1. Schaller Anderson Presents to March 8, 2006

2. Today’s Objectives Let’s talk about our teachers and school workers and their health care Do you know WHO is driving your health care costs? How do we know this? What can we do about it? What are the essential components of an ideal health care program?

3. Health: The Human Capitol Multiplier Your employees can be: The best-trained The most highly skilled The best equipped And work in the best supportive environment… BUT if they are not healthy, productivity and performance suffer

4. Major Causes of Lost Productivity Musculoskeletal problems like back pain, arthritis Mental health conditions like depression and anxiety and stress Pregnancy Respiratory conditions like asthma and allergies

5. What Happens To Us At Work? (Occupational Morbidity) February, 2006 study to rank all U.S. occupations assessing days of restricted activity, bed rest and missed work, medical claims, reported health status Of the 206 largest occupational groups in the U.S., –Social workers are ranked #1 –Floor buffers/polishers are #4 –Administrators/officials are #23 –Special education teachers are #25 –Counselors are #29 –TEACHERS are #61 These are ranked higher than police, machinists, welders, taxi drivers, nurses, plumbers and waiters out of 206 occupations

6. Key Workforce Strategies 1.Primary prevention of problems in the first place: health improvement, disease prevention, well care, worksite wellness policies and programs 2.Impact reduction strategies like case and disease management, Identification of highest risk members

7. Large Government Employer Per Capita Healthcare Spending

8. Large Government Employer Continuance Table Claim Amount and Percent of Costs Driven by Different Percentiles Incurred Claims between Feb 1, 2005 and Jan 31, 2006 (paid through Jan 31, 2006)

9. Large Government Employer Employee Conditions by Department

10. *All department names have been changed

11. Category Number of Employees Percentage Employees Hyperlipidemia215421.5% Back problems206420.6% Essential Hypertension199219.9% Other non-traumatic joint disorders173017.3% Other connective tissue disease161616.2% Other lower respiratory disease8918.9% Other skin disorders6486.5% Diabetes mellitus with out complications4814.8% Asthma454.5% Diabetes mellitus with complications292.9% Employee Summary of Conditions

12. Predictive Pathways: Ranks This is a search result from the main enrollment screen of Predictive Pathways (identifying data altered for privacy). By clicking on any member ID, you can retrieve a profile of that member’s detailed history.

13. Member Profile

14. So What Can We Do That Matters? Identify the costliest members Follow their claims Use all available Data Focus on key populations that drive your costs Worksite programs Care management

15. Member Impact Stories Case #1 - 38 Year Old Diabetic and Asthma Before Disease Management Disease Management Intervention Follow-up Call 2 Months Non-compliant –Not monitoring blood sugars –Not following diet HbA1C 9.0 (normal less than 7) Sick frequently secondary to poorly controlled diabetes Frustrated with physician Education regarding importance of: –Checking daily blood sugar –Glucometer and how to obtain new one –HbA1c being under 7.0 –Proper diet Provided names of other physicians Enrolled in diabetic education class Using glucometer regularly HbA1c 7.0 Feeling better, not ill in 2 months Attending diabetic classes and seeing nutritionist New primary care physician Endocrinologist involved in case

16. Member Impact Stories (Continued) Case #2 – Member with Congestive Heart Failure, Obesity Before Disease Management Disease Management Intervention Follow-up Call 2 Months Non-compliant –Had not seen cardiologist in over a year –Poor diet including high salt foods –No weight monitoring –No exercise Education regarding condition and importance of: –Regular cardiology appointments –Dietary modifications –Daily weight checks –Importance of exercise Demonstrates understanding of disease process by: –Cardiology appointments every 6 months –Daily checks and records: Blood pressure Pulse Weight –Calls cardiologist if change in status –Using treadmill on regular basis

17. Member Impact Stories (Continued) Case #3 – Follow-up with Member in Disease Management Member described chest pain with walking even short distances Disease Manager recognized possible signs of reduced blood flow to heart secondary to exercise Member instructed to call 911 and go to ER Surgery ensued with 4 vessel coronary artery bypass

18. Key Principles Of An Effective Health Plan Goal:To obtain improved health outcomes, stabilize cost and improve productivity Identify highest risk members for future cost and enroll them in disease specific programs and care management Educate members about their disease, its symptoms and effective tools for self- management Continuously monitor members between physician visits to encourage self-care, identify complications, help with care coordination

19. Summary of the Characteristics for Medical Plan Success Population identification process Evidence-based practice guidelines and assurance of high quality care Patient self-management education Support the provider/patient relationship through your policies and programs Emphasize reduction of preventable events Evaluate member outcomes on an ongoing basis Focus on high cost events: concurrent review and PA of hospital and high cost procedures Integrate Social needs, Behavioral Health, Pharmacy Use DATA to identify KEY ACTIONS which create better OUTCOMES