The presentation is a brief description to the proposed marketing strategy for the Hartford healthcare specifically targeting on the New Health Enhancement Program proposed for Connecticut state employees.

2. Contents CURRENT SCENERIO What are we facing? Research outcomes Patient’s DMP OUR STRATEGY Proposal Value Proposition RESULTS Costs Benefits

3. Strategy and Proposal

4. What are we facing?

6. Patient’s Decision Making Process

8. Sample Sample of Union Publications: Sample of HEP Card

9. Estimated Cost HEP Patient Priority Card: Free co-pay benefits: $ 100,000 Implementation Costs: $ 50,000 Advertisement in Employee Unions: Publications - $ 100,000 Events - $ 50,000

10. Benefits Penetration Rate 38 % to 50 % Increase of 12 % No. of patient visits 30,000 to 40,000 Increase of 10,000 Operating Revenue $23.4 M to $24.3 M Increase of $0.9 M Customer Equity $44 M to $ 58 M Increase of $ 14 M

12. Thank you!

13. APPENDIX - 1 Scanning the 5 C’s: The HEP to Customers: Preventive Care: In order to be eligible for the new Health Enhancement Program, individuals has to have age-appropriate wellness exams and immunizations, early diagnosis screenings (such as colorectal cancer screenings, Pap tests, mammograms, and vision exams). Those enrolled in the plan’s dental program must also get annual dental cleanings. Cost Effective: Enrollment in Health Enhancement Program, will enable them to pay lower monthly premiums and have no deductible for in-network care for the plan year. Patient Doctor Relationship: Patients value their primary care services in very high regards, as they are based on long-term relationships. The focus on promotion of this service to the customer should be based around that long-term relationship where PCPs are viewed as family doctors. Quality of Services: Overall experience with the Hospital during the visit is one of the most quantifiable factor for the patient. In order for HH to satisfy their patients needs, it is very important to provide flexibility in scheduling appointments, reasonable waiting period, clean facilities and friendly staff. Competencies: Location Proximity : provides exceptional Primary care services in 63 towns of central Connecticut Excellent Doctors: HHC has been recognized by Best Doctors for the most top-ranked doctors of any hospitals in the area. HHC has also been identified by the Federal government for having superior heart attack outcomes and it is a recipient of the ‘Gold plus Performance Achievement Award’ from the American Stroke Association. Renowned for Community Service : It provides education and research support to bring the latest technology, discoveries and innovations to patients and community. Technologically Advanced services: It is the leading provider of Robotic, minimally-invasive Bariatric and colorectal surgery.

14. APPENDIX - 1 Scanning the 5 C’s - continued: Complimentors: All State/non-State agencies that promote healthcare services across the state: The new healthcare enhancement program attracts advertisement by all such agencies, which in turn would help Hartford Healthcare (HH) for creating awareness about the program. Following are few examples of the agencies that help promotion of the program: State Agencies: State of Connecticut – Department of Public Health State of Connecticut – Office of Health Reform & Innovation State of Connecticut – Connecticut Commission on Health Equity Non-State Agencies Governor Malloy’s Care and Share InthistogetherCT.org Healthcare discussion blogs, which have blogs topics on the New Health Enhancement Progrram Health care magazines and publications that support Hartford Healthcare State employee unions: State employee unions are well aware of the benefits of the new health enhancement program. There are many union leaders are actively attracted towards Hartford Healthcare services and hence those unions can be expected as complimentors for the HH. Connecticut State Employee Association (CSEA) American Federation of Government Employees - Connecticut Chapter Connecticut State Employee Credit Union (CSE – Credit Union) Connecticut Employees Union Independent (CEUI) American Federation of State, County, and Municipal Employees United Public Service Employees Union – Connecticut chapter

15. APPENDIX-1 Scanning the 5 C’s – continued: Changing Context: HealthCare Quality : Over the past 30 years, the quality of healthcare services has improved tremendously. People now live healthier and longer life than people 30 years ago. Advanced Technology and R&D: One of the main reasons behind this drive is advancement in the technology and increased R & D Economy: One of the most important factors in the current market environment is the economic condition. Millions of Americans have lost homes, jobs and savings due to the financial crisis and recession. Healthcare service a necessity: However, since healthcare is always a big issue in people’s life with inelastic demand, people are still willing to be highly participated in the healthcare program Health enhancement program: Recently, government has introduced incentive ‘Health prevention program’ to optimize their employees health through preventive methods. This will help them to reduce healthcare costs and increase product i vity of their employees. One of the conditions to be eligible for HEP: that enrolled family members will need to get age-appropriate wellness exams and immunizations, early diagnosis screenings (such as colorectal cancer screenings, Pap tests, mammograms, and vision exams). Opportunity: HHC being one of the in network provider of the Healthcare Services for the State Employees has a vast opportunity for growth by attracting state employees.

16. APPENDIX-2 FOCUS GROUP/SURVEY Results: Fourteen Connecticut state employees from the University of Connecticut participated in our focus group. In the first stage our participants were informally asked to read and familiarize themselves with the HEP packet. They were then asked to comment on their various experiences pertaining to a variety of preventive health care interactions. Surprisingly the most common complaints related not to healthcare itself but to the basic service experience of interacting with the doctor’s office. Scheduling and waiting room times were recurring complaints (as is evidenced by the sampling of Discussion comments below.) Next our participants filled out Worksheet #1 which asked about complying with the new HEP. On a scale of 1 to 7, with 1 requiring “no changes in how I manage my preventive care, and 7 requiring “substantial changes” the subjects averaged a score of 2.8. This indicates that they generally do not anticipate major changes to stay in compliance with the HEP. For the next stage our subjects were asked to write a short paragraph about a “great” or “lousy” experience relating to various interactions with their healthcare providers. 10 people provided negative stories. Again scheduling and wait-times were the predominant complaints. All 4 “great” stories pertained to an appreciation of the interpersonal interactions with the doctor/doctor’s office. (See below for Worksheet #2 Notes). Lastly, our participants filled out Worksheet #3 which first asked how important they rated a host of healthcare attributes on a scale of 1 to 8 (1 being “not important at all” and 8 being “must have.” The attributes which received the highest scores are listed below.

17. APPENDIX-2 Survey results – continued: Average 7.1- You feel involved in making your own care decisions. 7.1 = You can get diagnostic appts. within a week 7.0 = Your primary care doctor’s offices and within 30 minutes of home 6.6 = You can get diagnostic appts. next day 6.5 = You can get diagnostic appts. within a week 6.2= Your primary care Dr. would be recognized by other patients as one of the easiest to talk to. 6.2 = Your Dr’s practice is affiliated with a wide range of medical specialists. 5.4 = You can get diagnostic appts. same day

19. FOCUS GROUP - Discussion Comments Good- same receptionist/nurse/same day scheduling Dr and office efficient, accessible, schedule next appt before leaving Coordinated care, heart attack-want one person to explain Dr retired, no notification, couldnt sked Dr moved offices and never went back Problems: Scheduling months out only one 8am appt/day Busy signal for 45 mins, closed at lunch Ideal state - being able to see primary care dr Followup routine Refills Someone should always answer the phone seen within 20 mins, clean, friendly, bloodwork done in advance, left and made her my primary care dr. Angered by repitition - when they should know med history want it to be quick - feel like so much time is wasted by answering so many questions could be better coordinated - Primary care appt - they seem to waste my time, dreaded scale, unpleasant, nurse vitals takes 20mins, then dr comes in backlogged dr, sked'd too many appts within one hour Gyno much more thorough than primary care dr 5-10 min - checkin 15 mins - Physicians asst 30 mins - waiting in exam room 10 mins - primary care dr waiting, kept waiting - not respectful respected valued – switched bc spent so much time waiting in the office after waiting one hour – then 5 min apt tell you whatever to get you out the door waste time – elect records while waiting APPENDIX-2

20. FOCUS GROUP WORKSHEET #2 LOUSY / C (prev care apt) Waited 30mins in exam rm before dr arrived The practice forces drs to sked more appts/day than they can really do and still fully treat each patient, always a backlog LOUSY / A (finding new healthcare provider) Prob with doing physical – insurance deemed unnecessary, dr offc wouldn’t compromise on bill New provider repeated same redundant recommendations (macrobiotic diet), frustrated enough after 3 yrs to find a new provider LOUSY / B (scheduling preventive care) Tried to schedule a checkup, dr never called back (had retired) – went to walk-in clinic and found new dr (who turned out to be excellent) LOUSY / C (prev care appt) Scheduled checkup very far in future, dr offc never called to remind and I showed up too late, rescheduled a month out – then dr was caught in traffic had to resked again LOUSY / C (appt) Heart attack – excellent care at Hartford Hospital but very poor followup after release from hospital, and then local cardiologist – had to work too hard to find out what I should be doing (diet, activity, etc) and what course of cardiac rehab to pursue. LOUSY / B (scheduling appt) With 2 daughters, pediatric group – the wait was terrible, could never see the same dr twice – had to reintroduce ourselves and revisit medical history – in the end chose a new provider APPENDIX-2

21. LOUSY / E (discuss screening results) Dr misinterpreted cholesterol results as high and suggested behavior modification (less meat etc), a year later realized results were misinterpreted and cholesterol was fine, was worried for a year for nothing LOUSY / C (appt) Wait, receptionist no change for co-pay, after vitals have to wait 30mins for dr who spends 10 mins w me LOUSY / E (discussing screening results) When nurse calls with results, nurse directs any questions to a dr – but must make an appt to do this, another day off from work, time to forget questions LOUSY / B (scheduling) Moved offices and didn’t tell me Because hadn’t seen me recently, couldn’t fit me in/long wait GREAT / C (appt) Had tests done three days prior to dr appt, seen within 20 mins, the physicians asst spent over an hour with me, made PA primary care ddr, would ensure I could be seen for other medical issues in the future GREAT / B (scheduling) Receptionist remembers who you are when you call and knows if it has been a while since last contact, love dr and travel over an hour to see him GREAT / E (discussing screening results) Negative results made me anxious, dr called to tell not to worry, dr was great in his explanation and followup, dr treated me not just as a patient but as a human being, have been going to him for 10 years GREAT / E (receiving prev care info from provider btw appts) GP noticed Blood calcium level high – led to finding cancerous hyperthyroidism because dr was vigilant when first noticed calcium levels APPENDIX-2

22. HEP Priority Card Benefits: Our mission is to offer comprehensive services in an environment where innovation and teaching are integral to care; where we are proud to serve patients and one another; where meeting the challenge of complex medical needs is viewed as a defining competency; and where quality and safety of care are a constant. 1 Since HHC has evening & weekend hours at 6 locations, and the state employees are typically work 9-5, M-F. The HEP Priority Card can provide you a priority of scheduling evening and weekend appointment to avoid unnecessary dissatisfaction. (i.e. Dissatisfaction of your manager because you may ask days off to see a doctor during work hours.) We are providing patient points for the patient with HEP Priority Card. When a cardholder make a health enhancement schedule, we give one point on the card. If a cardholder recommend someone else to become a member of HHC’s health enhancement group, we give one point to the new member on the card, and give two point for the referee. The points are accumulated, when a state employee reach 10 points on the card, we will use the points towards the employee’s one time future copay. HHC provides an umbrella of coordinated healthcare to provide for all aspects of Health Enhancement program within one provider network. THESE ARE COPAYS FOR REGULAR VISITS: Copays for health enhancement visits are already covered by HHC’s initiative 1. http://www.harthosp.org/AboutUs/MissionVisionValues/default.aspx APPENDIX-3

23. APPENDIX-4 Calculations for Customer Equity: NOW AFTER 1 year No. of employees 200,000 200,000 Penetration Rate (%) 38 50 Avg. Margin Per Customer (AMPC) ($) 100 100 Discount rate (i) (%) 12 12 Retention rate (%) 95 95 Customer Equity 44,705,882 58,823,529 Difference 14,117,647

24. CE Appendix: On communicating with the HHC executives who gave presentation, we were informed that currently their penetration rate is 38% and they target to achieve 50%. No. of patient visits currently are 2,20,000 totally. Out of that, 30,000 visits (13.63%) can be assumed to be of state employees. Increase in penetration rate will proportionately increase no. of patient visits, which comes out to 4.3 % increase in visits. Hence, the increase of 9469 visits i.e. 10,000 visits approximately. Likewise, operating revenue will also observe proportionate increase. Customer Equity calculations are posted in appendix-4 (slide no. 19) The table could not be posted here in notes, hence it is mentioned in appendix. APPENDIX-4

25. APPENDIX-5 REFERENCES: CT HEALTH POLICY DEPARTMENT OF PUBLIC HEALTH – CONNECTICCUT CTNEWS: http://www.ctnewsjunkie.com/ctnj.php/archives/entry/health_enhancement_program_presents_budget_hurdle/ http://jonpelto.wordpress.com/2011/09/29/wait-did-he-just-say-what-i-think-he-said-malloy-administration-and-the-state-employee-health-enhancement-program/ http://inthistogetherct.org/2011/06/hep-reassurance-statement/ http://employ.uchc.edu/benefits/index.html http://www.hr.uconn.edu/docs/HRPY_Nov_2011_thru_Jan__2012.pdf