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FORUM West Early Bird October 31, 2013 Deadline

ISSUE || September/October 2013

Health Care Consumerism:

The 2014 Game Plan How will you traverse the shifting benefits landscape?

HSAs: Saving the Reform Designed to Kill Them Designing a Wellness Program: Learning from Penn State’s Mistakes

INSIDE:

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Implemented Healthstat for his company last year.

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INSIDE

FEATURES

39 The 2014 Game Plan: Health Care Consumerism in the Post-PPACA World As you read this, the benefits landscape is undergoing a tectonic shift. The depth and breadth of this shift is unprecedented, and in many ways still unknown. What is the full scope of what’s happening? What benefits strategies will prevail in the coming years? Can public and private marketplaces coexist? How do I comply and still provide the best employee experiences without breaking the bank? It may be too early to have all of the answers. But with a little bit of context and a focus on consumers, uncertainty can quickly become opportunity — to transform, to innovate and to keep building the narrative of a consumer-centered health care and benefits world. By Shandon Fowler, Director of Product Management, Marketplaces, Benefitfocus

INSIDE The Institute for HealthCare Consumerism Launches Magazine Supplement HealthCare Exchange Solutions HealthCare Exchange Solutions helps you understand the choices in the health and benefit marketplace and make the best decisions among a complicated array of exchange solutions options.

COMING UP NEXT: On December 8, 2003, health savings accounts were signed into law by President George W. Bush. Ten years

later, there are over nine million HSA accounts with assets beyond $18.1 billion. To honor the growth and legacy of HSAs, we will be highlighting the tenth anniversary with a cover feature in the November/December issue of HealthCare Consumerism Solutions. The article will take the form of an oral history provided by business and thought leaders who have been instrumental to the success of HSAs throughout these last ten years. www.TheIHCC.com I HealthCare Consumerism Solutions™ I September/October 2013

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INSIDE 6

Publisher’s Letter

9

Briefs & Innovations t t t t

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11 FORUM West Preview 14 What’s Happening at the Institute? 15 Stats & Data

Health Care Shopping Data Reveals Unique Factors By Doug Ghertner, President, Change Healthcare

43 Corporate Member Profiles 50 Resource Guide/Ad Index

Events The 2013 IHC FORUM West Early Bird Rates www.theihccforum.com Sign up today for FORUM WEST. Join us December 5-6, 2013 in Las Vegas. We are back at the luxurious Red Rock Resort & Spa — a serene oasis set away from the hustle and bustle of the Las Vegas Blvd. The Resort’s exquisite rooms and breath-taking views of the canyon will make the perfect backdrop for our west coast event, not to mention all of the convenient amenities right there on-site (movie theater, bowling alley, restaurants, casino, spa, pools, and more). Registration will open soon. Come LEARN, CONNECT and SHARE with the top thought leaders in the rapidly growing health care consumerism megatrend.

DEPARTMENTS 8

Bachman’s Banter Delayed Employer “Pay or Play� and 2014 Compliance Mandates By Ronald E. Bachman, FSA, MAAA, Chairman, Editorial Advisory Board, The Institute for HealthCare Consumerism

33 Wellness Designing a Wellness Program: Learning from Penn State’s Mistakes By Tom Emerick & Al Lewis, Co-Authors, Cracking Health Costs

34 Health Savings Account HSAs: Saving the Reform that was Designed to Kill Them By Kevin McKechnie, Executive Director, HSA Council, American Banker’s Association

35 Pharmacy Benefits Management The Next Big Thing in Prescription Drugs is in Your Pocket By Susan Hayes, Principal, Pharmacy Outcomes Specialists

37 Rewards & Incentives Top 10 Reasons Why Your Corporate Health Incentives Program Will Fail By Russell Benaroya, Co-Founder and CEO, EveryMove

ONLINE EXCLUSIVES Oklahoma, MedEncentive Launch Innovative Pilot Program To Curb Health Costs

Membership Become a Member, Reap the Rewards Have you become a member of The Institute for HealthCare Consumerism (www.theihcc.com)? Why wait? Visit The IHC website today and sign up for a premium membership. Got a story to tell about an innovative health and benefit program or best practice in health care consumerism? Share it with fellow members of The Institute for HealthCare Consumerism. Share a case study, white paper, article or post a blog at www.theihcc.com. Members of The IHC also receive special discounts to attend Institute events, such as IHC FORUM.

4September/October 2013*HealthCare Consumerism Solutions™*XXX5IF*)$$DPN

As private and public sector employers alike continue to struggle with the burden of health costs, Oklahoma’s Office of Management and Enterprise Services (OMES) recently announced a partnership with MedEncentive to carry out a unique health cost-containment pilot program. The program aims to improve the health and health care provided to many state employees while lowering health costs for taxpayers and the State of Oklahoma. The program achieves this goal by using payer-sponsored financial incentives to reward both doctors and patients for adhering to best practices and healthy behaviors.

By Jonathan Field, Managing Editor, The Institute for HealthCare Consumerism

Mainstreaming Wellness: Partnership Provides Big Dividends for Employer and Employees

Mainstream Living in Des Moines, Iowa has always been focused on meeting the needs of vulnerable populations. Since 1975, Mainstream has connected people with physical and mental disabilities to services that enhance their quality of life, such as special needs employment, learning centers, and community based programs. The organization realized six years ago that it needed to do more if it wanted to truly thrive. It needed to extend that same mission of improving quality of life to its own employees. By Reno Berg, CEO, Mainstream Living, and Laura Vanden Bosch, Director of Public Relations and Marketing, Mercy Medical Center — Des Moines


Provide employees the right tools to make the most of their healthcare choices. At TSYS Healthcare®, our approach to client-driven innovation allows you to define and shape flexible, integrated payment solutions that meet your unique needs. Our independent industry partnerships and elite platform functionality help our clients build solutions that make sense. Our solutions include: Ř'HŵQHGFRQWULEXWLRQSODQRSWLRQVWRDVVLVWZLWKKHDOWKFDUHH[FKDQJHSUHPLXPV Ř$PXOWLSXUVHSD\PHQWSODWIRUPGHYHORSHGIRUKHDOWKFDUH Ř(QKDQFHG+5$FDUGIXQFWLRQDOLW\ Ř$QLQGHSHQGHQWSDUWQHUQHWZRUN Ř([SHULHQFHGKHDOWKFDUHDGYLVRUV Ř5HYHQXHJHQHUDWLQJŵQDQFLDOPRGHOV Integrity | Relationships | Excellence | Innovation | Growth

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LETTER

PUBLISHER www.theihcc.com VOLUME 9 NO. 6 | SEPTEMBER/OCTOBER 2013

Published by FieldMedia LLC 292 South Main Street, Suite 400 Alpharetta, GA 30009 Fax: 770.663.4409 CEO

Doug Field @ theihcc.com MANAGING DIRECTOR

At the time of this issue's publication, we will be less than one week away from October 1, the day when the health insurance exchanges set up by the Affordable Care Act will be open for public enrollment. The process of adding tens of millions of Americans into our health care system for the first time will begin, significantly changing the health care system as we know it. On the other side, private exchanges have recently been making national headlines. The announcement that Walgreens would join 17 other large U.S. employers in moving its employee population to Aon Hewitt's private exchange represents a step in the right direction toward consumerism in health care. At the Institute for HealthCare Consumerism, we are committed to helping you develop a game plan for traversing this new health and benefits landscape. In this issue of HealthCare Consumerism Solutions, you will find articles on successfully building a wellness program in the post-Penn State environment; on mistakes not to make with your corporate health incentives program; on how mobile apps are revolutionizing pharmacy benefits management; and much more. Shandon Fowler, Director of Product Management, Marketplaces, Benefitfocus, writes an excellent cover feature on the future of consumerism in health care, encompassing cost transparency, data analytics, defined contribution, exchange technology, high-deductible health plans and more. Beyond these pages, the Institute for HealthCare Consumerism is working equally hard on helping businesses navigate the new health and benefits landscape. For this year’s FORUM West in Las Vegas, we are excited to be launching a certification program in health care consumerism. To help employers, brokers, health plans and consumers navigate private exchanges, we are excited to introduce PrivateHealthCareExchanges.com, the only online guide to private exchanges and defined contribution solutions. And finally, as we continue to move forward into this post-PPACA world and together try to traverse the “tectonic shift� that is occurring in our industry, we hope to see you at FORUM West this December 5-6 for the industry’s first real-time look at this fall’s historic open enrollment.

Brent Macy MANAGING EDITOR

Jonathan Field SENIOR EDITOR

Heather Loveridge hloveridge@theihcc.com ACCOUNT MANAGER

Joni Lipson ART DIRECTOR

Kellie Frissell MARKETING COMMUNICATIONS MANAGER

Lana Perry ASSOCIATE DIRECTOR OF EDUCATION SERVICES AND PROGRAMS

Dusty Rhodes CHAIRMAN OF IHC ADVISORY BOARD

Ronald E. Bachman, CEO, Healthcare Visions EDITORIAL ADVISORY BOARD

Kim Adler, Allstate; Diana Andersen, Zions Bancorporation; Bill Bennett; Doug Bulleit, DCS Health; Jon Comola, Wye River Group; John Hickman, Alston+Bird LLP; Tony Holmes, Sanders McConnell, TSYS Healthcare; Roy Ramthun, HSA Consulting Services LLC; John Young, Consumerdriven LLC WEBMASTERS

Kevin Carnegie Tom Becher ASSOCIATE WEB ADMINISTRATOR

Tim Hemendinger DIRECTOR OF CONFERENCE SPONSORSHIP/ CORPORATE MEMBERSHIP/REPRINTS

Sincerely,

Rogers Beasley BUSINESS MANAGER

Karen Raudabaugh

Doug Field CEO/Publisher dfield@fieldmedia.com

™ Volume 9 Issue 6 Copyright Š2013 by FieldMedia LLC. All rights reserved.

™ is a trademark of FieldMedia LLC. ™ is published eight times yearly by FieldMedia LLC., 292 South Main Street, Suite 400, Alpharetta, GA 30009.

TO SUBSCRIBE: Make checks and money orders payable to ™ magazine 292 S. Main Street, Suite 400, Alpharetta, at the following rates: single copy $7.50; $75.00/yr in the U.S., $105/yr in Canada and $170/yr international. Please contact FieldMedia at 404.671.9551 PRINTED IN THE U.S.A. ™ is designed to provide both accurate and authoritative information with regard to the understanding that the publisher

legal advice is required, the services of a professional adviser should be sought. The magazine is not responsible for unsolicited manuscripts or photographs. Send letters to the editor and editorial inquiries to the above address or to

6September/October 2013*HealthCare Consumerism Solutions™*XXX5IF*)$$DPN


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BACHMAN’S BANTER

BY RONALD E. BACHMAN FSA, MAAA CHAIRMAN, EDITORIAL ADVISORY BOARD THE INSTITUTE FOR HEALTHCARE CONSUMERISM

WHO: Employers with 50 or more employees (defined as “Large Employers�). Employers with fewer than 50 full-time employers are not subject to the coverage mandate or penalties. WHEN: As of July 9, 2013, when the final guidance was issued, the implementation of certain employer requirements under PPACA were delayed from January 1, 2014 until January 1, 2015. WHAT: Three requirements were delayed until January 1, 2015: (1) The $2,000 penalty per employee (less a 30 employee exemption) for not providing essential benefits coverage to at least 95 percent of full-time employees. (Section 4980H(a) of PPACA) . (2) The $3,000 penalty for each full-time employee who qualifies for and receives a premium subsidy in an insurance exchange even though their employer offers essential benefits. (Section 4980H(b) of PPACA). Note: These penalties are called the “Employer Shared Responsibility Payments� (also referred to as “Pay or Play� requirements). (3) The collection of information regarding an employer’s offering(s) of essential benefits to enforce the penalties in (1) and (2) above. (Sections 6055 and 6056 of PPACA).

WHAT NOT: For large employers, other employer requirements remain in place and required in 2014: (1) The removal of plan annual limits, (2) Out-of-pocket cost sharing caps (for non-grandfathered plans), (3) Coverage of essential health benefits, (3) The maximum 90 day waiting period before coverage begins for new employees, (4) Health insurer assessments that may be passed on to large employer administrative costs,

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(5) The transitional reinsurance fee (estimated to be about $5.25 per member per month). Failure to comply with any of these requirements in 2014 may generate a penalty of $100 per day per affected plan member. Employers are required to self-report compliance failures. EXECUTIVE SUMMARY: Compliance with PPACA is confusing because some requirements placed on employers have been delayed until 2015 and some will take effect in 2014. If not followed, the other employer mandates that will take effect in 2014 can result in significant penalties. There are some implications of the delays. For example: (1) Employers preparing to minimize the number of covered employees: Employers will have an additional year to restructure their workforce to meet the 30 hour minimum standard for mandated employee coverage and avoid having to provide them with health insurance. In addition, the delay on the “pay or play� mandate provides an opportunity for employers to terminate coverage in 2014 without penalty.. (2) Employers preparing to provide PPACA qualified medical benefits: Employers will have extra time to test systems that track monthly work hours of employees, especially variable hour and seasonal employees. This will allow for a 12 month measurement period and a 90 day administrative period to be applied in determining whether an employee is full-time or not on January 1, 2015. Union contracts have more time to adjust existing contracts and/or negotiate new contracts to include the requirements of PPACA. ACTIONS: Employers subject to the pay or play mandate should consult with their broker, agent, insurers, or third party administrator regarding compliance issues that remain in effect for 2014. Employers should proceed with creating and testing mandated reporting systems. In addition, legal counsel may be valuable in assuring compliance with technical and coverage issues. Finally, employers should be prepared to communicate and respond to the many questions that the 2014 implementation and delays will generate from employees and dependents.


HEALTHCARE CONSUMERISM NEWS BRIEFS

TSYS Healthcare Launches Enhanced HRA Card Functionality

spending accounts (FSAs), health reimbursement arrangements and premium only plans currently provided by Ceridian.

recently introduced innovative and market-leading card functionality for health reimbursement arrangements (HRAs), a key component of the consumer-directed health care (CDHC) space. TSYS’ enhanced HRA functionality, coupled with technology-leading web services

Aflac Launches Enhanced Health Care Reform Website for Employers Health care reform is a puzzle to many U.S. employers and their employees. To help them better understand how to assemble the

market.

Payroll and HR Services Leader Paychex Chooses Evolution1 as Preferred Partner is Paychex®, Inc., a leading provider of payroll, human resource,

renewable insurance in the U.S., has enhanced its health care reform website with materials that explain the legislation in clear, easy-toresources designed to help employers understand health care reform and how the law affects both businesses and workers.

sized businesses. With headquarters in Rochester, New York, Paychex

Flex Enhances Health Savings Accounts for Growing Marketplace

country. Through the partnership, Evolution1’s industry-leading, award-winning health care administration platform will be available to Paychex’s health plan clients.

driven health care marketplace, recently announced numerous enhancements to its health savings account (HSA) capabilities. Available since 2004, FlexHSA® offers products for individual

Keas Open Enrollment Program Helps Companies Maximize Health Care’s Annual Trillion-Dollar Moment Keas, the market leader in corporate employee health and wellness, has announced it is offering the Keas Open Enrollment Program to help enterprises improve employee productivity and manage health care costs. Keas is transforming the traditionally complex and timeconsuming open enrollment process for HR teams and employees alike with a social approach that integrates quizzes, games and social challenges into its holistic health platform. Keas also introduced health and reducing employee health care costs is an enterprise priority in 2014.

SelectAccount Launches New Public Website and Online Capabilities SelectAccount, a leading provider of medical spending accounts and one of the top 10 account administrators in the country, announced that it has launched a new-and-improved public website. In addition, the company has enhanced its online account management capabilities for employer customers. The company’s website, SelectAccount.com, has been redesigned to feature a cleaner, fresher look and feel and

Teladoc Acquires Consult A Doctor, Expands Service Offerings And Member Base more than 6 million members, announced today the acquisition of Consult A Doctor, a telehealth company founded in 2007. With this acquisition, individuals and employees of small- to medium-size businesses will now have access to Teladoc’s national network of U.S.

Guardian Launches New Assessment Tool for Employee Benefits The Guardian Life Insurance Company of America (Guardian), one of the nation’s largest mutual life insurers and a leading provider of an online assessment tool to help employers better understand their needs of their company and employee population.

Trustmark Expands Distribution of Voluntary Insurance Products Through Benefitfocus HR InTouch

product information – like how the various accounts work, tools and resources to make the most of tax-advantaged plans and customer reviews.

WageWorks Enters Strategic Alliance with Ceridian to Further Extend Its Leadership in Consumer-Directed Benefits

enrollment to improving employee communication and education, to bring a new level of simplicity and convenience to managing

such as pre-tax accounts for health, commuter and other employee

InTouch, the integration of the Trustmark App allows employers to

with Ceridian, a leader in human capital management with more than 100,000 clients in over 50 countries. Under this alliance, WageWorks

from a single online portal.

www.TheIHCC.com I HealthCare Consumerism Solutions™ I September/October 2013

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IS M

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T H

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IS

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Announcing the inaugural IHC Certification designation allowing forward-thinking professionals the chance to become a

Certified HealthCare Consumerism Specialist (CHCS) through The Institute for HealthCare Consumerism’s IHC University Certification Program Take your professional career to the next level training to your credentials.

Learn more by visiting the IHC Certification program online at www.theihcc.com/university/certification

E M


2013 Real-Time Analysis, Thought-Leadership and Solutions from Experts and Your Peers.

REGISTER TODAY AND SAVE FORUM 8&45

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2013


LEARN.CONNECT.SHARE. What’s Happening at the Institute BY DUSTY RHODES  ASSOCIATE DIRECTOR OF EDUCATION  THE INSTITUTE FOR HEALTHCARE CONSUMERISM Editor’s Note: There is a lot going on right now at The Institute for HealthCare Consumerism. The health and benefits industry is moving at a feverish pace as we dive into this crucial open enrollment period, and The Institute for HealthCare Consumerism is similarly gearing up for a busy fall. From new ventures around private exchanges to the launch of our Health Care Consumerism Certification Program, The Institute will be there to meet the new and growing challenges of this industry. Dusty Rhodes, Associate Director of Education, runs down the list of what’s happening at The Institute in the lead up to FORUM West this December in Las Vegas.

Introducing Certification in Health Care Consumerism The Institute for HealthCare Consumerism (IHC) would like to announce our initial Health Care Consumerism Certification Program for FORUM West in Las Vegas. We will be offering two separate certification courses: one for our general audience (HR managers, benefits directors, CFOs and other employer health and benefits decision-makers) and one for brokers, advisors and consultants. Your choice of one of these courses — taken during the pre-conference events on Wednesday, December 4 — will qualify attendees for certification testing, scheduled for January 2014. CEU credits will be earned at each course, and the information learned during these courses will prepare the eligible attendees for successful completion of the process via online testing. Those that pass the certification testing will receive a CHCS (Certified HealthCare Consumerism Specialist) designation from The Institute for HealthCare Consumerism. Certification class seats are limited, so register today.

The IHC University Webinar Series As part of the IHC University and our on-going education efforts, The Institute has already produced many webinars this year for respected, industry-leading companies, such as Aflac, Jellyvision and Truven Health Analytics and Alegeus Technologies. All previously completed webinars can be found archived on the IHC’s website. We will also be aggregating webinars from across the industry as part of our webinar library. Have a completed or upcoming webinar you would like to showcase to our audience? Contact me at drhodes@theihcc.com.

Coming Soon: 2013 HealthCare Consumerism Superstars Issue Our annual HealthCare Consumerism Superstars issue will be back again this November, showcasing the creative problem

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solvers and innovators in the health and benefits space. With the CEO Leadership Award, Most Innovative Plan Design Award, Most Innovative Broker Award and many others, The Institute will recognize a broad array of professionals who go the extra mile. Superstar award winners will be recognized at FORUM West in Vegas, and we have received many excellent nominations from across the health care consumerism spectrum. The issue will also feature an expanded Industry Innovator section, highlighting the leading solution providers in this space. Superstars will publish digitally the first week of November and will hit mailboxes soon after.

Introducing PrivateHealthCareExchanges.com Beta In our view, the private health care exchange represents a significant advancement in the shift toward consumerism in health care. In April of this year, we launched the HealthCare Exchange Solutions magazine supplement, the industry’s first magazine to focus solely on health care exchanges. To continue that tradition of coverage, The Institute for HealthCare Consumerism is proud to announce PrivateHealthCareExchanges.com, the only guide for employers, brokers and consultants to navigate the private exchange and defined contribution solutions in this market. (See the September/October issue of HealthCare Exchange Solutions for an extended announcement of PrivateHealthCareExchanges.com)

Save the Date: 2014 FORUM & Expo We are proud to announce the dates for our 2014 FORUM & Expo in Atlanta. We will be back at the Cobb Galleria Centre from May 7 to 9 — yet with a slightly different name. We have dropped the “East� and changed to FORUM & Expo for our May event in Atlanta. The 2013 FORUM East was our largest event yet with over 700 attendees and over 50 sponsors. Due to the attendee growth, increased sponsor participation and overall success of the 2013 FORUM East, FORUM & Expo will feature expanded content and a larger exhibitor floor for three days instead of two. Get an early jump on the 2014 FORUM & Expo by visiting the FORUM website and signing up for email updates. With Castlight Health, Visa, MasterCard, TSYS Healthcare, HSA Bank and several others already sponsoring the May 2014 show, this is sure to be a don’t-miss conference.


BY DOUGLAS GHERTNER PRESIDENT AND CEO CHANGE HEALTHCARE

STATS & DATA

Health Care Shopping Data Reveals Unique Factors that Drive Consumer Decisions and Opportunities for Savings

A

s the cost of basic health care services continues to rise and place 2, please visit www.theihcc.com) illustrates how many miles individuals are an increased burden on individuals and families across the country, willing to travel to achieve greater medical and pharmacy savings. consumers need to take a more active role in their health care decisions — especially when it comes to choosing “shopable” health care Impact of Savings and Quality Ratings on Provider services.i Switching The strain of health care costs is a growing concern, given the average When it comes to selecting a provider, both savings and quality matter annual premium for a family is now $16,351, according to the Kaiser Family to consumers. Change Healthcare’s data found individuals were willing to Foundation. That’s up 4 percent from last year. Additionally, a recent survey switch providers to save money on office visits, which also provided the by Towers Watson found out-of-pocket expenses at the point-of-care are up by largest number of savings opportunities. In the case of physical therapy and 15 percent over the last two years from 15.9 percent to 18.4 percent. chiropractic care, consumers were not likely to switch providers, despite In an effort to identify the factors that drive consumer health care higher savings opportunities. In addition, 85 percent of providers selected decisions, Change Healthcare collected five Chart 1: Greatest Opportunities to by health care shoppers had equal or greater quality years of proprietary health care shopping data ratings than non-selected providers. Save on Health Care Costs to reveal insights into consumer shopping As we approach the broader implementation Savings Amount preferences, opportunities for savings and of the Affordable Care Act and the launch of the Service Type Per Opportunityii provider switching behavior. The data revealed health insurance exchanges, understanding consumer Medical Services findings in three main areas: shopping trends is key to helping individuals Physical Therapy $235.76 t Greatest opportunities to save on successfully navigate their health costs and benefits. Psychotherapy $147.77 medical and pharmacy services Today, fewer than 20 percent of employees understand Out of Network $119.71 t How far individuals are willing to their health benefits, according to benefits company Office Clinic $63.24 drive to save on health care costs Unum. Likewise, a recent Aflac report found 76 Chiropractic $53.77 t Impact of pharmacy and medical percent of employees do not understand the role Dental $42.87 savings and quality ratings on of the federal and state exchanges. These findings Pharmacy Services provider switching behavior illustrate the importance of educating consumers Switch to Generic with Discount $511.57 about benefits options in advance of open enrollment Brand Coupon $335.34 and the importance of making value-based health care Greatest Opportunities to Save Pharmacy Switch $129.67 decisions. The data revealed there is a great Generic Discount $89.15 Understanding what drives consumers’ health opportunity for consumers to save on a care shopping decisions will allow health plans and number of medical services with physical Source: Change Healthcare’s Proprietary Consumer employers to better educate and empower individuals therapy providing the greatest savings of Shopping Data (Based on National Health Claims Data) to maximize their benefits in this new era of health $235.76 per visit. In terms of pharmacy iiThis amount is a weighted average by age group (30 or under, 31-40, 41-50, 51-60, and 60 or over) reform. services, the greatest savings opportunity lies in switching from a brand name drug to a generic drug that is part of a generic Douglas Ghertner is president and chief executive officer of Change Healthcare, a discount program with an average savings of $511.57 per opportunity. Chart 1 leading health care transparency and consumer engagement provider. He leads the company’s mission to transform the way Americans purchase and utilize health provides a breakdown of savings amount per opportunity for various medical care services by driving sustainable engagement at the individual level. To learn and pharmacy services. more about Change Healthcare and its consumer engagement solutions, visit www. changehealthcare.com.

Impact of Savings on Driving Distance

____________________________________________________________

Consumers are willing to drive farther to save more, according to Change Healthcare’s data. For instance, 63 percent of individuals indicated they would drive 25 miles for greater medical savings, while 56 percent would drive the same distance to save on pharmacy costs. Chart 2 (To view Chart

i Commonly occurring services that offer consumers the opportunity to choose between providers ahead of time; not complex surgeries, acute events or imaging services.

www.TheIHCC.com I HealthCare Consumerism Solutions™ I September/October 2013

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ATLANTA, MAY 7-9, 2014

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THE ONLY CONFERENCE DEDICATED 100% TO HEALTH CARE CONSUMERISM WWW.THEIHCCFORUM.COM

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September/October 2013

Exchange

Navigating Exchanges and Vision Benefits Criteria to Consider When Exploring Private Exchanges Small Employer Private Exchanges: Wherefore Art Thou? Public vs. Private: The Regulatory Dialectic

ANNOUNCING

www.theihcc.com


INSIDE

FEATURE 11 Navigating Private Exchanges and Vision Benefits By January 1, 2015, small businesses with 50 or more full-time employees must offer their employees health care insurance that is in compliance with the Affordable Care Act (ACA). To help reduce overhead and simplify the administrative process for the newly required coverage, health insurance exchanges (or marketplaces) were created to allow companies and individuals to shop for health care in one place online. By Terri Wilson, Senior Vice President and General Manager of Strategic Partnerships and International Development, VSP® Vision Care

4

Publisher’s Letter CEO Doug Field covers the latest in the private exchange and defined contribution industry and what’s happening at the Institute around exchanges

5

8

News Briefs & Innovations

Regulatory & Compliance: Public vs. Private: The Regulatory Dialectic As public and private exchanges compete in the “survival of the fittest” race, both bring to the table enormous power and money. The power of the federal government and its taxing authority versus the power of private capital and American ingenuity. While 34 states have rejected setting up a state-run exchange, more than twice that many have launched or are expected to launch private state or regional exchanges before the end of the year. By Elena Merino, President/CEO, The Meridian Group

adoption of Aon Hewitt’s private exchange is the 18th such adoption by a large U.S. employer. As far public announcements go, Aon is inarguably outpacing the field early on.

The emergence of private exchanges provides employers with an entirely new approach to employee benefits that will help them control rising costs through defined contributions. In addition, these marketplace solutions foster deeper consumer engagement, setting the stage for the next evolution in the benefits industry. As employees assume greater financial responsibility for health insurance, our nation will move toward a consumer-driven system.

Keeping you up-to-date with the latest news, research and innovations in defined contribution and health insurance exchanges

7

DEPARTMENTS

Exchange Profile: Digital Benefits Marketplace Saves Employers Money and Provides Enhanced Consumer Experience

By Jonathan Field, Managing Editor, The Institute for HealthCare Consumerism

10 Special Announcement: Introducing PrivateHealthCareExchanges.com

By Bob Gaydos, Principal and National Director of Private Marketplaces, Digital Benefit Advisors

9

Editor’s Perspective: Walgreens Announcement, Recent Surveys Point to Future of Private Exchanges With the September 18 news that Walgreens was moving over 160,000 lives into the Aon Hewitt Corporate Health Exchange, the shift toward greater consumerism in health care was thrust into the national spotlight. Walgreen Co.’s

On September 23, to meet the need for a guide to private exchanges and defined contribution solutions, The Institute for HealthCare Consumerism announced the beta launch of PrivateHealthCareExchanges.com, the only online directory aimed at providing employers, health plans, brokers, consultants and consumers with the information to navigate this new market.

www.TheIHCC.com I HealthCare Exchange Solutions™ I September/October 2013

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PUBLISHER

Exchange www.theihcc.com VOLUME 1 NO. 4 | SEPTEMBER/OCTOBER 2013

Health Insurance Exchanges – Both Public and Private – Set to Take Center Stage

Published by FieldMedia LLC 292 South Main Street, Suite 400 Alpharetta, GA 30009 Fax: 770.663.4409 CEO

Doug Field @ theihcc.com

In the past few weeks, both public and private health insurance exchanges have been garnering national headlines, and for perhaps the first time, private exchanges have really been grabbing the nation’s attention. While their more widely publicized counterparts have been at the center of national debate for some time now, more and more Americans are beginning to understand the value and innovation coming from private exchanges.

MANAGING DIRECTOR

Brent Macy

MANAGING EDITOR

Jonathan Field

SENIOR EDITOR

On September 18, Walgreens announced that they would move 160,000 lives into Aon Hewitt’s private exchanges — a huge step forward for consumerism in health care. Private exchange and defined contribution strategies represent perhaps the greatest opportunity for employers to manage their health costs while empowering their employees that we’ve seen in years, and the trend of U.S. employers shifting their employee populations to a private exchanges has barely begun. This is only the tip of the iceberg.

Heather Loveridge hloveridge@theihcc.com ACCOUNT MANAGER

Joni Lipson

MARKETING COMMUNICATIONS MANAGER

Lana Perry

ART DIRECTOR

The Institute for HealthCare Consumerism is actively promoting this shift in health and benefits in a number of ways. At our December conference, FORUM West, we will be featuring a variety of exchange-specific content. With Alegeus Technologies, we will delve into recent survey data on private exchanges and defined contribution during a pre-conference “lunch and learn.”

Kellie Frissell

ASSOCIATE DIRECTOR OF EDUCATION SERVICES AND PROGRAMS

Dusty Rhodes CHAIRMAN OF IHC ADVISORY BOARD

I will be moderating a panel, “Exchanges or Marketplace? Whatever it’s Called, Get to Know It,” with leading private exchanges experts John Reynolds, Cielostar; Josh Hilgers, Health Partners America; Shandon Fowler, Benefitfocus; and more. At the end of day one, we will be hosting another panel, “Defined Contribution and Public/Private Exchanges: a Panel Discussion with Leading Experts” with Chris Covill, Mercer; Cindy Gillespie, McKenna Long & Aldridge; John Park, Alegeus Technologies; and more to come. FORUM West will provide the industry’s first real-time look at this fall’s historic open enrollment. We hope to see you there. Additionally, to help employers, brokers, health plans and consumers navigate private exchanges, we are excited to introduce PrivateHealthCareExchanges.com, the only online guide to private exchanges and defined contribution solutions. Thanks again to all of our contributors to this fourth edition of HealthCare Exchange Solutions — Elena Merino, The Meridian Group; Terri Wilson, VSP Vision Care; and Bob Gaydos, Digital Benefit Advisors — and to all our readers, we hope to see you at FORUM West.

Ronald E. Bachman, CEO, Healthcare Visions EDITORIAL ADVISORY BOARD

Kim Adler, Allstate; Diana Andersen, Zions Bancorporation; Bill Bennett; Doug Bulleit, DCS Health; Jon Comola, Wye River Group; John Hickman, Alston+Bird LLP; Tony Holmes, Sanders McConnell, TSYS Healthcare; Roy Ramthun, HSA Consulting Services LLC; John Young, Consumerdriven LLC WEBMASTERS

Kevin Carnegie Tom Becher ASSOCIATE WEB ADMINISTRATOR

Tim Hemendinger

DIRECTOR OF CONFERENCE SPONSORSHIP/ CORPORATE MEMBERSHIP/REPRINTS

Rogers Beasley

BUSINESS MANAGER

Karen Raudabaugh

™ Volume 1 Issue 4 Copyright ©2013 by FieldMedia LLC. All rights reserved.

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™ is a trademark of FieldMedia LLC. is published eight times yearly by FieldMedia LLC., 292 South Main Street, Suite 400, Alpharetta, GA 30009. Periodical postage ™

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TO SUBSCRIBE: Make checks and money orders payable to ™ magazine 292 S. Main Street, Suite 400, Alpharetta, GA following rates: single copy $7.50; $75.00/yr in the U.S., $105/yr in Canada and $170/yr international. Please contact FieldMedia at 404.671.9551 or PRINTED IN THE U.S.A. ™ is designed to provide both accurate and authoritative information with regard to the understanding that the publisher

legal advice is required, the services of a professional adviser should be sought. The magazine is not responsible for unsolicited manuscripts or photographs. Send letters to the editor and editorial inquiries to the above address or to

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BRIEFS

NEWS BRIEFS Towers Watson Signs Agreement With Federal Government to Facilitate Public Exchange Enrollments Towers Watson, a global professional services company, announced that it has signed a web broker entity agreement with the Centers for Medicare & Medicaid Services, which supervises the federally facilitated marketplace — the health insurance exchange operated by the federal government in 36 states. With this agreement, Towers Watson can help employers provide health insurance education and enrollment services to part-time and seasonal employees, retirees and their dependents by supporting them as they evaluate and purchase individual health plans on the federally run exchange.

Benefit Advisors Network Announces Private Exchange Partnership with Liazon Benefit Advisors Network (BAN) — a national network of progressive and independent employee benefit firms — has partnered with Liazon, operator of the Bright Choices Exchange®, to deliver a private exchange solution to their clients. Employer clients will be able to offer this exciting new online marketplace to their employees. The Bright Choices® Exchange is an online benefits store that is changing the way employers and employees buy benefits. Bright Choices allows employees to personalize their benefits package with a selection of health, dental, vision, life, disability, and other benefits from top national and regional providers.

Medical Mutual of Ohio Builds Private Exchange with Benefitfocus Marketplace Technology Medical Mutual of Ohio has selected leading cloud-based benefits software provider Benefitfocus to build a private insurance exchange for both group and individual market segments. Benefitfocus Marketplace Technology creates a full-service online private insurance marketplace for Medical Mutual to adapt their strategy as public exchanges come into play on January 1, 2014. Medical Mutual’s private exchange will be designed to allow the insurance carrier to integrate with the Federally Facilitated Marketplace (FFM). This integration is intended to create a seamless consumer-centric shopping experience, allowing individuals eligible for government assistance to apply subsidies to their purchases within the Medical Mutual Marketplace.

Eastbridge Survey: Carriers Weigh in on Private Exchanges, Including Broker Needs and Voluntary Products In a recent survey conducted by Eastbridge Consulting Group, Inc. titled “Health Care Reform: Private Exchanges & Voluntary Frontline Report,” carriers indicated that brokers are increasingly looking to their carriers for help in navigating through the new private exchange environment. The carriers claim that brokers want advice not only on product options and sales strategies, but also on new regulatory, compliance, and tax impacts for their clients. Carriers also believe that brokers will need to become more consultative in their approach with clients. In their opinion, it will become more about offering a wider array of products and more communication overall. Carriers believe that all sizes of brokers will be involved in the private exchange market, but that larger brokers will be earlier adopters of technology and change.

Federal Government Selects ConnectedHealth to Offer Qualified Health Plans via the Federally Facilitated Marketplace ConnectedHealth, the first consumer-focused e-commerce platform offering a robust benefits marketplace, has announced that it has been selected by the Centers for Medicare and Medicaid Services (CMS) to provide qualified health plans (QHP) to eligible consumers via the Federally Facilitated Marketplace (FFM), the federal government’s online health insurance marketplace. As a result of this agreement, ConnectedHealth will provide the most comprehensive range of health insurance shopping options — including private plans and plans available in the state or federal marketplace — to help employees who have employer-sponsored options, those shopping for individual coverage, and those who may qualify for a subsidy.

HealthPartners Launches Plan for Me Private Exchange Solution HealthPartners has announced the launch of its new private exchange solution, Plan for Me, designed to keep costs in check for employers while providing more choice and simplicity during the open enrollment process for members. For employers, Plan for Me is easy to administer and available with no hidden fees. Plan for Me supports several prepackaged plans, including new defined contribution and performance network options. Employers can also offer custom plans with this shopping tool.

Health Partners America Adds New Updates To Private Exchange Broker Blueprint Health Partners America has recently come out with updates to their Private Exchange Broker Blueprint, a tool that better prepares insurance professionals to understand Obamacare and prepare themselves to help individuals and employers secure the best health care plans quickly and easily using defined contribution and/ or private exchanges. With all the changes in the world of health insurance, America’s employers need highly educated agents to help them navigate the new hurdles and roadblocks being thrown in their direction. Health Partners America has provided a tool aimed at agents to do just that: the Private Exchange Broker Blueprint.

Highmark and Array Health Form Partnership as MyBenefits Defined Contribution Platform Expands Highmark Health Services has announced that it is making its MyBenefits defined contribution health insurance platform available to more businesses in more locations by forming a long-term strategic partnership with Seattle-based Array Health. Highmark Health Services’ long-term agreement with Array Health extends the relationship through 2015. It also includes an investment in Array Health by Highmark. MyBenefits started in 2011 as a pilot program that quickly gained momentum throughout 2012 and 2013 with small and mid-sized businesses (under 100 employees) seeking to manage their group health coverage costs, while providing their employees with more choices. Due to its success, Highmark is making it available to large group businesses.

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www.buckconsultants.com

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REGULATORY & COMPLIANCE

BY ELENA MERINO » PRESIDENT/CEO » THE MERIDIAN GROUP

Public vs. Private: The Regulatory Dialectic

A

s public and private exchanges compete in the “survival of the fittest” race, both bring to the table enormous power and money. The power of the federal government and its taxing authority versus the power of private capital and American ingenuity. While 34 states have rejected setting up a state-run exchange, more than twice that many have launched or are expected to launch private state or regional exchanges before the end of the year. The regulatory dialectic has been most prevalent in the banking industry.1 While the Glass-Steagall Act was enacted in 1933, decades later the law was repealed and signed into law in 1999 under the Financial Modernization Act.2 Then after decades of alternate attempts to restrict and loosen financial oversight of these institutions, the government stepped to in to save the very same institutions that it sought to direct through regulations. Will insurers be the next “too big to fail?” We have no doubt reached the high point in the regulatory dialectic in the health insurance industry. Will the ACA and its regulations ultimately result in robust and sustainable public and private exchanges? Will employers retreat or embrace public or private exchanges? While the promise of tax subsidies by the government to individuals may divert much of the individual consumer business to public exchanges, the two-year tax credit incentives for businesses with less than 25 employees will clearly be short lived. The delay of employee-level option by the federal SHOP exchanges and the limited medical and ancillary options available to small employers in the SHOP — along with the short-lived small business tax credit — will likely result in an upswing and immediate downswing in the public exchange option for small businesses. As such, SHOP exchanges that anticipate allowing larger employer groups to participate may not make it until 2017 to see this growth. Selecting and managing employee benefits, no matter how easy it is to “shop,” is a year-long financial and administrative commitment for employers that must not only select the best plans for their employers but must deal with employee-level questions and concerns that only the small employer or its broker would still have to address. Cafeteria (or 125) plans must continue to be set up and managed by employees in order to allow pre-tax expenses by employees. Account-based health plans, such as HSAs and HRA plans, to encourage the efficient use of services, engagement and accountability must all be integrated along with the insured health plans to control cost. Finally, unless brokers and agents get involved with SHOP exchanges, chances are employers will have go at it alone or pay a benefits advisor on a fee-based basis.3

As brokers’ and agents’ commissions continue to get reduced by employers due to the Minimum Loss Ratio (MLR), many brokers may have no choice but to charge a fee. The promise of private exchanges is great but carrier and general agent exchanges that seek to promote certain carriers may not get the attention of independent brokers or employers or regulators. While eHealth stunned the market by becoming the first private exchange to partner with the federal exchange, eHealth had to agree to offer customers any plan available on the federal exchange, regardless of whether it has a commission agreement with that carrier.5 Similarly, private exchanges must be ready and able to accept “any willing [insurance] provider” and be willing and able to communicate with existing employer systems if they are truly to add value and not add confusion. While professional employer organizations (PEOs) and Exclusive Provider Organizations (EPOs) have a place, employee-level choice and defined contribution calls for an open model that allows for multi-carrier, multi-employer systems solutions. Limited carrier exchanges that provide great decision-support tools and enrollment features may offer the best plans for the employer today — but not tomorrow. Likewise, while the best payroll services in the country may also offer Administrative Services Only (ASO) option, will they be willing/ able to share data with private exchange providers? Employers need to consider that moving between private exchanges, especially those that offer to defined contribution and/or exclusive payroll providers will not be easy — not only from a technical point of view, but from a financial and compliance point of view. Employer reporting in one year will require data from the prior year, which may not only span two plan years, but two contribution strategies and changing account-based plans. Alas, if private exchanges are to survive and ourish, they must take into account changing market participation, plans and pricing by insurers as well as employers’ existing systems and outsourced vendors. They must compete on service not with proprietary source codes. If hospitals are ready to move to open source EHR software, so must the industry that supports it. 4

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PRIVATE EXCHANGE PROFILE

Criteria to Consider When Exploring Private Exchanges

Digital Benefits Marketplace Saves Employers Money and Provides Enhanced Consumer Experience BY BOB GAYDOS » PRINCIPAL AND NATIONAL DIRECTOR OF PRIVATE MARKETPLACES » DIGITAL BENEFIT ADVISORS

The emergence of private exchanges provides employers with an entirely new approach to employee benefits that will help them control rising costs through defined contributions. In addition, these marketplace solutions foster deeper consumer engagement, setting the stage for the next evolution in the benefits industry. As employees assume greater financial responsibility for health insurance, our nation will move toward a consumerdriven system. While private exchanges are a strategy many businesses will consider, because these options are new, for some it will be difficult to determine which alternative best serves their needs. Testimonials from other companies, case studies and historical evidence will be miniscule — or nonexistent. Against this backdrop, how can you compare choices? When exploring options, here are some questions to ask and criteria to consider: t Does the decision support include access to qualified benefits counselors via telephone, e-mail or online chat? t Does a dedicated benefits administration team provide all the needed support on behalf of the employer — or is the system merely self-service? t Does the marketplace offer a wide of array of products and services beyond health insurance? And can the contribution system be designed to promote additional products and services? t Is the marketplace available to employers all off sizes, including small and mid-sized companies? And can the marketplace be offered to provide ancillary benefits only? Digital Benefit Advisors (DBA), a division of Digital Insurance, has launched Digital Benefits Marketplace, a private exchange that encompasses all of the criteria above. This sophisticated marketplace provides a comprehensive array of benefits, as well as a consumer experience unlike anything yet available. Digital’s system is based in a framework that has functioned for more than a decade. The company already has the infrastructure, operational capability and distribution systems to effectively launch and manage private marketplaces in multiple states. In fact, unlike other exchanges, Digital has a year of experience already operating a private exchange. The firm played a crucial role in the development of Vermont Chamber Preferred powered by Liazon Bright Choices — a private benefits exchange launched in October 2012. It’s endorsed by the Vermont Chamber of Commerce, managed by Digital Benefit Advisors and serves nearly 50 employers. Initially, Digital Benefits Marketplace is rolling out in states where DBA offices exist (such as Virginia, North Carolina and

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Florida). The company is negotiating with health insurance carriers in additional locations, as well as providers of ancillary and voluntary products. Offerings include health, life, disability, accident, critical illness, long-term care, dental and vision insurance, along with other products and services. Digital Benefits Marketplace also encompasses an employer segment that most of the industry neglects: both small and middle-market employers.

Advantages to Employers t t t t t t t

Fixed budget; long-term financial sustainability Reduced administrative burden Enhanced employee choice and satisfaction No costly set-up fees or time-consuming implementation Exceptional customer service with employee access to live professionals Compliance with all regulations Delivered by an established, national employee benefits leader

A Consumer Experience Like No Other Digital’s focus is on delivering a differentiated consumer experience that is a harbinger of things to come in the U.S. health care arena. The proprietary marketplace is a true online storefront with a comprehensive range of policies and plans from multiple carriers – and one crucial element that others lack: a call center with highly experienced customer advocates. t Regardless of an organization’s size, Digital’s private exchange solution provides access to knowledgeable customer service representatives to advise and guide individuals and families through the process. And, we have communications tools to educate the workforce. t Our resources help a company transition to a system that empowers employees to spend their benefits dollars where they perceive the greatest value. It places them at the center of the decision-making process and allows for greater customization based on needs. t This long-term strategy creates more educated, engaged consumers. Combined with cost transparency, this approach can lead to healthier lives and help drive down the cost of


t

care. t

t

t

Again, just to summarize, Digital Benefits Marketplace is: A private benefits exchange. – Available on a national basis. – Employer defines its contribution and lets employees choose their benefits. – Employees can choose from eight health plans, four dental plans, two vision plans and build their life, disability, critical illness and accident benefits. Full service for both employers and employees. – Consolidated benefits administration. We do it all. – Customer service with decision support. Simple. – Pre-built benefits stores that allow fast implementation. – Full sales support to help employers define their contributions. – Full implementation support to help the employer.

Comprehensive. – Single employer group contracts. – Ancillary products guaranteed issue/no participation limits. – Includes Consult-a-Doc, legal services — and more. – Targeting employers of all sizes — focusing on fully insured groups of 50-500 employees. (Exploring ways to take the employer size segment down to 10 – 15 lives, as well.) – Availability will vary state-to-state.

We know from 13 years of experience that complex benefits decisions require support from knowledgeable personnel. Digital has invested in technology to efficiently focus on providing a superior level of service to any size employer. Our view is that we’ve built a capability and cost advantage that will drive our competitive value well into the future.

EDITOR’S PERSPECTIVE

Walgreens Announcement, Recent Surveys Point to Future of Private Exchanges BY JONATHAN FIELD » MANAGING EDITOR » THE INSTITUTE FOR HEALTHCARE CONSUMERISM

With the September 18 news that Walgreens was moving over 160,000 lives into the Aon Hewitt Corporate Health Exchange, the shift toward greater consumerism in health care was thrust into the national spotlight.

CEOs, CFOs, HR executives and other benefits decision-makers are looking to make a significant change in their health benefits, one that may include the adoption of a private exchange or defined contribution solution.

Walgreen Co.’s adoption of Aon Hewitt’s private exchange is the 18th such adoption by a large U.S. employer. As far public announcements go, Aon is inarguably outpacing the field early on. The 2012 announcements by Sears Holding Co. and Darden Restaurants were unprecedented, and early into 2013’s enrollment period, the trend seems to be holding.

Research published earlier this summer by Alegeus Technologies, which polled more than 500 health benefit decision-makers at a crosssection of U.S. employers, suggests that 2015 will see the highest rates of adoption of private exchanges and defined contribution. Alegeus has called 2015 the “tipping point” of employer adoption.

The Walgreens announcement further confirms recent data that suggests that

represents many large employers’ perspective on health policy issues, echoes this sentiment: many U.S. employers are strongly considering moving into a private exchange, but the majority will do so beyond the 2014 benefits year. While the Walgreens announcement may provide us a glimpse into the future of health benefits, if industry consensus is confirmed, it is really only the tip of the iceberg.

Similarly, data published in August by the National Business Group on Health, a non-profit organization that

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Introducing PrivateHealthCareExchanges.com New web directory helps employers, brokers and consultants navigate the emerging private exchange and defined contribution markets

T

he emergence of private health insurance exchanges represents perhaps the most significant shift in how Americans purchase health benefits in years. And while many U.S. employers already have moved their employee population into a private exchange or are planning to do so for the 2014 benefits year, the trend will only continue to grow in 2014 and beyond. In fact, recent research published by Alegeus Technologies suggests that 2015 will see the highest rate of adoption of private exchanges among U.S. employers. According to an Aon Hewitt survey published earlier this year, about 28 percent of employers polled plan to move into a private health care exchange over the next three-to-five years. Yet the number and diversity of private exchanges and defined contribution solutions are still largely unknown to employers, benefit brokers and consumers — enter PrivateHealthCareExchanges.com. On September 23, to meet the need for a guide to private exchanges and defined contribution solutions, The Institute for HealthCare Consumerism announced the beta launch of PrivateHealthCareExchanges.com, the only online directory aimed at providing employers, health plans, brokers, consultants and consumers with the information to navigate this new market. Users will be able to search our database of private exchange and defined contribution solutions with important search criteria such as geography, number of insurance carriers, broker accessibility, type of company, distribution partners and more. We are currently gathering information from solutions providers

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in this space to develop the database, and companies can now submit directory listings on a three-tiered system: basic listing (free), enhanced listing ($99 per month) and premium profile ($499 per month). To view the benefits of each option, visit the Search Exchanges page at PrivateHealthCareExchanges.com. Advertising opportunities are also now open for skyscraper banners and more. During the beta launch, we would also like to hear constructive comments from the health and benefits industry. If you would like to leave a comment or something for us to consider, visit the Contact page at PrivateHealthCareExchanges.com. Private exchanges and defined contribution solutions are still relatively new, and many standards are yet to be set. Your input on what information you would like to see us gather from the solution providers will be invaluable in this process. We look forward to your comments. Additionally, in early October, soon after the Obamacare exchanges open for enrollment to the public, The Institute for HealthCare Consumerism will launch an interactive web tool at PublicHealthCareExchanges.com aimed at connecting employers, brokers, consultants and consumers with the state-based or federal public exchanges. For advertising opportunities on both new websites, please contact Brent Macy, Managing Director, The Institute for HealthCare Consumerism, at bmacy@theihcc.com. For general or media inquiries, please contact Jonathan Field, Managing Editor, The Institute for HealthCare Consumerism, at jfield@theihcc.com.


Navigating Private Exchanges and Vision Benefits BY TERRI WILSON » SENIOR VICE PRESIDENT AND GENERAL MANAGER OF STRATEGIC PARTNERSHIPS AND INTERNATIONAL DEVELOPMENT » VSP ® VISION CARE

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CCA Forum 2013 CCA Forum 2013 An integrated learning and networking experience An integrated learning and networking experience Know What You Pay For: Roadmap to Assess Success of Employer Offered Wellness Programs Know What You Pay For: Roadmap to Assess Success of Employer Offered This training institute will equip employers Wellness Programs with a “how to” to assess employee health

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By January 1, 2015, small businesses with 50 or more full-time employees must offer their employees health care insurance that is in compliance with the Affordable Care Act (ACA). To help reduce overhead and simplify the administrative process for the newly required coverage, health insurance exchanges (or marketplaces) were created to allow companies and individuals to shop for health care in one place online. As companies large and small mobilize to comply with the ACA, they are evaluating whether they should continue business as usual — or number of options have emerged to help employers make these decisions in order to meet the health care law’s compliance requirements. Frankly, there are still many unanswered questions surrounding the largest health care overhaul in the nation’s recent history. As more details emerge, businesses will be searching for the option that is in the best interest of both their employees’ health and the company’s bottom line.

Private Health Insurance Exchanges In addition to public exchanges created under the ACA and the traditional options of purchasing insurance directly from vendors or brokers, private health insurance exchanges are becoming an increasingly appealing option for employers. Private exchanges provide an online marketplace for employees to compare and purchase their health insurance are run or administered by state and/or federal government whereas private exchanges are managed by private companies like Mercer, Aon Hewitt and Towers Watson.

Things for Employers to Consider Exchanges may be a good way to reduce the administrative burden help improve employee satisfaction. With this in mind, it’s important to clearly understand the exchange’s offerings and requirements and make sure they are in line with employee and company needs. With so many

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in more creative ways. One of the best ways a company can manage risk, whether choosing coverage inside or outside of an exchange, is by selecting a plan that offers prevention programs and engagement strategies that keep members healthier and reduce costs. offering and should be a core component of your risk management strategy. Preventive care plans, like vision coverage, help keep employees healthier through early detection and treatment of serious health conditions. In fact, an annual eye exam than a routine physical.1 This preventive strategy leads to lower long-term health care costs and healthier employees. When you’re whether in the exchanges or through a direct relationship. The complexity of exchanges varies a great degree. Some exchanges offer many choices, which could seem overwhelming for your employees during open enrollment. Look for an exchange that offers strong decision support tools that help employees choose the right coverage based on their needs.

exchange environment, employees may need help to make individual choices based on value, network, price and health needs. Another thing to consider is that if your employee has a bad experience in an exchange, you may have limited options to help the employee. Most exchanges manage all of the vendor relationships on a large scale, so you may no longer have the personal touch points you may have today.

option with exchanges, it’s not a requirement. A third misconception is that vendors will struggle with channel against their direct business. Although it is another distribution channel, it’s more about increasing the number of ways a

exchange environment. When working directly with a carrier, For example, at VSP Vision Care, we want our clients to choose how or another to best meet a client’s needs. Employers may not have that same customization ability from an exchange since standardization is a key component of the exchanges. The structure of exchanges also varies, making it crucial to examine their requirements and offerings closely. One exchange may require you to offer all products on their platform, while others may allow you to choose whether or not to include the note of these requirements, particularly if a company has a strong relationship with a voluntary plan that it wants to keep.

alliance or directly with the client — to ensure their employees have a great experience with VSP as their vision coverage, regardless of how they get it.

The Bottom Line

larger companies can spend more time evaluating options. Regardless of company size or whether or not you choose to use the exchanges,

Common Misconceptions Many companies view the insurance exchanges as a way

cost-effective ways to help manage the health of your employees, so you

businesses would use. The format is certainly different from today’s health care model, but the quality of your company’s

options.

choosing what is right for your business’ needs—whether that is a particular exchange or continuing to work directly with your vendors. Another common mistake is viewing an exchange as synonymous a way a company can limit its risk by providing employees a

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____________________________________________________________


EXCHANGE SOLUTIONS SHOWCASE

HSA/HRA/FSA TECHNOLOGY: ADMINISTRATION & MANAGEMENT

TSYS HEALTHCARE TSYS Healthcare® provides end-toend strategic payment solutions for 706.649.5080 consumer directed healthcare. We www.tsys.com/healthcare partner with benefits administrators, healthcare@tsys.com financial institutions, health plans, and software providers to navigate all aspects of HSAs, HRAs, FSAs, transportation accounts, cash reimbursements, and lines of credit. TSYS Healthcare cards offer participants the security they expect along with the ability to conveniently access funds from multiple accounts and manage their benefits payments with simplified single-card access. Clients and partners benefit from simplified processes, reduced paperwork and cost savings that can contribute to improved return on investment. “We built the TSYS Healthcare platform to meet the market demand for reliable, configurable and intelligent solutions. Understanding the dynamic U.S. healthcare market, our customers rely on our option-driven system to prepare them for the future.” — Trey Jinks, Group Executive, TSYS Healthcare HSA / HRA / FSA ADMINISTRATION AND FINANCE

WageWorks helps employers

WAGEWORKS

support consumer directed

1100 Park Place, 4th Floor San Mateo, California 94403 United States of America

pre-tax benefit programs, including health care (FSA, HSA, HRA), wellness

888-9905099 www.wageworks.com

programs, commuting and child and elder care. Wage Works also offers retiree health care and COBRA Services. More than 100 of America’s Fortune 500 employers and millions of their employees use WageWorks.

BENEFIT ADMINISTRATION/PRIVATE EXCHANGES

Since 1988, CieloStar (formerly OutsourceOne) CIELOSTAR has helped brokers, employers and employees 530 U.S. Trust Building navigate the ever-changing world of benefits. 730 Second Avenue South Now, with the dawn of “Defined Contribution Minneapolis, MN 55402 Health Care” we are again on the leading edge. With a team of industry thought leaders, CieloStar 612.436.2706 makes navigating healthand benefits choices john.reynolds@cielostar.com easy for employers and employees by offering comprehensive benefits administration solutions with a high-touch, high technology model—most recently launching a proprietary private health insurance exchange.

“Fueled by the far-reaching impact and complexities of health care reform taking effect in 2013 and 2014, employers and employees increasingly find themselves in a ‘farmer’s market’ of benefits choices. Cielostar is uniquely positioned with enabling technology that helps purchasers and consumers make the best possible decisions and create a best-in-class benefits administration process. Our unique comprehensive approach to benefits offers everything from back room technology for enrollment, data, billing and call centers to complete solutions for COBRA, CDHP and health insurance exchanges.” — John Reynolds, CEO, Cielostar HSA / HRA / FSA ADMINISTRATION AND FINANCE

Evolution1 and our Partners serve more EVOLUTION1, INC. than 9 million consumers, making us 952.908.9056 the nation’s largest electronic payment, www.evolution1.com on-premise and cloud computing sales@evolution1.com healthcare solution that administers reimbursement accounts, including HSAs, HRAs, FSAs, VEBAs, Wellness and Transit Plans. It is the only solution that offers a single end-to-end user experience, provides innovative auto-substantiation technologies, and automates workflow for Partners, employers, and consumers. It does all this on one technology platform comprised of 1Cloud™, 1Direct™, 1Pay™, 1View™, 1Plan™, and 1Mobile™. Evolution1 and our Partners are dedicated to delivering value, reducing costs and simplifying the business of healthcare.

“The combination of our innovative products will further our leadership position in a rapidly changing healthcare market. Together with our Partners we are committed to reducing costs and simplifying the business of healthcare.” — Jeff Young Chairman and CEO, Evolution1

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ENGAGE AT EVERY STAGE

Ninety million consumers report having a hard time understanding their care choices, according to an Institute of Medicine study.* And as the healthcare landscape changes and insurance exchanges become available, consumers are likely to be more confused than ever. Though it remains to be seen what shape the new marketplace will take, it’s clear that consumers will require a range of tools to support their healthcare decision-making. From guiding individuals to their best-fit benefit plan to alerting them about gaps in care, Consumer Advantage from Truven Health Analytics™ provides a full array of solutions to engage consumers with personal, relevant, impactful information throughout the year. Consumer Engagement: The Key to a Successful Exchange Backed by more than 30 years of experience, our consumer experts, integrated platforms, and data management solutions have helped turn passive participants into active healthcare consumers. Recent successes include: Increasing adherence to colorectal cancer screenings by 22 percent Migrating 59 percent of employees from a PPO to a CDHP Reducing the number of “overinsured” employees by 14 percent Enrolling more than 1,000 new participants in a health savings account

Find the path to a healthier bottom line — visit booth #135 at AHIP Institute 2013 or go to truvenhealth.com/exchange

TRUSTED. PROVEN. ©2013 Truven Health Analytics Inc. All rights reserved.

Consumer confusion about their care choices is directly responsible for 3- to 6-percent higher healthcare expenditures.* * Source: Institute of Medicine Report Brief


BY TOM EMERICK & AL LEWIS CO-AUTHORS CRACKING HEALTH COSTS

WELLNESS

Designing a Wellness Program: Learning from Penn State’s Mistakes

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obody’s wellness program is perfect. Quite the contrary, the editor of the wrote that only 5 to 10 percent of

2.

3.

that goal of impact, even if perfection always remains over the horizon.

of the worst,” an appellation that one could argue is well-deserved for a risk assessment whether she intends to become pregnant. And yet no opposite: Penn State’s Human Resources department embodies The Onion’s

4.

By now, most of you know the story and outcome of Penn State’s foray into wellness. Over the summer, when many faculty were on vacation, Penn 5. combination of mandatory screening and mandatory doctor visits designed to identify every conceivable condition and pre-condition notwithstanding the nition of a healthy patient is one who hasn’t been examined carefully enough.” Penn State has become a national pariah that other program sponsors warn against, receiving coverage on Fox, the and

6.

7. What you may not know is that this program could create the ultimate HR consequence: unionization. Where did they go wrong and how can you avoid those mistakes? Here are a set of lessons that we think should be learned from Penn State for your own program. 1. Never lose sight of the mission of HR. It is not to create the most diagnosed workforce. It is to create the most productive workforce.

both doctor visits and biometric screens. And being told they have disease, a high probability as a result of Penn State’s hyper-diagnosis emphasis, isn’t exactly going to focus employees on their work.

wellness programs don’t think they save money, that vendors make up savings numbers, that screens can’t even theoretically save money and a whole body of research opposes them, and that the extra preventive doctor visits are useless. Fight your battles selectively Penn State is giving the health risk assessment (HRA) data to WebMD, which infuriated employees. There is no reason to do this. If you want management reports, vendors can give you the software to make them on your own, but you don’t need management reports because… …Most people lie on some HRA questions, so don’t bother asking questions about drinking habits, recreational drug use, and depression. Respondents will simply lie. Instead of creating a culture of health, you’d be creating a culture of deceit. Likewise, there is no recommends against that.

decidedly left-leaning American Federation of State, County and Municipal Employees picked up a blog from the decidedly not-left-leaning . And if a college’s second-worst nightmare is a critical

an army into battle, would you rather have troops with high morale or troops with low cholesterol?” This observation has two implications. First, forcing people to get extra medical workups against their will and against guidelines will reduce morale. Second, as far as productivity is

Speaking of morale, be attentive to employee opinion, an example being Penn State’s Change.org petition, which preceded their unionization drive. Do your own research. Don’t take your carrier’s word for what you should do in wellness any more than you would take a car dealer’s word for what a car should cost. Independent research would

8.

Speaking of which, pregnant women, for examples, should not have to be screened and have extra doctor visits. Results are meaningless. Likewise, people who already have chronic disease who are in disease management programs should be exempted. Be open to new information. Suppose your consultant works for Truven Health Analytics and advocates more preventive doctor visits. But then Truven publishes a new report saying that by far the largest contributor to spending and spending group is more preventive doctor visits. You should then rethink your position that more preventive visits and more screening are good things. Fact is, this country’s insured population has what Dr. Gilbert Welch calls Overtreated, and Seeking Sickness: Medical Screening and the Misguided Hunt for Disease. There are no books Underdiagnosed, Undertreated, or Let’s Hunt for Disease. Most importantly, do no harm. Besides the statistically certain harm caused by hyper-diagnosis, even the HRA advice can cause problems. Go through each question on your HRA and make sure that the advice won’t hurt your employees. Penn State’s HRA (supplied by WebMD), like many, advocates a prostate cancer test that the government recommends against and that the former head

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HEALTH SAVINGS ACCOUNTS

BY J. KEVIN A. MCKECHNIE EXECUTIVE DIRECTOR HSA COUNCIL, AMERICAN BANKERS ASSOCIATION

HSAs: Saving the Reform that was Designed to Kill Them Speechless. A rarity for me. It’s October of 2008 and I’m sitting with the Board of

Cassidy (R-LA) asked Center for Consumer Information and Insurance Oversight (CCIIO) Director Gary Cohen if the dollars spent from the account, since they are essentially redirected premium dollars, can be

D.C. The McCain and Obama campaigns are going to brief us on their vision Senator McCain’s staff behaved as you would expect senior advisors to presidential candidates to behave: thoughtful, serious, gracious, solicitous of both advice and counsel, and enthusiastic to gain our support. Unsurprising, given that candidates entrust these people with the singular We were prepared for a different vision from Senator Obama’s advisor, but one delivered in very much the same hushed, reverent, professional a shock to hear, then, that the Obama campaign had dispatched someone with the sole mission of breaking us the bad news; health care reform wouldn’t include HSAs and we should voluntarily disband the industry. It’s a special kind of animus that propels a candidate to tell those

dollars are actually expended, they will be counted towards that 80 cents that the insurance company has to spend.� Allowing this structure helps carriers move their HSA-related MLR up towards the magic 80 percent threshold.

None of the 10,500 pages of regulations hint at this treatment but why argue with success. Next up came the Actuarial Value (AV) rule. The AV rule determines Does a plan pay for a minimum of 60 percent of the expected health care costs a sample population could be expected to incur in a year? We argued included in the calculation. a handy calculator that allows people to input the parameters of their plan

our support, enacting a law with not one vote from the minority party and with the avowed intention of forcing us into other employment.

Then came the regulatory assault. The Federal Register says that the Affordable Care Act (ACA) accounts for more than 10,500 pages of proposals and regulations, which, for the faithfully minded is eight times the length of the . Light reading, indeed. Within the labyrinth of regulatory proposals the great mysteries of reform were explained: says that health insurance companies have to spend at least 80 percent of their premium dollars on medical expenses. The false logic that compelled such provisions says that prices will be lower if insurers are forced to and still lose 80 cents on every dollar is to increase prices faster than costs. which attracts more market participants, which in turn tends to lower premiums through competition. idea is to create a plan where premium dollars are re-directed to an account people can use to pay routine expenses and save for the future. The insurance isn’t there for daily health maintenance and that’s one reason the loss ratio is lower and one reason HSA plans are so much more affordable. We asked the Department of Health and Human Services (HHS) for relief from the MLR rule to no avail. That is, until Representative Bill 34September/October 2013*HealthCare Consumerism Solutions™*XXX5IF*)$$DPN

plans straight up and have resulted in an overwhelming demand for more affordable HSAs. Then came two more hard won concessions. The Internal Revenue is actually a very rational, mature regulator. They understand HSAs having regulated them for almost ten years. So, the IRS did what any thoughtful agency does: it makes choices about which areas of regulation it can safely

preventive care requirements mandated by the ACA with the preventive care requirements of HSAs and you have a bullet proof, compliant, affordable plan design, within the parameters of the law. For an administration struggling with accusations that its signature domestic policy is at risk of failing, HSAs have provided safe harbor for them and for all Americans who will shorty have to buy coverage. My advice is to savor the irony and be wary of the future. Opponents of HSAs, in trying to destroy them, have done more to promote their growth and ensure their future than most of their friends, so much so that I likely won’t have to be worried about HSAs again until President Obama leaves


BY SUSAN HAYES PRINCIPAL PHARMACY OUTCOMES SPECIALISTS

PHARMACY BENEFIT MANAGEMENT

The Next Big Thing in Prescription Drugs is in Your Pocket

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drugs and plans experiencing 80 percent generic drug use, you would think that the days of the double digit increases in the cost of prescription drugs is over. But many experts tell us that we need to brace ourselves for the over 400 bio-technically developed specialty drugs on the market with therapies of over $100,000 a year. So the question for 2014 now choose wisely when selecting drugs and get the most out of those drugs with the looming high cost drugs replacing older therapies?”

Background Until very recently, the cost of the entire prescription drug transaction was hidden from both the employer and employee. In some cases, it still is. For plans under traditional programs with their pharmacy lower amount and a higher amount is charged to the plan for the same transaction, with the PBM taking the fee. This type of pricing arrangement leaves little for plans trying to create a sense of consumerism, meaning plans that encourage patients to be more responsible consumers of health care dollars through high front-end for the employer to know the true cost of a prescription drug, then how should the patient to be expected to know the cost, and then have the means and access to that information allowing better consumerism of prescription drugs? A new day has dawned. More and more PBMs are being forced to offer transparent and pass-through deals where the pharmacy is reimbursed exactly what the plan sponsor pays and the plan sponsor reimburses the PBM for its services through a reasonable and fully disclosed administration fee. With this new day and new way of doing things, PBMs have now created

own a regular cellphone with 91 percent of the adult population owning some According to Pew’s previous reports, in May 2011, 35 percent of Americans owned smartphones, while in February 2012, 46 percent owned a more powerful phone. The conclusion to draw from this is that from a health care perspective, members need more and more timely information and many of plans’ members own the information gateway in their pocket. provide members the information that they want and when and where they want the information, all at a lowcost investment. And they can now do so by collecting a simple 10-digit number.

Options are Now Available Up to now, PBM mobile apps have been nothing more than what you could obtain over the internet through the PBM’s website. These dinosaurs of mobile up the general cost difference between brand and generic alternatives. But since few members drive to the pharmacy with a computer in the car, these simplistic tools did nothing to provide the information when the member needed it. New apps are now available through some leading-edge PBMs and a stand-alone application that can purchased and layered on to any willing PBM’s program (i.e. transparent program). There are many applications available and this article only highlights three of the many very good options. One that is really revolutionary is a program called Medvana. Medvana point-of-service to provide the lowest cost option compared to the distance the member is willing to go to get the prescription. Pricing under this the contracted rate for that drug at a particular pharmacy. In contrast,

The 2014 Mobile Environment The new best weapon to control prescription drug spend is sitting in your employees’ pocket or purse: their smartphone. Research reveals members want more savings and better service. In a 2010 survey of 15 health plans conducted by InfoAlchemy, members are confused by how health care is priced, eight of out ten members want mobile health care applications, member engagement through mobile is 400 percent higher than traditional internet applications and lastly, showing local options helps to reduce cost. According to new research from the Pew Research Center’s Internet &

the consumer can expect be charged. When the estimate is lower than the price the pharmacy actually charges the user, it causes confusion and a loss displayed is the price the pharmacy will charge and can push back on the pharmacy with authority if a higher price is presented to them. The program also provides quick access to alternative drugs that might cost less and yet are clinically effective. Users can quickly review the prices of other drugs in the therapeutic category so that the patient can request their doctor switch them to the lowest cost option. The value to plan sponsors, of course, is greater www.TheIHCC.com I HealthCare Consumerism Solutions™ I September/October 2013

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PHARMACY BENEFIT MANAGEMENT revenue from higher utilization compared to traditional plastic card discount programs, an innovative use of mobile and web applications to enable quick, free sharing of card with user’s friends and family and an ability to monetize each user in multiple ways in addition to drug discounts. For plan sponsors that are serious about improving compliance, a mobile app is invaluable in enabling feedback to better inform members and target compliance and adherence opportunities. Focused interventions

sponsors: No new ID cards at open enrollment or upon PBM transitions, of the interactive dialog between patient and physician. Patients can record progress, noting on any particular day how they are doing on a new or changed medication and indicate with slider bars if they are having any side effects. The results are recorded in the database and, at the patient’s

technology will allow plan sponsors to learn from each intervention and leverage patient engagement to better inform future interventions. Who was

how their patients are faring much earlier and more frequently than the scheduled checkup and does not rely on the patient’s recall so many days after incidents may have passed. The drug management screen tracks, via log-in to Citizens, a list of current medications, each of which can be opened

available on the same day in the month rather than making six trips a month for six different medications)? Having your member’s medicine cabinet at the

the number of doses that should have been taken by that date. The screen also provides a button to open up the managing of dosage alerts, if the patient would like to get timely reminders and optional logging of their adherence to the drug regimen.

real-time, and feedback is real-time, providing the ability to analyze what works for a particular population what doesn’t work for others immediately and making changes to the program instantaneously. For plan sponsors that can integrate the prescription drug data with the mobile application, the Another application available only through CitizensRx, a leading transparent PBM, is called 360 Health. With 360 Health, members can The home screen allows members to sign in and pull up their prescription drug card with all the pertinent information for the pharmacy. (Note to plan

Conclusions The last decade has been centered on getting the lowest cost drugs through transparent contracts and a push for generic availability. Now that we have these efforts done by many plan sponsors, the focus in the future will be to use the drugs that patients purchase more effectively. If you are a plan sponsor, talk to your PBM about what option they can provide you or contact many of the stand-alone options. And, oh, check out that ringing your smartphone.

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diabetes

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BY RUSSELL BENAROYA CO-FOUNDER AND CEO EVERYMOVE

REWARDS & INCENTIVES

Top 10 Reasons Why Your Corporate Health Incentives Program Will Fail

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ewards and incentives in health care is a hot topic today. After all, health rewards are a very powerful means for inducing desired behaviors, and many studies have reinforced the value of a healthy workforce on the top line and bottom line for corporations. It is no longer a question of why employers should implement rewards programs for their out how to do it right. If you’ve been to Las Vegas, then you know how those casinos make you feel when they give you a card that earns you free perks (ironically, more perks when you continue losing). The notion of being incentivized in a way

4.

reward, but it forces people to calculate in economic terms whether Instead of $100 in a gift card, substitute it with something that is

5.

gas. Spend money on your credit card, get points. One thing these all have in common is that the intended behavior is actually pretty easy (spend money, eat, gamble) but not necessarily good for you. The challenge with rewards programs in health care is that the desired behavior is actually harder to achieve (work out more, eat better, sleep more), and the incentives to change

incentives need to be implemented, but programs risk becoming a black hole of dollars wasted. Unfortunately, employers are leaning on some of the most basic reward techniques in the book, which often results in an employee taking action for the money and a missed opportunity to build a different kind of relationship with their most critical resource: their people. 7.

8.

3.

be critical. Your reward is not closely correlated with the action you want to incent. future reward vs. a smaller reward that we might get today. Meaning month. Most health rewards are too distant from the actual act of achievement that employees don’t assign the level of value that you think they should. Your rewards are too predictable. If I know exactly what I need to do to get a reward, then I will do the minimum required to achieve The concept of do this/get that rewards encourage the shortest distance to get the reward because people are more focused on the

Your rewards program actually encourages dishonesty. As the quarter draws to a close for many companies, employees will often rush to manually enter their health data to make sure that they to overestimate greatly their self-reported activity. Second, the only behavior change it drove was likely unintended. Smart rewards pro-

important.” Money is low on the list of reward value. Think about

2.

spouse). Your rewards don’t motivate. Daniel Pink, author of , asserts that motivation is the combination of mastery, autonomy and purpose. If you want to motivate desired behavior, is your rewards program triggering mastery, autonomy or purpose? Consider rewards creating rewards that employees will feel connected to and remember

6.

program because most are probably failing. Here are the top 10 reasons why: 1. Your rewards program doesn’t build loyalty. Frequent,

The effort to change the behavior is simply not worth the money you are spending. Dan Arielly, author of

9.

smartphones and devices) is available today to make that possible. Rewards are not sustained. According to Andrew Sykes, a well-respected wellness actuary, the reward must be delivered on a sustained basis to promote the behavior long term. Reward programs that give a 1x/year premium reduction or a 1x/year incentive for completing a form will not drive any sustained behavior change. Your rewards signal that employees are lazy. We have a skewed impression that employees are inherently lazy and need money to motivate. The reality is that the minute you don’t have a when the money is not aligned with motivation. Sure, for mechanical tasks without a lot of thought, money can work. For desired actions that require some creative, complex and cognitive skills, money crushes creativity. Healthy lifestyles can be achieved in many different ways but traditional rewards tend to narrow the possible actions. Compared to other reward programs in people’s lives, employer health rewards programs aren’t that fun. But they can be fun. Most administered rewards programs start with the rewards (e.g. the ability to amplify the success) and achievers aren’t

rewards are much more powerful. Now that you have achieved level www.TheIHCC.com I HealthCare Consumerism Solutions™ I September/October 2013

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THE 2014 GAME PLAN: Health Care Consumerism in the Post-PPACA World BY SHANDON FOWLER » DIRECTOR OF PRODUCT MANAGEMENT MARKETPLACES » BENEFITFOCUS

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s you read this, the benefits landscape is undergoing a tectonic shift. The depth and breadth of this shift is unprecedented, and in many ways still unknown. What is the full scope of what’s happening? What benefits strategies will prevail in the coming years? Can public and private marketplaces coexist? How do I comply and still provide the best employee experiences without breaking the bank? It may be too early to have all of the answers. But with a little bit of context and a focus on consumers, uncertainty can quickly become opportunity — to transform, to innovate and to keep building the narrative of a consumer-centered health care and benefits world.

How We Got Here Explanations for how and why a shift is happening now can be summed up in seven highly charged words: The Patient Protection and Affordable Care Act (PPACA).

These words contain two elements of the health care consumerism movement. On one side, there is the acknowledgment of the central role foremost, the PPACA aims to protect patients. On the other side, there is www.TheIHCC.com I HealthCare Consumerism Solutions™ I September/October 2013

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the promise that all of these new services and approaches are designed to make health care more affordable rather than result in the further ballooning of a sector that already accounts for It’s a tall order, to say the least. You might even say it’s impossible. But if you look beyond it is only one of many change agents advancing the cause of health care consumerism and the

answers to the questions of how to comply with the PPACA, but also evaluating strategies to be successful and competitive in the post-health reform world. In short, these changes will likely 1. 2. 3.

Recruiting and Retention Controlling Costs New Technology Fundamentally, these create the blueprint for life after the tectonic shift.

that closer meet their needs.

Communicate Value With online, consumer-friendly marketplaces and integration between payer, payroll tion that was once delivered in unattractive and impossibly dense spreadsheets can now be presented both dynamically and attractively. By revealing your employees’ total compensation (salary, health insurance, 401(k), voluntary bendynamically, employers can quickly multiply their own value in the eyes of their employees. They can also provide an easy measure of value as other alternatives in the public and private spheres continue to evolve.

consumption of those who have them, which further stabilizes health care costs. The blessing and curse of such plans is that they require a higher level of consumer engagement. Employees may pay less in premiums, but they’ll be on the hook to manage their own health consumption costs much more closely. Here again is where new technology can drive greater success for all. Employers can encourage higher adoption of HDHPs through smart presentation of plan options combined with on-demand decision support tools that that matter. This dynamic is the heart and soul of health care consumerism: individuals are empowered to make smarter choices, and

Change will happen. It may be

RECRUITING AND RETENTION

big. It will likely put the consumer

A recent poll by the website Glassdoor reveals that 76 percent of surveyed employees list medical coverage as the most important

first. And it will transform the

want medical coverage, they expect it. And not

more than doubled. With the tax advantages afforded to employers for employee coverage, it is possibly the only affordable option for most Americans even as it becomes less affordable for both employees and employers. Indeed, this imbalance of cost versus wages was a key motivator for the PPACA. We all know (and feel) the strains these imbalances put on the system. We also know How do you reconcile the market forces with the competitive demands?

Offer More Choice Thanks to new consumer-centric technologies and rapidly evolving strategies for using ever to get more for less. New exchanges and exchange platforms are being developed to help scale the costs associated with more choice as well, making it easier for large and small employers to offer more to their employees while controlling costs for both parties. In this shift is a unique hat trick: offer more choices, have lower

industry. CONTROLLING COSTS

Defined Contribution If HDHPs are the great hope for controlling

health care premiums have remained virtually Family Foundation. Some credit the ongoing implementation of key provisions of the PPACA as prompting more aggressive cost-control measures which are predicted to be more be partially true, more credit could be rightfully given to the rise in availability of consumerdriven health plans (CDHPs).

High-Deductible Health Plans: The Future (and Present) Reality of Coverage? We’re all familiar with the latest trend in health plan designs, with its higher deductibles and linked tax-advantaged health savings already been seen with HDHPs: They have reduced the premium amounts growth in premium expenditures. They have changed the health care

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could be the great hope for controlling premium costs. The added twist is that, through private exchanges, they can also empower employees to make their own decisions and manage their own

Here’s how it works: An employer eschews the traditional employees a set amount of money to spend on an expanded set of available plans, whether created broader private marketplace. online marketplace, reviewing plans with decision support tools and selecting coverage that most closely meets their needs and usage patterns while tracking their costs through shopping cart functionality. Early feedback from private marketplaces supports the notion that many


them (and their employer) on premium costs and potentially gives them more to spend on volunIf the employee’s choice is an HDHP, they may also be more inclined to manage their own usage patterns to keep their out-of-pocket costs lower, thereby reducing expense for all even further.

has been shown thus far offers great promise for employees and employers alike. Making real choice available to employees and adopting the right technologies to assist them in making those choices are strategies that could prove successful in controlling costs for employers.

THE TECHNOLOGY REVOLUTION Health care consumerism is not only powered by technological innovations, it is impossible to achieve without them. Necessity is the mother of invention, and the shift that we’re experiencing, while not easy, could be ultimately positive for everyone in the health care ecosystem.

Big Data The way we used to think about data is in still do. The difference is that what is immediately magnitude, and with it has expanded our ability to use it toward making better choices. Two areas in particular hold incredible enrollment experience, as well as ongoing health management: Claims Data Analytics – For employers, being able to rapidly, cumulatively and contextually analyze employees’ health care usage can greatly increase their ability to

for greater quality and lower prices, providing a win-win-win for payers, employers and employees.

and overall expenditures can drive them into plans that better suit their needs and budget with much more ease than in the past. Cost Transparency – Recent private and public efforts to catalog costs for standard procedures at hospitals across the nation may do for provider costs what the consumer Internet did for life insurance costs and standardized costs. The use of comparative costs is helping insurance carriers

Cloud-based,

software-as-a-service

likely most cost-effective way to address the

User Experience the user experience. It is how employees view how employers can effect change within their workforces. The user experience that may make the biggest impact is the one that is the simplest, most intuitive and most personalized. All of able effort using new tools and cloud-based technologies. – A recent study by

provide employers with several key features, from dynamic presentation of total compensation and smart decision support tools to easy management the criteria that companies should look for in any otherwise. Flexibility – There is much yet to be determined about the intended and unintended consequences of health care reform. The one certainty is that things will change in ways we haven’t yet predicted. As such, systems that more easily adapt to these chang-

substantial increase in understanding of which showing a side-by-side comparison with a cost calculator. Users went from picking the best plan less than one-in-four times without any cost calculators to picking the best plan two-in-three times with cost calculators. It’s still not perfect, but with hundreds of billions of dollars spent on health care premiums each year, even this minor shift has profound potential to save money and boost consumer satisfaction. Plus, as tools get better, the positive impacts could increase exponentially. – No matter what advances we can make in consumer experiences, cess. But with the help of simple and easily deployable decision support tools such as videos recommended plans, users can gain much more process. – The notion enrolling in them, will likely continue to become

needs while reducing employer and employee costs; for employees, having personal

Cloud Infrastructure

popularity. The good news is that consumers already know how to shop online. The key is to from the best practices of long-successful shopping websites such as Amazon and Travelocity. Convenience and Service – There is no replacement for human-to-human consultation. But assuming it’s cost-prohibitive to scale your should serve as your always-available customer

around-the-clock customer service portal.

administrators in a much better position to adhere to requirements as well as adopt new models for driving health care consumerism within their organizations. Scalability –The cornerstone of cloud infrastructure is that it expands as you expand, and it does so at much lower cost and with less effort than traditional enterprise software solutions. Flexibility is a key to exploring new strategies; scalability could be the key to survival. Usability – Just as health care consumerism focuses on the consumer experience, the consumerization of IT focuses on administrator tools as consumer tools, thereby making them far easier to understand and manage inside organizations.

What Happens Next? Lest we think that change will happen overnight, remember from science class that while tectonic plates move with a great deal of chaos, they don’t move a whole lot. An oftrepeated statement for most industries is that we overestimate how much will change in two years and we underestimate how much will change in

But these things are certain: change will happen. It may be big. It will likely put industry. As open enrollment continues on public that we have opened the door and are gazing out onto the new health care consumerism landscape. We may not shut the door on the old way immediately, but there is no looking back now. We are on the other side.

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HEALTHCARE CONSUMERISM SURVEYS, RESEARCH & STUDIES

Towers Watson Survey: Importance of Voluntary Benefits Expected to Surge As employers consider their health care and total rewards strategies in ing to a survey by global professional services company Towers Watson. ees’ security, health, wealth accumulation and address unique personal needs. The survey also found that the importance of VBS in companies’

EBRI: Satisfaction Levels Rise for CDHPs, Slip for Traditional Coverage Americans with health insurance appear to be warming up to so-called consumer-driven health plans, even as the traditionally greater popularity of traditional health plans is slipping, according to new research from the

of 2012, 8.2 million Americans in HSA-eligible health plans opened HSAs, a number that is expected to rise 73 percent to 14.2 million by the end of 2015.

Health Savings Accounts Reach $18.1 Billion In June According to the sixth semi-annual health savings accounts survey and resulting research report conducted by Devenir, HSAs have grown to an estimated $18.1 billion in assets representing over 9.1 million accounts at mid-year 2013. The survey data was collected in July 2013 and primarily consisted of the top 50 HSA providers in the health savings account market with all data being collected for the June 30, 2013 period.

Grand Rounds Introduces “Extended Family Benefit,� Reveals Results of Ideal Employee Benefits Survey Grand Rounds, the premier expert consultation service, has announced needs of familial responsibilities for today’s employee. The company

seven years of surveys, the EBRI/MGA 2012 Consumer Engagement likely than those in consumer-driven health plans (CDHPs) and high-

survey, conducted online in July by Harris Interactive on behalf of Grand Rounds among 2,026 U.S. adults, of which 928 are employed full or part time. The survey reveals surprising facts about today’s

the overall plan in all years of the survey. However, satisfaction levels trended up in most years of the survey among CDHP enrollees and trended down among traditional-plan enrollees.

and how far they will travel for expert medical opinions.

Fidelity Survey Finds Lack Of Understanding On How Health Savings Accounts Work As more American employers turn to high-deductible health plans to reign in escalating health care expenses, many are offering health savings accounts (HSA) in an effort to help curb the costs of health care for both employers and employees. But according to a new survey by Fidelity InvestmentsÂŽ of Americans who hold the responsibility

of respondents said they simply do not understand how an HSA works. Growth in HSA account openings continues at a brisk pace. At the end

NBGH: Large U.S. Employers Project a 7 Percent Increase in Health Care Benefit Costs in 2014 consecutive year employers have budgeted this amount, according to association of more than 365 large U.S. employers. The survey, one also found that some employers believe health insurance exchanges could be a viable option for certain populations. Additionally, more companies plan to offer workers a consumer-directed health plan as

tion may be.� So whatever else one says about Penn State’s administration, your life than to save it.� All these lessons have been lost on Penn State‌but they shouldn’t be lost on you. Learning them won’t guarantee you a successful program, but it will likely prevent you from implementing an unsuccessful one.

cooler� discussion and inspire action in a way that is engaging, fun and social. 10. Your rewards are prescriptive. Rewards that are tied to behaviors -

health that embeds into the fabric of how they live their life. Very few companies have cracked the code on health-related rewards and incentives, because most assume that money will drive the intended engagement will be dollars wasted. That said, we cannot ignore the power of rewards all around us today. What we can do is spend the time to make sure Progressive, innovative companies will crack this code in 2014.

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INTREPID

Liz Frayer, RHU 400 Interstate North Parkway, Suite 600, Atlanta, GA 30339 888-612-4644

“Our mission is to empower clients to www.intrepid7.com achieve a more sustainable health care policy; it’s about more than just giving the client a plan — it’s a process of educating the client and their employees to better understand the plan and ensure its success.  When we see the shift that occurs when employees have their ‘aha’ moment is when we feel we have done our job. —Liz Frayer, RHU, Intrepid

PROFESSIONAL DEVELOPMENT

Health Insurance 101: An Orientation is a new, flexible online course offered by AHIP. It is designed to teach health insurance basics to those new to health care or individuals who wish to review the fundamentals. The course is formatted in short modules; you learn at your own pace and on your own time, moving through the materials as you choose. Plus, AHIP will customize the course to fit your organization’s specific learning requirements.

AMERICA’S HEALTH INSURANCE PLANS 601 Pennsylvania Ave., NW South Building, Suite 500 Washington, D.C. 20004 Lindsey Miranda Canaley Tel: 800.509.4422 Fax: 202.861.6354 lmirandacanaley@ahip.org www.ahip.org/courses

HEALTH DECISION SUPPORT TOOLS

Castlight Health enables employers, their CASTLIGHT HEALTH 85 Market Street, Suite 300 employees, and health plans to take San Francisco, CA 94105 control of health care costs and improve care. Named #1 on The Wall Street 415.829.1400 Journal’s list of “The Top 50 Venturewww.castlighthealth.com Backed Companies” for 2011 and one of Dow Jones’ 50 Most Investment-Worthy Technology Start-Ups, Castlight Health helps the country’s self-insured employers and health plans empower consumers to shop for health care. Castlight Health is headquartered in San Francisco and backed by prominent investors including Allen & Company, Cleveland Clinic, Maverick Capital, Morgan Stanley Investment Management, Oak Investment Partners, Redmile Group, T. Rowe Price, U.S. Venture Partners, Venrock, Wellcome Trust and two unnamed mutual funds. Giovanni Colella, M.D. CEO and Co-Founder, Castlight Health HEALTHCARE DATA ANALYTICS

Med-Vision delivers health-plan risk MED-VISION LLC management and wellness strategies to Connie Gee, Vice President help employer groups achieve optimal connie.gee@med-vision.com employee health. Med-Vision’s healthcare 813-205-1577 data analysis tool, Med-View, guides www.med-vision.com employers in mitigating health risks. With www.med-view.net Med-Vision’s help, self-funded employers, healthcare facilities, municipalities, and school districts have reversed trends and decreased healthcare costs while enhancing care.

“You can’t change what you can’t measure. That’s why Med-Vision leverages Med-View’s analytics tool to investigate employee-health data and determine actionable solutions for employers. Med-Vision uses the data to implement innovative and customized plans for strategic wellness and disease management. Results include healthier employees, greater productivity, and drastically lower healthcare costs.” — Connie Gee, Vice President, Wellness Strategist & Health Data Analyst

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CORPORATE MEMBER PROFILES

WWW.THEIHCC.COM

HSA/HRA/FSA TECHNOLOGY: ADMINISTRATION & MANAGEMENT

MasterCard (NYSE: MA), is a global payments and technology company.

MASTERCARD WORLDWIDE 2000 Purchase St. Purchase, NY 10577-2509

It operates the world’s fastest payments processing network, connecting consumers, financial institutions, merchants, governments and businesses in more than 210 countries and territories. MasterCard’s products and solutions make everyday commerce activities—such as shopping, traveling, running a business and managing finances—easier, more secure and more efficient for everyone.

HEALTH ACCESS ALTERNATIVES

Carena provides 24/7, on-demand access to CARENA, INC. health care by phone, webcam, and house 1525 4th Avenue, Suite 300 call. Seattle-based Carena is committed to Seattle, WA 98101 delivering the best health care experience 800.572.2103 possible. Its technology-enabled care delivery www.CarenaMD.com model provides on-demand access to health James.Taylor@CarenaMD.com care 24/7, via phone, secure video, and house call. Carena provides health care solutions to patients through employers, health systems and through its consumer service, CareSimple.

“People are paying more out of pocket for care than ever—through higher co-pays and deductibles, reduced benefits, and in the rising costs of goods and services. Taken together, health care has become more expensive and less accessible. Our goal is to make health care more affordable by providing the right care at the right time for the right cost; to help people live healthier lives by removing the barriers to people taking control of their health care.” — Ralph C. Derrickson, President & CEO, Carena

TOTAL POPULATION HEALTH MANAGEMENT

Orriant helps businesses produce a better, more profitable product by creating a workforce that is healthier, more productive, and less expensive to insure.

ORRIANT

9980 South 300 West Ste. 100 Sandy, Utah 84070 801.574.2306 www.orriant.com suzanne.viehweg@orriant.com

Orriant’s proven strategy is to hold people accountable for improving their health as an integral part of your benefit strategy in a way that is fair and compassionate to all.

“Employers can fight back to control rising health care costs. Orriant’s strategies have helped major employers from almost every industry cut the cost of health care, improve the health and productivity of their workforce, and push hundreds of thousands of dollars to their bottom lines.” — Darrell Moon, Orriant CEO

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FSA/HRA/HSA/TRANSIT/COBRA: ADMINISTRATION & MANAGEMENT

September/October 2013 I HealthCare Consumerism Solutions™ I www.TheIHCC.com

eflexgroup (eflex) is a nationwide eflexgroup administrator of pre-tax benefits 2740 Ski Lane and COBRA. Committed to providing Madison, WI 53713 fast answers, fast claims, and web 877.933.3539 ext 300 self-service, we set the industry www.eflexgroup.com standards for service. With a efgsales@e exgroup.com customer focus and Lean Six Sigma methodology, we don’t talk about service, we prove it. See our metrics at e exgroup.com.

“eflexgroup’s customer service department should be a model for ALL customer service departments. The courtesy, professionalism and knowledge surpass ANY customer service department I’ve encountered! I feel the outstanding, exemplary customer service of eflexgroup is simply the best!” — Kimberly Adams, Southeast Energy Assistance [testimonial]


WWW.THEIHCC.COM

HSA/HRA/FSA TECHNOLOGY: ADMINISTRATION & MANAGEMENT

TSYS Healthcare® provides end-toTSYS HEALTHCARE end strategic payment solutions for 706.649.5080 consumer directed healthcare. We www.tsys.com/healthcare partner with benefits administrators, healthcare@tsys.com financial institutions, health plans, and software providers to navigate all aspects of HSAs, HRAs, FSAs, transportation accounts, cash reimbursements, and lines of credit. TSYS Healthcare cards offer participants the security they expect along with the ability to conveniently access funds from multiple accounts and manage their benefits payments with simplified single-card access. Clients and partners benefit from simplified processes, reduced paperwork and cost savings that can contribute to improved return on investment.

“We built the TSYS Healthcare platform to meet the market demand for reliable, configurable and intelligent solutions. Understanding the dynamic U.S. healthcare market, our customers rely on our option-driven system to prepare them for the future.” — Trey Jinks, Group Executive, TSYS Healthcare HSA / HRA / FSA ADMINISTRATION AND FINANCE

WageWorks helps employers

WAGEWORKS

support consumer directed

1100 Park Place, 4th Floor San Mateo, California 94403 United States of America

pre-tax benefit programs, including health care (FSA, HSA, HRA), wellness programs, commuting and

888-9905099 www.wageworks.com

child and elder care. Wage Works also offers retiree health care and COBRA Services. More than 100 of America’s Fortune 500 employers and millions of their employees use WageWorks.

CORPORATE MEMBER PROFILES

HSA ADMINISTRATION & FINANCE

At HSA Bank, we’ve been helping businesses HSA BANK optimize their health care spending for over 605 N. 8th Street Suite 320 15 years. We offer unmatched service and Sheboygan, Wisconsin 53081 expertise when it comes to health-based United States of America savings accounts. You can count on our 800.357.6246 dedicated business relations team for turnkey www.hsabank.com solutions and ongoing support that help your business and workforce save for a healthy future. To connect with your regional representative, call 866.357.5232 or visit hsabank.com.

“When implementing one of the first Medical Savings Account programs in the country, I had a belief that health care could be fixed with free-market principles. I still do. By adopting flexible and transparent practices that manifest core attributes of consumerism such as private exchanges, defined contributions, and self-funding; we will reform health care in our nation.” — Kirk Hoewisch, Co-Founder and President, HSA Bank, a division of Webster Bank, N.A. HSA / HRA / FSA ADMINISTRATION AND FINANCE

Evolution1 and our Partners serve more EVOLUTION1, INC. than 9 million consumers, making us 952.908.9056 the nation’s largest electronic payment, www.evolution1.com on-premise and cloud computing sales@evolution1.com healthcare solution that administers reimbursement accounts, including HSAs, HRAs, FSAs, VEBAs, Wellness and Transit Plans. It is the only solution that offers a single end-to-end user experience, provides innovative auto-substantiation technologies, and automates work ow for Partners, employers, and consumers. It does all this on one technology platform comprised of 1Cloud™, 1Direct™, 1Pay™, 1View™, 1Plan™, and 1Mobile™. Evolution1 and our Partners are dedicated to delivering value, reducing costs and simplifying the business of healthcare.

“The combination of our innovative products will further our leadership position in a rapidly changing healthcare market. Together with our Partners we are committed to reducing costs and simplifying the business of healthcare.” — Jeff Young Chairman and CEO, Evolution1

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CORPORATE MEMBER PROFILES

WWW.THEIHCC.COM

EMPLOYEE ENGAGEMENT TOOLS

Under the CIVA (CodeBaby Intelligent Virtual CODEBABY CIVA Assistant) brands of benefits and health 111 S. Tejon St. Suite 107 advisor, CodeBaby improves the healthcare Colorado Springs, CO 80903 consumer experience and optimizes online 877.334.3465 self-service on any web-based platform codebaby.com/online-solutions or device with absolutely no IT disruption. solutions@codebaby.com Benefits advisor offers guidance and selfservice options that help consumers and organizations alike to make better decisions about benefits selection. Health advisor engages new patient visitors on hospital or office websites or existing patients on wellness, prevention & disease management platforms.

“With the rapid changes in health care, our solutions provide organizations innovative ways to optimize their current platform while meeting the demand for an enhanced online experience. CIVA benefits and health advisor solutions are industryleading models that help consumers and organizations more efficiently navigate complex health benefit exchanges and patient portals. “ -Dennis McGuire, CEO BENEFIT ENROLLMENT AND ELIGIBILITY

Totem Solutions is a boutique benefits TOTEM SOLUTIONS consulting and administration firm offering highly 11330 Lakefield Drive specialized services and products. We serve Bldg 1, Ste 150 benefit management and HR professionals as an Duluth, GA 30097 extension of their team, allowing them to focus on key initiatives and core strengths. Our services 770-295-1600 include Employee Benefits Consulting, Benefits Toll-free 866-481-4917 Administration, Enrollment, & Communication, www.totemsolutions.com Health Care Reform Education, Enrollment, Reporting & Compliance, Leave and Disability Management Administration.

“We are hands-on benefits advisors for public and private sector companies throughout the country. Totem delivers employer-centric service that simplifies benefits administration and enrollment in order to facilitate employee understanding and ensure the best possible employee experience. Our goal is also our great passion and commitment: to offer organizations clear and accurate counsel accompanied by services and solutions that are easy to access, seamlessly implemented and custom fit, while providing a worry-free outsourcing solution.” — Debbie Schultz, President, CEO, Totem Solutions

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HEALTH DECISION SUPPORT AND COST-SAVING TOOLS

WiserTogether Inc., helps patients choose the right care at the time. It

WISER TOGETHER Praveen Mooganur

offers an innovative online treatment

202.276.3074

selection & shared decision support

www.wisertogether.com praveen.mooganur@wisertogether.com

platform that helps patients make evidence-based, cost effective

treatment decisions across musculoskeletal, cardiovascular, mental health, diabetes, pregnancy and respiratory illnesses saving payers money. Currently 1.5 million members have access to the platform through employers and health plans in the country. WiserTogether was founded in 2008 and is based in Washington, DC. — Praveen Mooganur, COO SUPPLEMENTAL HEALTH

Delta Dental leads the DELTA DENTAL industry in designing 1130 Sanctuary Pkwy, Suite 600 Alpharetta, GA 30009  innovative dental coverage programs that keep costs 770-641-5196 down and deliver quality care. Our diverse client list includes everyone from Fortune 100 companies to public agencies to individuals and families. Our customer’s satisfaction is based on our expansive dentist network, cost-saving mechanisms and superior customer service. We are part of the Delta Dental Plans Association that provides dental coverage to more than 56 million people in the US.


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HEALTHCARE ACCESS

HealthPerx is a health and wellness marketing company specializing in creative non-insurance benefit solutions that reduce absenteeism, increase productivity and decrease healthcare costs. Consultants: These benefits differentiate you from competitors.

HSA/HRA/FSA TECHNOLOGY: ADMINISTRATION & MANAGEMENT

HEALTHPERX Jeff Marks, CEO Jmarks@hperx.com Direct: 205 222-4062 Toll Free: 888 417-6187 www.hperx.com

Corporations: These will give you a far greater ROI than your wellness program while saving your employees thousands of dollars a year. Differentiator: Telemedicine Services: offering the entire family unlimited calls with no consult fees 24/7/365—anytime from anywhere Additional Health Benefits: offering significant savings for pharmacy, dental, vision, medical advocacy, travel assistance, telephonic counseling (EAP) and more Turnkey Program: billing, administration, fulfillment, call center, marketing HealthPerx benefits complement any and all existing benefit plans. — Je Marks, CEO PRESCRIPTION BENEFITS MANAGEMENT

Provider of Prescription Benefits Management services to self-funded employee groups, TPA’s, Brokers, and Consultants. Phoenix also offers a prescription savings card, RxAdvantage, for individuals and groups alike.

CORPORATE MEMBER PROFILES

PHOENIX BENEFITS MANAGEMENT

410 Peachtree Parkway, Suite 4225 Cumming, Georgia 30041 888.532.3299 main office 678.208.6257 marketing & pr 678.208.6252 sales 678.208.6255 fax

Phoenix Benefits Management is a prescription benefit manager sales@phoenixpbm.com providing traditional PBM services marketing@phoenixpbm.com to Self-Funded companies, TPA’s, www.phoenixpbm.com Brokers, and Consultants. We also provide comprehensive 340B services as well as our very own prescription savings card known as the Phoenix RxAdvantage Prescription Savings Card. Though our approach is scalable, our solutions are individualized. It’s been our experience and it is our firm belief that prescription benefit plans are not a one-size-fits-all proposition so we create a plan that is customized to fit the unique needs of each and every one of our clients.

DataPath, Inc., is one of nation’s largest providers of CDH solutions specializing in account-based administration systems.

DATAPATH, INC.

1601 WestPark Drive, Suite 9 Little Rock, AR 72204

501.296.9990 www.dpath.com Since 1984, service providers using DataPath systems have provided administrative solutions for over 1 million participants of FSA, HRA, HSA, and COBRA. DataPath is the only solutions provider to design and deliver a full Suite of systems for handling 125, 105, 132, COBRA, HSAs, Credit and Debit Cards all delivered to account holders through a single Internet portal, myRSC.com.

“With the significant changes in healthcare today, our software solutions allow users to create custom plans for clients that benefit both the employer and employee. Not only have we created a single platform for all systems with myRSC.com, with the integration of our mySourceCard Debit Card at Wal-Mart and other retailers, our clients are able to offer a hassle-free solution with 100% compliance.” ®

HSA/HRA/FSA TECHNOLOGY: ADMINISTRATION & MANAGEMENT

At Flex, we believe in making health FLEXIBLE BENEFIT SERVICE benefits more affordable for everyone. CORPORATION (FLEX) For 25 years, we have enabled thousands of clients to make their health care 10275 W. Higgins Road, Suite 500 dollars go further with our consumer Rosemont, IL 60018 driven plans and benefits administration +1-888-353-9178 services, including: fpsales@flexiblebenefit.com Flexible Spending Accounts (FSAs) www.flexiblebenefit.com Health Reimbursement Arrangements (HRAs) Health Savings Accounts (HSAs) Transit/Parking Reimbursement Accounts (TRAs) COBRA Administration And more! Flex continues to evolve and enhance our product portfolio with the addition of our scalable private insurance exchange, InsureXSolutions™. This latest innovation promotes a defined contribution funding model that allows employers to provide health and retiree benefits at a fixed cost, while offering employees with access to coverage options through our online insurance marketplace All Flex clients receive our personalized customer service and a wealth of resources that make our plans easy to use. Each plan we administer comes with online account access, simple transaction tools like debit cards, custom educational resources and unrivaled plan design expertise to keep you in compliance every step of the way. www.TheIHCC.com I HealthCare Consumerism Solutions™ I September/October 2013

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CORPORATE MEMBER PROFILES

WWW.THEIHCC.COM

HEALTH DECISION SUPPORT TOOLS

FSAstore.com is the only one-stop-shop FSASTORE.COM exclusively stocked with FSA eligible 244 5th Avenue, Suite J-257 products and services. At FSAstore.com, New York, NY 10001 consumers have access to more than 4,000 888.FSA.1450 (372-1450) FSA eligible products, a national database of FSA eligible services, and much-needed information through the FSA Learning Center. FSAstore accepts all FSA and major credit cards, offers 24/7 customer service, one-to-two-day turnaround for all orders, and free shipping on orders over $50.

“Each year consumers lose hundreds of millions of dollars simply because they do not deplete all of the pre-tax funds available to them in their FSA. But this year, more consumers than ever are realizing that they can use that money to buy many of the daily health products they need, and without a prescription. FSAstore.com strives to make it easy for participants to use and understand their FSAs.” — Jeremy Miller, Founder and President, FSAstore.com

BENEFIT ADMINISTRATION/PRIVATE EXCHANGES

Since 1988, CieloStar (formerly OutsourceOne) CIELOSTAR has helped brokers, employers and employees 530 U.S. Trust Building navigate the ever-changing world of benefits. 730 Second Avenue South Now, with the dawn of “Defined Contribution Minneapolis, MN 55402 Health Care” we are again on the leading edge. With a team of industry thought leaders, CieloStar 612.436.2706 makes navigating healthand benefits choices john.reynolds@cielostar.com easy for employers and employees by offering comprehensive benefits administration solutions with a high-touch, high technology model—most recently launching a proprietary private health insurance exchange.

“Fueled by the far-reaching impact and complexities of health care reform taking effect in 2013 and 2014, employers and employees increasingly find themselves in a ‘farmer’s market’ of benefits choices. Cielostar is uniquely positioned with enabling technology that helps purchasers and consumers make the best possible decisions and create a best-in-class benefits administration process. Our unique comprehensive approach to benefits offers everything from back room technology for enrollment, data, billing and call centers to complete solutions for COBRA, CDHP and health insurance exchanges.” — John Reynolds, CEO, Cielostar

TOTAL POPULATION HEALTH MANAGEMENT

Dr. tools Steven Level1Diagnostics uses new to M. Helschien LEVEL1DIAGNOSTICS Founderhealth and CC&BW evaluate employees’ cardiovascular 11722 Lightfall Court Heart disease is the number one killer Columbia, MD 21044 www.level1diagnostics.com in the U.S. and costs millions of dollars 410-707-5667 ◆ doc@level1diagnostics.com Dr. Steven Helschien, Founder in medical care and time lost from Sales: Penny Aleo, Executive VP work. Detection and prevention is the 443.878.3087 key to heart health. Level1Diagnostics pbaleo@gmail.com is an innovative program that, unlike conventional cardiology tests, provides new advanced technology testing and methods to detect and prevent the earliest signs of cardiovascular disease and encourage optimal health. “The biggest problem with traditional cardiology is that it is not preventive—there isn’t a testing program to evaluate people who don’t have any symptoms of heart disease, but may be at significant risk. Drugs and surgery are offered to patients instead of lifestyle change programs and supplements.” —Dr. Steven Helschien, Founder, Level1Diagnostics

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September/October 2013 I HealthCare Consumerism Solutions™ I www.TheIHCC.com

HEALTH DECISION SUPPORT TOOLS

Truven Health Analytics, formerly Healthcare at Thomson Reuters, delivers unbiased information, analytic tools, benchmarks, and services to the health care industry.

TRUVEN HEALTH ANALYTICS 6200 S Syracuse Way, Suite 300 Greenwood Village, CO 80111 734.913.3000

Hospitals, government agencies, employers, health plans, clinicians, and life sciences companies have relied on us for more than 30 years. We combine deep clinical, financial, and health care management expertise with innovative technology platforms and information assets to make health care better by collaborating with our customers to uncover and realize opportunities for improving quality, efficiency, and outcomes.


WWW.THEIHCC.COM

HEALTH INCENTIVES

MedEncentive offers a patented, web-based incentive system that’s been independently validated

MEDENCENTIVE

Cecily Hall Executive Vice President medencentive.com chall@medencentive.com

to control healthcare costs. Doctors and patients earn financial rewards for declaring adherence to best practices and healthy behaviors, provided they agree to be accountable to the other party for doing so. Easy to implement and

EMPLOYEE COMMUNICATION AND EDUCATION

ExperienceLab has created a breakthrough, CDHCENTRIC patented communication program that saves 507 S. 8th Ave. Bozeman, employers money by increasing adoption and Montana 59715 usage of consumer directed health (CDH) 617.224.6223 insurance plans among their employees. www.experiencelab.com CDHCentric, sold on a subscription basis, rtravis@experiencelab.com delivers regular, multi-media communications that are tailored based on seven unique attitudinal segments developed from proprietary research.

Traditional health plans protect employees from having to learn the basic skills for making cost-effective healthcare decisions. Our segmentation research, which is based on 20 years of behavioral marketing, found 7 unique personality types, and each makes healthcare decisions differently. The result is that, when employee messages are correctly tailored to their personalities, employees become health care consumers! — Roger Travis, President

embraced by users. SUPPLEMENTAL HEALTH

Transitions Optical, Inc. is the maker of Transitions® lenses, the #1-eyecare professional recommended photochromic lenses worldwide.

CORPORATE MEMBER PROFILES

TRANSITIONS OPTICAL 9251 Belcher Road Pinellas Park, FL 33782

800.533.2081 ext. 2262 www.healthysightworkingforyou.org

Transitions Healthy Sight Working for You® is an education initiative that helps HR professionals and benefits professionals communicate the value of the vision benefit to employees. More information and complimentary education tools are available at HealthySightWorkingForYou.org.

“Don’t overlook your employees’ healthy sight when thinking about your business goals. A vision benefit that includes an eye exam and sight-optimizing eyewear helps ensure that employees see their best, so they can do their best work, directly affecting your business.”

HEALTH ACCESS ALTERNATIVES

WeCare TLC is a medical risk management company that leverages onsite primary care clinics to provide solutions to rising healthcare costs while improving patient health and wellness.

WE CARE TLC

120 Crown Oak Centre Dr Longwood, FL 32750 800.941.0644 www.wecaretlc.com raegan.garber@wecaretlc.com

Our holistic approach to care empowers the clinic staff to act as patient advocates, which increases compliance and decreases unnecessary expensive services.

“Healthcare is now a right and employers are faced with the challenge of truly managing their healthcare costs. We have created a unique medical home clinic model that properly addresses quality of care and cost. This requires constant, aggressive, creative, and directed attention to accomplish but it can be done.” — Lynn Jennings, CEO, WeCare TLC

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RESOURCE GUIDE

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RADIO

Listen Live Every Friday from 11a.m.-12 p.m. EST Listen on your mobile device. Download on iTunes or Google Play

Join the conversation by tweeting or emailing your questions to us in advance, during or after each show: Twitter: @The_IHC Email: dfield@theihcc.com

ADVERTISING INDEX If you use the services of our solutions providers, please tell them you saw their ad in Solutions™.

ADVERTISING CONTACTS 404.671.9551 CEO/PUBLISHER

Doug Field

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MANAGING DIRECTOR

Brent Macy ACCOUNT MANAGER

Joni Lipson DIRECTOR OF CONFERENCE SPONSORSHIP/ CORPORATE MEMBERSHIP/REPRINTS

Rogers Beasley

AHIP ...................................................... 43

IHC Radio............................................... 50

Best Buy ........................Inside Back Cover

IHC Certification ..................................... 10

Buck Consultants ........................... HXS 12

Intrepid .................................................. 43

Carena ................................................... 44

Level1Diagnostics .................................. 48

Castlight Health ..................................... 43

MasterCard ............................................ 44

CCAForum ........................................ HXS 6

MedEncentive ........................................ 49

CieloStar..................................HXS 15, 48

MedVision.............................................. 43

CDHCentric ............................................ 49

Mercer Marketplace......................... HXS 2

CodeBaby............................................... 46

Orriant ................................................... 44

DataPath ................................................ 47

Phoenix Benefits Management................ 47

Delta Dental ........................................... 46

SelectAccount.......................................... 7

eFlex Group............................................ 44

Totem Solutions ..................................... 46

Evolution1................................HXS 15, 45

Transitions ............................................. 49

Flexible Benefit Service Corporation ....... 47

Truven Health Analytics ...........HXS 16, 48

FORUMWest ......................................11-13

TSYS Healthcare ..................5, HXS 15, 45

FSA Store ............................................... 48

UnitedHealthCare ..................... Back Cover

HealthPERX ............................................ 47

WageWorks .............................HXS 15, 45

HealthStat ......................Inside Front Cover

WeCare TLC ........................................... 49

HSA Bank ........................................38, 45

Wiser Together ................................36, 46

IHC Save the Date, FORUM West 2014.... 16 50

September/October 2013 I HealthCare Consumerism Solutions™ I www.TheIHCC.com


REWARD THEM WITH A HEALTHY DOSE OF FUN Staying healthy feels better with Best Buy® gift cards.

GIFT CARD INCENTIVES As powerful incentives, Best Buy gift cards energize your health and wellness program by motivating people with the things they want most, from TVs to tablets to smart phones. They’re hard to resist and easy to redeem online or in store. For instant e-mail delivery and easy personalization, choose our popular e-gift cards. Make your wellness program even more rewarding. Visit us online today.

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myHealthcare Cost Estimator

TO TAKE CARE OF BUSINESS WITH INNOVATIVE TOOLS FOR THE JOB myClaims Manager UnitedHealthcare Health4MeTM

UHC.TVSM

The right health information can take you a long way. At UnitedHealthcare, we offer innovative tools that put members in touch with their information. … myHealthcare Cost Estimator provides relevant information on care and estimated costs. … myClaims Manager helps you understand, track and pay your medical bills online. … UnitedHealthcare Health4Me is a mobile app that provides instant access to a family’s important health information. … UHC.TV presents exciting, engaging online content about good health and living well. Empower your employees. It’s good for their health – and the health of your business. For more information, visit welcometomyuhc.com or call 1-866-438-5651.

uhc.com All UnitedHealthcare members can access a cost estimator online tool at myuhc.com.  Depending on your specific benefit plan and the ZIP code that is entered, either the myHealthcare Cost Estimator or the Treatment Cost Estimator will be available. A mobile version of myHealthcare Cost Estimator is available in the Health4Me mobile app, and additional ZIP codes and procedures will be added soon. This tool is not intended to be a guarantee of your costs or benefits. Your actual costs and/or benefits may vary. When accessing the tool, please refer to the Terms and Conditions of Use and Why Your Costs May Vary sections for further information regarding cost estimates. Refer to your health plan coverage document for information regarding your specific benefits. ©2013 United HealthCare Services, Inc. Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by United HealthCare Services, Inc. or their affiliates. Health plan coverage provided by or through a UnitedHealthcare company. UHCEW506202-004


HealthCare Consumerism Solutions Sep/Oct 13