knowledge and analysis 

Value Based Benefits - Rx/DM incentive: Copay relief for medication adherence for specific drug classes

All benefits seamlessly

work together

to enhance your bottom line and the well-being of your employees

Seamless Linking HRA to PHR to Wellness Programs

14

Evidence Based Care

Effective application of evidence-based care is key to improving outcomes

Improving care for members at all

stages of health

Evidence-based care relies on research evidence to enhance patient care

Evidence-based strategies are built into our:

    Strategies for collaborating with members and physicians to improve health Clinical coverage decisions Strategies to identify care improvement opportunities Overall medical care management approach

Aetna Pharmacy Management

Medication adherence

22% of U.S. patients take less of the medication than is prescribed

American Heart Association: Statistics you need to know. http://www.americanheart.org/presenter.jhtml?identifier=107 Accessed November 21, 2007.

Aetna Pharmacy Management

Why adherence matters

“Of all medication-related hospital admissions in the United States, 33 to 69 percent are due to poor medication adherence, with a resultant cost of approximately $100 billion a year.”

Results of failure to adhere to prescribed medications:   Increased hospitalization Poor health outcomes    Increased costs Decreased quality of life Patient death Benner JS, Glynn RJ, Mogun H, Neumann PJ, Weinstein MC, Avorn J. Long-term persistence in use of statin therapy in elderly patients. JAMA 2002;288:455-461

The Logical Next Step

Several sources of data: 1.

Surveys of self-reported underuse and pill-splitting 2.

3.

Comparisons of people with less and more generous drug insurance Longitudinal studies of the introduction of payment caps Reducing or eliminating cost sharing (at least for some conditions or for some levels of risk) may increase adherence to efficacious medications In fact, the cost of paying for increased drug costs may be (more than) offset by the cost-savings from averted clinical events

Aetna Pharmacy Management

Overcoming barriers to adherence

Health plan pays member copay  Reduces member out-of pocket costs  Emphasizes the importance of continuing therapy   Education and outreach  Explains the need for medication therapy Breaks down complex therapies into manageable parts Offers strategies for coping with side effects Benner JS, Glynn RJ, Mogun H, Neumann PJ, Weinstein MC, Avorn J. Long-term persistence in use of statin therapy in elderly patients. JAMA 2002;288:455-461

Aetna Pharmacy Management

Investment in medication adherence can lead to dramatic reductions in overall cost of care

$10,000 $55 $8,000 $165 $285 $404

Rx $ Medical $

$6,000 $763 $8,812 $4,000 $6,959 $6,237 $5,887 $2,000 $3,808 $0 1-19% 20-39% 40-59% 60-79% 80-100%

Diabetes Medication Level of Adherence (% days supply/year)

Outcome is significantly higher than outcome for 80 100% adherence group (

P

<0.05). Differences were tested for medical cost and hospitalization risk.

Sokol M et al. Impact of Medication Adherence on Hospitalization Risk and Healthcare Cost. Medical Care. Volume 43, Number 6, June 2005

Sensitivity Analysis: Time Horizon

Health Affairs 2007; 26: 186

Benefit Design Research Study

Aetna / Harvard Proposal • Aetna to participate with Harvard in a study to formally test the hypothesis that by removing financial barriers (co-pay, co insurance and deductibles) for certain conditions we would:

– Increase medication adherence – Improve clinical quality – Decrease medical costs

We’re creating a future where…

Your employees and their families are fully

engaged

health and take responsibility for health care decisions in their

Work Site Clinics: Brings wellness to the worksite

The benefits experience they receive is

personalized

to meet their needs, based on experienced clinical knowledge and analysis 

Value Based Benefits - Rx/DM incentive: Copay relief for medication adherence for specific drug classes

All benefits seamlessly

work together

line and the well-being of your employees to enhance your bottom

Seamless Linking HRA to PHR to Wellness Programs

23

What is engagement?

Engagement

is an individual’s

ownership

of and

active participation

in his or her journey to optimal health and wellness

JOIN US

Engagement matters

• • • •

Up to 50%

of health care costs are due to unhealthy choices and preventable risks 1 In 2008, employers are projected to spend

46% more

for health care costs than in 2003, an average of $9,312 per employee 2 Chronic diseases cost businesses

more than $1 trillion

in lost productivity 3 U.S. companies lose nearly

$63 billion

in lost work and productivity each year due to employee injuries and illnesses 4 1 NAHU’s Healthy Access Briefing Report: Constraining Medical Costs, 2006, https://www.nahu.org/legislative/healthyaccess/Report-ConstrainingMedicalCosts.pdf

2 2008 Towers Perrin Health Care Cost Survey 3 “An Unhealthy America: The Economic Burden of Chronic Disease,” The Milken Institute, October 2007 4 Journal of Occupational and Environmental Medicine, July 2007

Your organization may already be paying

Lost productivity and a lack of focus on wellness can cost your organization We know…

Increased productivity

has been noted as a key reason plan sponsors adopt an onsite health center* Onsite programs using face-to-face coaching and motivational interviewing techniques result in

higher engagement levels

than telephonic only delivery of programs Worksite health services create and support an effective wellness strategy by helping to

create and maintain a culture of wellness

* Watson Wyatt “

Realizing the Potential of Onsite Health Centers” 2008

Study © 2007 Aetna Inc.

Our worksite health solution:

Aetna Health Connections Direct2you

• Expands and extends our Aetna Health Connections overall health and wellness solutions portfolio • Initial offering includes onsite delivery of: –

Selected Aetna Health Connections programs already delivered telephonically

–

Biometric screenings Our future vision of Direct2you solutions:

 Part-time clinical staff  Community-based centers  Remote outreach and engagement .

Direct2you

Aetna Health Connections

Available beginning 1/1/2009

The program includes face-to-face delivery of any combination of these programs:  Disease Management  Wellness Counseling  Behavioral Health (BH) Assessment and Counseling  Employee Assistance Program (EAP) Assessment and Counseling  Biometric Screenings available through Summit Health or Quest Diagnostics

We’re creating a future where…

Your employees and their families are fully

engaged

health and take responsibility for health care decisions in their

Work Site Clinics: Brings wellness to the worksite

The benefits experience they receive is

personalized

to meet their needs, based on experienced clinical knowledge and analysis

Value Based Benefits - Rx/DM incentive: Copay relief for medication adherence for specific drug classes

All benefits seamlessly

work together

line and the well-being of your employees to enhance your bottom

Seamless Linking HRA to PHR to Wellness Programs

29