Introducing: A Better Way to Achieve Pricing TransparencyDiabetes Management Compliance 31 Annual Hemoglobin A1C 86.9% 91.4% Annual LDL Test 86% 89.3% (Bad Cholesterol) Annual Kidney

© Copyright 2013, Health Advocate, Inc.

Abbie Leibowitz, M.D. EVP and Chief Medical Officer February 2013

IIntroducing:

A Better Way to Achieve Pricing Transparency


Health Advocate  The nation s leading independent health advocacy and assistance program  Offered by more than 9,500 clients nationwide  5.5M client members, 5M health plan members  Serving more than 40 million Americans  Covers the employee, spouse, dependents, parents and parents in-law  An expert staff of healthcare and insurance professionals  A strong and recognized brand enjoying a reputation for being objective and well-respected  A privately-held company founded in 2001  Financially strong, profitable, funded by the original founders and friends-and-family, and debt-free

1

Consumer Driven Healthcare

2 © Copyright 2013, Health Advocate, Inc.


Where Do You Start?

3

© Copyright 2013, Health Advocate, Inc. 4

Health Cost Estimator™

Health Cost Estimator+™


engage2HEALTH™

  Health Advocate data subsidiary based in Southern California   e2H team includes nationally regarded MDs, PhDs, statisticians, database experts and population health researchers   Strong history of conducting health data research to measure and improve the quality of care   Research focuses on strategies to enhance patient adherence to Evidence Based Medicine   Complete data warehouse and analytics capability   Using data to create behavior changes that improve clinical outcomes and reduce medical costs

Applied Health Services Research & Innovation


Health Advocate Data Sources

6

Medical Claims Other Vendors RX Claims STD/LTD Benefit Details Workers Comp Network Features Deductible/Co-ins Brand/Generic Programs Mail-order RX Disease Management Formulary Wellness Preferred Provider Networks UR & Case Management


Health Information Dashboards

Baseline Medical Claims Analysis

Pricing Transparency Tools

7

Chronic Care Solutions

Health Advocate Data Services

Data Analytics and Predictive Modeling

Data

Biometrics

Rx


Downloading the Application

8


New Health Advocate Pricing Tools Health Cost Estimator / Health Cost Estimator +™  Improved version of our “Generic” Pricing Transparency tool  Pre-service pricing decision support tool for non-data clients and when client specific information is not available  Part of Core Health Advocate service  Blended data from tens of millions of healthcare claims  Information analysis from national data sources as

well as proprietary Health Advocate client experience  Adjusted for CPI by zip code  Presents a range of typical costs for each procedure  Information on nearly every common procedure  Available by web and mobile devices  Provided at no additional cost  HCE+ uses client specific data

9


Health Cost Estimator

11 11

Health Cost Estimator Mobile App



Health Cost Estimator on the Web


Health Cost Estimator on the Web


Health Cost Estimator

14


0%

5%

10%

15%

20%

25%

30%

35%

Book of Business Client

All Category Distribution Client vs. Book of Business

January – December 2011

15


0%

5%

10%

15%

20%

25%

30%

35%

Book of Business Client

All Category Distribution Client vs. Book of Business

January – December 2011

16


Why Don’t More People Use Pricing Tools?

 For most people, the cost of care has little effect on what they pay because costs often exceed deductibles  Most pricing tools focus on the choice of the hospital because that data is easier to develop, but people typically focus on the choice of the doctor  The doctor you go to will almost always determine the hospital you go to  Doctors are paid by fee schedule and the contracted fees is the same, while Hospital fees vary widely   “Tools” promote themselves with a focus on outpatient radiology – CT/MRI, but costs are driven by larger procedures  Staying in-network is key to lower costs all around and is not that difficult to explain  Engaging the consumer in the discussion of price/costs is key. Is this really a smartphone app?

17


Examples of How We Help  Find qualified doctors, dentists, hospitals, other healthcare providers anywhere in the country  Expedite appointments including those with hard-to-reach specialists  Provide price information  Help resolving insurance claims  Negotiate billing and payment arrangements  Assist with eldercare, finding adult daycare, assisted living and other related issues facing parents, parents-in-law  Work with insurance companies to obtain appropriate approvals for needed services

 Obtain unbiased health information about complex medical conditions to help make informed decisions  Answer questions about test results, treatments and medication prescribed by the physician  Assist in the transfer of medical records, X-rays and lab results  Locate and research the newest treatments for a medical condition  Explain benefits and help facilitate access to appropriate care

18


Health Advocate Utilization Summary

Most Common Health Related Reasons for First Call

Most Common Administrative Related Reasons for First Call   Benefits Education   Claims Assistance   Enrollment Support   Eligibility   Coverage Advantage   Appeals Assistance

  Specialty Care Locator   Routine Care Locator   Health Information   Care Coordination   Rx Advocate   Mind Matters

19


Most Common Health Related Reasons for First Call

Most Common Administrative Related Reasons for First Call   Benefits Education   Claims Assistance   Enrollment Support   Eligibility   Coverage Advantage   Appeals Assistance

  Specialty Care Locator   Routine Care Locator   Health Information   Care Coordination   Rx Advocate   Mind Matters

•  “Help me find a new doctor” •  “Help me find a specialist” •  “I want a second opinion” •  “What hospital should I go to?” •  “I need help scheduling several

appointments” •  “I need an in-network mental health provider”

•  “What’s my deductible if I .?” •  “Why do I owe so much on this bill? •  “Is an out-of-network service covered?” •  “Can I appeal this bill?”

Health Advocate Utilization Summary

20


How Do We Get More People To Use Pricing Tools?

 Health Advocate has made a discussion of the cost of care a routine feature of all of our provider and hospital location services at no additional charge!  Our service focuses on the choice of the doctor also, since that’s how people access the health care system  We incorporate “Quality” measures into the discussion as relevant  Presenting information to the member as a standard feature of the help we provide makes the information timely  We can help members act on the information by scheduling appointments, arranging record transfers, coordinating services, interacting with health plans  Easy access to information – phone call for discussion as well as mobile platforms  Engaging the consumer in the discussion of price/costs is key

21


Smartphone Launch Communications

22

Client/Member Email

Announcement

Monthly Member Refresh Email


Smartphone Communications

23

HCE QuickView B2B Flyer


HealthAdvocate Agent Dashboard

24


II notice that you haven’t refilled your Lipitor prescription since 12/31/2010. Are you still taking this medication?

25

Addressing Gaps In Care


While I have you on the phone, I just wanted to let you know that your company has a free program that can help you with questions you may have about managing Asthma. I can help you join if you are interested.

Addressing Gaps in Care

26


HealthAdvocate Client Dashboard

27


HealthAdvocate Client Reporting Dashboard™

28


HealthAdvocate Personalized Member Dashboard

29


Preventive Cancer Screening Compliance

30

Colorectal Cancer 51.4% 69.2% (Ages 51-80) Breast Cancer 58.7% 68.6% (Ages 42-69) Cervical Cancer 66% 68% (Ages 42-69)

Screening

* Percent of eligible members out of your total enrolled population who had the identified preventive screening done

Case Study #1

Year 1 Year 2

HealthAdvocate Intervention Results


Diabetes Management Compliance

31

Annual Hemoglobin A1C 86.9% 91.4% Annual LDL Test 86% 89.3% (Bad Cholesterol) Annual Kidney Function 55.9% 57.4%

Measure

* Percent of eligible members out of your total enrolled population who had the identified preventive screening done

Case Study #2

Year 1 Year 2

HealthAdvocate Intervention Results



Baseline Medical Claims Analysis

 Comprehensive analysis of the previous year’s medical experience  Starting point to measure the impact of Health Advocate’s interventions  Matches expensive services offered by others  Requires access to medical and pharmacy claims data  e2H takes responsibility for getting the data  Client would pay data costs from vendors – if any  Simple client sign-off  Year-over-year Baseline Medical Claims Analysis comparisons available as a buy-up

33


79% 21%

All Others 6 Major Conditions

11% 8% 1%

18%

15%

47%

Asthma CAD CHF Depression Diabetes Hypertension

Breakdown of the 6 Conditions All Members

Condition Distribution Client Report – 2012 Data

34


Inpatient Hospital 27.6%

Outpatient 31.6%

Rx 20.6%

Phys./ Prof.

20.2%

6 Conditions All Others

By Category By Condition

TTotal Medical Costs Total Medical Costs = $12.0 Million

44% $5.3M

56% $6.7M

21% of the population covered under Client’s health plan have a diagnosis of one of these 6 conditions, but they account for 56% of total medical costs.

Highlight: •  CHF •  CAD •  Depression

•  Asthma •  Diabetes •  Hypertension

Conditions

% 7M

35


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

% of Members % of Cost

3 or more

2

1

0

Number of Chronic Conditions By Members and Cost

36


Medical Costs by Condition Per Patient Per Year

$13,472

$23,455

$7,434

$10,835

$12,223

$0 $20,000 $40,000

Diabetes

CAD

Asthma

Depression

CHF

Hypertension

$2,166 – Average Annual Cost of Patient without any

these conditions

$78,183

37


Patients Receiving Recommended Care Patients with Diabetes

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

No HbA1c 1 HbA1c 2 HbA1c >= 3 HbA1c Cholestrol Check

Nephropathy screening

n=27 n=38

n=27

n=76

n=50

n=30

Note: 122 Diabetic Patients

38


0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

100%

Cholesterol Check

Beta Blocker RX Statin RX

n=35 n=41

n=46

Note: 64 CAD Patients

Patients Receiving Recommended Care Patients with Coronary Artery Disease (CAD)

39


0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

100%

Beta Blocker RX Cholesterol Check

n=6

n=5

Note: 7 CHF Patients

Patients Receiving Recommended Care Patients with Congestive Heart Failure (CHF)

40


1 The Quality of Health Care Delivered to Adults in the United States. New England Journal of Medicine 348:26 p. 2643. 2 NCQA Hedis Report, 2011

CCompliance With Recommended Preventive Care

71%

61%

68%

77%

65%

43%

36%

66%

0% 30% 60% 90%

Breast Cancer Screening

Colorectal Cancer Screening

Cholesterol Level

Cervical Cancer Screening

Archdiocese of Indianapolis National Client

41


Medication Adherence by Condition

65%

40%

50%

40%

72%

71%

54%

58%

57%

58%

41%

73%

0% 20% 40% 60% 80%

Diabetes

Asthma

Depression

CHF

Hypertension

CAD

Archdiocese of Indianapolis National Avg.

1 Briesacher et al. Comparison of Drug Adherence Rates Among Patients with Seven Different Medical Conditions. 2008. Pharmacotherapy; 28:437-443 2 Ho et al. Medication nonadherence is associated with a broad range of adverse outcomes in patients with coronary artery disease. 2008. American Heart

Journal; Volume 155, Issue 4 , Pages 772-779

Client

42


OOverall Impact and Potential Savings 6 Chronic Conditions

Conditions Impact Potential Savings

Total 0.5% 1% 1.5% 2%

Hypertension 389 individuals (12.7%) $12,223/year medical costs $4,754,787 $23,774 $47,548 $71,322 $95,096

CHF 7 individuals (0.2%) $78,183/year medical costs $547,282 $2,737 $5,473 $8,209 $10,946

Depression 153 individuals (5.0%) $10,835/year medical costs $1,657,710 $8,289 $16,577 $24,866 $33,154

Asthma 90 individuals (2.9%) $7,434/year medical costs $669,022 $3,345 $6,690 $10,035 $13,380

Diabetes 122 individuals (4.0%) $13,472/year medical costs $1,643,585 $8,218 $16,436 $24,654 $32,872

CAD 64 individuals (2.1%)

$23,455/year medical costs $1,501,127 $7,506 $15,011 $22,517 $30,023

Total $10,773,512 $53,868 $107,735 $161,603 $215,470

1,739 Employees / 3,065 individuals

43


OOverall Impact and Potential Savings Prevention / Behavior Change

Conditionsz Impact Potential Savings

0.5% 1% 1.5% 2%

Brand to Generic $1,140/yr savings per switch = $853,860/yr $4,269 $8,539 $12,808 $17,077

Tobacco Use 0.9% of population $3,400/year excess medical costs $493 $985 $1,478 $1,970

Weight Management 2% of population $2,000/year excess medical costs $689 $1,379 $2,068 $2,757

Preventive Measures (mammography,

colonoscopy, etc.) 14% increase in compliance $142,500 $142,500 $142,500 $142,500

Emergency Room Use 9% of those covered had an ER visit in 2011 @ $631 per visit $871 $1,741 $2,612 $3,483

Avoidable Emergency Room Use

11% of ER visits in 2011 were avoidable =$21,471 $107 $215 $322 $429

Total $147,929 $155,358 $161,787 $168,217

1,739 Employees / 3,065 individuals

44


Developing High-Performance Networks for Employers

Low

er C

ost

Hig

her C

ost

Lower Quality Higher Quality

Specialty Plot: Pediatrics

Composite quality score of relevant specialty

measures – adjusted as a variance from the

mean

Score of the standardized cost difference of all attributed, physician charges

Multi-Specialty Pediatrics

Pediatrics

45


Benefits Gateway

 “800” Number, single-point-of-access for easy use  Reach a human voice in <30 seconds  Low cost and cost-effective  The ultimate integration tool  Motivates actions at the point of engagement  Maximizes the participation and value of all associated programs  Reduces medical costs and improves clinical outcomes

46


Help and support is direct and simple

A Complete Solution Pricing Tools, Baseline Medical Claims Analysis,

Health Information Dashboards and Benefits Gateway

47

Biometrics

Pharmacy


  Personalized communications encouraging preventive services or chronic care management

  Proprietary predictive modeling algorithms target high-risk members

  Letters tailored to member’s specific needs and best management of chronic conditions

  Ongoing reminders during the year reinforce prevention actions

  Pairing patient messaging with physician notification enhances compliance

  Options for outreach – Mail, email, Telephone

Personalized Member and Physician Communications

48

49

Data-Driven Personalized Member Communications

Exclusively for Local 830 Members

HealthAdvocateTM

Jon, your exam time is Now

You are due for an exam now and your plan requires that it

be completed by August 31, 2011 in order to avoid increased

deductibles in the new plan year beginning September 1, 2011.

Colon cancer is the number two cause of cancer death in the U.S.

Schedule a colonoscopy exam today

Act Now and Call Us!We will help you locate a physician, schedule your

appointment, and answer all your important questions.

Call Health Advocate at 866.799.2731

• This Exam is FREE! The cost of your colonoscopy is provided at NO COST to

you. If you receive a bill for a physician consultation, simply

submit a receipt evidencing this expense to the Fund Office

for prompt reimbursement.

• We are Here to Help You Locate a physician, schedule your appointment,

and answer your questions about the process.

• Take Charge of Your Health Avoid higher plan deductibles and help

lower future health insurance costs by

completing this exam.

©2011 Health Advocate, Inc. HA-M-1106008-2

Independent. Confidential. Convenient.Health Advocate is not affiliated with any insurance or third party provider. Health Advocate does not replace health insurance coverage, provide medical care or recommend treatment.

Jon Doe

123 Main Street

Anytown, PA 11111C1


50

Data-Driven Personalized Member Communications

Mailer #1: Personalized

Program Overview

Mailer #2: Act Now

Mailer #3: Schedule Today

Mailer #4: Don t Be Overdue


51

Physician and Worksite Communications

Doctor Letter Employer Poster



 HCE/HCE+ Physician & Hospital Cost and Quality Information – for all clients  Health Advocate Agent Dashboard  Client Aggregate Information Dashboard

 Baseline and Year-Over-Year Medical Cost Analysis  Client Reporting/Member Dashboards/  Benefits Gateway – how many calls & vendors do you want us to integrate?

Enhanced Core Services: No Additional Charge

Additional Services:

Health Advocate Data Model

52


  Includes data analysis to identify members with chronic conditions   Chronic care and preventive services   Includes Fulfillment costs and postage   Complements online messaging

  Target population driven by data analysis   High risk/high cost members   3 attempts to reach an individual   Unlimited number of interactions once contact is made

Personalized Messaging:

Outbound Calls:

Health Advocate Services

53



  Data collection and aggregation of medical claims – inpatient, outpatient, pharmacy, laboratory results and biometric data.

  Integration of health survey results, eligibility and benefits information within the claims data analysis.

  Prospective predictive and retrospective risk stratification and indexing at the individual level for each group based on claims experience, demographic information and benefit level.

  Creation of a longitudinal claims-based medical record for each covered individual.

54



  Baseline clinical and utilization analysis to identify gaps in care and develop a data driven decision support and intervention model.

  Web based Health Information Dashboard display highlighting clinical and utilization indicators, trending information and industry benchmarks, modified to the client’s needs as necessary.

  Drill down capability to define reports based on client characteristics, demographics, region, high cost cases, premium, benefit level, etc.

  A dedicated "blended" analyst to respond to any ad hoc analytical and reporting requests

55



  Uses Milliman’s MARA software to assess current risk and future predictive costs, enhanced with e2H proprietary coefficients.   Hybrid-enhanced risk scoring methodology offers clients reliable prospective risk scores, concurrent risk scores, event models, and customized approaches.

56



  Accurately forecasts costs and utilization, including predicting the likelihood of hospitalizations and emergency room use at the individual level.   Identifies individuals who would benefit from care management and disease management programs.   Predicts and measures the return-on-investment of various programs and strategies.

57


HealthAdvocate Assets

Core Benefits Gateway

Chronic Care

Enhanced Core

Data Warehouse


HealthAdvocate Assets

Core Benefits Gateway

Chronic Care

Enhanced Core

Data Warehouse

  Agent & Client Health Information Dashboards   Initial Baseline Medical Claims Analysis   Client Reporting Dashboards   Year over Year Baseline Medical Claims Analysis   Member Dashboard   Personalized Messaging   Smartphone App   Health Cost Estimator / Health Cost Estimator Plus   Medical Bill Saver   MedChoice Support   Wellness Advocate (HRA, Coaching, Biometrics)   EAP / Work Life (Behavioral Health Coaching)   Automated and Manual Text Messaging   Outbound Calls   Predictive Modeling   SQL Drill-down Dashboard   Data Analytics and Ad Hoc Reporting   Dedicated Analyst


  PEPM priced according client size   SQL based drill down client dashboard   Dedicated analyst for ad-hoc reporting   Unlimited support   Available NOW!


Chronic Condition Management

Health Advocate Data Services

  Sophisticated interventions leveraging Health Advocate’s engagement platform   Based on e2H predictive risk scores   Coaching across disciplines – Clinical (advocacy), Wellness (lifestyle), EAP (stress, depression, counseling)   Available 2nd quarter, 2013

60


EmpoweredHealth

Core Advocacy Wellness Advocate Prevention & Chronic

Care Messaging Benefits Gateway & Dashboards

Nurse Line EAP & Work Life MedChoice Support Pricing Tools & Medical Bill Saver



EmpoweredHealth

Core Advocacy Wellness Advocate Prevention & Chronic Care Messaging

Benefits Gateway & Dashboards

Nurse Line EAP & Work Life MedChoice Support Pricing Tools & Medical Bill Saver

62

Coree A dvocacy y Wellness AAAAAdvdvdvdvd ocate PrPrrPrevevee enne titionon & Chhroooronininnn c c CaCarere Messsssagagagga ining g

Beenen fits GGata ewayaya && DaDashboarards Core Benefits

Gateway Chronic

Care Enhanced

Core Data

Warehouse



EmpoweredHealth Hub



TThank You!


Abbie Leibowitz, MD EVP and Chief Medical Officer [email protected]

Introducing: A Better Way to Achieve Pricing TransparencyDiabetes Management Compliance 31 Annual Hemoglobin A1C 86.9% 91.4% Annual LDL Test 86% 89.3% (Bad Cholesterol) Annual Kidney

Documents