An overview of the Initial Design and Prize Guidelines for a proposed $10M+ Healthcare X PRIZE, released for public comment on April 14, 2009. Please help us design the best competition possible in creating an Optimal Health paradigm that engages and empowers individuals and communities in a way that will dramatically improve health value.

1. WELLPOINT HEALTH X PRIZE
Executive Summary
FO U N DAT I O N
PRIZE
1

2. 2
OvERvIEW Of THE WELLPOINT HE ALTH X PRIZE
The US spends $2.2 trillion per year on health care and that spend is increasing at a rate
much higher than inflation. The annual cost of hospitalizations and employee sick days
alone is $1 trillion dollars per year in the US, with about 38 million Americans
hospitalized annually. We spend 55% of our health dollar on the sickest 5% and the
healthiest 50% see an investment of only 3% of total health dollars. The current
health care model incentivizes expensive reactive care over proactive care. This has
resulted in the unsustainable growth in medical spend we see today.
The WellPoint Health X PRIZE is a $10 million 5 year competition for teams to design
and implement new models for health care that dramatically improve health for a
community of 10,000 people over 3 years. The centerpiece of the competition is a
comprehensive measure of health for the community and the individual. Teams will
have unprecedented access to information and will be able to improve the incentives,
interactions, and relationships between employers, payers, providers, and
consumers. They will engage consumers in the healthiest behaviors and programs and
thereby drive dramatic improvements in their community health score.
The community health score is a composite of objective measures across health
incidents (e.g., hospitalizations, sick days), functional health status (e.g., fitness,
activities of daily living), and the total spend on health. The winning team will cause
the greatest increase in the community health score in a community of 10,000 people
over 3 years. In the process they will showcase a more affordable, results oriented
health system whose lessons can be adopted across the globe.

3. 3
WHAT MARkET fAILuREs DOEs
THE WELLPOINT HE ALTH X PRIZE ADDREss?
Health care is expensive ($2.2T in 2007, or $7500/capita). The government reform effort is focused on im-
proving people’s access to the system, by changing how we pay into the system. The WellPoint Health X PRIZE
is focused on what we get for the dollars being spent; we look to optimize the return on our >$2T investment.
Specific market failures this prize will address are:
Market Failure Today Post-Prize
Incentives focused on Payment tied to visits, tests, and Payment tied to measurable improve-
volume, not value procedures ments in health
Lack of visibility into Medical, health, and payment Community Health Score provides
baseline and priorities records scattered, even at individual standard definition and unified health
level picture at a population level
Medical-only solution set “Coverage” limited to medical solu- Programs across wellness and illness
tions compete on results
Short term focus Focus on diagnosis and treatment of Personalized recommendations and
immediate issue feedback tie you into longer-term
programs
Engagement of people in programs Doctor tells you to do “x” with no Programs incent and engage you to
follow-up participate in highest impact solu-
tions
There is no standard definition or measurement for health. Because there is no definition for health, our system can-
not focus on solving the biggest issues; in fact, there is no way to track progress or outcomes. In the absence of data
highlighting the bigger picture, our health system has become increasingly reactive and procedure-based, with only 3%
of dollars spent on the healthiest 50% of the population; even as that “healthy” 50% has become increasingly obese and
at-risk for chronic illness. In fact, innovators who have created programs to improve health in a way that reduces medical
visits/services have been punished by the market because the current system pays for treatments not outcomes.

4. 4
THIs Is AN X PRIZE
Addresses Market Failure Lower quality currently rewarded with higher
revenue
Scalable 10,000 person pilot will be adopted across 34M
individuals (via WellPoint)
Achievable Numerous historical outcome improvements
undermined due to poor financial incentives
Dramatic Numerous personal stories of lives saved or
improved
Empiric Credible measures exist to document success
Leverage $10M prize across $1.2B in industry spend in
$2.2T industry
Transformative Opportunity to change the paradigms of health
system. Not incremental but transformative.
INDIvIDuALs WHO suPPORT THE PRIZE
Sample of advisors expressing support for the prize effort:
• Elliott Fisher, M.D., Jim Weinstein, D.O of the Dartmouth Institute for Health Policy
• Mark McClellan, M.D., former head of Medicare, currently at Brookings
• Newt Gingrich, Former Speaker of House, Founder, Center for Health Transformation
• Bill Bradley, Former US Senator
• Glenn Steele, M.D., CEO of Geisinger Health System
• Sam Nussbaum, M.D., Chief Medical Officer, WellPoint
• Dean Ornish, M.D., founder of Preventive Medicine Research Institute
• Susan Dentzer, Editor-in-Chief, Health Affairs
• Prof. Richard Thaler, Professor of Behavioral Science, University of Chicago
• Prof. Clay Christensen, Author: Innovator’s Prescription, Prof. Harvard Business School
• Herbert Pardes, M.D., CEO of NY Presbyterian
• Betsy Dietz, Partner at IBM Global Services
• Ginny Proestakes, Program Leader, GE Group Health Program

5. 5
DEsIgN Of THE WELLPOINT HE ALTH X PRIZE
The development of the WellPoint Health X PRIZE (WHXP) brought together leading thinkers on health from across
a wide range of stakeholders. We interviewed >50 thought leaders on the market failures and potential areas of focus
for the prize, refining them across an idea summit and a design summit. We announced an initial design for the prize
on April 14 and have refined the initial ideas via input from hundreds of emails/comments, numerous interactions with
leading thinkers, and a 2-day measurement summit that involved the leading organizations in measuring health system
impact.
The WHXP looks to transform the way health is delivered by defining health, measuring it, and incenting programs that
best deliver improved health. The WHXP creates a uniform measure, tentatively called the community health score, that
allows us to allocate resources to programs that make the biggest difference in the real world. We believe the WHXP can
dramatically improve the health of our families by creating a standard measure for health that is transparent, accountable,
and incents better results. The Wellpoint Health X PRIZE will be a catalyst for rewarding the innovators who find the
most effective and efficient means of improving real world health outcomes.
Our challenge is to demonstrate a health system that optimizes health, and engages individuals in impactful and personal-
ized programs across wellness and illness. While messaging will continue to be refined, our goals of measurably improv-
ing the health of a community through better programs and incentives continued to be met by excitement in the health
community:
The winner of the WellPoint Health X PRIZE will be the team that
designs and implements a new model for health care that causes the greatest
improvement in the health of a community of 10,000 people over 3 years,
as demonstrated by a drop in sick days and hospitalizations, an increase in
health status and reduction in total cost.
The winner of the $10M competition is the team achieving the greatest increase in the community health score:
• Reduced number of health incidents, including sick days and hospitalizations;
• Increased health status of a population; and
• Achieved at a lower cost.
WINNINg CRITERIA
Community
Health Health Total Health
Incidents Status Cost Score
• Hospitalization • Self-reported • Provider claims
• ER visit health • Disability
• Major morbidity • Physical fitness • Pharmacy
• Death • Sick days
• Team intervention

6. 6
sTRuCTuRE Of COMPETITION
The competition will take place over a five year period and will be divided into two stages:
1. Team Concept/Selection Phase:
The first phase of the competition requires each team to model how their solution will achieve the required im-
provement in the community health score for a representative 10,000 person community. WellPoint, Inc. will
supply each team with access to a data sample containing 10,000 records. Teams will model their interventions
against that data sample until they have reached the minimum threshold improvement in the community health
score.
As they reach the minimum threshold, they will share their modeled impact with judges, who will outline what
the teams will need to do to validate their assumptions. The selection of finalists will be based on the pro-
jected impact of their solution, the degree to which their assumptions have been validated, and their plan and
resources to deploy and operationalize their model. Five finalist teams will be matched to five test communities
at the conclusion of this phase.
This phase will occur over an 18-month period. Following team matching, there will also be a 6-month window
in which Finalist teams will ready themselves for deployment in the final phase.
2. Finalist Competition Phase:
The second phase of the competition is a three-year, real-life demonstration of the finalist’s model in a real
10,000 person community (with population coming from employers in WellPoint, Inc. markets).
Each finalist will be judged on how they actually impact the health outcomes and cost of their pre-selected
10,000 person population. These results will be compared to the community’s previous year baseline. The
teams will need to implement the programs they will have designed in the Team Concept/Selection Phase,
and drive significant participation, likely using the community, local providers, and employers to engage their
targeted users in their solutions. Five total teams and test communities will be involved in the Finalist Competi-
tion.
We expect >75 teams to enter the competition, coming from diverse backgrounds with expertise in predictive modeling,
care coordination, risk assessment, engagement, lean operations, etc. The most qualified entrants are likely to be existing
companies in the health sector, whose products or services would benefit significantly by the ability to offer improved in-
centives or through greater transparency. Since solutions will need to be comprehensive, we anticipate the need to attract
another 500+ experts and vendors into a “health innovator’s ecosystem,” an online and offline community facilitating
introductions, to help teams flesh out their concepts and deploy them into real world test populations.

7. 7
sAMPLE sCOREBOARD
Different approaches comparable
Comparison of Two Competitors in Year 3*
Team A Team B
Aggressive Disease Mgmt Wellness for all
Baseline Team result, Year 3 Team result, Year 3
Incidents 40 pts 16 pts
• Mortality 25 deaths 12 deaths 5 20 deaths 2
• Hospitalization 9,000 bed-days 5,000 bed-days 22 8,000 bed-days 6
• Top 10 conditions 5,000 episodes 3,000 episodes 12 4,000 episodes 6
• Disability 100,000 days 90,000 days 1 80,000 days 2
Status 2 pts 35 pts
• Self-reported N/A 1,000 people, 2 5,000 people, 20
avg 5 percentile avg 10 percentile
improvement improvement
• Fit test N/A No participation 0 2,500 people, 15
avg 15 percentile
improvement
Cost $80M $75M 6 pts $80M 0 pts
Community Health Score 48 pts 51 pts
*Note: Percentage improvement across incidents calculated from weighting given to specific sub-categories. Percentage improvement for health status calculated from aggregate
documented improvement in percentile for performance
EXECuTION
After much consideration, we have decided to suspend work on the Health X PRIZE effort. While we still believe
strongly in the need to improve the results and costs of health care, the current environment has added significant
challenges to running a successful competition over the next 5 years.
We feel we need to have a better understanding of how health reform efforts will impact the health care system.
Reform could result in cost impacts, impacts to accessibility, or impacts that health experts haven’t yet foreseen.
We greatly appreciate your support in helping to craft this ambitious endeavor. We believe that the insights gained
through your participation are valuable and will continue to shape the dialogue on improving the outcomes and
affordability of health.
For more information or questions, please contact:
Vijay Goel, MD Pam Rogers
Sr. Director, Health Prize Development Staff VP, Innovation
X PRIZE Foundation WellPoint, Inc.
vijay.goel@xprize.org pam.rogers@anthem.com