Global Culture of Health A Johnson & Johnson Model for Worksite Health & Wellness New York Business Group on Health April 7, 2010 Jennifer Bruno Executive Director, Strategic Accounts

of diabetes and cardiovascular disease could be avoided if people:  Ate a healthy diet  Exercised more  Quit smoking employees have behavioral health risks (e.g. stress, depression, sleep issues), leading to significantly greater productivity loss and healthcare costs of costs in the healthcare system could have been prevented through lifestyle behavior modification Sources: U.S. data, World Health Organization 2005, “Preventing Chronic Disease: A Vital Investment”; CDC Report, “Chronic Disease: At a Glance 2009”; Kaiser Foundation Almanac of Chronic Disease 2008 Edition – Partnership to Fight Chronic Disease; Presenteeism defined as lost productivity that occurs when employees come to work but perform below par due to any kind of illness We all play an important role in preventing the healthcare crisis 3/29/2010Confidential2 ANNUAL COST OF PRODUCTIVITY LOSS DUE TO CHRONIC DISEASES: ~$1 TRILLION 80% 70% 3 5 Out of

Health and Productivity as a Business Strategy High effectiveness companies (%) Low effectiveness companies (%) Average market premium Turnover rates Companies that approach health and productivity as a business strategy experience superior human capital and achieve significantly better financial outcomes. Watson Wyatt, 2009  Companies that approach health and productivity as a business strategy – by creating a balanced set of programs and practice and by monitoring the effectiveness of their approach- experience superior human capital and achieve significantly better financial outcomes.  High effectiveness: Health & Productivity focused companies showed an +11.7% average market premium vs. industry average; low effectiveness organizations were -15.8%  Turnover rates among the high effectiveness companies were 14.8% while low effectiveness companies reported total turnover of nearly 21%  Leading-edge employers are shifting their senior management discussions from the cost of benefits to how to create value through the investment in employee health and effectiveness.

Employers Seek Multiple Benefits in Health & Wellness  Decreased Healthcare Costs  Enhanced Productivity and Performance  Improved Employee Health  Increased Employee Engagement

OUR STORY Culture of Health 5

The world’s largest & most comprehensive health care company  2009 sales of $61.9 billion  More than 250 operating companies selling products throughout the world  Three worldwide business segments  Consumer  Medical Devices/Diagnostics  Pharmaceutical  Managed by a unique form of decentralized management 115,500 employees worldwide.  New Wellness & Prevention growth platform established in 2008:  Established to deliver workplace health and wellness programs and services – HealthMedia® and Human Performance® Institute Background

Business Value “The health of the employee is inseparable from the health of the Corporation.” “An important part of our Credo responsibility to our employees is providing them with resources to lead healthier lives. Good health is important to all of us. Good health is also good business.” William C. Weldon CEO Johnson & Johnson

Caring for people’s health has been our way of life since 1978 when our CEO at the time set the goal to have the world’s healthiest workforce. We know healthy employees are more engaged and productive, and disease prevention can avoid costly healthcare expenditures. We were among the first employers to offer health & wellness programs for employees, and continue to provide a supportive work environment that encourages healthy choices. A Long-term Commitment to a Culture of Health 8

Culture of Health Evolution Big Goals 1978 Integration 1995 Global 2004 Harmonization 2007 New Business Platform 2008  LIVE FOR LIFE ® : Partnership between Benefits, Safety, Medical, Wellness and EAP  James E. Burke, J&J Chairman and CEO, set two major program goals:  Encourage employees to become “healthiest in the world”  Reduce health care costs through on-site programs and services  Established Health & Wellness Shared Service, integrating:  Employee Assistance  Occupational Health  Wellness & Health Promotion  Disability Management  Global expansion of integrated services to provide:  Leadership  Consultation  Guidance  Support  Health & Wellness key policies harmonized as part of Global HR Transformation (GHRT)  Global Health Risk Assessment Pilot  Wellness & Prevention identified as key New Business strategy  Acquisition of HealthMedia, Inc. and Human Performance Institute, Inc. 9

Global Health Strategies to Drive Results Foster a culture of health Integrate service delivery with a focus on prevention, behavior modification and linkage to benefit design Use appropriate incentives Integrate data to support goals and metrics Commit long term

Our Strategic Approach 11  Keep well— mind and body  Keep safe  Identify and manage health and injury risks  Identify and manage/mitigate disease impact  Identify and focus medical and disease management resources  Address spectrum of needs  Use proven programs/methods  Measure outcomes/manage program investments

1. Create, Promote and Sustain an Organizational Culture of Health 2012 Goal: 75% of companies will have at least 12 health offerings (including all from the core list) 2. Reduce Population Health Risk Factors 2012 Goal: at least 70% of the assessed population is defined as low health risk (where Health Risk Assessment is implemented). 3. Assess and Manage Occupational Health Risks Identified Through the Medical Surveillance 2012 Goal: 90% or more of all planned Periodic Medical Surveillances will be completed Setting Global Enterprise Health Goals

CRITICAL ELEMENTS Culture of Health 13

5 Key Culture of Health Components 1. Leadership and Commitment 2. Enterprise Programs 3. Policies and Procedures 4. Promotion and Communication 5. Measurement and Results 14

Leadership & Commitment  Public advocacy for healthy, innovative workplaces  Internal management emphasis (talking the talk and walking the walk)  Communications inside and outside 15

Mental Health & Wellbeing Healthy Lifestyle Programs Access to Employee Assistance Professionals 24/7 Telephonic Counseling Online Mental Health Screening HealthMedia Digital Coaching Programs Resiliency/Stress Management Training Yoga and Meditation Occupational Health & Disease Mgmt. Health Education & Awareness Program Health Profile & Biometrics Health Profile Counseling Digital Coaching Programs Pedometers and Million Step Challenges Weight Watchers and Nutritional Counseling Tobacco Cessation Programs (PIQ) Onsite Occupational Health Clinics Employee Health Centers Medical Surveillance Compliance Medical Case Management Value Added Services (Phlebotomy, Pharmacy and Physical Therapy) CareConnect & Health Advocate My eHealth (Tip of the Day, Family Health Guides, Personal Trackers) Healthy People News Healthy People Bulletin Boards Global Health Observances (ie Move For Health, World Diabetes Day, Breast Cancer Awareness, World AIDS Day) Johnson & Johnson Employees and Families 16 Enterprise Programs

Addressing Lifestyle Factors Healthy People Initiative Annual Health Profile $500 Medical Benefit Discount Tracking and Enterprise-Wide Reporting Operating Company-Level Reporting/Accountability Started in U.S. in 1995 with global expansion currently underway. US Participation Rates 2009: 83%* *N=33,000 participating employees 17

Incentives and Employee Engagement Employees receive $500 discount on medical plan contributions  Increased Health Profile participation from 26% to 93% To maintain $500 discount  Employees take the Health Profile annually; invited to Health Advising if they show health risk  Health Advisors review results and refer employees to resources (e.g., HealthMedia ® Digital Coaching, Million Step Challenge, Disease Management) Financial Incentives for the HealthyPeople Medical Plan –$250 incentive for participation in Case/Disease Management –$500 incentive for participation in Maternity Program ($250 for enrollment plus $250 for postpartum screening) –$250 Preventive Colonoscopy Incentive (2010) –$150 HealthyWeight Incentive (2010)

Healthier consumers Fewer ER Visits Decreased inpatient hospital stays Higher productivity Lower absenteeism Better controlled health care costs Improved bottom lines Healthier consumers Fewer ER Visits Decreased inpatient hospital stays Higher productivity Lower absenteeism Better controlled health care costs Improved bottom lines HealthMedia, Inc. Digital Health Coaching Health Risk Assessment Weight Management Smoking Cessation Stress Management Nutrition Counseling Insomnia Back Pain Prevention Adolescent Health Physical Activity Health Risk Assessment Weight Management Smoking Cessation Stress Management Nutrition Counseling Insomnia Back Pain Prevention Adolescent Health Physical Activity Chronic Illness Management Hypertension, Hyperlipidemia, etc. Doctor-Patient - Pharmacist Relationships Management of secondary symptoms: stress, fatigue, etc. Diabetes Pain Management Back Pain Mgmt Chronic Illness Management Hypertension, Hyperlipidemia, etc. Doctor-Patient - Pharmacist Relationships Management of secondary symptoms: stress, fatigue, etc. Diabetes Pain Management Back Pain Mgmt Insomnia Depression Binge Eating Disorder Obesity Alcohol and Addiction Insomnia Depression Binge Eating Disorder Obesity Alcohol and Addiction Disease Management Disease Management Digital Health Coaching Programs Health & Wellness Health & Wellness Medication Adherence Medication Adherence Behavioral Health Behavioral Health Proven science-based behavior change models 19 Treats the Individual, Not the Condition

Policies & Procedures  Global harmonized policies  Tobacco Free  Wellness, Occupational Health, EAP  HIV-AIDS  And Others….  Standardized Procedures (“toolkits”) that allow for program/implementation worldwide 20

Promotion & Communication Clear Focus (Smoking, BP, Cholesterol, Physical Activity, Stress, Obesity, Diabetes) Tracking and Enterprise- Wide Reporting Operating Company-Level Reporting/Accountability Marketing & Communications Healthy People Branding Alignment of Incentives Healthy People Medical Plan CareConnect (disease mgmt.) Employee Health Centers 21

Measurement & Results Global Health Assessment Tool Accessible via J&J Intranet Reporting by all operating companies annually (413 reported in 2009) Reports can be queried by several variables with the option to export to excel Answering “yes” to having a GCH program at the site requires more in- depth validation of program elements 22

Culture of Health Measuring our Progress Global Health Assessment Tool  Captures metrics that support our global G&O  2009: 413 locations WW reporting  Immediate feedback provided to the site after tool completion (Culture of Health Scorecard)  GH Leaders review results 1:1 with Franchise Leaders for follow-up/next steps 23

 Integrated data drives planning, enables evaluation to achieve total economic value from benefit investments J&J Payroll & Eligibility Medical Drug Care Management STD and LTD Worker’s Compensation Dental & Vision Financial Accounting Health & Wellness Integrated Data Warehouse and Analytics Financial Management Vendor Performance & Quality Management Benefit Planning & Design Regulatory Compliance Program Evaluation Health & Productivity Management 24 Data Integration

Improving Health Risks via Tailored Health & Wellness Offerings and an Engaged Culture of Health High Risk (5+) Medium Risk (3-4) Low Risk (0-2) OVERALL INCREASE IN LOW-RISK CATEGORY OVER TIME. OVERALL DECREASE IN MEDIUM/HIGH-RISK CATEGORY OVER TIME. POPULATION HEALTH RISK REDUCTION (2006 TO 2009) % 13.9% 85% 1.6% 20.6% % 78.1% 1.4% % % 12.0% 87.1%

High Risk Factor (in descending order by High Risk Prevalence) Johnson & Johnson CDC US Data* Unhealthy Eating (<5 Servings / Day) 60.0% 75.6% (2007) Obesity (BMI 30.0+) 20.4% 34.1% ( ) Inactivity (<150 Moderate Minute Equivalents) 20.4% 30.5% ( ) Hypertension (Blood Pressure 140+/90+ mmhg) 6.3% 17.9% ( ) Cholesterol (Total Cholesterol 240+ mg/dl) 5.3% 16.3% ( ) Tobacco Use (Current User of Any Tobacco) 3.9% 29.6% (2006) Glucose (126+ Fasting) 2.5% 10.2%** ( ) Stress (Heavily or Excessively Stressed) 1.6% 3.0%*** (2006) *Based on “Health, United States, 2008” a publication by the Centers for Disease Control and Prevention and National Center for Health Statistics, except for “Unhealthy Eating” which is based off of the Behavioral Risk Factor Surveillance System (BRFSS) data from **CDC’s definition of high glucose / diabetes = “Physician Diagnosed and Undiagnosed Diabetes” ***CDC’s definition of stress = “Serious Psychological Distress” n=30,595 Population health risks trending superior to other industries Per capita health care costs consistently 1%-2% below benchmarks for past 10+ years J&J medical plan ranked in “top quartile ” of peer group benchmark Projected ROI from 2002 to 2008 estimated at $4 :$1 (medical expenditure and productivity. Proven Multi-dimensional Approach Yields Sustainable Results 26

In Summary  Johnson & Johnson has established a comprehensive and integrated approach to employee health management  Many of these programs are scalable to small business  Success springs from a culture of health, which is built into the fabric of our business  Commitment is key from the top leadership as well as strategic alignment with the business  “Carrots” can work  Employee buy in is important  A culture of health is not created overnight  Small, consistent steps can make a meaningful difference, and ultimately drive lower health care costs, and while enhancing employee health, productivity, and performance 27

To significantly improve the health, performance, and productivity of organizations and their employees Wellness & Prevention, Inc. 28

PARTICIPATION & ENGAGEMENT EFFECTIVE BEHAVIOR CHANGE SCALABILITY CREATE A CULTURE OF HEALTH OUTCOMES/ MEASUREMENT Factors for implementing a successful program 29

30 Healthy Enterprise Tool Assessing a Culture of Health

Customizing the solution to meet employer challenges Large global food manufacturer Key needs: Desire to create a culture of health Little participation and engagement in existing health and wellness programs Dissatisfied with disjointed approach to health &and wellness programs and looking for holistic approach Business performance improvement Solution: Comprehensive and collaborative approach that leverages existing assets and integrates innovative technologies Build culture of health with focus on driving participation Large global advertising agency Key needs: Protect greatest asset (their people) through improved health and productivity Drive higher level of energy and performance, while preserving highly creative and fast-paced culture Address issues with chronic stress, burn- out, overall health Solution: Holistic, yet focused solutions to drive engagement and productivity Personalize for flexible work settings 31

Unique behavioral change technologies key to holistic solution Science-based training to manage and expand their energy for greater health and performance Benefits: Increased engagement at individual and organizational levels Cross-disciplinary scientific approach (performance psychology, exercise physiology and nutrition) Effective and scalable digital coaching interventions that span Wellness, Behavioral Health and Disease Management Benefits: Increased participation & engagement through unique tailoring technology Highly scalable and cost-effective Clinical outcomes DIGITAL COACHING ENERGY MANAGEMENT TRAINING 1/25/2010CONFIDENTIAL32

Digital Coaching Engaging. Scalable. Effective. 33

34

Thank you! Jennifer Bruno Executive Director, Strategic Accounts Johnson & Johnson Wellness & Prevention Kathleen A. Devlin Director, Employer Markets - Northeast Johnson & Johnson Health Care Systems Inc. 35