Building on a claims integrated and verifiable

1
Building on a claims integrated and
verifiable wellness plan, data analytics and
chronic disease management Your Health Plan
Solution for a multi year/actionable strategy
2
Your Historical Perspective and Firsts
CSB and OSB

• 1989 1st Minnesota private/University/College to
  unbundle and move to a TPA model with a PPO and
  Flex. Saved 800,000 the first year
• 1993 1st Minnesota private University/College to
  contract with a
• discount RX vendor, and in 1995 combine both
  schools
• 2002 1st Minnesota private University/College to
  implement a CDHP Design Introduced a high
  deductible choice for less
• 2006 1st private University/College to implement
  SimplyWell wellness.
• (proprietary pricing at 50 less
  than market)
• 2006 Capped Transplant costs, Never Pay A
  Transplant Claim
• 2006 1st national private University/College to
  add AHDI data analytics, disease mgt, predictive
  modeling and provider profiling. (Gustavus story)
• __________________________________________________
  _________Still Average Cost Per Employee Per
  Year -below regional and national peers. 7,208
  OSB/SJU Comparison8,100 Your Peers

3
What Makes CSB OSB
Unique Cutting Edge Today?

• Data Analytics
• Using AHDI, SOMI analyzes your DATA to better
  design the plans, set rates and wellness programs
  to deliver the outcomes you want.
• No more
  guessing because..
• your data is actionable and credible
  Facilitating a 3 year strategy to hold down
  future large claim costs and help keep your
  member healthier
• Express Scripts RX Vendor
• 12-1- 07 Express Scripts replaced Restat to
  get 5-7 drug spend savings
• Effective 12-1-07, December was 47,611.
  Prior months average101,334
• SimplyWell- Wellness program
• Implemented SW Population Health Management
  plan in 2006-07
• Participation results were disappointing at
  23.
• This year we need stronger incentives to
  get 60 or more of the members in SW along with
  coordination with AHDIs analytics.

4
Historical Medical Costs
5
What happened in 2006-07 that caused total
claim costs to go 1.5 million over the prior
year?

• 15 claims between 50K and 100K
• 5 claims over 200K
• 5 claims between 100K and 200K
• 18 Cancer claims
• 8 heart related claims
• 5 potential transplants
• 38 large claims 39 of the plans total cost
  2,966,462
• Stop loss paid 522,868
• Your Net total Paid 2,443,594,for Chronic
  conditions

6
80/20 Rule
80 of the medical costs 20 of the member
You Need Both Chronic Disease Wellness Plans

That are Integrated and Work Together

• Plan Year Total Cost Large Claims Count
  
• 2003-04 4,963,312 880,050 8
  18
• 2004-05 5,129,231 1,385,408 9
  27
• 2005-06 6,107,088 1,523,338 8
  25
• 2006-07 7,440,024 2,158,308 16
  29
• 4 year average 25 Chronic Conditions
• 75 Everyone
  Else

7
You have Put it all
together Working Wellness Plan,
Chronic Disease Mgt, Provider Profiling,
Consumer Knowledge, Provider Discounts
You have all you need to Manage Your Risk

• Wellness Program 60 participation with claims
  integration from SOMI to SimplyWell can discover
  and help prevent Future Claims before a claim
  happens
• Preferred Provider Discounts Providers promise
  discounts for the promise of more patients
  (increased volume). Today every provider belongs
  to every network theres no gain in patient
  volume. You discount every claim today.
• Provider Profiling AHDI and SOMI monitor all
  discounts and together track actual total cost
  of care for each condition
• You now have the tools to know which
  providers have the best outcomes that are disease
  specific total cost of care
• Integrated Chronic Disease Management manage
  your chronic conditions start to finish to keep
  the cost down or prevent. Guide and help your
  members with Chronic Conditions before the costs
  explode. Good for them and the plan.
• The deepest discount is Preventing the claim
  from happening
• Your SOMI AHDI track your Providers for
  increased visits and tests against the
  discounts given
• We know your real discounts
  and net costs

8

CSB/OSB Stats Facts Fall of 2007
800 Employees, 464 Spouses, 644 Children
1,908 Total Members Insured

• Employee claim costs 3,593, Spouses 5,195,
  Children 1,056 (best risks)
• Total Drug costs (not in above) 1,219,881
  total 1,524 per employee
• Your stop loss premiums 2007-08 656,118
  (31,503 less than prior year)
• You will never pay a Transplant Claim again
• Youve kept your plan fixed costs under 9 for 18
  years (25-30 fully insured)
• You have an integrated Wellness program
  SimplyWell
• AHDI shows us you have 372 current chronic
  conditions.
• .working with your 24 hour nurse
  navigator for Disease Management
• Only 31 of your chronic members are getting the
  right care. ticking bombs
• With SimplyWell AHDI you could prevent up to 4
  million-future claim costs
• You insure more females than males than your
  peers
• You have an Older Average Age than your peers at
  49 (peers is 46)
• Half of your members are over age 50, with 29 of
  these over age 58

9
Your Wellness Stratification

• Healthy Well
• Eat Right
• Healthy Lifestyle 21
• Few Claims
• Unhealthy Well
• Unhealthy Diet 17
• Unhealthy Lifestyle
• More Claims 54 of
• population generates
• 98 of cost
• Chronically Ill
• Identified Illness 32
• Require Attention for
• Compliance
• Highest Cost
• 20 of population
• generates 80 of cost

CSB and OSB Today Using SimplyWell and AHDI
Claims based Integration
10
Funding Why youre Unbundled and Self Insured?

• You own your Claims Reserves To be used for the
  Higher Claim Years (you will have these)
• You own the job of Risk Manager
• Investing in Wellness goes right to your
  bottom line
• Save on Premium Tax Dollars left to spend on
  compensation
• You pay lower fixed costs - leaving more for
  actual claims (in 18 years annual fixed costs lt
  9) (Great HR Negotiations)
• Unbundling allows you to combine the best
  Whole Stop Loss, RX, Administration, Networks,
  Disease Management etc. Totally Flexible
  without member disruption

11
What does all of this mean?

• Your Health Plan is the plan of choice Need to
  know why
• Single ee rate is much higher than your peers
  Employees are much lower risks than spouses
• Your covered spouses are the highest cost
  category You might consider a higher EE SP
  rate
• Your covered Children are the lowest cost You
  might consider a lower EE Child/ren rate
• Your AHDI reports show Top Chronic Conditions and
  future costs to be Heart Disease, Diabetes,
  Mental Health
• Your SimplyWell reports show the greatest need is
  Fitness and Nutrition, which will help with Heart
  and Diabetes conditions

12
Bringing it All together to lower costs
AHDI, SimplyWell, Incentives, Plan Design

• Strive for a credible SW goal 60 of eligible
  participate
• need incentives that work
• The Incentives Premium Differentials for 7-1-08
  renewal. 10-15. Change rates to EE, EE/Ch, EE/Sp
  and Family
• Once SW results for 08 are in look at possible
  health Score options for 09 (more details to
  follow)
• Report back to the benefits committee with
  updated ADHI reports on Chronic Conditions,
  Disease Management and SW aggregate group reports
• Plan Design Changes Your new broker may
  recommend 2 health plans only (300/d and
  700/d), Cancer Screenings at 100, add
  Maintenance Care coverage for your Chronic
  Conditions (Diabetes, Asthma, Heart)
• You want these IN for care

13
Results of your SimplyWell Launch in
2007

• Total Number of College-Order Employees
  Participating in SimplyWell
• Women 157
• Men 78
• Average age of group 46

24.3 Participation
Education 1.3 HS or less 12.8 HS graduate 26
Some college 31.5 College graduate 28.5
Graduate degree
Ethnicity Mix 95.3 Caucasian 1.3 Hispanic
0.9 Black 0.9 Asian 0.9 Native American
0.9 Other Races
14
THE SIMPLYWELL ADVANTAGE

• Online personal health record
• Onsite comprehensive health screens
• CLIA certified laboratory
• Healthy lifestyle coaching
• 24-hour medical communications center
• Appointment management
• Education modules
• Health and wellness trackers
• Plan design customization
• Patient decision tools
• Group health plan integration

15
Risk Factors
Family History Risks
Source Group Summary as of 1/4/2007
16
2007 Risk Data 235 Total Participants
Your Stats were Better Than SimplyWell Average
AND THEN you had a very high claim
year You Must Have Chronic Disease Management
that Integrates with 60 Participation in
Wellness
17
Health Risk Assessment Findings Aerobic Exercise
Strength 59 of employees have no
regular strength maintenance program or an
inadequate program for optimal fitness. Stretchin
g 46 have no regular stretching program or an
adequate program for optimal fitness.
18
Health Risk Assessment Findings Nutrition Scale
Breakfast 59.8 say they eat breakfast daily or
almost every day. Snacks 85 of employees eat
snacks almost everyday. Fast Food 84.6 reported
eating typical fast food meals no more than
once per week. Fat Intake 55.1 use primarily
low fat items.
19
Personal Wellness Profile Score
Health Perception 49.1 of participants report
they believe their health is very good to
excellent.
The overall wellness rating gives a comprehensive
score based on the of the different major
wellness factors.
20
Health Risk Assessment Findings Occupational
Health
Occupational 82.1 think College-Order is
concerned about their health/safety Health
6.8 are not sure 4.3 do not think
College-Order is concerned about their health
and
safety. Job Satisfaction 92.8 of employees
indicate they are satisfied with their work.
21
Health Risk Assessment Findings Stress Signs
Coping 85.8 feel they are seldom or only
occasionally stressed and are coping well
11.6 feel they are stressed often and have
trouble coping at
times 2.6 experience heavy or excessive levels
of stress and are
having trouble coping or are unable to
cope. Happiness 90.2 of employees report being
very happy or pretty happy evidently coping
well with life.
22
Health Risk Assessment Findings Tobacco
Smoking 6.1 are current smokers. 2nd Hand
Smoke 5.6 of employees report regular
exposure. Chewing Tobacco 100 do not use
smokeless tobacco.
23
Health Risk Assessment Findings Substance Use
Score
Alcohol Score 27.7 of employees seldom or never
drink. 55.3 are light
drinkers. 0.9 are heavy drinkers. Drug Use
12.1 of employees use drugs every week or
month. 78 of employees rarely or never use
drugs.
24
Health Risk Assessment Findings Physician
Relationships
Sick days 27.5 of College-Order employees had no
sick days. 41.2 say they had 1 to 2 sick
days. 31.3 say they had at least 3 or more
sick days. Hospital days 95.3 had no
hospitalization during the last 12
months. Doctor visits 9.4 report no clinic
visits during the last year. 64.3 stated
they had 1 to 4 visits. 15.3
had 5 to 8 visits.
11.1 had greater than 9 visits during the last
year. Physician 85.9 of College-Order
employees have a personal physician. 14.1 do
not have a personal physician.
25
Recommend Health Actions
Top 4 Risk Factors

• 1) Improving Fitness
• 63 showed need for improving fitness levels
• 2) Weight Management
• 60 are above their recommended weight range
• Cancer Risk Reduction
• 49 have higher cancer risk
• 4) Managing Cholesterol Levels- Heart Care
• 47 had cholesterol over recommended levels

26
CSB/OSBs Team
SelectCareSM
Simplywell.com