New York Business Group on Health – Cerner’s Best Practice Behavioral Health Strategy

1. New York Business Group on Health – Cerner’s Best Practice Behavioral Health Strategy Christa Roberts Health & Wellness Strategist

2. Cerner at a Glance • Founded in 1979, based in Kansas City • Revenue 2009: $1.7B • Largest standalone healthcare IT company in the world • 8,500 facilities with approximately 2300 hospitals • 3,400 physician practices covering 30,000 physicians • 600 ambulatory facilities • 700 home health facilities • 1,500 retail pharmacies • Countries: 25 • Associates: 7,800 • Average Tenure/Age: 5/34 Years • Associate Mix: • 30% engineering • 30% IT services • 15% clinical • 25% sales & all others • All connected to common internet tools • Health Plan Spend 2009: $55 Million • Covered Lives in 2010: 11,400 • 5500 associate • 5900 dependents • 85% participation rate

3. Cerner Health & Wellness: Core Principles • Align with Cerner’s vision, mission, and culture • Build, support and promote a healthy and productive workforce • Provide comprehensive benefit offerings • Develop innovative and wellness focused benefits • Holistic view of health management: • Prevention • Early detection • Treatment • Management • Promote accountability and facilitate change: • Education • Tools • Support

4. 2010 Cerner Health Plan Design • High Deductible Health Plan • Health Reimbursement Account (HRA) with $400 employer contribution • Network: • Beechstreet • Direct contracts (115 contracts, 3,680 providers) • Out of network policy • 100% coverage of preventive care • 100% coverage at the Healthe Clinic (Professional Services & in-house labs) • Cerner typically covers 70% of the health plan premium.

5. Top 6 Conditions (2004-2007) Claims Data • Cancer • Cardiac and Cerebrovascular Conditions • Mental Disorders • Spinal and Back Pain • Arthritis and Joint Pain • Asthma and Chronic Pulmonary Conditions • Make up 28% to 30% of total spending each year

6. Key Points: Mental Disorders - 2007 • 36% of LTD cases at Cerner cited mental disorders as the primary cause. (4 out of 18) • Almost 10% of plan members were treated for mental disorders in 2007 • $1.4 million in medical and prescription • Anxiety and Depression make up 55% of all mental health cases at Cerner

7. The Mental Health Parity & Addiction Equity Act • The Mental Health Parity and Addiction Equity (MHPAEA) Act of 2008 • Requires health plans to ensure that financial requirements (i.e. co-pays, deductibles) & treatment limitations (such as visit limits) applicable to mental health or substance use disorder (MH/SUD) benefits are no more restrictive than the requirements/limitations applied to medical/surgical benefits • As a result of the MHPAEA requirements, Cerner made the following modifications to our plan: • Changed member share from 50% to 15% for Outpatient/Office Therapy Psychotherapy • Removed Outpatient Visit limitations • Removed Inpatient Day limitation

8. Cerner’s Relationship with New Directions • New Directions Behavioral Health (NDBH) • Provides Mental Health, Substance Abuse, Financial, Legal, Elder Care Referrals • Provides 24/7 toll free number for assistance, this is a dedicated number for Cerner – Counselors assess and refer to EAP, or prior authorization and medical management for outpatient, Intensive Outpatient or Inpatient care • Wellness Classes – onsite and WBT’s • Monthly Newsletter

9. Cerner & New Directions Behavioral Health • For the 2010 plan year, Cerner adopted a novel approach by working with New Directions to provide a single point of entry to associates for both their EAP benefits and the mental health plan benefits • Primary Goal: • To assess and educate associates and to provide them with the most appropriate mental health provider or program • Consolidated EAP and Mental Health Plan benefits by adding prior authorization and medical management requirements through NDBH and in the KC metro area utilized the NDBH provider network • NDBH used a single call in number, triaged members as appropriate to either the EAP or the health plan benefit • Increased EAP therapy sessions from 3 to 6

10. EAP Modifications & Expected Savings for 2010 • EAP rate increased from $1.61 to $1.76 ($.15 increase) per US Associate to an annual cost of $129,486.72 (an increase of $11,035.80) • Agreement between Healthe Exchange (TPA) and NDBH for cost $0.95 PPPM (Per Participant, Per Month enrolled in the health plan estimated at 11,000) for an annual cost of $125,400 • Includes prior authorization and case management • Use of the NDBH network in the Kansas City area was expected to reduce cost that was projected to exceed $100,000 in savings • Prior authorization and more effective use of the EAP program was expected to also lower cost • Jan – July 2009 compared to Jan-July 2010 • EAP usage up from 3% to 6% (National Average 4-6% per New Directions) • 9.4% referred on to outpatient counseling (historically 17-20%)

11. Decrease in Mental Health Claims comparing Jan-July 2009 to 2010

12. Communication Of EAP & Mental Health Benefits • Posters and Signage • My Cerner – Intranet Site • Healthe & Wise is one of many health centered groups on uCern (social networking) • Healthe & Wise consistently is in the top 10 of all Associate Only uCern groups for total activity on a monthly basis: • 222 discussions • 848 replies • 23,889 total views • 10 documents • 2,890 total views • 66 Blog Posts • 7,900 views • Average of 6.5 responses per thread • 1,233 group members • Total content views exceed 34,000 • -

13. Cerner’s Mental Health Coverage 2011 • New Regulations for 2011 • New regulations were issued this spring that introduced the terms “Non-quantitative” versus “quantitative treatment limitations”. Both the definition of these terms and the potential impact of the regulations are still a source debate within the industry. A Non-quantitative benefit limitation is broadly defined as a limitation due to medical management activity or other requirements. • Proposed Language Change to Health Plan: • Pre-Notification for Outpatient Services • Your outpatient provider should pre-notify visits through New Directions after the 8th visit. • Please ask your provider to complete this Outpatient Treatment Request (OTR) form. You mayprint the form and take it to your provider, or let your provider know that the form is available online

14. 2011 Proposed Language Change Continued • Inpatient, Partial Hospital, and Intensive Outpatient Services • Contact New Directions for pre-notification before receiving inpatient, partial hospital, and Intensive Outpatient Program services • New Directions will review your care while you are receiving it and work with your treatment team to make sure you have care after you leave the hospital. • You will receive a response to the pre-notification request by mail within 48 hours unless additional information is requested. • To contact New Directions for a referral or pre notification for behavioral health services or to receive a referral to a provider in your area: (toll free number)

15. Mental Disorders

16. Cerner’s Health Plan Coverage – Autism 2010 • Applied Behavioral Analysis (ABA) • This approach teaches social, motor and verbal behaviors as well as reasoning skills. • ABA is considered by many researchers and clinicians to be the most effective evidence-based therapeutic approach demonstrated thus far for children with autism. • Cerner’s Coverage: • Pre-authorization is required • Age range 18 months to 7 years. • Treating professionals must be licensed  •  Annual maximum = $25K • Speech Therapy, Occupational Therapy and Physical Therapy coverage is up to $3500 annual cap

17. Autism – Missouri Bill • Goes into effect 1/1/2011 • Limit of $40,000 annually for ABA unless treatment is ruled “medically necessary”.  • Since all ABA treatment has to be ruled medically necessary, essentially there is no annual cap. • Coverage offered through age 18. • Health plans can only review treatment plans every 6 months  unless provider agrees to more frequent review. • ERISA (ERISA § 514(a)) would preempt state based on the Plans ERISA and self funded status. 

18. Autism - Recommendation • State of Missouri passed a law related to autism coverage; questions around whether we should adjust our coverage to mirror the law • Recommendation: Do not mirror law, but adopt the following changes • Raise funding cap to $30,000 • Bundle Occupational Therapy, Physical Therapy, Speech Therapy • Raise age cap to 18 years

19. Challenges to Focus on in 2011 • Removing prior authorization for behavioral health services poses several challenges that require monitoring: • Ensure appropriate referral to a specialist (i.e. Psychiatrist, Therapist) and level of care • Ensure appropriate coordination with PCP • Monitor impact to overall health plan spend • Other considerations: • Provide assistance to associates at a time when they may have impaired thinking • Keep associates connected with our EAP and Case Management • Engage family member(s) when needed

20. Questions?