Healthy Lifestyles Tobacco Free

Well-Being Improvement Solution

Rev 5-15-15

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• Approximately 20% of the population smoke cigarettes1

• Tobacco use kills 440,000 Americans annually

Sources:1Center for Disease Control. Article Nov. 13, 2008 Smoking rate under 20% for the first time. 2CDC. Smoking-attributable mortality and years of potential life lost—United States, 1984. MMWR 1997;46:444—51. 3U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General

Market Overview

Business Impact of Smoking

Smoking causes at least 30% of cancer deaths1

Smokers account for $3,391 annually in sick time and health claims2

Nonsmokers exposed to secondhand smoke at home or work increase their heart disease risk by 25-30% and their lung cancer risk by 20-30%3

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Direct Medical Costs: Smokers versus Non-smokers

• Smokers cost on average $1,623 more per year in direct medical costs1

• Healthcare costs for smokers are 40% higher than those for non-smokers2

• Smokers have:• 7-15% more outpatient visits that non-smokers3

• 30-45% more hospital admissions than non-smokers3

• 75-100% more hospital days than non-smokers3

• More frequent and lengthier hospital visits4

• Longer recovery times from illness4

• Children of smokers use about four additional office visits per year5

• For every pack of cigarettes sold in 2004, approximately $5.31 was spent on smoking-related health care6

Sources:1CDC, MMWR 51(14): 300-3, 2002. 2Barendregt JJ, Bonneaux L, van der Maas PJ. The health care costs of smoking. The New England Journal of Medicine 1997;337:1052-1057 3Wagner EH, Curry SJ, Grothaus L, et al. The impact of smoking and quitting on health care use. Arch Intern Med 1995;155:1789-1795.) 4Penner M, Penner S. Excess insured health care costs from tobacco-Journal of 1990;32:521-3 tobacco using employees in a large group plan. Occupational Medicine 521523. 5Lesmes GR. Corporate healthcare costs and smoke-free environments. American Journal of Medicine 1992;93(Suppl1A):1A-48S. 6Centers for Disease Control. Sustaining State Programs for Tobacco Control: Data Highlights 2006.

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Why Healthy Lifestyles Tobacco Free

Healthy Lifestyles Tobacco Free is more than health and wellness. It’s a well-being improvement solution that focuses on physical, social and emotional behaviors that impact an individual’s total well-being, as well as associated medical costs, to drive lower costs and higher employee performance.

Healthy Lifestyles Tobacco Free is:

Designed to offer employees and their adult dependents the resources and guidance they need to become tobacco free and engaged in improving their lifestyle, changing behaviors and enhancing their well-being

Delivered on a revolutionary technology platform to support well-being improvement with a suite of integrated online, telephonic and on-site resources.

Supported by QuitNet • Founded in 1995 at Boston University.• In 2008, served more than 1.1 million users in all 50 states, 93% of all US counties

and 182 countries.• Servicing over 40 million covered lives in North America (Public Sector, Employers,

Health Plans).

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From Wellness to Well-Being

Traditional wellness programs have fallen short of their promise because of challenges related to:

• Driving sustained engagement

• Consistently creating behavior change

• Effectively proving the value

Healthy Lifestyles Tobacco Free meets these challenges by offering:• Multiple modalities to engage employee populations, including:

telephonic, online, live chat, email or onsite/in-person• Behavior change interventions delivered on a state-of-the-art platform

with the latest science (readiness to change, learning style, level of personal support and decisional balance), which recommends the appropriate behavior change approach based on a member’s psychographic profile

• High-quality delivery of personalized interventions

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The Well-Being Value Proposition

. . . to generate economic value . . .

Total Health Costs

Performance

. . . and relative national and local competitive advantage

from health investments

PhysicalHealth

MentalHealth

SocialHealth

Improve Well-Being

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COST GOES DOWN when overall well-being score goes up by 1 point.

PERFORMANCE GOES UP when overall well-being score goes up by 10%.

2.2% Reduction in likelihood of hospital admission 5% Fewer unscheduled

absences

1.7% Reduction in likelihood of emergency room visit 24% Lower presenteeism

1%Reduction in likelihood of incurring healthcare costs

5% Higher reported job performance

6% More days of ‘best work’ in a 28-day period

The value of improving Well-Being:

Source: “Evaluation of the Relationship Between Individual Well-Being and Future Health Care Utilization and Cost” Population Health Management, Volume 15, Number 00 2012. Patricia L. Harrison, MPH, James E. Pope, MD, Carter R. Coberley, PhD, and Elizabeth Y. Rula, PhD

Healthways Science of Center for Health Research. The Well-Being. 2011;12. Pages 5-6

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Healthy Lifestyles: Revolutionary

The enhanced Healthy Lifestyles Well-Being Improvement Solution:

• Expands member insight and impact with innovative, personal well-being plans

• Applies a consumer-centric model to engage and motivate

• Deeply embeds behavior change science into all interactions

• Leverages an integrated platform to drive and measure program success

Member Web Portal Tobacco Cessation Coaching

Marketing

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Online Support

System-FacilitatedWell-Being Plan

Engagement Marketing

Applying a consumer-centric model to engage and motivate

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• The primary risk behavior receives optimal tailoring

• Secondary risk behaviors receive stage-targeted guidance

• Evaluate progress by comparing prior stage and current stage

Healthy Lifestyles incorporates Pro-Change Behavior System’s* award-winning, cutting-edge strategies for simultaneously changing

multiple risk behaviors and minimizing participant demands.

Deeply embedding behaviorchange science into all interactions

*A behavior change model based on a member’s readiness to change.

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Leveraging an integrated platformto drive and measure program success

CommunityMailOnlineMobileWell-Being Assessment (WBA)

Reporting

Healthy Lifestyles

Well-Being Improvement Solution Design

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Healthy Lifestyles Tobacco Free Design Principles

• Move from health improvement to well-being improvement

• Improve ability to engage the member and sustain engagement

• Provide a personalized well-being plan to guide the member

• Allow for seamless integration across solution features

• Utilize most current behavior change science

• Provide the most effective outcome at the lowest cost intervention

• Enhance ability to demonstrate quantifiable value

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Well-Being Improvement Solution

Individualized Well-Being Plan:

Individualized Well-Being Plan

Personalization

Identification of Needs

Well-Being Assessment (WBA)

Outcomes

Lower Health Care Costs

Improved Health Status

Marketing Campaign and incentive strategies

Interventions

Online tools, trackers and resources, coaching for tobacco cessation

Prioritizes risks and suggests interventions based on the member’s readiness to change

Product Components:

Sustained Engagement Techniques:

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Integrated Solution

Healthy Lifestyles Tobacco Free provides an integrated member experience by:

Integrating with the Anthem Portal

• Members access Healthy Lifestyles through the Health and Wellness page

• Members have access to all of the resources on the Anthem Portal

Using the Well-Being Assessment (WBA)

• The WBA is the entry-point for the Healthy Lifestyles program

• The WBA drives the member online experience including the development of the Personal Well Being-Plan

• The WBA identifies members for telephonic tobacco cessation coaching

• The WBA results are available to the lifestyle coaches and the 360 health coaches

Referring members between lifestyle and disease management programs

• Members receive timely and appropriate support from the appropriate program and coach

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Healthy Lifestyles Tobacco Free Program Elements

• Well-Being Assessment (WBA)• Access to QuitNet• Risk stratification and engagement• Personalized lifestyle coaching for tobacco cessation• Nicotine Replacement Therapy (NRT) available for

purchase• Personalized well-being plan with additional online

tools, trackers and resources• Points-based rewards programs available:

1.Healthy Lifestyles points and rewards (default setting)

2.Anthem Health Rewards (available for purchase) offers incentives to members at the 3,000, 5,000 and 10,000 point thresholds

• Targeted marketing and promotion• Measurement and reporting • Account management support

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Healthy Lifestyles Points and Rewards Program

• Points-based rewards program available

• Program is based on incenting members for program participation to encourage them to reach milestones.

• Points can be redeemed online for health and wellness prizes, such as kitchen gadgets, fitness accessories, heart rate monitors and more.

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Healthy Lifestyles Points and RewardsA few ways members can earn reward points:

Point Earning Activity Points/Frequency

Complete the Well-Being Assessment 2,500 annually

Set up Well-Being Plan 500 annually

Track your weight 50 a week

Track your exercise, steps nutrition or food servings 1,000 every 90 days

Advance a focus area 250 annually

Make a journal entry 5 a day

Create an inspiration 150 three times a year

Use our resource centerEarn points when you watch a video, listen to a recording or read an article.

5 a day

• There are three point levels: 5,000, 10,000 and 15,000. • Rewards are redeemed from Healthy Lifestyles through the rewards catalog.

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Anthem Health Rewards OptionMembers earn points for completing the following activities:

Point Earning Activity Points/Frequency

Complete the Well-Being Assessment 2,500 annually

Set up Well-Being Plan 500 annually

Track your weight Earn points when you track your weight 10 times every 90 days.

500 every 90 days

Tracking activitiesEarn points when you track any two of the following at least 10 times: Tobacco cessation, food, exercise, servings and steps.

1,000 every 90 days

Advance a focus area 1,000 every90 days

Make a journal entry 10 a day

Create an inspiration 250 every90 days

Use our resource centerEarn points when you watch a video, listen to a recording or read an article.

10 a day

• Once members reach each of the 3,000, 5,000 and 10,000 point levels, they earn a reward from Anthem Health Rewards.

• Rewards are redeemed on the Anthem Health Rewards site.

Healthy Lifestyles

Online Integrated Platform

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Online Well-Being Improvement Solution

FEATURES

• Personalized member home page

• Self-improvement planning, including suggestions and goals to quit tobacco, manage stress, anxiety, exercise and nutrition

• Health and wellness practices, references, recipes and self-care tips for all family members

• Access to QuitNet, a comprehensive, Internet-based approach to tobacco cessation, including an online community of more than 1 million members

• Email and site reminders for vaccinations

• Online coaching from certified personal trainers, registered dieticians and accredited psychologists – all available to answer member questions

• Based on user input, integrated assessment data and behavior change science, the site presents tailored Well-Being Plans

Fully integrated platform designed specifically to support fitness, nutrition, tobacco cessation, preventative healthcare and other aspects of health and well-being

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Personal Well-Being Plan

• The Personal Well-Being Plan is received immediately after the individual registers and completes the WBA on the site

• Feedback prompts on-going use of the online member portal

• Each member is staged prior to starting an intervention using the Transtheoretical Model (Prochaska)

• WBA data is visible to health coaches

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Targeting Risk Behaviors for Improvement

When members set up their Well-Being Plan, they will choose up to three focus areas (one primary and two secondary). Members can select from the following focus areas:

Exercise & Fitness

Healthy Eating

Weight Management

Tobacco Cessation

Stress Management

Medication Adherence

Appointment Adherence

Depression Prevention

Self Care

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QuitNet Tools

• Access to QuitNet, the world’s largest “stop smoking” community – 10,000 new members every month!

• More than 15 years providing evidence-based web support

• Highly personalized content based on user’s Stage of Change

• Intensive social support from a global communityof quitters

• Online counseling by trained tobacco cessation specialists

• Quit medication selection and compliance support via Counselor

• Long-term relapse prevention with lifetime web support

Tobacco Free offers the most comprehensive, personalized smoking cessation program in the market.

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Visual Design Concept: Dashboard

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Well-Being Connect mobile app for iPhone, iPod Touch and Android

Once a member registers, the app can be downloaded to a mobile device to access Healthy Lifestyles to:

• Access their Well-Being Plan

• Track exercise, steps, food, calories, servings and more while on the go

• View messages and inspiration board

• Read group chatter and post new messages to groups

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Device Integration

The Healthy Lifestyles weight tracker, steps tracker and health record can sync with several wireless devices including:

• Fitbit Ultra, Fitbit One and Fitbit Zip

• Fitbit Aria Wi-Fi Smart Scale

• Withings Wi-Fi Body Scale

• Withings Blood Pressure Monitor

Health Coaching

Healthy Lifestyles

Health Coaching

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Health CoachingFEATURES

• Members that identify themselves as tobacco users stratify for the coaching program

• Team-based approach to maximize behavior change

• Tobacco cessation is a 5-call program focused on the member setting a quit date and then providing frequent support calls after the quit date

• Initial assessment includes individual data, learning style, readiness to change and level of social support

• Both coach and member working from Well-Being Plan

STRENGTHS

• Based on newest behavior change principles – focuses on tobacco cessation

• Utilizes motivational interviewing techniques

• Multiple modalities to increase engagement and outcomes: email, chat and telephone coaching

• Health professionals skilled in education, motivation, personal goal-setting and behavior change coaching

• Plus, online coaching is available for everyone. All members receive unlimited email access to a professional coach with specific expertise required to:

• Answer questions about exercise, diet or lifestyle

• Provide extra motivation and support

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Nicotine Replacement Therapy (NRT)

NRT is available for purchase as an additional component to Healthy Lifestyles Tobacco Free. The NRT medication platform offers the following benefits:

• Adding NRT enhances the quit rate when combined with effective behavioral support (web, phone, print, email).

• Glaxo provides NRT including PATCH, GUM, LOZENGE• Participant can order medication directly through their Health Coach

during a phone session. Coach will monitor compliance.• Our approach should not conflict with the client’s existing pharmacy

solution.• With effective and knowledgeable behavioral support, more employees

will use the NRT in the way that it was designed, making it more effective during cessation.

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Embedded Behavior Change

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updates

updates

Dynamic and Seamless

Member Web Portal

Coaching Application

Anthem nurses and coaches have access to confirm if a member is eligible for Healthy Lifestyles coaching.

Healthy Lifestyles coaches can also send a referral directly to an Anthem nurse or coach.

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Multi-Modality - Personalized Engagement

Member Web Portal

Telephonic(Coach)

Live Chat (Coach)

Email(pull to portal)

Healthy Lifestyles platform

Online modalities(groups, broadcastvideo events, etc.)

Healthy Lifestyles

Engagement Marketing

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Base Marketing

• Primary focus is the first 90 days

• Turn-key marketing program available via micro-site, which includes posters, emails and other marketing handouts

• Multi-modal communications to inform, mobilize and motivate members to follow through with healthy changes

• Marketing manager available to answer questions regarding micro-site

• Printed enrollment flyer

• Maintenance marketing including: system generated (e.g. engagement reminders) emails, seasonal emails, Did You Know? and Quick Tips

Healthy Lifestyles

Measurement and Reporting

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Standard Client Reports

QUARTERLY ACTIVITY REPORT

ANNUAL OUTCOMES REPORT

ANNUAL WBA REPORT*

• Provide population overview and program engagement

• Display identified risk profile and progress toward risk reduction

• Monitor program metrics

• Deliver comparative program utilization and engagement review and resulting savings

• Demonstrate net population risk reductions and related savings

• Utilize evolving science to provide conservative attribution of program benefits to performance: absenteeism, etc.

• Report provides employer overall Well-Being score and health risk summary

• Detailed overview of Well-Being Domains

• Utilizes comparative national data to assess health and disease impacts across Well-Being Domains

*Only available if client has WBA.

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Tobacco Free Outcomes

• Baseline: 3-5% of smokers nationally are able to quit cold turkey and recidivism compares to that of heroin addiction (95%)

• Tobacco Free (web only): 15% Intention to Quit and 20% Responder Quit Rate (based on survey responses – 78% response rate)

• Tobacco Free (Phone Coaching + NRT): 22-24% Intention to Quit with 35-37% Responder Quit Rate (based on survey responses – 75% response rate)

Success Rate SummaryQuitting Alone: 3-5%Behavioral Support: 20%Behavioral Support + NRT: 35%+

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Summary

Healthy Lifestyles Tobacco Free: • Actively engages individuals using multiple modalities and advanced

engagement• Leverages science and technology to change unhealthy behaviors and

promote positive ones• Provides access to QuitNet’s online tools, support groups and

resources• Tailors well-being plans, tools and trackers in the Member Web Portal

to each risk factor• Delivers value through long-term cost avoidance by reducing risks and

improving performance• We know that’s the key to success in well-being improvement!

The Healthy Lifestyles programs are administered by Healthways, Inc., an independent company.

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The Healthy Lifestyles programs are administered by Healthways, Inc., an independent company. © 2015 Healthways, Inc. All rights reserved. Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWi), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation (Compcare), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ®ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.

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