1PROPRIETARY AND CONFIDENTIAL

Wellness and Disease Management ProgramSales Staff Presentations

September 2014

May 23 , 2013

2PROPRIETARY AND CONFIDENTIAL

1. Current State Wellness and Disease Management

2. Definitions and CareFirst Policy

3. Integrated Wellness and Disease Management Model Program

4. Effective 1/1/15

5. Enhanced Wellness Program Features

6. Next Steps

Agenda

3PROPRIETARY AND CONFIDENTIAL

• Vendor Partners– HealthFitness delivers Wellness (Health Assessments, Lifestyle Coaching, Workplace Wellness Events)– Healthways delivers Disease Management (Chronic Condition Coaching)

• CareFirst has offered multiple options of program packages for both Wellness and DM– 3 different Wellness packages– 3 different DM packages

• Programs for Risk Accounts– Wellness is included– DM is NOT included

• Programs for ASO Accounts – there is a mix as of Q1 2014– 23 Wellness only– 61 DM only– 11 DM and Wellness– 83 Neither

• Pricing for Risk Accounts– Wellness (Health Assessments, Lifestyle Coaching) is included as part of premium

• Pricing for ASO Accounts– Wellness and DM pricing is broken out separate from the Admin

Current State Wellness and DM

4PROPRIETARY AND CONFIDENTIAL

Wellness Disease Management

Assessment Coaching Workplace Coaching

Fully Insured 2-199 Wellness Package 3 Wellness Package 3 N/A N/A

Fully Insured 200+ Wellness Package 3 Wellness Package 3 $ N/A

Self Insured $ $ $ $

Current State Wellness and DM

Wellness Package

Description

Option 1 Health Assessment, Online Health Coaching

Option 2 Health Assessment, Telephonic Health Advising, Online Health Coaching

Option 3 Health Assessment, Telephonic Health Advising, Online Health Coaching, Telephonic Health Coaching

Disease Management

Description

Package A 5 core chronic conditions

Package B Package A + Impact Conditions (11)

Package C Package B + Conditions (4)

Self Insured Purchase Options

Book of Business Program Offerings

Wellness Package 3 includes Health Assessment, Telephonic Health Advising, Online and Telephonic Health Coaching

5PROPRIETARY AND CONFIDENTIAL

DefinitionsWellness – Assessments are important to identification of where members fall on the continuum of care and what targeted services they should receive. Lifestyle Coaching is targeted to those members with high risk for unhealthy behaviors and have not yet been diagnosed with a condition.

Disease Management – Targeted chronic condition coaching (where we are identifying cases to outreach based on our predictive modeling) of members with full expression of a disease and who need outreach to be impactful.

CareFirst PolicyHealthways and HealthFitness will offer both Wellness and DM as opposed to having different vendors for one account. Healthways will manage all ASO and HealthFitness will manage all Risk.

Definitions and CareFirst Policy

6PROPRIETARY AND CONFIDENTIAL

Assessment Process• Well-Being Assessment• Biometric Screening/Physician Form

Incenting Member Participation• Plan Design (HealthyBlue/Blue Rewards)

Health Condition Tracks• Early identification that a member may be headed towards developing a condition

Coaching Interventions• Lifestyle Management Coaching• Disease Management Coaching (10 conditions)

Workplace Wellness Services• Supports a Culture of Wellness • Available for an additional fee; may be deducted from wellness credits

Integrated Wellness and DM Model Program

Ideal State Effective January 2015 for Self Insured Business OnlyVendor Partner: Healthways

7PROPRIETARY AND CONFIDENTIAL

• Risk Accounts– No change for 2015 – looking to incorporate DM for 2016

• ASO Accounts– Price Wellness ($1) and DM ($3) into every opportunity upon medical renewal– The cost of these programs will be included and not broken out into the Admin fee

• Messaging (depending on the mix outlined above)– Account members will receive targeted DM programs for 10 chronic conditions which includes:

1. Asthma 2. Diabetes3. Coronary Artery Disease4. Chronic Obstructive Pulmonary Disease5. Congestive Heart Failure6. Chronic Low Back Pain7. Osteoarthritis8. Atrial Fibrillation9. Irritable Bowel Syndrome10. Fibromyalgia

– Wellness Assessments and Lifestyle Coaching which are critical to identification and management are now included as core so that we can appropriately risk stratify and support the Account’s population

– This is part of our transition to a health care delivery manager so that we are meeting member where they are on the continuum of health

Effective 1/1/15

8PROPRIETARY AND CONFIDENTIAL

• Shorter, more engaging Health Assessment

• Social experience throughout, including Groups, Challenges, Forums, etc.

• Personalized Messaging

• Wireless device integration (i.e., FitBit, Withing, etc.)

• Text messaging capabilities

Enhanced Wellness Program Features

9PROPRIETARY AND CONFIDENTIAL

• Account Transition– Effective 2015 for eligible accounts upon their medical renewal date– Including in all RFPs – pricing, written description and executive summaries– Currently identifying most appropriate accounts for 1/1 on a case-by-case basis– Collaboration between Sales, Wellness and Underwriting to determine best approach

• Marketing Materials – New Print and PDF Brochure– Individual Sell Sheets and Program Descriptions– New Pricing Guide– Member facing materials (in development)

• For all groups moving to this program, Sales to please complete new H+W Request form

• Additional Questions: Please contact the Wellness Team for any questions– Scott Smith: 200+ Commercial, Health & Education Accounts– Jenna Schiffelbein: 200+ Municipal and Labor Accounts– Carla Savage: General Wellness

Next Steps