Chronic Care Solutions Driving better management of chronic medical conditions

1. Chronic Care Solutions Driving better management of chronic medical conditions

2. When members can’t get the right support to manage their disease, everyone suffers. • Worsening health • Loss of productivity • Higher healthcare costs The traditional models of engagement aren’t enough.

3. All companies face the challenge • Surveys show: • 50% of people have one or more chronic health conditions • 1 in 4 had two or more chronic health conditions • 5 times higher costs for those with one or more chronic conditions • $225.8 billion/year ($1,685 per employee) in productivity costs to employers • 4-5 times higherproductivity costs than direct medical costs Chronic medical diseases such as diabetes, cancer and heart disease, are the leading cause of disability and death in the US.

4. 91% of patients with chronic conditions say they need help managing their disease do not feel they are doing everything they can to manage their condition 59% • are only somewhat confident that they know their current metrics (e.g. blood pressure, weight) 43% 70% • would like more resources or clarity about management • unsure of their target numbers for key health indicators (blood pressure, cholesterol and weight) 35% • rate their ability to managetheir chronic condition as fair or poor 20% Source: Strengthening Chronic Care: Patient Engagement Strategies for Better Management of Chronic Conditions, West Corporation

5. Patients are ready and waiting for the right help at the right time to better manage their condition to enjoy an improved quality of life. The traditional disease models have not been efficient • Lack of integration with other services • Narrow engagement • Lack of live nurse coaching at all risk levels

6. Why Health Advocate Chronic Coaching Works

7. Integration of Advocacy, Wellness Coaching and Chronic Condition Management: The Value of Bundling Programs • Enhances coaching services to include management of chronic medical conditions to impact medical costs and outcomes. • Increase engagement in all programs through collaboration and cross referrals by >20%. In 2017, 61% of coaching cases were referred by internal Health Advocate programs. • Integrate biometric screening results to broaden early disease identification and enhance outreach. • Enhance and simplify your incentive strategy. • Intervention may avoid • Pre-diabetes • Hypertension • Cancer • Intervention may avoid • Heart Attacks • Amputation • Pneumonia • Avoidable ER & Inpatient Visits • Chronic Condition Coaching • Diabetes, Hypertension, Heart Disease • Chronic Kidney Disease, COPD, CHF, Asthma • Depression, Metabolic Syndrome • Wellness Coaching • Lack of Exercise • Poor Nutrition • Smoking

8. Integration with Advocacya key differentiator Member calls a Personal Health Advocate (PHA) to help them with a denied ER claim The PHA sees dashboard spotlights that member has asthma and repeat ER visits The PHA has a conversation about Chronic Care Nurse Coaching to help better manage asthma • Working one-on-one with Personal Health Advocate – a trusted, unbiased professional • Integration referral

9. Which chronic conditions are managed and why? • Diabetes • Asthma • Hypertension • Coronary Artery Disease • COPD • Depression • CHF • Chronic Kidney Disease • Metabolic Syndrome/Hyperlipidemia* *requires access to biometric/lab data

10. Chronic Condition Coaching Goals Through a dedicated nurse coach, provide evidence-based support for members with common chronic conditions designed to: • Improvehealth outcomes of members and educate them to better self-manage their conditions and lifestyles • Reduce gaps in care for recommended screenings, preventive care and medication management • Reduce utilization and costs associated with avoidable complications • Empower members to partner with their doctors to better manage their long-term health • Improve healthcare literacy

11. Data allows us to identify and risk stratify members with chronic medical conditions • Our data analytics use predictive modeling to identify members with one or more chronic medical conditions • In order to drive this process, we would need medical and pharmacy claims at a minimum. Biometric data can be integrated and used to drive earlier and broader identification. • When Health Advocate provides Wellness Coaching services, HRA results are also utilized. • The model considers the member’s condition status and co-morbidities to assign a predictive risk classification: Low, Medium or High risk • Predictive model is refreshed monthly when new claims data is provided

12. Chronic Condition Coaching Delivers • Dedicated Nurse Coaches provide condition-specific interventions • Coaching on evidence-based self-management and self-monitoring techniques • Full baseline health assessment to understand condition history and risks • Obtain, review and build adherence to provider’s treatment plan • Ensure engagement and provide coaching on partnering with their provider • Build knowledge about condition and ensure member is receiving recommended care • Medication management adherence issues • Identify and manage lifestyle/behavioral risks • Developing better healthcare consumerism skills such as shopping for medications, using pricing transparency tools, etc.

13. Inbound Identification via Health Advocacy Biometrics Integration Wellness Coaching Integration Targeted Home Mailings Health Advocate Nurse Coaches Text Push Messages Multiple Pathways to Engagement Targeted Phone Calls Third Party Referrals Onsite Clinic Integration Incentive Management

14. Member Engagement Portal – Push Notifications Chronic Care Management Opportunities • Members who download the app will be prompted authorized notifications • Notifications can alert members to eligibility for chronic care coaching • Alerts members to gaps in recommended chronic condition treatment and preventive care • Member will receive one push notification alert once a week

15. Chronic Condition Advice • Based on members identified with claims who have a chronic disease risk for a condition AND haven’t joined a program • If multiple care gaps exist, member will receive one prioritized message per week • If eligible for coaching, member is directed to log into secure site for detail Diabetes Advice Examples for Gaps in Care

16. Gaps in Care Home Mailers • Reaches 100% of members who are overdue for recommended chronic condition care • Directs employees to their personal physician and Health Advocate • Drives utilization of chronic condition management programs • Encourages completion of important tests such HbA1c and cholesterol monitoring • Provides guidance to evidence-based care • Promotes wellness/lifestyle changes and medication compliance

17. Case Study • Problem: • Mike was having difficulty managing his weight and diabetes, as well as unrecognized symptoms of hypoglycemia. He was using 50 units of insulin and taking 4 mg of medication daily to control his blood sugar. • Solution: • Working with his Nurse Coach, Mike: • Learned how to control his diabetes and self-monitor more frequently • Identified hypoglycemia symptoms and how to • handle them • Learned to better understand and adhere to his doctor’s medication plan, and keep his doctor informed of symptoms • Worked out an exercise plan and received automatic daily reminders to keep on track

18. Results: • After coaching, following his doctors’ plan, eating properly and exercising, Mike: • Lost 22 pounds • Stabilized his blood sugar levels • Reduced additional health problems • Most significantly, Mike’s doctor allowed him to come off insulin completely and reduce his glucose control medication dosage from 4 mg to 2 mg daily. “ After my doctor told me that I could go off insulin completely, I was shouting for joy in her office. The education and guidance you provided helped me reach my goal…Now on to more weight loss goals! ”

19. Case Study • Problem: • Following a hospital admission for breathing difficulties, Carolyn needed help to manage her uncontrolled asthma, stay compliant with her medication and find affordable medications. She entered coaching based on receiving a call from Health Advocate. • Solution: • Working with her Nurse Coach, Carolyn: • Learned about the numbers on the asthma control test (ACT) and, scoring <18, required discussing her asthma symptoms with her doctor • Discovered how to manage the underlying issues including cost and frequency that prevented her from taking medicine • Followed recommendation by her provider to switch to a more effective, less-costly medication • Received guidance to improve lifestyle issues around diet and exercise

20. Results: • After coaching, Carolyn: • Became more compliant in taking the recommended medication • Improved her ACT score from a 9 to 23 • Enrolled in a water aerobics class “ I’m feeling a lot better and you have really helped me a lot. ”

21. Chronic Condition ManagementActivity Reporting Provided monthly, quarterly or bi-annually: • Breakdown of disease prevalence and risk within the population • Unique members by disease state • Members with multiple conditions • Member engagement and enrollment • Gaps in care mailings • Care gaps coached on • Case collaboration activity • Compliance with recommended care

22. Chronic Condition ManagementAnnual Outcomes Reporting Provided annually, this report demonstrates the impact that our services have had upon: • Impact on prospective risk scores • Adherence to recommended treatment • Utilization of medical services • Claims trend differential between engaged vs. non-engaged members to establish ROI • Changes to PMPY treatment costs • Changes to biometric levels • Most client’s experience an ROI of 2:1 to 4:1

23. Thank you Chris Weale Director, Specialty Sales Chronic Care Solutions 610.397.7449 cweale@HealthAdvocate.com