Change Health Care Now

1. Change Health Care Now Denise Christy President Humana Michigan

2. From Zero-Sum Competition To Value-Creation • In “Redefining Health Care,” Michael Porter points the way to health care transformation • Health care represents zero-sum competition • Contrasts with the rest of the economy • Value is key • Products improve • Costs go down over time • In health care, quality and cost never both improve • This is health care’s main challenge

3. Challenges To Value-Creation • Fragmentation473,000 doctors practice in small settings • Investment constraints85% of acute care hospitals are not-for-profits • Investment orientationHospital/physician reimbursement structures favor revenue-producing duplication over cost-saving efficiency • IT underuse – Most industrialized countries have between 50-90% of medical records in electronic form compared to 5% for the U.S. • Equipment overuse – MRI growth is 9% annually with $100 billion in total expenditures • Closed competitionHealth benefits companies are selected on size and scale, not innovation and value

4. Building Health Care Value • Creating value in a $1.8 trillion non-system is challenging • A “system” will never create value until everyone changes roles

5. The Key Principles • Any plan has to include consumer empowerment, productivity, best practices, quality, transparency and technology • Three principles • Value for money, regardless of who’s paying • Value for consumers, in terms of who’s in control • Value for everyone with better products and lower costs

6. Three-Pronged Approach • Standardization • Consumer responsibility • Business leadership

7. Standardization

8. Standardization Standardization can lead to value and efficiency • Encourage all payers to join Availity, a web-based information exchange system • Developed by Humana and BCBS of Florida in 2001 • Designed to allow real-time administrative processing • Eligibility, referrals, authorizations and claims • Adopted in Florida by 100% of hospitals and 93% of physicians • Estimating more than 400 million transactions in 2007 • Expanding into Texas, New Mexico and Illinois • September 24th, Availity Presenting to Michigan

9. Standardization Evolving from administrative efficiency to consumer value • Ongoing payer impact • Reduced transaction costs • Call center savings • Medical cost savings • Growing consumer benefit • Transferability of comprehensive medical history • Real-time claims processing • HSA administration

10. Consumer Responsibility

11. A Robust Set Of Consumer-Focused Tools And Programs Clinical Programs and Forecasting Product and Network Design • Disease Management • Transplant Management • Utilization Management • Concurrent Review • Case Management • HumanaBeginnings • HumanaFirst® • Humana Health Assessment • Personal Nurse® • MyHumana personal web page • Maximize Your Benefit • Predictive modeling • Health Agent • Pharmacy MEDS Team • Traditional plans • Real-time operating platform • SmartSuite® • CoverageFirst® PPO • HumanaAccessSM card • RxImpact • Wellness programs • Medical spending accounts • HDHP with Health Savings Account • Humana Preferred • 90-Days-at-Retail Program • RightSourceSM Clinical Programs and Forecasting Product and Network Design The Humana Guidance Solution Consumer Education Financial Analysis and Forecasting Financial Analysis and Forecasting • Online Enrollment Center and Wizard • MyHumana personal Web page • Physician Finder Plus • Transparency tools • Healing Kitchen • Family Health Budget • Comparative Pricing by Pharmacy • YourHumana Handbook • SmartSummarySM Consumer Education • SmartStart • Customer Reporting Package • Benefit Utilization Director for brokers • Employer portaltools • RxCalculatorSM • Pharmacy Repricing and Formulary • Verisight Analysis • MD Consultation

12. Consumer Responsibility Guidance for Becoming a Better Health Care Consumer • Become a passionate self-advocate • 45% of Americans get the wrong care – don’t be one of them • Be skeptical, question everyone • Use a Family Health Budget tool • Gain control by knowing how much you spend on health-related expenses (checkups, vaccinations, routine prescriptions etc.) • Humana’s Family Health Budget tool is a simple seven-step process

13. Consumer Responsibility Guidance for Becoming a Better Health Care Consumer • Find health information online • Become proficient on a Website that can answer most of your health questions • Take a Health Assessment • Analysis of your daily habits and family history can provide you with clearer understanding of your health status • Tool available to general population summer, 2007

14. Business Leadership

15. Business Leadership Leadership leads to value-creation • Reward consumer engagement • Insist on transparency and accountability • Facilitate reform through business partnerships and alliances

16. Business Leadership Business Health Care Group of Southeast Wisconsin • Formed in response to Milwaukee’s health care costs averaging 25% higher than comparable Midwest cities • Includes 200-plus companies of all sizes and 75,000 members • Exclusive use of Humana Preferred “high-performance” network • ASO clients saw health costs decline by 15% in 2006 versus 2005

17. Going Forward

18. Going Forward • Stay connected • New changenow4health.comWebsite in mid-April • Consumer program updates • Availity growth and progress • Employer coalition results • Avenue to share best practices • Business action summit 2007 • Initiatives advanced by supporters It’s about change now Our commitment to changehealth care now begins today