CIGNA

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CIGNA John Carroll University Working
together to improve the health of your members
Our Single Focus
Improve health.
April 9, 2008
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Concerns
JCU Concerns

• Current State of Benefits
• Currently, our Plans A B fall into
  approximately the 90th percentile
• In other words, our plans rank among the
  richest in terms of benefits provided by
  universities
• Our employee contributions are among the lowest
  for both single and family coverage
• 15 for Plan A and 5 for Plan B
• Medical cost trends continue to run at levels
  higher than general CPI
• Currently at approximately 9 annually

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JCU Concerns

• Historical Plan Costs Have Been Climbing

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JCU Concerns

• Along With an Increase in Member Cost

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Concerns
JCU Concerns

• Rates will continue to escalate
• Cannot solve the problem by shifting costs
• PREVENTION - Improve health through an aggressive
  wellness program
• Provide additional support for highest risk
  groups
• Chronic conditions (back pain, diabetes, cardiac,
  asthma, cancer)
• 39-40 of cost
• Escalating prescription drug usage represents
  significant cost driver that can be partially
  mitigated with increased use of generic drugs
• Members desire more information on healthcare
  cost and quality
• Members desire lower costs and more network
  choices

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JCU Concerns

• Traditional Response to Rising Health Care Costs
  Cost Shifting

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JCU Concerns

• Proposed Response to Rising Health Care Costs
  Cost Control through Adoption of Wellness
  Initiatives

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Network Advantages through CIGNA

• Members desire lower costs and more choices
• Why cant I access University Hospitals
  in-network?
• What happens while I travel outside of Ohio
  need medical care?

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Whole Population Approach
Programs address the unique health needs of
every segment of your population
Acute 12 prevalence 44 cost
Chronic 23 prevalence 39 cost
At Risk 22 prevalence 10 cost
Healthy 43 prevalence 7 cost
Prevalence and cost percentages based on 2006
CIGNA book of business and industry statistics.
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PREVENTION - Improve health through an aggressive
wellness program

• Year One
• Health Risk Assessment (HRA) Campaign with
  Incentives for Completion
• Promotion of CIGNA Online Programs
• Health Fair Support
• Employee Cafeteria and Vending Machine Assessment
• Quarterly Health Education Series (3 per quarter
  starting 2Q)
• Year Two
• Quarterly Health Education Series (3 per quarter)
• Establish Just Walk 10K Steps Program
• Health Fair Support
• Year Three
• Reactivation of the Just Walk 10k Steps Program
• Quarterly Health Education Series (3 per quarter)
• Health Fair Support

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PREVENTION - Improve health through an aggressive
wellness program
P R O A C T I V E MEMBER O U T R E A C H

Improved Member Engagement
Everyone with identified gaps in care notified by
Well Informed via mail
Visits mycigna.com to take HRA
Receives HRA Profile indicating key risks
Participates in Health Screening
Receives report with biometric scores
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Everyone with weight, fitness, stress or sleep
risk sent invite to Online Coaching
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and referrals
and referrals
Everyone with missed Well Woman exam or
immunization is sent Health Reminders by mail
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• 24-hr Health Information Line
• Employee Assistance Program (EAP)/Work Balance
• Health Advisor
• Healthwise Library (mycigna.com)
• Healthy Babies Maternity
• Healthy Rewards Discounts
• Lifestyle Management (Stress, Weight, Tobacco)

Members referred to opt-in Health Advocacy
programs services
Everyone sent Welcome-Call Anytime letter from
Health Advisor
At-Risk receive telephonic outreach from Health
Advisor
Chronic receive mail and telephonic outreach from
Well Aware
HRA data combined with claim data and analyzed
through Health Advocacy Engine to determine
additional intervention opportunities
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Acute receive in-person or telephonic outreach
from Case Management Nurse
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Coaches will refer members to opt-in programs/se
rvices as appropriate
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PREVENTION - Improve health through an aggressive
wellness program
Overweight/Obese 66 of US adults Stress 43
of adults suffer adverse health effects related
to stress Tobacco Use 20.9 of US population
Lifestyle Impacts 65 prevalence 17 of current
cost with impact of 70 of future cost
Lifestyle Coaching Programs

• Participants self-enroll in telephonic and/or
  online support completely voluntary
• Coaching to address hard-to-change lifestyle
  issues
• Proactive referrals from other CIGNA programs
• Coaches are seasoned behavioral health nurses,
  trained in helping people change unhealthy
  addictions/compulsions
• Smoking cessation includes 8 weeks free supply of
  patch or 12 weeks supply of smoking cessation gum
• Success rates
• Weight 35 reduce by at least 5 at 12 months
• Stress 52 improve stress upon completion
• Tobacco 25-30 quit at 12 months

Weight Loss
Strength Resilience (Stress)
Tobacco Cessation
Success rates based on 2006 book of business and
program design
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Encourage treatment for the highest risk groups
CIGNA Well Aware for Better Health, Disease
Management
Chronic 23 prevalence 39 cost

• Uses integrated clinical data to target members
  with chronic and/or high-cost health conditions
• Key difference, we proactively contact members to
  participate in the program vs. current
  self-enrollment
• Drives patient/physician compliance with
  evidence-based guidelines to improve self care
• Provides written education and personal coaching
  to continuously track and motivate patient
  engagement
• Helps members avoid moving to higher risk/cost
  status by reducing complications and unnecessary
  hospitalizations (up to 12 reduction)
• Delivers up to 12 medical cost save by condition

• Asthma
• Cancer
• Chronic Bronchitis
• Diabetes
• Depression
• Emphysema

• Heart Disease
• Maternity (High Risk)
• Obesity (High Risk)
• Low Back Pain
• Pulmonary Disease

Managing the Most Prevalent, Costly Conditions

• Irritable Bowel Syndrome
• Osteoarthritis
• Osteoporosis (Symptomatic)
• Pressure Ulcers
• Urinary Incontinence

• Acid Related Disorders
• Atrial Fibrillation
• Fibromyalgia
• Hepatitis C
• Inflammatory Bowel Disease

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Pharmacy Integration Advantages through CIGNA
Pharmacy 34 prevalence 15 cost

• For the consumer
• Generic coupons to encourage lower cost
  utilization
• Cost information through the Prescription Drug
  Price Quote tool
• One toll-free number for medical and pharmacy
• Health Counselors, Case Managers, Disease
  Management and other clinicians have access to
  real-time pharmacy data, allowing them to
  identify drug to drug interaction, compliance,
  etc.

Integration is more than a data feed.
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Pharmacy Example

• Unhealthy lifestyles yields higher out of pocket
  expenses
• Example Betty Brand Name (all brands, all retail)

Bettys employer spends over 4,300 on his
medication alone
Source myCIGNA.com, prices as of 7/2/07
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Pharmacy Example

• Better decision-making is the first step
• Example Chris Consumer (all generic, all mail)

Chris saves over 1,300 annually, and his
employer saves almost 3,400 (80)
Source myCIGNA.com Prices as of 7/2/
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Pharmacy Example

• Better lifestyles are the ultimate goal
• Example Heather Healthy

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Member Data Advantages through CIGNA

• Cost and quality transparency is becoming a
  reality
• Consumers want to know
• How much is this service going to cost me?
• How do I pick the best provider?
• What are my options?