Sourced 1 A Risk Management Services Company

1. Sourced 1
Integrated Functional Disability
Management System
Robert Edward Lawson II

2. Mission Statement
Our mission is to provide Chief Executive Officers (CEOs) and Chief
Financial Officers (CFOs) in corporate America with a one-source
integrated benefits administration platform that redefines the concept of
workplace occupational and non-occupational benefits administration.
We will uncomplicate processes that prevent managers from realizing
cost efficiencies by integrating occupational and non-occupational lost
time and illness benefits administration within our client’s organization.
We will accomplish this by breaking down the barriers in traditional
benefits administration silos of managing occupational and non-
occupational risks. Our proactive approach at managing emerging risks
is unique in the marketplace. We will deal with disease and injury
proactively prior to its occurrence rather than the aftermath. By
redefining the standards by which industry views occupational and non-
occupational lost time and illness risk we will have delivered the most
significant cost control process for business currently in existence.

3. Executive Summary
“IFDMS” – An Integrated Benefits Administration System – combines several unique insurance,
risk management, third party administration and legal services all dedicated to reducing overall
costs of illness and absence in the workplace. Resulting benefits to our clients are lower workers’
compensation costs, early return to work outcomes, lower medical insurance outlays, better
aligned ancillary benefits with great potential savings using group carve out strategies all resulting
in a more productive workforce and significant cost reductions.
Our client is the CEO and CFO of Corporate America. CEO’s and CFO’s need to be able to have
metrics of reduced productivity due to workplace absence both from occupational and non-
occupational causes. Currently those metrics are limited in scope. They need to turn data into
knowledge, easily and accurately giving the organization the flexibility needed to implement best
practices and streamline workflow enterprise wide.
IFDMS accomplishes this by total integration of occupational and non-occupational benefits
administration. Our Integrated Benefits Management System is based on the unique
characteristics of each individual employer organization that focuses on early claim intervention, a
functional return to work philosophy, quality medical care and disease management. By breaking
down the barriers of communication, getting data in the hands of people in place to have an effect
on cost outcomes we significantly lower occupational and non-occupational disability and wage
replacement costs. Integration is not a new theme – doing this where all disciplines are completely
integrated into one company managing risk is entirely new.
We know, “chronic health and disability conditions” cannot be cured. However they can be treated
and managed to preferred outcomes whether its origin is occupational or non-occupational so that
in only in a few instances an employee cannot be returned to work to some functional capacity of a
job shortly after occurrence of disease or injury. When this system is employed using all the
information available to help the employee gain returned to work status as soon as medically
possible, the resulting cost savings enterprise wide are significant.

4. Strategic Integration Model
Integrated Functional
Disability Management
Proactive Cost Containment /
Predictive Financial Metrics
Total Integrated
Benefit Strategies
Comprehensive Risk
Management for
Captive Insurance
Increased Productivity
IFDMS Outcomes
Absence Management
Worker’s Compensation
Risk Management Serv.
Legal Case Management
Workers’ Compensation
Stop Loss Insurance
Loss Insurance
HR Services
FMLA Administration
ADA Compliance
OSHA Review
HIPAA / COBRA
Compliance
Traditional Benefits Management “Silos”
Group Employee Benefits
Disease Management &
Wellness
Pharmacy Benefit
Management
Health Care Administration
Flexible Benefits
Administration
Executive Fringe Benefits
Health Stop Loss Insurance

5. Workers’ Compensation
Self Insurance
Today it is estimated that over 50 million
U.S. citizens have employee benefits provided through self insurance
Customized cost-containment strategies and develop aggressive claims management to
match each self-insured company’s philosophy and goals
We work closely with employers to review claims thoroughly, including accident
investigation, evaluation of medical records and communication with physicians
On claims that are allowed, we review requests for treatment and forward to
IFDMS to ensure that medical bills are accurate and handle the payment of
those bills
Aggressively work with the injured workers, employers, physicians and the Sourced1
management team to successfully return injured workers to work
In cases where claims are denied, we file the denials with the Industrial Commission of Ohio
and assist the employer’s legal counsel in preparation at hearings

6. Integrated Functional Disability
Management Systems
Custom Fit Solutions based on unique characteristic of your organization
The Integrated Functional Disability Management model will provide your company with a quality
comprehensive system based on the unique characteristics of your organization.
 Policy & Procedures
 Injury Pay Language
 Provider network
Policies and Procedures that direct employees into employer solutions
Integrated Functional Disability Management empowers the employer to take a more active role in the
workers’ compensation Occupational and Non-Occupational Arena by providing them with the tools to
control the direction of a claim.
Wage Continuation languages with incentives
Wage continuation language controls the direction and outcomes of lose time claims. Directing claims with
incentives to desired outcomes plays an important role in reducing lost time severity.
Employer & Employee accountability
It is critical that a charge back system be put in place to hold all responsible parties accountable for their
part in managing costs. This system will include, but not be limited to, the following:
 Employer financial accountability
 Supervisor accountability
 Employee accountability
 Provider accountability
 Insurance accountability

7. Integrated Functional Disability
Management Systems
Vocational Assessment
In order to adequately define the environment in functional terms, the process involves defining permanent
positions, temporary assignments, and alternative employment options in functional terms. The key is to
identify the Exertional and non-Exertional components of the position in order to match the individual to
employment options and communicate with medical providers.
Functional Job Description Development
• The job matching concept encompasses identifying unique abilities of the individual and matching
them to the job
environment.
• All parties involved in the RTW process must be trained on vocational terminology language based
on the
DOT (U.S. Department of Labor Dictionary of Occupational Titles) This language will be used by
physicians,
psychologists and other treating professionals when reporting the functional capabilities of the
individual as it
relates to functional job demands (functional job descriptions).
• This language will also be used by the providers to report the progress and the maximum level of
functioning of
the individual.
• This universal language will be used by the employer in identifying the essential functions of the job
tasks
performed (functional job description).
System Training
• Provide training to all parties regarding program implementation policies, procedures, accident
investigation, and
program objectives.
• Provide training in the area of vocational terminology.

8. Claims Procedures System
Example #1
Employee is injured on the job, and seek medical treatment at one of employer
preferred medical providers. Employee returns to work with out additional
medical treatment.
Example #2
Employee suffered a lumbar strain on the job, and needs additional services in
order to return to the function of their original job.
•The attending physician reviews the medical diagnosis and the original
functional job description, and identifies their functional limitation.
• The doctor identifies functional capabilities and the employer identifies a
temporary work assessment within those restriction from a list of
transitional jobs and forwards the information to the physician and
vocational case manager with a prescription for services.

9. Flow of an Accident
Flow chart of an Accident
Return to the function of the original job
Rehabilitation/Transitional Work
Program
Places in a job within their phyical limitation
American Disability Act
ADA Committee
Structured Settlement Annuity
Premanent Restriction
Rehabilitation/Transitional Work Program
Medical Attention from selected Provider
Return to the functions of the original job
Medical Attention from selected Provider
Accident

10. Disease Management
and Wellness Integration
-2% 0% 2% 4% 6% 8% 10%
For our Wellness Clients It’s Working Even Better!!
National Average 9.20%
< 2 yrs on D2H 6.26%
2 yrs on D2H -0.76%
* Hewitt 2005 Employer Trend
** based on 130,000 lives
2005 Health Care Cost Trends: CBSA2005 Health Care Cost Trends: CBSA

11. Integrated Wellness
and Disease Management
Wellness Outreach Services
Assessment - Health Risk Assessment, Biometrics, Claims Data
Analysis – Develop individual and group specific wellness plan based on aggregate
risk
Interventions
Health Consumers
Health Fairs educational presentations
Education via Web site, mails, etc.
Active Consumers
24/7 nurse line
RN Behavioral coaching
Targeted education via website, mailings, ect.
Biometric screenings
Custom behavior change contract & action plan
Results – Fully Integrated Reporting
Health Risk Assessment
Biometrics
D2 (predictive modeling)
Ranking against benchmarks

12. Data Mining & Modeling Basics
HRA
OTHER
ELIGIBILITY
PBM
CLAIMS
Data Sources
Normative Data
Reporting Tools StratifierVirtual Medical Record
Data Preparation
Secure DataMart
Aggregation
Scrubbing
Normalization
Medical Intelligence &
Predictive Models
D2Hawkeye
Rules Library

13. It’s About Cost Avoidance
It’s not about ROI.
Traditional managed care efforts: Discounts, Case Management and Employee cost-
shifting provide some value.
Treating emerging high-risk members and improving quality of care provides a greater
savings opportunity.
Soft saving are more meaningful than hard savings. Consider this:
Getting a 30% discount on a $10,000 hospital bills creates a $3,000 hard dollar
savings.
Changing a four-day hospital stay to a three-day stay creates perhaps $5,000 in
hard dollar savings.
Avoiding the hospital stay altogether creates perhaps a $20,000 soft dollar savings.

14. Applying the D2 Rules Library
• Rules-based algorithms calculate
Risk Indices (RI) for each member using 24
months of medical and pharmacy data
• Risk scores are adjusted to create Adjusted
Risk Indices (ARIs), using:
• Evidence-based medicine
• Quality Indicators & Risk Measures
(QRMs)
• Members non-compliant to quality
measures are considered riskier, resulting
in an
Adjusted Risk Index (ARI)
higher than the
unadjusted
Risk Index (RI)
14
DIABETIC #2
No annual HgbA1c test,
eye exam, lipid profile,
or creatinine
No “long” office visit
Hospital admission &ER visit
Eight physicians
Sudden vascular claim
DIABETIC #1
Annual HgbA1c test,
eye exam, lipid profile,
and creatinine
Long office visit
No hospital admission
or ER visits
Rules Library
56.818.2 ADJUSTED
RISK INDEX
24.118.2 RISK INDEX
DIABETIC #2DIABETIC #1

15. Cost Containment Strategies
Cost management of claim dollars is achieved through:
PPO Network Management Services holds contracts with over 100 PPOs
National PPO supplemental networks
A strategy other than discounts and risk transfer to employees
A strategy to improve health and productivity of the corporation
A strategy to be proactive, not reactive.
Direct bill negotiation of all out-of-network claims over $5,000 & Direct Provider Contracting (as
needed)
Negotiated Savings Program
Transplant Networks (URN, LifeTrac, Multiplan, Interlink)
Pharmacy Benefit Managers (MedImpact, Express Scripts, and Advance PCS)
LabOne discount laboratory program
Guided2Healthsm services
24/7 Nurse Line

16. Cost Containment Strategies
Why Now?
75% of today’s healthcare dollars are spent on diseases caused by unhealthy
lifestyles
What we don’t know can hurt us – getting in front of high-cost cases by identifying at-
risk employees is critical
Soft dollar savings, which are far more important than hard dollar savings – “if you
don’t believe that, then you think buying clothes on sale at the mall improves your net
worth”
Stops chronic disease before it starts
Best approach is Total Population Management

17. Here is what a 500 life employer can expect:
At $6,000 per employee/year, medical cost would be $3,000,000.
Within that population, you could expect 73 hospital admissions per year.
The vast majority of those admitted will have chronic disease.
Some of these are the result of non-compliance.
Each admission will cost about $20,000 apiece, for a total of
$1,460,000, or almost 50% of the health care budget.
THE BOTTOM LINE…avoid an admission, save 1% of spending.
… Right about now the CFO gets interested in clinical compliance numbers

18. Integrated Benefit Strategies
Group Insurance
Health, Dental
Life
DI
Administrative
Services and Value-
Added Services
Qualified Retirement
Plans
Executive Fringe
Benefits
Flexible Spending
… While Saving You Money
We Put the Pieces Together …

19. Integrated Benefit Services
Group Insurance Consulting - (Health, Dental, Life, Disability, Voluntary Products)
Design group LTD/STD programs with return to work incentives built in
Work with management to develop a cost-effective employee benefits strategy
Recommend and implement a course of action
Day-to-day service from a dedicated account management team
Employee Communications
Provide resources and updates for compliance and legislative information
Preparation of government reporting (5500s)
Flexible Benefit Programs - Section 125 FSA, 105 HRA, 132 TRA, 223 HSA)
Provide all required documentation, testing and reporting
Full service claims administration FSA, HRA and TRA programs
On-site education meeting and materials with ongoing customer service and support

20. Integrated Benefit Services
Defined Contribution and Defined Benefit Plans – [401(k), 403(b), Profit Sharing, Money
Purchase Plans, ESOP]
Meet with plan Trustees to determine objectives of the qualified plan
Prepare all plan documents, IRS materials and Summary Plan Description
Employee education
Provide comprehensive record keeping and reporting
Monitor plan participation, results and government requirements
Offer a wide array of mutual fund choices
Executive Fringe Benefits
Executive Bonus Arrangement
Supplement your retirement savings with a Plan that allows excess income deferral
Administration for Non-Qualified Deferred Compensation Plans – Internet Access 24/7
Long-Term Disability wrap-around strategy
Long-Term Care insurance as pre-retirement business owner perk

21. Summary / Future Benefits
Significant Cost Reductions – Reversals of Current Trend Increases
Streamlining Administration – Elimination of “Benefit
Management Silos”
Simplified Processes = Lower Overall Costs
Integration of Incremental Benefits
Utilization of Captive Insurance Vehicle

22. Sourced 1
Integrated Functional Disability Management System
Thank you