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  • HEALTH & LIFESTYLE PERx Presentation

    1. 1. An Innovative and Transformative Strategy to Reduce Healthcare Costs
    2. 2. Managing Healthcare Costs• Employers continue to seek creative solutions to reduce healthcare costs, decrease absenteeism and increase productivity• They have been forced to restructure their benefit plans, often reducing benefits and raising deductibles and co-pays• This leaves some gaps in coverage and more exposure for employees• This also leaves some strategic opportunities
    3. 3. Managing Healthcare Costs• One creative solution is the HEALTH PERx™ Card, which offers a range of affordable healthcare benefits.• These benefits offer the entire family thousands of dollars in savings.• At the same time it offers the employer those creative solutions they seek
    4. 4. Disclosures • This plan is NOT insurance. • This plan provides discounts at certain healthcare providers for medical services. • This plan does not make payments directly to the providers of medical services. • The plan member is obligated to pay for all healthcare services but will receive a discount from those healthcare providers who have contracted with the discount plan organization. • This discount card program contains a 30 day cancellation period. • Member shall receive a full refund of membership fees, excluding registration fee, if membership is cancelled within the first 30 days after the effective date. • The range of discounts for medical or ancillary services provided under the plan will vary depending on the type of provider and medical or ancillary service received.
    5. 5. Benefit Choices Health Benefits Pharmacy Savings Card Telemedicine Vision Care Dental Care Hearing Care Physician & Hospital Discounts Medical Health Advisor Telephone Counseling (EAP) Lab, X-ray & Imaging Complete benefit information, provider locators, FAQs and links to Rx price finder and Lab discounts can be found by visiting
    6. 6. Health Care Reform  20-30 million consumers entering the system  A shortage of primary care physiciansWhat Will Happen?  Individuals will ignore symptoms and delay treatment which can lead to more serious medical complications  Individuals will leave work for minor issues which results in loss of productivity and unnecessary costs  Individuals will overuse Urgent Care and ERs Telemedicine can eliminate most of these problems
    7. 7. Health Care Reform and Telemedicine Access Points for Healthcare Medical Offices—physician assistants and nurse practitioners Walk-in Clinics–-Grocery Stores and Pharmacies Urgent Care and ER Clinics Telemedicine—Doctors by phone or secure email Telemedicine can provide immediate access to healthcare to every individual wherever they are, whenever they need it. The most efficient and cost effective method to deliver telemedicine is by phone.
    8. 8. National Center for Policy Analysis“Telemedicine has the potential for restructuring medical care in ways that can solve many of the problems, while reducing costs and improving quality of care.” National Center for Policy Analysis Convenient Care and Telemedicine White Paper, November 2007
    9. 9. Studies ShowPhysician telephone consults … have been proven to replace 45%-64%of doctor office visits and 15%-35% of hospital ER visits. Source: TelaDoc 2007Survey and Consult A Doctor Survey Results 2010Costs can be reduced as the healthcare system moves from in-personphysical exams to virtual visits. The average ER visit is $1024 andprimary care office visit is $140. Source: BCBS 2007: Health Cost EstimatorPatient satisfaction with telemedicine is high…due to convenience,comfort , privacy…and the security of having 24-hour access.Source: Us Department of Commerce, Office of Technology The Challenge: Most telemedicine services require a co-pay. This represents a significant barrier resulting in low usage rates. We have eliminated that barrier.
    10. 10. TelemedicineWe partner with a network of licensed, board certified physicians, available24/7/365 by phone or secure email, who can diagnose and treat non-emergency,routine medical conditions. They can prescribe medications when appropriate. Call :  Survey Results • When your physician is not available • Patient calls are diagnosed and treated • For non-emergent medical conditions or successfully more than 94% of the time (the questions other 6% cannot be treated by phone) with 98% • After normal business hours, nights, satisfaction rating. weekends • 64% of callers would have gone to physician and • When on vacation or in the field 15% to the ER—a significant savings of time and • Requesting prescriptions or refills money. Disclosures: Physicians do not prescribe controlled medications. Telemedicine is not insurance. Telemedicine does not replace your primary care physician.
    11. 11. Physicians:Facts  Experienced in Primary Care, Internal Medicine or Emergency Room practices  Fully credentialed by the NCQA Common Conditions Treated:  Cold/flu  Sore Throat  Bronchitis  Allergies  Sinus and Respiratory Infections  Headaches and Migraines  Stomach aches and Diarrhea  Urinary tract Infections  Minor Burns  Sprains  Insect Bites  Prescription Refills  Second Opinions
    12. 12. Return on InvestmentBased on typical investment in thisbenefit program (results vary according tonumber of variables)With 25% participation: Receive $1.86 for every $1 investedWith 33% participation: Receive $3.07 for every $1 investedWith 50% participation: Receive $4.65 for every $1 invested Imagine if every corporation strongly encouraged a “call first” policy Telemedicine is a game-changer! Disclosures: Office and ER visits taken from CDC Nat’l. Center for Health Statistics. Costs per office and ER visit based on BCBS negotiated rates. Reductions in office and ER visits based on actual survey results.
    13. 13. Pharmacy Savings CardWellness Health Solutions has directcontracts for discounts on both brand-name and generic drugs at more than67,000 pharmacies.Savings of 11% to 75% with an average of53% off the retail price of most Rxpurchases.
    14. 14. Pharmacy Savings CardEven though some individuals mayhave a pharmacy benefit, manyprescriptions aren’t covered. Ex: cosmetic drugs, appetite suppressants, smoking cessation prescriptions, prenatal vitamins or nutritional supplies, inject-able supplies, contraceptive devices, immunizations and vaccines and many more Our card covers them all.
    15. 15. Pharmacy Savings CardOther Features that promote consumerism: • RxPrice Retriever • Generic Navigator
    16. 16. Pharmacy Savings Card
    17. 17. The Rebate ProgramThe only Pharmacy Savings Card in thecountry to offer rebates from more than 30pharmaceutical manufacturers on over1,000 branded drugs.When consumer purchases a drug onrebate list, they will receive a preloadedMasterCard in the mail with their rebateamount. Many drugs offer $12-$20rebates.Subsequent rebates will be loaded ontothat same card.Every time a rebate is processed, cardholder will be notified by email.
    18. 18. Additional BenefitsMail Order Price GuaranteeOur Clients are eligible for additional programs: • Smoking Cessation programs at big savings • Diagnostic Lab, X-ray and Imaging Discounts • Access to ―Health & Wellness Focus‖ portalWellness Health Solutions can provide client with a desktop monitoring tool allowing you to monitor all pharmacy transactions in “real time.”
    19. 19. Additional BenefitsSmoking Cessation Program Present Pharmacy Savings Card and receive significant discount on Chantix™ prescription After 90 day program, receive additional $30 via Rebate Card Take advantage of educational materials and complete support program available through Pfizer ―The Get Quit‖ Plan
    20. 20. Additional Benefits Diagnostic Lab, X-Ray and Imaging Affordable: Deeply Discounted Rates: 10-60%. Convenient: Choose the lab location thats best for you Quality: Federally and state certified clinics. More than 2,900 radiology centers Easy Laboratory Testing: Order your tests online or call us. Results within 48-72 hours. Its that easy. No co-pays No deductibles Confidential: Results sent only to you.
    21. 21. Additional Benefits
    22. 22. Who Can Benefit People who do not currently have medication coverage Many drugs on PBM plan cost more than discount card People who are taking a drug not covered by their medication coverage Those with a high co-pay or deductible Those using another discount card There are more than 33,000 prescriptions below $7
    23. 23. Other Issues Wellness Health Solutions will collaborate with and assist as needed in producing marketing materials, printing , website development and distributing cards.
    24. 24. MarketingMaterials Pharmacy Cards Websites
    25. 25. SUMMARY• We own our own network—more than 67,000 pharmacies• We offer excellent discounts to the consumer (11-75%)• We offer cash rebates on many brand drugs• We collect and pay out on 93% of all prescriptions• We provide “real time” monitoring capabilities• We provide smoking cessation discounts and educational tools• We provide discounts on Lab, X-ray and Imaging• We provide a comprehensive, user friendly, wellness portal• Everything can be branded to your firm• We operate a “transparent” pass-through business model so there are no hidden features
    26. 26. This can be a stand-alone benefitGenerate Revenue with a Free Pharmacy Savings CardThis card is now being offered toAssociations, Non-profits, Municipalitiesand other groups for distribution to theirmembers and communities.Every time a prescription is filled, they earnrevenueWe can design website tools for pharmacycards online or print cards for ourdistribution partners.
    27. 27. Other Health Benefits Dental Care  Members save 15% to 50% on everything from general dentistry and cleanings to root canals, crowns and cosmetic dentistry where available.  More than 92,500 dental practice locations.  Save on specialty care, orthodontics, endodontics and periodontics where available. *Actual costs and savings vary by provider and geographical area. ** According to the Aetna Enterprise Provider Database as of  No limit on number of visits October 1, 2008. .
    28. 28. Other Health Benefits Vision Care  Save an average of 20%-60% on prescription eyeglasses, frames, lenses, tints, coatings, UV protection and specialty items  Savings on eye exams and 40-50% off the national average on LASIK surgery and PRK (where available)  Savings of 10%-30% on contacts  More than 12,000 locations including national chains and independent providers Pearle •Sears • JC Penny •Target • LensCrafters • Sterling •EyeMasters• QualSight LASIK
    29. 29. Other Health Benefits Hearing Care- Beltone Hearing Centers—1,350 locations  Free hearing screening and substantial discounts on hearing aids and other products and services. Newport Audiology Centers  35% discount off hearing aid prices at more than 2,000 locations  100% Service Satisfaction during the first 60 days Mail Order Hearing Aids  Save 40% to 60% off average National Retail Pricing on more than 100 models of name brand hearing instruments. Receive the lowest price available. 45-day in-home trial period and 1year factory warranty
    30. 30. Other Health Benefits Diagnostic Lab, X-Ray and ImagingAffordable: Deeply Discounted Rates – 10-60%.Convenient: Choose the lab location thats best for youQuality: Federally and state certified clinics. More than 2,900radiology centersEasy Laboratory Testing: Order your tests online or call us. Resultswithin 48 - 72 hours. Its that easy. No co-pays No deductiblesConfidential: Results sent only to you.
    31. 31. Optional Health Benefits Physician & Hospital—Galaxy Health™  Save 10-40% at more than 300,000 specialty physicians and thousands of hospitals and urgent care centers nationwide.  Save on cosmetic surgery procedures  One of the largest physician and hospital networks in the nation.  No age or health restrictions.
    32. 32. Optional Health Benefits Medical Health Advisor—Helps members: Navigate the healthcare and insurance systems Find the best doctors, hospitals and other providers Resolve insurance claims and billing issues Save time and money on healthcare bills Locate and research current treatments for a medical condition Help members make informed medical decisions Schedule appointments with hard to reach specialists Secure second opinions to provide peace of mind Identify renowned "best in class" medical institutions
    33. 33. Optional Health BenefitsTelephone Counseling (EAP)Our telephone counselors assist with problem resolution and suggest options to help members with personal issues of any size.HighlightsCounselors work with a multitude of issues including:  Depression, anxiety or stress  Conflicts at work or home  Reliance on alcohol, drugs, tobacco or food  Sexual, physical or emotional abuse  Loss and grief  Change and transitionMembers receive free unlimited telephone counseling 24/7.  All Counselor have a masters degree and five years of postgraduate experience
    34. 34. Other Benefits Lifestyle Benefits Emergency Roadside Assistance Identity Theft Protection Legal Services Direct Tax Help Line Pet Care Fitness Club Discounts Complete benefit information, provider locators and FAQs can be found by visiting
    35. 35. Lifestyle BenefitsEmergency Roadside Assistance – Up to 15 miles towing (up to $80 retail value) per occurrence maximum forcovered charges. Flat tire assistance, fuel, oil, fluid and water delivery service, lock-outassistance, battery assistance, & collision assistance.LifeLock ID Theft Protection * (for member only—family is extra) Identity Alert™ System – provides early notification whenever they detect your personal information being used to apply for many forms of credit or services WalletLock™ helps cancel and replace the contents of a lost or stolen wallet eRecon™ patrols the web and notifies you of illegal selling or trading of your information TrueAddress™ notifies you when a change of address is requested in your name Free annual credit reports from the three major credit-reporting agencies 24-hour customer service $1 million total service guarantee –if you become a victim of identity theft because of a failure in their service, they will help you fix it at their expense, up to $1,000,000
    36. 36. Lifestyle Benefits Legal Services Direct Nine free services which include:  Unlimited initial phone consultations for new legal matters  Initial one-on-one consultations for new legal matters  Document review (6 pages or less)  Letters written on the member’s behalf  Phone calls made on member’s behalf  Assistance with governmental programs  Assistance with small claims court representation  Free simple will with free annual updates  Free living will—state specific Eight commonly used legal services deeply discounted, such as traffic ticket defense, name change, simple divorce, simple trust and more. Plan attorneys will either charge $125 per hour, or 40% off their usual and customary hourly rate, whichever is greater.
    37. 37. Lifestyle Benefits Tax Help Line • Unlimited advice on federal taxation • Free tax return preparation for forms 1040 EZ, 1040A and standard 1040 • Deep discounts on numerous other tax schedules • IRS audit assistance • Tax planning • Review of prior years tax return • Member portal with tax tips, tax law changes, member advice and much more Pet Care- Receive 25% off all services at participating vets. Free pet tag and 24/7 location service. Receive 10-30% off at participating providers on pet services, such as boarding, doggie day care, training, pet sitting and grooming. Fitness Club Discounts-International Fitness Club Network--Guaranteed lowest rates at over 8,500 quality fitness centers nationwide. Introductory Free Week Trial to all clubs. All meet ACSM guidelines.
    38. 38. Other Features List-bill capabilities Fulfillment Kit and Membership Cards Website Access to benefits and provider locators Onsite member services call center staffed with Englishand Spanish speaking representatives who can help withenrollment, verify discounts and assist with customer serviceissues. Compliance Department monitoring state legislative requirements Marketing assistance and brochures Money Back Guarantee All benefits are good for the entire family* *LifeLock benefit covers cardholder only
    39. 39. Target Applications  Self-funded corporations  Fully insured companies with high deductible plans  Limited-liability plans  Schools, Government, Associations These low cost benefits complement any insurance plan by offering innovative strategies for reducing absenteeism, increasing productivity, and decreasing overall healthcare costs for the employer while encouraging employees to take more responsibility for their healthcare costs.
    40. 40. Value Proposition Employers Employees • Ability to add a benefit with a high perceived • Access to medical consultations 24/7 as well as value savings on pharmacy, vision, dental, hearing and more • A program that will decrease absenteeism, increase productivity and reduce overall • A benefit that can fill in many gaps in insurance healthcare costs coverage, particularly with high-deductible and consumer-driven healthcare plans • Ability to ensure that every employee has access to healthcare when they need it • A program that eliminates unnecessary visits to wherever they are the doctor or ER • Ability to promote health and wellness and • A benefit that can save the family thousands of encourage personal responsibility dollars a year • A program that can help with acquisition and • Lifestyle benefits that can save the family retention of employees additional money on everyday needs
    41. 41. Our Standard Packages
    42. 42. Packages and PricingVoluntary BenefitsSelect benefits to include and we will develop wholesale pricing.Involuntary or Embedded BenefitsBased upon group size and projections or guarantees, we will develop involuntary pricing package. Fulfillment Kits can be provided by client and reduce cost.
    43. 43. What we Have We have a transformative product We have the power to change the system We need to reinvent our business value-propositions We need to persuade others to see this vision We will help them see themselves as visionaries
    44. 44. Contact: