Population Health Management

NEW RESULTS WHAT WE DO NEXT GEN BENEFITS OUTCOME BASED
Population Health Management Retirement Health to Wealth
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EMPLOYER
STRATEGIES
BROKER
SERVICES
VENDORS
& TPAs
CONSULTING
SERVICES
Lifestyle Risk
Calculator
This presentation contains proprietary information. It is intend for use only by our contracted brokers and employer groups. Any redistribution or other use is strictly forbidden. The benefit descriptions are intended to
be a brief overview of some benefits available. For Agent/Broker use only. Not for distribution to the general public, nor for solicitation purposes.

Scott Hettesheimer Suite 1002 513-661-7581 Scott@GroupBenfitsExperts.com
Population Health Management
Copernican Evolution in
HealthCare Management
Benefits delivery platform, population health management, outcomes based
wellness initiatives, disease treatment compliance and much more.
Delivered from 1 Website.
A vendor agnostic platform.
AFFORDABILITY!

Overview
Affordability and competitive benefits that retain and attract talent, can
only be accomplished with better healthcare management and
simplifying your benefits delivery.
The Population Health Management system will create a healthier
world with its one-of-a-kind behavior motivation process driven with
Modifiable Risk Factor reporting.
Unlike any other solution on the market, the Lifestyle Risk Calculator
correlates behavior costs to retirement health to wealth.
Outcomes based financial & clinical incentives drive engagement,
creating significant outcome based measurable results.

Problems
How do we deliver all of our benefits from one website?
How do we engage all of our employees and dependents?
How do we simplify our benefits delivery?
How do we improve benefits satisfaction?
How can we manage all healthcare benefits by way of
supply chain management processes?
Limited Ability to Deliver
The Strategy Cornerstone

Benefits Delivery
Increasing Engagement
 Single Source Website, Login & Password
 Simple to Use & Familiar User Interface
 Managing All Health & Employer Communications
 Presenting All Benefits From One Website
 Healthcare
 Qualified Retirement
 Dental, Vision & Ancillary/Voluntary
 Connecting All HealthCare Data
 Claims
 Pharmacy
 Biometrics
 Manual Input Available for Wellness & Members

Benefits Delivery - User Interface
Single Source Website, Login & Password
Ex. A family health
manager will be able to
view all family activities
and alerts through the
News Feed
As an authorized
caregiver, user receives
a notification that a
family member has
completed a physical
activity challenge
The News Feed is
constantly updated
"To-Do" lists identify
tasks that are not
complete .
Users can add their
own "To-Do" items for
themselves and/or
their family members
Receive reminders of
an upcoming doctor’s
appointment

Benefits Delivery -User Interface
Managing All Health & Employer Communications

Peer Support Reinforces Engagement & Positive Change

Drill into specific health
topics: medications,
allergies, immunizations,
visits, procedures, etc.
Notifications: Based on
a user’s preferences, the
system will send out a
variety of notifications,
ranging from upcoming
calendar appointments
to a notification that
new data has entered
the user’s record
Alerts: The system will
notify a user if the
system has identified a
problem in the user’s
record
Familiar & Simple

 On-the-go employees present biggest
costs and biggest savings opportunities
 Dossia system leverages aggregated
data to engage employees with
personalized text-based programs to
promote health behavior change
Benefits Delivery – Communications
Engaging Hard but Critical-to-Reach Employees
No computer. No internet. No Problem.
Your employees don’t have to be web native to benefit
Text-based engagement
programs may include:
Mobile Engagement Solution
 Health awareness / communications
 Patient decision support
 Health care consumer support
 Health rewards & incentives
 Medication adherence
 Preventive care reminders
 Nutrition and activity promotion
 Diabetes management

 Choose apps that are meaningful
to you
 Apps integrate with PHR
 Many apps are free
 Dossia vets all apps for quality,
value and reliability
Benefits Delivery - Services
Health Marketplace… Because Your Health is Yours!
All apps are
segmented into
5 categories for
easy search

Disparate Health Data; All Shareholders Now Connected

HealthCare Cost Equation
Pre-Diagnosis:
Reverse disease trending
Slow disease progression
Better disease management
Avoid healthcare need
After-Diagnosis:
Negotiate deeper discounts
Discover cheaper prices
Shift more cost to member
Unknown effects of ObamaCare
In order to accurately manage risk, 100% of the risk must be identified. Historical
claims data only identifies current healthcare spending or current diagnoses, a
backward look of less than 20% of your members.
According to CDC’s analysis:
Forty-five percent of adults had at least one of three diagnosed or undiagnosed
chronic conditions—hypertension, hypercholesterolemia, or diabetes; one in
eight adults (13%) had two of these conditions; and 3% of adults had all three
chronic conditions.
Do You Know Who These People Are?

Founded by a group of
CEOs from some of the
largest employers in the
US, a platform was
created that functions
as the heart of your
corporate benefits
initiatives.

Promotion of Health
American Journal of Health Promotion, 1989 “Health promotion is the art and
the science of helping people change their lifestyle to move toward a state
of optimal health. Optimal health is defined as a balance of
physical, emotional, social, spiritual, and intellectual health. Lifestyle
change can be facilitated through a combination of efforts to enhance
awareness, change behavior, and create environments that support good
health practices.”
Current Health Care Model Focuses On: – Disease Status rather than health
status – Mortality rather than Morbidity. Traditional physical health risk
factor(s) with less emphasis on behavior change and quality of financial and
clinical state of health.
Serious need to Change Your Benefits Delivery Platform.This presentation contains proprietary information. It is intend for use only by our contracted brokers and employer groups. Any redistribution or other use is strictly forbidden. The benefit descriptions are intended to

Real Health Data … Real Health Decisions … in Real Time!
PRESENTING…..
Hospitals
&
Dashboard™
Doctor’s
Offices
Health
Plans
Labs
Pharmacies

…Total Personal Health Management System
Unique Attributes:
 Seamless integration
 Consumer Friendly
 Comprehensive clinical and
non-clinical data: 360o view
 Secure, Private
 Automated, Pre-Populated
Data
 Single Sign-On
 Sharing Capabilities
Personal, Patient-Controlled, Private, Comprehensive, Lifelong Electronic Health Record Plus a
Set of Personal Health Applications

Modifiable Risk Factors
Power Your HRA with Personal Health Information

Know Your Number Reporting

Risk Factors Impact on Claims

Health Issues Related to Obesity
 Sleep Apnea
 Diabetes Type II
 Hypertension
 Cholesterol
 Triglycerides
 Cardiovascular Disease
 Erectile Dysfunction
 Degenerative Joint Disease
 Gout
 Gerd
 Depression
 Metabolic Syndrome
 Venous Stasis
 Asthma
Achieving a healthy BMI – 24.9 or under
improves “Quality of Life” in 95% of
individuals and Mortality improves in
89% of individuals
Heart
disease
and
stroke
Type 2
diabetes
and
cancer
Colon
cancer
Gall
stones
Osteoarthritis in
hip and knee
joints
Respiratory problems

Statistics
Diabetes:
2008 Statistics:
24 million diabetics, 57 million pre-diabetes
2011 Statistics:
26 million diabetics, 79 million pre-diabetes
• Heart Disease
$448.5 billion in 2008. 16 billion more than in 2007
• Depression
Medical cost is $44 billion annually (Mental Health America)
• Obesity cost $147 billion annually (CDC 2006)

Statistics (Continued)
– 65% to 85% of heart disease
– 66% of cancers
– 91% of diabetes
– are caused by modifiable personal health behaviors
– If adapted – 50% reduction in all cause mortality
(Knoops et al., Rimm and Stampfer, 2004)

Leading Cause of Morbidity and Mortality
 Tobacco Use
 Unhealthy Diet
 Physical Inactivity
 Overweight and Obesity
 Increasing in prevalence.
 Only 10% of the population does not have any of 4 risk factors.
(American Cancer Society)

Lifestyle Risk Calculator
Correlating Behavior Cost to Lost Retirement Income

Personal Health Record
Life Long; Electronic; Portable.
Users may choose to share their record with
wellness coaches and disease managers
Health managers can monitor profile
updates and progress through Dossia’s activity
feed or the Dossia Dashboard
Care coordinators are able to securely
communicate through Dossia’s messaging
system
The Health Management System enables wellness and disease managers to contact
members via the medium of their choice: Dossia messages, text and email

Outcomes-Based
Wellness & Incentives
Chronic diseases related to lifestyle account for 75% of national medical
costs. Eleven separate studies by the Centers for Disease Control suggest that
worksite wellness programs can produce significant improvements in
employee health.
- Centers for Disease Control, 2006
53% of U.S. adults think its fair to ask those with unhealthy lifestyles to pay
more for their health insurance. (Up from 37% only three years ago.)
- Wall Street Journal/Harris Interactive Poll
56% of employers plan to hold employees more responsible for the cost of
health benefits.
- Washington Post, March 12, 2010

Outcome Based Wellness
Healthy Lifestyles Should Pay Less
Outcomes-based wellness is like other insurance discounts for state of health.
 Drivers with fewer tickets and accidents pay less
 Non-smokers pay less for life insurance
 Homeowners with security alarms pay less
It is fair for employees who live healthy lifestyles to pay a lower contribution
for their insurance.
Non-smokers should pay less than smokers.

Average, Measured, employer results;
After several years of a participation-based program, little lifestyle changes
are seen and typically cannot be measured.
The Outcome Based Wellness driven with financial incentives produce
different, measured results.
• Participation/Engagement (96+%)
• Measured improvement first year:
• 16+% more members passed blood pressure goal.
• 10+% went from obese (30+ BMI) to non-obese.
• 11+% lowered their cholesterol levels.
• 2+% quit smoking .
• Cost-shift in year one ROI was $3+ saved to $1 spent.
• Total Return on Investment for the first two years of the program,
including risk reduction, was $6+ saved to $1 spent.
• Non-incentives measures do not improve. Everything tied to money
did.

Average, Measured, employer results;
An Analysis of the Cost Effectiveness
•26% change in sick leave
•27% change in health claims
•40% change in workers’ comp
•24% change in disability management
Benefits for Employees include improvements in state of health, moral, quality of
retirement – Health to Wealth.
Reduce the overall cost of premium by integrating calculator into their activities of
daily living. Provides employees the tools to help them live a healthy lifestyle and
improve the quality of their life.

Evidence Based Reporting
Evidence Based Analysis; On-Demand Real, Measurable ROI
Measure Interventions & Quantify Value
• Who did what?
• What were the outcomes?
• What were annual health trends?
• What were year-to-year results?
• What did you spend?
• What did you save?
• What is ROI

Health Transformation Starts Once You Know The Problems
Advance a Culture of Health with:
 3-year historic health assessment
 Identification of key health cost trends
 Identification of key intervention strategies

…And Their Related Cost
Stratify Modifiable Risk:
 By condition
 By Rx use
 By clinical data
 By biometric data
 By claims data
 By individual or multiple
factors

See When & How your Population Engages
Track Key Indicators
of Health Engagement
 Unique logins
 Time on platform
 Apps installed
 Time on programs
 Challenges initiated
 HRA starts
 HRA completions

Six Sources of Payer ROI
 The aggregation point for varied health initiatives
 Single sign-on enables secure integration of all health apps within a unified
framework
 No need to navigate to multiple web sites
 No need to memorize multiple passwords
Enables your health initiatives to integrate with PHI
Integrates health apps with an individual’s PHI to create a holistic, personalized
experience
Applications are intuitive (i.e., Recipe Planner shows sodium-free recipes if PHI shows
hypertension)
Programs are interactive (i.e., Walking Program app displays progress on
Measurements app)
Integrated data design improves care coordination
Sharing capabilities, notifications & core apps enable physicians and pharmacies to be
alerted to adverse drug interactions
Integration with with clinical technologies (e.g., EHR) enables physicians to see a
patient’s complete health history

Six Sources of Payer ROI
 Enables portability of self-reported and professionally-sourced data
 Mitigates the incidence of duplicative, expensive diagnostic tests
 Reduce risk of misdiagnosis, medical errors in emergent situations
 Health Manager uses unadjudicated claim feeds
 Health Language™ program translates medical jargon into “plain-spoken
words”
 Easy-to-read data enables laypeople to understand and, when
appropriate, challenge inaccurate billing
 Dashboard analyzes clinical, claim and Rx data in near real-time
 Health Triggers & Health Rules enable automation of interventions to address
modifiable risk
 Drives personalized “just-in-time” interventions
 Real-time data improves response time to emerging population health issues

Best Practices
Evaluate your current culture. Does it support better behavior
Form a team to develop your program.
Implement effective communication programs. Manager education/Employee
participation in program implementation. Communicate confidentiality.
Design program to change behavior. Provide tools needed and incentive
programs to motivate employees to change.
Data management. Report Participation. Collect and store health behaviors
and personal risk factors. Validate effectiveness and success. Meet HIPAA
requirements.
Evaluation is shared with organization and used for learning and
improvement.
Creation of a supportive social environment for individual to achieve their
health goals.

Create a Phased Strategy
Begin by identifying good health standards, illustrating how each member’s
biometric measurements compare. Our “Know Your Number” reporting
identifies risk of chronic disease and illustrates peer comparisons. Incent for
disease treatment compliance, BMI reductions and the creation of an exercise
program – counting steps and walking. Employer impact – Break Even.
Year 2. Establish formulas to earn a 20% contribution to medical premium. Biometric
measurements confirm accomplishments. Employer Impact: up to 8% net savings.
Year 3. Be aggressive and implement formulas that represent behavior change that
achieves clinical outcomes that represent significant improvements in Biometric
measurements. Employee Impact is up to 30% of premium contribution and possible
loss of benefit incentives if not compliant with disease treatment. Employer financial
impact up to 15% net savings.

Benefits Satisfaction
 We simplify the delivery of needed healthcare for all members
 We help solve the Healthcare Need Crisis
 We help solve the Retirement Crisis
 We improve people’s lives – Health to Wealth
HealthCare is Complicated

Security
The most important thing is the privacy and security of patient data. When the platform was
built, it was done with complete HIPAA compliance. But beyond that, compliance with the
privacy laws of all 50 states relative to adolescents and sexually transmitted disease. SOC3
security, which is the same standard that is used in the banking industry. In addition, security is
tested annually by outside audit by companies like Intel, AT&T, and Walmart. Security
certification is done every year from SysTrust, which is the gold standard in technology security.
Security and privacy is without a doubt the most-important component of what we do… simply
because of the nature and product provided.
So, in addition:
Fully compliant with HIPAA Privacy and Security regulations; the organization works with
SysTrust auditors who do multiple SysTrust audits annually and certify HIPAA compliance. The
staff is required to undergo yearly HIPPA training courses to make sure everyone is up to date on
all HIPAA provisions. Extensive experience in integrating CCR, CCD, CDA, LOINC, ELINCS, HL7, HIE,
CVX, EDI X12, ICD, CPT, HCPCS and other healthcare data standards.

The Strategy Cornerstone
Conclusions
The Population Health Management System makes individuals’ aggregated health
data actionable, all applications brought together on a simple user platform
delivering personalized, data-driven strategies that enable users to get more value
from healthcare spending, better manage chronic conditions and pursue a
healthier lifestyle. Automated and targeted messaging fosters lasting engagement
and behavior change, yielding long-term value to employers, employees and
families. Employers overspend on health benefits for which they realize little
value. The Population Health Management System is the solution for forward
thinking employers that aim to rationalize their health benefits spending while
engaging their employees as true partners in achieving high value
healthcare, better satisfying their health needs.

Services
 Open Enrollment Custom CD Rom Creation
 DOL Audit Compliance Manual
 Benefits Business Plan Creation
 ERISA Academy
 Re-Invent Yourself Business Plan
 Full Benefits Audit
 New Small Group Self-Insured Solutions
 Benefits Delivery Platform
 Population Health Management
 Lifestyle Risk Calculator
Other Services:
www.AdvancedBenefitDesignInstitue.com

Contact:
Advanced Benefit Design Institute, LLC
3254 Montana Ave., Suite 1003
Cincinnati, Ohio 45211
513-661-7581
scott@GroupBenefitsExperts.com
http://www.AdvancedBenefitDesignInstitute.com

Population Health Management

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