Presented to the Detroit Regional Chamber 2010 Health Care Forum

1. CITY OF CINCINNATI HEALTH CARE INTIATIVES 2010

5. Healthy Lifestyles Program City of Cincinnati

11. Overview The Healthy Lifestyles Program is a wellness incentive program that encourages and rewards City of Cincinnati employees and their spouses for making positive choices for better health. Employees and spouses who participate in Healthy Lifestyles can each earn up to $500 per calendar year in financial incentives. The incentives that employees earn are credited to a Health Reimbursement Account (HRA) which employees can use to manage their out-of-pocket healthcare expenses. Healthy Lifestyles Program

12. Purpose The Healthy Lifestyles Mission is to encourage and motivate City of Cincinnati employees and their spouses to adopt healthier lifestyles, positively impact the City’s health costs, and develop and enhance a culture of organizational wellness and to foster improved health. Healthy Lifestyles Program

13. All City employees who are eligible for benefits and all spouses covered under the City’s Anthem health insurance program are eligible to enroll and participate in the Healthy Lifestyles Program. Dependent children are not eligible to participate. Who is Eligible to Participate?

14. Personal Health Information All Personal Health Information (PHI) shall be held strictly confidential by the Healthy Lifestyles Coordinator and Specialist, who are non-City employees. The City will not have access to any individual participant’s PHI, but may review data in aggregate form only. Coordinator Contact Information: Phone: 513-977-0053 Fax: 513-891-7286 Email: Katie_Gioielli@trihealth.com Specialist Contact Information: Phone: 513-977-0018 Fax: 513-891-7286 Email: Amy_Driscoll@trihealth.com Katie Gioielli Amy Driscoll Confidentiality

15. Program Incentives The Healthy Lifestyles Program offers incentives for various wellness related activities. Incentives are organized into three tiers: Tier 1: Biometric Measures & Exercise Tier 2: Preventive Care Screenings Tier 3: Programming & Events How the Program Works

16. General Measures Incentive Value Personal Health Assessment (PHA) $75 Health Assessment Score $35 Tobacco Free Pledge $35 Exercise / Activity Log $25 per qtr. Tier 1 Program Incentives

17. Biometric Measures Incentive Payments Measure $50 $30 $10 Optimal Borderline High High Risk Body Mass Index (BMI) < 25 25 – 29.9 > 29.9 Blood Pressure (BP) < 120/80 120/80 – 139/89 > 139/89 Total Cholesterol < 200 200 – 239 > 239 HDL Cholesterol > 60 40 – 59 < 40 LDL Cholesterol < 130 130 – 159 > 159 Triglycerides < 150 150 – 199 > 199 Glucose < 100 100 – 125 > 125 Tier 1 Program Incentives

18. Preventive Care Screenings Screening Depression Screening Colon Cancer Screening • Fecal Occult Blood Screening • Colonoscopy Cervical Cancer Screening Breast Cancer Screening Prostate Cancer Screening Dental Exam & Cleaning Annual Flu Shot Eye Exam $ Incentive $5 / year $5 / year $25 / year $5 / year $5 / year $5 / year $5 / per exam $10 / year $5 / year Tier 2 Program Incentives

19. Programming & Events Program / Event Wellness Program Events Health Fairs Educational Classes Athletic League Participation Nutrition Consultations Exercise/Lifestyle Programs Care Management Diabetes/Hypertension Coaching Program Health Club Membership Personal Training Personal Health Coaching $ Incentive $10 / event $10 / fair $10 / class $10 / league $25 / consult $25 / program $50 / program $100 / year $100 / year per person $100 / year per person $100 / year per person Tier 3 Program Incentives

20. What is a PHA? A Personal Health Assessment (PHA) is a questionnaire that assesses all areas of wellness: family history, nutrition habits, fitness habits, stress levels, biometric measures, etc. PHA participants will receive a feedback report complete with a summary of their health risks and Health Assessment Score. The PHA allows Healthy Lifestyles Participants to see how their lifestyle changes affect their overall well-being. Personal Health Assessment

21. Where Can I Get a Health Screening? OPTION #1: Schedule an appointment with your Primary Care Physician. OPTION #2: Call 1-877-MY-KROGER (877-695-7643) to schedule an appointment at a local Kroger Pharmacy. OPTION #3: Attend one of the City’s Healthy Lifestyles Health Fairs and get a free Health Screening done. No appointment is needed. OPTION #4: Call the Healthy Lifestyles Coordinator to schedule an Health Screening for your department. Must have 50% of your department participate for this option. Health Screenings

22. www.cityofcincinnati.trihealth.com Healthy Lifestyles Website

23. Coaching & Pt. Self-Management Program An employer sponsored coaching and patient self-management program that encourages employees & dependents with diabetes and/or hypertension to seek counseling from Kroger pharmacists in regards to appropriate pharmaceutical care and use of self-management tools. Participating Kroger pharmacists have completed diabetes certificate training and medication therapy management training. Patients will work with pharmacists through a series of meetings, determined by the pharmacist and patient, to promote a high level of compliance with recommended care. DIABETES & HYPERTENSION

25. HEALTHY LIFESTYLES STATISTICS 7/1/07 - 12/31/07 1/1/08 - 12/31/08 1/1/09 - 12/31/09 TOTAL # ELIGIBLE 7903 8293 8432 TOTAL # ELIGIBLE EMPLOYEES 5179 65.5% 5334 64.3% 5318 63.1% TOTAL # ELIGIBLE DEPENDENTS 2724 34.5% 2959 35.7% 3114 36.9% TOTAL # PARTICIPANTS 1701 21.5% 2863 34.5% 3386 40.2% TOTAL # EMPLOYEE PARTICIPANTS 1269 24.5% 2240 42.0% 2581 48.5% TOTAL # DEPENDENT PARTICIPANTS 432 15.9% 623 21.1% 805 25.9% TOTAL $$$$ EARNED $ 332,395 $ 631,483 $ 838,672 TOTAL $$$$ SPENT FROM HRA's $ 209,500 63.0% 480,360 76.1% ???? AVERAGE EARNED PER/PART. $ 195.41 $ 220.57 $ 247.69 TOTAL # BIOMETRIC SCREENINGS 959 56.4% 1402 49.0% 1834 54.2% TOTAL # PERSONAL HEALTH ASSESSMENTS 599 35.2% 1604 56.0% 2091 61.8% TOTAL # PARTICIPANTS EARNING $500 61 3.6% 300 10.5% 485 14.3% KEY STATISTICS THAT NEED TO IMPROVE. TARGETS: 60% PARTICIPATION - 75% OF PARTICIPANTS TAKING THE PERSONAL HEALTH ASSESSMENT W/BIOMETRIC MEASURES

26. HEALTHY LIFESTYLES HRA INCENTIVES EARNED 2007 2008 2009 ALL YEARS # of part. % of part. # of part. % of part. # of part. % of part. # of part. % of part. $400 - $500 203 11.9% 636 22.2% 757 22.4% 1596 20.1% $300 - $399 249 14.6% 505 17.6% 458 13.5% 1212 15.2% $200 - $299 398 23.4% 276 9.6% 276 8.2% 950 11.9% $100 - $199 208 12.2% 269 9.4% 212 6.3% 689 8.7% $0 - $99 643 37.8% 1181 41.2% 1683 49.7% 3507 44.1% TOTALS 1701 100.0% 2867 100.0% 3386 100.0% 7954 100.0% Target range for level of participation is > $300

27. EMPLOYEE PARTICIPATION BY DEPARTMENT (6/1/07 - 12/31/07) 2007 DEPARTMENT # OF ELIGIBLE # OF EMPLOYEE % of EMPLOYEE EMPLOYEES PARTICIPANTS PARTICIPANTS 01 & 02 CITY COUNCIL 27 4 14.8% 03 MAYOR 6 0 0.0% 04 CLERK OF COUNCIL 6 2 33.3% 09 RCC 107 43 40.2% 10 CITY MANAGER 39 18 46.2% 11 LAW 64 16 25.0% 12 HR 23 7 30.4% 13 FINANCE 115 76 66.1% 16 COMM. DEVELOPMENT 68 23 33.8% 17 PLANNING/LIC.&PERMITS 71 12 16.9% 18 CITIZ. COMPLAINT AUTH. 7 5 71.4% 19 RECREATION 185 48 25.9% 20 PARKS 116 27 23.3% 222 POLICE 1330 194 14.6% 224 FIRE 884 122 13.8% 23 TRANSPORT. & ENGIN. 159 82 51.6% 24 CABLE, FLEET & PRKING 108 20 18.5% 25 PUBLIC SERVICES 417 48 11.5% 26 HEALTH 402 126 31.3% 30 WATER WORKS 527 243 46.1% 41 MSD 518 153 29.5% 5179 1269 24.5%

28. EMPLOYEE PARTICIPATION BY DEPARTMENT (1/1/08 - 12/31/08) 2008 DEPARTMENT # OF ELIGIBLE # OF EMPLOYEE % of EMPLOYEE EMPLOYEES PARTICIPANTS PARTICIPANTS 01 & 02 CITY COUNCIL 26 7 26.9% 03 MAYOR 6 1 16.7% 04 CLERK OF COUNCIL 6 4 66.7% 09 RCC 105 39 37.1% 10 CITY MANAGER 46 34 73.9% 11 LAW 63 34 54.0% 12 HR 23 16 69.6% 13 FINANCE 117 80 68.4% 16 COMM. DEVELOPMENT 67 35 52.2% 17 PLANNING/LIC.&PERMITS 74 27 36.5% 18 CITIZ. COMPLAINT AUTH. 8 4 50.0% 19 RECREATION 188 60 31.9% 20 PARKS 117 25 21.4% 222 POLICE 1361 534 39.2% 224 FIRE 906 266 29.4% 23 TRANSPORT. & ENGIN. 165 86 52.1% 24 CABLE, FLEET & PRKING 103 17 16.5% 25 PUBLIC SERVICES 418 172 41.1% 26 HEALTH 431 242 56.1% 30 WATER WORKS 540 278 51.5% 41 MSD 564 279 49.5% 5334 2240 42.0%

29. EMPLOYEE PARTICIPATION BY DEPARTMENT (1/1/09 - 12/31/09) 2009 DEPARTMENT # OF ELIGIBLE # OF EMPLOYEE % of EMPLOYEE EMPLOYEES PARTICIPANTS PARTICIPANTS 01 & 02 CITY COUNCIL 25 9 36.0% 03 MAYOR 6 2 33.3% 04 CLERK OF COUNCIL 6 5 83.3% 09 RCC 105 44 41.9% 10 CITY MANAGER 46 32 69.6% 11 LAW 67 38 56.7% 12 HR 22 17 77.3% 13 FINANCE 118 88 74.6% 16 COMM. DEVELOPMENT 67 48 71.6% 17 PLANNING/LIC.&PERMITS 74 26 35.1% 18 CITIZ. COMPLAINT AUTH. 8 4 50.0% 19 RECREATION 186 62 33.3% 20 PARKS 117 28 23.9% 222 POLICE 1352 497 36.8% 224 FIRE 902 286 31.7% 23 TRANSPORT. & ENGIN. 165 97 58.8% 24 CABLE, FLEET & PRKING 42 11 26.2% 25 PUBLIC SERVICES 477 254 53.2% 26 HEALTH 429 254 59.2% 30 WATER WORKS 539 424 78.7% 41 MSD 565 355 62.8% 5318 2581 48.5%

30. HRA ACCOUNTING 2007 EARNED INCENTIVES $ 332,395.00 2008 HRA EXPENDITURES $ (216,619.00) 2008 CARRYOVER BALANCE $ 115,776.00 2008 EARNED INCENTIVES $ 631,483.00 2009 HRA BALANCE $ 747,259.00 2009 HRA EXPENDITURES $ (480,360.00) 2009 CARRYOVER BALANCE $ 266,899.00 2009 EARNED INCENTIVES $ 838,672.00 2010 HRA BALANCE $ 1,105,571.00

31. TRIHEALTH - HEALTHY LIFESTYLES - INVOICES - 2009 COORDINATOR WEBSITE ADM. SUPPORT HRA - ONLINE HRA - PAPER TOTAL OTHER TOTAL JANUARY $ 5,083.34 $ 416.66 $ 2,537.50 $ 290.00 $ 60.00 $ 8,387.50 $ - $ 8,387.50 FEBRUARY $ 5,083.34 $ 416.66 $ 2,651.25 $ 500.00 $ 80.00 $ 8,731.25 $ - $ 8,731.25 MARCH $ 5,083.34 $ 416.66 $ 2,800.00 $ 840.00 $ 13,020.00 $ 22,160.00 $ 23,496.00 $ 45,656.00 APRIL $ 5,083.34 $ 416.66 $ 2,450.00 $ 610.00 $ 2,800.00 $ 11,360.00 $ 17,330.00 $ 28,690.00 MAY $ 5,286.67 $ 416.66 $ 2,800.00 $ - $ 60.00 $ 8,563.33 $ 540.00 $ 9,103.33 JUNE $ 5,286.67 $ 416.66 $ 3,202.50 $ 860.00 $ 200.00 $ 9,965.83 $ 120.00 $ 10,085.83 JULY $ 5,286.67 $ 416.66 $ 2,800.00 $ 480.00 $ 140.00 $ 9,123.33 $ - $ 9,123.33 AUGUST $ 5,286.67 $ 416.66 $ 2,310.00 $ 410.00 $ 80.00 $ 8,503.33 $ - $ 8,503.33 SEPTEMBER $ 5,286.67 $ 416.66 $ 3,080.00 $ 770.00 $ 7,700.00 $ 17,253.33 $ 14,378.00 $ 31,631.33 OCTOBER $ 5,286.67 $ 416.66 $ 4,935.00 $ 960.00 $ 440.00 $ 12,038.33 $ 1,225.00 $ 13,263.33 NOVEMBER $ 5,286.67 $ 416.66 $ 2,310.00 $ 410.00 $ 80.00 $ 8,503.33 $ - $ 8,503.33 DECEMBER $ 5,286.67 $ 416.66 $ 2,310.00 $ 410.00 $ 80.00 $ 8,503.33 $ - $ 8,503.33 TOTALS $ 62,626.72 $4,999.92 $ 34,186.25 $ 6,540.00 $ 24,740.00 $ 133,092.89 $ 57,089.00 $ 190,181.89 654 1,237 1,891 OTHER INCLUDES: INCENTIVE & WELLNESS TRACKING MODULE LABS AND OTHER SCREENINGS HEALTH FAIR EXPENSES

32. TRIHEALTH - HEALTHY LIFESTYLES - INVOICES - 2008 COORDINATOR WEBSITE ADM. SUPPORT HRA - ONLINE HRA - PAPER TOTAL OTHER TOTAL JANUARY $ 5,083.34 $ 416.66 $ 1,041.25 $ 720.00 $ 340.00 $ 7,601.25 $ - $ 7,601.25 FEBRUARY $ 5,083.34 $ 416.66 $ 1,452.50 $ 420.00 $ 240.00 $ 7,612.50 $ - $ 7,612.50 MARCH $ 5,083.34 $ 416.66 $ 525.00 $ 490.00 $ 2,060.00 $ 8,575.00 $ 4,038.00 $ 12,613.00 APRIL $ 5,083.34 $ 416.66 $ 1,181.25 $ 190.00 $ 480.00 $ 7,351.25 $ 706.00 $ 8,057.25 MAY $ 5,083.34 $ 416.66 $ 2,030.00 $ 160.00 $ 8,820.00 $ 16,510.00 $ 16,197.95 $ 32,707.95 JUNE $ 5,083.34 $ 416.66 $ 2,677.50 $ 290.00 $ 220.00 $ 8,687.50 $ 12,100.00 $ 20,787.50 JULY $ 5,083.34 $ 416.66 $ 2,800.00 $ 220.00 $ 200.00 $ 8,720.00 $ - $ 8,720.00 AUGUST $ 5,083.34 $ 416.66 $ 2,520.00 $ 320.00 $ 140.00 $ 8,480.00 $ - $ 8,480.00 SEPTEMBER $ 5,083.34 $ 416.66 $ 2,607.50 $ 270.00 $ 80.00 $ 8,457.50 $ - $ 8,457.50 OCTOBER $ 5,083.34 $ 416.66 $ 5,967.50 $ 1,330.00 $ 4,560.00 $ 17,357.50 $ 4,410.00 $ 21,767.50 NOVEMBER $ 5,083.34 $ 416.66 $ 1,820.00 $ 1,090.00 $ 160.00 $ 8,570.00 $ - $ 8,570.00 DECEMBER $ 5,083.34 $ 416.66 $ 2,800.00 $ 1,630.00 $ 520.00 $ 10,450.00 $ - $ 10,450.00 TOTALS $ 61,000.08 $ 4,999.92 $ 27,422.50 $ 7,130.00 $ 17,820.00 $ 118,372.50 $ 37,451.95 $ 155,824.45 713 891 1,604 OTHER INCLUDES: INCENTIVE & WELLNESS TRACKING MODULE LABS AND OTHER SCREENINGS HEALTH FAIR EXPENSES

33. Diabetes Coaching Results: Baseline Mean Final Mean Change in Mean Number of Patients Mean Months Weight 217.26 217.21 -0.05 223 6.63 BMI 34.21 34.23 0.02 219 6.62 TC 167.8 158.73 -9.07 94 5.26 Triglycerides 141.29 130.61 -10.68 92 5.15 HDL 52.31 51.22 -1.09 93 5.13 LDL 85.29 81.36 -3.93 93 5.22 BP Systolic 136.61 131.85 -5.76 201 7.04 BP Diastolic 80.97 76.98 -3.99 201 7.04 HbA1c 7.58 7.06 -0.52 113 5.63

34. Heart Healthy Coaching Results: Baseline Mean Final Mean Change in Mean Number of Patients Mean Months Weight 195.51 194.78 -0.73 191 5.93 BMI 31.11 31.07 -0.04 184 6 Total Cholesterol 180.43 178.39 -2.04 76 4.69 Triglycerides 129.82 135.41 5.59 73 4.77 HDL 52.41 49.87 -2.54 78 4.63 LDL 103.17 100.84 -2.33 77 4.68 BP Systolic 137.63 131.25 -6.38 194 5.92 BP Diastolic 82.64 79.83 -2.81 194 5.92

35. City of Cincinnati Active Employees Change from Baseline: Baseline Mean Final Mean Change in Mean Number of Patients Mean Months Weight 221.77 222.29 0.52 144 4.25 BMI 34.18 34.38 0.20 138 4.29 Total Cholesterol 180.39 166.61 -13.78 33 3.74 Triglycerides 141.22 142.78 1.56 32 3.73 HDL 50.24 45.85 -4.39 34 3.66 LDL 99.16 92.94 -6.22 32 3.73 BP Systolic 134.77 131.84 -2.93 140 4.22 BP Diastolic 84.46 81.42 -3.04 140 4.22 HbA1c 7.77 6.97 -0.80 23 3.76

36. City of Cincinnati Retirees Change from Baseline: Baseline Mean Final Mean Change in Mean Number of Patients Mean Months Weight 194.61 193.28 -1.33 226 7.62 BMI 31.43 31.26 -0.17 224 7.58 Total Cholesterol 172.26 170.21 -2.05 124 5.24 Triglycerides 129.13 127.38 -1.75 120 5.24 HDL 54.0 52.11 -1.89 124 5.17 LDL 92.61 91.80 -0.81 125 5.19 BP Systolic 139.77 131.68 -8.09 216 7.96 BP Diastolic 80.22 76.72 -3.50 216 7.96 HbA1c 7.29 6.90 -0.39 75 6.07

37. % Patient in HbA1c Category: City of Cincinnati Active Employee s Baseline: Final: HbA1c < 7 11 14 7 < HbA1c > 9 5 8 HbA1c > 9 7 1

38. % Patient in HbA1c Category: City of Cincinnati Retirees Baseline: Final: HbA1c < 7 39 44 7 < HbA1c > 9 29 28 HbA1c > 9 7 3

39. % Patients in LDL Category: City of Cincinnati Active Employees Baseline: Final: LDL < 70 5 9 LDL < 100 16 11 LDL < 130 6 9 LDL < 160 1 2 LDL > 160 4 1

40. % Patients in LDL Category: City of Cincinnati Retirees Baseline: Final: LDL < 70 38 40 LDL < 100 36 35 LDL < 130 32 35 LDL < 160 18 13 LDL > 160 1 2

41. % Patients in LDL Category: All Enrollees (n=184) Baseline: Final: LDL < 70 48 56 LDL < 100 62 60 LDL < 130 46 50 LDL < 160 23 15 LDL > 160 5 3

42. COC Pharmacy Utilization 2007 -VS- 2008 Medication Compliance Rate Actives = 117% Increase Retirees = 40% Increase 6/1-12/31 2008 Total Number of Coaching Participants Total Pharmacy Claims COC Active 168 2347 COC Retiree 228 5155 COC Total 396 7502 6/1-12/31 2007 Coaching Participants prior to Enrollment Total Pharmacy Claims COC Active 168 1080 COC Retiree 228 3662 COC Total 396 4742

51. DIABETES AND HYPERTENSION PROGRAM PARTICIPATION 1/1/08 - 2/28/10 GROUP DIABETES HYPERTENSION TOTAL FEES AVERAGE ACTIVES 152 181 333 $ 218,639.24 $ 656.57 RETIREES 203 170 373 $ 268,045.73 $ 718.62 TOTALS 355 351 706 $ 486,684.97 $ 689.36 COPAYS WAIVED 706 $ - $ - TOTAL COSTS 706 $ - $ - ELIGIBLE POOL TOTAL PART. % PARTICPATION DIABETES 2188 355 16.2% HYPERTENSION 3121 351 11.2%

52. DIABETES AND HYPERTENSION PROGRAM PARTICIPATION 1/1/08 - 12/31/08 GROUP DIABETES HYPERTENSION TOTAL FEES AVERAGE ACTIVES 90 95 185 $ 63,445.67 $ 342.95 RETIREES 133 118 251 $ 125,778.12 $ 501.11 TOTALS 223 213 436 $ 189,223.79 $ 434.00 COPAYS WAIVED 436 $ 35,363.00 $ 81.11 TOTAL COSTS 436 $ 224,586.79 $ 515.11 ELIGIBLE POOL TOTAL PART. % PARTICPATION DIABETES 2188 223 10.2% HYPERTENSION 3121 213 6.8%

53. 1/1/09 - 12/31/09 GROUP DIABETES HYPERTENSION TOTAL FEES AVERAGE ACTIVES 152 181 333 $ 130,214.64 $ 391.03 RETIREES 153 119 272 $ 105,908.19 $ 389.37 TOTALS 305 300 605 $ 236,122.83 $ 390.29 COPAYS WAIVED 605 $ - $ - TOTAL COSTS 605 $ - $ - ELIGIBLE POOL TOTAL PART. % PARTICPATION DIABETES 2188 223 10.2% HYPERTENSION 3121 213 6.8%

59. QUESTIONS???