Neil Gordon, CEO of INTERxVENT's presentation from the Business of Aging 2012 Summit held at MaRS Discovery District, April 30, 2012.

1. MaRS
Business of Aging Conference
April 30, 2012

2. Agenda
Dr. Neil Gordon, Founder INTERVENT
 INTERVENT Overview
 Global vs Canadian
Corporate Wellness / Disease Management Program Uptake
 Outcomes / Science
Dr. Dorian Lo, EVP, Pharmacy and Healthcare at Shoppers Drug Mart
Case Study:
 Why Shoppers Drug Mart Implemented a Health / Wellness Program
 Shoppers Drug Mart Employee Program Overview
 Results
 Challenges
Conclusion

3. INTERVENT Founder
 Founded INTERVENT in 1997
Dr. Neil Gordon  Used evidence-based research and clinicalled INTERVENT’s
nationally recognized organizations and
guidelines from
Founder national/international expansion
 Past director of exercise physiology at the world renowned
Cooper Research Institute in Dallas, TX
 Former clinical professor of medicine at the Emory
University School of Medicine in Atlanta, GA
 Past Chairman of the American Heart Association
Committee on Exercise, Cardiac Rehabilitation and
Prevention
 Devoted over 30 years to the prevention of cardiovascular
disease and other chronic illnesses
 Published over 100 scientific manuscripts and 8 books on
prevention/disease management

6. INTERVENT Overview
 INTERVENT is a global lifestyle management
and chronic disease risk reduction company
based in Toronto, Canada and Savannah,
GA, USA.
 INTERVENT develops, licenses and provides
evidence-based programs for the prevention
and management of multiple chronic
diseases.
 Mission: To help significantly improve individual and
population-based measures of health while simultaneously
reducing health care costs and enhancing productivity

7. The Evolution of INTERVENT
 Programs originally based on research available in the
early 1990s, especially the Stanford Coronary Risk
Intervention Project (SCRIP).
 After completion of original research study in Dallas, TX,
INTERVENT USA, Inc. was founded in 1997; INTERVENT
Canada was subsequently launched in 2007.
 Since 1997, considerable time and effort has been spent
developing, testing and successfully implementing
INTERVENT’s evidence-based, technology-enabled,
outcomes-oriented, comprehensive lifestyle management
and chronic disease risk reduction programs.

8. A Treatment Platform that builds…
Risk Intervention Management
Assessment Options Areas
• Nutrition
• Weight Management
Evaluation and Follow-up
Self-help
• Physical Activity
Intervention
• Stress Management
(web/mail)
• Tobacco Cessation Numerous
• Diabetes
•Health Risk Assessment •Stratification Program
• High touch Modules
• Integrated with web-
based program
Health Coach
• Formal, structured,
Assisted Intervention systematic approach
(telephonic/web/on-site/mail)
• Personalized support

10. Gamma-Dynacare Partnership
Integrated Biometric Module

11. 1st Level 2nd Level
of Stratification of Stratification
(Industry Standard) (INTERVENT)
Lower
Lower Risk
Intensity
0-2 Risk Factors
Intervention
59%
35%
Moderate Moderate
Population Individual Intensity
HRA stratification
Risk
3-4 Risk Factors stratification Intervention
32% 30%
Higher Risk Higher
5 + Risk Factors Intensity
9% Intervention
35%
Level 1 = risk for future direct and indirect health care-related expenditure
(“health risk stratification”);
Level 2 = intensity of lifestyle health coaching required to facilitate risk Key:
reduction in moderate/higher-risk individuals and to keep
apparently healthy individuals healthy (“intervention intensity BOB Data
stratification”)

12. Referrals to
Allied Healthcare Providers
Consent to have EAP make an
outbound call

13. Physician Summary Report
Partnering with C-CHANGE to ensure concordance with Canadian guidelines

14. Lifestyle Management Programs:
Key Steps
 Be sure that the Lifestyle Management Program that
you select incorporates all of the following essential
components:
1. Identification of At-Risk Individuals
2. Risk Factor Determination
3. Goal Setting
4. Action Plan Formulation (guideline-based)
5. Action Plan Implementation
6. Referrals to Allied Health Care Providers (MD; Pharmacist; CDE; EAP)
7. Follow-up Evaluation and Progress Reports
8. Compliance Enhancement/Tracking
9. Aggregate Outcomes Assessment
10. All of the above should all be evidence-based…

15. Coaching Methodology
• Incorporates multiple behavior-change techniques: e.g., stages of
change, motivational interviewing, single concept learning theory
Coaching • Educational kits, audios, eating and exercise diaries and on-line materials
Philosophy support the foundation for behavioral change
• Comprehensive goals and action plan linked to health risk factors
• Dedicated health coaches assigned to participants; pull in specialists
as needed
Emotional
• Wellness Vision
Support • Focus is on the individual
• Evidence-based medicine approach
• Formal, structured, systematic approach
Interventions • Nature and intensity of intervention individualized based on
multiple factors, including risk status and readiness to change
Progress • System supports tracking of qualitative and quantitative results
• Follow-up reports utilized during the program allow the participant to
Tracking track their progress along the way
• Quality audits help ensure delivery of a high-quality program
Quality • Calls tracked and recorded

16. Better Health for Life℠
16

17. Better Health for Life℠
17

18. Interventions Driven by Hard
Science (with documented outcomes)
Approximately 100 published scientific abstracts or manuscripts documenting benefits in terms
of multiple risk factors, clinical variables, self-reported health status and ROI
(Including numerous publications in peer-reviewed medical journals and independent third-
party research)
Key scientific manuscripts include:
1. Comparison of single versus multiple lifestyle interventions: Are the antihypertensive effects
of exercise training and diet-induced weight loss additive? American Journal of Cardiology 1997;79:763-767
2. Comprehensive cardiovascular disease risk reduction in a cardiac rehabilitation setting. American Journal of
Cardiology 1997;80(8B):69H-73H
3. Comprehensive cardiovascular disease risk reduction in the clinical setting. Coronary Artery Disease 1998;
9:731-735.
4. Innovative approaches to comprehensive cardiovascular disease risk reduction in clinical and community-based
settings. Current Atherosclerosis Reports 2001; 3:498-506
5. Effects of a contemporary, exercise-based rehabilitation and cardiovascular risk reduction program on coronary
patients with abnormal baseline risk factors. CHEST 2002; 122:338-343
6. Effectiveness of 3 models for comprehensive cardiovascular disease risk reduction. American Journal of
Cardiology 2002;89:1263-1268
7. Effectiveness of therapeutic lifestyle changes in patients with hypertension, hyperlipidemia, and/or
hyperglycemia. American Journal of Cardiology 2004; 94: 1558-1561
8. Effect of comprehensive therapeutic lifestyle changes on pre-hypertension. American Journal of Cardiology 2008;
102; 1677-1680.
9. Health-risk appraisal with or without disease management for worksite cardiovascular risk reduction. Journal of
Cardiovascular Nursing 2008; 23: 513-518.
10. Clinical effectiveness of lifestyle health coaching: Case study of an evidence-based, technology-enabled, outcomes
oriented, comprehensive program. 2012 (In Review).

19. Scientific Evidence
INTERVENT U.S.A.
Percent change in 10-year Framingham CHD Risk Score in higher-risk employees
Source: Published in Journal of Cardiovascular Nursing, November 2008

20. Scientific Validation
INTERVENT U.S.A.
Percentage of participants who achieved goal levels in classic CVD risk factors
without medications within three months of initiating the program
Source: Published in American Journal of Cardiology, December 2004

21. Drug use among
INTERVENT compliers*
*No statistically significant differences between baseline vs. follow-up rates. Follow-up assessed at 12 weeks
Gordon NF; Am J Cardiol 2002; 89:1263-68

22. Publications

23. Return On Investment
INTERVENT U.S.A.
State of Oklahoma Pilot: Average Health Care Claims
Per Employee in 2002 vs. 2003
$2.30 savings for every $1 spent
Non-INTERVENT
Participants
INTERVENT
Participants
Notes: INTERVENT Program was implemented in January 2003. Participants enrolled in the INTERVENT Program in 2003 and
completed a full year of service and evaluations. Analysis performed, in part, by Milliman Consultants and Actuaries.

24. Return On Investment
INTERVENT Canada
138.4 minutes per week gain in exercise among sedentary
employees
35.7% improved medication compliance
ROIpresenteeism $4.42 for every $1 spent
Gamma-Dynacare Medical Laboratories Employee Case-study

25. Meta-Evaluation of Worksite Health
Promotion Economic Return Studies: 2012 Update
Chapman LS. Am J Health Promo 2012; 26: TAHP-1-TAHP-12
• Meta-evaluation of 62 economic return on
investment studies of multi-component worksite
wellness/health promotion
• Average duration of follow-up = 3.83 years
• Number of study subjects = 546,971
• Key findings:
 % Change in sick leave absenteeism = -25.1%
 % Change in workers’compensation costs = -40.4%
 % Change in disability management costs = -24.2%
 % Change in health costs = -24.5%
 Cost:Benefit Ratio = 1:5.56 (i.e., ROI = 556%)

26. US Companies Use of
Disease Management Programs

27. Shoppers Drug Mart
Select Data from HRA and Lifestyle
Health Coaching Summary Analyses

28. Shoppers Drug Mart
Dr. Dorian Lo, Executive Vice President, Pharmacy and Healthcare at
Shoppers Drug Mart
Previous positions include:
• President, Shoppers Drug Mart Health Solutions
• Medco Health Solutions, Chief Medical Officer,
Health Plans
• McKinsey & Company
• Boards: Society of Aging of New York, Chilton
Memorial Hospital Foundation
• MBA (Wharton) and MD (University of Western
Ontario)

29. Why did Shoppers Drug Mart
Implement a Program?
The program allowed us to further invest into our employees’
health.
• “Walk-the-Walk”of promoting good health and counseling
• Supports our culture of Caring
• Demonstrate SDM as a Top Employer
• Use health information to stratify patients for disease management
and holistic employee care

30. What Did We Hope to Achieve?
Shoppers had the following goals:
• Improve productivity through decreased absenteeism and better
employee health
• Improve intermediate outcomes and select clinical end-points
• Improve employee satisfaction

31. Description of the Program
• First Step: Health Risk Assessment (HRA)
• Phase 1 – offered to Corporate Head Office ~ 1200 employees
• Phase 2 – rolled out to Allied Business Units ~ 500 employees
• Integrated with flex benefits insurance program
• Integrated Lab Results
• Second Step: Referrals
• Referrals to Certified Diabetes Educators and Employee Assistance Program
• Coached programs for higher risk employees
• On-line lifestyle management programs
• Encouraging Success
• Optimum points and other incentives
• 76% of employees started an HRA
• 96% completion rate

32. Our Workforce: Mainly Women
BU 1 BU 2 BU 3 ALL BOB
Completed
832 110 261 1,203 --
HRA (Number)
Male 373 479
33 (30.0%) 73 (28.0%)
(n & %) (44.8%) (39.8%) (49.6%)
Female 724
459 (55.2%) 77 (70.0%) 188 (72.0%)
(n & % ) (60.2%) (50.4%)
(BU = Business Unit; ALL = All BUs combined; BOB = Book of Business)

33. Our Workforce:
Average Age of 40 y.o.
BU 1 BU 2 BU 3 ALL BOB
Age 42.3 M 37.1 M 39.1 M 41.5 M 43.4 M
(Years) 40.5 F 41.8 F 37.7 F 39.9 F 42.9 F
Males –
18.4% 7.3% 8.0% 15.1% 23.4%
Age 45 or Older
Females –
3.8% 10.9% 5.0% 4.7% 8.3%
Age 55 or Older

34. SDM Employees were at lower risk
than INTERVENT’s book of business
1st Level 2nd Level Lower
Lower Risk
of Stratification of Stratification Intensity
0-2 Risk Factors
(Industry Standard) (INTERVENT) Intervention
59% / 79%
35% / 59%
Moderate Moderate
Population Individual Intensity
HRA stratification
Risk
3-4 Risk Factors stratification Intervention
32% / 18% 30% / 23%
Higher Risk Higher
5 + Risk Factors Intensity
9% / 3% Intervention
35% / 18%
Level 1 = risk for future direct and indirect health care-related expenditure
(“health risk stratification”);
Level 2 = intensity of lifestyle health coaching required to facilitate risk Key:
reduction in moderate/higher-risk individuals and to keep
apparently healthy individuals healthy (“intervention intensity BOB;
stratification”) Shoppers Drug Mart

35. Our various business units had
similar Wellness Scores
80
79
78
78 77.6 77.6
Wellness Score
77 76.4
76
75
74
73
BU 1 BU 2 BU 3 ALL

36. 78.3% of Participants are at a higher
than desirable risk for CVD
Only 21.7% of participants are at a desirable risk for cardiovascular
disease. This is a concern but this is not a surprising observation.
BU 1 BU 2 BU 3 ALL
Known CVD, Heart Failure, and/or
4.1% 2.7% 3.4% 3.8%
Diabetes
One or More Potentially Modifiable
73.6% 78.2% 75.9% 74.5%
CVD Risk Factors
Total at Higher Than Desirable Risk
77.7% 80.9% 79.3% 78.3%
for CVD
Mean 10-Yr Risk for Coronary Heart
4.3% 2.0% 3.2% 4.0%
Disease
10% or Higher 10-Yr Risk for
7.7% 0% 0% 6.6%
Coronary Heart Disease

37. Weight remains the main risk factor
Prevalence (%) of Six Major Modifiable Risk Factors Among HRA
Participants by Business Sectors
Business Current Prehypertension Abnormal Prediabetes Overweight Physical
Sector Cigarette or Hypertension Cholesterol or Diabetes or Inactivity
Smoker and/or Obese
Triglycerides
BU1 8.2% 25.5% 12.6% 5.0% 54.6% 39.3%
BU2 14.5% 36.4% 10.9% 2.7% 58.2% 41.8%
BU3 8.0% 23.4% 7.7% 2.3% 42.9% 48.3
ALL 8.7% 26.0% 11.4% 4.2% 52.4% 41.5%

38. Stress is another main risk factor
Prevalence (%) of Other Select Risk Factors, Chronic Conditions or
Negative Health Behaviors
Business Great Deal Poor Sleep Apnea or Medications Medications Asthma
Sectors of Stress Eating Evidence of for Anxiety for
(Home/ Habits Another Sleep Depression
Work) Disorder
BU1 41.3% 32.7% 31.0% 3.5 3.4 6.9
BU2 44.5% 45.5% 32.7% 3.6% 5.5% 12.7%
BU3 39.1% 43.7% 28.3% 3.8% 4.2% 10.0%
ALL 41.1% 36.2% 30.6% 3.6% 3.7% 8.1%

39. High interest from our employees
Weight Management (%)
70
60
50
Percentage
40 35.9
30.9
30 25.5 26.3
20
10
0
Somewhat Interested Very Interested
Shoppers Drug Mart Book of Business

40. High interest from our employees
Exercise Training (%)
70
60
48.3
50
Percentage
40 34.9
29.4 29.1
30
20
10
0
Somewhat Interested Very Interested
Shoppers Drug Mart Book of Business

41. High interest from our employees
Smoking Cessation (%)
70
60
47.7
50
Percentage
40 36.2
30 23.9 26.8
20
10
0
Somewhat Interested Very Interested
Shoppers Drug Mart Book of Business

42. High interest from our employees
Nutrition (%)
70
60
49.0
50
Percentage
40 35.2
29.6 29.9
30
20
10
0
Somewhat Interested Very Interested
Shoppers Drug Mart Book of Business

43. High interest from our employees
Stress Management (%)
70
60
50
Percentage
40 32.8
30.8
30 28.1
22
20
10
0
Somewhat Interested Very Interested
Shoppers Drug Mart Book of Business

44. Lifestyle Health Coaching:
Demographics

45. Intermediate outcomes have
improved for participants

46. % of at risk participants has
decreased through coaching
Prevalence of Potentially Modifiable Risk Factors
Participants at Baseline + Follow-up (n=75; average follow-up=~20 weeks)
80
78.6
70
60
59.5
55.7
50 53.7
Percentage
45.9 Prevalence at
40 41.5 41.9 Program Entry
37 36.8
30 33.8
Prevalence at
Follow-up
20 22.7 Evaluation
18.2
10 12.0 12.0
0
Elevated Elevated Elevated LDL Obesity Cigarette Elevated Stress
Systolic BP Diastolic BP Cholesterol Smokers Blood
Glucose

47. Shoppers Drug Mart Considerations
Employers need to balance investments vs the importance of
qualitative employee health & wellness.
• HR and CFOs are reluctant to pay for programs until ROI is proven in
Canada
 HRA and disease management reinvestment is typically
combined with a restructuring of benefits offering
 Canadian studies are needed to establish ROI for employers
• Should Government subsidize DM since these activities can reduce
their medical expenditures
 US studies show that most of the impact from DM relates to
hospitalization and overall burden from chronic care
• Incentives and convenience are required to drive strong
participation (including on-site health clinics to collect lab results)

48. Conclusion
• HRA is a key enabling step in managing health and wellness since
it provides health data
• HRA’s use is in deriving positive ROI from interventions
• Employers can utilize existing research and their own data to
judge overall benefits of DM initiatives and to ensure programs
are targeted and customized to their employees’ needs