A fully-integrated health management solution that works for you

HealthyOutcomesmaternitycondition carecase managementwellness

For fully insured groups of 100 or more eligible employees

PAGE 2 of 12

Innovative ways to make a positive difference in your employees’ health What it isHealthy Outcomes combines four great programs into one valuable package that helps you keep your employees healthy – and your health care costs under control.1

+ Healthy Outcomes Wellness –our range of structured, virtually turnkey wellness programs1, 2

+ Healthy Outcomes Case Management –our personal outreach for high-risk individuals

+ Healthy Outcomes Condition Care –our disease management program

+ Healthy Outcomes Maternity –our program for expectant and new mothers3

Healthy employees, healthy companyHelp your employees live healthier, more productive lives while keeping your health care costs down with Blue Cross and Blue Shield of North Carolina’s (BCBSNC) Healthy Outcomes health management solution. The fact is that a healthier workforce can mean a healthier bottom line for your business. The direct and indirect costs of illness can really add up – that’s why BCBSNC provides solutions to help you curb these costs.

How can Healthy Outcomes support your employee health strategy?BCBSNC understands that your employees – and their families – have different needs according to their health conditions. And because the 4% of the population with chronic or complex conditions is driving 50% of total health care costs,4 being able to effectively target and focus health management efforts on the right individuals at the right time is important. Our sophisticated system identifies and targets:

+ Individuals with high-acuity needs, with intensive one-on-one interactions

+ Healthy individuals, with programs to maintain their current health.

Identifying those who need care - so we can work with them to get well.

For Every

100 Employees5

have cardiovascular disease

are asthmatic

are excessively overweight

are diabetic

25

8

34

11

use alcohol excessively

have high blood pressure

smoke

have high cholesterol

31

33

21

15

don’t wear seatbelts

don’t exercise

suffer from stress

20

33

44

HealthyOutcomesmaternitycondition carecase managementwellness

PAGE 3 of 12

4% of your population is driving 50% of costs4

A constant eye on your employees’ healthThrough our risk stratification process, we’re constantly monitoring your population to quickly identify individuals who may need attention. This helps to get people healthy and keep them healthy. And, it works to keep you and your employees’ health care costs down as well.

Risk StratificationParticipants re-stratified:+ Monthly based on claims+ Each time a Condition Care

Coach has an interactionwith the member

High RiskSpecialty Care &

Case Management

High/Moderate RiskCondition Care &

Utilization Management

Moderate/Low RiskLifestyle Risk

Reduction

Low RiskWellness Programs

& Services

Participant Acuity Level+ Acuity level assigned

by condition on amonthly basis

HighLow Moderate

Low

Moderate

High

+ Care Gaps+ Demographics+ Utilization+ Health Assessment+ Impact predictive

modeling rules

MemberEngagement

Risk Score& Profile

PredictiveModeling

Moving toward wellness

A new approach to health management: integrated, personalized, technology-enabled

HealthyOutcomesmaternitycondition carecase managementwellness

Improving health and wellness while keeping medical costs lowThe Healthy Outcomes programs work in concert with each other to help improve health and well-being. From innovative technology support for wellness programs, to disease management that covers five major chronic conditions, to comprehensive maternity management – Healthy Outcomes is a smart, effective way to help you keep your employees healthy, productive, and happy.

+Healthy Outcomes Wellness–ourrangeofstructured,virtuallyturnkeywellnessprograms1,2

+Healthy Outcomes Case Management –ourpersonaloutreachforhigh-riskindividuals

+Healthy Outcomes Condition Care–ourdiseasemanagementprogram

+Healthy Outcomes Maternity–ourprogramforexpectantandnewmothers3

PAGE 4 of 12

The Healthy Outcomes Health Management SolutionThe Healthy Outcomes Health Management Solution is fully integrated, supported by technology that allows providers across programs to access a single record per member.

WellnessHealth Portal

Health Assessment6

Online Education

Online Tracking

Wellness Incentive Tracking

Health Screenings7

Case ManagementComplex CareCatastrophic

Intensive Care

Condition CareAsthma

DiabetesCAD

Heart FailureCOPD

Maternity3

Maternity Management(for healthy and high

risk pregnancies)Postpartum Management

Depression Screening24/7 BabyLine®

Provider IntegrationPatient Care Summary

Physician Reports

Provider Engagement

Care Reminders

Member ServicesHealth Line BlueSM

Blue365® Discounts

Support,centered around

the member

PAGE 5 of 12

Research shows:

+ In3-5years,86%ofemployersexpecttohavesomekindofwellnessincentiveinplaceforemployees.8

+ 46%ofemployeeswillparticipateinabiometricscreeningfora$25giftcard.9

+ 85%ofemployeeswillparticipateinbiometricscreeningfor$500inpremiumreduction.9

We consolidate your employees’ data for you, giving you what you need to reward and motivate your employees.

Wellness: incentives drive behavior

DataEngine

Member completes activities and earns points toward their wellness plan goal

Activity Reporting

Health Assesment

+ Health Coach or user-reported data

+ Completion of online programs and challenges using the portal

+ Claims data

+ Biometric screening7

+ Health Assessment6

Employer rewards employees

+ Gift cards (incentive fulfillment available)

+ Cash

+ Premium contribution

+ HRA contribution

+ HSA contribution

+ Paid Time Off

+ And more11

Members check Portal to determine status10

Employer receives reporting to continually

motivate employees

PAGE 6 of 12

Making the experience personal The employee wellness experience is highly personalized, all beginning with the Health Assessment. Not only does this information serve as a baseline for your organization – it helps to customize the content delivered to an employee’s portal. For example, if an employee indicates they have asthma, our Healthy Living Program for managing asthma will be prioritized in the queue within their portal.

Actionable data to make decisions and drive behaviorAs part of Healthy Outcomes Wellness, you get detailed reporting that helps you reward employees the way you want – and helps you motivate employees to achieve their wellness goals. Imagine having access to reports that can help you develop countless, creative ways to reward your employees. It’s something you can really use to drive healthy behavior in your organization.

A wellness plan for every employer – from basic to robustHealthy Outcomes Wellness is a suite of 11 structured, virtually turnkey options, designed with input from market research and built to grow with your company. Whatever your organization’s size or industry, we’ll help you choose the right option. Each plan features:

+ Defined employee wellness goals

+ Detailed, actionable reporting for employers – so you can track employee progress

+ Integrated wellness tracking, with wellness goal data gathered from claims data, wellness portal activity completion data, health screening7 data, Health Assessment6 reporting data, and health coaching or employee reported data

+ A personalized Healthy Outcomes Portal, where employees can complete activities and track progress towards wellness goals you’ve chosen for them.10 The portal also features useful tools including fitness & meal planners, newsletters, a medical encyclopedia and much more

+ Rewards the way you want them: use your detailed reporting to reward employees – or let BCBSNC handle incentive fulfillment for you2

Wellness Plans

Core Series

Ideal for organizations just beginning to establish a wellness program or looking to supplement and formalize an existing program. It’s a way to introduce the Health Assessment to your employees and show them that their wellness is important to you.

Achiever Series

Adds more activities and builds on the Core Series. Achiever provides more complete programs that can really help create greater employee engagement and help build a company culture of health and wellness.

Coach Series

Adds a layer of accountability and health coaching that creates a highly engaging wellness program. You can choose to use biometric measures to help drive – and reward – healthy behaviors among employees.

PAGE 7 of 12

PAGE 8 of 12

Healthy Outcomes Case ManagementWith Healthy Outcomes Case Management, we identify employees who may need one-on-one attention for high-risk behaviors and conditions – and offer specialized services that can help them better manage their health, avoid complications and additional expenses, and reach health goals faster.

BCBSNC regularly analyzes member claims to identify those who might benefit from Case Management – for example, if our data shows a member is taking multiple medications and seeing several doctors, or when we identify gaps in care for a high-risk individual, Case Management helps the member take control. Members with high-risk conditions such as heart disease, diabetes, cancer, or stroke can benefit from the support, navigation, and coordination our Case Managers provide.

Here’s how Case Management works:

+ Health conditions are measured by a 360-degree clinical view and risk score assigned to the member based on his or her data.

+ A case manager or engagement specialist (depending on the complexity of the health condition) makes the initial contact with the member.

+ Employees complete a Member Health Survey or other assessment, giving the case manager information to create a customized care plan.

Proactively identifying and helping employees who need one-on-one attention means fewer claims - and savings for you. Case Management makes a difference.

Impact of Case Management

Case Management: Personalized attention, specialized services

maternitycondition carecase managementwellness

HealthyOutcomes

$2.37PMPM

savings13

ER Visits per 1,000 by Claims End Month11

Comparable

Months in Study

9/0811/

081/

093/09

5/097/

099/09

11/09

1/10

3/105/10

7/10

1000

900

800

700

600

Num

ber

of E

R V

isit

s

Case Managed

Provider engagementThrough provider engagement, BCBSNC makes sure that the member is receiving an optimal level of treatment – and that the care process is seamless. Our integration with providers through Care Reminders and the Patient Care Summary help to ensure that members receive appropriate attention through various channels. Healthy Outcomes programs are also designed for full integration with providers and practices who are a part of a Patient-Centered Medical Home (PCMH).

PAGE 9 of 12

Healthy Outcomes Condition Care provides:+ Integrationacrossthespectrumofcare+ Enhancedreporting

+ Robustremotein-homemonitoring

+ Communication

▪ n Member▪ n Provider▪ n ConditionCareCoach

+ Spanishprogramavailable

+ Customizedprogrambasedonobjectiveinformationandpatientself-reporteddata

+ Robustdiseasemanagementandmaternityonlineportal3

Disease management powered by data and technologyHealthyOutcomesConditionCareisBCBSNC’sdiseasemanagement(DM)program14.ConditionCarehelpsindividualswithchronicconditionslivethelivesthey’dliketolive.Oursophisticatedidentificationandsegmentationenginedrawsfromawealthofsourcesofmemberdatatosegmentandstratifyinividualsforcare–whichallowsustomakesuretheygetintotheprogrammostappropriatefortheiruniqueneeds.

Theprogramoffersaninnovative,integratedapproachtoDM,onethatoffersadedicatedConditionCareCoachtopartnerwiththememberandhealthcareprovider–bringingneededhelpandpeaceofmind.Memberscanreceive:

+ Supportformanagingtheircondition

+ Educationandresources

+ Coordinatedcarefrommultipleproviders

ConditionCarecentersonarangeoffivechronicconditions:

+ CoronaryArteryDisease(CAD)+ HeartFailure+ ChronicObstructivePulmonaryDisease(COPD)+ Asthma+ Diabetes

Using technology to bring care home to the patient

Condition Care Delivery Model

Condition Care: Our disease management is different

Condition

Technology

In-homeMonitoring

Heart Failure

COPD

Diabetes

DayLink® Monitor

DayLink Monitor

Electronic Scale

DayLink Monitor

GlucometerInformation < < < < < < Biometric

dat

a

Participant

All supported by a “safety-net” of timely care gap identification and closure including HEDIS measures

Condition Care Coach Physician

+ Remote in-home monitoring, where appropriate

+ Lab & medication monitoring

+ Education & goal setting+ Healthy Outcomes

Portal+ 24/7 nurse support

+ RN Interaction+ Teachable moments+ Comprehensive clinical

assessment+ Individualized care plans+ Care Gap closure+ Participant education &

empowerment throughgoal setting

+ Medication compliance & adherence monitoring

+ Monitoring byexperienced RNs

+ Timely, actionableprovider reporting

+ Care reminders+ Calls from Condition

Care Coach where appropriate

PAGE 10 of 12

Maternity management helps healthy mothers have healthy babies

Did you know? Every year in the United States:

+ 875,000 woman experience one or morepregnancy complications

15

+ 458,952 babies are born to mothers withoutadequate prenatal care

15

+ 467,201 babies are born prematurely15

+ 307,030 babies are born with Low Birth Weight15

Quality care for pregnant women and new mothersQuality health care during and after pregnancy is important. Healthy Outcomes Maternity16 is a maternity management program for both healthy and high-risk pregnancies. The program offers a variety of assessments to make sure women are getting the right care during pregnancy. And, it offers tools to help women get the support they need, when they need it, to support maternal and child health. Features include:

+ Obstetric risk assessments

+ Postpartum depression screening

+ 24/7 BabyLine® – a dedicated maternity nurse line where pregnant women and new mothers can get their questions answered by specialized nurses anytime, day or night

+ Text4BabySM – a mobile information service, which provides pregnant women and new moms with information to help them care for their health and give their babies the best possible start in life. Women who sign up for the service receive free SMS text messages17 each week, timed to their baby’s due date.

Maternity: Quality care, before and after the big day3

maternitycondition carecase managementwellness

HealthyOutcomes

aboutour

Program+ We provide multiple touchpoints

throughout pregnancy.

+ A dedicated maternity nurse line is included, to provide specialized support to expectant mothers.

+ Highest risk members are referred to Healthy Outcomes Case Management for ongoing monitoring/management.

+ We accomodate both English andSpanish languages.

PAGE 11 of 12

The benefits of Health Line BlueHealth Line Blue is our 24/7 nurse line — powered by technology that lets nurses quickly and easily access member information.

+ Single view of the member record providing a seamless experience n All program nurses work off the same clinical system which

houses a single, comprehensive record for each member n Healthy Outcomes case managers also have access to

Health Line Blue call details+ More meaningful modes of interaction with members

Via phone Chat

+ Communication with member’s primary doctor

+ Guidance with finding the most cost-effective providers

Answers to questions 24/7 with Health Line BlueHealth Line Blue helps members get assistance fast whenever they have a health concern. Day or night, members can call Health Line Blue and speak to a specially trained nurse immediately – offering peace of mind and convenient support.

How Health Line Blue can help:

+ Tips on symptom relief at home+ Guidance on finding immediate medical care in urgent situations+ Answering questions about overall health

The registered nurses at Health Line Blue can answer medical questions on almost any health care issue or treatment – often helping your employees save time and money. And theHealth Line Blue nurses offer support in either English or Spanish.

Health Line Blue is your first line against rising health care costs. One call can help employees find the most appropriate, most cost-effective resolution to a health care issue.

Answers to health concerns, 24/7

Retail Clinics Urgent Care ER

$ $$$$$

$$$$

Chart is for illustrative purposes only

Healthy Outcomes can help you improve your employees’ health and wellness – while helping keep your health care costs low. Call your authorized agent or BCBSNC representative to see all the benefits that Healthy Outcomes can offer you, your employees, and your company.

PAGE 12 of 12

A dedicated team working hard for you

Findout

more

BCBSNC offers Healthy Outcomes programs as a convenience to aid members in improving their health; results are not guaranteed. BCBSNC contracts with Alere Health Improvement Company, an independent third party vendor, for the provision of certain aspects of Healthy Outcomes programs and is not liable in any way for goods or services received from Alere. BCBSNC reserves the right to discontinue or change Healthy Outcomes programs at any time. The programs are educational in nature, and are intended to help members make informed decisions about their health, and to help members comply with their doctor’s plan of care. Decisions regarding care should be made with the advice of a doctor.

1) Healthy Outcomes Wellness is available for members who elect BCBSNC coverage from groups with 51 or more eligible employees. Dependent eligibility in the wellness program is determined by the employer. 2) Employer remains responsible for designing the rewards component and funding the incentive fulfillment. 3) Healthy Outcomes Maternity program is separate and apart from any maternity benefits. Members should consult their benefit booklet with regard to any medical benefits relating to maternity. 4) BCBSNC Internal Data, claims incurred from 3/2011 - 2/2012 for 100+ commercial group. 5) Department of Health and Human Services, 2011. 6) The Health Assessment is provided by Blue Cross and Blue Shield of North Carolina (BCBSNC) through an association with Alere. The purpose of this Health Assessment is to provide members with information to assist in maintaining and improving their health. Participation in this survey and any follow-up contacts based on individual results is completely voluntary. In filling out this survey, members will be disclosing Protected Health Information (PHI) that is protected by Federal and State law and will be protected as described in the “Notice of Privacy Practices” provided at enrollment or in their benefit booklet. Survey results will be shared with Alere and BCBSNC to provide additional health plan services and programs for members. Individual survey results will not be used to establish insurance coverage rates, eligibility for coverage, or employment decisions. Information will only be shared with employers for wellness program administration, incentive tracking and clinic administration purposes, upon employer request. 7) In order for the biometric screening component to be integrated, Group must contract directly with a BCBSNC preferred vendor who will bill Employer directly. 8) Aon Hewitt 2011 Health Care Survey. 9) PricewaterhouseCoopers Health Research Institute: What employers want from health insurers in 2010: Better information, more value. 10) Not all wellness plans feature online tracking for employees. 11) Please consult with your tax advisor and attorney to ensure that your rewards program complies with all applicable laws and regulations. 12) BCBSNC Internal Data. Case Management report comparing 2008 through 2010 engagement rates, December 2010. 13) BCBSNC Internal Date. Employer Dashboard Reporting. January 2011. 14) All programs, except Asthma, are for those 18 years or older. 15) http://www.americanpregnancy.org/main/statistics.html, accessed June 7, 2012. 16) Females aged 18 and older who are currently pregnant are eligible to enroll in the program. 17) Individual data plan charges from your wireless carrier may apply.

The cross, the shield and Blue365 are registered marks of the Blue Cross and Blue Shield Association. SM Service Mark of the Blue Cross and Blue Shield Association. All other marks are the property of their respective owners. blue Cross and blue Shield of north Carolina is an independent licensee of the blue Cross and blue Shield association. U8187, 7/12

Client Management

+ Responsible for overall account management+ Financial and health improvement goals+ Renewal activity+ Utilization and clinical reporting

Client Engagement+ Certified Corporate Wellness Coaches+ Strategy and execution of health care programs+ Administrative resources and service reporting

Health Care Management

+ Data analysis and recommendations+ Health and wellness strategy development & monitoring+ Overall health policy and management

Member Support+ Benefits and claims customer service + Health Line Blue 24/7 Nurse Line+ Member Services online or via mobile