Health OptimizationClinical Testing

Health Risk Questionnaire

Joe Weber, AssistMed

Wellness and Disease Management

Brought to You by…

andJoe Weber, AssistMed

An Ounce of Prevention is Worth a Pound of Cure

Medivon’s Health Optimization Solution

• Biometric Testing• Health Risk Questionnaire (Web-based)• Wellness Management (software-driven)• Disease Management (software-driven)• Incentives for Improving Health Status• Population Analytics

How Do We Assess Risk?• The challenge is to find individuals with risk factors

• Also asymptomatic people in the very earliest stage of disease

• A Health Risk Assessment (HRA) questionnaire identifies an individual’s risks related to diet, lifestyle, medical history, etc.

• Clinical testing uncovers unknown health risks and helps to stratify risk levels

• People determined to be at risk are enrolled in Wellness and Disease Management Programs

Clinical Testing Identifies Lurking Problems

• It’s quite expensive to have doctors do extensive clinical testing for everyone

• But if we perform mass screening efficiently, the cost per person is low, and the ROI is impressive

• Clinical testing dramatically enhances risk detection

In a sample of 12,000 people who completed the McMaster Health Index Questionnaire and also had worksite biometric testing, 33% self-reported “good” or “excellent” health but unknowingly had 3 or more clinical risk factors. Also, 74% could not self-report their cholesterol, blood pressure, or body fat.

Goals of Medivon’s Testing Program

1. Maximize participation

2. Administer the most effective tests and measurements

3. Systematic and smooth workflow for participants

4. Provide and explain results immediately

5. Encourage engagement with wellness and disease management programs, and with healthcare providers

6. Establish incentives to improve scores next year

1. Maximize Participation

• Emailed invitations to employees• Mailing to homes• Link to more info on Web• Incentives to participate, such as cash cards

“Nothing is more important to you than your own health and the health of your family. In order to live a long and healthy life, you first need to know if you have any risk factors… “

Get Your Health Grades TO: [Staff Person]

FR: [Principal of the Staff Person’s School]

RE: Free Clinical Testing for Staff at Our School Please read the message below to learn how to: Find out your clinical-test scores and key measurements Improve these scores and measurements, to optimize your health status and increase your life span Get $25…just for taking care of yourself Nothing is more important than your health. To live a long and healthy life, you first need to know if you have any risk factors. If you do, and you learn what they are, you can often just modify your diet and lifestyle to lower your risk. Or perhaps you will need a medication or some other help from your doctor. However, if you do nothing to identify and remedy your risk factors, the impact can be devastating. For many people unaware of their risk of heart disease, for example, the first symptom they notice is a heart attack. I don’t want you to be one of those people. As your Principal, I heartily join with our health insurer in encouraging you to “Get Your Health Grades”. On January 15th, from 9 AM to Noon, Our insurer is conducting an exciting and important event in our cafeteria, which will enable you to better understand your health status. I would like every single one of you to take advantage of this offering. We will be providing FREE clinical testing for you and also for your spouse if s/he can get to our school on that day. This is an offer you can’t refuse. Every staff member (and spouse) who participates in this clinical testing program will receive a $25 VISA cash card, which is redeemable wherever VISA is accepted. But the real reason you should schedule yourself to be tested is that getting your Health Grades will empower you to take whatever action is necessary to improve those Grades – thereby increasing your life expectancy as well as the quality of that extended life. Not only is your participation critically important for you personally. It also has impact on our school. Our insurer will be calculating the percentage participation for each school. All the schools will then be rank ordered. I would very much like our school to be near the top of this list. This will demonstrate that all of us recognize the importance of knowing our risk factors, so that we can take steps to lower our risk and optimize our health. I want the bragging rights that will come with very high participation. Please help me get them. You will receive a cholesterol test, glucose test for diabetes, blood pressure evaluation, and some other valuable tests and measurements. Note that the cholesterol and glucose testing will not be performed by inserting a needle into your arm. It’s just a simple fingerstick, to get only a small drop of blood. The entire testing process will take only about 10 minutes. And it might be the most meaningful activity you engage in all year. To make your appointment, stop by my office within the next week, and have Sally put you on the schedule. Alternatively, you can go to www.MedivonHEALTH.com, to make your appointment over the Web. I strongly desire that each and every one of you Get Your Health Grades, so that my staff’s health status becomes all that it can be. If there’s a reason why you can’t or won’t participate, please let me know. Here’s to your health!

2. Effective Tests & Measurements

•Total Cholesterol (via Cholestech)•HDL•Blood Pressure•Pulse•Irregular Heart Beat Detection •Glucose (diabetes risk assessment)•Body Fat Percentage•BMI (Body Mass Index)•Waist Girth•Hip Girth •Waist-to-Hip Ratio

Optional Disease-Detection Tests

C-Reactive Protein (CRP)General marker of inflammation, which is related to arterial damage

Lp-PLA2Measures enzyme that helps form rupture-prone plaque (heart attacks)

Ultrasound CIMT (SonoSite)Radiation-free imaging that measures thickness of carotid (neck) arteries and identifies any plaque. Indication of early vascular disease that could lead to heart attack or stroke.

3. Systematic Workflow• Individuals make appointments over the Web• Option for toll-free telephone scheduling• Receive immediate email confirmation• Send email appointment reminder the day before• Streamlined workflow to minimize wait time

Excel Gantt Chart © 2008 Vertex42 LLC

Biometric Testing Project by Medivon

Project Lead: Barack Obama

Today's Date: 12/3/2008 (vertical red line)

[42] Start Date: 10/7/2008 (Tue) 0

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Finalize Incentiv es Jennifer 10/07/08 10/09/08 3 100% 3 3 0Determine Cash Card Flow and Sign Contract Marty /Jennifer 10/07/08 11/10/08 35 100% 25 35 0Draft Member Letter Joe 10/10/08 10/16/08 7 100% 5 7 0Approv e Member Letter Jennifer 10/17/08 10/19/08 3 30% 1 0 3Draft District Letter Jennifer 10/17/08 10/19/08 3 100% 1 3 0Approv e District Letter Jennifer 10/20/08 10/22/08 3 100% 3 3 0Communicate w ith Districts Jennifer 10/23/08 10/29/08 7 100% 5 7 0Determine District Participation Jennifer 10/25/08 12/05/08 42 40% 30 16 26Determine School Participation Jennifer 10/25/08 12/05/08 42 40% 30 16 26Sign Business Associate's Agreement Marty 10/27/08 10/28/08 2 100% 2 2 0Determine # Members per District Jennifer 12/06/08 12/10/08 5 20% 3 1 4Estimate Participation % Sang 12/06/08 12/06/08 1 0% 0 0 1Assign Dates/Times to Each School Sang 12/06/08 12/06/08 15 0% 0 0 15Inform the Districts of the Dates/Times for Testing Sang 12/07/08 12/08/08 2 0% 1 0 2Deadline for Districts to Accept or Decline Jennifer 12/05/08 12/05/08 1 0% 1 0 1Confirm Dates/Times that Work for Each School Sang 12/09/08 12/10/08 2 0% 2 0 2Customize Appointment Softw are Joe 12/07/08 12/12/08 6 20% 5 1 5Populate AS w ith District/School Database Joe/Jennifer 12/13/08 12/14/08 2 20% 0 0 2Test AS, for SISC Approv al Joe/Jennifer 12/12/08 12/14/08 2 0% 1 0 2Determine # of Med Techs per Session Sang 12/09/08 12/10/08 2 0% 2 0 2Enhance AS if Necessary , and Confirm OK Joe/Jennifer 12/15/08 12/19/08 4 0% 5 0 4Run the Appointment Sy stem Joe/Sang 1/06/09 5/14/09 108 0% 93 0 108Finalize Results Reporting Form Joe/Sang 12/26/08 12/28/08 3 80% 1 2 1Finalize Test Description Sheet Joe/Sang 12/26/08 12/28/08 3 80% 1 2 1Finalize Handout to Encourage HRA Quest. Jennifer 12/26/08 12/28/08 3 0% 1 0 3Prov ide the Districts w ith Message for Members Jennifer 1/06/09 1/06/09 1 0% 1 0 1Send Out Communication to Members Districts 1/07/09 1/07/09 1 0% 1 0 1Verify that Districts Sent Out Communication Jennifer 1/08/09 1/10/09 3 0% 2 0 3Design and Produce Posters Joe/Jennifer 12/12/08 12/31/08 20 30% 14 6 14Distribute Posters Jennifer 1/02/09 1/05/09 4 0% 2 0 4Prov ide Districts w ith Reminder Communication Jennifer 1/11/09 1/13/09 3 0% 2 0 3Send Out Reminder to Members Districts 1/14/09 1/16/09 3 0% 3 0 3Tell One to One the Locations and Quantities Jennifer 1/15/09 1/15/09 1 0% 1 0 1Design and Produce Sticky -Back Badges Joe 1/03/09 1/09/09 7 20% 5 1 6Monitor Participation % by District & School Jen/Jennifer 1/13/09 5/12/09 120 0% 86 0 120Push HR and Superintendents When % is Low Jennifer 1/16/09 5/05/09 110 0% 78 0 110Biometric Testing Sang 1/20/09 5/15/09 116 0% 84 0 116Enter Data onto Results Reporting Form Sang 1/20/09 5/15/09 116 0% 84 0 116Enter Cash Card Number on Appt Sheet Sang 1/20/09 5/15/09 116 0% 84 0 116Fax Appt Sheets to One to One, daily Sang 1/20/09 5/15/09 116 0% 84 0 116Verify Cash Card Numbers match No. of Tests Sang 1/21/09 5/16/09 116 0% 83 0 116Calculate Participation % by District Joe 5/16/09 5/29/09 14 0% 10 0 14Distribute Ranked List of District Participation % Jennifer/John 6/05/09 6/07/09 3 0% 1 0 3Prov ide Statistics on Biometric Test Results Joe 6/04/09 6/18/09 15 0% 11 0 15Hav e BC Report HRA Users to One to One Jennifer 1/07/09 7/05/09 180 0% 128 0 180

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4. Provide Results Immediately• Two-part form – one for participant, one for data entry• Data uploaded to HRA database• Form shows the normal ranges for tests and measures• One-page explanation of each test and normal range• Med tech helps the participants understand any abnormal

results• This is the “teachable moment”, the time when we need to

have participants engaged with their health

Irregular Heartbeat

[Your Name and Logo Here]

Health Screening Results Form

Consent and Release: In consideration of my participation in this program, I understand and agree to the following: The information provided on this form is complete and correct to the best of my knowledge. Participation in this program may include referring me to my doctor or other provider of medical care or wellness management, and follow-up consultation. A low risk assessment is not a guarantee of good health, and participation in this program cannot substitute for a consultation with a physician for any medical or health-related condition, or for a regular physical exam. I hereby release and agree to hold harmless: Medivon, and Xxxxxxxx, including their employees and representatives, from any claims, liability or damages, including but not limited to personal injury or illness, arising in any way from my participation in this program. All personal medical information obtained through my participation in this program will be kept confidential, and will be used only for data analysis and reporting in aggregate format.

Signature Healthcare ID# Date

Name Date of Birth Age Female Male

I am: the Plan Member the Spouse a Dependent Not a Member Cash Card #

RISK

FACTORS

The more risk factors a person has, the greater the chance that person will have a heart attack or stroke. Some risk factors cannot be controlled, such as age, family history, ethnic heritage, and gender. But you can modify, treat, or control other risk factors to lower your overall risk of disease.

Please put an X in the box next to those that apply to you.

Personal History of Heart Attack / Heart Disease / Stroke / Peripheral Vascular Disease

Family History (parents or siblings) of Heart Attack / Heart Disease / Stroke / Peripheral Vascular Disease

I Have Been Diagnosed with Diabetes

Current Smoker / Recent Former Smoker (quit less than one year ago)

I’m Taking Medication for High Blood Pressure

Clinical Tests – COMPLETED BY TECHNICIAN Tech Name:

White Copy sent to Medivon – Yellow Copy to Med Tech – Pink Copy to Participant © Medivon 2008

Total Cholesterol

HDL Cholesterol

TC/HDL Ratio

Glucose

Blood Pressure

Height (Self Reported)

Weight (Self Reported)

Body Mass Index

Body Fat %

Waist Girth

Hip Girth

Waist/Hip Ratio

Pulse

[Your Name and Logo Here]

What Your Test Results Mean Total Cholesterol is a measure of the total amount of cholesterol in your blood at a given time. It is usually measured in milligrams per deciliter (mg/dL), and it’s an important factor in determining your risk of developing cardiovascular disease. Generally, you should strive to keep this number below 200.

HDL (High Density Lipoprotein) is the so-called “good” cholesterol, because it helps to clear excess lipids from the arteries. The higher this number is, the better. For men, an HDL of at least 45 mg/dL or more is ideal and is considered a negative risk factor for disease. For women, it’s 55 mg/dL.

TC/HDL Ratio is more indicative of cardiovascular disease than total cholesterol (TC) alone. An acceptable ratio for men is below 5.0; for women it should be below 4.4.

Glucose is a measure of the sugar level in your blood. High glucose levels are often an indication of diabetes or pre-diabetes. Since fasting was not required for this test, above 140 but less than 199 is an indication of pre-diabetes; 200 and above might indicate diabetes.

Blood Pressure is an indication of how hard your heart and arteries must work to pump blood through your body. Systolic pressure (top number) is when the heart beats. Diastolic pressure (bottom number) is when the heart is at rest. Above 120/80 is an indication of pre-hypertension. Above 140/90 is an indication of hypertension.

Pulse is the throbbing of your arteries, a measure of your heartbeat in beats per minute (BPM). A normal pulse rate for a healthy adult, while resting, can range from 60 to 100 BPM, although well-conditioned athletes may have a healthy pulse rate lower than 60 BPM. Irregular Heartbeat means that there is something wrong with your heart’s electrical system, which controls the contractions that move blood through your body. This causes the heart to not beat in regular intervals. Sometimes these rhythm disorders are an indication of a serious problem. Sometimes they are harmless. A physician would make that determination.

Body Mass Index (BMI) is a calculation based upon a person’s weight and height. BMI values between 18.5 and 24.9 are considered “normal” or “healthy. Those above 25 are considered “unhealthy” and range from a classification of “overweight” to “extreme obesity.” People who fall in the unhealthy range are generally at a higher risk for multiple health problems.

Body Fat % is the percent of your body that is composed of fat. Serious health risks have been associated with both too much and too little body fat. The recommended range for men is 8-14%. Women need more fat than men, so their recommended range is 20-25%.

Waist Girth has been shown to be significantly correlated with the chance of getting heart disease. It is also one of the easiest risk factors for you to control. No more than 40 inches for males and no more than 35 inches for females is desirable.

Waist/Hip Ratio is even more highly related to the chance of having a heart attack or some other form of heart disease. An “apple” shape, where your waist is large compared to your hips, is unhealthy. A “pear” shape is healthier.

© Medivon 2008

[Your Name and Logo Here]

Health Screening Results

for Janis Joplin

Healthcare ID# 000A1234 Birthdate 1/1/1949 Screening Date 2/1/2009

Membership Status Spouse Sex Female Age 29

RISK

FACTORS

The more risk factors a person has, the greater the chance of a heart attack or stroke. Some risk factors cannot be controlled, such as age, family history, ethnic heritage, and gender. But you can modify, treat, or control other risk factors to lower your overall risk of disease. You should share this report with your doctor.

No Personal History of Heart Attack / Heart Disease / Stroke / Peripheral Vascular Disease

Yes Family History (parents or siblings) of Heart Attack / Heart Disease / Stroke / Peripheral Vascular Disease

No Diagnosed with Diabetes

Former Smoker

No Taking Medication for High Blood Pressure

Clinical Test Scores

Green is in the healthy range. Red is needs attention. Orange is used if there’s an intermediate range.

A measure of the total amount of cholesterol in your blood at a given time. It is usually measured in milligrams per deciliter (mg/dL), and it’s an important factor in determining your risk of developing cardiovascular disease. Generally, you should strive to keep this number below 200.

High Density Lipoprotein is the so-called “good” cholesterol, because it helps to clear excess lipids from the arteries. The higher this number is, the better. For men, an HDL of at least 45 mg/dL or more is ideal and considered a negative risk factor for disease. For women, it’s 55 mg/dL.

Your heart must work harder when blood pressure rises. Systolic pressure (top number) is when the heart beats. Diastolic pressure (bottom number) is when the heart is at rest. Above 120//80 is an indication of pre-hypertension. Above 140/90 is an indication of hypertension.

Pulse is the throbbing of your arteries, a measure of your heartbeat in beats per minute (BPM). A normal pulse rate for a healthy adult, while resting, can range from 60 to 100 BPM, although well-conditioned athletes may have a healthy pulse rate lower than 60 BPM.

Your heart’s electrical system controls the contractions that move blood through your body. If something is wrong with it, your heart will not beat in regular intervals. Sometimes these rhythm disorders are an indication of a serious problem. Sometimes they are harmless. Ask your physician.

High glucose levels are often an indication of diabetes or pre-diabetes. Since fasting was not required for this test, above 140 but less than 199 is an indication of pre-diabetes; 200 and above might indicate diabetes.

Serious health risks have been associated with both too much and too little body fat. The recommended range for men is 8-14%. Women need more fat than men, so their recommended range is 20-25%.

BMI values between 18.5 and 24.9 are considered “normal” or “healthy. Those above 25 are considered “unhealthy” and range from a classification of “overweight” to “extreme obesity.” People who fall in the unhealthy range are generally at higher risk for multiple health problems.

The size of your waist has been shown to be significantly correlated with your chance of getting heart disease. It is also one of the easiest risk factors for you to control. No more than 40 inches for males and no more than 35 inches for females is desirable.

The waist-to-hip ratio is even more highly related to the chance of having a heart attack or having some other form of heart disease. Men should have a ratio below 0.90; women below 0.85. An “apple” shape, where your waist is large compared to your hips, is unhealthy. A “pear” shape is healthier.

The Framingham Heart Risk Score analyzes some of the data above to determine your risk of having a heart attack or other coronary death in the next 10 years. If your Score is less than 10%, you’re at Low Risk. If 10-20%, you’re at Moderate Risk. Above 20% is High Risk.

Total Cholesterol 220

HDL

Blood Pressure

42

125/85

Pulse Rate

Heartbeat

Glucose

Body Fat %

Body Mass Index

Waist Girth

Waist/Hip Ratio

10-Year Risk

72

Normal

150

13%

27

41

0.94

18% © Medivon 2008

5. Encourage Engagement• Participants are encouraged to bring results to their doctor, to

consider further evaluation or intervention• They are also provided information about the HRA and

wellness/disease management programs

6. Incentives to Optimize Health• Points for results and measurements in desirable range• Points convert to dollars, on a cash or gift card• In future years, also points/dollars for substantial improvement

in test results and measurements• All individualized data are shared solely with employee• The employer only gets aggregated statistics

Medivon• Extensive experience with health risk assessment and

biometric testing in a variety of venues• Focused on achieving our clients’ goals• Clients include Novartis, Costco, J&J, Publix, NFL, Self-

Insured Schools of California, etc.• The 4 Managing Partners have well over 100 years of

combined experience in healthcare• Managing Partner Peter Salgo, MD, is Medical Director;

responsible for clinical excellence• He is Associate Director of ICUs at Columbia Presbyterian

Medical Center

HealthMedia• The innovator and leader in Web-driven health optimization• HealthMedia is a Johnson & Johnson company• Partnered with Medivon for a total solution

Health Risk Questionnaire• Provided by HealthMedia• Assesses diet, exercise, lifestyle, medical history, etc.• Employees fill out over the Web• Answers are integrated with clinical test results, to

provide a comprehensive health status profile• Then used to construct a personalized plan for

wellness and disease management

HealthMedia® Succeed™ Configurable HRA

• Assesses 10 key health behaviors that impact health care costs and productivity

• Provides an overall Lifestyle Score• Reviews individual status across behaviors• Prioritizes top behaviors by addressing need,

motivation, and self-confidence• Summarizes behaviors where participants are doing

well and may not need to change• Reviews blood pressure and cholesterol levels• Reviews screenings and immunizations, based on

age, gender, and health history• Helps individuals plan for health improvements

Sample Personalized Report

Lifestyle Score

Behavior Chart assessing status of each behavior

Prioritized health behaviors

Personal disease history and family history

Tailored on perceived health and quality of life

Wellness & Disease Management• Technology and methodology that emulates the health coach

experience – without the cost of the coach• Revolutionary programs are engaging and are tailored to the individual• Employees take responsibility for their own health• Efficacy no longer depends upon the skills of the coach• No limit on capacity; highly scalable solution• Scientific evidence for the content and guidance• Programs have proven, published outcomes

HealthMedia

World-class CustomersSolving health and productivity problems for national health plans and large-scale employers.

Return on InvestmentOverall outcome is a function of both participation and efficacy

• Ultimate ROI is a substantial reduction in both healthcare costs and lost productivity

• Medical-claims and sick-day data are analyzed• Clinical test results monitored year-to-year to determine

improvements in lipid profiles, BP, waist girth, BMI, etc.

The HealthMedia AdvantageHealthMedia delivers higher ROI for its customers based on the scalability and effectiveness of its Web-based behavior change solution

ROI =Direct Medical Expense Savings + Productivity Gains

Cost of Solution

Demonstrated claims-based study cost savings

Proven improvements in productivity and satisfaction

Lower cost than traditional counseling methods with scalable delivery and

high efficacy

Better participation as result of access, privacy and convenience drive lower

costs

Join the Revolution• Change unhealthy behaviors using the web. Increase your ROI. Improve lives.

The Leaders in Health Optimization Solutions

andJoe Weber, AssistMed

Thank You