“The nation spent $2.3 trillion on health care in 2007. Three-fourths of that to treat chronic illnesses

1. “The nation spent $2.3 trillion on health care in 2007. Three-fourths of that to treat chronic illnesses whose prevalence could be reduced through prevention.” Tommy Thompson Former Secretary of Health & Human Services

2. America's employers have paid much of the health-care bill for more than half a century, and until the last 20 years or so, this was simply a cost of doing business. Cutting benefits, raising premiums and increasing co-pays and deductibles are not viable long-term solutions.

3. Allergies Carbohydrate Addicts Diet AIDS Asthma Protein Power Aging South Beach Antibiotic Resistance Autism DIET The Zone Volumetrics DISEASE Asthma Anthrax Sugar Busters Eat More – Weigh Less Alzheimer's Atherosclerosis Ascariasis Arthritis Choose to Lose Mediterranean A.D.D. Shangri-La Echinacea Body Comp Berries Green Tea Bio Impedance Hip to Waist Saw Palmetto Red/Green Algae BMI HRA Under Water SUPPLEMENTS 7 Site The Egg B.P. Vitamins Hoodia MEASUREMENTS PSA A1c Copper Bracelet Grape Seed Extract Venipuncture Glucose Lipid Panel Antioxidants Black Tea HDHP Fish Oil Chem 26 Homocystine PPO HRA FSA Finger Prick Fasting REIMBURSEMENT Pedometer Step Pilates Okuma's Wu-Long BowFlex Total Gym HMO HSA CDHP Spin EXERCISE Chitosan Slim Fast OOP POS Relacore The Ball WEIGHT LOSS Kick-Boxing Tai-bo Aerobics Dexatrim MeltRx 24 Ultra Metabolife Heavy Hands Nordic-Trac Ephedra Abdominizer 10,000 steps Mastigard

4. BRUTAL FACT Business on a Local Level

5. THE COST DRIVERS

6. BRUTAL FACT – ’04 Shock Claims CVD Relationship

7. R x CVDCOSTS #1 LIPITOR #2 ZOCOR #3 PLAVIX 417 CVD prescriptions at $ 47,250.00 AVERAGED PER MONTH

8. THE TI STRATEGY

9. ESSENTIAL ELEMENTS Focuses on Cardiovascular Disease Includes health screening in benefits design Follows evidence based medical standards Stratifies risk based upon clinical findings Directs “high-risk” to interventions that lower risk & normalize lab values Distributes non-compliant/un-successful into appropriate management

10. LEVEL 5 LEADERSHIP If you can’t measure it… You can’t manage it!

11. CREATIVE PLAN DESIGN 80/20 Base Plan 80/20 Participation In Screening & Interventions $1000 Deductible Premium Plan $250 Deductible

13. Highest Risk Risk Reduction ELEVATED CHOLESTEROL Abnormal Glucose High Blood Pressure Overweight Indicator Intervention Identify Risks Root Cause POOR DIETARY HABITS Physical Inactivity Tobacco Use RISK REDUCTION STRATEGY FOCUS ON CHOLESTEROL Reduce the population ‘At Risk’ Virtually No Risk CVD Risk Factors are shared by Diabetes, Digestive Diseases, Certain Cancers , Stroke and many other chronic and acute conditions

14. WE IDENTIFIED High Risk/High Cost…

15. HEALTH SCREEN Identify Associates at High Risk HRA - BMI - Blood Pressure - Glucose - Lipid Profile

16. CHOLESTEROL Identified Root Causes >240 12% <150 12% 200-239 31% 150-198 31% 32 – Identified @ Significant Risk

17. WE ATTACKED High Risk/High Cost…

18. ELIMINATE ROOT CAUSES Risk Reduction “Tell me and I forget, Teach me and I remember, Involve me and I learn.” - Benjamin Franklin Risk Reduction Dietitian Non-Compromising “Can Do” Philosophy

19. IMPROVINGOur Environment • Vending Labeling • Meetings • Cafeteria Walk the Talk

20. IMPLEMENTED Physical Activity 10,000 Steps

21. ESTABLISHED Tobacco Use Policy

22. DEMANDED Consistency of Message