Heart and Mind Connections: Integrated Strategies for Greater Health

1. Heart and Mind Connections: Integrated Strategies for Greater Health Client Summit Sessions July 17, 18, 20 Teleconference phone: 888-809-8974

2. Agenda • Connection Between Heart Disease and Mental Health: Joe Hullett • Northrop Grumman Newport News Wellness Initiative: Steven Apostoles • Pratt & Whitney Stress Management Seminar Program: Tracy Newmark, Amy Wilson • Discussion SummitQuestions@valueoptions.com

3. Why Heart Disease? • Human cost: No 1. killer of Americans and a leading cause of disability • Financial costs: Key contributor to rising health care and disability expenditures and a prime cause of decreased productivity SummitQuestions@valueoptions.com

4. The Costs of Heart Disease and Mental Health • Heart disease is often associated with a mental health diagnosis, which may not be properly diagnosed or may be undertreated. • There is a significant difference in medical health costs for individuals with coronary artery disease (CAD): • In one study, the costs to the employer for the physical health care of CAD patients without co-morbid behavioral health diagnoses was $883 per member per month. • These costs rose 54% to $1,358 per member per month for CAD patients with depression or anxiety.1 • Individuals with CAD who were treated with selective antidepressants for six months were: • 91% more likely to experience a significant reduction in the cost of hospital inpatient services • 72% more likely to experience a significant reduction in the cost of office-based services in the treatment of their disease2 SummitQuestions@valueoptions.com

5. About Heart Disease and Mental Health • Depression, anxiety, hopelessness, pessimism, hostility and anger have all been linked to heart disease.3,4,5 • Depression and anxiety disorders may affect heart rhythms, increase blood pressure, alter blood clotting, and lead to elevated insulin and cholesterol levels. These risk factors often predict, and are a response to, heart disease.6 • People with heart disease are more likely to suffer from depression than otherwise healthy people; conversely, people with depression are at greater risk for developing heart disease.7 • Those who have heart disease and who are depressed have an increased risk of death after a heart attack compared with those who are not depressed.8 SummitQuestions@valueoptions.com

6. Fighting Heart Disease: The Role of Behavioral Health Experts • Emotional, psychological and behavioral intervention and support is essential in helping to prevent or manage heart disease. • Behavioral experts can: • identify and manage behavioral health contributors that can impact heart health, such as depression, anxiety and chronic stress • support those who are living with heart disease • promote and help sustain a healthy lifestyle SummitQuestions@valueoptions.com

7. Initiative Components • Client summit • CD toolkit • Costs of heart disease and mental health diagnoses • Information about the heart and mind connection • Organizational/program considerations • Communication tools • Staff information and training • Affiliate information and training • Behavioral Health Management article SummitQuestions@valueoptions.com

8. Service Options Offered by ValueOptions • Standard: • 24/7 assessment and referral • Employee assistance program (EAP) • Stress reduction counseling • Depression screening • Intensive case management • Support for family and support systems • Primary care physician (PCP) behavioral health consultation • Educational programs • Enhanced services: • Lifestyle coaching • Tobacco cessation • Nurse line • Integrated care SummitQuestions@valueoptions.com

9. Benefits of an Integrated Cardiovascular/Behavioral Health Program • Increased referral rate to the EAP and mental health/substance abuse program • Decreased overall health care and disability costs • Enhanced productivity • Reduced absenteeism • Improved employee/member perception of organization’s commitment to their health and well-being SummitQuestions@valueoptions.com

10. Newport News Wellness Initiative SummitQuestions@valueoptions.com

11. Plan • All employees and dependents may participate (on their own time) • Participation is entirely voluntary and results are confidential • Four on-site wellness coordinators located throughout the yard • Clinic, Buildings 901 & 600, SPF Shop • Focus on early detection, prevention and risk reduction SummitQuestions@valueoptions.com

12. Initiatives • Health risk appraisal (HRA) • On-site screening/health fairs • Flu shots • Risk-reduction programs • Heart health • Cancer/diabetes prevention • Weight management • Nutrition/exercise • Stress management • Work/life balance SummitQuestions@valueoptions.com

13. Design Based on the seven benchmarks of the Wellness Councils of America: • Capturing Senior Level Support • Creating Cohesive Teams • Collecting Data • Crafting an Operating Plan • Choosing Appropriate Interventions • Creating Supportive Environments • Carefully Evaluating Outcomes SummitQuestions@valueoptions.com

14. Building Support • Sought senior level leadership commitment, including the Sector President, Senior VP of Programs and VP of Human Resources • Obtained buy-in from senior union officials • Tailored approach to address concerns of the various managers SummitQuestions@valueoptions.com

15. Creating a Cohesive Team • Chose our team well • Sought and received corporate support • Chose vendor who is willing to engage • Selected steering group committed to oversight “A committee is a cul de sac down which great ideas are lured and then quietly strangled.” SummitQuestions@valueoptions.com

16. Organizational Needs Demographic information Health risk appraisals Health screening data Medical claims Disability Absenteeism Ergonomics Employee Interests Focus groups Individual interviews/simple surveys Meetings Collecting Data to Drive Initiative SummitQuestions@valueoptions.com

17. Operations Plan • Vision • Goals • Objectives • Marketing • Timeline • Itemized budget • Evaluation plan SummitQuestions@valueoptions.com

18. Intervention Choices • Awareness • Education • Lifestyle modifications support • Healthcare providers collaboration • Incentives/disincentives • Screenings • Flu shots • Ergonomics • Job design/accommodation • Return to work • Workplace stress reduction SummitQuestions@valueoptions.com

19. Creating Supportive Environments • Establishing multiple permanent yard sites that provide privacy • Including dependents • Scheduling off-shift hours • Roving health screens • Engaging Food Services to provide healthy choices • Aligning organizational, HR and health promotion policies/practices • Benefit plan design • Coordinating with provider and community resources • Balancing high touch with high tech SummitQuestions@valueoptions.com

20. Consistently Measure Outcomes • Number of study years • Number of subjects • Number of separate interventions • Percentage change in sick leave • Percentage change in absenteeism • Percentage change in medical costs • Percentage change in workers compensation costs SummitQuestions@valueoptions.com

21. Concerns • Developing metrics to support ROI • Loss of momentum both at the Sector and Corporate • Engagement by healthcare providers • Duplicate programs provided by healthcare providers (HRA) increase costs • Integration with other benefit programs SummitQuestions@valueoptions.com

22. SummitQuestions@valueoptions.com

23. Pratt & Whitney • Pratt & Whitney is a world leader in the design, manufacture and service of aircraft engines, industrial gas turbines and space propulsion systems. • 40,000 employees worldwide, 20,000 domestic • HealthTimeSM, the Employee Wellness Network is managed by the Global Medical Department. • Contracts with Health Fitness Corporation (HFC) • HFC is a leader in corporate-based health improvement and has successfully implemented employee health management strategies in numerous Fortune 100 corporations. SummitQuestions@valueoptions.com

24. Vision, Strategy, Focus • To protect and enhance the health of Pratt & Whitney employees. • Identify and reduce preventable health risks through on-site programs • Help employees understand and obtain quality health care • Promote a healthy culture • Focus: • Cardiovascular disease • Cancer • Mental health (promotion and increased utilization of available EAP services) • Influenza (flu shot program) SummitQuestions@valueoptions.com

25. ValueOptions EAP Synergy • P&W researched available resources to meet established wellness goals. • EAP contract hours • On-site and off-site counseling services • Seminars on various subjects • Requested a stress management seminar. • Participants would learn new ways to deal with everyday stress, manage time and balance work/ family issues • Communication tool for promoting EAP services SummitQuestions@valueoptions.com

26. Stress Management Seminar • “Managing Stress for Life” • 18 seminars at domestic P&W facilities • September 2005 through January 2006 • Accommodated time constraints and shift workers • One session videotaped • DVD produced • Webcast uploaded to HealthTimeSM Web page on company intranet • Satisfaction surveys given to participants • 134 surveys returned (14 events) • Data analysis completed SummitQuestions@valueoptions.com

27. Participant Survey • 95% of participants ranked their satisfaction at a 5 or above (on a scale of 1-7) SummitQuestions@valueoptions.com

28. Usefulness of Information • 93% of participants ranked the usefulness of the information at a 5 or above (on a scale of 1-7) SummitQuestions@valueoptions.com

29. Handouts and Other Materials • 88% of participants ranked the handouts and materials at a 5 or above (on a scale of 1-7) SummitQuestions@valueoptions.com

30. Learning, Knowledge, Behaviors • 91% of participants reported that they increased their knowledge or improved their skills • 84% of participants reported that they will be making a behavior change SummitQuestions@valueoptions.com

31. Potential Program Savings: Stress Seminars at Pratt & Whitney Stress Seminars at Pratt & Whitney High Blood Glucose$22,650 HFC Results Calculator SummitQuestions@valueoptions.com

32. Participant Comments “Well done, kept everyone’s interest and spurred many conversations after.” “This seminar was highly informative and will certainly help with dealing with stressful situations in the future.” “I feel that these resources should be communicated more often. Not just me, but many people don't know about this or are hesitant about utilizing (the) EAP.” “Good introduction to stress, but I think more specific details on the very best ways of dealing with stress would be even more beneficial. Possibly real examples and back up ideas.” SummitQuestions@valueoptions.com

33. Summary • Communication tool for ValueOptions EAP services • EAP utilization increased 38% from 1Q 2005 to 4Q 2005 • Used data analysis to determine need for continuation of annual seminars • UTC EH&S Health Promotion Outreach Award SummitQuestions@valueoptions.com

34. Discussion SummitQuestions@valueoptions.com

35. Resources • American Heart Association: http://heart.org • National Business Group on Health’s business case for cardiovascular health: http://www.wbgh.org/pdfs/issuebrief_cphscardio.pdf • ValueOptions’ cardiovascular health initiative: http://valueoptions.com/spotlight_heart/html/pages/index.htm SummitQuestions@valueoptions.com

36. Sources 1 ValueOptions/IHCIS Comorbidity Study, 2003 2 Group Health Incorporated, www.ghi.com 3 Williams R.B. Neurobiology, cellular and molecular biology, and psychosomatic medicine. Psychosom Med, 1994; 56:308-315. 4 Denollet J., Brutsaert D.L. Personality, disease severity, and the risk of long-term cardiac events in patients with a decreased ejection fraction after myocardial infarction. Circulation. 1998; 97:167-173. 5 L.D. Kuzansky, K.W. Davidson, and A. Rozanski. The Clinical Impact of Negative Psychological States: Expanding the Spectrum of Risk for Coronary Artery Disease. Psychosom Med, May 1, 2005; 67(Supplement_1):S10-S14. 6 National Heart, Lung and Blood Institute 7 Nemeroff CB, Musselman DL, Evans DL. Depression and cardiac disease. Depression and Anxiety, 1998; 8(Suppl 1): 71-9. 8 Frasure-Smith N, Lesperance F, Talajic M. Depression and 18-month prognosis after myocardial infarction. Circulation, 1995; 91(4): 999-1005. SummitQuestions@valueoptions.com