Click to edit Master title stylePositive Trends Shaping the Future

of Employer Health Plans

January 2012© 2012 All Rights Reserved

Click to edit Master title styleEvolving Priorities

Key Trends Affecting Benefits in 2012 and Beyond

3

Leadership/Executive Level Priorities

• “That is so 2010, so 2011!” – Managing risk– Investments– Talent

• Focus shift continuing in 2012 – Talent Management– Leaders continue to change their Talent Management strategy

• What can, and what should, be done

– Emerging concern is growth – Attracting staff with the right skills

• More work with governmental and educational systems to recruit• Recruiting & integrating young employees

– Retention• Increased use of non-financial rewards • Development opportunities for workers to reach full potential

4

HR/Thought Leader Priorities

• #1 Challenge: Showing employees they are valued while dealing with health care reform

• 36% shifted more health plan costs to employees– 22% continue to shift – 18% are redesigning– On-going with Health Reform

• 25% of HR professionals still have a reduced HR staff• Top Concerns

– Managing benefit costs– Increasing employee engagement– Retaining quality employees

• 80% agree – A “caring employer” is important to attract and retain workers – Financially secure employees are more productive

5

Indicators of Growth & Reactions

• Jobs outlook– Conclusions from latest January reports and

identifiable trends

• Private Sector Shifts– 90% of CEOs expect sales to improve

• Most optimistic since 2002

– Mergers & Acquisitions on upswing

• Mood shift

6

Employee Attraction & Retention

• High Percentages of Employees Want Different Jobs– Why a New Employer is Viewed as Desirable

• Shifts in Particular Segments• Employers Should Develop Retention Strategies• Role of Demographics

– Younger – Seasoned

Click to edit Master title styleConnecting with the New Workforce

Will Technology Make Social and Work Lives Collide?

8

Generational Communications

Baby Boomers

Generation XGeneration Y

Tail-EndersPaper

Web-based

Text

Communication

Strategy

9

Making the Connection

• Who is the Target?• Generational Breakouts

– Very young– Millennials– Gen X– Tail End Boomers– Aging Boomers

• How to Connect with Millennials– What stereotypes can we assume about the Millennials?

• Connecting with Technology Natives vs. Non-Natives

Click to edit Master title styleBenefits Communication Focus

How are Plan Sponsors Communicating More Effectively?

11

“Health Care Literacy”

• Concept Defined• 50% of U.S. population has limited health care literacy

– Consider how to engage your audience • Experts say to focus on “Why?” or “How?” Messages

– Very, very ill people need the most assistance• Illness impairs our normal rational thought processes

– Cost to system • $106 billion to $238 billion annually

– Examples• Unnecessary care, misunderstood Rx, etc.

12

“Health Care Literacy” Study

• Study recommends– Standardization of terms and explanations– Active voice– Short sentences – Clear Language Certification Process

• Not dumbing down

– Use of focus groups • Employee communication testing & feedback• What if use not realistic?

13

Health Care Literacy & Best Practices Approach

• Government Study Recommendations– Different approaches

• Younger – Sound bites– Assumptions?

• Writing level / comprehension level – Most plan materials– Necessary writing levels

– What percentage of adults can navigate the current health care environment? Why?

14

Recommendations to Improve Health Care Literacy

• Focus on simple and attractive items

• Multilevel communications needed– Rule of 7

• Integrate technology

• Conversational pieces are most successful– YouTube example

• Pictures, graphs, flow charts (appeals process?), tables (changes in status?), video/audio, FAQs

Click to edit Master title styleValue & Quality:

Improving Health Care and Outcomes

16

• Government is developing reporting requirements for use by group health plans

• Reporting initiatives are designed to:– improve health outcomes – implement activities to prevent hospital discharge

readmissions– implement activities to improve patient safety and

reduce medical errors– implement and design wellness programsQuery: How will reporting achieve these goals?

Health & Wellness

17

Health Reform: Reporting on Care Management

• Requires employers to report on plan benefits and provisions that improve health outcomes

• Federal Agencies expect reporting on:– Quality

– Effective case management

– Care coordination

– Chronic disease management

– Care compliance initiatives.

• Carrier or TPA can and will likely assist• Expected realities?

Drawing on Experience: How to achieve measurable results in the real world

18

Plan Reporting on Care Management

Federal initiatives already impact health care delivery for everyone

• Accountable Care Organizations = managed care / narrow networks

• Changes by the agencies include monitoring home care settings in preference to a hospital, hospice or similar setting for Medicare

– Congress and federal agencies emphasize “reform” is not rationing

– Instead, they say the focus is on “considering alternatives” as consistent with realization what we are doing is not working

• Are other approaches cost effective?

• Do these approaches reduce hospital readmissions?

• Overall, do these approaches demonstrate better outcomes?

• Magnifies Federal concerns

– Danger of infection

– Medical errors

Click to edit Master title styleAlternate Health Plan Funding(Beyond Fully-Insured)

Emerging Captive Designs, The Case for Self-Funding, and Long-Term Planning

20

Interest in Use of Captives for Benefits

• Captive concept– Leverage of an existing captive leverage

• Note on taxes

– Group captives

• Compare to Other Funding Alternatives – Associations– MEWAs– Self-funding– Co-ops

• Brief review of federal concerns regarding captives & overcoming them

21

Interest in Use of Captives for Benefits

• Emerging use of captives– Which Employee Benefits?

• Medical -- volatile but possible• Low incidence, low cost• Manage-able benefits

– Emerging concept: Group medical captive with Board “to implement” best practices & wellness

• Positioning for transition

– Proposals & Pricing– “Stickiness”

• Contractual obligation• Financial buy-in

22

Self-Funding: The Basics

• Risk– Possibility of loss– Economic in nature or an unfavorable deviation from

expectations– Insurable risk involves only pure risk

• Methods of Handling Risk– Avoidance– Loss Prevention and Control– Retention– Transfer

23

Comparing Self-funded Plans to Fully-Insured Plans

• What’s in a Premium?– Projected claims experience– Claims history– Trending– Age/Sex factor of group– Pooling level– Plan design– Administration and reserves

24

The Role of Claim Experience

• Fully Insured: Carrier “Owns” Your Experience

• Self Funded: You “Own” The Experience• Claims Experience Identifies:

– Plan Status– Utilization Patterns– Trend Impact

• A Self-funded Plan is Managed by Understanding and Using the Claims Experience– Do not use self-funding if you are not willing or

able to take on the increased involvement in plan design and on-going management

25

Plan Liabilities

Expenses

ReservesClaims

Regardless of the funding method, these liabilities always exist.

26

PROS and CONS of Fully-Insured Plans

PROS

Fully-funded and guaranteed benefits Monthly costs stable No separate account for reserves

Less financial risk Insurer takes financial risk

Plan design flexibility Future year guarantees are possible

Fiduciary Responsibility Insurer has fiduciary responsibility

Terminating program No additional cost. Incurred claims are

covered

CONS

Acknowledged claim experience Worse than average claim experience may

cause unexpected higher costs Year 2+

Limited cash flow opportunity If claims are less than premiums, insurer

profits from excess funds Insurer overhead could be higher for

insured than self-funded

State mandates increase costs

State premium taxes

New federal carrier taxes on insured

groups (not self-funded)

27

PROS and CONS of Self Funding

PROS

Cash flow advantages Pay as you go approach Utilizing the float on claim payments

Cost savings No state/federal premium tax or state

mandates (new Exchange rules may alter this)

Interest on reserves Lower administration fixed costs One time “savings” of approx. 25%

Plan control & design flexibility Easier monitoring of claims costs Claims data provided

Stability of self-funding Employers rarely return Claims are claims: why pay more?

Fiduciary Responsibility Fiduciary options available Employer need not assume full

liability

CONS

Owning claims experience Worse than average claim years or

experience & unexpected costs

Budgeting the program

Increased employer involvement

Terminating program Return to fully-insured is “ugly”

Fiduciary Responsibility: Employer has fiduciary responsibility Stop Loss insurance market Contract limits on Stop Loss Aggregate Stop Loss attachment

corridor of 25% usually produces

higher employer maximum liability

28

Self-Funding Components• Claims Payment Ability

– Coordination of Benefits– Adherence to Plan Documents– Financial Accuracy– Coding Accuracy– Payment Accuracy– Timeliness of Payment– Electronic Submissions

• Administrative Abilities/Cost– Capitated or based on percentage of claims– What is included in basic fee– What networks are available– What is the access fee for networks– Actuarial & Underwriting included– Legal assistance and support– Printing

• Reporting Capabilities– What is included in reports– Any electronic capabilities– Payment details- to what level– Frequency of reports– Ad hoc availability/cost– Privacy– Comparison statistics

• Two Types of Stop Loss Protection

– Specific protects employer with sick employee

– Aggregate protects employer with sick group

29

Specific Stop Loss

$50,000

$75,000

$60,000

$70,000

$25,000

$0

$10,000

$20,000

$30,000

$40,000

$50,000

$60,000

$70,000

$80,000

Claimant A Claimant B Claimant C Claimant D Claimant E

Specific Deductible

Claimants C and E exceeded the specific deductible of $60,000

The insurer will reimburse claims above $60,000 (total of $25,000)

30

Aggregate Stop Loss

Attachment Point

Cumulative claims exceed the $600,000 aggregate attachment point; the insurer pays for claims that exceeded $600,000

$100$150

$200$250

$300$350

$400$450

$550

$650

$750

$50

$0

$100

$200

$300

$400

$500

$600

$700

$800

$900

$1,000

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

(In T

ho

usa

nd

s)

Monthly Cumulative Claims

31

Bundled vs. Unbundled

• Bundled = One Stop Shopping for all components. – Aetna, BCBS, CIGNA, Humana, United Healthcare– Seamlessness

• Unbundled = All plan components handled separately

Claim Adjudication: Third Party Administrator (TPA)

Stop Loss Insurance: Through Stand-Alone Stop Loss Carrier

Pharmacy Benefits: Through Pharmacy Benefit Manager (PBMs)

Network Services: Through Stand-Alone Network Provider

32

Bundled vs. Unbundled

Advantages• All services handled by one carrier• Typically are national carriers with

national networks• Network discounts are usually the

greatest with national carriers

Disadvantages• Plan Administration fees are

generally a lot higher than a TPA• Not as flexible as many TPAs in

custom plan designing• Tend to have a lower level of service

when compared to TPA

Bundled

Unbundled

Advantages• Lower administration fees • Greater flexibility (custom network &

plan design)• More hands-on service approach• Access to more stop loss carriers• “Better” for high-touch populations

Disadvantages• More carriers/vendors to track &

manage• Risk not tightly managed• Network discounts are generally not

as high as bundled carriers

33

Total Plan Cost Projection

• Year One: Self-funded cost very attractive:– 2-3 months of little to no claim activity– No additional state taxes on premium– Possible administrative savings– Caution: Fund first year cost assuming full 12

months of claim activity to establish IBNR reserves and lessen that second year “maturity” increase

• Over a ten year period, a plan could expect to see:– 2-3 worse than expected years– 1-2 better-than-expected years– 5-7 as-expected years

Click to edit Master title styleWellness

Helping Employees Improve Their Lives

(While Helping You, Too!)

35

Wellness FocusStress-Related Concerns

• Stress decreases benefit satisfaction• Results

– Missed deadlines– Missing whole project assignments– Poor work quality– Reduced patience

• Burnout is a blow to the spirit• Solution?

– Employers are considering stress management with all aspects of work environment and benefits

– Pushing vendors to deliver promised resources– Pushing employees toward the resources

36

Evolution of a Wellness Focus

• First Generation – 1980 – 1995ish

“A claim is a claim is a claim” so soft-sell

• Second Generation – 1995 to 2004ishUsing data to identify/price expected number of heart attacks

• Third/Current Generation – 2004 to current

Using data to predict who is most likely to have a heart attack and intervene to:

– Improve health

– Reduce expense

– Manage in the long term

3737Centers for Disease Control & Prevention, 2006 Behavioral Risk Factors Surveillance System

Behavior & Lifestyle: Weight Gain ’86-’06

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

And theConsequences:

Hypertension

Type 2 Diabetes

Osteoarthritis

Stroke

Coronary Heart

Gallbladder

Sleep Apnea

Respiratory Issues

Some Cancers

Obesity Trends Among U.S. Adults (BMI>30%)

1985198619871988198919901991199219931994199519961997199819992000200120022003200420052006

Healthcare Cost Drivers and Their Impact

38

• In 2014, new opportunities for employers to leverage wellness and prevention programs– PPACA enhances current rules regarding wellness

programs• Increase in applicable to wellness incentives from 20% to 30% of

total premium

• Compliant program: measurement, intervention, measurement

• Can extend to family with same process

– Government may increase the incentive up to 50% of the cost of coverage if the increase is determined to be “appropriate”

What does this mean for employer costs?

Wellness as a “Loophole” for PPACA

39

Current (Pre-2014) Considerations

• Consumer involvement directly impacts the bottom line

• Transparency tools – Improve consumer connectivity with cost of care – Impact of their behavior and decision outcomes

• Incentive-based Plans increasing in popularity– Just 20% shift now

4040

• Consumer expectations - Complete coverage for routine care

• E.R. instead of the family practitioner

• 100% Hospitalization

• $20 Copay

• $5/$10 Rx Programs

Plans Insulated Consumers From Actual Cost

41

Why ‘Targeted’ Wellness?

GOAL 1: Keep people healthy

GOAL 2: Help these people understand and prevent risks

GOAL 3: Support or Provide Interventions

Healthy/Low Risk At-Risk

HighRisk

Early

Symptoms

Active

Disease

COSTS

A ‘Healthy Plan’ has assessment, efforts to change, re-assessment, penalty or reward

42

One Approach: Link Incentives to Plan Design

• Three Level HRA/HSA Funding

• Assume a Deductible of $2,500 – (flexible)

• Target reimbursement of $1,500

Level 1 – $500

Traditional employer funding

‘No strings attached’ to the first $500 of employer money

Level 2 - $500

Wellness Commitment

The next $500 is based on employee participation in Wellness initiatives/activities

•$100 HRA (health risk assessment)

•$100 Work ‘walk club’

•$100 for biometric screening

•$100 bmi<25%

•$100 chol. <225

Level 3 - $250 - $500

401k Wrap(works best with HSA)

Employer matches up to $250 of employee committed $$ to personal wellness initiatives (health club membership) or straight funding

43

Health Reform & Wellness:Be Aware of Some Reactions

• Be aware of plan contribution approach of some other employers – Affects spouses who work for other employers; affects

families

• Consider Estimates of Workforce Participation– 65% Rule of Thumb:

• If not subsidized so a person’s cost is about 35%, many individuals do not elect health plan coverage

– Some employers will not be satisfied with federal standard of employee share at 9.5% of compensation

• Wellness gets turned on its head to shift costs– Better to focus on positives!

44

Absenteeism & Presenteeism

• 75% of CFOs believe absenteeism & presenteeism create the same level of concern as group health plan costs

• Delicate balance– Flexibility versus consistent absence management– Philosophy & effect on outsourcing– Driving vendors to excellence

• Increasing integration and management of time off is trend (and the pitch)– 6-10% ROI sought– 11%+ ROI promised– Savings through consistency, pure costs, time saved,

tracking/reporting better– 50-75% of employers want better employee experience

45

Ties with Wellness: Increased Interest in Integrated LOA Benefits

• Disability with Integrated STD /LTD / FMLA / Workers Comp

• Now often paired with “Leave Outsourcing Services”• Management of all federal, state, and voluntary time off

obligations– FMLA leave– LTD / STD (including self-funded)– Sick time– EAP– Workers’ Comp – State leave– State disability benefits– Military leave– Sabbaticals– Jury duty– Vacation– PTO

46

How LOA Outsourcing Works

• One-stop phone number – Toll-free

• Outside management of all requests, paperwork, deadlines, approvals, return to work

• Consolidated reporting / valuation• Additional “Hidden Value” that attorneys like

– Even-handed application of rules– No knowledge by vendor of “trouble employee”– Insulates employer somewhat from leave-related

information

Click to edit Master title styleStrategic Planning for Reform

Making the Right Decisions at the Right Time

48

2014 & Big Changes to Group Health Plans

What is the Strategy for Complying? For Avoiding? For Leveraging?

• Employer Mandate, Essential Plan, Costs, Penalties• Affordability• 90-Day Max. Waiting Period• Automatic Enrollment • Benefit Mandates • No Pre-Ex Exclusion• State and Federal Exchanges• Wellness Safe Harbor • Cadillac Tax (2018)

49

Status of Federal Health Reform & Moving Forward

Congress & Possible Repeal?• Senate has little appetite to repeal• Realities of repeal process

Supreme Court & Possible Overturn?• Lawsuits proceeding on individual mandate

– Supreme Court will decide by next summer• Employer regulation is a separate issue

Essential Plan Guidance Limited to Small Employers (under 100)

Timing and Rollout Proceed – 2012 and Beyond to 2014*

* See detailed guidance, timelines, and webinars at www.hubhealthreform.com

5050

The 3 – 5 Year Strategic Benefits Plan

Awareness Engagement AccountabilityE

duca

tion

Val

ue-b

ased

Out

com

es-b

ased

Participation

Dat

a C

olle

ctio

n

51

Knowing What is New (or “What’s in a Name”)

Anything New Under the Sun?• Reform & Cost Containment… in Theory • Accountable Care Organizations

• The truly federal solution• Health systems’ reactions

• Exchanges• January 1

• Catastrophic Options • Ah, to be young again

• Multistate Plans• Reform Promise: “Buy Insurance Across State Lines”• Consider the Reality

52

Sample 2014 Issues & Emerging Acceptable Compliance Strategies

Price the Financial Impact & Formulate Long-Term Approaches

• Determination of pricing & cost sharing across benefits, plan options, and tiers– Family contributions by employers will be curtailed or eliminated

• Model budget impact of participant & employer contributions– Recruiting costs– Using independent contractors / outside service providers

• Begin selection of plan options – 60% to 90%? Base with buy-up options, base + true

supplement, base + indemnity?– Network re-design and disruption / impact on providers?– Bells & whistles -- bundled or unbundled

53

Sample 2014 Issues & Emerging Acceptable Compliance Strategies

Develop an Understanding of Insurance Exchanges & Impact on Your Plan

• Private insurance exchanges – Administrative tool -- so-called “defined contribution” and choice

• State and Federal Exchanges– Fragmentation in market– Anticipated products & pricing– Advantages of a single federal exchange– Communication, on-line enrollment, and enforcement tool – limited…

• Know or estimate impact on plan enrollment– Loss of young & healthy to catastrophic coverage

• Catastrophic available on each exchange

– Loss of frugal to government option (yes, there is a federal plan)• Consider change to your plan year away from January 1

– Annual enrollment date for exchanges

54

Sample 2014 Issues & Emerging Acceptable Compliance Strategies

Health Plan Design and Overall Compensation & Benefit Design Considerations

• Evaluating Full-Flex concept (iFlex?)– Possible solution for overall design management– Distraction via choice– Employer cost re-allocation

• Role of voluntary benefits– More robust than ever– Replacing employer-sponsored ancillary coverages– Important -- differentiation as employer-of-choice

55

Sample 2014 Issues & Emerging Acceptable Compliance Strategies

Price the Financial Impact & Formulate Long-Term Approaches

• Affordability– $3,000 annual penalty per affected person

• Will each person who waives your coverage then decide to sign onto the exchange to enroll in some other coverage? Will any? How many?

– Setting affordability is a key issue for backing into an employer budget

• Keep default plan at bronze

– Setting affordability with payroll-tax-like approach– Offering unaffordable plan – not popular

56

Sample 2014 Issues & Emerging Acceptable Compliance Strategies

Health Plan Design and Overall Compensation & Benefit Design Considerations

• Regardless of Size…Reviewing Emerging Product / Plan Choices• Evaluate self-funding & other funding options (for example,

group captives & baby steps)• Monitor “Exchange” product choices• Know which carriers are exiting• Prepare for managed care re-birth• Consider “Narrow Networks” • Change management: How will you prepare employees?

• Default Plan Selection – Contain Your Costs

57

Sample 2014 Issues & Emerging Acceptable Compliance Strategies

Additional Benefit Design Considerations

• Other benefit replacements• Supplements• “Non-insurance” programs tie to medical

care received• Buy-ups to silver, gold, and/or platinum

levels• Concierge medical access• LTC, other

58

Sample 2014 Issues & Emerging Acceptable Compliance Strategies

Financially Prudent Strategic Planning• Evaluating current health plans (and those of

competitors & clients)• Cadillac Tax (2018)

– Avoidance

• Project costs to 2018 • Redesign plan if necessary to avoid

– 40% excise tax applies to increment of the health plan’s cost over:

» $10,200 Single» $27,500 Family

59

Sample 2014 Issues & Emerging Acceptable Compliance Strategies

Deal with the Details• No Pre-Ex Exclusion

– Impact on employee retention• Wellness Safe Harbor

– Will you use an incentive? – Will you use 30%? – Possibly 50%?

• Waiting period– Trend to use 90-day max– COBRA or Exchange coverage for Executives

• Use careful planning for favorable tax treatment and to avoid discrimination allegations

60

Sample 2014 Issues & Emerging Acceptable Compliance Strategies

Preparing for Administrative Issues• Coordination of delegated obligations with vendor

selection– Push responsibilities to vendors

• Comply with new employee disclosures… and continue communication strategy

• MLR rebates – maximize rebate; minimize administration• Enrollment form revisions• Administration Outsourcing & Vendor Selection

– Time tracking and payroll support are crucial for HR– Wellness, disease management crucial for reporting to agencies,

cost containment, and ROI• Employee rewards & preventive incentives• How will you select a vendor, design the wellness program, track

results, tie wellness to participant costs, measure ROI…?

Click to edit Master title styleRisk Avoidance with a Positive Benefits Environment

Defense Wins Games

(And Gets the Crowd Fired Up!)

62

Know their Motivation: Keep Courts & Agencies From Getting Involved

• Operate a plan that is consistent with the federal agencies’ visions of plan operation

• The agencies must respond to every seemingly legitimate participant complaint & may assist in lawsuits– Individuals don’t understand how plans may operate, and more

than ever are told to look to federal agencies for help

• The federal agencies are charged by law to conduct enforcement on a regular basis– The audit departments must validate enforcement efforts,

compiling and distributing reports within federal government

63

Hallmarks of Compliance

• Focus: Excellence vs. How You Might Get Caught• Know Confluence of Two or More Rules / Federal or

State Laws– FMLA, HIPAA & Workers’ Compensation– Change in Status and Medical Eligibility Rules

• By law or by plan document or a combination• Know Your Obligations• Control over Plan Administration• Have Sufficient Required Written Materials • Meet Your Deadlines

– COBRA, for Example• Keep Required Documentation• Keep in Compliance When “Conducting Business”

64

Look Your Best… Every Day• Start with document compilation and reviews

– Focus on same list of documents as agencies or court might– Focus on possible abusive practices (earlier slides)

• Focus on administration and actual practices– Make sure your administrative processes (and those of service

providers) are in order• Hold internal compliance discussions, focusing on any

failures to follow plan documentation, systematic failures (such as missing of deadlines), or other compliance gaps may exist

– “Shoot the gaps”– Avoid paper trails showing red flags on gaps– Correct failures as found

• Document good faith compliance on questionable issues or for gray areas

– Eligibility challenges or determinations– Discrimination testing

65

Additional Tips for Conflict Resolution

• Be responsive • Meet all deadlines• Seek legal counsel

advice• Designate a point person

as single contact • Provide progress updates

to counsel, especially on any emerging concerns

• Be respectful and cordial

• Get information but don’t cross line into pushiness

• Make sure you have all requested items and fill in any gaps as soon as possible

• Ask about any alleged violations, and mitigate/ discuss with counsel

• Communicate

66

Avoiding Common Lawsuit Triggers

• Do Not Allow People Into Plan If Really Are Not Eligible– It is more difficult to remove people who were added outside of

the normal course of eligibility

• Do Not Continue People Who Are No Longer Eligible– Tightly administer eligibility under the plan document, as well as

FMLA and COBRA– If you feel sorry for someone, they are more likely to need the

coverage and hence more likely to sue if you “lead them on” to believe their eligibility has not ended

• Do Not Set Precedents Because of Who is Asking• Do Not Approve Claims Not Covered By Your Plan• Do Not Pay Outside of a Self-Funded SPD / Contract

– Unless issue of reasonable interpretation of written plan terms– Re$ult: No Reinsurance

67

Be Diligent Build a Budgetable Roadmap through 2014 Drive immediate savings Keep compliant:

Health Care Reform All Federal and State compliance requirements Drives a positive workplace & reflects “good business”

Focus on Improving the Health Status of the population which will: Identify health risk before major negative health events Keep employees healthier and more productive Improve Absenteeism and Presenteeism ROI

Click to edit Master title style

Thank You!

www.hubhealthreform.com