1. PHIP EXECUTIVE SUMMARY
Thank you for your interest in Mertech’s Personal Health Improvement Program (PHIP). PHIP is an innovative six week program that organizations offer
to members as part of a design to deliver long-term savings by emphasizing better patient outcomes.
PHIP offers ACOs many benefits including the opportunity to demonstrate effective medical cost offsets within the same year the patient graduates from
PHIP. Among these benefits are:
A statically significant return on investment 300+% within year one of the patient completing PHIP.
A statically significant medical cost offset by thousands of dollars again in year one for patients graduating the program.
Graduates also demonstrated a statically significant decrease in absenteeism.
Attributes that facilitate NCQA accreditation as an ACO.
PHIP is a structured behavioral medicine learning program delivered in classrooms or by telephone for groups of patients, and treats significant patient
dysfunction that is not addressed by traditional primary care medicine. Patients learn a model, which they apply in their everyday lives, for investigating
and assessing the effectiveness of their behaviors and moods and how they are related to their health. Through active participation over 6 weeks in
clinician-led classroom exercises or telephone discussions (completed in 6 classroom/telephone sessions) and home study and practice, patients learn new
behaviors which in turn alter mood and affect body processes. With PHIP the member receives high touch clinical relationship and works with the same
clinician over the entire program. This strategy helps to personalize the group interaction and address individual goals. PHIP is an innovative program
that addresses a medical population not effectively served by traditional resource management programs.
History and Development: PHIP had its beginnings as the Ways to Wellness (WTW) program offered by Harvard Pilgrim Health Care (HPHC)
Behavioral Medicine Department. The PHIP program was designed by a physician as an intervention for patients with stress-related complaints, including
headaches, back pain, fatigue, insomnia, and gastrointestinal discomfort. For the majority of these patients with somatic complaints, no known organic or
psychiatric explanation could be identified even after subspecialty referral and extensive work-up. These patients can become dissatisfied high users of
biomedical services which alone do not reduce their distress or suffering because of the non-recognition of the emotional basis for their symptoms. Rather
than exclude or restrict access to medical care for this patient population, PHIP has successfully provided such patients with an efficient and effective
treatment that addresses the underlying stress and mood-related component of their physical complaints.
Many of the individuals who have benefited from PHIP are patients who have been learning to cope with chronic disease, such as multiple sclerosis,
coronary artery disease, asthma, and rheumatoid arthritis, or a life-threatening illness like cancer or AIDS. Both condition-specific PHIP offerings (for
diagnoses such as asthma and irritable bowel syndrome) and the basic PHIP program have proven to be valuable and effective components of an overall
management strategy which has been helpful in improving quality of life, health status and symptomology and decreasing physical discomfort, anxiety and
distress for these patients.

2. PHIP can also be combined with employee wellness programs using tools such as, health risk assessments that identify behaviors and habits that can
benefit from change to healthier behavior
PHIP Outcome Studies: Randomized controlled studies in varied settings have repeatedly shown the efficacy of PHIP and Ways to Wellness. In a study
published by Hellman, et al., WTW was compared with a Stress Management Information Class, which presented data on stress and its relation to illness
but did not incorporate any practice of new stress management behaviors. For individuals receiving the WTW treatment, pretreatment physical discomfort
scores declined when measured 6 months after the intervention. In contrast, post-intervention scores in the Stress Information Group increased from
pretreatment levels. In addition, the mean number of medical visits for the WTW group fell from 5.7 in the 6 months before participating in WTW to 1.8
in the 6 months afterward.
A study by McLeod compared physical symptoms, depression, somatization, life satisfaction, and symptoms of psychological stress in a group of adults
with stress and mood-related physical complaints who received the WTW treatment and a waitlist group who were expecting treatment (the control group.)
Based on data collected before and after the course for both groups, and at six months post-intervention for the WTW group, the WTW patients showed
significantly greater improvement in physical symptoms, depression, and somatization than did the patients in the waitlist group. Life satisfaction scores
for the WTW group nearly doubled, symptoms of psychological stress decreased, and levels of interpersonal trust increased when compared with the
control group.
PHIP was evaluated in a variety of clinical settings including both group practices and health centers. Results of this clinical evaluation were similar to
previous studies. Participants showed statistically significant improvement in their physical distress, psychological distress, and health status after PHIP as
depicted below. These improvements were maintained three months after the course and were associated with decreases in medical utilization for a full
year after treatment.

4. Anxiety
Depression
Brief Symptom Inventory (BSI) Brief Symptom Inventory (BSI)
66 N=356
N=356 66
64
64
Level of Distress
62 p<.001
Level of Distress
p<.001 62
60
60
58
58
56
56
54
54
52
52
Before After 6 Month F/U
Before After 6 Month F/U
Relief from Bodily Pain Sustained Improvement in Pain
36-item Short Form Health Survey (SF-36)
Scores Over Time for Various Patient
75
Groups Patient Groups:
60
70 Headache (N=111)
Freedom from Bodily Pain
Mean SF-12 Scale Score
GI (N=139)
65 55
Arthritis (N=100)
Mean Score
60 50 Chronic
55 Problems (N=145)
45 Back Pain (N=101)
50
45 40
40 N=356
P<.001 35
35 (p<.0001)
30
30
Pre-program Post-program 6-month Follow-up
Before After 6 Month F/U
Source: PHIP Commercial Client Quality Assurance Data
Note: All Comparisons show significant improvement from Pre to Post Program; sustained at 6 months

5. How Would You Rate the Importance
of a Program Such as PHIP as Part of
Your Overall Health Care? N=356
44%
31%
Directly
After 11% 10%
PHIP (%) 4% 1%
Extremely Very Moderately Slightly Not No
Important Important Important Important Important Response
37% 34%
6-month 17%
Follow-up 8%
(%) 1% 3%
Extremely Very Moderately Slightly Not No
Important Important Important Important Important Response

6. A retrospective study (Locke-Ford-McLaughlin) conducted between at a large northeastern HMO on high utilizing patients (defined as minimum annual
costs of $1,500 but not exceeding $20,000 within a 6-month period) compared pre- and post-program utilization for patients who completed the PHIP
program. Utilization was measured for the 12 months prior to referral and for 12 months after referral or completion of the program. Utilization costs for
the PHIP group declined in the 12-month period post-PHIP by a mean of $1616.00 from $4079.00 (for the 12 month period pre-PHIP) to $2462.00 (for the
12 month period after completion of the program). The authors observed that the cost savings for the PHIP group exceeded those for a control group
(patients who were referred but refused participation in PHIP) by $1008.00 and that the reduction in health costs over time in the PHIP group was roughly
three times greater than in the comparison/control group. Viewing the change in costs as a percentage change from baseline (baseline defined as utilization
costs for the pre-referral 12 month period, the PHIP group experienced a 25% decline contrasts with less than a 1% change for the control group.

7. Consistent with these results a national health plan customer over a two year period measured Absenteeism and Presenteeism for
patients prior to t he program and following their completion of the program. Patients reported significantly less time off and greater
presence in the workplace following the PHIP program.

8. PHIP Quality Assurance Reporting: “Quality Assurance” Package is designed to help customers assess the clinical impact of PHIP with your members.
It is a tool for measuring and evaluating this behavioral medicine in a standardized questionnaire administered at three different points in time, at the first
class (T1), the last class (T2) and six months after the last class (T3)
Below is a special analysis performed for management displaying the cumulative quality assurance reports since the inception of PHIP at (client name
deleted) through the most recent calendar year.

10. Detailed statistical analysis
can be found on each
specific symptom sheet
*:p< .1 **: p < .05 *** :
p< .001
n for T1 Before 6 Months After PHIP n for T1
Physical Distress After PHIP (T2)
and T2 PHIP (T1) (T3) and T3
Headache 80 1.750 1.388 ** 1.333 ** 57
Stomach 87 1.885 1.368 *** 0.915 *** 59
Teeth Grinding 50 1.980 1.400 ** 1.257 ** 35
Numbness 78 2.179 1.436 *** 1.164 *** 55
Joint or Muscle Aches 130 2.431 1.846 *** 1.874 *** 87
Palpitations 53 1.528 0.981 *** 0.795 *** 39
Bowel Problems 74 2.176 1.257 *** 1.091 *** 55
Sweating 53 1.906 1.132 *** 0.897 *** 39
Hot or Cold Spells 64 1.969 1.250 *** 1.021 *** 48
Weakness 85 2.082 1.447 *** 1.105 *** 57
Back Ache 102 2.333 1.686 *** 1.479 *** 71
Faintness 38 1.447 0.842 ** 0.586 *** 29
Chest Pain 46 1.435 1.022 ** 0.657 *** 35
Fatigue 130 2.466 1.838 *** 1.477 *** 88
Shortness of Breath 61 1.803 1.180 *** 0.933 *** 45
n for T1 Before 6 Months After n for T1
Psychological Distress After PHIP(T2)
and T2 PHIP(T1) PHIP(T3) and T3
Temper 62 1.581 1.081 ** 0.833 *** 42
Lonely 87 2.011 1.448 *** 1.018 *** 56
Fearful 78 1.859 1.372 ** 0.981 *** 54
Urge to Smash 22 1.545 1.136 0.444 *** 18
Argumentative 50 1.460 0.960 ** 0.541 *** 37
Sleeplessness 117 2.265 1.701 *** 1.613 *** 80
Blue 99 1.980 1.465 *** 1.116 *** 69
No Interest 72 2.000 1.278 *** 0.962 *** 52
Fearful 78 1.859 1.372 ** 0.981 *** 54
Panic 41 1.732 1.195 ** 0.759 *** 29
n for T1 Before 6 Months After n for T1
Global Health Assessment After PHIP(T2)
and T2 PHIP(T1) PHIP(T3) and T3
Health 142 2.310 2.070 ** 1.919 *** 86
Distress 123 2.195 1.642 *** 1.418 *** 79
Quality of Life 109 2.119 1.615 *** 1.229 *** 70
Daily Activities 103 2.049 1.534 *** 1.103 *** 68
Relationships 126 2.000 1.611 *** 1.342 *** 76