Corporate Medicine – Meeting New ChallengesMarch 27, 2008

Clarion E. Johnson, M.D.Medical Director

Medicine and Occupational Health-Global

CORPORATE MEDICINE -MEETING NEW CHALLENGES

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Overview of Presentation

• Brief Overview of ExxonMobil

• Examples of how Society of Behavioral Medicine interests are being applied

in the private sector

– Overview of ExxonMobil Medicine and Occupational Health

• Core Services, Areas of Focus and the Occupational Health Centers of Excellence

– Partners in Health: ExxonMobil’s comprehensive heath care strategy

– Malaria Control Program

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Addressing the Needs of a Global Work Force

• We operate facilities or market products in nearly 200 countries and territories

• With 84,000 employees

• UpstreamExploration, Development, Production

• DownstreamFuels and Lubricant Refining and Marketing

• ChemicalManufacture and Marketing

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In Diverse Work Settings

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MEDICINE & OCCUPATIONAL HEALTH (MOH)

• Worldwide staffing: 460 including ~ 100 physicians on staff

• Operations around the globe:

– North America: Canada (Imperial Oil), Mexico,

USA (10 cities)

– South America: Argentina, Brazil, Chile, Colombia

– Europe: Benelux, Eastern Russia (Moscow),

France, Germany, Italy, Norway, UK

– Africa: Angola, Chad, Cameroon, Equatorial Guinea, Nigeria

– Middle East: Qatar

– Asia Pacific: Australia/Pac Islands, Indonesia, Japan, Malaysia, Singapore, Thailand,

Western Russia (Sakhalin)

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MEDICINE & OCCUPATIONAL HEALTH (MOH)

GLOBAL – CORE SERVICES

• Emergency response support

• Assessment and management of health risks

• Worker health protection programs (e.g. Hearing Conservation, Benzene, Asbestos)

• Fitness for Duty

• Injury/Illness Management

- Prompt, adequate and appropriate

- Communication with safety and line management

• Alcohol and Drug Use (ADU) policy support

• Travel health services including EMERS (Emergency Medical Response System)

• Operational Integrity Management System (OIMS) support

• Malaria prevention programs

• Oversight of field medical services (offshore platforms, pipelines, small facilities, terminals)

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MEDICINE & OCCUPATIONAL HEALTH (MOH)

GLOBAL – AREAS OF FOCUS

• Globally, the types of services are quite similar to the U.S., but methods and settings may differ

– Some on-site services are provided (varies by country)

– Some primary care services are provided (varies by country)

– Some overlap between provision of primary care and occupational health services

– More remote oversight of MOH activities

– Challenging medical issues

– Challenging public health issues

• Infectious diseases

• Sanitation and potable water

– Availability of local medical services

– Evacuation of personnel with critical medical issues

– Language and cultural issues

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OCCUPATIONAL HEALTH CENTERS OF EXCELLENCE (COE)

• MISSION: To create value and preserve ExxonMobil’s license to operate by protecting the health of our employees, business partners and customers through evidence-based, cost-effective occupational health services which meet applicable regulations, ExxonMobil policies and OIMS expectations.

MEDICINE & OCCUPATIONAL HEALTH (MOH)

• Pursuing Globalization / Harmonization Opportunities in the areas of:

– Injury / Illness Stewardship– Global IH / OH Practices– Exposure reduction for activities identified in the

Exposure Assessment System (EAS) as higher risk– Travel Medicine– Occupational Evaluations

• Achieved through development of global common processes, tools & training, effective use of technology and cost-efficient delivery of clinical services.

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MEDICINE & OCCUPATIONAL HEALTH (MOH)

Leveraging Our Diversity: Clinical Service TeamsLeveraging Our Diversity: Clinical Service Teams• Address clinical service

delivery issues• Utilize global personnel with

expertise/interest in specificareas

• Have ongoing responsibility for updating standardized forms & procedures

• Monitor new developments and trends

• Recommend evidence-based modifications

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PARTNERS IN HEALTH

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HEALTH & PRODUCTIVITY

Source: U.S. Department of Health & Human Services; 2004

So what are the costs of ill health and lost productivity?

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HEALTH & PRODUCTIVITY

Poor behavior is damaging U.S. population health status —with significant cost consequences for employers

• 2004 U.S. health care spending totaled about $1.8 trillion (about 14% of GDP)

• Modifiable conditions impact health care costs, productivity, and mortality– Obesity accounts for as much as 36 percent of cost increases

– Obese individuals are twice as likely to have high absenteeism

– Average diabetic misses 8.3 days per year vs. 1.7 days for people without diabetes

Source: U.S. Department of Health & Human Services; 2004

$14

$117

$132

$300

$0 $50 $100 $150 $200 $250 $300 $350

Asthma

Obesity

Diabetes

Heart Disease & Stroke

Major Diseases and Chronic Conditions Are Key Cost Drivers

Billions Per Year

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$0 $10 $20 $30 $40 $50 $60

Mental disorder

Normal pregnancy

Infectious disease

Nervous system

Genitourinary

Fractures

Digestive

Musculoskeletal system

Circulatory

Neoplasms

HEALTH & PRODUCTIVITY – COST IMPLICATIONS

The Cost of Lost Productivity

MedicalDisabilityLost Productivity

Source: IBI Research Insights, The Impact of Linking Medical and Disability Data, April 2006.

Millions Per Year

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HEALTH & PRODUCTIVITY – COST IMPLICATIONS

Per Employee Direct Disability Costs by Industry

Source: Integrated Benefits Institute, 2004.

$0 $15,000 $30,000

Auto Suppliers

Banks

Energy

Financial Services

Health Care Services

High Tech Mfging

Insurance

Mfging>20k

Mfging <10k

Retail

Telecom

Group Health Workers' Comp STD LTD Incidental Absence/PTO FMLA

$11,202

$12,114

$8,839

$10,875

$20,150

$10,658

$12,211

$11.077

$12,021

$6,537

$16,083

Dollars Per Employee Per Year

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HEALTH & PRODUCTIVITY – EVOLVING STRATEGY

Integrated Health and Productivity Management

Integrated BenefitManagement

Programmatic Benefit Management

• Few Employers – Present

• Some Employers – Future (3-5 years)

• Some Employers – Present

• Many Employers – Future (1-3 years)

• Many Employers – Past, Present, Future

Medical

Behavioral Health

Pharmacy

LTD

STD

Incidental Absence

Life, AD&D, Other Benefits

Health Portal/ HRA

Wellness and Prevention

Care Management

Occ Health and Safety

Worker’s Compensation

Employee Health Management

Integrated Disability

Management (IDM)

Life, AD&D and Other Benefits

Integrated Health Management with

Focus on Employee

Presenteeism and Productivity

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PARTNERS IN HEALTH

GOAL: To provide U.S.-based employees with resources and programs that help them enjoy healthier and longer lives, leading to better managed health care costs.

We attempt to reach this goal by helping EM employees and their dependents who are participants in the Medical Plan to :

• Stay healthy

• Become better “users” of health care by offering them tools and resources to help make good health care choices

• More easily access quality health care that’s truly needed

• Avoid unnecessary health care costs

Partners in Health, ExxonMobil’s comprehensive health care strategy, was implemented for U.S. employees and pre-65 retirees in late 2003

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PARTNERS IN HEALTH

Achieved primarily through specialized resources delivered through the health plan, supported by comprehensive participant communications

• Participant outreach, coordination of care and direction to Centers of Excellence by dedicated Health Advocate teams

• Disease and care management programs for cardiac, diabetes, musculoskeletal, and cancer

• Health information and risk awareness through customized health portal and annual health risk assessment

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Partnersin

Health

Partnersin

Health

Assess your health status, learn hot to maintain

health, address health risks before disease develops.

Mayo Clinic

Health Risk Assessment

Specifically trained cancer management nurses help

manage the clinical oncology experience

Matria

Cancer ManagementNationally-recognized facilities

offer expertise to deliver superior outcomes for serious conditions

Aetna and CIGNA

Centers of Excellence

Highly-trained nurses help participants manage

conditions where lifestyle choices influence outcomesMatria, Aetna, CIGNA,

Medco

Disease Management

Highly-trained nurses ensure individual gets care needed

Aetna and CIGNA

Health Advocate/24 RN Line

Learn how to stay healthy,Get good information,

Make informed choices Mayo Clinic

Health Portal

Specifically trained health coaches help individuals lose

weight and stop smokingASH

Healthyroads

CounselingMagellan

Life Assistance Resources

PARTNERS IN HEALTH

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PARTNERS IN HEALTH

Tool to assist employees assess health status, learn how to maintain health and address health risks before disease develops.

Health Risk Assessment

Programs in the areas of Obesity Management and Smoking Cessation will be introduced in 2008

Wellness

Special care for individuals in active cancer treatment to manage the medical and emotional side effects of living with and surviving cancer.

Cancer Care Management

For specific conditions requiring high-level knowledge, experience and expertise that is critical to a positive outcome, individuals and their care givers may be referred to a facility in another part of the country that is recognized for excellence in that specific medical area.

Centers of Excellence

For certain diseases, especially those where changing lifestyle habits can have a positive impact, a Disease Management nurse can provide ongoing education and guidance.

Disease Management

Highly experienced, licensed, registered nurses, specifically trained to work with individuals one-on-one and help them navigate through the health care system and make informed choices.

Health Advocates

Trained nurses provide answers to emergent health questions any time of day or night; make referrals to Health Advocates.

24 Hour Nurse Line

DescriptionProgram

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PARTNERS IN HEALTHHEALTH PORTAL• Customized website and Health Risk Appraisal

• Internet gateway to a world of reliable health care information

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Behavioral Health Program

Source: U.S. Department of Health & Human Services; 2004

Some last words…Supporting all our other health and productivity improvement efforts:

Behavioral Health Behavioral Health ProgramProgram

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Behavioral Health Program

According to the Employee Assistance ProfessionalAssociation of America, a well-run Employee Assistance Program (EAP) can reap an employer the following savings:

• 33% percent less use of sick leave benefits• 65% lowered incident of workplace accidents• 30 % deduction in worker’s compensation claims• 35% decrease in health insurance expenditures

The US Department of Labor has shown that for every dollar invested in an EAP, the employer saves five to sixteen dollars.

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PARTNERS IN HEALTHBEHAVIORAL HEALTH• Confidential, counseling services that

help individuals and their eligible family members work through challenges of life.

– Counseling– Work-Life issues– Financial Issues– Legal Issues– Emotional aspects of other health

problems

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Behavioral Health Program

ExxonMobil Employee Health Advisory Program includes:

– Telephonic Consultations (24/7) and Crisis Support

– Face to Face Counseling Sessions--short term problem resolution & referrals

– Management Consultation Support Services (Supervisory Referrals)

– Employee and Supervisory Worksite Trainings

– Critical Incident Stress Debriefing Sessions

– Program promotion (push e-mails, posters, wallet cards, website, health fairs)

– Legal and Financial Services

– Dependent Care Resources and Referrals (child to elder care)

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Behavioral Health Program

Managed Mental Health Program– Cross referrals between medical vendor and MH vendor– Co-manage cases with medical vendor with medical and mental

health diagnosis (example—heart disease with depression)– Intensive mental health case management with acute, chronic and

complex conditions (frequent contact up to 1 year with patient and family)

According to the National Institute of Mental Health, an estimated 17 million Americans experience serious depression each year. Patients with depression utilize significantly more health care services, leading to health care costs that can be twice as much as for those without depression.

Annual costs for lost productivity and absenteeism exceed $3,000 per employee with depression.

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Behavioral Health Program

AfterCare Program

– Structured relapse prevention counseling for employees in recovery from chemical dependency addiction for 2 year duration

– Company support through supervisor, MOHD and union representation

– Random drug testing for all cases and Supervisory addiction training

Alcohol and drug abuse has been estimated to cost American business

roughly 81 billion dollars in lost productivity in just one year - $37 billion

due to premature death and $44 billion due to illness.

Of these combined costs, 86 percent are attributed to drinking.

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Malaria Control Program

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Malaria Control Program

BACKGROUND• As personnel numbers increased in sub-Sahara Africa, we needed a Malaria

Control Program (MCP)

• In 2001, EM developedand implemented a comprehensive MCP based on A-B-C-Dstrategy:

A = AwarenessB = Bite PreventionC = Chemoprophylaxis

for non-immunesD = Diagnosis early

& treatment

GOALS• Zero malaria cases

in non-immunes• Zero serious malaria

cases/deaths in semi-immunes

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Adding Management Controls to Malaria Control Program

Despite intensive training efforts and the provision of effective anti-malarial medications as well as bite prevention supplies and vector control efforts, four malaria deaths occurred in Contractors providing services to EM

MALARIA CHEMOPROPHYLAXIS COMPLIANCE PROGRAM (MCCP)• Developed to address issues of non-compliance with chemoprophylaxis• Random urine testing program that seeks to verify the use of effective malaria

chemoprophylaxis by non-immune personnel in areas where required by EM• Required for all EM employees AND all contractors performing services for EM

in malarious areas

MALARIA VISA• Standard online training program using videos and content questions, repeated

annually, to ensure all personnel understand how to protect themselves from contracting potentially fatal falciparum malaria

• Non-immunes sign ‘Attestation Forms’ agreeing to random testing to verify compliance with anti-malarial medication requirements

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Malaria Control Program – Bite Prevention & Vector Control

MALARIA CONTROL OFFICERS MANAGE PROGRAM IMPLEMENTATION AND STEWARDSHIP

PERSONAL PROTECTION• Mosquito bite prevention with insecticide (DEET), permethrin treatment of

clothing, insecticide-treated bednets• Vector control utilizing basic public health measures, including use of indoor

residual spraying, reduction of standing water, etc.

EARLY DIAGNOSIS AND TREATMENT• Needs to be addressed in malarial areas with little remote access or limited

access to quality health care• Needs to be addressed in developed countries (US and Europe) where health

care providers are unfamiliar with diagnosing malaria and not equipped to provide rapid and effective treatment

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Summary of Presentation

• Brief Overview of ExxonMobil

• Examples of how Society of Behavioral Medicine interests are being applied

in the private sector

– Overview of ExxonMobil Medicine and Occupational Health

• Core Services, Areas of Focus and the Occupational Health Centers of Excellence

– Partners in Health: ExxonMobil’s comprehensive heath care strategy

– Malaria Control Program

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Questions ?

Questions ?

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