Been There Done ThatNow What Where Weve Been

Been There, Done That…Now What? Where We’ve Been and What’s Next in Healthcare Brought to you by ADP® Presented by ACAP Health

Today’s Speakers John A. Haslinger, Vice President NAS Marketing-Benefits , ADP Wally Gomaa, President ACAP Health The material and any accompanying remarks are provided for informational purposes only and nothing contained in either should be taken as legal opinion, legal advice or a comprehensive compliance review. The ADP Logo and ADP are registered trademarks of ADP, Inc. All other registered trademarks are the property of their respective owners. 032011© 2011 ADP, Inc.

Key Market Trends

Range of Health and Wellness Programs and Services Emerging Services Extended Health and Wellness Engagement & Incentives HR Benefit Assistance Pharmacy Benefit Managers There a vast number of wellness programs and services focusing on the prevention of illness or injury Continued expansion is expected Health Information Databases Wellness and Risk Reduction Analytics and Prediction Health Risk Assessments Onsite Health Services Web Portal • Personal health records • Healthy Workplace Health • Educational content • Health Fairs • Self mgt tools (tracking, etc. ) • Onsite RN / Coaching Plans • Online programs • Biometric Screenings Consultative Services Health Coaching • Program Development (e. g. Fitness • Lifestyle risk modification programs, Campaigns, etc. ) Behavioral Health & Employee Assistance (e. g. smoking cessation, Health Advocacyweight mgt, etc. ) • Health guides / navigation support Content & Education Peer to Peer Programs Health Information Tracking

The Wellness Continuum Prevention & Risk Management Lifestyle Information § Fitness (e. g. Yoga) § Travel § Personal Care § Nutrition § Entertainment § Elective Procedures § Alternative Medicine § Vision / Dental § Home Products (e. g. , air/water filtration) § PHR § Web Portals & Communities § Decision support (e. g. , physician finder, symptom checker) § Books / Magazines § Forums § Educational content & information Screening § Health Risk Assessments § Health & Productivity Assessment § Worksite Screening § Drug Screening § Disease Screening Chronic and Disease Management Coaching & Education Immunizations § Childhood § Travel § Seasonal § § § § HPV Diphtheria Hepatitis A Hepatitis B Yellow Fever Shingles … § Weight Loss / Nutrition § Smoking Cessation § Fitness § Maternal Health § Stress Mgmt § Incentive Programs § Field-based Health Education § Lifestyle Behavior Note: On-Site Health Clinics can typically provide services and offerings across multiple segments of this taxonomy Disease Management § One-on-one Patient Counseling § Call Center § Patient Care Alert § Online Progress Tracking § Provider Directory § Benefits Assist. § Reporting § § Care Management Terminal/ High Risk Healthy/ Low Risk Wellness Market End of Life Care § Specialized § Hospice call center Centers § Home Monitoring Services § Durable Medical Equip. § Ambulance Transportation § Atrial Fibrillation Asthma § Decubitus Coronary Disease Ulcers Pulmonary § Fibromyalgia Disease § Hepatitis C Diabetes

Organizations Offer Financial Incentives for Participation and Use Multiple Wellness Programs

Wellness as an Engagement Lever Both Employers and Employees Agree That Wellness Programs Are Effective q Improving productivity • 48% of employers who offer wellness programs say they are effective at improving productivity 1 • 57% of employees who participate in wellness programs say the programs are effective at improving productivity 1 q Employees who participate in wellness programs report greater success than those who don’t participate in • Get regular checkups: 89%1 • Weight loss: 84%1 • Increased exercise: 84%1 • Manage blood pressure: 81%1 • Manage cholesterol: 81%1 Employees take advantage of wellness opportunities 2 q 79% of employees take advantage of health-related educational tools and resources when offered by employer q 77% participate in blood sugar and cholesterol screening q Engaged by opportunity to • Improve overall physical health • Lower personal health care costs • Obtain incentives or rewards for participating Sources: 1. Met. Life 8 th Annual Study of Employee Benefits Trends, 2010 2. 2010 Job Satisfaction Survey, Society for Human Resource Management (SHRM)

Been There, Done That…Now What? Where We’ve Been & What’s Next in Healthcare Presented by: Wally H. Gomaa, MHA / MBA President ACAP Health Consulting, LLC (214) 363 -4433 wgomaa@acaphealth. com May 2011

Where We’ve Been Property ACAP Health Consulting, LLC Not for Distribution

Healthcare Cost Source: OECD Health Data 2009 KFF, 2008 US News & World Report, 2005 Property ACAP Health Consulting, LLC Not for Distribution

Healthcare Cost & Obesity Source: OECD Health Data 2009 KFF, 2008 US News & World Report, 2005 Property ACAP Health Consulting, LLC Not for Distribution

Healthcare Cost Obesity & Sugar! 110 lbs Property ACAP Health Consulting, LLC Not for Distribution 205 lbs

Where We’ve Been Source: World Health Organization Property ACAP Health Consulting, LLC Not for Distribution

Where We’ve Been Source: World Health Organization Property ACAP Health Consulting, LLC Not for Distribution

What’s Next? Future Disease “Production” Slowing the “production” of NEW disease is the ONLY sustainable way to flatten the trajectory of healthcare trends. Property ACAP Health Consulting, LLC Not for Distribution

Where We’ve Been Are Traditional Wellness Programs Working? • Employers’ average weight has increased each of the past 4 years • The average weight has increased from 178. 2 to 194. 6 since 2005 • The average employee BMI is considered obese as considered by the Centers for Disease Control Property ACAP Health Consulting, LLC Not for Distribution

Where We’ve Been Are Traditional Wellness Programs Working? • Elevated glucose risk is steadily increasing • This pattern was closely correlated to diabetes incidence & related claims Property ACAP Health Consulting, LLC Not for Distribution

Where We’ve Been Financial Impact of Diabetes • Traditional approach • Diabetes disease management program • “Loss Control” approach • Shut down the factory • The majority of new diabetics are Type II • Type II diabetes is almost completely avoidable Annual Medical Claims Healthy vs. Diabetic $ 22 512 $ 25 000 $ 20 000 $ 15 000 $ 10 000 $ 5 000 $ 1 721 $Property ACAP Health Consulting, LLC Not for Distribution Avg yrly cost for healthy employee Avg yrly cost for diabetic employee

What’s Next? “Clinical Improvement” Programs A small percentage of claimants drive the majority of paid claims each plan year Claimants* Claims* Majority of next years “Red” group will come from those with no previous claim risks Property ACAP Health Consulting, LLC Not for Distribution

What’s Next? Metabolic Syndrome Programs Property ACAP Health Consulting, LLC Not for Distribution

Property ACAP Health Consulting, LLC Not for Distribution

Alzheimer’s Cataracts Sleep Apnea Breast Cancer Heart Attack Gall Bladder Disease Nonalcoholic Fatty Liver Disease Pancreatitis Pancreas Cancer Diabetes Depression Stroke Retinopathy Esophagus Cancer Cardiovascular Disease Congestive Heart Failure Hypertension Pulmonary Disease Colorectal Cancer Kidney Disease/Cancer Erectile Dysfunction Ovarian Cancer Gynecological Abnormalities Urinary Tract Cancer Psoriasis Arthritis Gout Endometrial Cancer Non-Hodgkins Lymphoma Leukemia

Metabolic Syndrome: Impact on Mortality Rate (%) Without metabolic syndrome With metabolic syndrome Isomaa B et al. Diabetes Care. 2001; 24: 683 -689. Property ACAP Health Consulting, LLC Not for Distribution

Clinical Met. S Reversal Age • Naturally Slim 10 -week behavior change program delivered via distance learning technology • 40+% percent reversal rate of metabolic syndrome lab values • Average weight loss of 10+ pounds over the 10 week program • 100% of fees tied to clinical lab improvement Property ACAP Health Consulting, LLC Not for Distribution

Clinical Lab Improvement- 10 Weeks Property ACAP Health Consulting, LLC Not for Distribution

Diabetes Risk Reduction- Clinical Property ACAP Health Consulting, LLC Not for Distribution

Impact on Hypertensive Risk Property ACAP Health Consulting, LLC Not for Distribution

Impact on Obesity Risk Property ACAP Health Consulting, LLC Not for Distribution

Longitudinal Weight Loss Data (18 to 60 months post graduation) Property ACAP Health Consulting, LLC Not for Distribution

Sample Employer Medical Utilization N ≈ 7, 000 Lives • Sample employer participants reported a 29. 9% reduction in Rx dosage / therapies • Sample employer has seen consistent reduction in hospitalizations Property ACAP Health Consulting, LLC Not for Distribution Confidential-Not for Distribution

Sample Employer Medical Trend N ≈ 7, 000 Lives Property ACAP Health Consulting, LLC Not for Distribution Confidential-Not for Distribution

Program Graduation Rate & Engagement Property ACAP Health Consulting, LLC Not for Distribution

How Did Sample Company Achieve Those Results? – Naturally Slim was developed based on observing how True Thins are able to eat what they want and yet maintain a healthy weight & normal biometrics – Non-macronutrient approach produced substantially better long term results – Leverages principles of endocrinology and how the brain chemically responds to food stimulus – Delivered at an utilizing a proprietary modeled behavior design – 10 -week curriculum of approx. 1 hour per week of “class” time delivered through an e -learning platform with an Alumni program and “refresher” program – 100 percent performance guarantee based on lab improvement and weight loss Property ACAP Health Consulting, LLC Not for Distribution

For More Information For more information on Payroll, Benefits Administration, Tax and Compliance, or 401 K visit www. adp. com For more information on Wellness, contact info@acaphealth. com or visit www. naturallyslim. com

Question and Answer If you haven’t done so already, please submit your questions through the question tab on your screen.

Thank You A recording of this webinar will be posted on ADP. com/healthcare and on HR. com’s archives within 24 to 48 hours. This program, ORG-PROGRAM-86367, has been approved for 1 (General) recertification credit hour toward PHR, SPHR and GPHR recertification through the HR Certification Institute. Please be sure to note the program ID number (PROGRAM-86367) on your recertification application form. For more information about certification or recertification, please visit the HR Certification Institute website at www. hrci. org. Future Health Care Reform and Benefits Management webinar dates and other helpful information will be published on adp. com/healthcare.