Identifying Needs

INSIGHTS IN WELL-BEING IMPROVEMENT

CREATE CHANGE SUSTAINED ENGAGEMENTS BEHAVIORS

DELIVER OUTCOMES

IDENTIFY NEEDS

Assesses well-being beyond physical health.

Our Well-Being Improvement Solution identies needs with deep foresight and preventive impact.

Views each person within a population from a complete perspective. Anticipates, prioritizes and prevents costly health events through predictive models.

Insights in Well-Being Improvement: Identifying Needs

Healthways guides well-being improvement across populations with deeper foresight, and more preventive impact, than other solution providers. We assess well-being beyond physical health and use sophisticated models to predict and prioritize costly health events that our interventions can prevent. OPPORTUNITY FOR IMPROVEMENT
Despite a proliferation of health and wellness programs, medical expenditures and chronic disease continue to rise. Evidence indicates a large-scale failure to contain the containable. Yet the potential for positive change is significant and measurable. In a 2010 study, Healthways Center for Health Research found nearly $1 trillion in healthcare costs could be saved over 10 years by reducing risks in the U.S. commercially insured population by 25%. Critical to containing the containable are solutions with sophisticated foresightsolutions that reduce healthcare demand by anticipating and intervening to improve well-being and stop or reduce preventable costs. Identifying needs is the first step in the process for wellbeing improvement. Traditional health programs have often failed to prevent costly disease by:

HEALTHWAYS APPROACH
Our Well-Being Improvement Solution uses proprietary tools that work in concert to identify improvement needs and determine appropriate support across the population:

Guiding improvement for every personincluding the healthiestwith a deep and comprehensive view of the social, emotional, and physical factors that influence well-being. Directing proactive outreach to the highest opportunities for well-being improvement individuals who are predicted to incur high health costs without intervention and who have health risks and gaps in care that Healthways interventions are designed to address.

MEASURING WELL-BEING
The Healthways Well-Being Assessment (WBA) provides a uniquely full view of the factors that influence healthcare costs, health risks, and human performance. The WBA advances the traditional health risk assessment (HRA):

Identifying needs too latefor example, offering diabetes management support to individuals with a diabetes diagnosis who are already complying with standards of care, while in the broader population, other individuals with risks for diabetes move toward chronic disease. Overlooking the interrelationships of risks, demographics, and other factors that influence well-being and ultimately impact medical costs and human performancereaching out only to address specific high risks, such as smoking or hypertension. Ignoring individuals without current indicators of disease or high risks.

Containing an assessment of health risks accredited by the National Committee on Quality Assurance and based on the research of Dee Edington, Director of the University of Michigans Health Management Research Center. For individuals and populations where biometric screening data is available, objective data can replace self-reported measures for BMI, blood pressure, cholesterol, etc.

 Addressing the six scientifically defined areas of well-being tracked in the Gallup-Healthways WellBeing Index:
Life evaluation, or overall outlook Emotional health Physical health Healthy behavior Work environment and quality Basic access to health and life resources

recommends obtaining objective biometric data from populations where feasible. Healthways can manage biometric screening for customer populations through established relationships with screening partners. Screenings include an abbreviated physical exam measuring height, weight, blood pressure, and BMI and a blood sample. Healthways follows a four-step event management process to ensure accurate and valuable results:

Providing a comprehensive view of public wellbeing in the United States since January 2008, the Gallup-Healthways Well-Being Index (WBI) amasses new data each day and has surpassed one million completed surveys. Because Well-Being Assessment measures can be matched against those in the WBI, Healthways can benchmark an organizations WBA results with current national data. The WBA includes the tested depression screening tool PHQ-2. Delivering additional insights on productivity and organizational cultureinfluences on absenteeism and presenteeism, based on the published research of Ronald Kessler, a professor of healthcare policy at Harvard Medical Center.
As part of our Well-Being Improvement Solution, Healthways administers the WBA annually to customer populations via the member web portal and on paper as needed.

Preparation Offering online scheduling to participants and providing detailed administrative information for customer contacts at the worksite Training Using trusted screening partners who train, certify, and retain individual examiners Fulfillment Ensuring standardized equipment and supplies, provided from a central source Site management Specifying pre-screening visits for lead examiners and sufficient staffing for positive participant experience
Our technology integrates screening results with other health data from the Well-Being Assessment. Healthways can also incorporate screening results from customer-selected providers. Resulting individual reports and an aggregate customer report provide a convenient and complete health picture.

Adding Biometric Screening

A random sample of 12,000 people completing both a health risk assessment and worksite biometric screening found that:

Evaluating Risk
Healthways uses WBA and screening data to identify the need for health coaching outreach within customer populations. An identification algorithm selects individuals for coaching interventions. Health risk, cost, and behavior change research and Healthways customer experience influence the rules used within the algorithm, which looks for:

74% did not know their levels of cholesterol, blood pressure, or body fat 42% more participants tested positive for nicotine than reported they smoked 33% reported good or excellent self-perception of health but unknowingly had three or more clinical risk factors 28% reported good eating habits but had dangerous blood fat levels3
To increase the accuracy and understanding of health risks and related improvement efforts, Healthways

Single risks with particularly high potential for future health complications and costs, such as extreme obesity Multiple moderate risks, such as a positive depression screening and suboptimal exercise

Insights in Well-Being Improvement: Identifying Needs

PREDICTING ADVERSE HEALTH EVENTS AND AVOIDABLE COSTS

To augment the WBA with a focus on identifying and applying resources to the most urgent needs, Healthways uses multiple neural network and clinical risk predictive models. We are consistently improving those models based on research, trends, and client data. With more than 30 years of customer experience, Healthways has one of the largest multi-terabyte healthcare outcomes data warehouses in the world. As a result, our predictive models are highly evolved. Healthways uses a matrix of predictive models on a quarterly basis within most customer populations. The models help identify not only who within the population is likely to experience high-cost health events within the next 12 months but whose costs are preventable who has risks or gaps in care that our solutions are designed to address. We integrate needs identification with the capabilities of our interventions, making the wisest use of health management resources. Models essentially find and screen the best opportunities for cost savings through health improvement, producing a prioritized ladder of individuals for outreach. The process gradually funnels opportunities by:

Screening for addressable risks and gaps in care. For example, individuals with: Previously diagnosed heart disease who are not on a statin No physician office visit in the last 12 months Prescriptions for more than 15 drug classes in the period Chest pain-related emergency room visits
The absence of addressable risks and gaps indicates that individuals are already receiving proper care and taking necessary steps to minimize health problems. Outreach to these individuals is less likely to provide care or cost benefits.

Finding Savingsand Helping People Overlooked by Old Methods

Traditional disease management programs look for intervention opportunities within narrow disease corridors, but these condition-specific approaches overlook 20 to 30% of the people who most need help. Healthways predictive models break out of disease silos. We find needs among people without current disease diagnoses and people with existing diagnoses who may be headed for a different chronic condition or event. The following four examples cut potential costs by nearly $60,000:

Analysis Analyzing 12 months of customer claims data, supplemented with age and gender information, and weighing more than 180 factors that give insight into utilization and clinical patterns to forecast highcost events. Indicators may include new outpatient diagnoses; a lack of compliance with certain standards of care; or prior-year inpatient stays. Integration Integrating predicted high-cost events with actionable codesmore than 400 distinct diagnosis codes indicating risks and conditions that Healthways solutions effectively address. (For example, hospitalizations for cancer surgery or childbirth can be anticipated but would not be actionable codes.)

Member A Data show unspecified chest pain, palpitations, high cholesterol, hypertension, shortness of breath, and carotid artery stenosis, treated in an inpatient stay. Interventions could prevent or delay progression to congestive heart failure and atrial fibrillation. Preventable inpatient costs: $10,000. Member B Data show evidence of cerebrovascular disease, peripheral artery disease, hypertension, back pain, and multiple emergency room visits for headaches and urinary tract infections. Interventions could help prevent sudden collapse and coronary artery disease. Preventable inpatient costs: $11,000. Member C Data show a diagnosis of chronic obstructive pulmonary disorder, high cholesterol, and recent outpatient visits for back pain and pneumonia. Interventions could prevent coronary artery disease

leading to a bypass graft. Preventable inpatient costs: $15,000.

Member D Data show asthma diagnosis and a recent blood clot, with outpatient, inpatient, and emergency room visits for coagulation disorders. Interventions could prevent a coronary event (acute myocardial infarction). Preventable inpatient costs: $23,000.

An algorithm using biometric screening and claims data can identify the presence of chronic conditions and initiate the delivery of standards-of-care information via low-cost delivery channels. Customers can add automated screening for additional clinical metrics, such as missing preventive tests and procedures.

INITIATING ACTION
Needs identified through our proprietary tools spark integrated preventive action at multiple levels: by individuals, Healthways professionals, and customer leadership.

Reflecting Customer Populations

Healthways customizes predictive models for particular populations. We have developed a predictive model for Medicare Advantage populations based on the interactions and impacts of risk factors on senior members. Also for senior populations, our end-oflife model can identify members at the highest risk of death in the coming 12 months and connect them with a unique intervention set that helps them think through and express their wishes about heroic measures and palliative care. For large health plans and employers, we may recommend customizing predictive models based on unique population patterns. Because our predictive models can be tuned to produce a ranked array of outreach opportunities, Healthways can work with each customer to determine strategies to optimize business objectives: return-on-investment, total savings, or other metrics. We typically perform a tailored opportunity analysis before solution implementation:

Educating and Focusing Individuals

Every person who completes a Well-Being Assessment receives a personalized results report providing a pointin-time snapshot of health and well-being. Reports call out areas that need attention using clear cues, colors, and symbols.

Identifying scores in each of the six areas of wellbeing as helping, hurting, or neutral to well-being and offering improvement tips. Displaying personal statistics and healthy targets (based on age and gender) for measurable risks and conditions including BMI, exercise, tobacco use, stress, depression, cholesterol, blood pressure, alcohol use, and medical conditions. Recommending immediate steps to action, based on healthy behaviors connected to an individuals risks and conditions.
Reports link to and prompt use of the member web portal, which guides each user to access and update a Personal Well-Being Plan, complete daily actions tailored to individual needs, and use relevant online resources. Comprehensive chronic condition selfmanagement tools are among the resources reached through the member portal. Even individuals with healthy scores in all aspects of the WBA will find personalized tips for well-being improvement on their assessment report and be encouraged to use a Personal Well-Being Plan to focus on specific behaviors to maintain good health.

Applying Healthways predictive models to customer data Presenting alternatives for population outreach, guided by model results Recommending an approach based on customer priorities and budget

Pinpointing Additional Needs

In addition to the high-priority needs identified through our predictive models, the Healthways Embrace technology platform supports real-time evaluation of new incoming data and initiates needed action. Hospitalization claims data may prompt outreach by Healthways professionals to prevent potential readmissions.

Insights in Well-Being Improvement: Identifying Needs

Informing Healthways Professionals

Healthways predictive models and assessment algorithms scientifically and cost-effectively identify high-opportunity health needs across large populations. Healthways health professionals take needs identification to the next level, supported by our technology platform and tools. A portal for Healthways professionals highlights an individuals identified areas of need and associated behaviors and provides access to all the rich content within each participants assessment and claims history. Questions and prompts help the professional to explore identified needs. Based on a greater understanding of individual situation and status, our health professionals may:

Additional Factors Reporting on additional factors that influence productivity: caregiver responsibilities, job overload, adequate training, technology issues, financial stress, and depression or anxiety. Organizational Risks Identifying the prevalence of 11 organizational risks, proven to increase healthcare costs and/or lost productivity by the University of Michigans Health Management Research Center. Summarizing Summarizing demographic data and the prevalence of 21 health conditions compared to national data. Where biometric screening data is available, objective measures can replace self-reported measures for BMI, blood pressure, cholesterol, etc.
By surveying people about the broader aspects of their lives that are known to affect health but are seldom taken into account, customers gain a more holistic, relevant perspective on health and well-being, and Healthways can recommend targeted measures to support improvement efforts across the population. Healthways can provide additional views of WBA data that shed light on variations within and across an organization, showing results by:

Focus interventions on new or related improvement needs. Move individuals out of proactive outreach programs. Extend a program of outreach for participants who need continued support to close high-priority gaps or reduce risks.

Providing Customer Organizations with Actionable Insights

Customers receive an aggregate WBA report that provides a clear sense of population well-being and its impact across the organization.

Division Location Job classification Other criteria

These results can help reveal barriers to well-being improvementleadership issues in a particular location, cultural or environmental differences in healthy habits, or disconnects between employee groups. Healthways can work with organizations to address specialized needs through program design and implementation.

Benchmarking Benchmarking aggregate scores in each of the six areas of well-being against national WBI data for the same survey period. Comparative performance better, worse, or the same as the benchmarkis clearly noted. Detailing Detailing aggregate responses to key questions within each well-being areafor example, levels of healthy eating and regular exercise within healthy behavior and job satisfaction and supervisor treatment within work environment.

A BETTER WAY
For greater impact across populations, wellbeing solutions must simply prevent more costs. Identifying needs is the first step in the process. Healthways proprietary toolspredictive models, algorithms, and the Well-Being Assessment support that process in the most effective possible way:

Enabling every member of the population to recognize, understand, and act on well-being improvement needs: optimizing care for those with health conditions; reducing and eliminating lifestyle risks; and sustaining good health. Equipping individuals, Healthways professionals, and customer organizations with complete, integrated information and clear guidanceconsidering factors beyond physical measures with significant influence on health and well-being. Accurately and efficiently forecasting highcost events. Focusing resources on the best opportunities to prevent those costsopportunities where Healthways interventions produce results.

REFERENCES
An Unhealthy America: The Economic Burden of Chronic Disease, Charting a New Course to Save Lives and Increase Productivity and Economic Growth, Milken Institute, October 2007. 2 Savings Potential from Prevention & Risk Reduction for the Commercially Insured, A Report from The Healthways Center for Health Research, May 2010. 3 Measuring the Success of the Healthways myHealthIQ Program, Healthways Center for Health Research, 2006.
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Identifying Needs
INSIGHTS IN WELL-BEING IMPROVEMENT

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