Consumerism in health care

1. Consumerism in health care

2. Who We Are Health benefits company headquartered in Louisville, Kentucky 45 year existence with a legacy of embracing change Approximately 11 million members Geographic and socioeconomic diversity Diverse lines of business Government Employers Direct to Consumer A laboratory for consumerism � As a way to improve health As a way to control costs As a way to engineer experience � and Innovation Innovation Center Health Services Research Center Humana Europe

3. What do insurers in the US do? Manage insurance risk (whom to cover and at what price) Design products (what�s covered, at what level, with what premium and co-payment) Contract with providers & configure networks (decide whom to contract with, on what basis, and at what price) Manage utilisation risk (utilisation review, case management, nurse advice, authorisations, etc) Manage transactions (pay providers and manage claims) Manage Information

4. Convergence of forces Demography Chronic illness Pace of new technology Rising expectations The rise of the �experience� economy Democratisation of information and expertise Healthcare systems need demand and delivery side reforms �If you want the same result, keep doing what you�re doing�

5. Consumerism is Here Deep cultural trend Related to other social and demographic factors Aging of the baby-boomers Ideological swing toward personal responsibility Facilitated by technology Democratization of clinical knowledge Genomics and personalized medicine Personal health monitoring Healthcare lags behind other industries

6. Expert systems Focused on the system Regulation, planning, system engineering Economics, medicine, engineering sciences Evidence-based care Explicit cost-benefit tradeoffs Value-based health benefits Value-based purchasing Cost and quality transparency Medical expertise is valued

7. Choice, independence, and transparency Looking from the outside�in Importing from other industries Customizing and personalizing Leveraging technology Humanizing health care Taking an ecological perspective Making it fun

9. Transforming Consumer Experience

10. Predicting individual health risk Improving decision quality Understanding attitudes and behaviors Working through incentives Engineering experience Coaching healthy behavior Focus on delivering value to consumers Customized benefits Personalized services Focus on delivering value to consumers Customized benefits Personalized services

11. Identify consumer needs for behavior change on a segmented basis (eventually an individual basis) Provide the right incentives for that consumer to engage in that behavior change Provide necessary support tools and communications to help the consumer achieve that goal Reward the consumer for milestones and achievements Reassess consumer needs based on progress made�repeat steps 1-4.Identify consumer needs for behavior change on a segmented basis (eventually an individual basis) Provide the right incentives for that consumer to engage in that behavior change Provide necessary support tools and communications to help the consumer achieve that goal Reward the consumer for milestones and achievements Reassess consumer needs based on progress made�repeat steps 1-4.

12. Severity & event prediction Health risk assessment Disease cluster / progression Segmentation / clustering Data visualization Evaluation Knowledge discovery methods Behavior analytics Creating an Engine for Ongoing Insights

14. From individuals to populations

15. Segmentation and engagement

16. A New Marketplace Approach Is Emerging [Not required. Use level of audience sophistication on topic to determine if needed.] [Time: 1 minute] This is the foundation for a new approach. The National Business Group on Health identified organizations that have been successful in managing their healthcare costs. These Best Performers averaged only a 5% trend increase over a two-year period versus a 10% and 15% increase from the other categories. How did the Best Performers manage their healthcare costs so effectively? Integrating Educating Analyzing and measuring impact [Not required. Use level of audience sophistication on topic to determine if needed.] [Time: 1 minute] This is the foundation for a new approach. The National Business Group on Health identified organizations that have been successful in managing their healthcare costs. These Best Performers averaged only a 5% trend increase over a two-year period versus a 10% and 15% increase from the other categories. How did the Best Performers manage their healthcare costs so effectively? Integrating Educating Analyzing and measuring impact

17. Today�s Dilemma [Not required. Use level of audience sophistication on topic to determine if needed.] [Time: 1 minute] Traditionally only direct behavioral health care expenses have been analyzed But the correct focus is analyzing the impact of both direct and indirect behavioral health expenses. When you do so the direct expense of 2-3% expands to approximately 60%. [The Medicare Humana program includes Prescription Drug Plans, Behavioral Utilization Management, Behavioral Health Calls, etc.] [Not required. Use level of audience sophistication on topic to determine if needed.] [Time: 1 minute] Traditionally only direct behavioral health care expenses have been analyzed But the correct focus is analyzing the impact of both direct and indirect behavioral health expenses. When you do so the direct expense of 2-3% expands to approximately 60%. [The Medicare Humana program includes Prescription Drug Plans, Behavioral Utilization Management, Behavioral Health Calls, etc.]

18. Integrated Medical-Behavioural Health Model [Not required. Use level of audience sophistication on topic to determine if needed.] [Time: 2-4 minutes depending upon detail presented] [Talking points if drilling down on the details further in presentation.] I�ll go in to further detail around most of the points on this slide in a minute. Before moving forward let me just mention that our IMBH approach is centered around integration with the health plan while ensuring the member receives the behavioral expertise needed to identify and manage their condition. [If not drilling down further on IMBH, but want to provide just a high-level overview then select a few key items to discuss based upon presentation objective. Recommend ensuring we discuss Corphealth�s Approach. Do not read the entire slide. This is just a �info on a page� slide for you to pick and choose what is relevant for your meeting.] [Not required. Use level of audience sophistication on topic to determine if needed.] [Time: 2-4 minutes depending upon detail presented] [Talking points if drilling down on the details further in presentation.] I�ll go in to further detail around most of the points on this slide in a minute. Before moving forward let me just mention that our IMBH approach is centered around integration with the health plan while ensuring the member receives the behavioral expertise needed to identify and manage their condition. [If not drilling down further on IMBH, but want to provide just a high-level overview then select a few key items to discuss based upon presentation objective. Recommend ensuring we discuss Corphealth�s Approach. Do not read the entire slide. This is just a �info on a page� slide for you to pick and choose what is relevant for your meeting.]

19. IMBH Savings � Early Medicare Results [Not required.] [Time: 3 minutes] [NOTE: THIS IS MEDICARE DATA ONLY] Program participants that completed their goals had lower healthcare costs than the control group by over $5,520 per year Program participants that did not �graduate� the program had lower healthcare costs than the control group by almost $1,680 per year What is most interesting is that regardless of whether a member completed the program, is in process of the program or dropped out � there is still a savings of $780 per participant. [Average out across all through participation levels] Projected savings assumed Contact Rate across co-morbid population, Engagement Rate, Goals Completion Rate and different savings capture rates At a 3.5% contact rate across 1.3 million members, projected annual savings is $33 million [Not required.] [Time: 3 minutes] [NOTE: THIS IS MEDICARE DATA ONLY] Program participants that completed their goals had lower healthcare costs than the control group by over $5,520 per year Program participants that did not �graduate� the program had lower healthcare costs than the control group by almost $1,680 per year What is most interesting is that regardless of whether a member completed the program, is in process of the program or dropped out � there is still a savings of $780 per participant. [Average out across all through participation levels] Projected savings assumed Contact Rate across co-morbid population, Engagement Rate, Goals Completion Rate and different savings capture rates At a 3.5% contact rate across 1.3 million members, projected annual savings is $33 million

20. Management of advanced Diabetes and CHF

21. Motivational support for healthy behaviour

22. Typical Results

23. Ethnographic research Understand members, their families, and experience Understand how to communicate with members Early results regarding Product complexity Support for low-income employees Support for the healthy during acute episodes Cognitive processes and decision analysis Understand how individuals make decisions for more effective/persuasive guidance and interventions Anthropology of health Another key element for change and innovation is a deep and �intimate� understanding of consumers � the people who get health benefits and use healthcare. And we are bridging the gap that has limited transaction-oriented companies Examples of new approaches include ethnography and decision science. This year we are �living� with 36 families for the year . . . doing video, audio and written diaries tracking and learning from their decisions. Less than six months into this we have some meaningful preliminary findings Consumers see value in increased plan design choices, but Consumer confidence is declines in proportion to product complexity Consumers have trouble understanding the value of their benefits -- and seeing the relationship between premium and out-of-pocket costs Consumers learn by doing � transparency and using benefits increases understanding There is a potential �collar divide�: special assistance needs to be targeted to lower income employees The chronically ill are well served by guidance and support services � but the healthy may need better support during acute episodes In addition we are doing ______ work in understanding how people make decisions � for example, how _____ people decide to take medications. Another key element for change and innovation is a deep and �intimate� understanding of consumers � the people who get health benefits and use healthcare. And we are bridging the gap that has limited transaction-oriented companies Examples of new approaches include ethnography and decision science. This year we are �living� with 36 families for the year . . . doing video, audio and written diaries tracking and learning from their decisions. Less than six months into this we have some meaningful preliminary findings Consumers see value in increased plan design choices, but Consumer confidence is declines in proportion to product complexity Consumers have trouble understanding the value of their benefits -- and seeing the relationship between premium and out-of-pocket costs Consumers learn by doing � transparency and using benefits increases understanding There is a potential �collar divide�: special assistance needs to be targeted to lower income employees The chronically ill are well served by guidance and support services � but the healthy may need better support during acute episodes In addition we are doing ______ work in understanding how people make decisions � for example, how _____ people decide to take medications.

24. Use of health services Promoting health planning Personalized health tips Supports better care decisions Personalised communication

25. Incentives

27. We prefer to take an ecological view. All of us working, using, or supporting the health system � patients, caregivers, facilities � exist in an economy, a social system, an organic environment � and all of us are influenced by and influence each of these systems. We prefer to take an ecological view. All of us working, using, or supporting the health system � patients, caregivers, facilities � exist in an economy, a social system, an organic environment � and all of us are influenced by and influence each of these systems.

28. Virtual Me connects users to: Their Health Health financing Health Records Care Providers Virtual Me connects users to: Their Health Health financing Health Records Care Providers

31. Games for Health

33. Summary From health care to health � physical, mental, social well-being Manage population through smart segmentation and personalisation Data driven decision making but deep consumer insight Leverage technology but humanise care Invest today for future savings Cede control but provide support Redesign system to integrate experience Engage people by meeting them where they are