1. Cooperative Health Overview
Managed by

2. Agenda NJPA Overview Benovate Overview What is happening? Why? (trend)
The Cooperative Health Program
Creating the Savings with Competitive Bidding
The Impact on our Clients

3. Who is NJPA? National Joint Powers Alliance Cooperative Purchasing
Government Agency
National Solutions under Contract
NJPA Cooperative Health Program

4. Who is Benovate? NJPA Cooperative Health Program Manager
Develop Low Risk “Health” Pools
Health Management
Risk Management
Cost Containment

5. Benovate solutions to control costs
Utilize Predictive Modeling for Health Engagement
Health Assessments & Screenings
Focus on Sleep, Stress, Lifestyle, Disease Prevention
Health Coaching & Advocacy
Health Technology & Web Based Solutions
Custom Wellness & Care Plans
Health Rewards Platform
Employer Outreach & Hospital Integration

6. Why? Healthcare Trends
Average Annual Premiums for Single and Family Coverage,

7. Why? Healthcare Trends
Cumulative Increases in Health Insurance Premiums, Workers’ Contributions to Premiums, Inflation, and Workers’ Earnings,

8. NJPA Conclusions Traditional Consumer Driven Plans Weren't Working
Network Model was antiquated.
Employers could benefit enough to want to extend healthcare into the workplace.
Employees needed better more convenient access to care and care coordination
Traditional care model assumes one size fits all
Traditional wellness was only a piece of the puzzle
The Problem is “Trend”, no end in sight without a different model
How many doctors or clinicians? Who in the room thinks the Affordable Care Act will result in lower costs?
How many carrier reps? Who in the room knows what their health insurance renewal will be in 2015?
How many insurance brokers? Would you like to know?
People in the wellness industry? My goal today is not to sell you on Benovate, my goal is to ask you to consider an alternatve
HR professionals? Model of healthcare, one where hospitals can be profitable, brokers continue to provide
Business Owners or Senior Executives? valuable service to their clients, carriers become more profitable and one where doctors get paid to keep their patients healthy…..Tough Sell?.. Maybe..but lets give it a shot.

9. Changing the Game: Gaining Control of Risk
Create Neutral Risk, Lower Future Exposure
School Districts
Municipalities
Health Management Required
Non-Profits
Higher Education

10. Cooperative Health: Creating a Health Rewards Pool
2015
Avg: 5%
(From Soft Quote)
20%
2014
2014
2015
Avg: 12.8%
30%
15%
15%
VS.
50%
15%
15%
45%
43%*
Current Fully Insured or Self Funded
Benovate Partially Self Funded Option

11. Cooperative Health: Creating a Health Rewards Pool
Goal Loss Ratio: < 25%
Long Term
Premium Control
45%
15%
15%
43%*
* Leverage Improved Claims Experience for Lower Premium
Benovate Partially Self Funded Option

12. Returning your Money Achieving the Goal of 25% Less then Underwritten
Creating a Health Rewards Pool
Returning your Money Achieving the Goal of 25% Less then Underwritten

13. Employer Use of Funds Sample Employee Use of Funds Sample
Reinvesting in Health
Sample Group
90 Lives (Bronze Plan: Employer 60% Payment)
Max Premium: $400,000
Available Incentive: $100,000
Goal Loss Ratio: $300,000
Total 2014 Claims: $320,000
Employer Use of Funds Sample
Fund Incentives Programs
Allocate % to Captive
Offset Health Management Expenses
Reduce Premiums Next Year
Employee Use of Funds Sample
Fund FSA/HSA/HRA
Health Bonus
Health Rewards
Voluntary Benefits

14. Goal: Health Rewards Captive

15. Health Rewards Program Benefits
Lower Costs
Better Health
Managed Risk
Max Risk is Total Premium
Aggregate Risk Policy for Claims Over Premium
Specific Loss Policy Per Person
ACA Compliant
Lower Cost Structures
Efficient Administration
Transparency
Prevention Focus vs Treatment
Lifestyle Change
Safer Work Environment
More Productive Employees
Increased Awareness
Lower Presenteeism, Absenteeism

16. Controlling Health Care Costs
The Health Care Cost Equation

17. Healthcare Cost Equation
Healthcare Services Costs (Costs)
Multiplied by (x)
Healthcare Services Utilization (Utilization)
(=‘s) Equals Total Healthcare Costs

18. 4 Strategies To Control Costs
Gain Control of the Cost Structures
Predict Disease
Predict “Un-health”
Create Transparent Cost Structures
Review & Audit (before you pay)

19. #1 Control Costs: Create a Pre-disease Model Avg Cost of Heart Attack; $67,000, Avg Cost to Prevent, $3,700
Cost
Predictive Health Modeling determines risk by condition and lifestyle.
Drives “appropriate” Utilization.

20. #2: Determining Health Risk
Health Risk Assessment
Stress Risk Assessment
Behavior & Lifestyle Data
Biometric Data
~Readiness & ROI – this gives us a snapshot of each employer group, in terms of where they’re at and how we can best work with them. We want to make sure they have all the resources in place that are necessary for a program like ours to truly have an impact.
~Beyond the traditional biometric and Health Risk Assessment data, we gather data around Stress, Behavior, and Lifestyle. This allows us to create a more “wholistic” view of health; which is important when the goal is to create lasting change and see a true ROI
*USHC HRA gathers data around these 7 factors: Age, Gender, Ethnicity, Lifestyle (exercise, tobacco use, diet, stress, etc.), Biometrics (blood chem., BP, BMI, etc.), Medical History, Family History (with a signed waiver)

21. #3: Transparent Cost Structures
Transparent Pharmacy Benefit Management
“Cost Plus” and “Reference Based Billing”
Insurance Captive, Claims Data & Management
True “3rd party” Third Party Administration

22. “Cost Plus” or “Referenced Based Billing”
Transparent Pharmacy
500 Employee Company: Re-priced
Pharmacy Represented 22% of the total plan cost
Spread elimination: $119,426 of $741,000, 16%
Rebate Reduction Estimate: $8,000, 1%
Therapeutic Substitution: $14,076, 1.8%
Total Savings: $141,502; 19% Total Savings
Typical Charge Master
Network Discount, 30-70% off of what?
Medicare plus 150%-400%
Cost Plus Medicare plus 54%
Reference Based Pricing, Medicare plus %
“Cost Plus” or “Referenced Based Billing”

23. Level Funded, Unbundled Self Funded, to Captive
Benefits
No Risk Contribution
Like Minded Employers
Control Costs Today
Manage Trend in the Future
Lower Cost
Increased Transparency
Reporting and Cost Control
“3rd Party”, Third Party Administrator

24. Strategy #4: Medical Bill Review
Alabama Union Group
100% of all OON claims reviewed had adjustment
$376,196 in savings adjustments
Average claim reviewed $22,935
$10,449 average savings per claim
Arkansas Company (small group)
100% of all claims (17) had adjustments
$311,000 in savings adjustments
Average claim adjusted $37,423
$18,297 average savings per claim

25. 4 Strategies to Control of Utilization
Align your “group utilization”
Eliminate “One Size Fits All” Health Management
Data Driven Plan Design, Cost Focused Consumerism
Drive Appropriate Utilization, Incent Care Plan Execution, and True Lifestyle Change

26. #1 Group Utilization Summarized
The Kitchen Table
Plan Cost
Deductible
Co-Pay
Rx Costs
“The Value”
The Plan vs No Plan
My Plan vs My Spouses Plan
Employer A vs Employer B

27. Avoiding One Size Fits All
#2 Customized Intervention
Avoiding One Size Fits All
Marketing Message Across the Entire Population

28. #3 Standardize Plan Design Rate Step Correlation to Employee Plan Selection
If I have healthcare needs, premium costs are irrelative.
If I am healthy and young, I may look for alternatives.
If I am single and young, I may just waive and pay the PPACA penalty.

29. #4 Driving Appropriate Utilization
Wisdom of the Medical Home
Primary Care Physician Relationship works well
Patients rate relationship and respect highly
Biggest factor in deciding whether or not to participate
Higher rates of preventative care delivered
National best practice control of targeted chronic diseases

30. Determining Risk Standard Biometric Panel Stress, Sleep, & Lifestyle
Health Risk Assessment
Stress Risk Assessment
Behavior & Lifestyle Data
Biometric Data

31. The “Big Four”
Mental and Nervous System, Metabolic, Cancers and Musculoskeletal
Predictive Modeling developed for over 60 conditions and lifestyles. Those conditions and lifestyles that impact cost and quality of life the greatest fall into four broad categories of conditions or disorders: Mental and Nervous System, Metabolic, Cancers and Musculoskeletal

32. Control Costs: Stratify Risk Aggregate Disease Risk Report
So… what happens after we’ve gathered all that data? We put all the data we gather through our Predictive Modeling tool – our algorithms take all that data and allows us to report not only on risk factors like poor nutrition, low exercise, etc. but also risks for cancers, mental health issues, metabolic, pulmonary, and musculoskeletal conditions, and their potential costs.
Once we’re able to look at a group in terms of risk, we stratify the risk, and provide focused solutions for each category; making sure that the dollars being spent are most appropriately channeled.
For those that fall into the Elevated, High, and Serious Risk categories, we emphasize a disease management focused approach. These are the folks we need to pay attention to - through a variety of incentives, making sure the individuals with chronic conditions are engaging with their health coaches and primary care physicians on a regular basis.
For the participants that fall into the Moderate Risk category, we provide what would most closely resemble “traditional wellness” offerings: Physical and Nutritional Programming, healthy activity challenges, tobacco cessation, community health engagement programs, etc.
And for those that fall into the lower end of the spectrum – their program looks different. If they’re already healthy, we provide resources that help them to focus on stress mitigation, incentivizing each participant to engage in activities that reinforce positive health behaviors and reward balanced living. This can be anything from visiting a financial planner, to taking continuing education classes, to utilizing the preventative appointments.

33. One Size Does Not Fit All
There must be an understanding where the costs really are…and where they are going

34. Conditions & Lifestyles Mapped

35. Cost of Care: Revenue & Expense Modeling by Condition, Network Alternative

36. Health & Lifestyle Coaching
Physical, financial, relationship & personal development health
Individualized Coaching
Employee and Family
Stress Management
Improved Health
Assistance Navigating Disease
Physical Health
Relationships
Career/Growth
Finance

37. Access to Assessments & Data
Personal Health Desktop The Personal Health Desktop (PHD) is a secure, online HIPAA-compliant web portal accessible from any Internet-connected device. This system provides participants secure access to features including:
Medical history/lab results
Health Risk Assessments
Personal Health Assessment reports
Risk Resolutions guidelines
Medical library
Health Counts rewards program

38. Provider & Community Engagement
Earning Points, Rewards, or Dollars for Care Plan Engagement
Improved Health
And… True Lifestyle Change

39. Goal: Data Driven Consumerism
Benovate’s “Your Data” Approach
Give the consumer the data and tools
Incent Participation
Provide Coordination

40. Summary: Tying it All Together
Employer Strategy & Savings Continuum
Hospital - Provider
Relationship Strategies
Plan Design
Options
(HDHP)
Alternative
Funding
Plans
Risk Pool
Management
Wellness
Strategies
4% - 8%
7% - 10%
2% - 3%
5% - 6%
5% - 7%
Employee cost-
shift to target
Plan
Utilization
Fixed
Costs, Plan
Flexibility
& Reinsurance
Plan Design,
Contribution
& Population
Alignment
Population Health
Management
& Improvement
On-site Medical Clinics
Narrow Physician Networks
Hospital Cost Plus Contracts

41. Phased Deployment of Solutions
Assessments & Early Intervention
Custom Wellness & Care Plans
Incentives for Healthy Choices
Health & Lifestyle Discounts
Lower Cost Health Management
Our process is built upon five very important steps to improving health and decreasing cost

42. Measureable Outcomes

43. Per Participant Risk Burden Trend

44. Connectivity

45. Considerations for Engagement
Request and analyze your data
Target areas for improvement
Phased Approach; Manage then Engage in Health
Community Initiative: Affiliate

46. Thank you!