1. Bon Secours Virginia Creating a Culture of Wellness 2012

2. Today’s Discussion – Creating a Culture of Wellness – Personal Health Assessment Results – Becoming Accountable for Our Care – Employee Wellness Strategies 2

3. Program Guiding Principals 1.Create a culture of Wellness and Wellbeing that empowers employees to make healthier choices at home and at work 2.Decrease healthcare costs through prevention, wellness and interventions 3.Provide programs and services to motivate employees to make life-long behavioral changes. 4.Collect and analyze data to develop, support and maintain program design and optimal results. 5.Decrease controllable risk factors. By coordinating and centralizing the care of employees, companies can take control of medical costs and tailor services to meet employees needs. 3

4. Value-Based Design Patient-Centered Medical Home On Site Clinic Total Health Management Integrated Health and Disability Best in Class Vendors Decision Support/Data Warehouse Employee ACO TREND Bon Secours trend reduction: $159M savings over 5 years Every 1% reduction in trend saves average $5.5M per year 2011-2015 Annual Cost (in millions)

5. High Cost of Poor Health HYPERTENSION: Hypertension is associated with a cost of $392 per employee per year. DIABETES: Annually, an employee with diabetes will cost $13,243 on average, while an employee without diabetes costs only $2,560 on average ASTHMA. Annual per capita employer expenditures for asthmatic patients is approximately 2.5 times those for control subjects ($5,385 vs. $2,121, respectively). The estimated direct cost of obesity to the medical plan for Bon Secours Virginia is: $5.3 Million or $1429/employee/year. Indirect costs are related to absenteeism and productivity loss. Research shows that as the weight of a worker increases, productivity decreases and absenteeism increases. 5

6. Understanding our Challenges 20% of the employee population drives 80% of current year cost Poor lifestyle choices drive 50% -70% of health care cost 20% of the employee population drives 80% of current year cost Poor lifestyle choices drive 50% -70% of health care cost Determinants of Health A Small % Drives Cost PopulationCosts Source: Institute for the Future, Centers for Disease Control and Prevention A 1% reduction in employee utilization = $750,000 6

7. Personal Health Assessment Results

8. Personal Health Assessment (PHA) Prior to 2011 40% of employees participated in the PHA. Beginning in 2012 the PHA was aligned with the Health Plan and employees who did not participate paid $800.00 more per year for Health Insurance. Coupled with a strong incentive and an equally robust communication and branding strategy, in 2012 95% (12,350) of employees participated in the PHA process. 8

9. PHA Participation and Risk Stratification Hampton RoadsRichmond Risk CategoryCountPercentCount Percent Low Risk (0-2 Risks)122142%2738 44% Moderate (3-4 Risks)104336%2048 33% High (5+ Risks)66323%1378 22% PHA Participation292789.2%607395% Average # Risk Factors3.103.02 9

10. Top 8 Controllable Risks Overweight (BMI >27.5)55% Sedentary Lifestyle48% Hypertension35% High Cholesterol36% Low HDL Cholesterol17% High Stress17% Low Job Satisfaction15% Low Life Satisfaction11% 10

11. Becoming Accountable for Our Care Building an Employee ACO for Bon Secours Virginia Health System

12. ACO Program Description The ACO pilot targets the highest risk employee population in Bon Secours Virginia. This program is strictly voluntary and operates outside the BSHSI benefit plan. In order to attract and retain a significant number of this targeted group, it is necessary to offer financial incentives. The incentives are paid out over the course of the program as the employees reach clinical and lifestyle change milestones. Each employee who participates in the program will be assigned a Good Health Navigator at InHealth. The Navigator is responsible for establishing goals and tracking progress made throughout the course of the ACO program. 12

13. Management of High Risk Partner with high risk employees to support changes in lifestyle and navigate to a Medical Home Telephonic Health Coaching Goal oriented and incentive based. Confidential and Voluntary – Diabetes – Hypertension – Asthma 13

15. Early Results

16. Employee Wellness Focus 2012

17. Low Risk Moderate Risk High Risk AwarenessTargeted InterventionHigh-Risk Intervention Communication  Web-based information  Targeted messaging and emails reminders of prevention screenings and disease prevention  Weekly wellness tips and Bimonthly Good Life Newsletter Incentive Program  Complete the PHA and Wellness plan  Complete all age related recommended screenings. Examples: Physical with PCP, Annual Mammogram (or baseline for women 35-40) and Pap for women or Prostate Exam and PSA for men  Complete Self-care workshop and complete personal health record for future visits to PCP Same as low risk plus Communication Quarterly tailored messages, email and home mailing on specific risks such as hypertension. Incentive Program Group Coaching (Healthy Weigh, Compass to the Good Life) Complete 1-2 coaching Sessions either in person or telephonic Complete 2 Healthstream/Webinars based on wellness goals Same as low risk plus Communication Invitational letter from EWS mailed to home with a follow up phone call from CENVANET to those who have not responded. Incentive Program If Diabetic, Hypertensive, Asthma or Back (Ortho) complete 6 coaching sessions with CENVAT for disease and medication management or enroll into disease management program such as DTC or Cardiac Wellness. Other high risk employees not identified in the 4 groups above will work with the nurse navigator Weight Management: Referral into weight loss program based on BMI Physical Activity If you are Diabetic and/or Hypertension, Group exercise classes made available Physical Activity If you are Diabetic and/or Hypertension, Physical assessment and group training sessions available over a 3 month period then a reevaluation. Physical Activity Bon Secours Virginia Employee Wellness Model of Care Tobacco Cessation: Quitline or Freshstart in person class SeIf-Care/Mental Health 17

18. 2012 Targeted Wellness Programs Accountable Care Interventions Driving employees to Primary Care Physicians Patient Navigators Targeting High Risk Good Health Clinic Episodic care and case management of High Risk Accountable Care Interventions Driving employees to Primary Care Physicians Patient Navigators Targeting High Risk Good Health Clinic Episodic care and case management of High Risk Healthy Eating and Foods Nutrition Education Revamping Cafeterias and Vending Self Care Initiative Take Charge of Your Health Get a Doc and Get a Physical Campaign Healthy Eating and Foods Nutrition Education Revamping Cafeterias and Vending Self Care Initiative Take Charge of Your Health Get a Doc and Get a Physical Campaign 18

19. 2012 Targeted Wellness Programs Physical Activity Get Moving campaign Stairwell campaign Commit to Get Fit Campaign Team Lean – “Biggest Loser” Competition Walking paths Fitness challenges Onsite group exercise classes Fitness Center Discounts Physical Activity Get Moving campaign Stairwell campaign Commit to Get Fit Campaign Team Lean – “Biggest Loser” Competition Walking paths Fitness challenges Onsite group exercise classes Fitness Center Discounts Weight Management and Nutrition Healthy Weigh webinar based lifestyle modification Medical Weight Loss Pilot Weight Watchers at Work Tobacco Cessation Reinforcement of tobacco free campus Freshstart classes (1:1, web based, telephonic, group) Weight Management and Nutrition Healthy Weigh webinar based lifestyle modification Medical Weight Loss Pilot Weight Watchers at Work Tobacco Cessation Reinforcement of tobacco free campus Freshstart classes (1:1, web based, telephonic, group) 19

20. Good Results fy11 vs. fy12

21. Good Results fy11 vs. fy12 Bon Secours Richmond’s Personal Health Assessment (PHA) participants experienced a 12.10 % ↓ in medical claims while non-participants experienced a 14.80 % ↑. The total cost avoidance equals $1.5 million. Health insurance rates have ↓ $10 per employee per month. Participants in the Bon Secours Richmond Good Life Wellness Program showed a 43% ↓ in “Controllable Risk Factors” for a net reduction in medical claims of $1 million. Sedentary lifestyle ↓ from 41.9 % to 38.4 %. Average number of risk factors ↓ from 2.46 to 2.3 per employee. Productivity ↑ by 26 % by targeting those medical conditions most affecting the work force such as migraine headaches, allergies and musculoskeletal pain.