1 28th National Conference on Health, Productivity and Human Capital September 16-18, 2014

Putting Data-Driven Insights from Biometric Screenings to Work in Your Workplace

Industry studies reveal growing interest in data-driven insights

Sixty-five percent (65%) of employers offering wellness programs with 50+ employees, said they offer a health assessment while 49% offer clinical wellness screenings.

– 2012 RAND Employer Survey

Forty-seven percent (47%) of employers said they plan to reward or penalize participants based on biometric outcomes other than smoker, tobacco status by 2014.

- 2013 Towers Watson/National Business Group on Health Employer Survey on Purchasing Value in Health Care (583 Employers)

Nearly all (99%) of large employers (200 or more workers) offer at least one wellness program and 55% offer a disease management program.

- 2013 Kaiser Family Foundation Employer Health Benefits Survey (1,276 Employers)

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Three things to consider

1. If you ask your employees to provide personal health information during a screening program are you making the most of the opportunity to inform and engage them with the information?

2. Are you leveraging this information to inform and drive your coaching, incentive and disease management programs?

3. Are you using this data to evaluate your strategy, your vendor partners, and sharing the program outcomes with your employees and management?

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Provide Objective Measures to Set Incentives

Stratify Population for Insight to Differences

Structure Benefits

Target Interventions

Establish Baselines for Improvement

Provide Data to Motivate Participants

Identify Health Risks

Fully leveraging powerful screening data

Screenings Provide an Opportunity to Inform

and Engage

Source: Biometric Health Screening for Employers a Consensus Statement, JOEM October 2013

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Biometric screenings provide insight to previously undetected health risks

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Distribution of Study Participants by Chronic Disease Risk*

* Chronic conditions studied include hyperlipidemia, diabetes, and chronic kidney disease. Note: numbers may not sum to 100 due to rounding errors.

Lab-Identified Risk

Self-Identified Risk

No Risk Identified

• Our research indicates that without employer-sponsored laboratory testing, more than 1 in 3 working-age adults may have unidentified disease(s)

• The percent of participants with newly identified disease risk (36%) is significantly higher than those who self-identified (24%) as having one or more of these three conditions

• When left untreated, these conditions can progress to more advanced stages, potentially resulting in needless expense and irreversible harm

Confidential – Do not copy or distribute

Source: Quest Diagnostics, Value of Laboratory Tests in Employer-Sponsored Health Risk Assessments for Newly Identifying Health Conditions: Analysis of 52,270 Participants. PLoS ONE, 2011. | 5

Perception versus reality: clinical data provides clarity on risk status

Source: Quest Diagnostics Health and Wellness Database 2014

11% of those participants who had never been diagnosed with high blood pressure, but later screened, had a result consistent with High Blood Pressure/Hypertension.

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Perception versus reality: clinical data provides clarity on risk status

2% of those participants never diagnosed with any form of diabetes, had a high glucose result and another 19% had an elevated result.

5% of those participants never diagnosed with high cholesterol, had a high LDL Cholesterol Result and another 18% had an elevated result.

| 7 Confidential – Do not copy or distribute Source: Quest Diagnostics Health and Wellness Database 2014

Wellness screening should send a positive message to your organization, and it can

Screen for things that will add value to the employee to help make sure they

have a chance to learn something.

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“If my employer did this, it would signal to me that they were genuinely concerned about my health and that would make me feel like a valuable employee.”

Do not stop at height, weight and tobacco give

yourself the opportunity to tell them something they

do not already know.

Make the most of the “Moment of Impact” that screening provides you

• Make the most of your moment with the participant and their screening data

• Provide your participants with a personalized experience that guides them to the next steps in their health

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Personalized imagery and content that allows participants to engage

with their results will maximize your investment in screening.

• Focus participants on their next steps through integration of programs that you have invested in already

• Promote a conversation with their personal physician

Make the most of the “Moment of Impact” screening provides you

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Do not wait on the data feed to your coaching provider

give participants a targeted message so that they can

take immediate action.

Are you leveraging this information to inform and drive your coaching, incentive and disease management programs?

Key Question #2

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• WHAT is Equity Healthcare? - An initiative launched by Blackstone in 2009 to help PE Firms and their portfolio

companies improve health outcomes and manage health care costs - 5 PE Firms, 47 portfolio companies, ~280,000 members

• 60% Blackstone, 40% other PE firms • WHO are we?

- A physician-led group with deep experience in employer health management, payer operations/informatics, clinical management, and innovation

• HOW do we do it? - Partner with best-in-class vendors to create clinical center of excellence units staffed with

specialized skill sets - Customize – each company has its own work plan focused on unique trend drivers - Innovate - our employers get new products sooner than mid-market - Plug-and-play, EH fee priced at cost, post-divestiture access

EH optimizes healthcare cost management through innovation, process management and consumerism

Equity Healthcare – The Story

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2014 companies that are part of EH ~280,000 members

New in 2014

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EH uses its volume to create dedicated centers at Aetna and United that manage care differently

The Equity Healthcare approach

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Focusing on the 90% claims: customization is key

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“Managed Consumerism is the Only Logical Step”

OLD –

• “We pay 80% of costs and leave it to health insurers to manage the rest – it’s up to employees to decide how engaged they want to be in their health”

NEW –

• “We will protect employees financially against catastrophic expenses and fund their preventive services….but the vast number of healthcare decisions in the middle need to made by employees and resemble other important decisions they make in their lives….and enough of their money has to be at stake to get them engaged.”

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Building Blocks of Consumerism

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The Results

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EH Delivers Better Results than Same Store, Off-the-Shelf

• Composite of Aetna and UHC experience based on 2012 incurred claims with 6 months of run-out • Utilization: Inpatient Admits & Emergency Room Visits • Quality: Inpatient Re-admission and Non-Urgent Emergency Room Use

8.8%

2.4%

-5.9%

-3.1%

-8% -6% -4% -2% 0% 2% 4% 6% 8% 10%

MemberEngagement

Quality

Utilization

Claims Trend

Lower Is Better

Higher Is Better

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Are you using this data to evaluate your strategy, your vendor partners, and sharing the program outcomes with your employees and management?

Key Question #3

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About The Neiman Marcus Group

• One of the larger luxury retailers in the US

• 42 full line stores (Including Bergdorf Goodman)

• 40 discount stores (Last Call)

• 90 total locations

• 16,000 total associates – US only - 6,000 are sales associates - 75% female

• 13,500 associates are eligible for benefits - 10,000 elect medical

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Timeline of Medical Insurance/Wellness 2011 Introduce biometric screenings for Associates Participation Only - $600 Premium Differential

2012 Biometric screenings become results based

$200/$400 Premium Differential

Must pass both waist circumference/cotinine test

Those that fail can do coaching

2013 Add spouses to biometric screenings – results based

$200/$400 Premium Differential

2014 No changes to program

Timeline of Biometric Screenings

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Timeline of Medical Insurance/Wellness • Ongoing participants can only take their screening in March/April –

no exceptions

• Screenings can be taken at either an onsite event or a Quest Patient Service Center

• Participants that fail the waist circumference/cotinine test have until August to complete coaching to get full credit

• New hires have to take their screening within 45 days of date of hire - Participation only (not results based)

- Spouses are not required

How Does the Program Work?

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Challenges of Biometric Screenings

• Associates historically have had a sense of entitlement with regard to benefits

• Highly suspicious of changes

• How to communicate to multiple locations

• How to sell associates on “blood draw” vs “finger stick”

• How to incent (“carrot” vs “stick”)

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Why did NMG Choose Quest Diagnostics?

• Favorable pricing through Equity Health

• Ability to fast track results to nurse team

• Quest is a known entity to most of our associates

• Over 2,000 Patient Service Centers in the US which can do screenings

• Ability to report results online a day or two after screening

• Nordstrom had a good experience with them

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Results of Screenings

• Overall, biometric screenings have been a success - Expected 70% participation, but actual results have been between 72% and 78% - Spouse participation has been in the low 60’s

• Roughly 2/3 of participants attend an onsite event - Others go to a Quest Patient Service Center - Do not allow a Physician Form

• For those that take a screening, roughly 30% fail either waist circumference or cotinine test

• Only 25% complete coaching for those that fail!!! • For the large majority of associates, the feedback has been positive

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Neiman Marcus participants had a lower percentage of “out of range” values than did Quest retail client counterparts and the Quest Diagnostics database overall, for all metrics except for HBA1c.

Neiman Marcus has a lower percentage at-risk on nearly all factors

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Neiman Marcus has seen a 3.5% reduction in those with high waist circumference results. The Quest Diagnostics average for the same cohort period is a 1% decrease in those with elevated waist circumference readings.

Weight status drives the trend in many clinical factors; Neiman’s trend is better than others for weight status

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On both factors analyzed in Neiman Marcus’s outcomes program, improvements have been shown among those who have passed the factor each year the incentive has been in place.

73% of the Neiman Marcus participants meet both criteria.

Outcome-based Test Results

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Why Was It Successful?

• We could not communicate the program enough – 5 minute CEO video rolling out program – Multiple calls with HR (both internally and with Quest) – Numerous calls/meetings with senior teams – Highlighted associate’s success stories – Mailings/Postcards – Intranet postings

• Quest was a great partner – Project manager assigned to us was fantastic – Held our hand through the process

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Next Steps

• Have seen slight improvement but want to see healthier associates/spouses

• How can we get associates/spouses to participate in coaching?

• Should we incorporate physical exams in the process?

• Do we revise the incentive structure?

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Questions?

For more information, please visit BlueprintForWellness.com,

or contact Wendi Mader, Wendi.S.Mader@QuestDiagnostics.com

Thank You

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