Schaller Anderson Presents to

1. Schaller AndersonPresents to March 8, 2006

2. Today’s Objectives • Let’s talk about our teachers and school workers and their health care • Do you know WHO is driving your health care costs? • How do we know this? • What can we do about it? • What are the essential components of an ideal health care program?

3. Health: The Human Capitol Multiplier Your employees can be: • The best-trained • The most highly skilled • The best equipped • And work in the best supportive environment… BUT if they are not healthy, productivity and performance suffer

4. Major Causes of Lost Productivity • Musculoskeletal problems like back pain, arthritis • Mental health conditions like depression and anxiety and stress • Pregnancy • Respiratory conditions like asthma and allergies

5. What Happens To Us At Work? (Occupational Morbidity) • February, 2006 study to rank all U.S. occupations assessing days of restricted activity, bed rest and missed work, medical claims, reported health status • Of the 206 largest occupational groups in the U.S., • Social workers are ranked #1 • Floor buffers/polishers are #4 • Administrators/officials are #23 • Special education teachers are #25 • Counselors are #29 • TEACHERS are #61 These are ranked higher than police, machinists, welders, taxi drivers, nurses, plumbers and waiters out of 206 occupations

6. Key Workforce Strategies • Primary prevention of problems in the first place: health improvement, disease prevention, well care, worksite wellness policies and programs • Impact reduction strategies like case and disease management, Identification of highest risk members

7. Large Government Employer Per Capita Healthcare Spending

8. Large Government Employer Continuance TableClaim Amount and Percent of Costs Driven by Different PercentilesIncurred Claims between Feb 1, 2005 and Jan 31, 2006 (paid through Jan 31, 2006)

9. Large Government EmployerEmployee Conditions by Department

10. Large Government EmployerEmployee Conditions by Department *All department names have been changed

11. Employee Summary of Conditions

12. Predictive Pathways: Ranks This is a search result from the main enrollment screen of Predictive Pathways (identifying data altered for privacy). By clicking on any member ID, you can retrieve a profile of that member’s detailed history.

13. Member Profile

14. So What Can We Do That Matters? • Identify the costliest members • Follow their claims • Use all available Data • Focus on key populations that drive your costs • Worksite programs • Care management

15. Member Impact Stories

16. Member Impact Stories (Continued)

17. Member Impact Stories (Continued)

18. Key Principles Of An Effective Health Plan Goal: To obtain improved health outcomes, stabilize cost and improve productivity • Identify highest risk members for future cost and enroll them in disease specific programs and care management • Educate members about their disease, its symptoms and effective tools for self- management • Continuously monitor members between physician visits to encourage self-care, identify complications, help with care coordination

19. Summary of the Characteristics for Medical Plan Success • Population identification process • Evidence-based practice guidelines and assurance of high quality care • Patient self-management education • Support the provider/patient relationship through your policies and programs • Emphasize reduction of preventable events • Evaluate member outcomes on an ongoing basis • Focus on high cost events: concurrent review and PA of hospital and high cost procedures • Integrate Social needs, Behavioral Health, Pharmacy Use DATA to identify KEY ACTIONS which create better OUTCOMES