~ $1 Trillion 62% HEALTH ENGAGEMENT CRITICAL TO THE SUSTAINABILITY OF EMPLOYER SPONSORED HEALTHCARE. Annual spend on healthcare by employers

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1 HEALTH ENGAGEMENT CRITICAL TO THE SUSTAINABILITY OF EMPLOYER SPONSORED HEALTHCARE Employers are an important stakeholder in the provision of healthcare in the US today...yet OTHERS CONTROL THE SYSTEM P R O V I D E R S 62% ~ $1 Trillion N E W E N T R A N T S EMPLOYER BENEFITS C A R R I E R S Percent of non-medicare Americans covered by employers Annual spend on healthcare by employers C O N S U M E R S D R U G C O M PA N I E S G O V E R N M E N T MERCER

2 HEALTH ENGAGEMENT WHY DO EMPLOYERS CARE? 7 OUT OF 10 AMERICAN WORKERS say financial stress is their most common cause of stress. 1 80% OF EMPLOYEES report an increase in their health care costs in the past two years and 56% are saving less for retirement as a direct result of more health care costs. 2 22% OF US EMPLOYEES admit to missing at least one day of work in the past year to deal with a financial problem. 3 $40,000 IS THE MEDIAN retirement plan account balance for working-age families. 4 1 American Psychology Association, Stress in America: Are Teens Adopting Adults Stress Habits? (2014) 2 Bank of America/Merrill Lynch, Workplace Benefits Report (2013) 3 MetLife, Inc.,10 th Annual Study of Employee Benefits Trends: Seeing Opportunity in Shifting Tides (2012) 4 National Institute for Retirement Security, The Retirement Savings Crisis: Is It Worse Than We Think? (2013) 27% 29% 23% 8% 4% 4% 3% 6% STOMACH ULCERS SEVERE ANXIETY SEVERE DEPRESSION HEART ATTACKS People With Low Levels of Financial Stress People With High Levels of Financial Stress Source: Associated Press-AOL health poll, Debt Stress: The Toll Owing Money Takes on the Body MERCER

3 MERCER S NATIONAL SURVEY OF EMPLOYER-SPONSORED HEALTH PLANS HEADLINE SURVEY RESULTS Cost growth slowed to 2.4% in 2016, but faster growth is predicted for 2017 The underlying trend the average cost increase before plan changes remains around 6%, far outpacing inflation Enrollment in high-deductible CDHPs rose to 29% of covered employees, helping to slow cost Under excise tax threat, large employers continued to add CDHPs, most often as an option Sharp increase in prescription drug cost is driving overall medical plan trend Specialty Rx cost increases are in the double digits for many employers With the growth in CDHPs, a move to personalize the consumer experience Employers add financial wellness and advocacy programs; offerings of telemedicine soar Network strategies ACOs, Centers of Excellence, other narrow networks increase the visibility of quality Employers look beyond cost-shifting to focus on pay for value and better quality MERCER

4 EMPLOYERS HAVE RELIED ON COST-SHIFTING TO CURTAIL COST GROWTH IN THE HEALTH REFORM ERA Average PPO deductible for individual, in-network coverage Small employers Large employers V $1,663 $1,681 $1,738 $1,805 $1,410 $1,452 $1,113 $1,192 $511 $565 $587 $666 $684 $785 $833 $ Mercer National Survey of Employer-Sponsored Health Plans

5 THE TOP COST-MANAGEMENT STRATEGY: CONSUMER-DIRECTED HEALTH PLANS Large employers By 2019, 72% of large employers expect to offer a CDHP 72% Percent of employers offering CDHPs Percent of covered employees enrolled in CDHPs 59% 61% 48% 32% 36% 39% 33% 28% 20% 8% 23% 10% 13% 15% 18% 23% By 2019 (projected) Mercer National Survey of Employer-Sponsored Health Plans

6 WHILE SOME EMPLOYERS MAINTAIN HRA-BASED PLANS, THE REAL GROWTH HAS BEEN IN HSA-ELIGIBLE PLANS Percent of large employers offering plan HSA-eligible v CDHPs HRA-based CDHPs 60% 50% 53% 50% 41% 40% 30% 24% 27% 32% 20% 10% 0% 14% 17% 10% 11% 10% 11% 14% 12% 8% 8% Mercer National Survey of Employer-Sponsored Health Plans

7 OFFER INCENTIVES IN CONNECTION WITH WELL-BEING PROGRAMS Large employers v Financial rewards, such as lower premiums, cash/gift cards 64% EARNED FOR Non-financial rewards, such as lottery, recognition, token gifts 24% Financial penalties, such as higher premiums, loss of plan eligibility Participation 66% Outcomes 29% No incentives provided 25% 17% MAXIMUM ANNUAL VALUE MEDIAN Charitable contributions on behalf of members 4% Participation $300 Outcomes $350 Offer lower premium for non-tobacco use 22% 26% Mercer National Survey of Employer-Sponsored Health Plans

8 INCENTIVES INFLUENCE PARTICIPATION RATES SO DOES INCLUDING SPOUSES IN THE PROGRAM Large employers 52% 51% 50% 47% 49% 47% 43% 36% 30% 27% % eligible employees completing an HRA % eligible employees with validated screening % eligible employees completing an HRA % eligible employees with validated screening Offer financial incentive Don't offer incentive Offer non-financial incentive Spouses may participate Spouses may not participate Mercer National Survey of Employer-Sponsored Health Plans

9 LESSONS LEARNED FROM EMPLOYERS: INCENTIVE DO THEY WORK? Financial Incentives are not known to drive sustained health engagement they are a nudge to get started INTRINSIC incentives: Motivation to engage in activities that enhance or maintain a person's selfconcept. I exercise because it makes me feel good. I want to be healthy for my family. OPPORTUNITIES FOR IMPACT? EXTRINSIC incentives: Motivation that comes from outside an individual. Rewards provide satisfaction and pleasure that the task itself may not I want the reward/prize. I want recognition. Expand beyond traditional financial incentives. MERCER

10 HEALTH ENGAGEMENT 2.O TECHNOLOGY IS ENABLING INNOVATION AND PERSONALIZATION DATA IS THE FOUNDATION THE WORLD IS MOBILE SIMPLIFY THE COMPLEX AN EXCEPTIONAL AND PERSONALIZED EXPERIENCE MERCER

11 HEALTH ENGAGEMENT 2.0: THE NEXT WAVE OF THINKING & ACTION MAKE IT RELEVANT & TIMELY FOR ME MAKE IT PERSONAL TO ME PROVIDE CONSUMER-GRADE TRUSTED SUPPOPRT Personalize incentive design create my own personal health itinerary Capitalize on when I reach into the system, because that s when I want to engage Meet me where I am - omni-channel communications Apply game mechanics because sustained health engagement needs to stay fresh Learn from the best of marketing MERCER

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