FORUM East april 12-13, atlanta
solutions iSSUE || March/april 2012
Innovative Health and Benefit Management
Putting the Employee in the Driver’s seat of Your Health Plan
Getting its Game On: hospital Uses Innovative Online Product to Promote employee Wellness A right to Know Turning Mountains of data into a Functioning strategy for self-funded employer Benefit Plans
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Healthcare is
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with a partner who identifies and manages health risks early. Healthstat’s unique predictive modeling system promotes early knowledge and treatment of health risks to prevent sudden complications from derailing your business. Our experience, advanced technology and scalability can help you create an environment of wellness that works. As the leading provider of on-site primary care, health risk intervention, chronic care management and occupational medicine, Healthstat is here to make healthcare better. Inspire a healthy change today, by visiting healthstatinc.com.
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Features
Inside 33 Getting It’s Game On Chilton Hospital, a non-profit community hospital with 1,450 employees and more than 630 physicians, has embraced a new approach to workplace wellness, tapping into gaming, social networking and a little friendly competition. Through a partnership with Keas, a San Francisco-based health and wellness company, the hospital, located in Pompton Plains, N.J., had 37 percent of its total population participate in its inaugural “100 Days to Health” Challenge. In 12 weeks the hospital staff shed 1,230 pounds and recorded 1,274 extra days of exercise. By Julie McGovern
37 Putting Employers in the Driver’s Seat
of Your Health Plan
40 Turning Mountains of Data into a Viable Strategy for Self-funded Employer Benefit Plans
Most businesses have piles, mounds and even mountains of data within the organization. The challenge is to gain access to and organize all this data in a way that transforms it into actionable management information. Thanks to innovations by Benefit Informatics, third party administrator Unified Group Services has grown into a regional leader in the TPA industry.
Like it or not, employers, by default, are now in the business of health. Health care costs are expected to rise by 8.5 percent this year, compared with an 8 percent increase in 2011, according to PricewaterhouseCooper’s Health Research Institute. As health care costs continue to skyrocket, Ceridian discovered two-thirds of its large-employer clients are fighting back by offering a high-deductible health plan with either an HSA, HRA or FSA, putting the consumer in the driver’s seat when it comes to health plans. By Ernie Harris
By Chris Metcalf
COMING UP NEXT: CDHC Solutions highlights the third annual IHC FORUM East in Atlanta, and pays a visit to OptumHealth’s Chief Executive Officer Dawn Owens, four years after the publication highlighted her. The issue also will featuring thought leaders touching on topics such as: Health Care Consumerism, Health Plans, HSAs, Population Health Management, Supplemental Insurance and much more. On the Cover: To help curb rising health care costs, forward-thinking employers are putting the employee in the driver’s seat when it comes to becoming a consumer of health benefits. www.TheIHCC.com I CDHC Solutions™ I March/April 2012
3
Inside
Departments
8 Editor and Publisher’s Letter
18 Health Care Consumerism
March May be Over, but the Madness is Just Beginning
Key Product Pricing and Design Issues in PPACA
11-15 CDHC Solutions FORUM East • • • • • •
Featured Speakers Benefits of Attending FORUM Professional Credits Available for CRCs and HR Professionals Agenda for FORUM East Sponsors/Exhibitors Looking Ahead to FORUM West
By Ronald E. Bachman
19 HSA/FSA/HRA Administration & Finance Educate Employees on Three Ways to Manage HSAs to Increase Engagement By Duncan Van Dusen
16-17 People on the Move 16-17 Briefs/Innovations
• UMB Announces 36 Percent Increase in HSA Balances • Consumers Saved Nearly $1.3 Billion on Prescription Drugs with DRX DrugCompare Tools in 2001 • Humana Extends Partnership With Video Game Leader UBISOFT by Offering Rewards for Healthy Gaming • Blue Cross and Blue Shield of Kansas City Launches Blue365 Website
43 Ask the Broker
21 Exchanges Can CO-OPs Go Toe-to-toe With Established Health Insurers?
23 Supplemental Health & Voluntary Benefits Critical Illness Insurance: A Voluntary Benefit That Bridges Financial Safety Net Gaps
Getting Employees Educated, Engaged in HSA Enrollment
By Steve Davis
By Alex Tolbert
By Jodi Anatole
44 Stats & Data
Employers Struggling With Uncertainties of Health Reform Law
24-25 Health Rewards & Incentives
47 Who’s Who Profiles
Healthy Rewards: Incentive Trends to Build a Successful Employee Wellness Program
50 Resource Guide/Ad Index
By Jaimee D. Chism
27 Population Health Management
Event
Digital Health Coaching for Population Health Management
The 2012 IHC FORUM West
www.theihccforum.com
Our second annual FORUM West has expanded and will be in Las Vegas. Don’t gamble on your health and benefit management. An employer can lose money on a badly managed health plan quicker than a casino slot machine. Join us in the desert to LEARN, CONNECT and SHARE with the top thought leaders in health care and key leaders in the health care consumerism movement at the Red Rock Resort on Sept. 6-7. FORUM West also will feature an expanded pre-conference agenda, beginning Sept. 5. For more information visit www. theihccforum.com. Have you become a member of The Institute yet? Have something to share? Become a member and post a blog on www. theihcc.com today.
By Dr. Shawn T. Mason
29 Decision Support Tools/ Transparency The Right to Know By John Young
31 H ealth Plan Communication Ten Steps for Beating Benefits Bewilderment By Justyn Harkin
P r i n t a n d O n li n e K e y Connect with CDHC experts and community members online at www.CDHCSolutionsMag.com by looking for the following symbols at the end of each article: blog
MEMBER
BLOG
WHO’S WHO PROFILE
BROKER/ADVISOR/ CONSULTANT
EMPLOYEE COMMUNICATION & EDUCATION
HEALTH PLANS
HSA/HRA/FSA ADMIN & FINANCE
S TOTAL POPULATION HEALTH/WELLNESS
4
PHARMACY BENEFITS MGMT
March/April 2012 I CDHC Solutions™ I www.cdhcsolutionsmag.com
POLICY & LEGIS PERSPECTIVE
SUPPLEMENTAL BENEFITS MGMT
TOOLS AND TECHNOLOGY
MEDICAL TOURISM
fisglobal.com
We’re forging new connections among patients, payers, providers and financial institutions. The increasingly consumer-directed U.S. healthcare system is marked by rising costs, regulatory changes and chronic inefficiencies that plague all parties involved. FIS™ Healthcare Solutions is helping to transform the healthcare industry by facilitating the flow of information and funds among patients, payers, providers and financial institutions.
Thanks to deep industry expertise, proven technology and extensive relationships across the financial and healthcare payments spectrum, FIS can deliver a complete healthcare solution suite that seamlessly connects thousands of individuals and organizations. As a result, healthcare providers get a single interface for streamlining HIPAA and financial transactions. Payers gain a consumerdirected healthcare (CDH) administration platform to improve relationships with members and employee groups. Patients have a more seamless healthcare experience – from saving and paying for care, to making treatment decisions. And financial institutions are well positioned to strengthen and grow their healthcare customer relationships. To learn more about our complete healthcare solution suite, visit www.fisglobal.com/healthcare.
Visit Booth #1 in the exhibit hall to learn more about our healthcare payment solutions.
FIN A N C I AL S OL UTIONS
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PAYMENT SOLUTIONS HEALTHCARE
© 2012 FIS and/or its subsidiaries. All rights reserved.
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BUSINESS CONSULT ING
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WHaT’s HaPPEnInG aT THE InsTITUTE
exclusively Online | Visit www.theihcc.com for instant access to constantly evolving communities. Here are just a few of the latest lessons and perspectives by industry insiders:
the ihc brings you the collective Voice on health care consumerism via a social networking site that uses a 24/7 virtual, portable format.
How Social Networking Can Boost Your Workout
By Laurie Tarkan
“A growing number of companies are banking on social media to boost the participation rates in their employee wellness programs. As it is, about 90 percent of companies (with more than 5,000 employees) use the web to deliver their wellness programs.”
Health Decision Support Tools HDMs Enables Health Plans to Demonstrate Improved Quality and Outcomes at Centers of Excellence
“When our health plan clients told us that they needed to more effectively communicate the incredible power of their Centers of Excellence to the marketplace, we were eager to work with them to develop a targeted solution,” said Rick Abbott, Vice President of Health Plan Services for HDMS.
HSA/HRA/FSA Admin & Finance Health Care Reform Impacts CDHPs At Many Points
“Health care reform’s impact on CDHPs has so far encouraged more employers to consider accountbased plans to lessen consumers’ insulation from actual health care costs,” explained William Giaconia, insurance provider Cigna’s vice president for consumerism products.
Medical Travel
By John Goodman, president, National Center for Policy Analysis
An Online Market For Medical Care
“The patient’s identity is kept confidential until a transaction is consummated. MediBid-affiliated physicians and other medical providers respond by submitting competitive bids for the requested care.”
Blogs | Sharing thought leadership with 65,000+ members. It’s our mission to feature blogs with helpful advice, best practices and solutions that really work. Connect with experts who take pride in learning and staying motivated: A Health and Fitness Instructor Allows You To Become Self Inspired!
Four Shifts In Employee Benefits That All Communicators Must Understand
By Wellness Coach
By Jennifer Benz, Benz Communications Founder
“A Health Instructor will help you control the significant aspects that control your lifestyle, such as fat or loss, nutritional workouts, training, pressure, cigarette smoking, booze and many other aspects.” Activating Consumers with Financial Control: Lessons from Health Savings Accounts By Dr. Wendy D. Lynch, Co-director Center for Consumer Choice in Health Care, Altarum Institute
“No longer an oddity, millions of families have accounts funded by tens of thousands of employers.” 6
March/April 2012 I CDHC Solutions™ I www.TheIHCC.com
“There are four major shifts happening in benefits right now that all corporate communicators need to know about...”
social networking | Follow us on Twitter: Twitter.com/the_IHC Join the discussion in LinkedIn Group: HealthCare Consumerism FORUM by the IHC Join our Facebook Group: The Institute for HealthCare Consumerism
What’s Missing From Your Benefits Program? Allstate Benefits. The partner who’ll keep employees covered in today’s changing benefits environment. And, with the #1 critical illness product in America, it’s no wonder we’re one of the fastest-growing benefits providers in the country. Call an Allstate Benefits Representative today and let the Good Hands go to work for you.
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L e tt e r
Editor & Publisher
www.theihcc.com VOLUME 8 NO. 2 March/April 2012
March May be Over, but the Madness is Just Beginning
Published by FieldMedia LLC 292 South Main Street, Suite 400 Alpharetta, GA 30009 Tel: 404.671.9551 • Fax: 770.663.4409 ceo/ Publisher/Editor-In-Chief
Doug Field 404.671.9551 ext. 101 · dfield@ fieldmedia.com Associate Publisher
Brent Macy 404.671.9551 ext. 103 · bmacy@fieldmedia.com Editorial Director
March is known for its madness when it comes to college basketball and all the bracketbusting upsets that occur during the three weeks of the NCAA tournament; however, the madness is not just limited to that month. For three days in Washington D.C., in a classic Roman architecturally designed building, usually ignored by the public and tourists sightseeing in our nation’s capital, the Supreme Court building was in the spotlight. Generally quiet and reserved, the four-story structure, located at One First Street, took on a media spectacle usually reserved for a region final or the Final Four in New Orleans. However, there were no 3-pointers made and Rick Pitino and John Calapari were not around, but the atmosphere was just as electric as the Louisiana Superdome, as nine Supreme Court justices listened to opening arguments and will ultimately decide the fate of the PPACA, ACA, ObamaCare or whatever you want to call the health reform law. For 90 minutes on March 26, two hours on March 27 and concluding with another 90-minute session of arguments on March 28, Supreme Court justices Sonia Sotomayor, Stephen Beyer, Samuel Alito, Elena Kagan, Clarence Thomas, Antonin Scalia, Chief Justice John Roberts, Anthony Kennedy and Ruth Bader Ginsburg listened to arguments in court case number 11-398, Department of Health and Human Services vs. Florida. The justices were focusing on the Anti-injunction Act on the first day, minimum coverage provision on the second day, and concluded with severability on the last day of arguments. In all, it was five hours of arguments heard by nine people who will ultimately determine how you and I will purchase and receive health care. No case has been given as much attention by the justices in more than 50 years. The economic and political ramifications of a decision could have repercussions for years to come. Health care accounts for 20 percent of the nation’s economy, and the health reform law is arguably the defining moment of President Obama’s administration. It is a rare and historic case, one that will impact most Americans and potentially a presidential race. So March, and the arguments on the health reform law may be over, but the madness is just beginning. Got an opinion on the three days in March? Become a member of The Institute for HealthCare Consumerism (www.theihcc.com) and share your opinion with fellow members of The Institute. If you were not able to come to IHC FORUM East in Atlanta, you still have time to register for our IHC FORUM West in Las Vegas, coming Sept. 6-7 at the Red Rock Resort. Come to LEARN, CONNECT and SHARE.
Todd Callahan 404.671.9551 ext. 105 · tcallahan@fieldmedia.com Senior Editor
Mavian Arocha-Rowe 404.671.9551 ext. 104 · marocha@fieldmedia.com Associate Editor/Social Media Manager
Jonathan Field jfield@fieldmedia.com Associate Editor
Matt Macy 404.671.9551 • mmacy@fieldmedia.com Sales Associates National Account Manager
Brent Macy 404.671.9551 ext. 103 · bmacy@fieldmedia.com Vice President of Business Development
Susan Yakots 404.671.9551 ext. 102 · subscriberservice@fieldmedia.com Business development Associates
David Cerri 404.671.9551 ext. 106 · dcerri@fieldmedia.com Account Manager
Joni Lipson 800.546.3750 · jlipson@fieldmedia.com Rogers Beasley 404.671.9551 · rbeasley@fieldmedia.com Art Director
Kellie Frissell 404.671.9551 ext. 107 · kfrissell@fieldmedia.com Chairman of CDHC Solutions Editorial 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, Mercer Health & Benefits; Marc Kutter, PilotHSA; Sanders McConnell, My HSA Rewards; Roy Ramthun, HSA Consulting Services LLC; John Young, CIGNA Webmaster
Kevin Carnegie kcarnegie@fieldmedia.com Tom Becher webmaster@fieldmedia.com Copy Writer + PR
Lana Perry 770.298.1959 · lperry@fieldmedia.com Reprints
Susan Yakots 404.671.9551 ext. 102 · subscriberservice@fieldmedia.com Business Manager
Karen Raudabaugh 404.671.9551 ext. 108 · kraudabaugh@fieldmedia.com CDHC Solutions ™ Volume 8 Issue 2 Copyright ©2012 by FieldMedia LLC. All rights reserved.
Sincerely,
CDHC Solutions ™ is a trademark of FieldMedia LLC. CDHC Solutions ™ is published eight times yearly by FieldMedia LLC., 292 South Main Street, Suite 400, Alpharetta, GA 30009. Periodical postage paid at Alpharetta, GA and additional mailing offices. TO SUBSCRIBE: Make checks and money orders payable to CDHC Solutions ™ magazine 292 S. Main Street, Suite 400, Alpharetta, GA 30009 or visit www. cdhcsolutionsmag.com. Non-qualified persons may subscribe 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 or subscriberservice@ fieldmedia.com for name/address changes. PRINTED IN THE U.S.A.
Todd Callahan Editorial Director tcallahan@fieldmedia.com 8
March/April 2012 I CDHC Solutions™ I www.TheIHCC.com
Doug Field CEO/Publisher dfield@fieldmedia.com
CDHC Solutions ™ is designed to provide both accurate and authoritative information with regard to the understanding that the publisher is not engaged in rendering legal, financial or other professional service. If 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 tcallahan@fieldmedia.com. Permission to reuse content should be sent to, tcallahan@fieldmedia.com.
How Much Do You Know About Wellness Programs? It’s been proven over and over again that healthy employees tend to be happier and more productive. That’s why wellness programs have become so prevalent. And, that’s why we developed two convenient online courses providing you with everything you need to know to create and maintain a culture of wealth in your organization.
Wellness, Part One: Wellness, Prevention, and Value-Based Care This course takes a practical approach to worksite wellness, guiding you through the stages of program development.
Wellness, Part Two: Combating Chronic Diseases through Workplace Wellness Programs This course offers an in-depth look at chronic diseases along with the unhealthy behaviors that often precipitate illness, positioning the workplace as a venue for combating disease.
For details, visit www.ahip.org/courses or call the Support Team at 800.509.4422. Learn. Achieve. Succeed. www.ahip.org/courses 800.509.4422 Support@AHIPInsuranceEducation.org Content and Design AHIP—All Rights Reserved: © AHIP 2012
A winning combination Our unique experience in both the healthcare and payment services industries means unmatched expertise and reliability. Known for our elite levels of customer service and a long-term commitment to the industry, TSYS Healthcare速 is focused on lasting relationships and people-centered payments . SM
Integrity | Relationships | Excellence | Innovation | Growth
Learn more at www.tsyshealthcare.com or call us at +1.706.649.5080
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息 2012 Total System Services, Inc.速 All rights reserved worldwide. TSYS速 is a federally registered service mark of Total System Services, Inc.
APRIL 12-13, 2012
Formerly CDHC Solutions FORUM
thE JOURnEY tO hEalthCaRE COnsUMERisM FEATURED SPEAKERS: Ron Bachman
Roy Ramthun
FSA, MAAA, Sr. Fellow, Center for Health Transformation; President, Healthcare Visions; Chairman of The Institute For HealthCare Consumerism Editorial Advisory Board
An expert on health savings accounts and consumer directed healthcare issues
Wendy Lynch
Trudy Nacin
Founder, Lynch Consulting Senior Scientist, Health as Human Capital Foundation
Division Chief, State Health Benefit Plan Georgia Department of Community Health
John Young
John Hickman
Senior Vice President, Consumerism CIGNA HealthCare
Partner Alston+Bird LLP
D.W. Edington, Ph.D.
Karen Hunt
Professor, Division of Kinesiology, Director Health Management Research Center, University of Michigan
Vice President of Sales and Marketing Paragon
Elizabeth Dixon
Kristine Hackbarth-Horn
Wellness Director Chick-fil-A
Chief Operating Officer of People Goodwill of North Central Wisconsin
WHO SHOULD ATTEND? CEOs/Presidents/CFOs HR and Benefits Executives Health Plan Administrators Corporate Wellness and Medical Directors
Benefit Brokers Third Party Administrators Benefit Consultants Bankers
WWW.thEihCCFORUM.COM
Formerly CDHC Solutions FORUM
www.theihccFORUM.com
Benefits of Attending
What You’ll Learn
In today’s challenging economic and legislative climate, companies everywhere are opting to put healthcare decision making into the hands of their employee consumers. Now in our third year, the IHC FORUM East (formerly CDHC Solutions FORUM) is the only conference that offers your business proven, implementable healthcare consumerism solutions — all at a fraction of the cost of other conferences.
Through five cutting-edge general sessions, 24 workshops, intimate roundtable discussions and unlimited networking opportunities, you’ll:
No matter where you are on your journey, the FORUM will equip you with the money-saving strategies you need to successfully navigate the healthcare consumerism landscape and avoid the bumps along the road. This year’s FORUM is a must-attend event for C-level executives, HR professionals, benefit managers, corporate wellness directors, healthcare brokers and regional health plan providers interested in lowering healthcare costs, complying with the Patient Protection and Affordable Care Act (PPACA) and engaging their employees in consumerdirected health plans. In just a day and a half, you’ll get expert insights from the industry’s foremost thought leaders and policy makers, and real-life examples from peers on how to:
LEARN from forward-thinking industry experts, policymakers and peers on the cusp of the latest healthcare consumerism trends. CONNECT with health and benefits professionals from across the board, including employers, brokers and health plan providers who have successfully implemented consumerdirected plans. SHARE leading practices, valuable insights and real, actionable solutions.
This Year’s Highlights: • Industry thought leaders including, Ron Bachman, Dr. Wendy Lynch, Roy Ramthun, and John Hickman • The latest on supplemental health benefits, pharmacy benefit management and HSA/HRA/FSA administration • Expert advice on population wellness strategies and employee incentives
• Cut costs now • Comply with the PPACA to avoid hefty fines • Build the best possible plan for your company • Avoid common pitfalls of transitioning to healthcare consumerism • Turn disengaged employees into involved, well-educated healthcare consumers It is our pleasure to host this conference series. We thank you for your participation, and we continue to pledge unmatched dedication to integrity and industry knowledge through our FORUMs, publications and online communities. We look forward to seeing you there.
Doug Field CEO of The Institute for HealthCare Consumerism
Ron Bachman, FSA, MAAA Chairman of The Institute for HealthCare Consumerism Editorial Advisory Board
FORUM East 2012
What is Healthcare Consumerism? Healthcare consumerism is about transforming an employer’s health benefit plan into putting economic purchasing power — and decision making — into the hands of participants. This is best achieved by supplying employees with the decision making information and support tools they need, along with financial incentives, rewards and other benefits that encourage personal involvement in altering health and healthcare purchasing behaviors.
IF YOU MISSED US IN ATLANTA JOIN US IN LAS VEGAS: SEPT 6-7, 2012 WWW.THEIHCCFORUM.COM
the Only Event 100% Dedicated to Innovative Health and Benefit Management Solutions 2012 FORUM East Agenda at a Glance Day 1: Thursday, April 12, 2012 7:30 a.m.
Registration Open
8:00 a.m. – 9:00 a.m.
Networking Breakfast / Exhibits Open
9:00 a.m. – 9:15 a.m.
Welcome Doug Field, CEO, The Institute for HealthCare Consumerism
9:15 a.m. – 10:30 a.m. Opening General Session: “The Journey to HealthCare Consumerism” 10:30 a.m. – 11:00 a.m. Networking Break / Exhibits Open 11:00 a.m. – 12:00 p.m. Track #1 Workshops – Select One 101 – Employee Engagement Strategies: Unlocking the Potential of your CDHC Program 102 – Best Practices to Increase Employee Participation in your HDHP/HSA Plan 103 – The Changing Role of Supplemental Health Benefits and Healthcare Consumerism Initiatives 104 – Making the Health Commitment 105 – Comprehensive Healthcare Redesign: 25 Keys to Redesign U.S. Health Care 106 – Providing Decision Support Tools to Engage Your Employee Population to Become Better Consumers of Healthcare 107 – Results Based Healthcare Benefits: Managing Costs Through Personal Responsibility 108 – Simplifying and Administering Consumer-directed Health Plans
12:00 p.m. – 1:00 p.m. Table Topic Lunch 12:00 p.m. – 1:30 p.m. Lunch in Main Ballroom / Table Topic Lunch / Exhibits Open 1:30 p.m. – 2:30 p.m.
Afternoon General Session: “Health Provider Panel”
2:30 p.m. – 2:45 p.m.
Networking Break / Exhibits Open
2:45 p.m. – 3:45 p.m.
Track #2 Workshops – Select One 201 – Aligning Leadership Development and Health Improvement to Maximize Investment in Employee Total Well-being 202 – Controlling Costs and Expanding Choice within Defined Contribution Healthcare 203 – Successful Engagement Strategies Utilizing Incentives to Promote Compliance with Wellness and Care Management Programs 204 – Engaging Employees in Smart Healthcare Purchasing Decisions 205 – Taking the Fear Out of High-deductible Health Plans 206 – Show Me the Money: Improving Health Status with Consumer Directed Accounts 207 – Health Investment Strategies: The Convergence of Technology, Health Investment and Consumer Choice 208 – Value-Based Insurance Design and Chiropractic Care: An Unlikely Partnership?
3:45 p.m. – 4:15 p.m.
Networking Break / Exhibits Open
4:15 p.m. – 5:15 p.m.
Closing General Session “Population Health Management Multi Stakeholder Panel”
5:15 p.m. – 7:15 p.m.
Opening Night Reception / Exhibits Open / Prize Drawing
7:30 p.m. – 9:30 p.m.
League of Leaders Dinner and Networking Event (Invitation Only)
continued on the next page
2012 FORUM East Agenda Continued Day 2: Friday, April 13, 2012 7:30 a.m. Registration Open 8:00 a.m. – 9:00 a.m. Networking Breakfast / Exhibits Open 9:00 a.m. – 10:00 a.m. Opening General Session: “HealthCare Reform: A Potential Pothole on the Journey to HealthCare Consumerism”
10:00 a.m. – 10:30 a.m. Networking Break / Exhibits Open 10:30 a.m. – 11:30 a.m. Track #3 Workshops – Select One 301 – Health Care Reform, Medicare and What Each Means to Retirement Plans and an Employer’s Bottom Line 302 – COBRA in the Age of Health Reformal 303 – Ten Ways to Make Your Benefits Communication A LOT More Engaging. Wait – Special Bonus for IHC Participants: 11 Ways! 304 – Picking a Self-funded Claims Administrator 305 – Broker Track: Defined Contribution and Private Exchanges: The Revolution of Small Group Benefits 306 – CDHP + Price Transparency = Bigger Savings and ROI 307 – The Coming Impact of Consumer Designed Health Tech 308 – Updating your CDHP, Health Reform and Cost Strategies – A Total Replacement CDHP Case Study
11:30 a.m. – 12:30 p.m. Grand Finale Networking Break / Exhibits Open / Exhibitor Prize Drawings 12:30 p.m. – 1:30 p.m. Closing General Session: “Employer Panel: What HealthCare Consumerism Means to You” 1:30 p.m. End
P HR • G ®
®
R
PHR
•S
PH
Professional Credits Available for CRCs and HR Professionals
®
For the latest updates and to register, visit www.theihccforum.com or call 404.671.9551
Renaissance Atlanta Waverly Hotel Two Galleria Parkway Atlanta, GA 30339 (770) 989-5095 Discount room rate for attendees: $149.00. Discounted room rates are available until 5 p.m. on Wednesday, March 21, 2012. After that, the hotel’s prevailing rates apply. Register online, or call the Renaissance Waverly Hotel Reservations at (800) 228-9290, and mention you are attending the IHC FORUM East.
Register for the IHC FORUM at www.theihccforum.com. Group rates are available. Receive a 50% discount when you sign up two or more attendees.
ut
HR
Hotel Info
e
®
The 2012 FORUM East General Session and Workshops have been approved for 8.25 recertification credit hours toward PHR, SPHR and GPHR recertification through the HR Certification Institute. For more Ce tit rt i fi c a t ion I n s information about certification or recertification, please visit the HR Certification Institute homepage at hrci.org. The use of this seal is not an endorsement by the HR Certification Institute of the quality of the program. It means that this program has met the HR Certification Institute’s criteria to be pre-approved for recertification credit.
Registration Rates FOR FORUM WEST - SEPT 6-7, 2012 Early Bird Standard
Attendee Type Employer: Government & Non-Profit Employer: Private Sector TPAs, Benefit Brokers, Consultants Solution Providers
Rates $295.00 $395.00 $395.00 $895.00
Attendee Pricing Includes: • • • • •
Three innovative workshops of your choice Five general sessions with top industry leaders Continental breakfast and boxed lunch Opening night reception Conference workbook
$495.00 $595.00 $595.00 $1,095.00
$695.00 $895.00 $895.00 $1,295.00
Receive a 50% discount on each person when you sign up two or more attendees. Discount will automatically be applied during checkout.
Silver Sponsors & Exhibitors
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Group Rate Discount Available
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IF YOU MISSED US IN ATLANTA JOIN US IN LAS VEGAS SEPT 6-7, 2012
Briefs
People on the move
People on the Move MagnaCare, a health plan management company, announces the appointment of Tom Considine, former commissioner of the New Jersey Department of Banking and Insurance (DOBI), as chief operating officer. Considine will draw upon his exemplary track record and wide-ranging experience in the public and private sectors to implement key business strategies and advance MagnaCare as the leader in delivering self-insurance solutions to employers. As Commissioner, Considine brought a seismic cultural change to the DOBI, promoting growth, without sacrificing consumer protections. Additionally, he brought private sector metrics and performance management to state government. Their effectiveness resulted in the repeal or scale-back of 21
CDHC Innovations UMB Announces 36 Percent Increase in HSA Balances UMB Healthcare Services, a division of UMB Financial Corporation, announced account balances for its health savings accounts (HSA)s grew 36.1 percent surpassing $400 million dollars following 2011 open enrollment. The number of HSAs stood at nearly 220,000 at year-end. UMB Healthcare Services also saw a 37.9 percent growth in its debit cards associated with flexible spending account (FSA)s, health reimbursement arrangements (HRA)s and HSAs. Total accounts reached more than 2.4 million accounts at year-end. The company attributes this growth to UMB Healthcare Services’ continued focus on individual client service and ongoing product innovation. “We are excited to see the continued adoption and acceptance of consumer-directed health care plans by individuals looking to better manage current health care costs while saving for the future,” said Dennis Triplett, CEO of UMB Healthcare Services. “Advantageous for the employee and the employer, consumer-directed health care empowers individuals to take personal responsibility for their health and expenses, and enables employers to better reign in rising health care costs.” Triplett also added the important role employers continue to play in the growing adoption of these plans by educating and taking the time to communicate to employees on the benefits of participating in a highdeductible health plan (HDHP) partnered with an HSA.
Consumers Saved Nearly $1.3 Billion on Prescription Drugs with DRX DrugCompare Tools in 2011 DRX, a leading provider of health care comparison tools, technology and data, released information showing the substantial savings offered by the company’s DrugCompare suite of online prescription drug comparison tools. An analysis of user activity in 2011 showed the DRX tool helped consumers save an estimated $1.3 billion—a $300 million increase from 2010. Based on conversion rates, this savings were realized from a total potential savings of $11.8 billion, had all users acted on the information provided by DrugCompare. The cholesterol-lowering drug Lipitor was the top drug searched (> 587,200 searches), while the top drug by projected annual savings was the proton pump inhibitor (PPI) Carafate (estimated savings of $72.1 million). Currently, DrugCompare covers 100 therapeutic classes, or nearly 85 percent of the top 200 pharmaceutical drugs sold in the United States. “DrugCompare is the most well recognized therapeutic alternative database in the market,” said Toby Rogers, COO of DRX. “This tool helps 16
March/April 2012 I CDHC Solutions™ I www.TheIHCC.com
burdensome regulations, as well as the reduction of new product review and approval time by up to 58 percent Consumer Health Technologies Inc. (CHT), the health care software and services company providing consumer engagement and group administration solutions for health care payers and third party administrators (TPA), has added an experienced brand building executive to its team, by appointing Gary Johnson as the chief marketing officer. Johnson comes to Consumer Health Technologies with 20-plus years of brand and business development experience in management roles with Kimberly-Clark (general manager- global trade marketing of professional health care division), MedAssets (senior VP marketing, product strategy and planning of revenue cycle-supply cost
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users, whether members of a health plan or cash paying consumers, access tremendous potential savings and make cost-effective drug purchasing decisions. The launch of mobile DrugCompare in summer 2011 expanded the tool’s reach even further, enabling consumers to view and compare prescription drug savings right at the point of prescription.”
Humana Extends Partnership with Video Game Leader Ubisoft by Offering Rewards for Healthy Gaming Humana Inc., one of the nation’s leading health care companies, announced it is extending its partnership with video game leader Ubisoft by offering rewards for healthy gaming. Through its revolutionary wellness and loyalty solution, HumanaVitality, HumanaVitality members are now able to seamlessly earn Vitality Points™ for exercising using Ubisoft’s breakthrough fitness games, “Your Shape: Fitness Evolved” and “Your Shape: Fitness Evolved 2012,” available exclusively on Kinect for Xbox 360 This partnership marks the first time a fitness video game has been integrated with a health care solution in this way. “This agreement furthers Humana’s commitment to making fun things healthy and healthy things fun,” said Shankar Ram, vice president of innovation for Humana. “By integrating with ‘Your Shape,’ HumanaVitality members can automatically earn Vitality Points that may be redeemed for items such as electronics and hotel stays. These types of aspirational incentives will motivate and encourage people to make healthier choices.” HumanaVitality members automatically began earning points on March 26. To log their data, members link their personalized Humana Fit account to the “Your Shape Center,” an online component of the Xbox Kinect game. Similar to Humana Fit—which is a free, interactive web platform—the “Your Shape Center” will help people reach their health potential with exercise tracking. Following the one-time setup, all activities logged via “Your Shape” will automatically transfer workout data for HumanaVitality and Humana Fit members. “Now HumanaVitality members will receive 15 Vitality Points per day for burning at least 200 calories while playing ‘Your Shape,’ which equals a 30-to60 minute workout,” said Joe Woods, CEO of HumanaVitality. “Through this program, we are offering a total health solution that combines gaming, rewards and self-tracking by creating a motivating, personalized experience.”
Blue Cross and Blue Shield of Kansas City Launches Blue365 Website Blue Cross and Blue Shield of Kansas City (Blue KC), the area’s largest health insurance company, announced the launch of its improved health and
software solutions) and CompuGroup Medical US (senior VP marketing, EHRs, practice management Valence Health, a leading provider of clinical integration and health plan services, has named Tom Sharpe as its new vice president of marketing. For more than 20 years, Sharpe has developed and implemented marketing strategies and communications for corporate and nonprofit entities within the health care sector. Before joining Valence, Sharpe served as vice president of marketing and public relations at the Healthcare Information Management Systems Society (HIMSS) where he led all activities related to product development, pricing, brand management and marketing for the association, as well as all external communications with industry and national media.
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wellness website, Blue365, which provides value-added benefits and offers for Blue KC members. The website, www.Blue365deals.com/BlueKC, features discounts, both national and in the Kansas City area, on a variety of health and wellness resources. “The launch of our health and wellness resource website demonstrates Blue KC’s commitment to helping our members make healthy choices,” said Dr. Gregg Laiben, medical director. “Being healthy doesn’t have to be expensive. Blue365 makes it convenient and affordable for our members to stay well all year long.” Created by the Blue Cross and Blue Shield Association to help members navigate the health care decision-making process and maximize their health benefits; Blue365 includes local offerings available all the time, and special national deals featured each week. Savings on products and services such as teeth whitening, hearing aids and Lasik surgery offer Blue KC members discounts on health care services that might not fully be covered under their health insurance plan. Other savings include discounts on gym memberships, cosmetic procedures and eyeglasses. Blue365 gives members access to health and wellness programs such as Healthways Fitness Your Way. Healthways offers discounts on health and wellness specialists, vitamins and exercise equipment. In addition, for a $25 monthly membership, members have access to more than 8,000 gyms nationwide, including 24 Hour Fitness, Gold’s Gym, Bally’s Total Fitness and YMCA, as well as online tools to track nutrition and exercise goals.
WESTMED Medical Group Launches ACO in Collaboration with UnitedHealthcare and Optum WESTMED Medical Group announced it is collaborating with the UnitedHealthcare and Optum businesses of UnitedHealth Group to launch an accountable care organization (ACO) for its more than 220 physicians in Westchester County, N.Y. Collaborating with UnitedHealthcare will enable WESTMED physicians to be eligible for incentives based on measurements in disease management and prevention, patient safety and appropriate care utilization. Participating physicians will be measured and rewarded based on quality health outcomes, patient satisfaction and reduction of medical costs in the Westchester market to below current, trend-adjusted levels. Bonus eligibility requires both care quality and cost metrics are achieved concurrently to help ensure physicians focus on providing the right level of care for patients. WESTMED Medical Group, based in Purchase, N.Y., is a large multi-
Humana Inc. announced Thomas J. Liston, the company’s senior vice president of senior products, has been promoted to the new role of president, retail segment for Humana. In this role, Liston will lead Humana’s growing retail businesses, including senior products (which covers all Medicare products sold to individuals); HumanaOne plans for individuals and families; and retail sales, which includes a broad portfolio of health, wellness and financial protection products distributed by Humana’s MarketPOINT organization. Before the announcement, Liston has—since 2008—led Humana’s senior products area, including Medicare Advantage plans, special-needs plans, stand-alone prescription drug plans and Medicare supplement products. continued on page 46
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specialty group medical practice staffed by more than 220 physicians providing coordinated, efficient, quality care at its nine locations in central and lower Westchester County. Its patient-centered medical home program has received the highest level of recognition (Level 3) from the National Committee for Quality Assurance (NCQA) for providing coordinated, efficient and quality primary care. NCQA is a nonprofit organization dedicated to improving health care quality. WESTMED physicians will use Optum’s analytical tools to help identify best practices for overall patient wellness and disease management, and measure their own performance in these areas over time.
GoodRx Launches Drug Comparison iPhone App GoodRx announced it has created an innovative prescription drug price comparison technology that provides consumers with accurate drug prices from virtually every U.S. pharmacy. GoodRx, available as both a website www. goodrx.com and free iPhone app, allows consumers to compare drug prices, which can differ greatly between competing pharmacies, and find discounts, free coupons and savings tips. Consumers simply enter the name of a prescription drug and their ZIP code. GoodRx immediately displays both a list and a map of prices for both the brand-name and generic versions of the drug from local and mail-order pharmacies. GoodRx’s database contains more than one million prices for more than 6,000 brand name and generic drugs. In addition, consumers can set up refill reminders and price alerts through GoodRx’s My Prescriptions feature, which emails the latest prices in time for a consumer’s next refill. “The good news is that the price of many important prescription drugs has decreased over the last few years. The bad news is that prices vary wildly and health insurance covers less and less of those costs. We can instantly compare prices for home electronics, airline tickets and cars—so why not drugs?” asks Doug Hirsch, co-founder and chief executive officer of GoodRx. “GoodRx empowers consumers, doctors and health care providers to make educated decisions about what drugs to prescribe and where to fill them. This technology not only saves money but also encourages consumers to fill and refill the prescriptions they need to stay healthy.”
UnitedHealthcare Offers Employers 24/7 Nurse App UnitedHealthcare is making it easier for its plan participants to take greater control of their health through a new mobile app, Health4Me. Now available for continued on page 46 www.TheIHCC.com I CDHC Solutions™ I March/April 2012
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Bachman’s Banter
By Ronald E. Bachman FSA, MAAA Chairman Editorial Advisory Board The Institute for HealthCare Consumerism
Key Product Pricing and Design Issues in PPACA
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an health care consumerism survive PPACA? As the federal health reform legislation is being debated and challenged in court, employers and insurers must understand the key pricing and product design issues contained in PPACA. If only parts of PPACA are ruled unconstitutional, some of these issues may survive at the federal level under regulatory authority provided to HHS or continue under state health insurance reforms. Four key issues affecting employee engagement and health care consumerism are: price compression, single risk pool, medical loss ratio and health insurance exchanges. Let’s look at each separately.
Price Compression PPACA specifically overrides all actuarial analysis and studies on relative costs. Actual claim cost ratio between age 60 and age 20 is about 5 to 1. But, under PPACA, individuals can no longer be charged premiums relative to their expected claims. The law states pricing between old and young must be compressed to no more than 3 to 1. That law states: “The premium rate charged by a health insurance issuer for health insurance coverage offered in the individual or small group market such rate shall vary with respect to the particular plan or coverage involved only by— • Whether such plan or coverage covers an individual or family; • Rating areas as allowed by HHS, • Age, except that rates shall not vary by more than 3 to 1 for adults, • Tobacco use, except rates shall not vary by more than 1.5 to 1. • Rates shall not vary with respect to the particular plan or coverage involved by any other factor.” Under PPACA rates for the younger insureds will increase by 50-100 percent to pay for the limitation of lower premiums charged to older insureds. But, not to worry, the government will provide subsidies to the young who cannot afford the higher premiums by reducing provider reimbursements to Medicare and adding a tax on insurance. Those not qualifying for subsidies will have to pay more.
Fully Insured Single Risk Pool PPACA requires all individual and small group plans to be included as a single risk pool. This concept prevents a group plan in benefiting directly if they support wellness, prevention, health literacy, personal responsibility, or other programs to engage employees in making better health and health care decisions. Why encourage personal responsibility among your employees if others in the single risk pool do not take the extra contractual efforts to do the same? The law states: INDIVIDUAL MARKET – A health insurance issuer shall consider all enrollees in all health plans (other than grandfathered health plans) offered by such issuer in the individual market, including those enrollees who do not enroll in such plans through the exchange, to be members of a single risk pool. SMALL GROUP MARKET – A health insurance issuer shall consider all enrollees in all health plans (other than grandfathered health plans) offered by 18
March/April 2012 I CDHC Solutions™ I www.TheIHCC.com
such issuer in the small group market, including those enrollees who do not enroll in such plans through the exchange, to be members of a single risk pool. MERGER OF MARKETS – A state may require the individual and small group insurance markets within a state to be merged if the state determines appropriate. The products under a single risk pool may limit the value of significant behavior changes that lower costs and improve quality of care.
Medical Loss Ratio (Fully Insured Plans Only) PPACA limits the charges for administration, management, marketing and sales support, and risk premium (profits) for individual and small group insurance plans. There is no equivalent limit on business expenses or profits in the doctor’s office, the hospital, or any other vendor. If expenses are too high the insurance plans must provide a rebate. The law mandates: • Starting with plan years Jan. 1, 2011, PPACA requires insurers to submit a report showing the ratio of claims incurred to premiums earned for fully insured individual and small groups. • The report will include the percent of total premiums spent on clinical services, for activities that improve health care quality; and on all other non-claims expenses. • HHS will have reports on an Internet website for medical loss ratios reported by May 31 of the year following the plan year. • Rebates are determined on a state level. • Issuers are required to provide an annual rebate to each enrollee if the percentage of premium spent on medical care is less than 85 percent for large groups and 80 percent for individuals and small groups. • Medical loss ratio standards may limit the ability to add non-clinical behavioral change support services.
Health Insurance Exchanges (Fully Insured Plans) Exchanges under PPACA are government agencies or non-profit organizations where private health insurance policies are offered to individuals and small groups with PPACA eligibility and coverage mandates, including premium subsidies for low-income individuals. Subsidies are available only if insurance is purchased through an exchange. Employers may find it advantageous to drop their current fully insured health insurance plan, pay a penalty, and have individuals enroll in a subsidized exchange. Alternatively, small employers may find it better to establish self-insured plans using significant specific and aggregate stop-loss insurance. Exchanges for fully insured plans will be available in 2014. States need to show progress in establishing exchanges by Jan. 1, 2013 or a federal exchange may be implemented in those states. Until 2016, states can set exchange eligibility at 50 or 100 employees. In 2017, states may include employers with more than 100 employees. To read this article in its entirety, please visit www.theihcc.com
HSA/FSA/HRA Admin and Finance
By Duncan van dusen » Ceo, Co-founder Tango health
Educate Employees on Three Ways to Manage HSAs to Increase Engagement
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s more employers seek higher participation in high-deductible health plans (HDHP)s with health savings accounts (HSA)s, educating employees about all the benefits and ways to manage HSAs can be extremely valuable. When employees have a better understanding of an HSA’s value, it can have a positive impact on their experience with a high-deductible plan and they’re more likely to open and use their HSAs. When more employees use HSAs, both employees and employers reap tax savings and additional satisfaction. But education around HSA management methods needs dramatic and thoughtful improvement. Most employers, brokers and carriers focus employee education around how to use HSAs like checking accounts for tax-free payments of medical expenses because it is the method they’re most familiar with. This is a valid yet narrow view of how to manage HSAs that can be categorized as the “low-balance” or “yearly Health Savings Account planner” HSA management model. It works well (HSA) Management Model for employees who have a good understanding of Long-term Investment Similar to 401(k) their yearly medical spending, have the ability to set money aside, and want to reap immediate tax Low-balance Money In = Money Out savings on their planned health expenses—but that As-needed only covers about a third of the HDHP-enrolled Retroactive Tax Savings on population. Unexpected Medical Expenses Besides this method, there are two additional ways HSAs can be managed that deserve much more attention than they get. These two methods are categorized as the “long-term investment” and “as-needed” models. These strategies appeal, respectively, to employees who want to reap long-haul tax benefits or those who need to maximize cash flow from each paycheck. Employers and benefits specialists should familiarize themselves with each method and educate employees about them. Doing so will help HSAeligible employees understand that regardless of their financial situation or goal, simply opening an HSA is in their best interest. It also will help more of the employee population to find personal relevance in HSAs, thus increasing participation and engagement. Above is an overview of these three common ways HSAs can be managed by employees, along with the goals of each model and the type of employees who use it. Each method has unique benefits. All enable users to save on taxes.
HSAs provide, which include growing contributions (theirs and their employer’s) tax-deferred with tax-free interest and withdrawing money taxfree any time prior to age 65 if needed to pay for health expenses.
Low-balance Account – Money In Equals Money Out Employees who maintain low-balance accounts can be categorized as “Yearly Planners.” As mentioned earlier, this HSA management model is the one most people are familiar with. They have a good understanding of how much they typically spend on health care each year, and they contribute only as much money as they anticipate needing, factoring in any contribution from their employer in addition to their own. This method allows them to immediately pay for planned medical expenses with tax-free dollars, saving 25 to 35 percent. Any HSA funds not used in a given year can be saved and rolled over to the next year. Who Uses This Model?
Employee Goals
Savers
Contribute maximum to HSA and pay health expenses with after-tax dollars to maximize pre-tax investment for future medical expenses, retirement or other savings needs
Yearly Planners
Contribute just enough money to cover health expense needs or the medical deductible to earn immediate tax break
NonPlanners
Maximize cash flow from paycheck Receive tax-free reimbursement on medical expenses after they have occurred
As-needed Account – Safety Net for Tax-savings on Unexpected Medical Expenses Employees who use their HSA as-needed are considered “Nonplanners.” They open their HSA, but contribute no money to it. Their primary concern is maximizing cash flow from every paycheck. While they are called “Non-planners,” there is a little planning in their HSA management method – they have understood enough about HSAs to foresee that by simply opening the account they can take advantage of future benefits. When a medical expense occurs, they can add money to their account and reimburse themselves, providing a retroactive discount of 25 to 35 percent tax savings on all medical expenses. Many employees don’t know of this convenient method for recovering all of the income and payroll tax dollars on their health care spending with no upfront planning or cash commitment. Once they take advantage of this model, they save taxes and their employer does too, since the employer recovers their FICA at the same time.
Long-term Investment Account - Similar to 401(k)
A Win-win Situation
Employees who use their HSAs as long-term investment accounts are “Savers.” They pay for health expenses outside of their HSA using after-tax dollars and may reimburse themselves tax-free at any time (even years later) from their HSA. They often contribute the maximum allowed by the IRS. They care most about taking advantage of the long-term financial benefits
When employers help employees understand there is a way to manage and get value from an HSA regardless of their financial goals, it increases employee participation in HSAs, raises satisfaction with HDHPs and leads to greater tax savings for both parties.
www.TheIHCC.com I CDHC Solutions™ I March/April 2012
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By sTeve dAvIs manaGinG Editor heALTh PLAn WeeK
eXChAnGes
Can CO-OPs Go Toe-to-toe With established health Insurers?
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in Montana, nearly 25 percent of all adults lack insurance. Larry he Obama administration is betting billions on the future of nonprofit Consumer Operated and Oriented Plans (CO-OPs). The Turney, project officer, Montana Health Cooperative (MHC), notes the groups responsible for building the new entities say they’ll be able cO-Op could be an attractive option for those who don’t have coverage, as to offer health coverage that is less expensive and more appealing than well as for those who want something different. and turney knows what more traditional options. the reform law envisions establishing at least he’s up against. prior to joining Mhc, he spent 19 years working for the one cO-Op in each state to compete against existing health insurance state’s dominant carrier—blue cross and blue Shield of Montana. the Montana cO-Op has been approved for $58.1 million in federal loans. companies in the small-group and individual markets While seven applicants received loans, seven others were asked to Last month, cMS awarded $638 million in low-interest loans to seven nonprofit groups that intend to operate Consumer Operated and supply more information and several were rejected. One of those asked to provide more detail was the Evergreen Group, Oriented plans in eight states. Many more a cO-Op venture in Maryland. applications are under review. the funding is Evergreen intends to target Peter Beilenson, M.D., health officer part of $3.8 billion earmarked to get at least for howard county, Md., who is heading the one cO-Op up and running in every state. the working-class families with group, says hhS wanted more detail about bulk of the loans will be used to ensure solvency. how the group would build the neighborhoodthe reform law originally allocated $6 billion in annual incomes of between based clinics—dubbed “team-lets”—that are at loans, but Congress whittled that figure down to the heart of its closed-panel model. $3.8 billion last year. 133 and 400 percent of “they wanted to know if we could get but past attempts to alter the marketthe federal poverty level enough primary care doctors, so we were able based health insurance industry have to give a good amount of info about how we been unsuccessful. and after 20 years of (FPL)—between $28,000 and would do that,” beilenson says. consolidation, the health insurance industry is Evergreen intends to target working-class now dominated by huge, diverse corporations $88,000 for a family of four. families with annual incomes of between 133 with extremely deep pockets. beating health and 400 percent of the federal poverty level insurers at their own game on their home turf (FpL)—between $28,000 and $88,000 for a family of four. will be difficult if not impossible for the new entities. based on an actuarial study conducted by Milliman, beilenson Moreover, the new entities could find it difficult to build scale, create provider networks and compete against well-established, deep-pocketed estimates the cO-Op will need about $50 million in federal funding to get health insurers. they also must reach certain milestones on an aggressive up and running, and about 20,000 members in the first year to sustain the timeline leading up to 2014 when health insurance exchanges become business model. it also is seeking about $10 million in private funding to help it build the team-lets. hhS doesn’t allow the federal loans to be used operational. courtney White, a consulting actuary at Milliman, predicts the for clinical purposes. While Montana’s turney doesn’t think insurance carriers are worried majority of states—though not all—will have a cO-Op in place by 2014. State insurance exchanges, which are slated to begin enrolling members yet about the new competition, he does say they appear to be “very in October 2013, will offer cO-Ops a unique opportunity to quickly build interested in what we’re doing.” scale as millions of previously uninsured and underinsured americans Steve’ Davis’ journalism career includes more than a decade of health business reporting experience, including 10 years as the managing editor of health plan Week qualify for federal premium subsidies. and inside consumer-directed care. His deep knowledge of health care management but attracting members won’t be easy. White says cO-Ops will need and contacts throughout government and industry make health plan Week and inside a strong marketing force that can explain their story and demonstrate health insurance Exchanges “must” reading for health care executives. Steve joined the benefits of a CO-OP over a traditional insurance company. They’ll AISHealth in 2002. also need to make sure they’re ready to sell coverage by the time state exchanges begin their open-enrollment period on Oct. 1, 2013. Missing that initial wave of uninsured could be detrimental to the success of a cO-Op.
www.TheIHCC.com I CDHC Solutions™ I March/April 2012
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Congratulations
to the 2011 Transitions Vision Benefits
Broker of the Year! Regular eye exams and quality eyewear help protect employees’ eyes and overall health – and ensure they’re seeing their best – so they can perform their best. Transitions Optical is proud to recognize brokers who go above and beyond to promote vision benefits. Learn more about the importance of vision benefits and the Transitions Vision Benefits Broker of the Year award at www.HealthySightWorkingForYou.org
Patrick Tibbs
Financial Services Representative Everence Financial Advisors
By Jodi Anatole Vice President, Critical Illness Metlife
Supplemental Health & Voluntary Benefits
Critical Illness Insurance: a Voluntary Benefit that Bridges Financial Safety Net Gaps
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ith tough economic times and ever-increasing health care costs, the surveyed say they have heard of CII. Among those employees, the majority financial impact that a critical illness, such as a heart attack, cancer, is confusing it for health insurance, disability income insurance, or a or stroke, can have on a typical U.S. household can be devastating. government insurance program. Notably, about 75 percent of employees, who don’t own critical illness Many Americans lack the resources needed to cope with unexpected expenses not covered by health insurance, as well as the associated loss of insurance or have never heard of it, find the concept appealing once the product’s features are explained. Most are income. A study conducted by MetLife exposes Offering critical illness insurance even willing to pay the entire premium. the gaps in personal financial safety nets that a health situation may create even if an Engaging Employees can have a positive impact on individual has medical and disability income An effective campaign aimed at employees’ perception of their coverage. The study also outlines steps maximizing employee participation in a employers can take to help employees obtain voluntary CII benefit should: employer because it helps fill a the right amount of protection with critical Promote CII as a supplement – illness insurance (CII) as a voluntary benefit. Promoting critical illness insurance alongpotential gap in their financial The study found the average financial side other core benefits as a supplement to burden associated with recovering from a existing medical and disability income bensafety nets at a low cost. critical illness is $35,500, most of which is efit plans can help employees better underlinked to lost income. The reality is many stand the gaps in their coverage and how CII American households may find it difficult to absorb this shortfall. can strengthen their financial safety net for meeting out-of-pocket medical With nearly one in two working Americans having less than $5,000 in and non-medical expenses. savings to cover expenses in the event of a major illness, and more than half Illustrate CII benefits – For better communications, employers can those admitting to having less than $500, it is not surprising 55 percent of correlate an employee’s benefits offering with his or her individual financial full-time working Americans are somewhat or extremely concerned that a concerns, or demonstrate how financial protection benefits are relevant in critical illness could impact the financial well-being of their families. building a strong personal safety net and helping to provide peace of mind. Critical illness insurance can help address these situations. CII can Strong benefit communications also can help reinforce the employer’s complement existing medical and disability coverage and other financial commitment to their employee’s well-being and strengthen employee protection products by providing a lump sum payment to help offset the engagement in the benefits program. increase in out-of-pocket expenses resulting from certain critical illnesses. Highlight CII simplicity – Keeping the product simple is one significant way to ensure the benefit communications are straightforward and effective. The lump sum CII offers eliminates the need for ongoing claims Advantages for Employee and Employer Alike paperwork. There also is flexibility for employees, who can use the lump CII can be an important addition to an employer’s voluntary benefits package that can help employees be better prepared for the financial sum payment as they see fit for both medical and non-medical expenses. Offering critical illness insurance can have a positive impact on consequences of a critical illness. And, as employers are increasingly looking for ways to manage their benefits budget, CII can help employers ease the employees’ perception of their employer because it helps fill a potential gap transition to higher deductible health plans by providing employees with a in their financial safety nets at a low cost. In addition, it helps employees lump-sum payment to make up for unforeseen expenses associated with a more easily handle financial issues during a critical illness, which allows them to focus on their physical recovery and may help them return to full critical illness. CII does not replace medical insurance, but augments it by providing productivity. cash to cover copayments and even experimental treatments not covered Jodi Anatole is vice president, critical illness insurance, MetLife, where she is responsible for in traditional health plans, lending an enhanced appeal to an employer’s product strategy, management and overall operations. overall health benefits program. With a mere 7 percent of employees who Metropolitan Life Insurance Company (MetLife) is a subsidiary of MetLife, Inc. (NYSE: MET), a leading global provider of insurance, annuities and employee benefit programs, serving 90 say they own CII, a tremendous opportunity exists for employers to help million customers in over 50 countries. For more information, visit www.metlife.com. their employees develop a financial safety net in the event of a critical illness. The research data contained in this article is included in a white paper, Critical Illness However, educating employees about critical illness is key to ensure Insurance: Critical Times Require Critical Solutions, which is available at www.metlife.com/ their participation. The study found just 28 percent of full-time employees criticalillness. www.TheIHCC.com I CDHC Solutions™ I March/April 2012
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Rewards & Incentives
By Jaimee D. Chism Employee Loyalty Practice Leader Itagroup
Healthy Rewards: Incentive Trends to Build a Successful Employee Wellness Program
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s Americans find themselves mired in the continuing debate over Wellness Incentive Landscape Grows Wider a national health care system, one problem is certain: Health care Because of growing health care costs, many employers are upping their costs continue to rise with no end in sight. The U.S. is spending reliance on wellness incentives to boost the dual goals of participation and about $2.5 trillion per year on health care, and the employers’ share of behavior change. Now, with the introduction of the Patient Protection and health insurance premiums rose 9 percent last year, according to a Kaiser Affordable Care Act, the cap on wellness incentives—now at 20 percent of an Family Foundation report, with double-digit employee’s total health insurance premium increases accumulated over the last 10 years. cost—is set to increase to at least 30 percent Because of growing health care Since nearly 50 percent of all insured and as much as 50 percent by 2014, allowing Americans get their health insurance through companies ever wider latitude in developing costs, many employers are employers, according to Gallup, it stands to and implementing a wellness incentive reason that if we can figure out how to help strategy. upping their reliance on wellness employers lower their health care costs, it Before even beginning to examine the incentives to boost the dual goals of broad array of wellness incentives, there would make a major impact on the problem. The introduction of wellness programs are a number of important issues proactive participation and behavior change organizations need to address when creating at companies to promote and reward healthier behavior continues to grow. Today, effective wellness program incentives, as more than 80 percent of America’s businesses suggested in a 2011 SHRM Foundation with 50 or more employees offer some form of wellness program or activity, report, “Wellness Strategies to Improve Employee Health Performance and according to the Society for Human Resource Management (SHRM). the Bottom Line.” But as more companies offer and expand these programs—from health They include: risk assessments to smoking cessation to weight loss—there have been • Survey your employees to determine what incentives are likely to growing calls from senior corporate management to quantify the benefits motivate them. wellness programs are producing—not just for the employees, but for the • Start with a modest allocation to boost or maintain participation; if organization’s bottom line. needed gradually increase the allocation. The use of incentives to promote employee enrollment and participation • Monitor the impact of existing incentives on participation. has proven to be an important component in successful wellness programs. • Revise the incentive mix when participation levels drop initially, A 2009 survey conducted by MasterCard and Harris Interactive found 61 rather than waiting until participation rates have substantially percent of employees participate in a wellness program if incentives are declined. offered versus only 26 percent when there is no incentive, aside from better • Adjust the type, level, variety and timing of incentives to maximize health, to participate. That same survey found 25 percent of employees said results. the lure of an incentive was the primary reason they enrolled in a wellness program. In surveying employees about their incentive choices, keep in mind That speaks for the power of incentives to help motivate people toward that within the employee population, there are three groups to consider. The a positive course of action. first group includes employees who are already living a healthy lifestyle no The ITAGroup has seen a shift in the way organizations of all sizes are matter what incentives are provided by the organization. The second group, utilizing their employee recognition programs. No longer is it about just estimated at about 60 percent of the workforce, has good intentions. They providing years of service awards. In fact, organizations are beginning to want to be healthy, and want to live a healthier lifestyle. Those in this group understand how to leverage these programs to change or reinforce specific need encouragement, and this is where incentives will do the most good. behaviors, such as healthy living. The third group, about 10 to 20 percent, is comprised of individuals who The WorldatWork report, “Trends in Employee Recognition 2011,” will not change no matter what incentive or reward is offered. Changing the notes that 86 percent of organizations have some type of recognition behaviors of these individuals normally takes a major life-changing event program in place; however, only 34 percent are using these programs to that is typically outside of the organization. change or reinforce specific behaviors. This represents a huge opportunity, Employers need to determine how to motivate each of these groups, especially in the area of helping employees improve their health. and to be realistic about the impact a wellness program and related incentives have on each of these groups. Each group of employees has 24
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different motivations for participating in wellness programs and the better job the organization can do in identifying these motivations the more successful incentives will be in changing or reinforcing specific behaviors. While in the process of surveying employees about incentives, be mindful that it’s sometimes the little things that can make a big impact.
Choosing the Incentives That Work Among the many types of wellness incentives, it is important to choose from a selection of incentive rewards that are attractive to the participant as well as the company. The January 2012 Principal Financial Well-being Index found when it comes to what workers desire and what employers offer, the two groups diverge. We often call this a perception gap or the gap in what employees desire and management’s perception of what employees want. The top four incentives workers said they would like to see are: 1. Fitness center discounts, 2. On-site preventive screenings, 3. Access to wellness experts, such as nutritionists, and 4. On-site fitness facilities. Employers, on the other hand, primarily offer online wellness information, educational tools or resources and printed wellness information. Fitness center discounts ranked high for both participant and employer. The Principal Index noted while 45 percent of workers chose overall physical health as the reason for participating in a wellness program, another 30 percent cited receiving a meaningful incentive from their employer as the prime reason to participate. This shows the important role incentives have in wellness program enrollment and continued participation. Today, one of the fastest growing wellness incentives to enter the corporate arena is health insurance premium and copay discounts. The discount incentive is popular among both employees and companies because both save money in the process. According to a 2010 survey by Buck Consultants, almost 75 percent of nearly 1,300 companies polled said they offered, or plan to offer, such discounts. These programs offer discounts in varying amounts to employees who complete activities such as wellness screening, weight-loss program, smoking cessation program and exercise classes. Proponents of the insurance discount say by offering a discount, a clear path is drawn between wellness and the cost of insurance, making individual employees more accountable for their own health and giving them ability to control the cost of their insurance. Along with insurance discounts, gift cards and merchandise point programs continue to be popular choices among most companies, together with fitness club discounts and memberships. Some employers, including, not coincidentally, health care providers, are taking a more holistic and longer-term approach to wellness incentives. For example, the Cleveland Clinic, as part of its “Lifestyle 180” employee wellness program, offers as an incentive one-on-one coaching by health professionals about nutrition, cooking, exercise and stress management. In addition, the clinic’s incentive package includes no-cost access to Weight Watchers and Curves fitness centers, in addition to Clinic-owned fitness centers, where employees can earn an annual participant award.
Challenges: Measuring Results, Speaking the CEO’s Language We all understand the huge implications of the overall cost of health care in the United States. Many times, organizations do not want to invest dollars in wellness programs and the associated incentives because there is not an immediate payback. Often, it is the HR function, which is not properly leading the charge. HR should not approach wellness initiatives as solely a “feel good, do the right thing” activity. Instead, the HR function, if it were to introduce a wellness program, must have a firm understanding of the financial impact on the organization— not only how the company may benefit, but how much it will cost. One major issue facing wellness programs is often the benefits and implications for the company are long term, sometimes to the point where an employee may no longer be with the company by the time the health and financial impact is seen. While it is difficult to capture the ROI for wellness programs, HR leaders must become proactive on how best to measure the cost and benefit to the organization. Whether it is participation level, overall health levels, or some other metric, measurement must be baked into a wellness program at the beginning of the design stage. As HR professionals position themselves as true strategic partners in the organization, they must be able to speak the language of the CEO and other senior leaders in the organization. Whether talking about wellness programs, or broader recognition programs, a clear focus on capturing and calculating the ROI of these programs is critically important.
Leading the Way to a Successful Program One of the most important ways to build enrollment and participation in a wellness program, aside from incentives, is to fully embrace the program as extremely important and to lead by example. This means organizations themselves and their leaders need to build a culture of healthy choices across the entire enterprise. A great example of that is the telecommunications firm Sprint Nextel. At Sprint Nextel, the entire executive team regularly comes together to lead and participate in a wide range of wellness events, including fitness walks, team sports and sharing personal, sometimes difficult stories about individual and family health challenges. Approaching the wellness program with passion, and celebrating individual and group accomplishments, can go a long way toward selling the benefits of a wellness program. Praise, as part of any wellness incentive awarded, is a sure formula for success.
Looking Ahead: Incentive Trends to Watch As wellness programs continue to evolve, so will the incentives, which come with them. According to health care management company OptumHealth, many employers will begin to emphasize healthy outcomes as a requirement for incentives; going beyond participation alone. Some organizations also may require health screenings—with positive results—in order to receive insurance discounts or other rewards. To read this article in its entirety, please visit www.theihcc.com
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@AIGBenefits
AIG Benefit Solutions
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By Shawn T. Mason, PhD Associate Director, Research Outcomes and Data Analytics Wellness and Prevention Inc.
Population Health Manaement
Digital Health Coaching for Population Health Management
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he overarching problem with population health management in our society includes both the sheer scope of the issue and the reach of interventions. In terms of scope, one has to understand “effective population health management” as a concept encompasses acute care, disease management, preventive care and public health. In terms of reach, such interventions should be designed for accessibility and address both the needs of the person who is essentially healthy and trying to remain so, as well as someone trying to “self-manage” one or more chronic health risks or conditions. As such, efforts will require input from multiple disciplines and implementation will employ a variety of programs and services that reach and engage large groups of people in need of help across the health spectrum. The above represents neither easy nor small tasks, as evidenced by many attempts with minimal successes. The science behind these efforts is developing with the need, but not without many lessons learned along the way. For example, many employers use informational websites and monetary incentives to improve employee health. However, both come with their limitations. It has been well established that health education alone is not sufficient for changing health or lifestyle behaviors—people need motivation. Monetary incentives are often used to promote motivation, but they are not a straightforward strategy either, specifically with regard to sustainability and long-term health behavior change. It’s counter-intuitive in many ways; however, if not carefully employed, monetary incentives can actually be working against long-term lifestyle changes. Movements like consumer health and patient-centered medical homes are built upon the notion effective population health cannot be successful unless we empower the population to play a more active role in health. Despite the recent advent of accountable care organizations (ACOs), it is becoming clear to researchers, providers, consultants and other opinion leaders that the traditional medical establishment alone, with its acute care focus, cannot solve the problems of managing the health of large populations using the current arsenal of interventions. Consequently, there is a fundamental imperative to promote behavior change as a primary and secondary prevention strategy if we are to have meaningful and sustainable impact on a population’s health. One of the popular strategies to promote behavior change in larger numbers of individuals at a lower cost than traditional health care providers is called “health coaching.” Although there is still no widely-accepted definition of health coaching Susan Butterworth, vice president for health management services at Health Future, described it as “a behavioral health intervention that facilitates participants in establishing and attaining health-promoting goals in order to change lifestyle-related behaviors, with the intent of reducing health risks, improving self-management of chronic conditions and increasing health-related quality of life.”
It is typically delivered face-to-face or telephonically to extend the reach and quality services for behavior change. While this represents a significant improvement in reach and provision of personal services for individuals, it is associated with some limitations for a segment of the population. Live coaching will remain appropriate. However, for the broader population, it is not an efficient solution. Among other issues, cost, scale, and availability will be prohibitive. As technology advances and as more people have access to digital services, other options become available. “Digital health coaching” has emerged as an innovative solution to the challenges facing population health management and live health coaching. Digital health coaching is an individualized, interactive, technologybased experience that recreates the important elements of the live coaching experience in a digital environment. It is driven by intelligent technology that uses behavioral science models and theories, behavior change techniques, evidence-based guidelines and educational/learning theory to create individualized interactions that help people better manage their health and well-being. Digital health coaching can 1) employ a comprehensive health assessment, 2) triage to other services and programs (including live coaching), 3) evaluate health and behavioral progress, and 4) integrate with multiple communication channels to support health-related goals. The transformative potential of digital health coaching draws from the fact that once developed, it can be delivered to large populations at relatively low cost, reaching segments of the population across the health spectrum.
Key Characteristics of Digital Health Coaching 1.
Digital health coaching incorporates a variety of theories, models, techniques and guidelines, selectively and consistently applied (i.e. standardized).
2.
Digital health coaching is interactive and highly tailored (i.e. personalized).
3.
Digital health coaching uses technology-based delivery modes that are automated, self-contained and integrated.
4.
Digital health coaching incorporates strategies to encourage participation, engagement and retention.
5.
Digital health coaching also includes automated assessment of outcomes.
Forward-thinking organizations have begun increasingly to embrace health and wellness programs that address behavioral change (i.e. population). They see a strategic business advantage in having a physically and emotionally healthy, engaged and active constituency. Favorable modification of health compromising behaviors like smoking, physical inactivity, unhealthy eating habits and suboptimal medication adherence are just some of the behavioral population risks for which effective behavioral interventions should be part of a population health and wellness strategy. www.TheIHCC.com I CDHC Solutions™ I March/April 2012
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By John Young Senior Vice President Consumerism
Decision Support Tools
The Right to Know
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o quote those sage philosophers, Voltaire and the Amazing Spiderman: “With great power comes great responsibility.” In the case of consumer-driven health plans, individuals have assumed both greater power and responsibility in making health care choices for themselves and their families. With this power and responsibility comes an important right; the right to know: health care costs, quality and alternatives. In the industry we call this “transparency”—but it’s really more important than that. If the goal is to have informed consumers making the best and most cost-efficient health care choices, then access to the right information how, when and where they want is fundamental to making rational, wise, and successful health care decisions. At Cigna, we’ve seen that our Choice Fund CDHP customers were twice as likely as those enrolled in traditional managed care plans to use online cost and quality information to help select a doctor or to review potential medical costs But up until now, our promise to deliver on this right-to-know has been slowed by incremental improvements in technology and limitations in our ability to manage data. That is beginning to change. In March 2012, Cigna launched a new, online service providing accurate information on out-of-pocket pricing quality information on doctors and hospitals for more than 200 common medical procedures (and representing more than 80 percent of all claims).
Cost According to Plan Using the “Find Doctors and Services” search directory on Cigna’s customer website, myCigna.com, customers can assess medical costs – including specialist, facility and related fees—according to the real-time status of their health plan deductibles and co-insurance, as well as their available health spending account funds, before choosing their physician. What’s really groundbreaking is health care consumers can now shop for care in the same way it’s delivered. For example, you can look up a knee arthroscopy by doctor and get a precise estimate for what you will pay to get care through that doctor—that includes not just the doctor’s fee, but also related services such as diagnostics and anesthesia, as well as hospital or facility costs Rather than using broad cost ranges or averages, these estimates are based on actual claims payments. The estimates are backed by more than five years of testing and research using Cigna’s Cost of Care Estimator (http://newsroom.cigna.com/article_display.cfm?article_id=1016), which has delivered about 500,000 estimates annually to patients by their health care professional at an accuracy rate of within 10 percent of the patient’s cost 90 percent of the time. By synchronizing the cost information now provided on myCigna with the Estimator tool, the consumer can now see the same information health care professionals see prior to an office or hospital visit.
Here’s where the right to know-your-alternatives plays into the rights to know quality and cost. Our new online tool enables the consumer to compare a physician’s costs for performing a procedure at different hospitals. When performed at various facilities, these services can vary significantly both in terms of quality and price As a consumer, it is vital to be able to assess your alternatives prior to choosing a doctor, because once that decision is made, the choice of where to go to have the procedure done has, in essence, already been made.
Location, Location, Location It’s for this reason Cigna embedded its cost, quality and comparison capabilities in the provider directory – to have the pertinent information in the right place at the right time. Otherwise, for the most part, a consumer finding the best and most cost efficient health care professionals can be largely hit or miss. By integrating cost, quality and alternatives information into every search for a doctor or service, we’ve seen an average of 15,000 visits to our tools each and every business day. Our approach of placing the right information how, when and where consumers want it was validated several years ago when we introduced a drug price quote tool into myCigna’s online formulary drug list of covered medications. For years, health plans had been seeking a way to ensure contracted physicians have up-to-date information on what drugs are covered – a need that has become even more acute as more plans offer different coverage according to drug tier (brand name preferred, non-preferred, generic and so forth.) Cigna made all the key pharmacy information available to customers on their mobile phones: what drugs are covered, in which tier, list lower cost generic equivalents and then do the math on potential cost savings at local pharmacies using real-time pricing. By making this information available to our pharmacy customers before they leave the doctor’s office, we’ve helped CDHP customers enrolled in Cigna Pharmacy Management, lower their costs by 14 percent compared to those in a traditional plan. How will this success translate to medical plans? Too early to tell, but according to a study by Thomson Reuters, about $36 billion could be shaved off the costs of our nation’s employer-based insurance plans when employees use pricing tools to select health services. And so what I see as a consumer’s right, is really a health plan’s obligation—to our clients, our customers and the communities we serve. If you are interested in seeing the new myCigna tools in action, visit: http://newsroom.cigna.com/images/9022/852406_myCigna_2012_ v36_640x360_FINAL.wm John Young is responsible for the marketing and sales of Cigna’s Choice Fund consumer-driven health plans.
www.TheIHCC.com I CDHC Solutions™ I March/April 2012
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Those who can, do. Those who can’t, imitate. (or try to) Self-funded benefits administration is not simple
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By Justyn Harkin Communication Specialist The Jellyvision Lab
Health Plan Communication
Ten Steps for Beating Benefits Bewilderment
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n its ninth annual Study of Employee Benefits Trends, insurance, annuities and employee benefit programs provider, MetLife discovered 55 percent of surveyed employees do not consider their benefits materials clear or comprehensive. And if that weren’t depressing enough, there’s a good chance the other 45 percent didn’t understand the question. Facing giant stacks of complicated charts, baffling legalese, and choices that simply don’t apply to them, employees spin out into a state of benefit bewilderment, where they put off important benefits decisions, or worse, choose options that might not be the best for them. Fortunately, there are 10 easy steps any organization can take to help improve their benefits communication efforts: 1. Replace “benefits talk” with plain English. Jargon like “qualified dependents of benefits-eligible employees” only creates confusion. Instead, just say “your family.” If you absolutely need to use technical terms, provide a simple glossary so your employees will know what you’re talking about. 2. Take a look at your plan names. Can they be shortened? If you can turn something like “InsurCo Active Lifestyles High Deductible 2500 PPO Access Freedom Plus” into the much easier-to-read “PPO,” then do it. 3. Consider paring down your benefits buffet. Do you need more than one dental or vision plan? Without a solid decision support tool to crunch the numbers, your employees likely have no idea which of the multiple plans best fits their needs. 4. Present information in a way people can read. If you saw a hat with a price tag saying $5.13/8.45/9.73/13.64, you’re probably not wearing that hat home. Don’t expect your employees to understand how to read premiums this way, either. 5. Don’t subject employees to confusing charts and graphs. If you can’t figure out the gist of a chart in just a few seconds, it isn’t simple enough. 6. Summary plan descriptions are scary and huge. You don’t have to get rid of SPDs altogether, but providing employees with a simple, one-page overview of key plan highlights will make things easier for them and for you.
If your employees can’t understand their benefits options, there’s no way they’ll be able to make informed choices that best suit their health care needs.
7. Have a writer—not a lawyer or benefits expert—craft your communications. He or she can do wonders for eliminating jargon and explaining things in simple ways. And when the lawyer and benefits expert try to revise it back into the original incoherence, be sure to protect your writer’s efforts. 8. Provide interest-specific meetings during open enrollment. Don’t try to tackle everyone’s needs in one long session. Instead, let employees attend the meetings that are relevant for them. With sessions like “The Basics for Singles” and “The Basics for Families,” you’re bound to have more engaged attendees. 9. Create an email helpdesk for benefits questions—this allows employees to ask their questions when they have them, but be sure that whoever staffs the helpdesk always provides a reply within 24 hours. 10. Provide an online portal for FAQs and additional benefit details. This makes things easier for mobile employees, and gives on-site employees a way to share information with their families.
If your employees can’t understand their benefits options, there’s no way they’ll be able to make informed choices that best suit their health care needs. Taking simple actions like the ones above can eliminate benefit bewilderment, reduce the strain on your organization during open enrollment periods, and leave you with happy, engaged employees who understand and value the benefits your company provides. Justyn Harkin is a communications specialist at The Jellyvision Lab, providers of ALEX™, the Jellyvision Benefits Counselor, a virtual, cloud-based human resources personality who effectively eliminates mundane, and often confusing, benefit communications.
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Getting Its Game On
Wellness
Chilton Hospital uses Innovative Online Product to Promote Employee Wellness
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merica spends an estimated $2.4 trillion on health care annually, according to the U.S. Centers for Disease Control and Prevention (CDC). And employers are picking up a sizable share of the tab. Faced with rising insurance premiums, lost productivity and other liabilities associated with absenteeism, organizations simply can’t afford to play games when it comes to employee wellness. Unless, of course, playing games actually works. Chilton Hospital, a non-profit commu-
nity hospital with 1,450 employees and more than 630 physicians, has embraced a new approach to workplace wellness, tapping into gaming, social networking and a little friendly competition. A good idea for the office? I wasn’t sure either… until we experienced some rather encouraging results. Last March, Chilton introduced an innovative online tool created by Keas, a San Francisco-based health and wellness company. The unique program engages employees in a playful yet powerful way, while ultimately improving healthy behaviors, lifestyles and outcomes. Right off the bat, 37 percent of the hos-
By JUlie MCGoVern, sPhr ViCe President oF adMinistration/ HuMan resourCes Chilton hosPital
pital’s eligible employees registered for an inaugural “100 Days to Health” challenge. Seventy-nine percent of employees participated, and nearly half of them stuck with it. In just 12 weeks the players collectively shed 1,230 pounds and recorded 1,274 extra days of exercise. Furthermore, 73 percent of those employees reported feeling more positive toward Chilton and 64 percent thought the initiative made them more productive at work. www.TheIHCC.com I CDHC Solutions™ I March/April 2012
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Captured your attention? Mine, too. Although it’s still too early to determine if these statistics translate into reduced health expenses, I believe Keas is a potential game changer when combined with other elements of a comprehensive corporate wellness program.
Chilton’s Commitment to Wellness Workplace wellness is nothing new at Chilton Hospital. As one of the region’s major health care providers—and largest employers— the hospital has maintained a longstanding commitment to health promotion. Located in Pompton Plains, N.J., at the crossroads of Morris, Passaic and Bergen counties, Chilton is a 260-bed, fully accredited acute care hospital, serving more than 160,000 patients across 33 communities. With a focus on personalized, compassionate care, the hospital provides a full continuum of advanced, state-ofthe-art medical, outreach and wellness services. The hospital’s mission offers a unique perspective. Alongside the escalating health care costs facing all businesses, Chilton has a front row seat to the effects of illness and chronic disease, such as diabetes, obesity, high blood pressure and heart disease. We also know many of these conditions can be averted or effectively managed through lifestyle and behavior modification. That’s why Chilton Hospital is staunchly dedicated to programs that educate and empower people to take charge of their health. And where better to start than with our own staff. Recognized by the American Heart Association as a Fit-Friendly institution, Chilton promotes a culture of wellness and physical fitness for its workforce. In fact, the hospital established a committee exclusively dedicated to developing creative wellness solutions. Comprised of representatives from Food and Nutrition, Human Resources, Occupational Medicine and various other departments, the group has spearheaded and supported many successful wellness activities. Importantly, our corporate wellness program features a diverse range of components, including: • Lights Out – Chilton offers a completely smoke-free environment. • Our Best Feet Forward – Chilton built a walking trail around the main hospital campus, launched walking and hiking clubs, distributed free pedometers and encouraged participation in charity walks.
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• Play Ball – Our workforce expressed an interest in sports teams, so the hospital is organizing a softball league this year. • Vital Signs – Recognizing the importance of health risk assessment and monitoring, Chilton started the “Do You Know Your Five?” program, which helps employees identify and track BMI, cholesterol, blood glucose, blood pressure and weight/waist measurement. • Eat Well – Chilton offers many healthy options in the employee cafeteria while educating employees about nutrition, healthful cooking and portion control. • Fitness & Wellness Classes – From yoga to zumba, employees may join a variety of fitness classes, as well as programs for weight loss, smoking cessation, stress management and other key health issues sponsored by the hospital. Keas’ online game is the newest—and most unique—addition to Chilton’s employee wellness initiative. Opportunity came knocking last spring when the hospital was invited to participate in a pilot program orchestrated by the local chamber of commerce. Keas is completely different than anything the hospital had tried before, and presented an intriguing way to engage the entire workforce. So Chilton joined companies like Pfizer, Quest Diagnostics, Novartis and six others willing to “play.”
Keas Promotes “Power of Play” Keas was developed by the company’s co-founder/CTO Adam Bosworth, also architect and former head of Google Health. From his perspective, most individuals can improve their health by achieving four basic goals: eating better, sleeping better, relieving stress and exercising. The biggest obstacle, he says, is motivation. And that’s the idea behind Keas. Bosworth turns getting healthy—and staying healthy—into an online game that harnesses social media, team building and competition. The company co-founder describes it as “Facebook meets Farmville,” promising a system that’s simple and genuinely fun for employees. Most importantly, he points out, it works. Since 80 percent of chronic diseases are preventable through lifestyle and behavior change, according to the CDC, Keas focuses on nutrition, physical activity, stress management, cholesterol and weight management. The software suite essentially operates through an online social network that features games, quizzes and a Facebook-style newsfeed.
How does it actually work? The games begin with the formation of teams, which is an essential ingredient to what Bosworth calls his “secret sauce.” Keas’ research found participants are six times more likely to stick with the program if they’re part of a team that breeds accountability, support and positive peer pressure. Next is goal-setting, whereby individuals establish personal health goals and then earn points for tasks that help them attain those goals—such as eating less meat, walking 30 minutes a day, or joining a yoga class. They also rack up points by taking health quizzes or accepting a health quest. At the end of the challenge, players and teams with the highest scores are rewarded with cash or prizes, along with coveted “bragging rights.” One of the distinguishing features of Keas is its social aspect. The challenge is driven by online message boards, blogging and activities allowing employees to cheer on their colleagues— and compete with them. They can share healthy recipes, report accomplishments and encourage co-workers to bypass those cookies in the cafeteria. The system is designed to keep staff engaged in the Keas games—and hooked on improving their health.
Wellness
Game On… Chilton launched the Keas in March 2011 as part of the Morris County Chamber of Commerce “100 Days to Health” challenge. The 12-week pilot program was introduced with a multimedia awareness campaign, including emails, posters, brochures and a kickoff celebration in the employee cafeteria. The hospital invited all staff, physicians and board members to “play” and nearly 40 percent of the employees joined, forming 50 teams of about six people each. More impressively, of the 355 staff members who signed on, 79 percent logged into the program and 46 percent stayed active over the course of the challenge. The engagement level was more than twice the industry norm and slightly higher than the average of other participating companies. The results? Some were measurable, some weren’t, and others remain to be seen. But overall, the preliminary outcomes are promising. Several quantifiable findings are worth noting, particularly with regard to health risks and behaviors. More than 90 percent of participants indicated they improved at least one health characteristic as a result of the program, including the following: • Weight Loss: 114 of 335 respondents reported a total of 1,230 pounds lost • More Fruits and Veggies: 57 of 130 respondents reported 8,918 extra servings • Increased Exercise: 52 of 130 respondents reported 1,274 extra days of physical fitness Evaluations also provided data regarding employee feedback. A vast majority of registrants—more than 70 percent—came away from the challenge with more positive feelings about Chilton, and nearly that many thought the experience improved their workplace productivity. Independent from the Keas tracking, Chilton’s annual employee survey revealed a seven percent jump in employee satisfaction; we believe the Keas experience contributed to that increase.
Additionally, Keas inspired valuable fringe benefits, such as increased morale, teamwork and camaraderie. Clinicians teamed up with administrators and support staff, building relationships across all shifts and levels of the organizations. There was a palpable energy in the hallways, as employees discussed winning strategies and pumped up their teammates. And there were undeniable signs of a healthier culture, as more employees walked outside during breaks, toted carrots to meetings and gained newfound appreciation for the stairs.
Employee Buzz Chilton employees had a lot to say about Keas and the “100 Days to Health” challenge. In fact, they posted more than 6,000 comments to the newsfeed. Furthermore, some viewed the experience as far more than a “game changer,” but also a life changer. Radiology Administrator Christopher Synol challenged himself to lose weight; now he’s 15 pounds lighter. Calling Keas an “electronic trainer,” the program motivated him to make smarter choices—especially in the employee cafeteria. “I passed on the burgers and pizza, and chose more fruits and salads,” he says. Synol also paired up with a colleague to start a hiking club. About 20 Chilton employees joined them for weekend outings. “Keas was fun… and definitely put me on the right track to better health,” adds Synol. Pat Ledford, director of health information management, also embraced the challenge. Not because she wasn’t already taking steps to improve her health, but because she hoped Keas would inspire co-workers to do the same. Over the past five years, Ledford gave herself a “health makeover,” losing 42 pounds and adding “boot camp” to her fitness routine. “Keas was a great way to share my interest with everyone else… to get people moving and paying attention to what they ate,” Ledford says. “I blogged every day, sometimes twice a day. Keas also helped me energize my personal goals.” Another Keas fan is Jill Irwin of Information Systems, who learned that small changes in
lifestyle add up, and can have a big impact on health. “I walked outside during lunch instead of eating at my desk, and took the stairs instead of the elevator,” Irwin explains. “Five flights of stairs can be a good workout.” At the end of the challenge, Irwin toned muscles, lost weight and developed new friendships at work.
Looking Ahead Clearly, Keas proves that games can be productive, even in the workplace. I’m not suggesting that Keas offers a total wellness solution, but I am confident it can complement a thoughtfully constructed corporate health program. Looking ahead, Chilton will expand the Keas initiative in 2012—with improvements from lessons learned. For instance, the hospital discovered employees were much more interested in competing with their co-workers than employees from outside companies. So we’ll keep the challenge in-house. We’re also working with Keas to enhance the points and incentive structure. (Our staff wanted the prestige more than the money.) And we’ll explore options for altering the length and frequency of the health challenges; perhaps we’ll offer two shorter challenges to sustain motivation. Of course we’ll also be following longterm impact. Keas enables users to track results over time, including engagement, activity levels and health results. Our hope is that Chilton’s investment in Keas—and our employees—will lead to less unscheduled absenteeism, reduced turnover, increased productivity and lower health care costs. Ultimately, Chilton Hospital’s goal is a healthier, happier workforce, along with a healthier organization. If Keas can help us achieve that, we’re certainly in the game… and everyone comes out a winner. Julie McGovern, SPHR is vice president administration/human resources for Chilton Hospital in Pompton Plains, N.J. She has extensive human resource experience in health care and is the author of The Happy Employee, Adams Media.
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CDHCS312
Putting the Employee in the Driver’s Seat of Your Health Plan
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f there’s one key to success with consumer-driven health care, it’s the driven consumer. Employers are increasingly adopting the idea their employees, who have long been considered consumers outside of their benefits programs, should decide how to spend their own health care dollars—largely because it has become a proven best practice for curbing escalating costs. Health care costs are expected to rise by 8.5 percent this year compared with an increase of 8 percent in 2011, according to PricewaterhouseCoopers’ Health Research Institute. As a leading benefits administrator, Ceridian discovered two-thirds of its large-employer customers fought back in 2011 by offering a high-deductible health plan with at least one personal tax-advantaged account—either a health savings account (HSA), a health reimbursement arrangement (HRA), or a flexible spending account (FSA). More employers are expected to follow suit this year. “Many of our customers have overcome the perceived barriers to health care consumerism,” said Bart Valdez, executive vice president and general manager of Ceridian U.S., and previous head of Ceridian Benefits Services. “What they’re ready for now is that next level—where the true business value of health care consumerism emerges through savings, productivity and a culture of health.”
cOnsUMeRisM “Many of our customers have overcome the perceived barriers to health care consumerism. What they’re ready for now is that next level — where the true business value of health care consumerism emerges through savings, productivity and a culture of health.” Bart Valdez, executive vice president, general manager, Ceridian U.S.
Employer Trends Like it or not, employers are now, by default, in the business of health. As employers continue to navigate the complexities and uncertainties of the Patient Prevention and Affordable Care Act (PPACA), health care consumerism seems to be the legislation’s agreed-upon bright spot, whether or not the law is defeated in court or at the ballot box. Innovative employers are moving forward with strategic benefits program changes rather than waiting to see what happens. From defined contributions to full-replacement plans to wellness promotion, prevention and management, a range of advanced plan designs are being implemented around the promise of consumer-directed health care (CDHC). But if we’ve learned anything over the past 30 years—during which time we’ve witnessed the introduction and underutilization of FSAs—it’s this: Health care consumerism succeeds in significantly lowering health care costs only when employees are truly engaged in their plans. Employee engagement has long been a top business challenge. Employers are beginning to understand that engaging employees in their health care requires a new kind of relationship, one built on
By ernie harris senior ProduCt Manager For CdHC CeriDian U.s.
communication and trust, with the employer clearly defining the goals of the partnership. “We’re working to prepare our employees to move into a different world, where employees are engaged in their health and their health plans in a very different capacity than they were when we introduced managed care networks and people got comfortable in the world of copays,” said Brenda Stevenson, benefits operations manager for L.L. Bean Inc. By almost any standard, L.L. Bean, celebrating its centennial this year, has been successful. “This year was the first year in our history that we did not pass along premium increases for health insurance to our employees,” Stevenson said. “It was an exciting milestone for us, and we attribute that to active engagement of employees and their families.”
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Employers just embarking on their health care consumerism journey can benefit from the successes and best practices of early-adopters like L.L. Bean, as well as partnership opportunities and recent market innovations. Benefits consultants, coalitions and vendor partners can help employers take advantage of valuebased benefit design, health activities programs, incentive and wellness initiatives and promising technologies such as mobile applications. “Mobile is definitively on the rise, and this technology is well aligned with CDHC,” said Kory Erb, CEO and COO of Axcept Media, an interactive and mobile communication company specializing in health care. “Consumers have realtime access to their accounts—whether in their cars or at a provider’s office. Employers should recognize their health plan designs will need to allow for the use of technology. That’s just the way health care will be.”
Bridging the Gaps While more employers are viewing consumerism as a solution to their health care cost burdens, employees themselves are far from engaged in health care consumerism. According to Zillow, the average person spends 40 percent more time purchasing a pair of new shoes than selecting their health plan. There may be good reasons for that: navigating a very complex, fragmented and difficult-to-access health care delivery system is daunting. Lack of time and money also are contributing factors. Since high participation in consumerdriven plans is essential for reducing taxes and improving employee health and productivity, an employer’s success in generating maximum savings depends on it. According to the Centers for Disease Control and Prevention, 50 percent of a person’s health status is a result of their behaviors. The goal for employers is to motivate employees to be more willing to change unhealthy behaviors. However, forcing employees to be responsible for their health and health care spending doesn’t work. It often results in under use of necessary services and lack of participation in treatment regimens. Rather than containing costs and improving health, the opposite occurs. “So where do employers begin?” asks Jeff Bakke, chief strategy officer at Evolution1, a provider of innovative CDHC technology. He believes successful engagement is all in the planning … or rather, the plan—literally. “Employers need to realize that it takes more than one year to achieve results,” Bakke said. “Ceridian’s continuum model outlines a multi-year business strategy, and this is critical in building a successful CDHC program. There are 38
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a lot of things employees will need to learn about and adapt to, from the complex consumerism concept all the way down to the technology supporting these plans.” By taking small steps toward a long-term plan to build engagement thoughtfully into the plan design, the entire organization—from senior management on down—moves toward creating a healthy workplace environment and a culture of health.
Rules of Engagement One of the biggest mistakes early adopters of CDHC made was implementing their programs without first putting employee engagement strategies in place, said Doug Field, CEO and founder of The Institute for HealthCare Consumerism. “What those companies learned was that it’s all tied together around engagement, incentive and discipline programs,” Field said. “Those programs are the centerpiece.” Today, companies are putting this knowledge into practice. But if engagement lies at the center of health care consumerism, employee education is what keeps it in place. HSBC Bank, a Ceridian customer with more than 24,000 U.S. employees, formed an engagement strategy that included consolidating its health plan offerings, providing lucrative contributions to employees’ HSAs and FSAs, and educating employees face-to-face about their health care options. “We have many employees ask in regard to high-deductible health plans, ‘Why would I choose to spend $3,000 out of pocket?’” said Chris
Hunt, vice president of benefits administration for HSBC. “So we ask them, ‘How much have you spent on health care in any other year?’ and explain the concept of CDHC, and you start to see the light bulb go on.” HSBC already has more than 37 percent of its workforce enrolled in a high-deductible health plan, paired with an HSA just three years after incorporating these plans into its offerings. In general, employees say they do not receive enough information regarding health benefits, according to a November 2011 survey by the Midwest Employee Group on Health. Employees and their spouses respond to clear, relevant, concise communications on benefits coverage and options, out-of pocket costs and descriptions of benefit changes. When Ceridian created its ParticipationPLUS program two years ago to provide complimentary FSA communications and planning tools to employers and their employees, it noted that customers who used it increased their plan participation rate between 6 and 8 percent. Stevenson, with L.L. Bean, says employee communication is by far the biggest challenge, yet the payoff can be significant. “What’s amazing is that in 2012, 36 percent of our employees are voluntarily in a plan that qualifies as an HSA-compatible plan, without any company contribution,” Stevenson said. “I think we’ve been successful in helping employees understand there are opportunities to contribute some of their premium savings into health savings accounts and, depending on their utilization, to save money.” Also, L.L. Bean requires active employee
benefits enrollment every year, which, Stevenson said, keeps their employees’ attention when changes occur. This enabled better communication with employees when the company moved away from copay plans. “In 2009 we were getting ready to eliminate our copay plan,” Stevenson said. “Working with our Ceridian team, we communicated to our employees that we made a conscious decision to default people into a PPO plan with a deductible, but they had the choice to come back and elect a copay plan if they wanted.” Texas Instruments (TI) also found communication to be fundamental to fast employee adoption of CDHC plans. The company first offered a high-deductible health plan (HDHP) to its more than 16,000 U.S. employees in 2011, alongside Preferred Provider Organization (PPO), Exclusive Provider Organization (EPO) and Health Maintenance Organization (HMO) plans. In the first year, 27 percent of eligible employees migrated to an HDHP. By year two, participation increased to 36 percent. “One of the ways we achieved such results is we held numerous on-site meetings with employees,” said Neisha Strambler-Butler, manager of health benefits, work-life programs and HR administration for TI. As an incentive, the company also offered employer contributions: $500 for employee coverage only, $1,000 for family coverage. Strambler-Butler said when asked, “What most influenced your enrollment decision for 2011 benefits?” almost 30 percent of the 972 employees, who responded, answered “premium costs.” Just more than half that many, 16 percent, said the “employer contribution” had the greatest influence. HSBC, currently in its third year of its CDHC program, also offers employer contributions to increase participation. “When you introduce plan designs that ask employees to take more of the burden of costs, there has to be an incentive for them to move there,” Hunt explained. “We feel that the contributions to the health savings accounts are the most effective and well-received.” As a further incentive toward wellness, HSBC also offers a 20-percent premium discount for those who are tobacco-free or agree to quit. Ceridian customer MacLean-Fogg Company, after more than 10 years of offering an FSA alongside its traditional health care options, recently implemented an extensive integrated wellness program to boost the effectiveness of its CDHC program. “In addition to education efforts around how to best use FSA and HSA dollars, we now conduct biometric screenings and health risk
assessments, tailor wellness programs to each location’s health challenges, offer lower health insurance rates and HSA contributions for participation and have on-site nurses for wellness coaching,” said Tim White, MacLean-Fogg’s corporate benefits manager. As a result, MacLean-Fogg already achieved 70-percent participation in its wellness program in this first year and is confident it will achieve a quick return on investment.
Healthy Employees, Healthy Companies Just as plan changes are best introduced gradually and with frequent communication, efforts to change employees’ behaviors are best introduced through a series of small steps, aligned with organizational priorities. Employers should progress from long-term planning to improving employee awareness to boosting participation and outcomes. In other words: engage, educate, incent and drive.
Engage When you plan your engagement strategy, work backward from your desired outcome to the steps that will take you there. Ask questions like: • What do we want to accomplish? • How does this relate to the organization’s goals? • How will we measure success? • Whom do we need to reach? (All or selected employees? Family members?) • What steps will employees need to take? • What information/tools will employees need? Make sure you measure engagement where you can, through employee surveys or other means. “One of the things that L.L. Bean did just the past year for the first time within the Ceridian enrollment system was to embed three questions at the end of the enrollment process,” Stevenson said. “We asked questions about their experience with the information and what tools did they use that we made available to them, and what they found most valuable.” Then, plan in a post-enrollment evaluation within your benefits team, in which you discuss the following year’s plan enhancements.
Educate As you develop your engagement programs, be sure to use a shared language to foster a shared understanding. Always refer to things the same way, preferably skipping the jargon and industry terminology, and don’t assume a certain level of understanding. Start from the beginning, and explain yourself.
Provide only what’s relevant to different employee groups through personalized communications focusing on the health status of the employee and their readiness to change. Use testimonials and stories to prove the value of CDHC to the consumer. Always answer the question, “What’s in it for me?” and, where family involvement is a factor, get the message to the home. Consider postcards. “Be as upfront and transparent as possible,” Hunt, of HSBC, said. “We knew that we had to provide as much information not only about the plan, but why we are making the changes. By letting employees know the why and not just the what, they became more involved in the overall process.”
Provide Incentives “I would urge the employer to contribute at least some funds to employees’ CDHC accounts,” Bakke of Evolution1 said. “The employer contribution is really the No. 1 incentive for participation and engagement in the plan. Even a small amount has a dramatic impact.” Monitor your data around incentives. Are people using their accounts for current expenses, or are they saving for the future? Also, gather data around the claims experience. If you see a reduction in expenses, is it due to the cost share with employees or a reduction in services? You don’t want employees delaying treatment because of cost.
Drive If there’s one secret to driving engagement, it’s communicating to employees in person. “It became more obvious that face-to-face conversations were necessary in the process to add the ‘human factor,’” Hunt said. “It is absolutely necessary for this to occur at some point in the process in order to be successful. Finally, don’t do it alone. If internal resources are limited, have vendors send communications directly to employees. Request vendor collaboration to integrate related messages. The future of health care consumerism is about engaging employees and other stakeholders in new relationships that foster a culture of health. Use whatever means you have available to begin forging those relationships. Ernie Harris is the senior product manager for Consumerdirected health care (CDHC) for Ceridian. Over the course of his 24-year career, he has served in product management roles for Raymond James, Baltimore Gas & Electric and TDAmeritrade. As an emerging thought leader on consumerism in health care, Harris is focused on how employers can best deploy their benefits resources to meet the often competing goals of offering world class health care benefits and maintaining strong balance sheets. www.TheIHCC.com I CDHC Solutions™ I March/April 2012
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Data Analytics
Turning Mountains of Data into a Functioning Strategy for Self-funded Employer Benefit Plans
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ost businesses have piles, mounds and even mountains of data within the organization. The challenge is to gain access to and organize all this data in a way that transforms it into actionable management information. Unified Group Services (UGS), an Anderson, Indiana-based third party administrator (TPA) for self-funded employer benefit plans, faced this situation. The task was to transform this disorganized mass of numbers and raw data from clients and reconfigure them into useful data UGS clients can use when developing a comprehensive employee health plan. Through diligent work, and a partnership with Benefit Informatics, UGS was able to accomplish its goal, and in the process, help its clients save time and money, which was good for everyone’s bottom line. “From our first meetings with UGS, our relationship has been more of a partnership than vendor-customer,” said Brian Hubbard, technical operations director at Benefit Informatics. “We have worked very closely with Rich [Mousty] and Andrew [Eller] to provide a seamless reporting and analysis platform that could be deployed internally and externally to customers and affiliated brokers.” The partnership between UGS and Benefit Informatics, a health care data integration and analytics company, has played a key role in the growth of UGS, which started from humble beginnings and has become one of the larger full-service TPAs in the Midwest. UGS was created in the sunroom of Co-founder and President Rich Mousty’s home. He, along with Co-founder and Executive Vice President Faith L. Hailey, had become disillusioned by changes created by the new owner of their previous company, So the two rekindled their entrepreneurial spirit and thus UGS was born in 1996.
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Mousty discovered a previously untapped market, providing administrative services to employers, who are self-funding their employee benefits package. UGS experienced a steady growth from the start. Eight years after its creation, UGS’s operations had out grown the sunroom in the Mousty house, and in February 2004, the company relocated to a new 13,000 square foot facility. By 2008, the company had added 9,000 square feet to its existing facility in order to provide space needed for current and future growth. With more and more employers moving to self-funding, demand for UGS’s services continued to grow. Applying a straight-shooting, no nonsense approach to the business, Mousty and UBS continued to increase both market share and revenues in a very competitive market. Client retention and customer service has been the hallmark of the company. From a startup with less than 20 employees and a few self-funded clients, UGS has grown to more than 150 clients and nearly that many employees. TPAs are challenged to balance fast and effective claims administration and customer service with accurate and timely reporting of health plan activity to clients and their broker/consultants. UGS had relied on its claim adjudication system and a variety of standard and custom reports developed in other programs in order to report back to clients. This process was acceptable for a small TPA operation, but with in excess of 100 clients and more than 50,000 members covered and their affiliated brokers requiring plan utilization and reports, UGS, was experiencing growing pains and required a new solution. “We needed to upgrade this
function with a more efficient solution that allowed us to provide both standard and ad-hoc or customized reports to our clients and brokers,” Mousty said. “We evaluated a number of options before selecting Benefit Informatics.” In choosing Benefit Informatics for its health plan analysis and reporting solution, UGS was impressed with the flexibility and timely access to claim information and the easy-to-access format in which the information was presented. The ability to schedule reports within the system and then make them available in a secure environment using the Connect service was another attractive aspect of Benefit Informatics. “We chose to partner with BI for a very specific reason—client reporting,” Mousty said. “We have been amazed with how flexible and valuable their system has become to our business,” UGS provides an array of standard monthly reports, along with customized sixmonth and annual reports utilizing Benefit Informatics. UGS clients demand a great deal from their administrator, and in turn, UGS demands a great deal from Benefit Informatics, and the health care data integration, warehouse,
By Chris Metcalf
analysis and reporting company, based in Jenks, Okla., has been more than willing to assist the former startup company. “Andrew [Eller] and other users at UGS have played an important role in giving us feedback and direction in providing a comprehensive data analytics solution for all of our customers,” Hubbard added. “They have pushed us to develop better applications and reports and enhance the data coming into the data warehouse. We have both benefited from our relationship.” Because Benefit Informatics receives a regular daily upload from UGS, the information available to UGS personnel and approved employees of UGS clients and their brokers is near real-time. This level of integration provides UGS clients with a comprehensive view of their claim activity and overall health plan costs. “We are able to give our clients and brokers electronic access to their claim information, whether it has been scheduled to run or if they want to access the system and create reports and analysis for specific needs,” Mousty said. “And because BI’s system provides plan analysis, we are able to use it to create plan models to help our clients design a health plan that best meets their needs.” Special requests from clients and broker/ consultants also are handled much faster than before UGS partnered with Benefit Informatics. When a broker called recently asking for multiple reports on a particular client, he asked to have the information within a couple of weeks. UGS provided the reports along with additional information within a couple of hours utilizing Benefit Informatics’ data analysis and reporting resources.
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Marketing and Communications Director
One of the ways we measure a TPA is by looking at the TPA’s relationships with their brokers and selffunded clients. Unified is able to maintain strong and very long lasting relationships with their self-funded clients. Integration into UGS business operations and deployment strategies has been another key aspect of Benefit Informatics. UGS personnel from a number of departments can access health plan information to assist clients with customer services, wellness, renewal, stop-loss disclosure and other needs. UGS also is able to integrate a variety of external systems utilizing Benefit Informatics, including single sign-on and automated data feeds. “We didn’t know how much we would use BI for data analytics and other needs,” Mousty said. “We are able to utilize it in so many ways and customize the information for each client. Benefit Informatics is an important tool for our deployment plans and our strategic marketing. They are a partner in our success.” Despite a lengthy recession and a stagnant economic recovery, UGS has continued to grow. In less than 20 years, UGS has gone from a twoperson startup project to employing more than 100 people, servicing more than 130 customers in 30 states, and processing more than $420 million in health care claims in their 22,000-square-foot facility in Anderson. Despite all the growth, UGS has stayed true to its core value of providing great customer service in all aspects of business operations. In the ever-changing world of health care and economics, UGS is dedicated to providing employers with the services and tools needed to control employee health benefit plan costs. UGS is committed to using
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Benefit Informatics
cutting-edge technology, such as that provided by Benefit Informatics and other proven partnerships, to give clients information and services that enable them to control expenses while offering top-of-the-line benefit programs. These services are delivered with timely and careful attention to every client, providing each individual with personal service through an experienced and professional team. But a mission statement has no value if it is not reflective of the actual actions of the company; therefore, UGS is dedicated to training each employee and instilling these principles in the company culture so it mirrors the ideals upon, which UGS was founded. Mousty’s strategy appears to be working, according to Derek Cox, executive vice president of Perico Life Insurance Co., a Delawaredomiciled life insurance company operating on an admitted basis throughout the United States and a market leader in group life, accident and health insurance. “Perico Life Insurance Company has had a longstanding terrific professional relationship with Unified Group Services,” Cox said. “One of the ways we measure a TPA is by looking at the TPA’s relationships with their brokers and selffunded clients. Unified is able to maintain strong and very long lasting relationships with their self-funded clients. The brokerage community also holds Unified Group Services in the highest regard. Unified has also continuously searched for and implemented many claim control measures through their cost containment and PPO vendors. By doing this, the self-funded client benefits with both a reduction in their claims expenses and, as a result, their stoploss premiums and factors. We look forward to dealing with Unified Group Services for many years to come.” Additionally UGS was honored last month by being named a Blue Ribbon Small Business Award winner by the U.S. Chamber of Commerce. UBS was one of 75 companies from across the United States earning recognition for its dedication to the principles of free enterprise and its contributions to restoring jobs and prosperity. “In our entire history, we have never laid a worker off due to downsizing. We are very blessed to have several of the employees we hired during our first year still working with us,” Mousty said.
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NOMINATE & RECOGNIZE INNOVATIVE HEALTH & BENEFITS MANAGERS
Do you know someone who goes the extra mile? A health and benefit manager who is a creative problem solver and innovator We’re looking for the industry’s true superstar—professionals in health care and benefit management, including: solutions providers, brokers, tpas, employers, benefits coordinators, and HR managers, who have excelled at implementing solutions to complex health care benefits issues. Superstars to be published december 2011 and will be accessible to more than 70,000 readers.
NOMINATE A
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John J. Robbins Sr., Memorial CEO Leadership Award: to an outstanding leader of any size organization who is an exceptional businessperson, as well as a successful parent and pillar of the community. CEO Leadership Award: to an outstanding leader of any size organization, who embraces supports and endorsed an innovative health care or benefits program. Most Innovative Plan Design Award: To an HR/Benefits executive who identified and solved a problem using an innovative health care or benefits program. Most Effective Plan Implementation Award: To an HR/Benefits team that successfully implemented a health care or benefits program and exceeded goals or reaped unanticipated awards. Most Innovative Employee Education/Communication Award: to an employer, who designed and implemented tools for their employees that exceeded plan participation.
500 - 2500 employees
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Most Innovative Employee Empowerment Award: to an employer, who designed and implemented tools that had a high engagement of employee participation in a health care or benefits program. Most Effective Population Health & Wellness Award: to an employer who uses the most innovative method to reduce absenteeism and chronic disease costs to improve overall employee health. Public Policy Leadership Award: an individual who encourages health care consumerism in public policy through legislation. Most Effective Solution Provider Award: to a solution provider who introduces the most innovative health care or benefit solution. Most Innovative Partner-Consultant Award; to a consultant who worked most effectively with an HR/Benefits team to implement a health care or benefits program. Most Innovative Broker Award: to a broker, who learned a client’s needs and provided the most effective solution for the employer.
Nomination Categories: 2501 - 7500 employees
7500+ employees
For details, please visit www.ihcc.com. Nominations open April 1, 2012. Magazine publishes December 2012. E-mail your Superstar nomination to nominations@fieldmedia.com or nominate online.
Ask The Broker
By Alex Tolbert Team Member Bernard Health LLC
Getting Employees Educated, Engaged About HSA Enrollment
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re you considering offering a health savings account-based health plan to your employees? Do you already offer one, but don’t have the participation you’re looking for? At Bernard Health, we have built an industry-leading track record by helping our clients achieve an average, first-year employee health savings account (HAS) participation rate of 81 percent. Here are five tips from what we’ve learned along the way!
“copay plan.” If you have one plan called the “HSA plan” and the other called the “copay plan,” then you are doing a better job of naming your plans in a nonpejorative, meaningful way. This also has a huge impact on enrollment success.
4. Choose one bank to be the custodian for all of your employees’ HSAs
Don’t just tell employees they are “on their own” when it comes to getting their HSA opened. Work with a bank that will make it easy for all your employees to get their HSAs opened at the same time, and with minimal effort. 1. HSAs’ purpose is to equalize the tax treatment of A bank like this may charge a monthly insurance and cash fee of some sort for the HSA (something in the It is easy to get dragged “in the weeds” If you have a disjointed process $2 - $3 range is typical), but that incremental quickly when researching HSAs. From a high cost can really be worth it versus a bank that level, keep in mind their purpose is simply for getting the HSAs opened and has “free” HSAs but a disjointed on-boarding to equalize the tax treatment between health funded, employees aren’t going to process. Besides, if you are contributing to insurance and cash. Before HSAs, you could your employees’ HSAs, then your messaging to give your employees health insurance and be happy. Besides, you can always employees on this point can simply be that the write it off as a business expense, and your employees paid no taxes on the benefit. offer a second, “free” HSA in a future $2.50 monthly fee is coming out of what you are contributing on their behalf. Now, with HSAs, you and your employees year once everyone has a strong What makes an on-boarding process can do the same thing with cash. This takes “disjointed?” Ask the bank if they require a copy away the perverse tax incentive that favored understanding of the program. of each employee’s driver’s license in order to insurance over cash. get the HSA opened for each employee. If the answer is yes, be careful. Not all banks require 2. HSAs are different than this, and you want to work with one of the banks HSA-based health insurance that doesn’t. The HSA-based health insurance is Remember: you offer health benefits in part to what you pay premiums for to the health insurance have happy employees. If you have a disjointed process company. Having that type of health insurance is what for getting the HSAs opened and funded, employees allows you to have an HSA. Get your messaging right aren’t going to be happy. Besides, you can always offer a second, “free” HSA in around this point, or your employees will be lost. a future year once everyone has a strong understanding of the program.
3. Don’t call your other health plan the “PPO plan.” We see this all the time and it’s a big mistake. The term “PPO” refers to the network of providers available with a certain health plan. Historically, the opposite of “PPO” was “HMO.” If you call your non-HSA plan the “PPO plan” and then your other plan your “HDHP” or “high-deductible health plan,” many of your employees or their spouses will say, “Oh, well I definitely want the PPO network” and they’ll go no further in their analysis in taking your “PPO plan.” In doing so, they are assuming because of the way you’ve named the plans, the HSA plan is not on a PPO network. Of course, that is generally not true. Generally, both plans are on the exact same PPO network. Naming one of them the “PPO plan” is therefore pretty misleading. Instead, we suggest calling your non-HSA plan the “traditional plan” or the
5. Don’t charge less for the HSA-based health plan option Many employers “share” the HSA savings by charging employees less for the HSA plan. This is the wrong approach. Instead, you should charge employees the exact same for both your traditional health plan and your HSA plan. Then, share the HSA premium savings with employees by contributing to their HSA. This one tweak to your plan structure will have a tremendous impact on your enrollment success. Founded in 2006, Bernard was inspired by the need for a “most trusted advisor” in the face of increasing health insurance complexity. We work to achieve our mission to be the world’s most trusted advisor in this area through a unique mix of technology and personal touch. Find us online at www.bernardhealth.com or www.bernieportal.com.
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Stats & Data
Employers Struggling With Uncertainties of Health Reform Law
O
ver two years have passed since the Patient Protection and Affordable Care Act (PPACA) was signed into law, and many employers still remain puzzled about the effect the new regulations will have on the health care delivery system, cost, quality and employer-based model for benefits. With an election year under way and a Supreme Court having heard opening arguments on March 26-28 and a ruling still looming sometime this summer, employers are rightfully concerned with the future of employerbased benefits. In order to get into the minds of HR and business leaders regarding the future of the PPACA, Conner Strong & Buckelew conducted a health care reform survey with more than 75 individual employers. The survey was sent to employers in all industry segments, including commercial accounts and governmental entities. Most of the respondents are East Coast headquartered businesses offering comprehensive employee benefits to full-time associates. The survey focuses on how regulatory changes enacted in 2011 have already impacted employers, but the primary focus is on how HR and business leaders anticipate future mandates and changes will affect their businesses. Highlights of the survey results are below: • Some aspects of health reform already began to impact employers in 2011. Twenty-eight percent reported that health care reform added an additional six percent to their 2011 benefits plan renewal costs. Twenty-four percent reported that reform added between four percent and six percent to their 2011 renewal costs. • In anticipating 2012 budgets, 32 percent of respondents expected minimal increases attributed to health care reform. However, some
Incentives Typically Offered at Larger Employers Provide Incentives for Participating in Health Improvement Programs 78%
Yes
75%
38% 22%
25%
•
•
•
•
•
No
•
63%
62%
•
37% •
Mid-Market
Large
Jumbo
Total
Note: N = 146 Mid-Market (<5,000 employees) Large (5,000 – 15,000 employees) & Jumbo (15,000+ employees). Size based on number of benefits eligible employees in the U.S. Source: National Business Group on Health/Fidelity Investments Benefits Consulting, Employer Investments in Improving Employee Health Survey, January 2011.
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March/April 2012 I CDHC Solutions™ I www.TheIHCC.com
employers though otherwise. Twenty percent of respondents expected a larger increase related to reform. Much concern remains about both the short and long-term impact of the law. Fifty-two percent of respondents are concerned about their ability to offer benefits to their workers in the future. Uncertainty remains a constant when it comes to the law. Whether it’s the upcoming presidential election or the ongoing court battles, 44 percent say it’s still too early to truly measure the impact of the law, while 32 percent do believe it will have a negative impact on their business. In the end, 40 percent of respondents believe that Congress or the courts will not alter or revoke the law. Thirty-six percent believe changes may be made and 24 percent are unsure. In thinking about the future of their benefit plans, close to 50 percent of respondents are planning to make plan design/coverage changes to their benefit plans to contend with the impact of health care reform. Many of the major aspects of PPACA take place in 2014. Perhaps due to the uncertainty of the law or a lack of appreciation for the magnitude for the 2014 changes, 56 percent of respondents have yet to formally begin to plan for its impact. Come 2014, many employers will have to decide whether to continue to offer coverage or pay a penalty to the government. The issue has gained a good deal of attention as employers and plan sponsors have begun to calculate the cost of coverage versus the cost of the penalty. Some 60 percent of respondents have indicated they do not plan to eliminate coverage. Twenty-eight percent are still evaluating the matter in greater detail. In examining the issue of dropping coverage for workers, 96 percent of respondents say it is important to their business culture that they continue to offer benefits. Furthermore, 92 percent believe that if they did drop coverage, it would be received unfavorably by their employees. When thinking of the full impact of the law and areas of concern, sixty-eight percent of respondents are concerned with its anticipated new costs. Sixty percent indicated they were concerned with the many unknown aspects of the law while 56 percent said they were concerned with costs that insurance companies may pass along. In spite of the overwhelming information available about the law and its near-term impact, when asked if they had enough information to make important business and benefit decisions, some 60 percent of respondents said they did not. Sixty-four percent reported that their employees also did not understand the changes related to the law.
The impact of the law has forced organizations to engage senior leaders in examining its impact. Sixty-four percent of respondents report that c-suite level executives have been involved and engaged in making decisions related to the law. Yet, only 28 percent report having created a formal committee or process to review the impact of the law on an ongoing basis. The results of the survey show an employee benefits world that is struggling with the increasing reality of health reform. While some companies have already begun planning for major changes, many do not properly understand the ramifications of the law and have not yet begun preparing. To access the entire survey results, visit www.theihcc.com. â&#x20AC;˘
Health Care Reform Survey Have You Begun to Plan for the More Significant Changes Coming in 2014?
No, we have not yet begun to plan
56%
Yes, we have begun to plan I am unfamiliar with the changes coming for 2014
28%
16%
Most Companies Plan to Increase Employee Incentives in 2012 The survey also found that a small but growing number of companies are requiring employees to participate in health-improvement programs in order to be eligible for medical benefits. Last year, five percent of companies required their workers to complete biometric testing or be excluded from coverage. That number is expected to nearly double in 2012 to nine percent. Likewise, seven percent of companies required completion of a health-risk assessment last year. This year 10 percent of companies will require it. In 2011, incentives aside, the average employer spent $169 per employee on health-improvement programs in 2011, comparable to $154 in 2010 and up from $108 in 2009. While smoking cessation and Employee Assistance Programs (EAPs) are the most prevalent lifestyle-management offerings in the workplace, healthy cafeteria food options are expected to be introduced by 16 percent of employers this year. Currently, 51 percent of companies offer such choices. Among health-risk management programs, 11 percent of companies are planning to introduce health care advocates (who help employees find medical specialists and navigate the health care system). Currently, 46 percent of companies have advocates. Condition-management programs are expected to remain unchanged from 2011, with companies investing the most in managing conditions related to diabetes and asthma. With health costs rising each year, many innovative Related to Health Care Reform companies have found ways to better their employees Do You Feel Your Employees Understand the health and lessen the financial burden of health care. Changes Realted to Healthcare Reform? As the latest Fidelity/NBGH study shows, companies are increasingly realizing the efficacy of a properly designed 64% incentives program in changing behaviors and reducing health costs.
While companies are dealing with the difficulties associated with health reform, they are still finding a way to provide proper incentives for their employeesâ&#x20AC;&#x2122; health. According to a new survey conducted by Fidelity Investments and the National Business Group on Health (Business Group), most companies plan to increase the dollar value of incentives offered to employees in 2012. The survey is the latest in a series of studies Fidelity and the Business Group have conducted since 2009 to analyze the growth of healthimprovement programs in the workplace. These programs typically consist of condition-management services, lifestyle-management services and healthrisk management services. The survey found that almost three out of four companies used incentives in 2011 to engage employees in health-improvement programs and the average incentive value was $460. That figure has steadily increased from an average of $430 in 2010 and $260 in 2009. According to the study, employers used different types of incentives including cash, gift cards and contributions to health savings accounts. The majority (57 percent) agreed that incentive-based programs had a better than expected success rate at increasing employee participation.
No
36%
Unsure Yes
0%
www.cdhcsolutionsmag.com I CDHC Solutionsâ&#x201E;˘ I March/April 2012
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Briefs
People on the move
Continued from page 17
Numera announced appointments for two key leadership posts: Bill Reid as vice president, product development and Feroze Motafram as vice president, operations. The additions reinforce the company’s long-standing commitment to innovation, efficiency and performance as a leader and pioneer in health coaching technologies. Reid and Motafram are charged with the design and deployment of these technologies and services. Reid, who will be responsible for shaping the product vision and roadmap, comes to Numera following a successful 10-year career with Microsoft, where he managed development of strategic health products, including Microsoft HealthVault and Amalga. Motafram, who is a recognized innovator of supply chain management and new product introduction processes, will oversee supply chain management, supplier relations, provisioning and fulfillment. Prior to Numera, he was vice president of operations for Cardiac Science Corporation. William G. Bithoney, MD is joining the Health care business of Thomson Reuters as the national provider business medical leader. Dr. Bithoney comes to Thomson Reuters with considerable experience in health delivery. Most recently, he served as interim president and chief executive officer, chief operating officer, and chief medical officer at Sisters of Providence
CDHC Innovations
Blue Cross and Blue Shield of Georgia Takes AIM at Health Care Costs Blue Cross and Blue Shield of Georgia (BCBSGa) is pleased to announce the launch of an innovative program offering members a choice in selecting highquality and cost-effective imaging services. Using technology from American Imaging Management (AIM), this voluntary program will provide BCBSGa members with information to help them compare the costs and quality of imaging services that their health care provider has recommended. “This exciting project further reinforces our ongoing transparency initiatives,” noted Morgan Kendrick, president, BCBSGa. “The addition of AIM gives our members yet another way to receive the cost and quality information they need to make the best possible health care decisions for themselves and their families.”
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MSA Executive Search, the executive search practice of Integrated Healthcare Strategies, a national consulting firm dedicated exclusively to health care, announced a nationwide search for Eastern Maine Healthcare Systems (EMHS) concluded with the placement of Derrick O. Hollings as the new senior vice president, treasurer and chief financial officer. Hollings began his new post on April 9. In the new position, Hollings will oversee strategic and tactical matters relating to financial services, treasury, property management, and self-insurance programs. Responsibilities include oversight of support services that are provided across the system, and nearly 200 full and part-time employees.
UnitedHealthcare » Blue Cross Blue Shield » Univita Health
the Apple iPhone and iPad—and coming to the Android this spring—Health4Me brings important health information for people on the go. The free mobile app provides millions of UnitedHealthcare employer plan participants 24/7 access to a registered nurse, enables them to locate a nearby in-network physician, hospital or other medical facility and gives access to their personal health benefits information. An “Easy Connect” feature lets users select the type of questions they have about their claims and benefits, and request a callback on their mobile device from a UnitedHealthcare customer service representative. The app is available on Apple’s iTunes App Store as a free download for iPhones and other Apple devices such as iPads supporting iPhone apps. “Health4Me makes navigating health care easier for our 26 million plan participants and puts key information, including health and wellness tools, right in the palms of their hands,” said Jeff Alter, CEO, UnitedHealthcare Employer & Individual. “Today’s technology allows consumers to do more with their mobile devices, and Health4Me enables them to manage their health and interact with UnitedHealthcare in a way that is convenient for them.”
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Health System in Springfield, Mass., for three years. While there, Dr. Bithoney developed a budget plan to eradicate a $15 million budget deficit, ultimately helping the system become the most profitable community hospital in Massachusetts, while improving its risk-adjusted mortality rate. At Sisters of Providence, Dr. Bithoney’s team developed a model accountable care organization (ACO), which led to the system being recognized with the American College of Healthcare Executives (ACHE) 2010 Award for Most Outstanding Innovation in Health Care in the United States for its ACO.
Once a referral is made for an MRI and/or CT scan by a physician at a specific facility, members will receive a call providing them information on other in-network facilities offering the same imaging services, and how those facilities rank in terms of cost and quality so they can make an informed decision as to where they want to receive these services.
Univita Health Acquires All-Med Services Univita Health, a leader in providing home-based care management, has announced the acquisition of All-Med Services of Florida (All-Med) All-Med is one of the largest integrated providers of homebased care, exclusively managing more than one million lives. As a result of the acquisition, Univita will now support more than five million lives through its comprehensive approach to coordinating and managing care for health plan members, including the most complex and chronically ill. “Our unique home-based care management model that is based on the integration of home care and complex care management continues to demonstrate transformational value for health plans and other payors,” said Hugh Lytle, president and chief executive officer of Univita. “The addition of All-Med will allow us to expand that model, and grow into new geographical markets, even more quickly and effectively.” Since its founding in 1987, All-Med has partnered with major health plans as a single point of contact for managing all home care services, including skilled nursing, infusion pharmacy, durable medical equipment and respiratory services. Univita’s integrated care model focuses on the 30 percent of patients that account for approximately 90 percent of the U.S. health care spend. The acquisition of All-Med enhances Univita’s proven capacity to support growing high-risk populations, including dual eligibles, by integrating medical and non-medical care in the home.
www.theihcc.com
Who’s Who Profiles
Access these profiles online at www.TheIHCC.com and www.EmployersWeb.com Decision Support & Cost-Savings Tools
HSA/HRA/FSA Technology: Administration & Management
TSYS Healthcare 706.649.5080
www.tsyshealthcare.com healthcare@tsys.com TSYS Healthcare® provides end-toTSYS Healthcare end strategic payment solutions for 706.649.5080 consumer directed healthcare. We www.tsyshealthcare.com 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.”
My HSA Rewards allows individuals My Hsa Rewards to earn cash rewards for purchases 12460 Crabapple Road made through merchants Suite 202-254 participating in the program. Alpharetta, GA 30009 At launch, the merchant network consists of hundreds of major online 404.551.5543 retailers representing thousands of www.myhsarewards.com brands. The program works like an sanders@myhsarewards.com airline mileage program, but, instead of earning miles, participants earn cash rewards that are directed to a health savings account (HSA). There is no cost to the employer or the employee to join.
“If you want to grow your Health Savings Account faster and with ease, My HSA Rewards is a smart and simple way to put real cash into your HSA from the purchases you make every day.”
— Trey Jinks, Group Executive, TSYS Healthcare
— Sanders McConnell, President, My HSA Rewards
HSA / HRA / FSA Administration and Finance
Evolution1, Inc. 952.908.9056 www.evolution1.com sales@evolution1.com
Evolution1 and its Partners serve more than seven million consumers, making it the nation’s largest electronic payment, on-premise and cloud computing healthcare solution that administers reimbursement accounts, including HSAs, HRAs, FSAs, VEBAs, Wellness and Transit Plans. It is the only solution that meets more than 1,200 unique plan designs, provides innovative auto-substantiation technologies, simplifies user experience, and automates workflow for Partners, employers, and consumers. It does all this on one technology platform comprised of Lighthouse1™, PayDirect®, the Benny® Prepaid Benefits Card, Lighthouse1 OneCard™ and integrated web portals. Evolution1 and its 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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Who’s Who Profiles
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Solutions to help your innovative health and benefit programs. HSA/HRA/FSA Technology: Administration & Management
Population Health and Wellness
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
Total Population Health Management
LifeSynch changes behaviors to improve lives. LifeSynch Our approach integrates care of the mind and body to enhance health, increase productivity and 2101 W. John Carpenter Frwy Irving, Texas 75063 minimize unnecessary medical expenses. Built 800-207-5101 on a solid foundation of understanding human www.lifesynch.com behavior and how to motivate behavior change, we deliver proven outcomes through: n Proven methods that lead to increased n Customizable programs that easily engagement and sustained behavior incorporate into existing benefits and change. services. n Clinicians and coaches who provide n Scientifically proven best-practice personalized attention and form trusted guidelines to proactively manage care. relationships with members. n Scalable, user-friendly technology.
“Whether it’s LifeSynch’s health coaching, EAP/Work-life, integrated medical-behavioral health or utilization management services, we integrate our behavioral health and behavior change expertise to ensure our members reach their goals and achieve sustainable, long-term improvements toward their health and well-being.” – Sean Slovenski, President of LifeSynch,
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March/April 2012 I CDHC Solutions™ I www.TheIHCC.com
Since 1988, Flex has provided comprehensive, benefit reimbursement services to employers throughout the U.S. that are better, faster and more seamless than any in the marketplace. We are advocates of consumer-driven health plans and have fully-dedicated ourselves to the strategic concept of taxadvantaged and account-based programs.
Flexible Benefit Service Corporation (Flex)
10275 W. Higgins Road, Suite 500 Rosemont, IL 60018 www.JustFlexit.com 866.472.0882 fpsales@flexiblebenefit.com
Our core portfolio includes: COBRA Administration n Flexible Spending Accounts (FSAs) n Health Reimbursement Arrangements (HRAs) n Health Savings Accounts (HSAs) – Employer & Individual Solutions! n Transit/Parking Reimbursement Accounts (TRAs) n And more! n
Our robust, integrated resources provide everything employers need to integrate Flex Plans, including scalable features, simplified transactions/ reimbursements, plan design expertise, education/ communication resources and online access.
Just Flex It™ today and discover how simple benefits administration can truly be.
www.theihcc.com
Who’s Who Profiles
Access these profiles online at www.TheIHCC.com and www.EmployersWeb.com HSA/HRA/FSA Technology: Administration & Management
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.
Ceridian provides CDHC administration Ceridian with your business in mind. As a leading 3201 34th Street South provider of human resource, benefits and payment solutions, Ceridian helps St. Petersburg, FL 33711 organizations control costs, save time, optimize their workforce, grow revenue and 727-395-1764 minimize financial risk. Ceridian’s CDHC ernie.harris@ceridian.com administration services are designed to generate significant, sustainable savings through increased employee engagement. Our solution includes innovative features such as integrated account access, promotional communications, online claims and receipt uploads, and a mobile application coming soon.
“The key to controlling health care costs is also an employer’s most valuable resource – their employees. Ceridian goes beyond typical benefits administration to help employers form a phased, multiyear plan for engaging employees in their health and health care, which significantly lowers costs in the long term.” – Ernie Harris, Senior Product Manager for CDHC, Ceridian
HSA / HRA / FSA Administration and Finance
After 25 years of delivering best of breed products and services in the consumer-directed marketplace, we have embarked on a journey with Aetna to become the nation’s largest, most innovative, consumerdirected health plan solution. Together, we represent a unique solution for employers of all sizes allowing them the ability to consolidate vendors for one-stop shopping and an integrated healthcare experience for their employees. When you combine Aetna, a pioneer in the development and growth of consumer-direct health plans with PayFlex, an innovative, technology-driven provider of account-based plans, you get a dynamic combination of national presence, proven experience and solid performance. Rob Butler, PayFlex Systems USA, Inc., President
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Who’s Who Profiles
Solutions to help your innovative health and benefit programs. Pharmaceutical Benefits Management
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
Envision Pharmaceutical Services, Envision Pharmeceutical Inc is a full service pharmacy benefits Services, Inc. management company that delivers! John Ewell, EVP Marketing We deliver because our business 925.487.3266 model is based on transparency www.envisionrx.com and full disclosure, guaranteeing jewell@envisionrx.com 100% pass through pricing of all pharmaceutical manufacturer rebates and administrative fees at the point-of-sale. Additionally, our affiliate, Envision Insurance Company, is a national Prescription Drug Plan which enables us to offer a variety of solutions for your retirees. Envision is truly a “different” PBM!
“Envision is pleased to be recognized by its clients surveyed by the Pharmacy Benefits Management Institute for three consecutive years as the top performer in virtually every category evaluated. This solidifies our leadership position in providing transparency and full disclosure to the PBM marketplace while continuing to find innovative solutions.” — Kevin M. Nagle, President & CEO, Envision Pharmaceutical Services/Rx Options
R e s o u r c e
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G u i d e
advertising index Aetna..................................Inside Back Cover
IHC FORUM East.................................... 11-15
AHIP..................................................... 9, 50
IHC Health & Wellness Library....................26
AIG........................................................... 30
IHC Membership Benefits............................20
Allstate....................................................... 7
IHC Superstars............................................42
Ceridian......................................................49
LifeSynch....................................................48
Doug Field dfield@fieldmedia.com · ext. 101
DataPath................................................... 48
My HSA Rewards.........................................47
Associate Publisher
Delta Dental................................................49
PayFlex.......................................................49
DSS Research.............................................48
Target.........................................................32
Envision Pharmaceutical Services................50
Transitions..................................................22
Evolution1...................................................47
TSYS Healthcare.................................. 10, 47
Flexible Benefit Service Corporation............48
UMR...........................................................28
FIS Healthcare Solutions...............................5
UnitedHealthCare.......................... Back Cover
HealthStat......................... Inside Front Cover
US Bank......................................................36
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advertising contacts 404.671.9551 CEO/Publisher
Brent Macy bmacy@fieldmedia.com · ext. 103 Vice President of Business Development
Susan Yakots syakots@fieldmedia.com, ext. 102 Business Development Associate
David Cerri dcerri@fieldmedia.com, ext. 106 Account Managers
Joni Lipson jlipson@fieldmedia.com Rogers Beasley rbeasley@fieldmedia.com Reprints
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Quality health plans & benefits Healthier living Financial well-being Intelligent solutions
Smarter is a healthier workforce and guaranteed savings.
Aetna wellness programs reduce your costs, guaranteed. • • •
Save $100,000 at renewal.1 Tools and employee incentives guarantee 1–2% trend reduction.2 Aetna’s Healthy Lifestyle Coaching provides a 1.51 return on investment.3
See the proof at smarteris.aetna.com/well Illustrative only. Average savings for a customer with 1,500 members and an average $400 per member per month premium. May not be representative of the experience of all plan sponsors. Underwriting criteria will determine whether specific customers will qualify for this guarantee. This program may not be available in some states for insured products. Check with your local Aetna representative. 2 Aetna guarantees 1-2% trend reduction at renewal when minimum levels of employee and member (disease management) participation are reached across Aetna programs. Availability subject to underwriting requirements. 3 Aetna Informatics book of business study (2011). Not a guarantee of performance; Healthy Lifestyle Coaching program results will vary. © 2012 Aetna Inc. Plans offered by Aetna Life Insurance Company and its affiliates. Health benefits and health insurance plans contain exclusions and limitations. 2012005
1
Engaging consumers to make informed health care decisions
UnitedHealthcare’s industry-leading consumer-driven health (CDH) plans were designed to get employees on the path to good health with improved lifestyle habits and use of the health care system. That’s why our plans offer: • 100% preventive coverage and personalized messaging based on individual health care needs • Easy-to-use resources for employees, including treatment cost estimators, Quicken HealthSM Expense Tracker, and Health Care LaneSM to help members understand and maximize their health care benefits • Banking through our own OptumHealth Bank, Member of the FDIC, offering integrated access to account balances and a debit card that makes payments easier Tools like these help employees become active in their own health care decisions. We also offer the employer ready-to-use tools to implement and successfully maintain its consumer-driven health plans.
For more information on UnitedHealthcare’s CDH plans, visit uhctogether.com/CDH or call 1.866.438.5651.
Grow Healthy.
©2011 United HealthCare Services, Inc. Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by or through UnitedHealthcare Insurance Company, United HealthCare Services, Inc. or their affiliates. Health plan coverage provided by or through a UnitedHealthcare company. UHCEW506202-001