WORKSITE WELLNESS FROM MAKING THE CASE TO MEASURING

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WORKSITE WELLNESS FROM MAKING THE CASE TO MEASURING THE RETURN Proprietary & Confidential |

WORKSITE WELLNESS FROM MAKING THE CASE TO MEASURING THE RETURN Proprietary & Confidential | Trotter Wellness® | Copyright © 2012 | All Rights Reserved

TODAY’S PRESENTATION Why Wellness? Keys to Success Required Program Components ROI Case Studies Proprietary

TODAY’S PRESENTATION Why Wellness? Keys to Success Required Program Components ROI Case Studies Proprietary & Confidential | Trotter Wellness® | Copyright © 2012 | All Rights Reserved

HEALTHCARE COSTS ARE RISING If food prices had risen at the same rates as

HEALTHCARE COSTS ARE RISING If food prices had risen at the same rates as medical inflation since the 1930 s, we would be paying an astronomical amount for common grocery items. One Dozen Eggs $80. 20 One Roll of Toilet Tissue $24. 20 One Dozen Oranges $107. 90 One Pound of Butter $102. 07 One Pound of Bacon $122. 48 One Pound of Coffee $64. 17 Source: American Institute for Preventive Medicine, 2007. Proprietary & Confidential | Trotter Wellness® | Copyright © 2012 | All Rights Reserved

COST PER RISK FACTOR Added healthcare costs an individual could incur each year if

COST PER RISK FACTOR Added healthcare costs an individual could incur each year if he/she had one or more of the listed risk factors. Source: Health Affairs 2012: Ten Modifiable Health Risk Factors Are Linked to More than One-Fifth of Employer-Employee Health Care Spending, Goetzel et al. Based on 2009 data. . Proprietary & Confidential | Trotter Wellness® | Copyright © 2012 | All Rights Reserved

POTENTIAL OPPORTUNITY FOR HEALTHCARE SAVINGS Participants in the caution, high risk category cost an

POTENTIAL OPPORTUNITY FOR HEALTHCARE SAVINGS Participants in the caution, high risk category cost an average of 208% more than those in the excellent category per claim paid. OVERALL WELLNESS SCORE $5, 000 $4, 304 $4, 000 $3, 000 $2, 620 $2, 068 $2, 119 Excellent (80 -100) Doing Well (60 -79) $2, 000 $1, 000 $0 Needs Improving (20 -59) Caution, High Risk (< 20) Proprietary & Confidential | Trotter Wellness® | Copyright © 2012 | All Rights Reserved

HEART DISEASE AND STROKES Heart disease is the number one leading cause of death.

HEART DISEASE AND STROKES Heart disease is the number one leading cause of death. Strokes is the third leading cause of death. Estimated total annual medical expenditures. - $148 billion for heart disease - $37 billion for strokes Many of the risk factors can be prevented, modified or controlled including high blood pressure, high cholesterol, excess weight, nutrition and physical activity. Proprietary & Confidential | Trotter Wellness® | Copyright © 2012 | All Rights Reserved

POTENTIAL OPPORTUNITY FOR HEALTHCARE SAVINGS Participants with two or more preventable health risks cost

POTENTIAL OPPORTUNITY FOR HEALTHCARE SAVINGS Participants with two or more preventable health risks cost an average of 371% more than those with zero to one preventable health risks. PREVENTABLE HEALTH RISKS $10, 000 $7, 964 $8, 000 $6, 488 $5, 739 $6, 000 $4, 000 $2, 000 $1, 955 $1, 671 Zero Risk 1 Risk $0 2 to 3 Risks 4 to 5 Risks 6+ Risks Proprietary & Confidential | Trotter Wellness® | Copyright © 2012 | All Rights Reserved

OBESITY National Obesity Trends - About ⅓ of U. S. adults (33. 8%) are

OBESITY National Obesity Trends - About ⅓ of U. S. adults (33. 8%) are obese. - Approximately 17% (or 12. 5 million) of children and adolescents aged 2 through 19 years are obese. - Data from the National Health and Examination Survey (NHANES) Trends by State 1990 – 2010 - During the past 20 years, there has been a dramatic increase in obesity in the United States and rates remain high. In 2010, no state had a prevalence of obesity less than 20%. Thirty-six states had a prevalence of 25% or more; 12 of these states (Alabama, Arkansas, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Oklahoma, South Carolina, Tennessee, Texas, and West Virginia) had a prevalence of 30% or more. Proprietary & Confidential | Trotter Wellness® | Copyright © 2012 | All Rights Reserved

OBESITY TRENDS AMONG U. S. ADULTS BRFSS, 1990 Proprietary & Confidential | Trotter Wellness®

OBESITY TRENDS AMONG U. S. ADULTS BRFSS, 1990 Proprietary & Confidential | Trotter Wellness® | Copyright © 2012 | All Rights Reserved

OBESITY TRENDS AMONG U. S. ADULTS BRFSS, 1995 Proprietary & Confidential | Trotter Wellness®

OBESITY TRENDS AMONG U. S. ADULTS BRFSS, 1995 Proprietary & Confidential | Trotter Wellness® | Copyright © 2012 | All Rights Reserved

OBESITY TRENDS AMONG U. S. ADULTS BRFSS, 2000 Proprietary & Confidential | Trotter Wellness®

OBESITY TRENDS AMONG U. S. ADULTS BRFSS, 2000 Proprietary & Confidential | Trotter Wellness® | Copyright © 2012 | All Rights Reserved

OBESITY TRENDS AMONG U. S. ADULTS BRFSS, 2005 Proprietary & Confidential | Trotter Wellness®

OBESITY TRENDS AMONG U. S. ADULTS BRFSS, 2005 Proprietary & Confidential | Trotter Wellness® | Copyright © 2012 | All Rights Reserved

OBESITY TRENDS AMONG U. S. ADULTS BRFSS, 2010 Proprietary & Confidential | Trotter Wellness®

OBESITY TRENDS AMONG U. S. ADULTS BRFSS, 2010 Proprietary & Confidential | Trotter Wellness® | Copyright © 2012 | All Rights Reserved

THE COSTS OF LOST PRODUCTIVITY Employers, on average, have $3 of health related productivity

THE COSTS OF LOST PRODUCTIVITY Employers, on average, have $3 of health related productivity costs for every $1 of medical or pharmacy claims costs. - Source: Journal of Occupational & Environmental Medicine, July 2007 Lost productivity represents 7. 9% of total corporate earnings and 5. 3% of human capital costs. - Source: Health and Human Capital Foundation Proprietary & Confidential | Trotter Wellness® | Copyright © 2012 | All Rights Reserved

THE IMPACT ON WORKERS’ COMPENSATION A greater than 8 -fold difference in Workers’ Compensation

THE IMPACT ON WORKERS’ COMPENSATION A greater than 8 -fold difference in Workers’ Compensation costs between recommended weight and obese workers. - Duke University A 7 -fold difference in Workers’ Compensation costs between high and low risk workers. - University of Michigan Obese claims are 2. 8 times more expensive than non-obese claims at the 12 -month maturity. The cost difference climbs to a factor of 4. 5 times at the three year maturity and to 5. 3 at the five year maturity. - National Council on Compensation Insurance (NCCI), 2009 Proprietary & Confidential | Trotter Wellness® | Copyright © 2012 | All Rights Reserved

RECAP THE “WHY” Healthier Workforce Reduced Workers’ Compensation Costs Reduced Health Claim Costs Increased

RECAP THE “WHY” Healthier Workforce Reduced Workers’ Compensation Costs Reduced Health Claim Costs Increased Productivity Reduced Sick Time Proprietary & Confidential | Trotter Wellness® | Copyright © 2012 | All Rights Reserved

WORKSITE WELLNESS FROM MAKING THE CASE TO MEASURING THE RETURN KEY COMPONENTS FOR ROI

WORKSITE WELLNESS FROM MAKING THE CASE TO MEASURING THE RETURN KEY COMPONENTS FOR ROI Proprietary & Confidential | Trotter Wellness® | Copyright © 2012 | All Rights Reserved

Why Wellness Proprietary & Confidential Trotter Wellness® Copyright © 2013 All Rights Reserved

Why Wellness Proprietary & Confidential Trotter Wellness® Copyright © 2013 All Rights Reserved

THE FOCUS POPULATION HEALTH CARE RESOURCES ($) 18% 80% Well (40% Alleged Well) 25%

THE FOCUS POPULATION HEALTH CARE RESOURCES ($) 18% 80% Well (40% Alleged Well) 25% 33% 14% Episodic 5% Chronic 1% Catastrophic 24% Proprietary & Confidential | Trotter Wellness® | Copyright © 2012 | All Rights Reserved

KEY SUCCESS FACTORS Leadership Message and Participation Total Population Participation Incentives Communications and Logistics

KEY SUCCESS FACTORS Leadership Message and Participation Total Population Participation Incentives Communications and Logistics Yearlong Program and Cultural Change Long Term Programming & Goals Measurements Proprietary & Confidential | Trotter Wellness® | Copyright © 2012 | All Rights Reserved

COMPREHENSIVE WELLNESS PROGRAM COMPONENTS Logistics Health Risk Assessment (HRA) Health Coaching Biometrics Online Tools

COMPREHENSIVE WELLNESS PROGRAM COMPONENTS Logistics Health Risk Assessment (HRA) Health Coaching Biometrics Online Tools and Interventions Yearlong Programming Reporting and Measurements GOAL: Healthier Employees and Lower Costs Proprietary & Confidential | Trotter Wellness® | Copyright © 2012 | All Rights Reserved

INCENTIVE PLANNING Critical to obtaining a return on investment for the client. Proper incentives

INCENTIVE PLANNING Critical to obtaining a return on investment for the client. Proper incentives drive program critical participation. Must fit the culture of the organization. Communicates the importance and value of the initiative. Proprietary & Confidential | Trotter Wellness® | Copyright © 2012 | All Rights Reserved

WORKSITE WELLNESS FROM MAKING THE CASE TO MEASURING THE RETURN RESULTS Proprietary & Confidential

WORKSITE WELLNESS FROM MAKING THE CASE TO MEASURING THE RETURN RESULTS Proprietary & Confidential | Trotter Wellness® | Copyright © 2012 | All Rights Reserved

COMPARISON RESULTS OVER 1 ST 24 MONTHS PERCENT AT RISK 100% 90% 80% 70%

COMPARISON RESULTS OVER 1 ST 24 MONTHS PERCENT AT RISK 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Initial HRA End of Year 1 End of Year 2 Fitness 78% 75% 68% BMI 78% 64% 63% Smoking 22% 21% 20% Hypertension Pre Hypertension 10% 39% 6% 37% 3% 35% Cholesterol 46% 43% 41% Nutrition 89% 85% 74% Pre Diabetes 17% 16% 7% Proprietary & Confidential | Trotter Wellness® | Copyright © 2012 | All Rights Reserved

Sample Results: Aspen Equipment ü A leading installer of truck mounted cranes in the

Sample Results: Aspen Equipment ü A leading installer of truck mounted cranes in the Midwest ü Specializing in crane rental, light truck uplifting, equipment rental and snow plow installation ü Small Employer: <100 employees ü Leadership backed wellness initiative ü Employees and Spouses Proprietary & Confidential Trotter Wellness® Copyright © 2013 All Rights Reserved

Aspen Equipment: Program Incentives ü Members were required to participate in the events listed

Aspen Equipment: Program Incentives ü Members were required to participate in the events listed below for a quarterly benefit credit towards medical premium; $75 Single ($300 Annual) / $150 Couple ($600 Annual) • • Biometric Screening Completion of a Health Risk Assessment Participation in quarterly Health Coaching sessions Set and achieve. Participation a minimum. Results of one action or maintenance health goal Participants HRA Participation Enrolled Completed Percentage Year 1 93 81 87% Year 2 84 66 79% Year 3 73 64 88% Proprietary & Confidential Trotter Wellness® Copyright © 2013 All Rights Reserved

Aspen Equipment: Behavior Change Year 3 Results 25% improvement in fitness-related risk 11% improvement

Aspen Equipment: Behavior Change Year 3 Results 25% improvement in fitness-related risk 11% improvement in cancer-related risk 8% improvement in nutrition-related risk ü $4. 63 : $1 ROI 18% Change in Overall Wellness Score Year 1: 38% at Risk Year 2: 24% at Risk Year 3: 20% at Risk Proprietary & Confidential Trotter Wellness® Copyright © 2013 All Rights Reserved

Aspen: Health Risk Reduction Proprietary & Confidential Trotter Wellness® Copyright © 2013 All Rights

Aspen: Health Risk Reduction Proprietary & Confidential Trotter Wellness® Copyright © 2013 All Rights Reserved

Sample Results: Waupaca Foundry ü Largest producer of gray, ductile, and compacted graphite iron

Sample Results: Waupaca Foundry ü Largest producer of gray, ductile, and compacted graphite iron in the world ü Leadership backed wellness initiative ü Implemented in all sites, spouses and retirees ü Alignment of benefit plan design, health risk reduction strategies and health coaching support Proprietary & Confidential Trotter Wellness® Copyright © 2013 All Rights Reserved

Sample Results: Waupaca Foundry ü $75 per month incentive ($900 per year) benefit credit

Sample Results: Waupaca Foundry ü $75 per month incentive ($900 per year) benefit credit towards medical premium ü Program Requirements: ü Biometric Screening ü Health Risk Assessment ü 2 Health Coaching Sessions ü Choice: Annual Physical or 3 rd Health Coaching Session Proprietary & Confidential Trotter Wellness® Copyright © 2013 All Rights Reserved

Sample Results: Waupaca Foundry ü Year 5 Results ü 89% Participation ü 9 Point

Sample Results: Waupaca Foundry ü Year 5 Results ü 89% Participation ü 9 Point improvement on Overall Wellness Score ü 37% improvement in fitness-related risk ü 34% improvement in cancer-related risk ü 17% improvement in nutrition-related risk ü $16 : $1 ROI Proprietary & Confidential Trotter Wellness® Copyright © 2013 All Rights Reserved

Waupaca Foundry Case Study Proprietary & Confidential | Trotter Wellness® | Copyright © 2012

Waupaca Foundry Case Study Proprietary & Confidential | Trotter Wellness® | Copyright © 2012 | All Rights Reserved

FUNDING YOUR PROGRAM Participation is key for wellness program success. Incentives in excess of

FUNDING YOUR PROGRAM Participation is key for wellness program success. Incentives in excess of $500 annually normally drives 80% or greater participation. Most popular incentive is a differentiation in premium contribution with non participants paying more for benefits. The non participants can fund your program cost. Wellness Program Cost Analysis Sample Program Optimal Health™ Program $129 Total Employees 300 Total Annual Cost $38, 700 Annual Premium Incentive (Penalty) $20 per paycheck incentive for meeting minimum requirements for “Active Participation” $520 Assume 80% participation | 20% pay penalty (60) 31, 200 Net Annual Program Cost $7, 500 Proprietary & Confidential | Trotter Wellness® | Copyright © 2012 | All Rights Reserved

WORKSITE WELLNESS FROM MAKING THE CASE TO MEASURING THE RETURN QUESTIONS Proprietary & Confidential

WORKSITE WELLNESS FROM MAKING THE CASE TO MEASURING THE RETURN QUESTIONS Proprietary & Confidential | Trotter Wellness® | Copyright © 2012 | All Rights Reserved