anthem lumenos plans— a health plan that is part of the solution

Anthem Lumenos Plans—A Health Plan that is Part of the Solution

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The health of your business depends on the health of your employees. It’s an investment you make every day.

Anthem's suite of Lumenos® consumer-driven health plan (CDHP) products provides a completely new approach to better health care management – one that promotes healthier behaviors and encourages and supports consumer decision making.

Good Employee Health is Good for Business.

Why Employers Consider CDHPs

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Why Are Employers Considering CDHPs?

• Introduce consumerism • Want employees to have a better understanding

of the cost of care

• Offer employees more choice• Improve the quality of care• Improve employee health• Improve employee satisfaction• Offer employees opportunity to lower tax burden• Increased employee contribution levels• Long-term and retirement savings• Manage medical costs through better employee health

To Reduce Costs We Need to Understand What Drives the Increase

• Health Behaviors• Ineffective Care• Inefficient Care

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Source: Milliman Medical Index 2006

Health Behavior Costs: $6,69150% of total medical spending

Employee Behaviors: 50-70% of Health Care Costs

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62% of the rise in private insurance costs from 1987-2002 was due to population risk factors and their treatment

The Medical Cost of the “Big 3”

• Average 10% of total claims costs attributable to obesity

• 60% of Americans exceed ideal BMI

• Soon to become the leading cause of death

• Average 10% of total claims costs attributable to tobacco

• 25% of Americans smoke

• Leading cause of death...Still

• 60% perform no substantial activity or exercise

Source: Thorpe, et al, Health Affairs, June 2005

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What Does This Mean For The Average Company?

Target $50M per year(avg company of 10,000 employees)

Focus on behaviorchange, not just benefits

Return to bottom line rapidly by impacting absenteeism, disability, turnover, etc.

Decreases costs within 18 months

Reduces total employee costs(total fringe)

Strategically Addressing Challenges

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The 3-Step approach to better health care management

Reduce Risk Factors & Improve Effective Care

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Reduce Risk Factors& Improve Effective Care

• Start with a sound clinical strategy• A consumer-focused health improvement strategy to

make it easier for employees to take proactive stepstoward healthier behaviors and better care • Support with helpful tools to create educated consumers

• Back it up with account-based CDHPs• Giving consumers more control and rewards for improved health

behaviors and health care decisions

• Support through a bold, ongoing communications approach/ marketing program• Provide a sequence of communications to educate and build

enthusiasm

Start with Sound Clinical Strategy

Incentive-based Health Improvement

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• Provide rewards for updating or completing health risk assessment

• 80% completion goal

Identify, improve risk and care

Incentive-based Strategy

• Take optimal care of the sick

• Engage population to understand& reduce risks

• Provide incentives to complete risk reduction programs

• Maintain low risk group to a minimum of 70%

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Risk Factors Reduction

Risk factors include:• Smoking• Physical inactivity• BMI• Alcohol drug use• Job/personal dissatisfaction

Source: D.W. Edington Research GM-UAW LifeSteps Health Promotion Program

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Annual medical costs by health risk level and age

Health Risks Predict Medical Costs

Source: StayWell data analyzed by University of Michigan

High Risk

Medium Risk

Low Risk

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• $50 reward* for online completion (limited to one reward per family each year)

• $200 reward* for graduating from a health coaching program (limited to one reward per eligible family member each year)

• Goals achieved with knowledge, skills and functional provider-patient relationship

• $100 reward* for enrollment for each eligible family member

• Participation in health coaching programs• Engaging with health coach to identify goals; and

understand and manage their health condition

Identify, improve risk and care

Incentive-based Strategy

IdentifyMyHealth

Assessment

EngageHealth Coaching

Participation

EngageHealth Coaching

Completion

*Rewards may be allocations to account or, for fully-insured HSA plans, credit dollars to redeem for gift cards to select health-focused retailers.

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Tobacco- Free Program

Where to Begin – Healthy Lifestyles Programs


• $50 reward* for successful completion (available for employee and spouse; limited to one/lifetime)

• Counseling calls with tobacco treatment specialist

• Individualized plan, decision support for pharmacotherapy and nicotine replacement fulfillment

• Individualized coaching and support via phone, and ongoing access to online resources

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Where to Begin – Healthy Lifestyles Programs

Healthy Weight Program

• $50 reward* for successful completion (available for employee and spouse; limited to one/lifetime)

• Telephone course sessions address diet and healthy eating, physical activity and exercise, stress management, maintenance and relapse prevention

• Phone counseling facilitated by a registered dietitian or health educator

• Includes educational materials appropriate for consumer’s specific needs


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Six- to nine-month partnership

Engagement & Graduation – Health Coaching

• Assess medical history, medications, review of systems, lifestyle behaviors, depression screen

• Educate about disease/condition

• Compare treatment plan with current guidelines

• Clarify patient’s belief and value system

• Assess self-management motivation and capability

• Specify principal care physician and next appointment

• Create support and adoption of self-management plan

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Incentive Status Participation Average (Range)Health Coaching Enrollment Book of Business Full Replacement

Incentive 3% 6.5%

No Incentive 1% 2.8%

Increased Health Coaching Enrollment 3X (up to 6X)

Results are from historical Lumenos client data. Data is not yet available to show participation averages for the current Anthem program.

Health Coaching Enrollment Results

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Self & Health Assessment Referral = Early Behavior Change

“engaged consumers”Lumenos 2005 = 47% (with incentives)

Healt

hA

ssess

ment

2002 No Incentives

2003 HRA Incentive Only

2004 Integrated Incentives

2005 Integrated IncentivesSelf

Cust

om

er

Serv

ice

Pro

vid

er

Ris

k Scr

een

Hosp

ital

Per

cen

tag

e o

f H

C E

nro

llees

Referral Source

Source: Results from Lumenos book of business 2002-2004

Health Coaching Enrollment

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Health Coaching Programs

Examples of conditions supported:• Asthma • Cancer • Congestive Obstructive Pulmonary Disease (COPD) • Coronary Artery Disease • Diabetes (Type I, II) • Heart Failure • Hypertension • Hyperlipidemia • Low Back Pain • Maternity

Back It Up With Account-based CDHPs

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Clinically Appropriate Plan Design

• Preventive care• Coverage for nationally recommended

preventive care services

• Health account• Health account should be sufficient

for many people

• Out-of-pocket responsibility• The amount consumer pays to satisfy their

remaining deductible after health account funds are exhausted

• Traditional health plan coverage• Coinsurance and annual

out-of-pocket protection

Sample Plan Design

Traditional Health Coverage

Health Account

and/or

Rewards

Preventive Care

Out-of-Pocket deductible to Traditional Health Coverage

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Types of Lumenos Plans

• Health Reimbursement Account (HRA)

• Health Incentive Account Plus (HIA Plus)

• Health Savings Account (HSA)

• Health Incentive Account (HIA)

Anthem's Lumenos HRA, HIA and HIA Plus Plans

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Anthem's Lumenos HRA Plan

• Consumers use employer-funded HRA dollars

to pay for covered expenses

• Earn more dollars for their HRA through

rewards for healthy behaviors

• Preventive services are covered at 100%

• Unused HRA dollars roll over from year to

year and can be used for future health care

expenses

• Traditional Health Coverage covers expenses

after the deductible


HRA

Funded by annual employer allocation

Plus

Additional reward dollars

Preventive Care100% In-Network


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Anthem's Lumenos HIA Plus Plan

• Works like an HRA, except the account allocations are provided by Anthem as a part of the health plan

• Consumers earn more dollars for their HIA through rewards for healthy behaviors

• Preventive services are covered at 100%• Unused account dollars roll over from year to

year • Traditional Health Coverage covers expenses

after the deductible

HIA Plus

Funded by annual plan allocation

Plus

Additional reward dollars




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Anthem's Lumenos HIA Plan

• Companion product to introduce elements of

consumerism

• Can replace an existing PPO offering with

a similar PPO plan design

• Has the added benefit of financial rewards for

healthy behaviors

• Includes Traditional Health Coverage to cover

expenses after deductible

• Also includes all of the tools, services and

programs to encourage and reward positive

consumer behaviorTraditional Health

Coverage

HIA

Funded by reward dollars



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Sample HRA/HIA Plus Consumer Experience Pharmacy Service

1) Consumer visits pharmacy to fill a prescription

2) Pharmacy connects to Anthem to determine consumer’s benefit and funds available

3) Anthem determines consumer’s benefits and HRA funds available “real-time”

4) Anthem debits consumer’s HRA and pays pharmacy for the prescription

5) Pharmacy provides consumer with prescription.

Consumer pays nothing out of pocket.

$

Rx

Rx

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1) Consumer visits physician

2) Physician submits claim to Anthem

3) Anthem determines consumer’s benefits and HRA funds available

4) Anthem applies benefit and debits consumer’s HRA then pays physician for the services

5) Anthem sends consumer Claims Recap record of benefit applied and account funds used

$

$

Sample HRA/HIA Plus Consumer Experience Physician Service

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Integrated Plans

• Employer product set-up: One combined health plan and HRA

employer application (no additional paperwork)

• Consumer enrollment: One combined health plan and member

application (no additional paperwork)

• Direct payment from plan to providers and pharmacy

• Customer service: Customer Service Advocate can assist with all

benefit information as well as health account service

• Consumer portal: Consumers go to anthem.com for both their

benefit and plan details

Anthem's Lumenos HSA Plan

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What is Drawing Employers to HSA Plans?

Most requested features include:• Preventive benefits covered before the deductible is satisfied• Condition management services

(asthma, diabetes, CAD/CHF, etc.)• Online access to health education tools• Online access to account information/personal health records• Access to health care cost information• Access to hospital/physician quality information

Anthem’s Lumenos HSA Plans include all of these highly requested features!

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Anthem's Lumenos HSA Plan

• Consumers can fund their HSA with pre-tax dollars and can use funds for health care expenses

• Employers can also contribute to employees’ HSAs

• Additional dollars earned with rewards for healthy behaviors*

• Preventive services are covered at 100%• Includes Traditional Health Coverage to

cover expenses after the deductible


HSA

Funded by annual employee and/or

employer contributions

Plus

Additional funds available through rewards

(optional)




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Rewards

Allocations to HSA

• Reward dollars earned are deposited directly into the consumer’s HSA

• Reward allocations are tax-free to the employee, so amounts count toward the annual HSA contribution limit

• Use like any HSA funds – tax-free if used for qualified medical expenses

Rewards may be allocations to account or, for fully-insured HSA plans, credit dollars to redeem for gift cards to select health-focused retailers.

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HSA Integration with Partner Bank

• Employer product set-up• One combined health plan and HSA employer application

• Consumer enrollment• One combined health plan and HSA consumer application

• Employer funding implementation• Plan-based resources and partner bank resources that will

support employers’ efforts to facilitate payroll-based funding• Customer service

• Customer Service Advocate can assist with all benefit information, level 1 HSA account service, and warm-transfers to partner bank for level 2 support

• Consumer portal• Consumers will come to anthem.com for both their benefit

and HSA details• HSA consumer communications

• Consumers will receive all of their benefit and banking enrollment materials from Anthem

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Sample HSA Consumer Experience Pharmacy Service

1) Consumer visits pharmacy to fill a

prescription

2) Pharmacy connects to

Anthem to determine consumer’s benefit

3) Anthem determines consumer’s benefits “real-time” and passes back to pharmacy the amount the consumer is responsible for paying

4) Pharmacy provides

consumer with prescription and charges the appropriate amount

5) Consumer uses HSA checkbook or debit card to access HSA funds and pay pharmacy

Rx

$ Rx

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1) Consumer visits physician

2) Physician submits claim

to Anthem

3) Anthem applies benefits and notifies physician of the amount the consumer is responsible for paying

5) Physician sends bill to consumer

6) Consumer uses HSA checkbook or debit card to access HSA funds to pay physician

4) Anthem sends consumer Claims Recap record of benefit applied

$

$

Sample HSA Consumer Experience Physician Service

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Offerings and Product Approaches

Full suite of CDHP options allows for personalized strategies for employers

• Single Lumenos CDHP offering

• Multiple CDHP pairings – for example, HRA or HSA paired

with HIA to replace (transition from) existing PPO

• Lumenos CDHP offered alongside a non-CDHP

Consumer Support

Online Health Site

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Online Health Tools

View your coverage, doctors and prescriptions – without a single click

Easily access health services to help improve your life – and those around you

Provide access to your health information for loved ones

Quickly find doctors and facilities in-network – and see which ones are best

View complex information through simple charts, graphs and illustrations

Get a side-by-side view of your claims and benefits

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Integrated view of benefits and claims for subscriber and their dependents for each plan

Single click for additional eligibility and benefits information

Immediate access to claims with ability to filter by family member

Ability to sort claims by date of service, provider, total charges, member responsibility and more

Convenient combined view of benefits & claims

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Side-by-side comparison of credentials – education, awards and more

Single click for maps and directions

Link to doctor’s website if available

Detailed cost & quality information in the doctor’s profile, including Zagat Health Survey where available

A simple way to find the best doctor or facility

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Symptom Checker

MyHealth Assessment

MyHealth Record

Health Trackers

Healthy Lifestyles

Condition Centers

WebMD Articles

360° HEALTH® TOOLS

Convenient tools that improve member health

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Online MyHealth Assessment

Consumer Advocacy:High-touch Service

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Enhanced Consumer Experience

• Customer Service Advocates provide high touch service - • Every touch point is an opportunity to educate

• Dedicated service centers for consumers• Customer Service Advocates with in-depth

Lumenos plan knowledge

• Single point of contact for consumer• Plan and account information

• Monthly Status/Claim Recap – combining benefits and account status information

• Web experience

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Sample Monthly Status and Claim Recap

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Enhanced Consumer Experience

• Integration with PBM• Point of sale processing for integrated medical/Rx deductible helps

ensure accuracy

• Integration with providers• Direct pay model for HIA, HRA and HIA Plus products

• Integration with preferred partner bank• Simplified service and account administration for HSA

Support with Bold, Ongoing Marketing and Communication CampaignMore than just an enrollment event!

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True, long-lasting changein our employees’ personalbeliefs and actions occurs

only when a consistentsupport system is provided.

The Cultural Imperative

• Current health plans focus on employees when they are “sick”… little to no focus is placed on the true “health” of the employee

• Programs should support and protect long-term investment in employees

• Employees spend a majority of their day with the Company… we can potentially impact their health behaviors quicker than other avenues

• The impact of employee health is far-reaching

to include:• Total benefit costs

(medical, disability, workers’ comp)• Productivity• Employee morale• Corporate results

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Open Enrollment Communications Strategy

The following strategies will help consumers understand our Lumenos plans and their appeal:

Preparation – presentations to senior leadership and HR, building the case for change and delivering the solution

Announcement/Awareness – announce the change, show the importance of the change and the value to the employee

Education – inform and build comprehension through repetitive communications, utilizing easy-to-understand examples

Employee Buy-In – face-to-face interaction to drive the message throughout the organization and deal with concerns

Enrollment – provide enrollment support via phone and online

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Consumer Driven PlanPre-Enrollment Communication Timeline

Presentations to key management

Communication from leadership to all employees on new benefits strategy

Week 3

Pre-Enrollment Awareness/ Education Phase

Train-the-Trainer: Presentations to HR and Sr. Leadership

Week 1 Pre-Enrollment Preparation Phase

Week 2Pre-Enrollment Announcement/Awareness Phase

“Did You Know”poster series begins

Week 4

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Sample Consumer Driven Plan Pre-Enrollment Communication Timeline

2 Weeks Prior to Go LiveWeek 5 & 6Pre-EnrollmentEducate/ Buy-In Phase

Week 7 & 8Open Enrollment

Distribution ofOE Packet•Consumer brochure•Plan Summary•FAQs•Case Studies•Preventive Care flyer or guidelines

• Employee Seminars• Webcasts

• OE Meetings

ID CardNew Customer Getting Started Guide

• Welcome Kit (HSA Only)

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Lumenos Communication Lessons Learned

Initiate communication with employees early and often. Timeline will vary based on size of employer group and/or clients goals for CDH enrollment.

• E-mail/Direct Mail• Internet• Seminars/Cafeteria Fairs/Webinars

Organizational commitment from management• HR and senior managers must be viewed by employees

as committed to plan• Education/training for benefits staff• Support to answer questions • Finalize benefit design early

CDHP is a new concept with a new language• Engage and commit to education and communication

with employees

Why Anthem Lumenos Plans?

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• Proven results• Consumer centric health improvement model• Best in class products• Network breadth and discounts give consumers more

for their health care dollars• Comprehensive communication and engagement• Consumer advocacy• Total integration for seamless consumer experience

Why Anthem?

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• 53% report increased knowledge in managing health care• 36% report that they are more actively involved in health-related behaviors • 20% of consumers said their health has actually improved since enrolling in a Lumenos plan

•Reduction in overall pharmacy costs by 15% • 92% generic drug substitution•Reduced outpatient visits by 18%

Source: Results from Lumenos book of business 2005

• Increase in preventive care spent (CDHP = 5% of total medical expenses v. 2-3% for rest of market)

Positive Results

When coupled with the right clinical strategy

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We can help lead your business and employees to better health.

We deliver measurable results and real value – right now and long term.

Let’s get started.

Good Employee Health is Good for Business.

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Legal Disclaimer

Anthem Blue Cross and Blue Shield is the trade name for the following: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. In Connecticut: Anthem Health Plans, Inc. In Georgia, Blue Cross and Blue Shield of Georgia, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Company in Ohio. In Virginia: Anthem Health Plans of Virginia, Inc. (serving Virginia excluding the city of Fairfax, the town of Vienna and the area east of State Route 123.) In Missouri: RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and certain affiliates administer non-HMO benefits underwritten by HALIC. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Wisconsin: Blue Cross Blue Shield of Wisconsin (“BCBSWi”) underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation (“Compcare”) underwrites or administers the HMO policies; and Compcare and BCBSWi collectively underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ® Anthem, Lumenos and 360°Health are registered trademarks. Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.

anthem lumenos plans— a health plan that is part of the solution

Documents

health care costs

better employee health

effective care slide

health behavior costs

better health care management

health affairs

health risk assessment

good employee health