FORUM East · May 9-10, Atlanta Formerly CDHC Solutions
ISSUE || January/February 2013
EXCHANGES Transforming How Insurance is Purchased, Received
The Value of Private Exchanges Defined Contribution Model, Private Exchanges Shifting Power to Consumers How Health Care Reform Will Impact Vision Benefits – Bringing the Facts Into Focus
PRSRT STD U.S. Postage PAID Permit #104 Ft. Atkinson, WI
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Implemented Healthstat for his company last year.
Reduced his health claims. Saved the company $700.
Found out he had diabetes. Learned to manage it at work.
28-36 EXCHANGES Transforming How Insurance is Purchased, Received The emergence of public and private health insurance exchanges will be a true game changer in the way employers offer insurance to their employee population, how brokers sell insurance and how consumers purchase insurance. HealthCare Consumerism Solutions offers three different prospectuses in this issue on private exchanges; private exchanges using the defined contribution model and the public exchanges, created and managed by state and/or federal governments.
28 The Value of Private Exchanges
Much of the media focus of late has been on the value of public health care exchanges, the costs to taxpayers associated with them and the readiness of various states and the federal government to operate them. For more than a decade various entities have been operating private exchanges that are cost effective and have benefited employers and employees alike without burdening taxpayers. The value of an exchange, public or private, goes well beyond the introduction of a defined contribution account that allows employers to better manage their portion of health care costs. Ernie Harris
32 Defined Contribution Model, Private Exchanges Shifting Power to Consumers
35 Public Exchanges Must Answer Multiple Questions Under Tight Deadlines
Challenging economic times in the United States have had an impact on nearly every American. For millions of people, health care—and its related costs—are a significant financial concern. Businesses, of course, also have felt these challenges and have looked for new and innovative ways to help keep health care costs in check. One solution getting a great deal of attention is the defined contribution model, where the employer makes a fixed dollar contribution to each employee.
Signed into law by President Obama on March 23, 2010, the Affordable Care Act (ACA) aims to dramatically reduce the ranks of the uninsured population in the U.S. within the next few years. The passage of the law has set into motion a flurry of activity at the state and federal levels to accommodate the millions of consumers who will find health coverage accessible for the first time. The ACA establishes a vital role of health benefit exchanges (HBE) that are to manage standardized, state-regulated U.S. health care plans and be fully certified and operational by Jan. 1, 2014. Craig Tobin
40 How Health Care Reform Will Impact Vision Benefits – Bringing the Facts Into Focus What’s the first thought that comes to your mind when you hear the term “health care reform”? If you’re like most HR or benefit professionals, your mind probably darts to the impact of the heavily debated legislation on employee medical benefits. That makes a lot of sense; after all, health care reform will have its greatest effect in this area. However, the Patient Protection and Affordable Care Act (PPACA) also will trigger a “ripple effect” for ancillary benefits. In the case of vision, for example, employers are already starting to ask questions about whether their employee vision plans will need to change in terms of structure, coverage and costs to both them and their workforce. Jeff Spahr
COMING UP NEXT: The Institute for HealthCare Consumerism and its official publication, HealthCare Consumerism Solutions, will launch HealthCare Exchange Solutions, a 16-page supplement focusing on the latest news on the emergence of both public and private health insurance exchanges and what it means for employers, brokers, advisors, consultants, TPAs and regional health plans. ON THE COVER: While it may not be realistic that employees will be able to go to the market and pick up health insurance like picking up a loaf of bread or milk at the neighborhood grocery store, the emergence of insurance exchanges will make insurance more accessible and put the power back into the hands of the consumer on making health care decisions. www.TheIHCC.com I HealthCare Consumerism Solutions™ I January/February 2013
6-7 What’s Happening at The Institute 8
21 Regulatory & Compliance
Editor and Publisher’s Letter
HealthCare Consumerism Solutions Expanding to Include Exchange Solutions
Development of Private Health Insurance Exchanges Predate PPACA Ron Bachman
11 Guest Commentary Fifty-two Card Pickup
13-17 IHC FORUM East Preview t t t t
Making Consumerism Work Speakers and FORUM agenda Benefits for attending FORUM Super Saver and Early Bird Rates
23 HSAs Evolutionary Health Care Financing: The Global Switch to HSAs J. Kevin A. McKechnie
18-20 People on the Move 18-20 Briefs/Innovations
t Aetna Consumer-directed Health Plans Continue to Save Millions for Employers t Truven Health Analytics Develops Solution to Evaluate Wellness Program Effectiveness t United Airlines Opens Free Workplace Health Clinic at O’Hare t Mercer Selects Benefitfocus to Provide Technology Platform for Private Exchange
24 Population Health Management Corporate Wellness: 2013 is Time for an Upgrade Dr. Dee Edington
43 Who’s Who Profile 50 Resource Guide/Ad Index
25 Supplemental Health Ease the Sting of High-deductible Health Plans with Voluntary Benefits and Effective Communication Randy Finn
The 2013 IHC FORUM East www.theihccforum.com
For the fourth year in a row, IHC FORUM East returns to the Cobb Galleria Centre in Atlanta on May 9-10. The only conference series 100 percent dedicated to innovative health and benefit management has an expanded preconference, including a one-day Employee Benefits FORUM on May 8 from 7:30 a.m. to 5:15 p.m. that is exclusively for employers. This preconference is coproduced by the Atlanta Chapter of Worldwide Employee Benefits Network (WEB). The theme for this year’s conference series is “Making HealthCare Consumerism Work.” Registration is now open. Come LEARN, CONNECT and SHARE with the top thought leaders in the rapidly growing health care consumerism megatrend.
26 Pharmacy Benefit Management Pharmacy Benefit Management Business Adapting to Dramatic Demand for Specialty Medications Sumit Dutta
Become a Member and Reap the Rewards
Have you become a member of The Institute for HealthCare Consumerism (www.theihcc.com)? Why wait? Visit The IHC website today and sign up for a premium membership. Got a story to tell about an innovative health and benefit program or best practice in health care consumerism? Share it with fellow members of The Institute for HealthCare Consumerism. Share a case study, white paper, article or post a blog at www.theihcc.com. Members of The IHC also receive special discounts to attend Institute events, such as IHC FORUM.
4 January/February 2013 I HealthCare Consumerism Solutions™ I www.TheIHCC.com
27 Health Care Access Alternative Consider an On-site Wellness/Telemedicine Team for Better Employee Engagement Tony Chandler
WHATâ€™S HAPPENING AT THE THE CEOâ€™S DESK members Â speak Â out The industry is currently at a tipping point where weâ€™re seeing the rapid adoption of health care consumerism across the marketplace regardless of health care law developments. Within The Institute for HealthCare Consumerism you will find yourself at the forefront of the latest updates regarding health care law and how it may or may not impact your business and the industry as a whole. All of this is happening within our 24-7, collaborative online environment where all facets of this industry are currently learning, connecting and sharing. If youâ€™re reading this magazine and have not yet signed up for your membership to The Institute for HealthCare Consumerism online, youâ€™re missing out on being part of the one place that aggregates all stakeholders within the health and benefits management industry and allows you to connect with your peers, brokers, advisors, consultants and solution providers with a quick log-in. Through articles, white papers, surveys, member contributed blog posts, forum discussions, video content and HealthCare Consumerism Radio, youâ€™ll immediately benefit from a collaborative environment that speaks to health care consumerism related growth, best practices and pain points. Sign up today for your Membership to The Institute for HealthCare Consumerism at: theihcc.com/membership Sincerely, Doug Field Founder & CEO, The Institute for HealthCare Consumerism Publisher, HealthCare Consumerism Solutions Magazine
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spotlight Minneapolis Â this Â week, Â Boston Â the Â next, Â a Â layover Â in Â Atlanta Â and Â then Â itâ€™s Â off Â to Â Dallas Â and Â a Â West Â Coast Â swing Â for Â meetings Â in Â Phoenix, Â Los Â Angeles Â and Â Seattle.
airports Â and Â company Â board Â rooms Â than Â probably Â any Â other Â person Â in Â the Â health Â care Â industry.
That Â is Â not Â the Â itinerary Â for Â the Â last Â leg Â of Â the Â latest Â U2 Â tour. Â It Â is Â just Â another Â business Â week Â in Â the Â life Â of Â John Â Young, Â who Â has Â been Â honored Â by Â The Â Institute Â for Â HealthCare Â Consumerism Â with Â the Â 2012 Â John Â J. Â Robbins Â Senior Â Memorial Â HealthCare Â Consumerism Â Leadership Â Award.
<RXQJÂ¶VWUDYHOVKDVPDGHKLPDÂ¿[WXUH as Â a Â speaker Â and Â moderator Â at Â The Â Institute Â for Â HealthCare Â Consumerismâ€™s Â FORUM Â conference Â series. Â Young Â blends Â educational Â and Â insightful Â tools Â into Â an Â informative Â and Â entertaining Â presentation. Â He Â has Â been Â an Â attendee Â favorite Â when Â he Â takes Â the Â stage.
For Â more Â than Â a Â decade, Â Young Â has Â been Â a Â tour Â de Â force Â in Â the Â health Â care Â consumerism Â movement. Â It Â is Â not Â only Â a Â job Â but Â a Â passion Â and Â way Â of Â life Â for Â Young, Â who Â has Â been Â involved Â with Â this Â megatrend Â since Â 2000. During Â his Â professional Â career, Â Young Â has Â logged Â several Â miles Â on Â the Â odometer Â of Â countless Â rental Â cars, Â accumulated Â WKRXVDQGVRIIUHTXHQWÃ€\HUSRLQWVDQGVSHQWPRUHWLPHLQ 6 January/February 2013 I HealthCare Consumerism Solutionsâ„¢ I www.TheIHCC.com
John Young, 2012 John J. Robbins Senior Memorial HealthCare Consumerism Leadership Award winner
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LEARN. CONNECT. SHARE.
online Â exclusives
Costco Offers Pharmacy Benefit Management Services Costco Â Wholesale, Â the Â business Â known Â for Â
Three Tips to Integrate Physical and Financial Wellness -HQQLIHU%HQ]
its Â low Â prices Â and Â oversized Â products, Â has Â entered Â in Â WKHSKDUPDF\EHQHÂżWPDQDJHPHQW3%0 PDUNHW ZLWK&RVWFR+HDOWK6ROXWLRQV&+6 &RVWFRLV looking Â to Â drive Â demand Â and Â increase Â revenues Â from Â their Â pharmacies Â and Â prescription Â drug Â sales. Â Costco Â is Â leveraging Â their Â brand Â name, Â going Â after Â the Â 6.4 Â million Â business Â members Â that Â are Â already Â with Â Costco Â Wholesale Â and Â bringing Â them Â over Â to Â CHS. Â This Â strategy Â of Â focusing Â on Â existing Â business Â members, Â and Â businesses Â located Â near Â Wholesale Â stores, Â means Â Costco Â is Â focusing Â on Â the Â mid-Âmarket, Â businesses Â with Â under Â 20,000 Â employees Â being Â covered. Â Costco Â is Â able Â to Â separate Â itself Â from Â the Â competition Â by Â following Â the Â same Â business Â model Â that Â has Â made Â Costco Â Wholesale Â a Â success;Íž Â selling Â their Â products Â a Â modest Â margin Â above Â cost. Â CHS Â offers Â prescriptions Â through Â Costco Â in-Âwarehouse Â pharmacies Â and Â an Â extensive Â network Â of Â 64,000 Â independent Â pharmacies Â working Â with Â Costco Â to Â offer Â low Â cost Â prescriptions. Â Participants Â of Â the Â plan Â also Â receive Â other Â exclusive Â services Â from Â in-Â warehouse Â pharmacies Â including Â clinical Â services, Â walk-Âup Â immunization Â services Â and Â free Â health Â screenings.
Your Â wellness Â campaign Â may Â be Â missing Â a Â huge Â RSSRUWXQLW\$QGLWÂśVDOOEHFDXVHRIKRZ\RXGHÂżQHWKH ZRUGÂłZHOOQHVVÂ´2UUDWKHUKRZ\RXGRQÂśWGHÂżQHLW Employers Â use Â it Â in Â their Â communication Â as Â their Â go-Âto Â term Â for Â physical Â health. Â Thereâ€™s Â nothing Â wrong Â with Â that. Â But Â for Â your Â employees Â and Â their Â families, Â a Â healthy Â life Â is Â about Â much Â more Â than Â a Â healthy Â Body Â Mass Â Index Â %0, *RRGKHDOWKPHDQVQRWVWUHVVLQJDERXWELOOV or Â retirement Â and Â having Â enough Â money Â to Â enjoy Â the Â weekends Â with Â the Â kids. Â Your Â campaign Â should Â address Â WKHZKROHSHUVRQ,WVKRXOGSURPRWHÂżQDQFLDOOLWHUDF\ as Â equal Â to Â physical Â health. Â That Â means Â encouraging Â HPSOR\HHVWRFRQWULEXWHWRWKHLUN RSHQLQJDWD[ DGYDQWDJHGKHDOWKVDYLQJVDFFRXQW+6$ WRSD\IRU HOLJLEOHPHGLFDOH[SHQVHVLIWKH\KDYHDKLJKGHGXFWLEOH SODQ DQGSDUWLFLSDWLQJLQWKHÂżQDQFLDOSURJUDPVWKDW\RX offer.
Whole Foods CEO Mackey Continues Leadership in Free Market Health Reform John Â Mackey, Â Whole Â Foods Â CEO Â and Â Co-Âfounder, Â has Â received Â a Â lot Â of Â publicity Â lately Â for Â his Â brazen Â comments Â about Â PPACA Â and Â the Â state Â of Â the Â nationâ€™s Â health Â care Â system. Â But, Â while Â some Â have Â criticized Â him Â for Â poor Â word Â choice, Â Mackey Â has Â been Â a Â consistent Â innovator Â and Â leader Â in Â the Â free Â marketâ€™s Â approach Â to Â health Â reform. Â While Â health Â care Â costs Â have Â sky-Ârocketed Â in Â UHFHQW\HDUVDQGFRPSDQLHVKDYHVWUXJJOHGWRÂżQGZD\V to Â keep Â costs Â down, Â Mackey Â has Â personally Â taken Â the Â role Â of Â curbing Â health Â costs Â and Â improving Â employeesâ€™ Â health Â to Â heart. Â And Â he Â has Â done Â it Â not Â by Â mandates, Â but Â through Â incentivizing Â wellness, Â engaging Â employees Â and Â offering Â innovative Â health Â plans. Â In Â December Â of Â 2011, Â The Â Institute Â for Â HealthCare Â Consumerismâ€™s Â Editorial Â Advisory Â Board Â selected Â John Â Mackey Â for Â the Â cover Â of Â the Â annual Â HealthCare Â Consumerism Â Superstars Â issue. Â In Â the Â cover Â story, Â the Â Institute Â published Â a Â piece Â written Â by Â Mackey Â simply Â entitled Â â€œHealth Â Care Â Reform,â€? Â wherein Â he Â OD\VRXWKLVWKRXJKWVRQÂż[LQJWKH86KHDOWKFDUHV\VWHP
Why I Am More Egalitarian Than Most Liberals on Health Care -RKQ*RRGPDQ
Most Â people Â would Â place Â me Â on Â the Â political Â right. Â Yet Â when Â it Â comes Â to Â health Â care, Â I Â am Â more Â egalitarian Â than Â almost Â everybody Â on Â the Â left. Â I Â always Â have Â been. Â By Â that Â I Â mean Â I Â am Â more Â egalitarian Â than Â the Â defenders Â of Â the Â %ULWLVK1DWLRQDO+HDOWK6HUYLFH1+6 DQGWKHGHIHQGHUV of Â Canadaâ€™s Â system Â of Â socialized Â medicine. Â Iâ€™m Â also Â more Â egalitarian Â than Â Paul Â Krugman Â and Â the Â leaders Â of Â the Â Physicians Â for Â a Â National Â Health Â Program. Â Not Â only Â that, Â but Â a Â great Â many Â Republicans Â agree Â with Â my Â approach Â to Â health Â care Â â€” Â even Â as Â they Â oppose Â ObamaCare. Â
Transparency + Accountability
5D\)DELXV0'7UXYHQ+HDOWK$QDO\WLFV I Â celebrate Â the Â efforts Â of Â the Â state Â of Â Massachusetts Â to Â advance Â price Â transparency Â within Â health Â care. Â With Â the Â ZLGHYDULHW\RIKHDOWKSODQDOWHUQDWLYHVDQGEHQHÂżWGHVLJQV it Â has Â never Â been Â easy Â for Â consumers Â to Â estimate Â what Â their Â out Â of Â pocket Â costs Â will Â be Â before Â accessing Â elective Â care. Â In Â many, Â maybe Â most Â cases, Â the Â information Â is Â not Â available. Â Truven Â Health Â data Â analysis Â has Â shown Â wide Â and Â unexplained Â variation Â in Â the Â cost Â of Â the Â same Â service Â within Â metropolitan Â service Â areas Â -Â Â sometimes Â this Â variation Â can Â be Â three Â fold Â or Â more, Â and Â patients Â are Â generally Â unaware Â of Â this. Â Providing Â online Â tools Â to Â disclose Â a Â price Â is Â a Â good Â start. Â Enhancing Â these Â tools Â to Â allow Â for Â price Â comparisons Â is Â the Â next Â step. Â Studies Â show Â that Â tools Â like Â our Â Treatment Â Cost Â Calculator Â KDYHWKHSRWHQWLDOWRVLJQLÂżFDQWO\UHGXFHWRWDOKHDOWKFDUHFRVWVIRUHPSOR\HUVE\ providing Â their Â workers Â the Â ability Â to Â compare Â prices.
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2013 Register Now and Save
Donâ€™t miss the opportunity to be at the forefront of the continued growth of health care consumerism. Registration is now open for IHC FORUM East in Atlanta on May 9-10. Register today to take advantage of Early Bird rates. May 9-10 Cobb Galleria Centre Atlanta www.theihccforum.com
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EDITOR & PUBLISHER www.theihcc.com VOLUME Â 9 Â NO. Â 1 Â | Â JANUARY/FEBRUARY Â 2013
+HDOWK&DUH&RQVXPHULVP6ROXWLRQV ([SDQGLQJWR,QFOXGH([FKDQJH6ROXWLRQV Since its creation, this publication has been dubbed by the health care industry as the voice for innovative health and benefit management. As the health insurance arena expands with the creation of public and private exchanges, The Institute for HealthCare Consumerism, and its official publication, HealthCare Consumerism Solutions, are growing to meet the dynamic needs of the health care consumerism market. On Feb. 18, www.theihcc.com, the online community of The IHC providing a place for its members to LEARN, CONNECT and SHARE in a 24/7, global environment helping them continue their journey toward health care consumerism, launched the HealthCare Exchange Solutions community. Like the other communities at The IHC, HealthCare Exchange Solutions community provides highlights of the emerging private and public health insurance marketplaces with an emphasis on helping employersâ€”and the multi-stakeholders working with themâ€”understand defined contribution model and the different exchanges. The community includes industry trends, compliance issues, solutions and perspectives from each stakeholder. In addition to the community, The Institute will launch a biweekly enewsletter to its members, highlighting articles and blogs from the top thought leaders and the latest news in regard to the creation and development of private as well as state-and federally-run health insurance exchanges. Coming in the next issue of HealthCare Consumerism Solutions, we are proud to launch â€œHealthCare Exchange Solutions,â€? a 16-page supplement within this publication designed to further educate our members on this emerging trend reshaping the way employers, brokers, consumers and all stakeholders receive health insurance. In this issue we preview what readers can expect from â€œHealthCare Exchange Solutions.â€? There are three articles in this issue discussing defined contribution, private exchanges and the emergence of government-run exchanges on the state and federal level. The public-exchange article also tackles the obstacles and challenges the government is facing to establish insurance exchanges under a tight Jan. 1, 2014, deadline. The Conversation Continues at The IHC Continuing to utilize our multi-media platform at The Institute, HealthCare Consumerism Radio is back and new and improved. With our new radio partner, Americaâ€™s Web Radio, the conversation on innovative health and benefit management continues live every Friday from 11 a.m. to noon (EDT). The shows also are archived on The Institute website for our membersâ€™ convenience.
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Kellie Â Frissell H[WÄ NIULVVHOO#ÂżHOGPHGLDFRP CHAIRMAN Â OF Â IHC Â ADVISORY Â BOARD
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Kim Â Adler, Â Allstate;Íž Â Diana Â Andersen, Â Zions Â Bancorporation;Íž Â Bill Â Bennett;Íž Â Doug Â Bulleit, Â DCS Â Health;Íž Â Jon Â Comola, Â Wye Â River Â *URXS-RKQ+LFNPDQ$OVWRQ%LUG//37RQ\+ROPHV0HUFHU +HDOWK %HQHÂżWV0DUF.XWWHU$Ă€DF6DQGHUV0F&RQQHOO0\ HSA Â Rewards;Íž Â Roy Â Ramthun, Â HSA Â Consulting Â Services Â LLC;Íž Â -RKQ<RXQJ&,*1$ WEBMASTER Â
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Register for Forum and Save After visiting The IHC website, browse the Exchange Solutions community and read the â€œHealthCare Consumerism Exchange Solutions,â€? employers, brokers, advisors, consultants and TPAs can further sharpen their saw by attending IHC FORUM East coming May 9-10 in Atlanta. The discussion on exchanges will be at the forefront of the program, as the topic will be featured in a general session and also in an innovative share session. These discussions will showcase the top thought leaders in the private and public exchange arenas. Visit www.theihccforum.com to register and take advantage of great savings to attend the forum and pre-conference events. We look forward to seeing you in Atlanta this spring.
Karen Â Raudabaugh H[WÄ NUDXGDEDXJK#ÂżHOGPHGLDFRP +HDOWK&DUH&RQVXPHULVP6ROXWLRQVâ„˘ Â Volume Â 9 Â Issue Â 1 Copyright Â ÂŠ 2013 Â by Â FieldMedia Â LLC. Â All Â rights Â reserved. +HDOWK&DUH &RQVXPHULVP 6ROXWLRQVâ„˘ Â is Â a Â trademark Â of Â FieldMedia Â LLC. Â +HDOWK&DUH &RQVXPHULVP 6ROXWLRQVâ„˘ Â is Â published Â eight Â times Â yearly Â by Â FieldMedia Â LLC 6RXWK 0DLQ 6WUHHW 6XLWH $OSKDUHWWD *$ 3HULRGLFDOSRVWDJHSDLGDW$OSKDUHWWD*$DQGDGGLWLRQDOPDLOLQJRIÂżFHV TO Â SUBSCRIBE: Â Make Â checks Â and Â money Â orders Â payable Â to Â +HDOWK&DUH Consumerism Â Solutions â„˘ Â magazine Â 292 Â S. Â Main Â Street, Â Suite Â 400, Â Alpharetta, Â *$ RU YLVLW ZZZWKHLKFFFRP 1RQTXDOLÂżHG SHUVRQV PD\ VXEVFULEH at Â the Â following Â rates: Â single Â copy Â $7.50;Íž Â $75.00/yr Â in Â the Â U.S., Â $105/yr Â in Â Canada Â and Â $170/yr Â international. Â Please Â contact Â FieldMedia Â at Â 404.671.9551 Â RUVXEVFULEHUVHUYLFH#ÂżHOGPHGLDFRPIRUQDPHDGGUHVVFKDQJHV PRINTED Â IN Â THE Â U.S.A.
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BY GREG SCANDLEN FOUNDER CONSUMERS FOR HEALTH CARE CHOICES
Fifty-Âtwo Â Card Â Pickup
emember when you were a kid and someone asked you if you wanted to play â€œfifty-two pickupâ€? with your new deck of cards? He would throw them all into the air and you would pick them up. Fun! The health care industry today resembles this game. All of the cards have been thrown into the air and we are gradually picking them up. But the order has changed completely. Things are no longer assembled in tidy boxes by suit and number but completely re-ordered into new relationships. I am not speaking here about â€œhealth reformsâ€? as envisioned by Washington, but about what is happening in the market. The â€œreformsâ€? just add to the complexity of the environment for the real players in health care. If anything, Washington will serve to retard the transforming re-arrangements. This notion has been nagging at me ever since consumer-driven care started becoming a reality, but was focused especially by Bill Boylesâ€™ latest issue of â€œConsumer Driven Market Report.â€? (For subscription information, e-mail Bill Boyles at Interpro Publications email@example.com) Things had been quite stable for half a century before Consumerdriven Health. On the financing side there were insurance companies doling out benefits. Even Medicare and Medicaid did not alter that fundamental arrangement. These companies paid benefits to doctors, hospitals, maybe also to some â€œallied professionals,â€? labs and drug stores. And that was the â€œsystem.â€? All this began to change with the advent of cash accounts in health care financingâ€”first flexible spending accounts (FSAs), then medical savings accounts (MSAs), then health reimbursement arrangements (HRAs), then health savings accounts (HSAs). Suddenly the banks were involved in financing health care. There may not have been much competition between insurers (all offering virtually identical products at virtually identical prices), but the new players (banks) started working hard to get a piece of the pie. They brought in the card companies (credit, debit and discount), which began to blend with wellness and incentive programs, which relied on infotech companies. Boyles says the â€œnew configurationâ€? is â€œACCOUNTSCARDS-INCENTIVES,â€? all powered by technology. Notice that he gives insurers barely a mention. 6XGGHQO\WKHEDQNVZHUHLQYROYHGLQÂżQDQFLQJKHDOWK FDUH7KHUHPD\QRWKDYHEHHQPXFKFRPSHWLWLRQEHWZHHQ LQVXUHUVDOORIIHULQJYLUWXDOO\LGHQWLFDOSURGXFWVDWYLUWXDOO\ LGHQWLFDOSULFHV EXWWKHQHZSOD\HUVEDQNV VWDUWHG ZRUNLQJKDUGWRJHWDSLHFHRIWKHSLH
At the same time all of this is being supercharged by employers moving to defined contribution and private exchanges. Boyles wraps up his newsletter with an essay on three â€œLookoutsâ€? (not â€œoutlooksâ€?) for 2013. The first is the entirely new environment for employers and insurers. They will have to start reserving for the new federal premium tax, limit premium increases to avoid a federal rate review, add costs to comply with exchange data requirements, and deal with new underwriting uncertainty
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as they can no longer ask medical questions of applicants. He concludesâ€” Chances are very good that employers and insurers will have no choice but to cut benefits even more to subsidize all the new sources of costs. The next lookout isâ€”Everybody will be looking for relief from the incredible complexity of the â€˜newâ€™ U.S. health system coming this year, and rising costs will make simplicity a lovely word to the ears of employers and consumers. Concerns include a new emphasis on coordination of benefits across payers, cost shifting from expanded Medicaid programs, the complexity of dealing with different exchanges in different areas with a portion of employees in them while others are not, plus the complexity of subsidies for some and not others and the prospect of having three different account arrangements (FSA, HSA, HRA) across all these platforms. A vendor who can smooth all this out will be very popular. Finally, Boyles discusses the likelihood of market consolidation of the various vendors. He doesnâ€™t expect any winner-take-all consolidation in the near future. There is too much innovation going on for the market to become that settled. Instead, he expects that some breakthrough innovations will become standard across all of the market, enhancing everyoneâ€™s market position. I havenâ€™t mentioned yet, but it is worth noting, that similar realignments are happening in the medical service delivery side. Some of this is due to the ACO push that merges physicians and hospitals, but the real revolution was already happening before ACOs were even thought of. This includes the advent of retail clinics, medical tourism both foreign and domestic, concierge medicine, physician-owned hospitals, at-home testing and monitoring, and many other innovations. Much of this was anticipated years ago when I was running Consumers for Health Care Choices. Here are some links for extra reading you can visit while at www.theihcc.com. t +PIO(PPENBOTQFBLJOHBUPVSBOOVBMNFFUJOHJO8BTIJOHUPOJO 2006. t #JMM#PZMFTTQFBLJOHBUPVSBOOVBMNFFUJOHJO8BTIJOHUPOJO t 5POZ.JMMFS GPVOEFSPG%FmOJUZ)FBMUI BUUIFTBNFFWFOU t (BSZ"IMRVJTU PG#PP["MMFO)BNJMUPO BUBCBORVFUJO-BT7FHBT in 2007. We canâ€™t know how all this will settle out or even when it will become settled. All we know now is that the entire health sector is going to look very different in the future than it was just a few years ago when all the cards were neatly organized in a little package. Note: This article was originally posted at www.ncpa.org on Feb. 11, 2013. www.TheIHCC.com I HealthCare Consumerism Solutionsâ„˘ I January/February 2013
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valuable tools I’ve ever received. The analysis medical costs, prediction for next year’s out-ofpocket expenses, and recommendation for the best plan for me has taken the worry out of open enrollment. – Actual Employee Email to Human Resources Regarding Informed Enrollment
ATLANTA MAY 9-10, 2013
MAKING HEALTHCARE CONSUMERISM WORK In the Year Ahead and Beyond FEATURED SPEAKERS: Ron Bachman
FSA, Â MAAA, Â Sr. Â President, Â Healthcare Â Visions;Íž Â Chairman Â of Â The Â Institute Â For Â HealthCare Â Consumerism Â Editorial Â Advisory Â Board
An Â expert Â on Â health Â savings Â accounts Â and Â consumer Â directed Â health Â care Â issues
Partner Alston+Bird Â LLP
Co-Âdirector, Â Altarum Â Center Â for Â Consumer Â Choice Â in Â Health Â Care
Chris Covill Exchange Â Product Â Leader Â and Â Partner Mercer
Dawn Bading Vice Â President, Â Human Â Resources Kaiser Â Permanente
Cindy Gillespie Senior Â Managing Â Director McKenna Â Long Â & Â Aldridge Â LLP
Patti Taylor 'LUHFWRU*OREDO%HQHÂżWV Newell Â Rubbermaid
Steve Lafferty, Sr. Director Â of Â Clinics Â and Â Health Â Partnerships, Â Target )RUPHU'LUHFWRU7DUJHW%HQHÂżWV
WHO SHOULD ATTEND? CEOs/Presidents/CFOs +5DQG%HQHÂżWV([HFXWLYHV Health Â Plan Â Administrators Corporate Â Wellness Â and Â Medical Â Directors
%HQHÂżW%URNHUV Third Â Party Â Administrators %HQHÂżW&RQVXOWDQWV %DQNHUV
2013 NO OTHER CONFERENCE IS DOING WHAT THE IHC FORUM DOES!
Learn how to get your employees to become better health care consumers and lower your health care benefit costs.
LEARN FROM EXPERTS AND EACH OTHER AT THE IHC FORUM t -FBSOOFXTUSBUFHJFTUPFOIBODFZPVSDVSSFOU health and benefit offering t )FBSUIFMBUFTUVQEBUFTBOEDIBOHFTUPUIF health care law t $POOFDUXJUILFZJOEVTUSZMFBEFST TFFUIFMBUFTU TPMVUJPOTBOECFBCMFUPJNQMFNFOUUIFNSJHIUBXBZ t #VJMEZPVSIFBMUICFOFmUTLJMMTJOPVSFEVDBUJPOBM XPSLTIPQT FBSO$&BOE 41)3DSFEJUT t /FUXPSLXJUIZPVSQFFSTÂ‰)FBSXIBUIBTXPSLFEGPS UIFNBOETIBSFZPVSTVDDFTTFT
WHAT YOUâ€™LL LEARN The FORUM EAST and WEST conferences will be day and a half events plus valuable pre-conferences the day before, with 40 speakers participating in five general sessions and your choice of 24 workshops. In addition to networking with top industry leaders, you will learn how to successfully be on the cutting edge of new health care benefits through topics and discussions, such as: t .BLJOH)FBMUI$BSF$POTVNFSJTN8PSL t )FBMUI$BSF3FGPSN)PXUP$PNQMZÂ‰-BUFTU6QEBUFTGSPN Experts t 1PQVMBUJPO)FBMUI.BOBHFNFOU*NQMFNFOUJOHB4VDDFTTGVM 8FMMOFTT1SPHSBN t &YQFSU1BOFM$SFBUJOH$POTVNFSTPG)FBMUIBOE)FBMUI$BSF t 1VCMJDWFSTVTQSJWBUFFYDIBOHFT GSPNQMBOEFTJHOUPFNQMPZFF participation t &NQMPZFS1BOFM8IBU-FBEJOH&NQMPZFSTBSF%PJOHUP.BLF )FBMUI$BSF$POTVNFSJTN8PSL
Visit www.theihccforum.com to preview the agenda and register for the conference.
WWW.THEIHCCFORUM.COM %FBS)FBMUI#FOFmUT.BOBHFNFOU1SPGFTTJPOBMT "UUIF*)$'036. UIFPOMZDPOGFSFODFEFEJDBUFEUPJOOPWBUJWF IFBMUIBOECFOFmUNBOBHFNFOU XFDPOUJOVFUPEFMJWFSQSPHSBNNJOHUIBU is engaging, educational and packed with networking and new business PQQPSUVOJUJFT5IJTDPOUFOUOPUPOMZDVUTBUZPVSCPUUPNMJOF CVUBMTP HJWFTZPVBEFFQFSMPPLBUUIFFYJTUJOHNFHBUSFOETBOEDIBMMFOHFTXJUIJO PVSJOEVTUSZ/PNBUUFSXIFSFZPVBSFPOZPVSKPVSOFZ UIF*)$'036. XJMMFRVJQZPVXJUIUIFNPOFZTBWJOHTUSBUFHJFTZPVOFFEUPTVDDFTTGVMMZ OBWJHBUFUIFIFBMUIDBSFDPOTVNFSJTNMBOETDBQFBOEBWPJEUIFCVNQT along the road. 5IJTZFBST*)$'036.&BTU8FTUBSFNVTUBUUFOEFWFOUTGPS$MFWFM FYFDVUJWFT DPSQPSBUFXFMMOFTTEJSFDUPST )3QSPGFTTJPOBMT IFBMUIDBSF brokers and regional health plan providers interested in engaging their FNQMPZFFTJODPOTVNFSEJSFDUFEIFBMUIQMBOT8IFUIFSZPVBOEPSZPVS DPNQBOZBUUFOETPOFPSCPUIFWFOUT UIFTBNFQSFNJVNDPOGFSFODF FYQFSJFODFBOENFBTVSBCMFSFTVMUTDBOCFFYQFDUFE 8FVOEFSTUBOEZPVIBWFNBOZDPOGFSFODFTUPBUUFOEBOEBMJNJUFE BNPVOUPGUJNFBOECVEHFU TPXFQSPWJEF&BSMZ#JSE3BUFTBOE5FBN %JTDPVOUTGPSUIJTBOEEBZFWFOUUPNBLFUIJOHTBMJUUMFFBTJFS -PPLGPSXBSEUPTFFJOHZPVUIFSF
Doug Field Founder and CEO The Institute for HealthCare Consumerism
NEW AT THE FORUM Our Employee Benefits Forum Pre-Conference (produced in conjunction with WEB Atlanta) is exclusively designed for employers. This is your chance to talk shopâ€” uncensoredâ€”with your professional counterparts. IF YOU CANâ€™T MAKE EAST, THEN START PLANNING NOW FOR IHC FORUM WEST 2013 AT THE RED ROCK RESORT IN LAS VEGAS! DETAILS WILL BE AVAILABLE SOON AT
DEC 5-6, 2013
DOES YOUR PROFESSIONAL CHECKLIST INCLUDE ISSUES DEALING WITH HEALTH CARE SPEND, HEALTH INCENTIVES, COMPLIANCE, ENGAGEMENT IN HEALTH CARE CONSUMERISM AND UNDERSTANDING DEFINED CONTRIBUTION AND PRIVATE/PUBLIC EXCHANGES? IF SO, YOU AND YOUR TEAM WILL FIND IMMEDIATE AND LONG-TERM VALUE FROM ATTENDING THE IHC FORUM EAST.
2013 FORUM EAST AGENDA AT A GLANCE WEDNESDAY, MAY 8, 2013 7:30 am â€“ 5:15 pm
Pre-Conference: Employee Benefits Forum 2013
1:00 pm â€“ 5:00 pm
Pre-Conference: A Roadmap for Making Healthcare Consumerism Work
12:00 pm â€“ 7:00 pm
Exhibitor Set Up
THURSDAY, MAY 9, 2013 7:30 am
7:30 am â€“ 8:45 am
Networking Breakfast / Exhibits Open
8:45 am â€“ 9:00 am
Welcome by Doug Field, CEO, The Institute for HealthCare Consumerism
9:00 am â€“ 10:30 am
Opening General Session: â€œMaking Health Care Consumerism Workâ€?
10:30 am â€“ 11:00 am
Networking Break / Exhibits Open
11:00 am â€“ Noon
Track No. 1 Workshops (Choose One) Âą$FKLHYLQJ0\*RDOV$7ULS7KURXJKWKH)LQDQFLDO:HOOQHVV:RUNVKRS 102 Â â€“ Â HSAs: Â A fter Â 2014 Âą6+$5(6(66,21(YROYLQJ5HODWLRQVKLS%HWZHHQ%URNHUDQG(PSOR\HUDQG+RZWR%HQHÂżWWKHPRVWIURP a Â Partnership Âą&RQWUROOLQJ&RVWVDQG([SDQGLQJ&KRLFH8VLQJ'HÂżQHG&RQWULEXWLRQ+HDOWK&DUH 105 Â â€“ Â Health Â Pays: Â Using Â Incentives Â to Â Drive Â Wellness Â and Â Behavior Â Change 106 Â â€“ Â The Â R ight Â Care Â (Not Â Just Â Cost)! 107 Â â€“ Â Pre-ÂPaid Â Card Â Programs Â to Â Engage Â Consumers Â and Â Help Â Employers Â Manage Â Costs Â in Â 2014 Â & Â Beyond Âą%HDWLQJWKH(QUROOPHQW%OLW]+RZWR'HOLYHU<HDU5RXQG%HQHÂżWV&RPPXQLFDWLRQ
Noon â€“ 1:00 pm
Table Topic Lunch Discussion
Noon â€“ 1:30 pm
Lunch / Exhibit Open
1:30 pm â€“ 2:45 pm
Afternoon General Session: â€œHealthCare Consumerism is Here to Stay!â€?
2:45 pm â€“ 3:00 pm
Networking Break / Exhibits Open
3:00 pm â€“ 4:00 pm
Track No. 2 Workshops (Choose One) Âą$GYDQFHG%URNHU&RXUVH 202 Â â€“ Â Ownership Â and Â Incentives: Â Creating Â Multiple Â Incentive Â Channels Âą7KH9DOXHRI&RQQHFWLQJ&RQVXPHU1HHGVZLWK%HQHÂżWVWKURXJK(QUROOPHQW7HFKQRORJ\ 204 Â â€“ Â SHARE Â SESSION: Â Health Â Care Â Access Â When Â You Â Want Â It, Â How Â You Â Want Â It 205 Â â€“ Â The Â MedEncentive Â Solution: Â Achieving Â the Â Triple Â A im Â by Â Triangulating Â the Â Interests Â of Â Payors, Â Providers Â and Â Patients 206 Â â€“ Â SHARE Â SESSION: Â How Â to Â More Â Effectively Â Engage Â Consumers Â and Â get Â Increased Â Participation Â from Â your Â Employee Â Population Â 207 Â â€“ Â Consumer Â Engagement: Â The Â Key Â to Â a Â Successful Â Exchange Â 208 Â â€“ Â Ten Â Steps Â to Â Delivering Â on Â the Â Promise Â to Â Employers: Â ACOs Â Enhance Â Quality Â of Â Care, Â Improve Â Patient Â 2XWFRPHVDQG'ULYH&RVWHIÂżFLHQF\
4:00 pm â€“ 4:15 pm
Networking Break / Exhibits Open
4:15 pm â€“ 5:15 pm
Closing General Session: Defined Contribution and Public/Private Exchanges: A Panel Discussion with Leading Experts
5:15 pm â€“ 7:15 pm
Opening Night Reception / Exhibits Open
2013 FORUM EAST AGENDA CONTINUED FRIDAY, MAY 10, 2013 7:30 am â€“ 8:30 am
Networking Breakfast / Exhibits Open
8:30 am â€“ 10:00 am
Opening General Session: Helping Employees Become Better Consumers of Health Care and Health Leading Employers and Experts will discuss the leading trends, challenges and opportunities in building better Consumers of Health
10:00 am â€“ 10:30 am
Networking Break / Exhibits Open
10:30 am â€“ 11:30 am
Track No. 3 Workshops (Choose One) Âą0DNLQJWKH+HDOWK&RPPLWPHQW 302 Â â€“ Â The Â Economics Â of Â Healthy Â Sleep Âą6+$5(6(66,21([FKDQJHVRU0DUNHWSODFH":KDWHYHULWÂśV&DOOHG*HWWR.QRZLW 304 Â â€“ Â Improving Â Consumer Â Health Â Through Â Value-ÂBased Â Plan Â Design Âą*HWWLQJWKH0RVWIURP\RXU%URNHU5HODWLRQVKLSDQG+RZWKDWLV&KDQJLQJ 306 Â â€“ Â The Â Role Â of Â Mobile Â Health Â in Â Changing Â Behavior Âą*DPH0HFKDQLFVDQG2WKHU*DPH&KDQJHUVLQ%HQHÂżWV(GXFDWLRQ 308 Â â€“ Â SHARE Â SESSION: Â Building Â Better Â Consumers Â of Â Health Â Care Â and Â Health
11:30 am â€“ Noon
Final Break and Sponsor/Exhibitor Drawings
Noon â€“ 1:00 pm
Closing General Session: Employer Panel: â€œWhat leading Employers are doing to Make HealthCare Consumerism Work
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Hotel Information Renaissance Â Waverly Â Hotel Â *DOOHULD3DUNZD\ 800.228.9290 Â or Â 770.953.4500 Special Â FORUM Â Rate Â $153 Â (Cutoff Â Date Â 4/17/13) Â
Conference Location Cobb Â Galleria Â Center 7ZR*DOOHULD3DUNZD\ Atlanta, Â GA Â 30339
Register for the IHC FORUM at www.theihccforum.com. Group rates are available. Receive a 25% discount when you sign up two or more attendees.
The Â 2013 Â FORUM Â East Â ProgramKDVEHHQDSSURYHGIRUUHFHUWLÂżFDWLRQFUHGLWKRXUVWRZDUG3+563+5 DQG*3+5UHFHUWLÂżFDWLRQWKURXJKWKH+5&HUWLÂżFDWLRQ,QVWLWXWH)RUPRUHLQIRUPDWLRQDERXWFHUWLÂżFDWLRQRU UHFHUWLÂżFDWLRQSOHDVHYLVLWWKH+5&HUWLÂżFDWLRQ,QVWLWXWHKRPHSDJHDWKUFLRUJ7KHXVHRIWKLVVHDOLVQRWDQ HQGRUVHPHQWE\WKH+5&HUWLÂżFDWLRQ,QVWLWXWHRIWKHTXDOLW\RIWKHSURJUDP,WPHDQVWKDWWKLVSURJUDPKDV PHWWKH+5&HUWLÂżFDWLRQ,QVWLWXWHÂśVFULWHULDWREHSUHDSSURYHGIRUUHFHUWLÂżFDWLRQFUHGLW
Professional Credits Available for CRCs and HR Professionals
For the latest updates, program details, speaker bios and to register, visit www.theihccforum.com or call 404.671.9551
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REGISTRATION RATES FOR FORUM EAST - MAY 9-10, 2013 Member / Non-Member
Early Bird Rates
Please Â Note: Â Rates Â above Â do Â not Â include Â member Â discount.
Attendee Pricing Includes: Â‡ Â‡ Â‡ Â‡ Â‡ Â‡
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Group Rate Discount Available Receive Â a Â 25% Â discount Â on Â each Â person Â when Â you Â sign Â up Â two Â or Â more Â DWWHQGHHV'LVFRXQWZLOODXWRPDWLFDOO\EHDSSOLHGGXULQJFKHFNRXW
IF YOU CANâ€™T MAKE EAST, START PLANNING NOW FOR IHC FORUM WEST! DEC 5-6, 2013, THE RED ROCK RESORT IN LAS VEGAS DETAILS AVAILABLE SOON AT WWW.THEIHCCFORUM.COM.
PEOPLE ON THE MOVE
PEOPLE ON THE MOVE MedConnections, one of the worldâ€™s leading mobile health application development companies, announced the appointment of Kevin Woodard as president. Woodard brings more than 25 years of health care financial management and business development expertise to MedConnections. Prior to joining MedConnections, Woodard was chief financial officer of Avivia Health from Kaiser Permanente, where he oversaw finance and business development functions. During his tenure there, revenues grew from zero to $20 million per year, servicing 1.5 million participants per year. MedConnectionsâ€™s flagship application, iPharmacy, has already helped more
HEALTHCARE CONSUMERISM SOLUTIONS
Aetna Consumer-directed Health Plans Continue to Save Millions for Employers The Â ninth Â annual Â Aetna Â HealthFund Â study Â shows Â that Â employers Â UHSODFLQJ WKHLU WUDGLWLRQDO KHDOWK EHQHÂżWV SODQV ZLWK $HWQD +HDOWK)XQG consumer-Âdirected Â plans Â saved Â nearly Â $350 Â per Â member Â per Â year. Â The Â lower Â health Â care Â costs Â result Â in Â savings Â of Â $20.8 Â million Â over Â a Â six-Â year Â period Â for Â every Â 10,000 Â members. Â The Â Aetna Â HealthFund Â study Â is Â the Â longest Â running Â review Â of Â consumer-Âdirected Â plans Â in Â the Â industry, Â drawing Â experience Â from Â a Â decade Â of Â claims Â data. Members Â with Â Aetna Â HealthFund Â plans Â spent Â less Â on Â most Â types Â of Â health Â care Â services, Â including Â specialist Â doctorâ€™s Â visits, Â emergency Â room Â visits Â and Â total Â pharmacy Â costs. Â Despite Â lower Â overall Â health Â care Â costs, Â members Â with Â Aetna Â HealthFund Â plans Â received Â routine Â preventive Â care Â from Â their Â primary Â care Â doctors Â 11 Â percent Â more Â than Â members Â ZLWK WUDGLWLRQDO 3UHIHUUHG 3URYLGHU 2UJDQL]DWLRQ 332 SODQV $HWQD HealthFund Â members Â also Â had Â higher Â rates Â of Â screenings Â for Â cervical Â FDQFHU QHDUO\ SHUFHQW KLJKHU FRORUHFWDO FDQFHU SHUFHQW DQG SURVWDWH FDQFHU SHUFHQW DV ZHOO DV PDPPRJUDPV SHUFHQW DQG LPPXQL]DWLRQVSHUFHQW â€œEmployers Â are Â trying Â to Â control Â rising Â health Â care Â costs Â by Â getting Â their Â employees Â to Â be Â more Â empowered Â when Â making Â health Â care Â decisions,â€? Â says Â Tom Â Mafale, Â head Â of Â national Â accounts Â sales Â operations Â for Â Aetna. Â â€œAetna Â HealthFund Â plans Â continue Â to Â be Â a Â proven Â solution Â to Â achieve Â that Â important Â goal. Â Encouraging Â people Â to Â receive Â the Â right Â care Â at Â the Â right Â time Â is Â one Â important Â way Â to Â help Â reduce Â health Â care Â costs Â for Â both Â employers Â and Â individuals. Â Health Â care Â reform Â has Â increased Â access Â to Â preventive Â care, Â but Â Aetna Â HealthFund Â members Â still Â use Â this Â type Â of Â care Â more Â frequently Â than Â other Â members.â€? Employers Â that Â completely Â transitioned Â their Â employees Â to Â Aetna Â HealthFund Â plans Â saw Â the Â most Â dramatic Â cost Â savings. Â However, Â HPSOR\HUV ZKR XVHG VHYHUDO ÂłEHVW SUDFWLFHVÂ´ LGHQWLÂżHG WKURXJK WKH study Â had Â cost Â savings Â that Â were Â almost Â as Â high Â as Â the Â employers Â who Â completely Â switched Â over Â to Â HealthFund Â plans. Â
Truven Health Analytics Develops Solution to Evaluate Wellness Program Effectiveness Truven Â Health Â Analytics, Â formerly Â the Â health Â care Â business Â of Â Thomson Â Reuters, Â announced, Â in Â collaboration Â with Â Emory Â University, Â WKH UHOHDVH RI D QHZ PRGHO WR HYDOXDWH WKH UHWXUQ RQ LQYHVWPHQW 52, of Â population Â health Â and Â wellness Â programs. Â The Â Truven Â Health Â ROI Â 18 January/February 2013 I HealthCare Consumerism Solutionsâ„˘ I www.TheIHCC.com
than two million users improve medication literacy, medication adherence and reducing their medical and pharmacy costs. Aflac, the No. 1 provider of voluntary and guaranteed-renewable insurance in the United States, announced the hiring of Drew J. Niziak, a 20-year veteran of the insurance industry, as its new senior vice president of broker sales and Aflac Benefits Solutions Niziak (ABS), a wholly owned subsidiary of Aflac. In his new role, Niziak will oversee the broker sales strategy and lead the development of national and regional marketing relationships with insurance brokers through ABS and Aflac. ABS provides specialized services to the companyâ€™s most
AETNA Âť TRUVEN HEALTH ANALYTICS Âť UNI Model Â is Â designed Â to Â help Â organizations Â identify Â which Â health Â risks Â are Â most Â prevalent Â and Â costly Â to Â their Â company, Â quantify Â the Â relationships Â EHWZHHQ PRGLÂżDEOH ULVN IDFWRUV DQG PHGLFDO H[SHQGLWXUHV DQG GHYHORS FRVWEHQHÂżFLDOKHDOWKSURPRWLRQDQGGLVHDVHSUHYHQWLRQSURJUDPVEDVHG on Â the Â results. 7KH 7UXYHQ +HDOWK 52, 0RGHO LQFRUSRUDWHV RUJDQL]DWLRQVSHFLÂżF demographic, Â health Â risk, Â and Â program Â impact Â data, Â plus Â data Â from Â peer-Â reviewed Â studies. Â It Â shows Â the Â relationship Â between Â health Â risk Â and Â cost, Â DQGSUHGLFWVFRVWVDYLQJVIURPSURJUDPVGHVLJQHGWRDGGUHVVPRGLÂżDEOH health Â risks: Â high Â blood Â glucose, Â obesity, Â physical Â inactivity, Â depression, Â poor Â nutrition/eating Â habits, Â tobacco Â use, Â high Â total Â cholesterol, Â high Â stress, Â high Â blood Â pressure, Â and Â high Â alcohol Â consumption. Â The Â model Â incorporates Â both Â prospective Â and Â retrospective Â estimates Â to Â calculate Â the Â ÂżQDQFLDOUHWXUQRIDFRPSDQ\ÂśVZHOOQHVVSURJUDP Âł:HNQRZWKDWLQGLYLGXDOVZLWKRQHULVNIRUDVSHFLÂżFSUREOHPRIWHQ have Â additional Â risks Â also Â associated Â with Â that Â problem. Â For Â example, Â there Â are Â seven Â combined Â risk Â factors Â that Â contribute Â to Â heart Â disease: Â obesity, Â high Â stress, Â tobacco Â use, Â high Â blood Â pressure, Â high Â blood Â glucose, Â KLJKWRWDOFKROHVWHURODQGSK\VLFDOLQDFWLYLW\Â´VD\V5RQ*RHW]HO3K' research Â professor Â at Â Emory Â University, Â director Â of Â the Â Institute Â for Â Health Â and Â Productivity Â Studies, Â and Â vice Â president Â of Â consulting Â and Â applied Â research Â at Â Truven Â Health Â Analytics. Â
United Airlines Opens Free Workplace Health Clinic at Oâ€™Hare United Â Airlines Â announced Â the Â opening Â of Â the Â airlineâ€™s Â new Â employee Â health Â clinic Â at Â Oâ€™Hare Â International Â Airport. Â The Â clinic, Â managed Â by Â Walgreens, Â will Â serve Â a Â broad Â scope Â of Â employeesâ€™ Â health Â needs, Â such Â as Â urgent Â care Â for Â routine Â illness, Â travel Â and Â other Â immunizations Â including Â Ă€XVKRWVSUHSDFNDJHGPHGLFDWLRQVMREUHODWHGSK\VLFDOWUDLQLQJDQGSUH employment Â physicals, Â at Â no Â cost Â to Â employees. Â The Â convenient Â access Â to Â these Â and Â other Â health Â care Â services Â is Â available Â to Â all Â United Â employees, Â including Â the Â more Â than Â 10,000 Â co-Âworkers Â in Â the Â Chicago Â area. Âł:HÂśUHFRQWLQXLQJWRPDNHVLJQLÂżFDQWLQYHVWPHQWVLQ8QLWHGLQFOXGLQJ investments Â in Â our Â co-Âworkers,â€? Â said Â Unitedâ€™s Â Chairman, Â President Â and Â CEO Â Jeff Â Smisek. Â â€œThis Â clinic Â will Â offer Â convenient Â health Â services Â at Â no Â charge Â to Â keep Â our Â co-Âworkers Â feeling Â and Â performing Â well.â€? The Â 5,200-Âsquare-Âfoot Â facility, Â located Â in Â the Â airportâ€™s Â Terminal Â 2 Â arrivals Â area, Â is Â the Â only Â one Â of Â its Â kind Â for Â any Â airline Â at Â Oâ€™Hare. Â United Â
significant brokerage partners through an experienced team of business developers, consultants, strategic account managers and broker service professionals while Aflac provides dedicated services and support to mid-tier and regional brokers in partnership with Aflacâ€™s sales force. Walgreens announced the promotion of Joseph Magnacca from senior vice president to executive vice president. Magnacca also retains his title as president of daily living products and solutions. Magnacca oversees Walgreens merchandising and inventory strategy, private brands, insights and analytics, and Magnacca the New York-based Duane Reade drugstore chain, which Walgreens acquired
in 2010. A retail industry veteran of more than 20 years, Magnacca joined Duane Reade in 2008 as senior vice president and chief merchandising officer. He was later promoted to executive vice president at Duane Reade and then to president of the drugstore chain following its acquisition by Walgreens. He was named Walgreens president of daily living products and solutions in 2011. Brian Griffin has been named president and general manager of Empire BlueCross BlueShield. In this position, Griffin will be responsible for the management of Empireâ€™s local group and individual business in New York, including sales, account management, provider relations and contracting, FRQWLQXHGRQSDJH
ITED AIRLINES Âť MERCER Âť BENEFITFOCUS Âť TEXAS HEALTH RESOURCES Âť HEALTHWAYS also Â offers Â health Â care Â clinics Â for Â its Â employees Â at Â its Â Cleveland, Â Houston, Â *XDPDQG1HZDUN1HZ<RUNKXEV Âł0RUH HPSOR\HUV DUH UHFRJQL]LQJ WKH EHQHÂżWV RI ZRUNVLWH KHDOWK centers Â and Â wellness Â programs Â to Â improve Â the Â overall Â health, Â satisfaction Â and Â productivity Â of Â their Â employees, Â while Â also Â reducing Â costs,â€? Â says Â :DOJUHHQV3UHVLGHQWDQG&(2*UHJ:DVVRQÂł7KLVSURMHFWEULQJVWRJHWKHU two Â companies Â with Â deep Â Chicago Â roots Â to Â make Â health Â and Â wellness Â a Â top Â priority.â€? 7KLVPDUNVWKHÂżIWKZRUNSODFHKHDOWKFOLQLFIRU8QLWHGDOOPDQDJHG by Â Walgreens. Â Unitedâ€™s Â Oâ€™Hare Â facility Â adds Â to Â the Â more Â than Â 370 Â employer-Âbased Â worksite Â health Â and Â wellness Â centers Â managed Â and Â RSHUDWHGE\:DOJUHHQV(PSOR\HU6ROXWLRQV*URXS
Mercer Selects Benefitfocus to Provide Technology Platform for Private Exchange %HQHÂżWIRFXVWKHQDWLRQÂśVODUJHVWSURYLGHURIKHDOWKFDUHDQGEHQHÂżWV technology, Â announced Â it Â will Â provide Â the Â technology Â platform Â for Â the Â SULYDWH EHQHÂżWV H[FKDQJH WR EH RIIHUHG E\ 0HUFHU D JOREDO FRQVXOWLQJ leader Â in Â talent, Â health, Â retirement Â and Â investments. Â Mercer Â Marketplace Â is Â a Â cloud-Âbased Â private Â exchange Â designed Â to Â lower Â employer Â costs Â DVVRFLDWHGZLWKFRPSHWLWLYHHPSOR\HHEHQHÂżWSDFNDJHV 7KH %HQHÂżWIRFXV 3ODWIRUP ZKLFK VXSSRUWV WKH SULYDWH EHQHÂżWV exchange, Â will Â provide Â Mercerâ€™s Â clients Â the Â convenience Â of Â an Â online Â retail Â marketplace Â where Â they Â can Â shop, Â enroll, Â manage Â and Â exchange Â all Â EHQHÂżWVUHODWHGLQIRUPDWLRQ â€œMercer Â Marketplace Â is Â an Â important Â addition Â to Â the Â suite Â of Â solutions Â that Â Mercer Â provides Â to Â clients,â€? Â says Â Sharon Â Cunninghis, Â 1RUWK$PHULFD+HDOWK %HQHÂżW5HJLRQ/HDGHURI0HUFHUÂł,WZLOODOORZ HPSOR\HUV WR FRQWLQXH RIIHULQJ FRPSHWLWLYH EHQHÂżWV WR WKHLU HPSOR\HHV which Â is Â an Â important Â attraction Â and Â retention Â tool, Â while Â actively Â managing Â spending Â and Â reducing Â their Â administrative Â responsibilities. Â (PSOR\HHVZLOOKDYHDFFHVVWRDEURDGHUDUUD\RIEHQHÂżWVDVZHOODVWKH DELOLW\WRWDLORUWKRVHEHQHÂżWVWRWKHLUSDUWLFXODUQHHGVZLWKWKHQHFHVVDU\ support Â to Â make Â appropriate Â decisions.â€? 'HYHORSHG ZLWK %HQHÂżWIRFXV WHFKQRORJ\ 0HUFHU 0DUNHWSODFH GHOLYHUVWKHĂ€H[LELOLW\DQGFXVWRPL]DWLRQUHTXLUHGIRUQDYLJDWLQJFRPSOH[ EHQHÂżWSRUWIROLRV$GGLWLRQDOO\WKH%HQHÂżWIRFXV3ODWIRUPHQDEOHV0HUFHU 0DUNHWSODFHWRVXSSRUWGHÂżQHGFRQWULEXWLRQPRGHOVEDVHGRQDSHUFHQWDJH of Â an Â employeeâ€™s Â income Â or Â a Â standard Â amount Â set Â by Â the Â employer, Â further Â VLPSOLI\LQJEHQHÂżWDGPLQLVWUDWLRQIRU0HUFHUÂśVFOLHQWEDVH
Texas Health Resources, Healthways Advance Physiciandirected Population Health Initiatives Supporting Commercial ACO Design and Deployment Texas Â Health Â Resources Â and Â Healthways Â announced Â the Â launch Â of Â two Â initiatives Â in Â their Â ongoing Â strategic Â alignment Â to Â deploy Â an Â integrated Â physician-Âdirected Â population Â health Â solution Â to Â drive Â health Â outcomes Â and Â cost Â savings. Â 7KH ÂżUVW LQLWLDWLYH LV LPSOHPHQWDWLRQ RI D FRQVLVWHQW V\VWHPZLGH approach Â to Â optimize Â the Â care Â of Â inpatients Â with Â diabetes Â and Â improve Â coor-Â dination Â of Â care Â after Â the Â patient Â is Â discharged. Â Texas Â Health Â launched Â the Â GLDEHWHVFDUHFRRUGLQDWLRQLQLWLDWLYHLQ-DQXDU\DWÂżYH7H[DV+HDOWKKRV-Â pitals Â in Â Dallas, Â Plano, Â Arlington, Â Hurst-ÂEuless-ÂBedford Â and Â Fort Â Worth. Â 7KHVHFRQGLQLWLDWLYHLGHQWLÂżHVLQSDWLHQWVZKRDUHPRVWDWULVNIRU readmissions, Â and Â aligns Â inpatient Â and Â post-Âhospital Â care Â teams Â around Â the Â patientâ€™s Â needs. Â Effective Â coordination Â of Â care Â after Â the Â patient Â is Â discharged Â can Â improve Â quality Â and Â patient Â safety, Â lower Â cost, Â improve Â patient Â outcomes Â and Â help Â prevent Â costly Â readmissions. Â Coordination Â of Â care Â across Â the Â continuum Â of Â services Â is Â part Â of Â Texas Â Healthâ€™s Â overall Â strategy Â to Â integrate Â health Â services Â and Â help Â patients Â navigate Â through Â the Â complex Â environment Â of Â care. Â Both Â approaches Â involve Â the Â patientâ€™s Â primary Â care Â provider Â to Â facilitate Â monitoring Â and Â timely Â interventions. Â These Â initiatives Â are Â critical Â elements Â supporting Â the Â construct Â of Â the Â accountable Â care Â agreement Â announcement Â made Â by Â Texas Â Health Â last Â week Â and Â the Â ACO Â agreement Â announced Â in Â mid-ÂJanuary Â between Â Texas Â Health Â and Â Blue Â Cross Â and Â Blue Â Shield Â of Â Texas. Â â€œTexas Â Health Â is Â collaborating Â with Â physicians, Â commercial Â insurers Â and Â employers Â to Â develop Â an Â accountable Â care Â model Â that Â not Â only Â cares Â for Â people Â when Â they Â are Â ill, Â but Â also Â focuses Â on Â keeping Â people Â healthy Â and Â out Â of Â the Â hospital Â unless Â they Â are Â acutely Â sick Â or Â injured,â€? Â Doug Â Hawthorne, Â CEO Â of Â Texas Â Health Â Resources, Â says. Â â€œBeginning Â with Â the Â physicians, Â nurse Â practitioners Â and Â physician Â assistants Â of Â Texas Â +HDOWK 3K\VLFLDQV *URXS ZH DUH OHDGLQJ WKH ZD\ LQ WUDQVIRUPLQJ IURP the Â fee-Âfor-Âservice Â model Â to Â a Â value-Âbased Â model. Â We Â are Â creating Â a Â physician-Âdirected Â care-Âteam Â approach Â that Â we Â believe Â will Â foster Â more Â accountability Â across Â the Â continuum Â of Â care, Â from Â the Â individual Â patient Â to Â the Â physician Â to Â every Â other Â provider Â on Â the Â team. Â Our Â ultimate Â goal Â is Â to Â help Â physicians Â manage Â the Â health Â of Â their Â patient Â populations Â and Â improve Â their Â health Â and Â well-Âbeing.â€? Â FRQWLQXHGRQSDJH www.TheIHCC.com I HealthCare Consumerism Solutionsâ„˘ I January/February 2013 19
PEOPLE ON THE MOVE
underwriting and product delivery, as well as maintaining customer relationships. In addition, he will be responsible for the development of Empireâ€™s long-term strategic direction and collaborating with local and state elected officials and thought leaders to improve the health of New Yorkers. Griffin brings deep experience to his new role, with more than 30 years of health plan experience. He has held senior leadership positions with significant strategic and profit and loss (P&L) responsibility with Medco Health Solutions and US Healthcare (now Aetna). Griffin started his career as a sales representative for Empire BlueCross BlueShield. Truven Health Analytics, formerly the health care business of Thomson Reuters, announced that Dr. Michael Taylor, M.D., has been appointed chief medical officer. He was previously vice president and national business leader for Truven Health Analytics. As chief medical officer, Dr. Taylor will develop and deepen relationships Taylor with customers, advise on product development and provide counsel to Truven Health Analytics management on business strategy and medical issues. Dr. Taylor is a physician executive with extensive experience in population health. He joined Truven Health Analytics in 2011 from Caterpillar Inc., where he was the medical director for health promotion and disease management. Dr. Taylor was directly responsible for Caterpillarâ€™s wellness program, with more than 100,000 participants in the U.S. This comprehensive program, which included health promotion exams, biometric screening, tobacco cessation, and diabetes prevention and management programs, was part of
an overall effort that led to a health care cost trend well below the national average over an eight-year period at Caterpillar. Aetna announced it has named David A. Queller as the new head of national accounts. Queller will lead the national accounts organization in delivering innovative and integrated benefit solutions that drive measurable health and productivity improvement for its large employer customers, and help them adapt to a rapidly changing marketplace. He assumes his new role immediately. Queller has spent the last two years as president of Aetnaâ€™s Southeast region. In this role, he has been accountable for network, profit and loss, and sales for the region. In addition to his regional responsibilities, he plays an active leadership role in Aetnaâ€™s enterprise strategic planning, performance management, and business operations council. Previously, Queller spent eight years in Aetna National Accounts. He led the National Accounts organization for the entire Eastern region of the country for five years, consistently demonstrating positive results for the company. The DentaQuest Institute is pleased to welcome Robert D. Compton, DDS as its new executive director. The DentaQuest Institute is a national leader in improvement strategies that are advancing the effectiveness and efficiency of dental programs in safety net centers, hospital dental programs and private practice dentistry. Dr. Compton will lead the DentaQuest Institute in its work with oral health professionals across the United States on quality, prevention FRQWLQXHGRQSDJH
Treatment Selection & Shared Decision Support Platform Web + Mobile
muscle, bone, and joint issues
January/February 2013 I HealthCare Consumerism Solutionsâ„˘ I www.TheIHCC.com
BY RONALD E. BACHMAN FSA, MAAA CHAIRMAN EDITORIAL ADVISORY BOARD THE INSTITUTE FOR HEALTHCARE CONSUMERISM
REGULATORY & COMPLIANCE
Development of Private Health Insurance Exchanges Predate PPACA Who: Â Individuals, Â small Â employers Â and Â large Â groups. Â Private Â exchanges Â target: Â‡ Employers Â who Â want Â to Â better Â control Â their Â health Â care Â costs, Â‡ (PSOR\HHVZKRZDQWWRFKRRVHWKHEHQHÂżWSURJUDPWKDWZRUNVEHVW for Â their Â own Â families, Â‡ The Â need Â for Â portability Â as Â workers Â move Â between Â jobs, Â and Â‡ The Â need Â for Â two-Âincome Â families Â to Â combine Â their Â resources Â into Â a Â VLQJOHEHQHÂżWVSURJUDPIRUWKHZKROHIDPLO\ When: Â Some Â local Â exchanges Â have Â been Â operating Â for Â many Â years. Â New Â regional Â and Â national Â private Â exchanges Â may Â start Â operating Â in Â 2013 Â and Â 2014. Â PPACA Â increased Â awareness Â and Â the Â need Â for Â a Â new Â health Â insurance Â purchasing Â system. Â In Â addition, Â some Â of Â the Â private Â exchange Â developers Â KRSH WR JHW D VKDUH RI WKH 33$&$ IHGHUDO H[FKDQJH EXVLQHVV *RYHUQPHQW GHÂżQHG33$&$H[FKDQJHVDUHVFKHGXOHGWREHJLQ-DQ What: Â The Â development Â of Â private Â exchanges Â predates Â PPACA Â and Â is Â growing Â independent Â of Â PPACA. Â Exchanges Â produce Â a Â new Â process Â of Â shopping Â for Â health Â insurance. Â Like Â any Â business, Â consumers Â seeking Â value Â will Â ultimately Â decide Â which Â exchanges Â will Â succeed. Â Exchanges Â will Â process Â traditionally Â funded Â health Â insurance. Â However, Â an Â important Â impetus Â for Â exchanges Â is Â the Â potential Â use Â of Â health Â reimbursement Â arrangements Â +5$V WKDW DOORZ HPSOR\HUV WR GHVLJQDWH D VXP RI PRQH\ WR SD\ IRU WKH health Â care Â needs Â of Â employees, Â whether Â through Â an Â insurance Â program Â or Â through Â the Â direct Â payment Â of Â medical Â services. Â Private Â exchanges Â can Â combine Â employer-Âpaid Â HRA Â contributions Â with Â employee-Âpaid Â Section Â 125 Â contribution Â to Â allow Â for Â individual Â health Â plans Â to Â be Â paid Â on Â a Â tax-Âfree Â basis. Â Executive Â Summary: Â Developing Â private Â exchanges Â may Â be Â grouped Â into Â three Â categories. Â Some Â are Â focused Â on Â the Â small Â group Â market, Â others Â on Â ODUJHJURXSVDQGVWLOORWKHUVRQUHWLUHHKHDOWKEHQHÂżWV Business Â group Â exchanges: Â Developed Â from Â existing Â employer Â associations. Â They Â typically Â will Â ensure Â portability Â for Â employees, Â but Â only Â when Â the Â employee Â moves Â between Â participating Â employers Â and Â health Â plans. Insurer-Âsponsored Â exchanges: Â Developed Â for Â insured Â policyholder, Â making Â it Â easy Â to Â move Â current Â small Â employers Â into Â an Â exchange Â and Â allow Â individual Â employees Â a Â wider Â choice Â of Â health Â plan Â design. Â The Â portability Â WKHDELOLW\RIDFRQVXPHUWRNHHSWKHVDPHFRYHUDJHDVWKH\PRYHEHWZHHQ MREV LV DYDLODEOH WR LQGLYLGXDOV PRYLQJ DPRQJ FRPSDQLHV FRYHUHG E\ WKH same Â insurer. Â Independent Â companies: Â Developed Â with Â various Â sponsorships, Â existing Â relationships, Â and Â business Â models. Â These Â companies Â include Â existing Â
information Â technology Â vendors, Â consultants/brokers, Â and Â entrepreneurs. Â These Â players Â seek Â to Â meet Â the Â needs Â of Â existing Â health Â industry Â customers, Â employer Â groups, Â and Â broker Â clients. Â They Â see Â the Â opportunity Â to Â expand Â on Â existing Â services Â and Â technology Â to Â create Â new Â businesses Â in Â a Â growing Â market. Â The Â potential Â for Â private Â exchanges Â comes Â from Â the Â mid-Â Â and Â large-Â group Â markets Â that Â will Â not Â be Â involved Â in Â the Â state-Âbased Â federal Â PPACA Â exchanges. Private Â exchanges Â can Â address Â some Â of Â the Â existing Â problems Â in Â our Â current Â system. Â‡ (PSOR\HUFRVWVZLOOEHÂż[HGDQGFRQWUROODEOH$QHPSOR\HUZLOOEH able Â to Â contribute Â only Â what Â it Â can Â afford. Â‡ Employees Â will Â be Â able Â to Â choose Â their Â plan Â design, Â the Â one Â that Â works Â best Â for Â their Â own Â family. Â‡ Coverage Â will Â eventually Â be Â portable, Â so Â employees Â can Â keep Â the Â same Â coverage Â as Â they Â change Â jobs, Â or Â lose Â their Â job Â altogether. Â‡ Unlike Â individual Â coverage Â today, Â the Â employee Â contribution Â may Â be Â tax Â free Â through Â using Â a Â Section Â 125 Â payroll Â deduction. Â Â‡ Two-Âincome Â families Â may Â be Â able Â to Â use Â contributions Â from Â different Â employers Â to Â purchase Â a Â single Â plan Â for Â the Â whole Â family. Private Â exchanges Â can Â move Â health Â insurance Â to Â a Â system Â of Â individual Â choice Â and Â ownership Â and Â allow Â employers Â to Â concentrate Â on Â their Â core Â EXVLQHVV7KHUHPD\EHOHJDORUUHJXODWRU\FODULÂżFDWLRQVWRDFFRPPRGDWHWKH effective Â uses Â of Â private Â exchanges. Â :LWKRUZLWKRXW33$&$HPSOR\HUVDUHÂżQGLQJZD\VWRPDNHÂłFRQVXPHU empowermentâ€? Â a Â reality. Â People Â want Â to Â have Â more Â control Â over Â their Â own Â lives. Â They Â are Â demanding Â choice Â and Â individual Â ownership Â of Â their Â health Â EHQHÂżWVDVWKH\DUHLQHYHU\RWKHUDVSHFWRIWKHLUOLYHV+5$VDQG'HÂżQHG Contribution Â plans Â with Â personal Â choice Â and Â ownership Â of Â health Â coverage Â is Â the Â latest Â iteration Â of Â this Â demand Â for Â health Â care Â consumerism. Actions: Â Employers Â will Â need Â to Â determine Â the Â value Â of Â considering Â private Â H[FKDQJHVDVDQDOWHUQDWLYHWRWKHLUFXUUHQWKHDOWKEHQHÂżWSODQV(PSOR\HUV will Â need Â to Â determine Â the Â economics Â and Â employee Â attitudes Â in Â moving Â to Â a Â GLIIHUHQWV\VWHPRIKHDOWKLQVXUDQFHSXUFKDVLQJ7KHUHDUHPDQ\EHQHÂżWVDQG some Â drawbacks Â that Â need Â to Â be Â considered. Â Employers Â should Â check Â with Â their Â compliance Â and Â legal Â teams, Â insurance Â brokers, Â agents, Â consultants, Â and Â insurers Â before Â reviewing Â or Â deciding Â to Â use Â a Â private Â health Â insurance Â exchange Â approach Â to Â health Â coverages. Â The information presented and contained within this article was submitted by Ronald E. Bachman, President & CEO of Healthcare Visions and the Chairman of the IHC Editorial Advisory Board. This information is general information only, and does not, and is not intended to constitute legal advice. You should consult your legal advisors to determine the laws and regulations impacting your business.
www.TheIHCC.com I HealthCare Consumerism Solutionsâ„˘ I January/February 2013
BY J. KEVIN A. McKETCHNIE EXECUTIVE DIRECTOR AMERICAN BANKERS ASSOCIATIONâ€™S HSA COUNCIL
Evolutionary Health Care Financing: The Global Switch to HSAs
inter Â in Â Edmonton, Â Alberta Â isnâ€™t Â for Â the Â weak Â at Â heart. Â We Â arrived Â Â in Â the Â fall Â of Â 2006 Â after Â a Â quick Â layover Â in Â already Â chilly Â Chicago. Â 7KLVZDVWKHÂżQDOVWRSLQZKDWZDVDPXOWLFLW\PXOWLFRQWLQHQWDO tour Â of Â national Â health Â care Â systems Â and Â their Â weaknesses. The Â provincial Â government Â invited Â us Â to Â solve Â a Â problem Â that Â the Â embarrassment Â of Â energy Â riches Â in Â Alberta Â was Â making Â acute: Â How Â to Â operate Â a Â single-Âpayer Â system Â trying Â to Â serve Â a Â population Â that Â was Â doublingâ€”at Â least Â in Â Red Â Deerâ€”every Â 18 Â months? Â The Â call Â on Â Albertaâ€™s Â treasury Â was Â enormous, Â as Â was Â the Â inability Â of Â what Â remains Â a Â systemic Â issue Â in Â the Â provinceâ€™s Â health Â care Â delivery Â V\VWHP $V WKH VHUYLFHVHOLJLEOH SRSXODWLRQ JUHZ ZLWK WKH RLO ÂżHOGV WKH infrastructure Â of Â hospitals, Â doctors, Â nurses Â and Â even Â bedpans Â remained Â relatively Â static. Â Collapse Â was Â imminent. With Â too Â many Â oil Â sands Â workers Â pushing Â through Â the Â doors Â of Â KRVSLWDOVHQHUJ\FRPSDQLHVZHUHEHJLQQLQJWRĂ€\ZRUNHUVWRQHLJKERULQJ provinces Â or Â even Â out Â of Â Canada Â to Â the Â United Â States Â for Â care. Â Once Â the Â other Â Canadian Â provinces Â realized Â they Â were Â treating Â Albertaâ€™s Â workforce Â without Â gaining Â Albertaâ€™s Â revenue Â in Â return, Â the Â other Â provinces Â tried Â charging Â a Â fee. Â They Â quickly Â discovered Â such Â charges Â were Â actually Â illegal Â in Â Canada. Â The Â United Â States Â became Â the Â only Â option. However, Â the Â challenge Â in Â America Â was Â a Â foreign Â worker, Â even Â a Â Canadian, Â doesnâ€™t Â have Â access Â to Â American Â health Â insurance Â products. Â But Â since Â most Â oil Â workers Â were Â only Â looking Â for Â routine Â care, Â energy Â companies Â negotiated Â with Â provider Â networks Â and Â armed Â their Â employees Â with Â cash. Â The Â purpose Â of Â this Â cash Â was Â to Â be Â used Â for Â health Â care Â in Â newly Â created Â accounts. Â Employees Â could Â keep Â this Â cash Â and Â it Â would Â be Â replenished Â every Â year.
The Â HSA Â community Â is Â bracing Â for Â record Â enrollments, Â probably Â up Â by Â as Â much Â as Â 30 Â percent, Â insuring Â around Â 16 Â million Â Americans, Â according Â to Â some Â estimates. Â And Â thus Â begins Â the Â new Â class Â war: Â Americans Â who Â can Â pay Â for Â health Â care Â with Â cash Â and Â insurance Â versus Â Americans Â who Â have Â to Â rely Â on Â what Â the Â government Â wants Â to Â pay Â the Â same Â providers Â through Â entitlement Â reimbursements. Â
It Â means Â that Â the Â administration Â has Â taken Â the Â positive Â steps Â the Â HSA Â Council Â asked Â them Â to Â make Â to Â ensure Â the Â most Â affordable Â plansâ€” DOZD\V+6$TXDOLÂżHGSODQVÂ˛DUHDYDLODEOHLQWKHH[FKDQJHVDQGLQVXUDQFH companies Â wonâ€™t Â be Â penalized Â in Â their Â MLR Â performance Â for Â continuing Â to Â RIIHU+6$TXDOLÂżHGSODQV%XWLWDOVRPHDQV$PHULFDQVLQVXUHGLQWKHVH plans Â will Â not Â only Â have Â a Â way Â to Â save Â for Â future Â care Â but Â also Â will Â have Â a Â ZD\WRFRPSHWHIRUFDUHZKHQWKHĂ€RRGJDWHVRSHQLQ The Â regulatory Â environment Â remains Â a Â stormy Â one. Â But Â at Â least Â the Â millions Â of Â Americans Â insured Â with Â HSAs Â will Â be Â better Â equipped Â than Â most Â to Â manage Â the Â coming Â provider Â shortage. Â Â
7KH $IIRUGDEOH &DUH $FW $&$ PDNHV WKH DFFRXQWEDVHG ÂżQDQFLQJ system Â even Â more Â attractive Â to Â American Â government Â than Â the Â oil Â boom Â makes Â it Â to Â Alberta. Â As Â the Â uninsured Â gain Â access Â to Â subsidized Â health Â care Â ÂżQDQFLQJWKHFUXVKRQ$PHULFDQUHVRXUFHVZLOOEHOLNH5HG'HHUÂśV-XVW like Â in Â the Â single-Âpayer Â environment, Â everyone Â will Â be Â insured, Â but Â instead Â of Â relying Â on Â the Â ever-Âdiminishing Â reimbursements Â of Â an Â entitlement Â regime, Â some Â will Â have Â what Â Albertaâ€™s Â oil-Âworkers Â haveâ€”cash.
Why is that Going to be Such an Advantage? The Â ACA Â marches Â the Â reach Â of Â Americaâ€™s Â entitlements Â upward, Â in Â terms Â of Â Medicaid Â eligibility Â with Â respect Â to Â income Â and Â downward, Â in Â terms Â of Â Medicare Â eligibility Â in Â terms Â of Â age. Â These Â patients Â canâ€™t Â have Â an Â HSAâ€”at Â least Â not Â yet;Íž Â but Â give Â me Â and Â my Â team Â a Â year Â and Â weâ€™ll Â seeâ€”so Â they Â only Â have Â what Â the Â government Â will Â reimburse Â to Â offer Â a Â provider Â for Â care. Â The Â insured Â marketplace, Â largely Â the Â employer-Âsponsored Â space, Â has Â more Â attractive Â reimbursements Â but Â also Â has Â HSAs, Â which Â are Â cash Â accounts Â earmarked Â for Â health Â care. Â A Â lot Â of Â them.
Who Will Win? The Â government Â is Â hedging Â its Â bets. Â Before Â the Â Christmas Â holidays, Â two Â major Â changes Â in Â administration Â regulatory Â posture Â gave Â this Â industry Â DKXJHERRVW7KHÂżUVWDQGEHWWHUNQRZQRXWFRPHLVWKH$FWXDULDO9DOXH $9 UXOHZKLFKDVZULWWHQVHHPVXQKHOSIXOWR+6$VLVSDUWQHUHGZLWKD calculator Â making Â it Â nearly Â impossible Â to Â disqualify Â an Â HSA-Âplan Â from Â sale Â in Â an Â exchange. 8QEHOLHYDEO\WKHFDOFXODWRUZRUNVLQVXFKDZD\WKDW+6$TXDOLÂżHG plans, Â without Â any Â contributions Â to Â the Â account, Â generally Â qualify Â as Â bronze Â plans. Â If Â contributions Â are Â made, Â HSAs Â score Â higher, Â sometimes Â even Â as Â high Â as Â platinum Â plans. /HVVQRWHGLVWKHWHVWLPRQ\RI*DU\&RKHQGLUHFWRURIWKH&HQWHUIRU Consumer Â Information Â & Â Insurance Â Oversight, Â who Â appeared Â before Â the Â House Â of Â Representatives Â on Â Dec. Â 13, Â 2012. Â â€œThe Â [MLR Â Rule] Â 80/20 Â rule Â says Â insurance Â companies Â have Â to Â spend Â 80 Â cents Â of Â every Â premium Â dollar Â on Â care,â€? Â says Â Cohen Â about Â the Â RSHUDWLRQRIWKHPHGLFDOORVVUDWLR0/5 UXOHÂł7RWKHH[WHQWWKDWWKH+6$ dollars Â are Â actually Â expended, Â they Â will Â be Â counted Â toward Â that Â 80 Â cents Â that Â the Â insurance Â company Â has Â to Â spend.â€?
What Does this all Mean?
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www.TheIHCC.com I HealthCare Consumerism Solutionsâ„˘ I January/February 2013
POPULATION HEALTH MANAGEMENT
BY DR. DEE W. EDINGTON FOUNDER EDINGTON ASSOCIATES
Corporate Wellness: 2013 is Time for an Upgrade
DQ(OOLRWWRI5DOSK%HQHÂżWVLQFHQWUDO1HZ<RUN &RUSRUDWHDQGSROLWLFDO informs Â individuals Â of Â potential Â debilitating Â chronic Â disease Â that Â could Â rob Â them Â of Â their Â health Â and Â meets Â with Â each Â employee Â and Â their Â spouse Â GXULQJ EHQHÂżWV VHOHFWLRQ SHULRGV WR H[SODLQ OHDGHUVKDYHQHYHUEHHQ retirement Â security.â€? $ÂżQDQFLDOWRROIRUIXOO\LQVXUHGFRPSDQLHVZDV their Â options. Â He Â has Â a Â nearly Â 100 Â percent Â client Â retention Â rate Â and Â close Â to Â 100 Â percent Â employer Â VRLQWHUHVWHGLQKRZJRRG created Â and Â implemented Â by Â Chris Â Hogan Â and Â Scott Â :RRG DW WKH %HQHÂżW &RPPHUFH *URXS LQ 3KRHQL[ satisfaction Â rates. KHDOWKFDQLPSDFWFRVWV Their Â â€œTrend Â Neutralizerâ€? Â system Â was Â developed Â )DFHWRIDFHWLPHEHWZHHQDEHQHÂżWVFRQVXOWDQW to Â show Â the Â 50-Â250 Â employee Â companies Â the Â role Â and Â employees Â may Â not Â seem Â like Â a Â wellness Â strategy, Â but Â it Â is Â oneâ€”if Â not Â the Â bestâ€”investment Â in Â engaging Â DQGSURGXFWLYLW\PDNLQJ cost Â trend Â plays Â in Â the Â calculation Â of Â future Â costs. Â HPSOR\HHV DQG WKHLU IDPLOLHV LQ WKHLU EHQHÂżWV DQG QRZDQRSSRUWXQHWLPHWR The Â need Â for Â this Â system Â arose Â from Â the Â inability Â of Â the Â carriers Â to Â provide Â the Â utilization Â cost Â data. Â The Â their Â health. Â Elliottâ€™s Â approach Â is Â an Â important Â step Â in Â the Â right Â direction Â as Â we Â strive Â to Â help Â our Â corporate Â EULQJZHOOQHVVSURJUDPV Trend Â Neutralizer Â provides Â the Â underwriter Â with Â the Â opportunity Â to Â retrospectively Â evaluate Â a Â clientâ€™s Â clients Â establish Â a Â culture Â of Â health Â within Â their Â performance Â in Â seven Â areas Â that Â all Â parties Â agree Â organizations. WRDKLJKHUOHYHORI leads Â to Â better Â outcomes. Â If Â the Â client Â performs Â Corporate Â wellness Â initiatives Â have Â been Â around Â consistent Â with Â best Â practice, Â their Â trend Â factor Â may Â for Â 40 Â years, Â beginning Â in Â the Â early Â 1970s. Â The Â HQJDJHPHQW be Â reduced Â to Â zero. Â The Â carrier Â has Â none Â of Â the Â risks Â early Â wellness Â programs Â and Â those Â leading Â up Â to Â of Â a Â prospectively Â based Â pricing Â strategy;Íž Â however, Â 2013 Â concentrated Â on Â tactical Â individual Â behavioral Â change. Â After Â four Â decades Â of Â programming, Â it Â is Â clear Â the Â results Â have Â been Â the Â carrier Â is Â able Â to Â reward Â the Â groups Â who Â are Â doing Â what Â the Â carrier Â wants Â disappointing Â and, Â in Â fact, Â are Â stuck Â at Â a Â less-Âthan-Âoptimal Â position Â within Â them Â to Â do Â without Â having Â to Â subsidize Â the Â expenses Â for Â groups Â that Â are Â not Â nearly Â every Â organization. Â There Â is Â little Â to Â no Â evidence Â our Â population Â is Â in Â compliance. $ODQ :DQJ DW $),6%HQHÂżWV D EHQHÂżWV DQG ZHOOQHVV FRPSDQ\ LQ healthier Â or Â more Â productive Â today Â than Â when Â the Â programs Â began. Â However, Â what Â has Â emerged Â is Â a Â growing Â awareness Â of Â the Â potential Â Emeryville, Â Calif., Â in Â considering Â the Â impact Â of Â PPACA Â to Â small Â businesses, Â of Â a Â healthy Â workforce. Â Corporate Â and Â political Â leaders Â have Â never Â been Â came Â to Â the Â conclusion Â the Â employer Â will Â never Â be Â absolved Â of Â the Â so Â interested Â in Â how Â good Â health Â can Â impact Â costs Â and Â productivity, Â responsibility Â to Â have Â a Â healthy Â workforce Â whether Â the Â employees Â get Â their Â making Â now Â an Â opportune Â time Â to Â bring Â wellness Â programs Â to Â a Â higher Â insurance Â from Â the Â exchanges Â or Â through Â the Â employer. Â Regardless Â the Â level Â of Â engagement. Â Realizing Â this Â opportunity Â is Â the Â responsibility Â of Â HPSOR\HUZLOOZDQWWRFUHDWHDFXOWXUHRIKHDOWKDQGSURYLGHRWKHUEHQHÂżWVWR LQGLYLGXDOVZKRUHFRPPHQGZHOOQHVVKHDOWKDQGGLVDELOLW\EHQHÂżWGHVLJQV drive Â down Â costs Â and Â improve Â workplace Â effectiveness Â because Â the Â employer Â will Â have Â very Â little Â control Â to Â affect Â premium Â outcome Â in Â the Â exchanges. Â to Â organizations. Â Purchasing Â insurance Â in Â the Â traditional Â sense Â will Â likely Â result Â in Â lower Â costs Â when Â the Â employer Â becomes Â engaged Â in Â promotion Â a Â culture Â of Â health. New and Progressive Strategies for 2012 Âł*RRG +HDOWK LV *RRG %XVLQHVVÂ´ KDV DOZD\V EHHQ RXU IRFXV ZKHQ Developing Â low-Ârisk Â maintenance Â strategies Â illustrates Â the Â type Â of Â widespread, Â culture-Âbased Â thinking Â that Â is Â critical Â as Â companies Â move Â working Â with Â clients Â says Â David Â Rearick Â and Â Stephen Â Cherniak Â at Â Marsh Â & Â toward Â the Â successful Â implementation Â of Â new, Â inspired Â approaches Â to Â McLennan Â Agency Â LLC Â in Â Atlanta. Â We Â achieve Â that Â by Â assisting Â our Â clients Â with Â a Â focus Â on Â vision Â and Â helping Â individuals Â and Â the Â workplace Â thrive Â in Â a Â sustainable Â way. Â That Â opens Â the Â door Â to Â Elliottâ€™s Â approach Â to Â engaging Â employees Â in Â their Â health Â environment. Â A Â vision Â from Â leadership Â that Â supports Â the Â principle Â that Â DQGEHQHÂżWVFKRLFHVZKLFKSURYLGHVDPDMRUFRPSHWLWLYHHGJHHYHQDJDLQVW â€œgood Â health Â is Â expectedâ€”not Â hoped Â forâ€?;Íž Â and Â an Â environment Â that Â focuses Â on Â and Â is Â supportive Â of Â the Â workforceâ€™s Â ability Â to Â do Â their Â job Â and Â manage Â less Â expensive Â programs. Â An Â idea Â that Â will Â gain Â traction Â over Â the Â next Â few Â years Â is Â focusing Â on Â the Â their Â lifestyle. Â Finally, Â today Â it Â isnâ€™t Â about Â wellnessâ€”it Â is Â about Â well-Âbeing. Â We Â need Â ÂżQDQFLDOZHOOQHVVRIHPSOR\HHV6LPSOLFLW\+HDOWK3ODQKDVGHYHORSHGDWRRO WRKHOSHPSOR\HHVXQGHUVWDQGWKHÂżQDQFLDOLPSOLFDWLRQVRIWKHLUKHDOWKDQG the Â objective Â data Â like Â biometrics;Íž Â but Â a Â high Â blood Â pressure Â or Â BMI Â is Â EHQHÂżWVGHFLVLRQVLQDFRPSHOOLQJZD\7KHFRPSDQ\ÂśVKDQGKHOGPRELOHDQG often Â the Â result Â of Â an Â unhappy Â marriage, Â someone Â with Â an Â abuse Â problem, Â web-Âbased Â applications Â assess Â an Â individualâ€™s Â health Â risks Â and Â behaviors, Â ÂżQDQFLDOLQVHFXULW\RUPHQWDOLOOQHVVÂ˛WKHVHDUHWKHURRWFDXVHVDQGKXPDQ calculate Â the Â excess Â costs Â of Â any Â risks Â and Â demonstrate Â potential Â savings. Â resource Â challenges Â that Â every Â health Â enhancement Â strategy Â must Â look Â for Â *UHJ +XPPHU 0' DQG &(2 VWDWHV ÂłÂŤWKH +HDOWK ,QGH[ &DOFXODWRU and Â address.â€? Â 24
January/February 2013 I HealthCare Consumerism Solutionsâ„˘ I www.TheIHCC.com
BY RANDY FINN ASSISTANT VICE PRESIDENT, PRODUCT DEVELOPMENT COLONIAL LIFE & ACCIDENT INSURANCE COMPANY
SUPPLEMENTAL HEALTH MANAGEMENT
Ease the Sting of High-deductible Health Plans with Voluntary Benefits and Effective Communication
KH FRVW RI SURYLGLQJ DIIRUGDEOH KHDOWK EHQHÂ¿WV WR HPSOR\HHV WRSV HYHU\H[HFXWLYHÂ¶VOLVWRIZRUULHV7KDWÂ¶VZK\FRQVXPHUGULYHQEHQHÂ¿WV including Â high-Âdeductible Â health Â plans Â and Â health Â savings Â accounts, Â are Â gaining Â traction. Â These Â options Â can Â help Â employers Â drive Â down Â the Â cost Â of Â PDMRUPHGLFDOFRYHUDJHEXWDGGLQJYROXQWDU\EHQHÂ¿WVWRWKHPL[FDQRIIHU even Â more Â advantages Â for Â employers Â and Â employees.
High-deductible Plans are Growing in Popularity Statistics Â from Â the Â Kaiser Â Family Â Foundation Â and Â Health Â Research Â & Â Educational Â Trust Â show Â the Â number Â of Â workers Â enrolled Â in Â HDHPs Â grew Â from Â 8 Â percent Â in Â 2009 Â to Â 19 Â percent Â in Â 2012. Â These Â plans Â tend Â to Â be Â more Â SRSXODU DPRQJ VPDOOHU Â¿UPV XQGHU HPSOR\HHV +'+3V DUH RIWHQ offered Â in Â conjunction Â with Â HSAs, Â tax-Âpreferred Â accounts Â employees Â can Â use Â WRSD\IRUTXDOLÂ¿HGPHGLFDOH[SHQVHV How Â large Â is Â the Â average Â deductible Â for Â employees Â in Â todayâ€™s Â world? Â For Â those Â with Â HDHPs, Â it Â was Â nearly Â $2,100 Â in Â 2012. Â Overall, Â 34 Â percent Â of Â employees Â have Â an Â average Â deductible Â of Â $1,000 Â or Â more Â for Â single Â coverageâ€”a Â number Â that Â has Â tripled Â since Â 2006. Increasing Â the Â deductible Â on Â a Â company Â health Â plan Â can Â help Â employers Â VLJQLÂ¿FDQWO\ ORZHU WKHLU FRVW IRU PDMRU PHGLFDO FRYHUDJH %XW UDLVLQJ GHGXFWLEOHVSXWDGGLWLRQDOÂ¿QDQFLDOEXUGHQRQHPSOR\HHV,IQRWPDQDJHG and Â communicated Â properly, Â such Â a Â move Â can Â be Â highly Â unpopular Â with Â the Â employee Â population. Â
Voluntary Products Can Pair Nicely With HDHPs To Â help Â offset Â the Â high Â deductibles Â workers Â face Â with Â an Â HDHP, Â many Â employers Â have Â turned Â to Â voluntary Â products Â for Â a Â much-Âneeded Â solution. Â Though Â voluntary Â products Â are Â typically Â employee-Âpaid, Â employers Â often Â Â¿QGWKH\FDQSD\IRUDOORUSDUWRIWKHVHEHQHÂ¿WVIURPWKHFRVWVDYLQJVWKH\ realize Â from Â redesigning Â their Â health Â plans. No Â matter Â who Â pays Â the Â premium, Â voluntary Â products Â can Â help Â offset Â the Â deductibles, Â co-Âinsurance Â and Â other Â out-Âof-Âpocket Â medical Â and Â nonmedical Â costs Â associated Â with Â hospital Â stays, Â injuries Â and Â illnesses. Â By Â offering Â employees Â a Â soft Â landing Â with Â a Â voluntary Â product, Â employers Â are Â able Â to Â take Â the Â edge Â off Â the Â increased Â deductible Â associated Â with Â an Â HDHP. Â
What Types of Voluntary Products Work well with High-deductible Health Plans There Â are Â several Â types Â of Â voluntary Â products Â complementing Â HDHPs, Â and Â many Â of Â these Â plans Â are Â HSA-Âcompliant. Â‡ +RVSLWDO FRQÂ¿QHPHQW LQGHPQLW\ LQVXUDQFH Â Voluntary Â KRVSLWDO FRQÂ¿QHPHQW FRYHUDJH KHOSV SD\ WKH QRQPHGLFDO DQG medical Â out-Âof-Âpocket Â expenses Â related Â to Â a Â hospital Â stay. Â‡ Cancer Â and Â critical Â illness Â insurance: Â Employees Â diagnosed Â with Â cancer Â or Â another Â covered Â critical Â illness, Â such Â as Â a Â stroke Â
RUKHDUWDWWDFNFDQXVHWKHSODQÂ¶VEHQHÂ¿WVWRKHOSSD\IRUKHDOWK insurance Â deductibles Â and Â copayments Â as Â well Â as Â nonmedical Â expenses. Â‡ Accident Â insurance:$FFLGHQWLQVXUDQFHSD\VEHQHÂ¿WVZKHQDQ insured Â is Â injured Â as Â a Â result Â of Â a Â covered Â accident Â â€” Â injuries Â such Â as Â joint Â dislocations, Â broken Â bones, Â burns, Â lacerations Â DQGUXSWXUHGGLVFV(PSOR\HHVFDQXVHWKHEHQHÂ¿WVWRKHOSSD\ for Â nonmedical Â and Â medical Â out-Âof-Âpocket Â expenses Â such Â as Â deductibles Â and Â copayments Â resulting Â from Â a Â covered Â accident.
Donâ€™t Overlook the Importance of Benefits Communication When Â employees Â are Â faced Â with Â picking Â up Â the Â tab Â for Â a Â larger Â portion Â of Â their Â medical Â expenses, Â they Â need Â help Â understanding Â why Â changes Â were Â made Â and Â how Â their Â coverage Â is Â impacted. Â Thatâ€™s Â why Â offering Â clear Â and Â HIIHFWLYHEHQHÂ¿WVFRPPXQLFDWLRQLVPRUHLPSRUWDQWWKDQHYHU Choosing Â a Â voluntary Â carrier Â offering Â complimentary Â one-Âto-Âone Â counseling Â as Â part Â of Â its Â enrollment Â services Â help Â employees Â understand Â WKHFKDQJHVPDGHWRWKHLUEHQHÂ¿WVDQGWKHQHZRSWLRQVDYDLODEOHWRWKHP$ SURYLGHUWKDWFDQHQUROODOOHPSOR\HHEHQHÂ¿WVLQFOXGLQJFRUHEHQHÂ¿WVDOVR removes Â a Â major Â hassle Â for Â the Â employer. ,Q IDFW VXUYH\V RI HPSOR\HHV ZKR PHHW LQGLYLGXDOO\ ZLWK EHQHÂ¿WV counselors Â during Â their Â enrollments Â prove Â the Â effectiveness Â of Â the Â one-Â WRRQH PHWKRG 9LUWXDOO\ DOO HPSOR\HHV SHUFHQW VXUYH\HG E\ &RORQLDO /LIHVD\SHUVRQDOEHQHÂ¿WVFRXQVHOLQJLPSURYHGWKHXQGHUVWDQGLQJRIWKHLU EHQHÂ¿WVDQGSURYLQJWKLVW\SHRIFRPPXQLFDWLRQLVLPSRUWDQWSHUFHQW (PSOR\HUV DOVR Â¿QG YDOXH LQ RQHWRRQH EHQHÂ¿WV FRXQVHOLQJ $OPRVW SHUFHQW RI HPSOR\HUV EHOLHYH SHUVRQDO EHQHÂ¿WV FRXQVHOLQJ VHVVLRQV VWURQJO\LPSURYHHPSOR\HHVÂ¶XQGHUVWDQGLQJRIWKHLUEHQHÂ¿WVDQGFRYHUDJH needs.
The Role of Employers is Changing 7KH PRYH WRZDUG FRQVXPHUGULYHQ EHQHÂ¿WV FKDQJHV WKH UROH RI employers. Â No Â longer Â are Â they Â always Â providing Â and Â paying Â for Â traditional Â EHQHÂ¿WV ,QVWHDG WRGD\Â¶V HPSOR\HUV PXVW QRZ SURYLGH DFFHVV WR DQ DUUD\ RITXDOLW\EHQHÂ¿WVÂ²ERWKFRUHDQGYROXQWDU\$QGWRNHHSHPSOR\HHVKDSS\ DQGHQJDJHGWKH\PXVWSURYLGHHIIHFWLYHEHQHÂ¿WVFRPPXQLFDWLRQKHOSLQJ ZRUNHUVEHWWHUXQGHUVWDQGDQGDSSUHFLDWHWKHEHQHÂ¿WVWKH\Â¶UHRIIHUHG 5DQG\ )LQQ LV DVVLVWDQW YLFH SUHVLGHQW RI SURGXFW GHYHORSPHQW DW &RORQLDO /LIH &RORQLDO /LIH LV D PDUNHW OHDGHU LQ SURYLGLQJ ILQDQFLDO SURWHFWLRQ EHQHILWV WKURXJK WKH ZRUNSODFH LQFOXGLQJ GLVDELOLW\ OLIH DFFLGHQW FDQFHU FULWLFDO LOOQHVV DQG VXSSOHPHQWDO KHDOWK LQVXUDQFH 7KH FRPSDQ\Â¶V EHQHILW VHUYLFHV DQG HGXFDWLRQ LQQRYDWLYH HQUROOPHQW WHFKQRORJ\ DQG SHUVRQDO VHUYLFH VXSSRUW PRUH WKDQ EXVLQHVVHVDQGRUJDQL]DWLRQVUHSUHVHQWLQJQHDUO\PLOOLRQZRUNLQJ$PHULFDQVDQG WKHLU IDPLOLHV )RU PRUH LQIRUPDWLRQ YLVLW ZZZFRORQLDOOLIHFRP RU FRQQHFW ZLWK XV DW ZZZIDFHERRNFRPFRORQLDOOLIHEHQHILWV ZZZWZLWWHUFRPFRORQLDOOLIH DQG ZZZ OLQNHGLQFRPFRPSDQ\FRORQLDOOLIH www.TheIHCC.com I HealthCare Consumerism Solutionsâ„¢ I January/February 2013
PHARMACY BENEFIT MANAGEMENT
BY SUMIT DUTTO SENIOR VICE PRESIDENT AND OFFICER CATAMARAN
Pharmacy Benefit Management Business Adapting to Demand for Specialty Medications
KHSKDUPDF\EHQHÂżWVPDQDJHPHQW3%0 EXVLQHVVFDQEHGLIÂżFXOWWR understand. Â This Â is Â especially Â true Â during Â periods Â of Â transition, Â like Â now, Â when Â the Â health Â care Â industry Â is Â adapting Â to Â dramatic Â changes. Â 7KH PRVW VLJQLÂżFDQW LQFOXGH LQFUHDVLQJ GHPDQG IRU VSHFLDOW\ SKDUPDF\ medications, Â changes Â stemming Â from Â the Â Affordable Â Care Â Act, Â and Â shifts Â toward Â value/outcomes-Âbased Â payment Â models Â and Â dynamic Â provider Â care Â delivery Â models. Â Employers, Â TPAs Â and Â managed Â care Â executives Â are Â all Â carefully Â examining Â these Â areas Â to Â ensure Â they Â are Â prepared Â for Â the Â future Â consumer-Âcentric Â health Â care Â environment.
touch Â clinical Â programs. Â BriovaRx Â has Â specialty Â pharmacies Â in Â locations Â throughout Â the Â United Â States, Â which Â serve Â to Â promote Â close Â relationships Â with Â providers Â and Â patients Â regionally. Â
The Â United Â States Â spends Â more Â money Â per Â person Â on Â health Â care Â than Â any Â other Â prosperous Â nation Â in Â the Â world, Â yet Â the Â health Â care Â outcomes Â are Â not Â necessarily Â better. Â This Â situation Â is Â leading Â a Â push Â toward Â developing Â new Â payment Â models Â that Â reward Â positive Â outcomes Â or Â penalize Â negative Â ones. Â In Â 2012, Â Medicare Â &DWDPDUDQÂśVUHVSRQVHLVWR Â began Â adjusting Â downward Â reimbursement Â Health Care Reform for Â hospitalizations Â for Â three Â conditions: Â There Â are Â more Â than Â 48 Â million Â uninsured Â IRFXVRQFOLQLFDORIIHULQJVWKDW rates Â heart Â attack, Â heart Â failure Â and Â pneumonia. Â Americans Â today. Â Although Â many Â of Â the Â uninsured Â are Â working, Â some Â employers Â may Â not Â DOORZĂ€H[LELOLW\IRUSKDUPDF\ Managed Â care Â organizations Â are Â experimenting Â with Â new Â contracting Â models Â with Â accountable Â offer Â health Â insurance Â or Â employees Â may Â not Â be Â eligible. Â We Â know Â the Â uninsured Â are Â more Â likely Â EHQHÂżWVHUYLFHVWREHGHOLYHUHG care Â organizations Â to Â reimburse Â based Â on Â new Â outcome Â measures. Â Catamaran Â is Â partnering Â to Â forego Â health Â care Â services Â when Â they Â are Â ill, Â but Â starting Â in Â 2014, Â nearly Â all Â Americans Â will Â be Â ZKHUHEHQHÂżFLDULHVFKRRVHWR with Â its Â clients Â to Â provide Â pharmacy Â information Â and Â reporting Â to Â their Â membersâ€™ Â physicians Â to Â required Â to Â obtain Â health Â care Â insurance. Â For Â the Â HQJDJHLQGHSHQGHQWRIGUXJ Â support Â these Â new Â contracts. Â working Â uninsured, Â if Â their Â employer Â does Â not Â As Â we Â move Â forward Â in Â this Â evolution Â offer Â a Â plan, Â employees Â will Â be Â able Â to Â purchase Â GLVWULEXWLRQFKDQQHOVXFKDV Â of Â health Â care, Â Catamaran Â is Â continuously Â insurance Â through Â a Â health Â care Â exchange. Â focused Â on Â bringing Â more Â value Â to Â the Â clients Â 7KLVLQĂ€X[RIQHZFRQVXPHUVRIKHDOWKFDUH UHWDLOLQGHSHQGHQW Â we Â serve. Â Recent Â investments Â include Â mobile Â ZLOO DIIHFW KRZ KHDOWK FDUH LQVXUDQFH EHQHÂżWV technologies Â that Â provide Â smart Â phone Â users Â are Â structured, Â but Â not Â just Â for Â the Â previously Â FKDLQRUPDLOVHUYLFH Â with Â myriad Â capabilities Â such Â as Â medication Â uninsured. Â Catamaranâ€™s Â response Â is Â to Â focus Â adherence Â reminders, Â drug Â interaction Â alerts Â RQ FOLQLFDO RIIHULQJV WKDW DOORZ Ă€H[LELOLW\ IRU SKDUPDFLHV and Â information Â on Â cost-Âeffective Â medications. Â SKDUPDF\EHQHÂżWVHUYLFHVWREHGHOLYHUHGZKHUH We Â also Â utilize Â patient Â risk Â scoring Â models Â EHQHÂżFLDULHV FKRRVH WR HQJDJH LQGHSHQGHQW RI drug Â distribution Â channel Â such Â as Â retail, Â independent, Â chain Â or Â mail Â in Â order Â to Â better Â allocate Â our Â clientsâ€™ Â health Â care Â dollar Â on Â patient Â engagement Â that Â is Â more Â likely Â to Â bring Â near-Âtime Â value. Â Catamaran Â offers Â service Â pharmacies. D WUXH DOWHUQDWLYH WR WKH VWDWXV TXR LQ SKDUPDF\ EHQHÂżW PDQDJHPHQW DQG GHOLYHUV LQQRYDWLRQ Ă€H[LELOLW\ DQG SRZHUIXO UHVXOWV $V ZH FRQWLQXH Specialty Trend For Â many Â payers, Â specialty Â drug Â trend Â exceeded Â 20 Â percent Â in Â to Â closely Â monitor Â industry Â dynamics, Â our Â focus Â remains Â on Â building Â a Â 2012, Â and Â this Â included Â drugs Â where Â the Â average Â annual Â costs Â are Â tens Â of Â Ă€H[LEOH \HW FRPSUHKHQVLYH VHW RI SURJUDPV WR VXSSRUW WKH GHOLYHU\ RI thousands Â of Â dollars. Â In Â fact, Â specialty Â drugs Â can Â even Â reach Â hundreds Â of Â HVVHQWLDOKHDOWKEHQHÂżWVIRURXUFOLHQWV thousands Â of Â dollars Â annually Â on Â the Â extreme Â end Â of Â the Â cost Â spectrum. Â Large Â PBMs Â have Â dedicated Â specialty Â pharmacy Â divisions, Â like Â Catamaranâ€™s Â 'U 6XPLW 'XWWD LV UHVSRQVLEOH IRU FOLQLFDO SURGXFWV VHUYLFHV DQG PHGLFDO DIIDLUV DQGOHDGVRYHUDOOKHDOWKFDUHVWUDWHJ\DW&DWDPDUDQ+HKHDGVWKHWHDPUHVSRQVLEOH BriovaRx Â Specialty Â Pharmacy, Â to Â help Â payers, Â providers Â and Â patients, Â with Â IRU WKH GHYHORSPHQW RI &DWDPDUDQÂśV FOLQLFDO SURJUDPV FOLQLFDO UHSRUWLQJ GUXJ LQIRUPDWLRQSXEOLFDWLRQVIRUPXODU\PDQDJHPHQWSURFHVVDQGSURIHVVLRQDOSUDFWLFHV the Â complexities Â involved Â in Â managing Â these Â expensive Â medications. Â The Â strategies Â employed Â by Â specialty Â pharmacies Â to Â manage Â rising Â &DWDPDUDQ WKH LQGXVWU\ÂśV IDVWHVWJURZLQJ SKDUPDF\ EHQHILW PDQDJHU KHOSV drug Â trends Â include Â narrowing Â the Â specialty Â pharmacy Â distribution Â RUJDQL]DWLRQV DQG WKH FRPPXQLWLHV WKH\ VHUYH WDNH FRQWURO RI SUHVFULSWLRQ GUXJ FRVWV 0DQDJLQJ PRUH WKDQ PLOOLRQ SUHVFULSWLRQV HDFK \HDU RQ EHKDOI RI network, Â prior Â authorization Â and Â step Â therapy, Â determining Â appropriate Â PLOOLRQPHPEHUVWKHFRPSDQ\ÂśVIOH[LEOHKROLVWLFVROXWLRQVLPSURYHSDWLHQWFDUHDQG plan Â design, Â preferred Â products Â in Â certain Â specialty Â classes Â and Â high Â HPSRZHULQGLYLGXDOVWRWDNHFKDUJHRIWKHLUKHDOWK
January/February 2013 I HealthCare Consumerism Solutionsâ„˘ I www.TheIHCC.com
BY TONY CHANDLER PARTNER HEALTH SOLUTIONS INSURANCE AGENCY
HEALTH CARE ACCESS ALTERNATIVE
Consider an On-site Wellness/Telemedicine Team for Better Employee Engagement
Another Â incentive Â is Â cash Â rewards Â for Â proof Â an Â employee Â has Â had Â his Â ellness Â programs Â are Â here Â to Â stay. Â There Â are Â many Â different Â types Â and Â paths Â to Â follow, Â each Â company Â needs Â to Â strongly Â look Â at Â what Â or Â her Â annual Â physical Â and Â all Â testing Â associated Â with Â the Â exam. Â This Â is Â not Â meant Â to Â be Â invasive Â or Â intrude Â on Â someoneâ€™s Â privacy, Â but Â it Â is Â used Â they Â need Â for Â a Â wellness Â plan. Â What Â results Â are Â they Â after? Telemedicine Â also Â is Â an Â up-Âand-Âcoming Â strategy Â used Â by Â many Â as Â a Â method Â to Â prove Â the Â employee Â has Â complied. Â Staying Â with Â the Â cash Â theme, Â we Â have Â seen Â a Â remarkable Â employer Â successful Â companies Â to Â improve Â employee Â satisfaction Â both Â at Â home Â incentive Â where Â they Â offered Â $50 Â for Â every Â and Â work. Â A Â major Â question Â is Â how Â you Â get Â pound Â lost Â and Â kept Â off Â during Â a Â contest Â time Â employees Â to Â actively Â engage Â in Â both Â wellness Â $QRWKHULQFHQWLYHLVFDVK frame. Â One Â employee Â received Â a Â check Â for Â and Â telemedicine Â for Â productive Â results. Â almost Â $1600! Â Now Â thatâ€™s Â taking Â wellness Â One Â of Â the Â most Â successful Â approaches Â is Â UHZDUGVIRUSURRIDQ seriously! Â The Â above Â incentive Â also Â works Â well Â actually Â having Â a Â wellness/telemedicine Â team Â where Â the Â employee Â receives Â a Â gift Â card Â for Â established Â on-Âsite Â at Â the Â employer Â group. HPSOR\HHKDVKDGKLVRU completing Â a Â health Â risk Â assessment. Â It Â is Â important Â to Â choose Â individuals Â who Â Based Â on Â the Â common Â promotion Â of Â have Â power Â or Â the Â respect Â of Â the Â employees. Â KHUDQQXDOSK\VLFDODQGDOO health Â reimbursement Â accounts Â within Â group Â Respect Â is Â the Â key Â factor. Â In Â this Â way Â it Â is Â easier Â WHVWLQJDVVRFLDWHGZLWKWKH KHDOWK EHQHÂżWV ZH KDYH VHHQ HPSOR\HUV XVH to Â engage Â all Â the Â other Â employees. Â By Â having Â a Â checklists Â where Â employees Â get Â points Â for Â team Â of Â employees Â put Â together Â to Â coordinate Â H[DP7KLVLVQRWPHDQWWR completing Â items. Â The Â more Â points Â they Â get Â activities, Â it Â becomes Â a Â more Â managed Â process. Â the Â greater Â reimbursement Â they Â receive Â from Â Setting Â up Â schedules Â for Â the Â months Â EHLQYDVLYHRULQWUXGHRQ their Â HRA. Â Itâ€™s Â a Â positive Â program, Â and Â the Â ahead Â also Â served Â to Â increase Â engagement. Â always Â know Â where Â they Â stand Â with Â Posters Â in Â the Â lunch Â rooms Â or Â common Â meeting Â VRPHRQHÂśVSULYDF\EXWLWLV employees Â their Â HRA Â bank. Â places Â of Â the Â employees Â should Â be Â placed Â as Â Telemedicine Â has Â and Â will Â continue Â ZHOO DV QRWLFHV WKURXJK LQWHURIÂżFH PDLO $OO XVHGDVDPHWKRGWRSURYHWKH to Â reduce Â health Â care Â claims. Â Therefore Â this Â correspondence Â is Â put Â together Â to Â get Â the Â employers Â use Â incentives Â here Â as Â well Â to Â word Â out, Â but Â it Â must Â be Â communicated Â by Â the Â HPSOR\HHKDVFRPSOLHG increase Â engagement. Â Once Â it Â is Â communicated Â wellness/telemedicine Â teams Â to Â the Â employees. Â properly Â in Â a Â group Â setting Â and Â through Â Some Â groups Â have Â actually Â implemented Â a Â cost Â written Â communication, Â employees Â will Â approach Â whereas Â the Â employee Â would Â pay Â more Â if Â they Â donâ€™t Â comply Â to Â a Â wellness Â plan, Â such Â as Â quitting Â smoking Â understand Â this Â method. Â No Â longer Â will Â they Â need Â to Â leave Â work Â in Â the Â or Â entering Â into Â a Â weight Â cessation Â program. Â This Â may Â be Â seen Â as Â middle Â of Â the Â day Â to Â take Â a Â sick Â child Â to Â the Â doctor. Â When Â used Â properly, Â FRXQWHUSURGXFWLYH WR WU\LQJ WR LQFUHDVH SDUWLFLSDWLRQ DQG EDFNÂżUH ZLWK most Â employers Â will Â reimburse Â a Â portion Â of Â the Â expense Â to Â utilize Â this Â technology Â as Â an Â incentive Â to Â increase Â usage. Â We Â have Â seen Â rewards Â given Â regard Â to Â results. Here Â are Â some Â of Â the Â most Â effective Â methods Â seen Â to Â engage Â to Â employees Â at Â the Â end Â of Â the Â year Â when Â they Â can Â see Â the Â reduction Â in Â employees Â in Â wellness Â plans. Â One Â large Â automotive Â dealership, Â emergency Â room Â visits. Â As Â you Â can Â see, Â money Â talks Â and Â will Â continue Â to Â do Â so Â as Â the Â with Â multiple Â locations, Â started Â a Â few Â years Â ago Â by Â installing Â on-Âsite Â gymnasiums Â for Â employee Â use. Â Not Â a Â full-Âblown Â gymnasium, Â but Â a Â primary Â incentive Â to Â engage Â employees Â Â in Â these Â phenomenal Â programs. Â treadmill, Â exercise Â bike Â lightweights Â and Â basic Â weight Â training. Â The Â 3URPRWLQJ D KHDOWKLHU DQG PRUH VDWLVÂżHG ZRUNIRUFH LQ DGGLWLRQ WR treadmill Â is Â even Â equipped Â with Â a Â platform Â for Â a Â laptop Â computer Â to Â reducing Â stress, Â will Â go Â a Â long Â way Â toward Â bending Â the Â health Â cost Â curve Â and Â reducing Â health Â care Â expenses. Â PD[LPL]HZRUNHIÂżFLHQF\
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THE VA PRIVATE EX
28 January/February 2013 I HealthCare Consumerism Solutions™ I www.TheIHCC.com
LUE OF XCHANGES
BY ERNIE HARRIS Â» CHIEF STRATEGY OFFICER WORKABLE SOLUTIONS
uch Â of Â the Â media Â focus Â of Â late Â has Â been Â on Â the Â value Â of Â public Â health Â care Â exchanges, Â the Â costs Â to Â taxpayers Â associated Â with Â them Â and Â the Â readiness Â of Â various Â states Â and Â the Â federal Â government Â to Â operate Â them. Â For Â more Â than Â a Â decade Â various Â entities Â have Â been Â operating Â private Â exchanges Â that Â are Â FRVWHIIHFWLYH DQG KDYH EHQHÂ¿WHG HPSOR\HUV DQG HPSOR\HHV DOLNH ZLWKRXW burdening Â taxpayers. The Â value Â of Â an Â exchange, Â public Â or Â private, Â goes Â well Â beyond Â the Â LQWURGXFWLRQ RI D GHÂ¿QHG FRQWULEXWLRQ DFFRXQW WKDW DOORZV HPSOR\HUV WR better Â manage Â their Â portion Â of Â health Â care Â costs. Â Exchanges, Â or Â perhaps Â a Â PRUHDSSURSULDWHWHUPZRXOGEHRQOLQHEHQHÂ¿WVPDUNHWSODFHVRIIHUYDOXH WRPXOWLSOHSDUWLHVLQDGGLWLRQWRGHÂ¿QHGFRQWULEXWLRQDFFRXQWV www.TheIHCC.com I HealthCare Consumerism Solutionsâ„¢ I January/February 2013
Costs are on the rise Controlling Â health Â care Â costs Â is Â a Â responsibility Â that Â falls Â on Â all Â of Â us: Â individuals, Â employers Â and Â insurance Â carriers. Â Similar Â to Â the Â process Â of Â managing Â budgets Â for Â your Â department, Â your Â company Â or Â your Â personal Â household, Â two Â of Â the Â foundational Â requirements Â for Â managing Â health Â care Â FRVWVDUHDFFHVVWRLQIRUPDWLRQDQGHIÂżFLHQF\
Online Benefits Marketplace Values Employer Benefits
s /NLINE ENROLLMENT FOR ALL EMPLOYERS FROM TWO TO MILLION LIVES s #ONSOLIDATED BILLING FOR ALL BENElTSÂˆ ONE INVOICE ONE PAYMENT s 2EDUCED BENElTS ADMINISTRATION COSTS
s %ASY ACCESS TO BENElTS EDUCATION AND DECISION SUPPORT TOOLS s "ROADER CHOICE OF BENElTS THAT BETTER MATCH INDIVIDUAL NEEDS s )NTEGRATED HEALTH CARE COST MANAGEMENT TOOLS
s ,OW COST ELECTRONIC ENROLLMENT OF SMALL AND MID SIZED GROUPS s #ONSOLIDATED PREMIUM PAYMENTS s #OSTS SAVINGS THROUGH AUTOMATION
Employer Benefits ,QWRGD\ÂśVPDUNHWSODFHPRVWRQOLQHEHQHÂżWVHOLJLELOLW\DQGHQUROOPHQW solutions Â target Â employers Â with Â more Â than Â 1,000 Â employees. Â This Â is Â due Â in Â large Â part Â to Â the Â inherent Â complexity Â of Â these Â systems Â and Â the Â costs Â associated Â with Â implementing Â them. Â 3ULYDWHEHQHÂżWVPDUNHWSODFHVDOVRSURYLGHDFRVWHIIHFWLYHDOWHUQDWLYH IRUVPDOODQGPLGVL]HGHPSOR\HUVZKRGHVSHUDWHO\ZDQWWKHHIÂżFLHQFLHV of Â an Â electronic Â system Â but Â cannot Â afford Â the Â high Â costs Â of Â the Â solutions Â JHQHUDOO\DYDLODEOHLQWKHPDUNHW %\ DJJUHJDWLQJ EHQHÂżWV RIIHULQJV DFURVV D ODUJH SRSXODWLRQ RI HPSOR\HUVSULYDWHEHQHÂżWVPDUNHWSODFHVSURYLGHPXFKWKHVDPHĂ€H[LELOLW\ available Â today Â for Â large Â employers Â for Â a Â fraction Â of Â the Â cost. Â According Â to Â the Â U.S. Â Census Â Bureauâ€™s Â 2010 Â report, Â there Â are Â more Â than Â 5.734 Â million Â employers Â in Â the Â U.S.â€”5.725 Â million Â of Â them Â employ Â fewer Â than Â 1,000. Â These Â employers Â represent Â 99.8 Â percent Â of Â the Â total Â number Â of Â employers Â in Â the Â U.S. Â and Â employ Â 60.9 Â million Â individuals Â or Â SHUFHQWRIWKHZRUNIRUFH $V DQ HPSOR\HU RXWVRXUFLQJ EHQHÂżWV HOLJLELOLW\ HQUROOPHQW maintenance Â and Â billing Â saves Â an Â average Â of Â $165 Â per Â employee Â per Â year. Â 1DWLRQDOO\ VPDOO DQG PLGPDUNHW HPSOR\HUV VWDQG WR VDYH a%1 DQQXDOO\E\PRYLQJWREHQHÂżWVPDUNHWSODFHV
Show Me the Money Employers Â can Â save Â 13 Â percent Â or Â more Â by Â moving Â to Â a Â private Â EHQHÂżWV PDUNHWSODFH LQ SHU HPSOR\HH EHQHÂżWV DGPLQLVWUDWLRQ IHHV DQG SURYLGHWKHLUHPSOR\HHVZLWKDPRGHUQDQGLQIRUPDWLYHEHQHÂżWVVKRSSLQJ and Â management Â experience. Â For Â the Â average Â company Â employing Â 100 Â people, Â thatâ€™s Â a Â savings Â of Â almost Â $2,000 Â per Â year Â in Â administrative Â FRVWV IRU GRLQJ VRPHWKLQJ WKDW \RXU HPSOR\HHV ZLOO VHH DV D PDUNHG improvement Â over Â the Â traditional Â paper Â enrollment Â process.
Convenience %H\RQG WKH VDYLQJV DVVRFLDWHG ZLWK EHQHÂżWV DGPLQLVWUDWLRQ WKH SULYDWH EHQHÂżWV PDUNHWSODFH DOVR FDQ RIIHU D FRQVROLGDWHG LQYRLFH IRU DOO 30
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PDQDJHG EHQHÂżWV DOORZLQJ WKH HPSOR\HU WR PDNH D VLQJOH SD\PHQW )RU most Â small Â employers Â remitting Â payment Â to Â multiple Â providers Â monthly Â LV RIWHQ LQFRQYHQLHQW DQG GLIÂżFXOW WR UHFRQFLOH 5HFRQFLOLDWLRQ LQ WKH PDUNHWSODFH LV SURYLGHG RQ D VLQJOH UHSRUW VLPSOLI\LQJ WKH MRE RI WKH ÂżQDQFHGHSDUWPHQWDQGDOORZLQJWKHPWRIRFXVRQWKHEXVLQHVVDWKDQG Lastly, Â all Â activity Â can Â be Â monitored Â and Â all Â participants Â can Â be Â managed Â in Â a Â single Â place Â providing Â consolidated Â access Â to Â all Â the Â information Â required Â by Â the Â employerâ€™s Â leadership Â team.
Employee Benefits Individuals Â continue Â to Â feel Â the Â costs Â associated Â with Â increased Â insurance Â premiums Â every Â year. Â According Â to Â the Â Kaiser Â Family Â Foundation Â $QQXDO 5HSRUW RQ (PSOR\HU +HDOWK %HQHÂżWV HPSOR\HHV KDYH experienced Â a Â 102 Â percent Â increase Â in Â premium Â costs Â since Â 2002. Â Although Â heath Â care Â insurance Â providers Â often Â are Â maligned Â as Â being Â driven Â only Â by Â cost Â and Â not Â by Â compassion, Â they Â too Â have Â serious Â challenges. Â An Â LQVXUDQFH FRPSDQ\ LV LQ WKH EXVLQHVV RI PDQDJLQJ ULVN DQG SURYLGLQJ protection Â to Â the Â insured Â against Â unforeseen Â events Â that Â may Â occur Â at Â some Â point Â in Â the Â future. Â This Â is Â where Â the Â individual Â can Â help Â themselves, Â their Â employers Â and Â even Â their Â insurance Â providers. Fifty Â years Â ago, Â individuals Â bought Â health Â insurance Â in Â much Â the Â same Â manner Â as Â they Â did Â auto, Â life Â or Â disability. Â They Â purchased Â pure Â insurance Â which, Â according Â to Â Merriam-ÂWebster Â is: Â ÂłFRYHUDJHE\FRQWUDFWZKHUHE\ RQHSDUW\XQGHUWDNHVWRLQGHPQLI\RUJXDUDQWHHDQRWKHUDJDLQVWORVVE\ DVSHFLÂżHGFRQWLQJHQF\RUSHULOÂ´ Insurance Â is Â not Â a Â vehicle Â to Â manage Â the Â day-Âto-Âday Â expenditures Â DVVRFLDWHGZLWKWKHÂłQRUPDOFRXUVHRIDFWLRQÂ´+RZHYHUWKLVLVZKDWKHDOWK insurance Â has Â evolved Â into Â over Â the Â past Â 50 Â yearsâ€”a Â payment Â plan Â more Â WKDQDPDQDJHURIULVN
s ! TOOL TO PROTECT AGAINST FUTURE UNFORSEEN EVENTS s !UTO s (OME s ,IFE s $ISABILITY
s ! TOOL COMMONLY USED TO EQUALIZE THE PAYMENT FOR ALL HEALTH CARE ACTIVITY FROM ROUTINE TO UNFORSEEN
6RZKDWFDQDQLQGLYLGXDOGRWRXQZLQGÂżYHGHFDGHVRIFKDQJH",WÂśV simple;Íž Â be Â an Â active Â consumer Â of Â health Â care. Consumerism Â is Â the Â fundamental Â force Â that Â aligns Â commercial Â SURYLGHUVZLWKWKHPDUNHWV WKH\VHUYH7RGD\PRVWSHRSOHGRQÂśWNQRZ how Â much Â health Â care Â actually Â costsâ€”itâ€™s Â funny Â money Â because Â under Â the Â PDQDJHGFDUHPRGHOZHDVDVRFLHW\DUHQRWUHTXLUHGWRNQRZ$OOZHNQRZ is Â that Â we Â need Â health Â insurance Â and Â it Â should Â cover Â whatever Â we Â need. Â ,I LW GRHVQÂśW ZH WKLQN LW LV EHFDXVH WKH LQVXUDQFH FRPSDQLHV DUH JUHHG\ Insurers Â are Â not Â necessarily Â greedy Â but Â they Â are Â businesses Â that Â must Â SURYLGHDVHUYLFHWKDWLVÂżQDQFLDOO\YLDEOHRUWKH\FHDVHWRH[LVW A Â 2011 Â survey Â of Â hospital Â emergency Â room Â costs Â reported Â the Â cost Â RI DQ (5 YLVLW UDQJHG IURP WR RU PRUH GHSHQGLQJ RQ WKH severity. Â The Â report Â divided Â the Â range Â of Â visits Â into Â three Â categories, Â low-Â level, Â moderate-Âlevel Â and Â high-Âlevel Â with Â no Â hospital Â reporting Â a Â cost Â of Â less Â than Â $150 Â for Â a Â low-Âlevel Â visit. Â For Â those Â with Â a Â comprehensive Â PHGLFDOSODQDQ(5YLVLWPLJKWUHTXLUHDRUFRSD\ZLWKDQ\FRVW beyond Â that Â paid Â for Â by Â the Â insurance Â company Â and Â seen Â as Â â€œfreeâ€? Â by Â the Â consumer. Â A Â great Â plan Â for Â the Â consumer, Â but Â not Â necessarily Â a Â long-Âterm Â ÂżQDQFLDOO\YLDEOHVROXWLRQIRUWKHLQVXUHU
What are the Alternatives? <RXFDQÂśWJRZLWKRXWWKHFDUH\RXQHHG$ÂżYHPLQXWHUHVHDUFKSURMHFW revealed Â two Â alternatives Â for Â low-Âlevel Â needs Â in Â my Â area, Â both Â of Â which Â happen Â to Â be Â national Â programs. Â CVS Â and Â Walgreens Â both Â offer Â in-Âstore Â health Â clinic Â services Â with Â many Â open Â 24 Â hours. Â Fees Â range Â from Â $79 Â to Â $89 Â for Â a Â â€œroutineâ€? Â visitâ€”nearly Â half Â of Â the Â lowest Â reported Â cost Â to Â visit Â DQ(5)RUWKRVHZLWKDKLJKGHGXFWLEOHKHDOWKSODQWKLVZRXOGEHDPRUH FRVWHIIHFWLYHDSSURDFKIRUURXWLQHQHHGVRYHUWKH(5
Managing Out-of-pocket Costs (YHQ ZLWK PRUH FRVWHIIHFWLYH RSWLRQV DYDLODEOH PDQ\ RI XV MXVW canâ€™t Â afford Â to Â bear Â the Â cost Â of Â health Â care Â needs Â as Â budgets Â are Â tight Â in Â a Â down Â economy;Íž Â another Â reason Â many Â families Â gravitate Â toward Â more Â comprehensive Â health Â plans. Â There Â are Â other Â options Â though, Â some Â which Â may Â surprise Â you. The Â Kaiser Â annual Â report Â provides Â estimates Â for Â the Â national Â average Â cost Â of Â health Â care Â by Â plan Â type. Â In Â 2012, Â a Â family Â paid Â an Â estimated Â $4,563 Â SHU\HDUIRUDWUDGLWLRQDO+02ZKHUHDVWKHVDPHIDPLO\ZRXOGKDYHSDLG DQ HVWLPDWHG IRU D TXDOLÂżHG KLJKGHGXFWLEOH SODQ +'+3 Â˛D GLIIHUHQFH RI SHU \HDU )RU WKRVH IDPLOLHV WKDW HQUROO LQ TXDOLÂżHG high-Âdeductible Â plans, Â they Â also Â can Â participate Â in Â a Â health Â savings Â account Â RU +6$ ,Q IDPLOLHV FDQ FRQWULEXWH XS WR SUHWD[ WR WKHLU +6$)RUDUHODWLYHO\KHDOWK\IDPLO\HQUROOLQJLQDQ+'+3DQGDQ+6$ would Â allow Â that Â family Â to Â save Â potentially Â $843 Â per Â year Â with Â no Â change Â LQ KLVWRULFDO RXWRISRFNHW IHHV 6LQFH PRVW +'+3V FRYHU SUHYHQWDWLYH U.S. Employer Data - Number and Size 2010 U.S. Census Data 4,000,000
# of Employers
Benefits Marketplaces )LJXULQJRXWDOOWKHRSWLRQVDQGSLFNLQJWKHEHVWKHDOWKSODQIRU\RXU VLWXDWLRQLVQRHDV\WDVN7KDWÂśVZKHUHEHQHÂżWVPDUNHWSODFHVFDQKHOSWKH individual Â employee. Â They Â provide Â a Â consolidated Â health Â portal Â integrating Â GHFLVLRQVXSSRUW WRROV WDLORUHG WR DQ LQGLYLGXDOÂśV VSHFLÂżF QHHGV SODQ comparison Â tools Â and Â integrated Â access Â to Â health Â care Â reimbursement Â DFFRXQWVOLNH+6$VDQG)6$V7KHVHPDUNHWSODFHVDUHDRQHVWRSVKRSIRU DOOWKHQHHGVDQLQGLYLGXDOPD\KDYHDQGLWJRHVEH\RQGPDMRUPHGLFDO 0DQ\ EHQHÂżWV PDUNHWSODFHV DOVR DOORZ LQGLYLGXDOV WR UHYLHZ DQG HQUROO LQDQFLOODU\EHQHÂżWVDVZHOOVXFKDVGHQWDOYLVLRQGLVDELOLW\DQGHYHQSHW insurance.
Carrier Benefits :KLOHWKHEHQHÂżWVIRUHPSOR\HUVDQGHPSOR\HHVDUHVLJQLÂżFDQWWKHUHÂśV VRPHWKLQJ IRU LQVXUDQFH FDUULHUV DV ZHOO :LWK QHZ OHJLVODWLRQ PHGLFDO ORVVUDWLRRU0/5UXOHV UHTXLULQJFDUULHUVWRÂż[WKHLUDGPLQLVWUDWLYHFRVWV coming Â online, Â many Â providers Â are Â searching Â for Â ways Â to Â reduce Â costs. Â 3ULYDWH EHQHÂżWV PDUNHWSODFHV RIIHU UHOLHI IRU VRPH RI WKH URXWLQH FRVWV currently Â born Â by Â the Â carrier.
Universal Electronic Enrollment 7RGD\ PRVW FDUULHUV SURYLGH HOHFWURQLF HQUROOPHQW WR ODUJH PDUNHW employers Â but Â the Â relationship Â is Â typically Â one-Âto-Âone Â between Â the Â employer Â and Â the Â carrier. Â As Â such, Â carriers Â have Â been Â reluctant Â to Â offer Â WKLV VHUYLFH GRZQPDUNHW EHFDXVH RI WKH LQFUHDVH LQ VXSSRUW FRVWV associated Â with Â managing Â thousands Â if Â not Â hundreds Â of Â thousands Â of Â HQUROOPHQWIHHGV7KLVLVZKHUHWKHEHQHÂżWVPDUNHWSODFHKHOSVWKHPRVW 7KHPDUNHWSODFHDFWVDVDQDJJUHJDWRURIHQUROOPHQWDFWLYLW\SUHVHQWLQJ LWVHOIDVDMXPERHPSOR\HUWRWKHFDUULHU7KLVDOORZVWKHFDUULHUWRVKLIW the Â responsibility Â of Â managing Â the Â hundreds Â of Â thousands Â of Â individual Â UHODWLRQVKLSV WR WKH PDUNHWSODFH DQG UHDS WKH EHQHÂżW RI VXEVWDQWLDOO\ increased Â electronic Â enrollment. )RUWKHLUSDUWWKHPDUNHWSODFHDOUHDG\KDVWKHH[SHUWLVHWRPDQDJH this Â type Â of Â interaction Â and Â delivers Â value Â to Â the Â employer Â in Â the Â form Â of Â an Â online, Â electronic Â shopping Â and Â enrollment Â experience.
Billing and Commissions Payments 1,500,000
0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-74 75-99 100-149 150-199 200-299 300-399 400-499 500-749 750-999 1,000-1,499 1,500-1,999 2,000-2,499 2,500-4,999 5,000 +
# of Employers
# of Employees
FDUH ÂżUVW GROODU WKDW PRQH\ FDQ DFFXPXODWH WR VDYH IRU IXWXUH KHDOWK care Â events Â that Â may Â arise. Â Families Â also Â have Â the Â option Â to Â contribute Â additional Â monies Â above Â the Â $833 Â to Â cover Â routine Â costs Â that Â are Â covered Â WRGD\E\Ă€H[LEOHVSHQGLQJDFFRXQWV)6$ DQGVDYHXSWRSHUFHQW7KLV LV MXVW RQH RSWLRQ DQG RQH VFHQDULR 1RW DOO LQGLYLGXDOV ZLOO UHFHLYH WKH VDPHÂżQDQFLDOEHQHÂżWVDVHDFKVLWXDWLRQLVXQLTXH
7KHPDUNHWSODFHDOVRDFWVDVWKHFHQWUDOL]HGELOOLQJVROXWLRQIRUDOO providers. Â It Â provides Â a Â single Â invoice Â to Â the Â group Â and Â remits Â premium Â SD\PHQWV WR WKH EHQHÂżWV SURYLGHUV 0DQ\ PDUNHWSODFHV DOVR KDYH WKH DELOLW\ WR GLVEXUVH EURNHU FRPPLVVLRQ SD\PHQWV 3UHPLXP ELOOLQJ DQG commissions Â payments Â are Â two Â large Â cost Â items Â in Â any Â carriers Â operating Â EXGJHWERWKRIZKLFKFDQEHKDQGOHGE\WKHEHQHÂżWVPDUNHWSODFH
The Good, the Bad and the Healthy 5HJDUGOHVV RI \RXU LQGLYLGXDO SRVLWLRQ RQ KHDOWK FDUH UHIRUP RQH thing Â is Â clear: Â individuals Â and Â their Â employers Â continue Â to Â feel Â the Â crunch Â of Â increasing Â health Â care Â costs. Â There Â are Â certainly Â many Â potential Â options Â WRPDQDJHWKHVHLQFUHDVHVRYHUWLPHEXWSULYDWHEHQHÂżWVPDUNHWSODFHVDUH available Â today Â and Â promise Â to Â deliver Â at Â least Â some Â relief. Â As Â the Â ancient Â proverb Â says, Â â€œA Â bird Â in Â the Â hand Â is Â worth Â two Â in Â the Â bush.â€? Â Â
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Defined Contribution Model, Private Exchanges Shifting Power to Consumers BY DAVID URBANIAK » PRODUCT MANAGER » EVOLUTION1
January/February 2013 I HealthCare Consumerism Solutions™ I www.TheIHCC.com
KDOOHQJLQJ HFRQRPLF WLPHV LQ WKH 8QLWHG 6WDWHV KDYH KDG DQ LPSDFW RQ QHDUO\ HYHU\ $PHULFDQ )RU PLOOLRQV RI SHRSOH KHDOWK FDUHÂ²DQG LWV UHODWHG FRVWVÂ²DUH D VLJQLÂ¿FDQW Â¿QDQFLDO FRQFHUQ %XVLQHVVHV RI FRXUVH DOVR KDYH IHOW WKHVH FKDOOHQJHV DQG KDYHORRNHGIRUQHZDQGLQQRYDWLYHZD\VWRKHOSNHHSKHDOWKFDUHFRVWV LQ FKHFN 2QH VROXWLRQ JHWWLQJ D JUHDW GHDO RI DWWHQWLRQ LV WKH GHÂ¿QHG FRQWULEXWLRQPRGHOZKHUHWKHHPSOR\HUPDNHVDÂ¿[HGGROODUFRQWULEXWLRQ WRHDFKHPSOR\HH(PSOR\HHVWKHQXVHWKDWPRQH\WRSXUFKDVHLQVXUDQFH PDNLQJLQGLYLGXDOFRVWEDVHGGHFLVLRQVDERXWWKHW\SHRILQVXUDQFHWKDW EHVWPHHWWKHLUXQLTXHQHHGV 7KHGHÂ¿QHGFRQWULEXWLRQPRGHODOORZVHPSOR\HUVWRVHWWKHLUDQQXDO EHQHÂ¿WVEXGJHWKHOSLQJWKHPWRUHGXFHRUVWDELOL]HHYHULQFUHDVLQJKHDOWK FDUH FRVWV $W WKH VDPH WLPH LW JLYHV HPSOR\HHV PRUH FKRLFHV WKDQ HYHU EHIRUHDQGWKHRSSRUWXQLW\WRVKRSIRUWKHFRYHUDJHWKH\QHHG7KH\DOVR FDQ FRQWULEXWH WKHLU RZQ SD\UROO GROODUV LQ D WD[DGYDQWDJHG ZD\ WR FRYHUUHPDLQLQJSUHPLXPDPRXQWVDVZHOODVRWKHUHOLJLEOHRXWÂ±RISRFNHW H[SHQVHV 6RXQGVUHYROXWLRQDU\ULJKW"1RWHQWLUHO\ Defined Contributionâ€”Why Now? $ GHÂ¿QHG FRQWULEXWLRQ PRGHO LV QRW D QHZ LGHD 7KH FRQFHSW KDV EHHQ DURXQG IRU PRUH WKDQ \HDUV EXW WKH FXUUHQW PDUNHW FRQGLWLRQV resulting Â from Â the Â passing Â of Â the Â Patient Â Protection Â and Â Affordable Â Care Â $FW33$&$ DQGJXDUDQWHHGLVVXHFRXSOHGZLWKWKHFRQWLQXHGULVLQJFRVW of Â health Â care, Â have Â been Â catalysts Â for Â businesses Â to Â reexamine Â their Â health Â EHQHÂ¿WPRGHOVLQDQDWWHPSWWRÂ¿JXUHRXWWKHLUUROHLQWKHFKDQJLQJKHDOWK care Â ecosystem. Â Another Â factor Â to Â consider Â is Â an Â emerging, Â technology-Ârich Â environment Â enabling Â new Â and Â effective Â ways Â for Â consumers Â to Â shop Â for Â DQGFRPSDUHKHDOWKFDUHSODQVDVZHOODVPDQDJHWKHÂ¿QDQFLDODFFRXQWV used Â to Â pay Â for Â these Â plans. Â Consider Â this: Â‡ More Â than Â 85 Â percent Â of Â the Â worldâ€™s Â online Â population Â has Â used Â WKH,QWHUQHWWRPDNHDSXUFKDVH1LHOVHQ Â‡ Four Â out Â of Â 10 Â large Â companies Â offer Â a Â single Â web-Âbased Â portal Â access Â to Â employees Â for Â a Â wide Â variety Â of Â informationâ€” LQFOXGLQJEHQHÂ¿WVSD\VWXEVWLPHDQGDWWHQGDQFHWD[ ZLWKKROGLQJDQGPRUH7RZHUV:DWVRQ Â‡ Ninety-Âone Â percent Â of Â consumers Â said Â researching Â products Â RQOLQHPDGHWKHPIHHOPRUHFRQÂ¿GHQWDERXWWKHLUSXUFKDVHV 3ULFH*UDEEHUFRP Since Â the Â concept Â of Â using Â dollars Â provided Â by Â an Â employer Â to Â VKRS IRU KHDOWK FDUH LQVXUDQFH LV D UHODWLYHO\ QHZ ZD\ WR WKLQN DERXW GHOLYHULQJ DQG HQUROOLQJ LQ HPSOR\HHEHQHÂ¿WV XVHUIULHQGO\ WRROV WKDW help Â consumers Â navigate Â their Â insurance Â plan Â will Â be Â critical. Â The Â tools Â need Â to Â illustrate Â the Â employeeâ€™s Â coverage Â options, Â while Â at Â the Â same Â time Â SURYLGLQJFOHDUYLVLELOLW\LQWRWKHLUFRPSOHWHÂ¿QDQFLDOKHDOWKFDUHSLFWXUH Technology Â offerings Â that Â include Â planning, Â budgeting, Â consumer-Âdecision Â support Â tools Â and Â the Â facilitation Â of Â electronic Â premium Â payments, Â all Â in Â DPXOWLFKDQQHOHQYLURQPHQWZLOOEHWKHEDVHOHYHOIRUFRQVXPHUPDUNHW entry.
7KH GHÂ¿QHG FRQWULEXWLRQ PRGHO LV an Â evolution Â of Â consumer-Âdirected Â health Â care Â plans Â such Â as Â a Â health Â savings Â account Â +6$ RUÃ€H[LEOHVSHQGLQJDFFRXQW)6$ that Â exist Â and Â are Â widely Â available Â today. Â Accessing Â consumer-Âdriven Â health Â care Â information Â is Â increasingly Â common, Â with Â 85 Â percent Â of Â companies Â providing Â such Â access. Â At Â the Â same Â time, Â the Â need Â for Â technology Â to Â facilitate Â and Â service Â these Â new Â distribution Â channels Â creates Â both Â D PDUNHW JDS DQG DQ RSSRUWXQLW\ IRU DGPLQLVWUDWLRQ WRROV UHFRUGNHHSLQJ DQG reporting Â features Â for Â administrators Â and Â HPSOR\HUV $V WKH GHÂ¿QHG FRQWULEXWLRQ PRYHPHQWFRQWLQXHVWRJURZWKHPDUNHW can Â expect Â to Â see Â even Â more Â advanced Â technology Â solutions. Â This Â is Â good Â QHZV IRU WKH FRQVXPHU ZKR LV WDNLQJ RQ LQFUHDVHG Â¿QDQFLDO DQG EHQHÂ¿W SODQ GHFLVLRQPDNLQJUHVSRQVLELOLW\ According Â to Â health Â care Â insurer Â :HOO3RLQW ,QF GHÂ¿QHG FRQWULEXWLRQ plans Â will Â be Â mainstream Â within Â two-Â to-Âthree Â years. Â The Â company Â is Â close Â to Â signing Â 30 Â midsize Â and Â large Â employers, Â including Â one Â with Â more Â than Â 50,000 Â ZRUNHUV 6LPLODUO\ 0HUFHU D JOREDO FRQVXOWLQJ OHDGHU LQ WDOHQW KHDOWK retirement, Â and Â investments, Â found Â 56 Â percent Â of Â employers Â are Â FRQVLGHULQJ D SULYDWH H[FKDQJH WR SURYLGH EHQHÂ¿WV WR HLWKHU FXUUHQW employees Â and/or Â retirees. Â 7ZRODUJHUHPSOR\HUV6HDUV+ROGLQJV&RUSDQG'DUGHQ5HVWDXUDQWV ,QFÂ²WKH SDUHQW FRPSDQ\ IRU UHVWDXUDQW FKDLQV LQFOXGLQJ 2OLYH *DUGHQ 5HG /REVWHU DQG PDQ\ RWKHUVÂ²PRYHG WR GHÂ¿QHG FRQWULEXWLRQ SODQV IRU their Â full-Âtime Â employees Â on Â Jan. Â 1, Â 2013. Â ,IWKLVQHZPHWKRGRIRIIHULQJDGHÂ¿QHGFRQWULEXWLRQSODQWRIDFLOLWDWH KHDOWKEHQHÂ¿WVSURYHVWREHHIIHFWLYHDQGDFRVWVDYHUIRUHPSOR\HUVPDQ\ PRUH RUJDQL]DWLRQV ZLOO OLNHO\ PDNH WKH VZLWFK ZLWKLQ WKH QH[W WR months. Â A Â 2011 Â McKinsey Â survey Â of Â 1,300 Â employers Â found Â 30 Â percent Â will Â GHÂ¿QLWHO\RUSUREDEO\VWRSRIIHULQJHPSOR\HUVSRQVRUHGJURXSLQVXUDQFH in Â the Â years Â after Â 2014. Â
Health Insurance Exchanges: A New Household Term 'HÂ¿QHG FRQWULEXWLRQ SODQV DQG SULYDWH H[FKDQJHV DUH WZR VLGHV RI the Â same Â coin. Â Private Â health Â insurance Â exchanges Â as Â a Â component Â to Â GHÂ¿QHGFRQWULEXWLRQSODQVDUHVSULQJLQJXSLQUHVSRQVHWRWKHSDVVDJHRI WKHKHDOWKFDUHODZDQGWKHFKDQJHLQKHDOWKEHQHÂ¿WPDUNHWFRQGLWLRQV A Â private Â exchange Â is Â a Â private Â business Â owned Â and Â operated Â by Â EURNHUV SD\HUV RU WKLUG SDUW\ DGPLQLVWUDWRUV 73$V $ SULYDWH H[FKDQJH generally Â consists Â of Â an Â online Â shopping Â experience Â for Â health Â care, Â dental, Â YLVLRQDQGRWKHUEHQHÂ¿WV7KHSULYDWHH[FKDQJHDOORZVFRQVXPHUVWRVKRS and Â compare Â servicesâ€”similar Â to Â how Â consumers Â today Â shop Â and Â compare Â DLUIDUH SXUFKDVHV :KHQ SXUFKDVLQJ D SODQH WLFNHW FRQVXPHUV DOPRVW H[FOXVLYHO\XVHWKH,QWHUQHWWRFRPSDUHWLFNHWSULFHVDLUOLQHVDQGGHSDUWXUH and Â arrival Â times. Â With Â an Â exchange, Â consumers Â are Â able Â to Â select Â and Â compare Â critical Â insurance Â plan Â factors Â to Â suite Â their Â particular Â familyâ€™s Â QHHGVVXFKDVSURYLGHUQHWZRUNEHQHÂ¿WVFRYHUHGTXDOLW\RIFDUHDQGSULFH www.TheIHCC.com I HealthCare Consumerism Solutionsâ„¢ I January/February 2013
,Q UHVSRQVH WR WKH PDUNHW Currently, public exchanges at be Â worth Â nearly Â $60 Â billion Â in Â premium Â revenues Â in Â 2014, Â according Â to Â PwC Â opportunity, Â a Â variety Â of Â business Â the state level appear to be +HDOWK5HVHDUFK,QVWLWXWHHVWLPDWHV7KH entities Â are Â launching Â their Â own Â private Â H[FKDQJH PDUNHW LV H[SHFWHG WR WULSOH LQVXUDQFH H[FKDQJHV &RPSDQLHV OLNH in various phases, with some WR QHDUO\ ELOOLRQ E\ *LYHQ $RQ +HZLWW DQG :DOJUHHQV DUH JHWWLQJ WKDW VR PXFK LV DW VWDNH SURIHVVLRQDOV LQWR WKH H[FKDQJH PL[ 8QLWHG+HDOWK states already putting their HPSOR\HUV DQG FRQVXPHUV DOLNH *URXSÂśV H[FKDQJH SURJUDPV DOUHDG\ DUH trying Â to Â get Â a Â true Â sense Â of Â how Â EHLQJRIIHUHGLQVWDWHVZKLOHEHQHÂżWV exchange plan into action while are Â exchanges Â will Â operate. Â consulting Â firm Â Mercer Â announced Â ,Q -DQXDU\ WKH 86 'HSDUWPHQW in Â January Â it Â was Â building Â a Â health Â others are just beginning to RI+HDOWKDQG+XPDQ6HUYLFHV'++6 insurance Â exchange Â for Â employers. Â gave Â four Â more Â states Â the Â approval Â to Â set Â Wal-ÂMart Â also Â is Â investigating Â consider how they will get up Â their Â own Â exchanges. Â Idaho, Â Nevada, Â the Â idea Â of Â building Â a Â private Â health Â their arms around an 1HZ 0H[LFR DQG 8WDK MRLQHG VWDWHV insurance Â exchange, Â which Â would Â be Â DVZHOODVWKH'LVWULFWRI&ROXPELDWKDW geared Â toward Â small Â businesses. Â Wal-Â all-encompassing regulation. have Â been Â granted Â approval Â to Â set Â up Â Mart Â would Â use Â its Â size Â as Â leverage Â state-Ârun Â exchanges. Â So Â far Â temporary Â WR PDNH DQ LQVXUDQFH PDUNHWSODFH federal Â grants, Â totaling Â $964 Â million, Â competitive Â and Â available Â to Â a Â broader Â KDYH EHHQ GLVWULEXWHG WR VWDWHV +RZHYHU VWDWH UXQ H[FKDQJHV PXVW EH base Â of Â companies Â and Â individuals. Â 1R WZR SULYDWH H[FKDQJHV DUH DOLNH KDYLQJ D YDU\LQJ OHYHO RI VHOIVXIÂżFLHQWE\-DQXDU\ Currently, Â public Â exchanges Â at Â the Â state Â level Â appear Â to Â be Â in Â various Â capabilities Â within Â the Â individual, Â small Â group, Â large Â group, Â and/or Â retiree Â PDUNHWV3ULYDWHH[FKDQJHVGLIIHUHQWLDWHWKHPVHOYHVLQDYDULHW\RIZD\V phases, Â with Â some Â states Â already Â putting Â their Â exchange Â plan Â into Â action Â including Â distribution Â channel Â strategy, Â product Â offerings, Â and Â robust Â ZKLOHRWKHUVDUHMXVWEHJLQQLQJWRFRQVLGHUKRZWKH\ZLOOJHWWKHLUDUPV tools Â that Â integrate Â with Â wellness, Â educational Â materials, Â and Â consumer-Â around Â an Â all-Âencompassing Â regulation. Â Minnesota, Â for Â example, Â recently Â unveiled Â legislation Â that Â will Â lay Â the Â driven Â health Â care Â account Â platforms. Â Common Â ways Â to Â segment Â are: JURXQGZRUNIRUKHDOWKLQVXUDQFHH[FKDQJHVDOORZLQJPLOOLRQUHVLGHQWV Â‡ 6LQJOHFDUULHU([FKDQJHV Â These Â exchanges Â are Â generally Â RI WKH VWDWH WR VKRS FRPSDUDWLYHO\ IRU KHDOWK LQVXUDQFH HIIHFWLYH 2FW promoted Â by Â a Â single Â carrier Â such Â as Â BlueCross Â BlueShield Â +RZHYHU 0LVVLVVLSSL KDG DSSOLHG IRU DSSURYDO WR EHJLQ PRYLQJ and Â target Â employers Â who Â wish Â to Â continue Â to Â play Â an Â active Â role Â in Â both Â the Â selection Â of Â insurance Â carrier Â and Â plan Â design. Â forward Â on Â its Â state Â exchange, Â but Â faced Â a Â disagreement Â over Â how Â much Â DXWKRULW\VWDWHRIÂżFLDOVVKRXOGZLHOGRYHUWKHRSHUDWLRQV 'HSHQGLQJRQWKHOHYHORIHPSOR\HUHQJDJHPHQWLQWKH 6RPHVWDWHVÂ˛VXFKDV$UNDQVDVDQG'HODZDUHÂ˛KDYHGHFLGHGWRRSW EHQHÂżWGHVLJQLQVXUDQFHSURGXFWVPD\EHFXVWRPL]HGIRUWKH out Â of Â a Â state Â exchange Â and Â instead Â have Â chosen Â to Â participate Â in Â a Â federal Â employee Â group Â or Â individuals. SDUWQHUVKLS H[FKDQJH 7KH IHGHUDO JRYHUQPHQW DQWLFLSDWHV LW ZLOO OLNHO\ Â‡ 0XOWLFDUULHU([FKDQJHVThese Â exchanges Â typically Â offer Â end Â up Â operating Â exchanges Â in Â at Â least Â 32 Â states. Â The Â deadline Â for Â states Â to Â DUDQJHRILQVXUDQFHFDUULHUVSURPRWHGE\DEURNHUEHQHÂżW declare Â their Â intentions Â to Â participate Â in Â the Â federal Â partnership Â exchange Â consultant Â or Â administrator. Â These Â exchanges Â offer Â a Â broad Â was Â Feb. Â 15. array Â of Â insurance Â plan Â types Â and Â plan Â designs. Â Employers, Â ZKRZLVKWRWDNHDPRUHKDQGVRIIDSSURDFKWREHQHÂżW selection Â for Â their Â employees, Â gravitate Â to Â this Â model. In Conclusion ,I HGXFDWLQJ FRQVXPHUV DERXW WRGD\ÂśV KHDOWK FDUH EHQHÂżWV LV challenging, Â trying Â to Â ensure Â every Â American Â fully Â understands Â and Â Private Versus Public Exchanges The Â private Â exchange Â world Â is Â fully Â functioning Â today, Â and Â is Â not Â to Â JUDVSVÂ˛DQG LQ WXUQ IXOO\ XWLOL]HVÂ˛WKHLU EHQHÂżW RIIHULQJ LV HTXDOO\ be Â confused Â with Â the Â public Â exchanges Â that Â are Â still Â being Â created Â due Â to Â demanding. Â In Â the Â coming Â months Â and Â years, Â employers Â and Â consumers Â mandates Â by Â PPACA. Â In Â the Â â€œpay Â or Â playâ€? Â concept, Â private Â exchanges Â allow Â will Â face Â many Â education Â hurdles. Â 7KH KHDOWK EHQHÂżWV LQGXVWU\ LV PRELOL]LQJ YHU\ TXLFNO\ LQ SDUDOOHO DQHPSOR\HUWRFRQWLQXHWRÂłSOD\Â´DQGRIIHUEHQHÂżWVWRWKHLUHPSOR\HHV Whereas Â the Â public Â exchange Â will Â support Â government-Âfunded Â health Â ZLWKGHIHQVHRIRULQVSLWHRIWKH33$&$$VWKHFROOHFWLYHKHDOWKEHQHÂżWV LQVXUDQFHDQGWKHVXEVLG\ÂłSDLGÂ´E\HPSOR\HUVZKRRSWRXWRIWKHEHQHÂżWV industry Â begins Â to Â plan Â and Â respond Â to Â the Â mandates Â found Â within Â the Â UHJXODWLRQRQHWKLQJLVFHUWDLQ([FKDQJHVDQGWKHGHÂżQHGFRQWULEXWLRQ game. Â The Â PPACA Â mandates Â the Â creation Â of Â government-Âfunded Â health Â health Â insurance Â model Â will, Â without Â a Â doubt, Â shift Â the Â entire Â industry Â insurance Â exchanges. Â A Â public Â exchange Â is Â a Â health Â insurance Â exchange Â DV ZH NQRZ LW :KHWKHU KHDOWK LQVXUHU WHFKQRORJ\ SURYLGHU WKLUG SDUW\ run Â by Â a Â government Â or Â government Â contracted Â agency. Â These Â â€œpublicâ€? Â DGPLQLVWUDWRUHPSOR\HURUFRQVXPHUZHFDQDOOEHQHÂżWIURPWKLVVKLIWLI exchanges Â will Â allow Â individuals, Â families, Â and Â small Â employers Â to Â we Â educate Â ourselves Â and Â fully Â understand Â the Â impacts Â of Â this Â model. Â purchase Â health Â insurance Â and, Â for Â those Â with Â incomes Â between Â 133 Â and Â SHUFHQWRIWKHIHGHUDOSRYHUW\OHYHO)3/ WRKDYHDFFHVVWRSUHPLXP 'DYLG 8UEDQLDN LV D 3URGXFW 0DQDJHU IRU (YROXWLRQÂŒ WKH OHDGLQJ SURYLGHU RI FRPSUHKHQVLYHHOHFWURQLFFDUGSD\PHQWRQSUHPLVHDQGFORXGFRPSXWLQJVROXWLRQV and Â cost-Âsharing Â government Â subsidies. Â IRUWKHDGPLQLVWUDWLRQRIIOH[LEOHVSHQGLQJDFFRXQWV)6$V KHDOWKVDYLQJVDFFRXQWV By Â Jan. Â 1, Â 2014, Â public Â run Â exchanges Â are Â scheduled Â to Â begin Â +6$V KHDOWK UHLPEXUVHPHQW DFFRXQWV +5$V GHILQHG FRQWULEXWLRQ 9(%$V RSHUDWLQJ DV SDUW RI WKH 33$&$ :KLOH WKH ODQGPDUN OHJLVODWLRQ LV ZHOOQHVVDQGWUDQVLWSODQV)RUPRUHLQIRUPDWLRQSOHDVHYLVLWZZZHYROXWLRQFRP FKDQJLQJWKHKHDOWKFDUHEHQHÂżWVLQGXVWU\LWDOVRLVRSHQLQJXSDZKROH RUFRQWDFW'DYLGDWGXUEDQLDN#HYROXWLRQFRP new Â revenue Â stream Â for Â insurers. Â Public Â health Â insurance Â exchanges Â will Â
January/February 2013 I HealthCare Consumerism Solutionsâ„˘ I www.TheIHCC.com
Public Exchanges Must Answer Multiple Questions Under Tight Deadlines BY CRAIG TOBIN Âť FOUNDER, MANAGING DIRECTOR Âť EVENTUS SOLUTIONS GROUP
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KH $&$ HVWDEOLVKHV D YLWDO UROH RI KHDOWK EHQHÂżW H[FKDQJHV +%( that Â are Â to Â manage Â standardized, Â state-Âregulated Â U.S. Â health Â care Â SODQVDQGEHIXOO\FHUWLÂżHGDQGRSHUDWLRQDOE\-DQ7KDWLVD rather Â demanding Â ramp-Âup Â deadline, Â considering Â the Â combination Â of Â new Â processes, Â technologies Â and Â human Â resources Â that Â must Â be Â aligned Â and Â ready Â to Â navigate Â the Â uncharted Â territory. Â 7KH HPHUJLQJ RQOLQH PDUNHWSODFH IRU XQLQVXUHG DQG XQGHULQVXUHG will Â offer Â information Â and Â resources Â for Â individuals Â and Â small Â businesses Â to Â compare Â policies Â and Â premiums, Â and Â buy Â affordable Â insurance Â directly Â or Â with Â a Â government Â provided Â subsidy Â when Â eligible;Íž Â qualifying Â income Â levels Â DUHQRWWRH[FHHGSHUFHQWRIWKHSRYHUW\OHYHO)3/ 6PDOOEXVLQHVVHV will Â be Â eligible Â for Â subsidies Â as Â well. Â But Â how Â much Â can Â be Â really Â processed Â RQOLQH"
The Role of a Customer Service Center Information Â from Â existing Â private Â exchanges Â indicates Â less Â than Â half Â of Â insurance Â plan Â shopping Â and Â enrollment Â activities Â are Â fully Â transacted Â RQOLQH,QWKHPDMRULW\RISXUFKDVLQJLQWHUDFWLRQVFXVWRPHUVZLOOEHJLQRQ an Â exchange Â website Â but Â ultimately Â call Â a Â customer Â service Â representative. Â In Â terms Â of Â ongoing Â costs, Â customer Â service Â center Â operations, Â not Â technol-Â RJ\ZLOOEHWKHODUJHVWSHUFHQWDJHRIRSHUDWLQJFRVWVVLJQLÂżFDQWO\DIIHFWLQJ WKHÂżQDQFLDOVXVWDLQDELOLW\RIVWDWHH[FKDQJHV,QIDFWFXVWRPHUFRQWDFWZLOO represent Â the Â largest Â ongoing Â expenditure Â after Â the Â development Â and Â imple-Â mentation Â of Â the Â technology Â and Â initial Â launch Â cost. Â 7KDW LV VLJQLÂżFDQW EXW HYHQ WKRXJK WKH GHDGOLQH IRU WKH SURJUDP start Â is Â approaching, Â many Â exchanges Â have Â yet Â to Â consider Â how Â best Â to Â staff Â service Â centers Â with Â experienced Â customer Â service Â agents Â who Â can Â ensure Â the Â programs Â indeed Â provide Â broader Â coverage Â for Â the Â eligible Â population. 7REHIXOO\RSHUDWLRQDOE\DQGÂżQDQFLDOO\VHOIVXVWDLQDEOHE\ exchanges Â must Â rapidly Â orchestrate Â the Â implementation Â of Â both, Â enrollment Â enabling Â technology Â and Â personalized Â multi-Âchannel Â service Â center Â sup-Â port. Â State-Âoperated Â programs Â must Â strive Â to Â perform Â with Â administrative Â RSHUDWLQJ HIÂżFLHQFLHV WKDW FRPSDUH IDYRUDEO\ ZLWK WKH SURJUDPV RSHUDWHG in Â the Â private Â sector. Â Most Â of Â the Â general Â public Â doesnâ€™t Â understand Â each Â state-Âbased Â exchange Â needs Â to Â be Â completely Â self-Âsustainable Â with Â no Â state Â or Â federal Â funding Â effective Â Jan. Â 1, Â 2015. Â In Â order Â to Â remain Â viable Â long-Âterm Â exchange Â each Â state Â needs Â to Â FRPSHWHLQWKHFRPPHUFLDOKHDOWKFDUHPDUNHWSODFHDQGWKHFRVWVWRRSHUDWH WKHVWDWHH[FKDQJHVZLOOQHHGWREHHIÂżFLHQWVRWKDWLWZLOOEHDEOHWRSURYLGH FRPSHWLWLYHLQVXUDQFHSURGXFWVWKURXJKTXDOLÂżHGKHDOWKSODQVWRLQGLYLGX als Â and Â small Â group Â businesses. Â Â‡ Software Â solutions Â will Â integrate Â many Â aspects Â of Â health Â insurance Â deliveryâ€”including Â a Â consumer Â portal, Â eligibility Â
determinations, Â ÂżQDQFLDOVHUYLFHVSODQ enrollment, Â and Â billing Â administration. Â Â‡ Service Â centers Â have Â the Â potential Â to Â greatly Â LQĂ€XHQFHWKHSXEOLFÂśV perception Â of Â the Â new Â law. Â They Â must Â include Â an Â integrated Â &50SODWIRUPLQRUGHUWR provide Â effective Â personalized Â support Â to Â facilitate Â enrollments Â DQGHIIHFWLYHO\HGXFDWHLQGLYLGXDOVHPSOR\HUVDQGÂżHOGEDVHG resources Â assisting Â consumers Â on Â all Â aspects Â of Â the Â Affordable Â Care Â Act. Â As Â in Â so Â many Â other Â cases, Â the Â technology Â is Â merely Â a Â complement Â to Â the Â human Â resources Â that Â will Â ultimately Â determine Â the Â exchangeâ€™s Â effectiveness. Â U.S. Â residents Â who Â live Â at Â or Â near Â poverty Â level Â may Â not Â have Â self-Âservice Â access Â or Â experience Â with Â Web-Âbased Â tools Â and Â technologies. Â For Â many Â RIWKHPLWDOVRPD\EHDÂżUVWWLPHH[SHULHQFHEX\LQJDKHDOWK care Â -Â Â or Â in Â fact Â any Â -Â Â insurance Â product. Â These Â prospective Â insurance Â purchasers Â will Â require Â assistance Â with Â understanding Â the Â health Â insurance Â terminology, Â how Â to Â determine Â eligibility Â or Â proceed Â with Â their Â enrollment Â and Â will Â require Â an Â educated Â customer Â service Â professional Â to Â help Â them Â through Â the Â plan Â evaluation Â and Â selection Â process. Â The Â impact Â of Â the Â customer Â service Â teams Â is Â unquestionably Â profound. *XLGDQFHRQSDUWLFLSDWLRQLQDOWHUQDWHSURJUDPVVXFKDV0HGLFDLGDQG &KLOGUHQÂśV +HDOWK ,QVXUDQFH 3URJUDPV &+,3 UHSUHVHQWV DQRWKHU FULWLFDO contact Â center Â responsibility. Â The Â service Â staff Â must Â develop Â seamless Â integration Â strategies Â with Â existing Â state Â agencies Â supporting Â consumers Â with Â multiple Â program Â eligibility. Â There Â will Â be Â considerable Â overlap Â with Â existing Â assistance Â programs, Â and Â service Â center Â staff Â will Â need Â to Â bring Â clarity Â to Â the Â confusion Â many Â residents Â will Â experience. Â Additionally, Â with Â the Â anticipated Â policy Â changes Â that Â will Â occur Â as Â these Â programs Â mature, Â the Â caliber Â of Â the Â staff Â and Â performance Â of Â the Â service Â center Â will Â largely Â determine Â customer Â acceptance Â and Â satisfaction Â with Â the Â entire Â exchange Â concept. Many Â states Â are Â contemplating Â tiered Â levels Â of Â agent Â support, Â combining Â resources Â who Â are Â trained Â to Â effectively Â educate Â and Â inform Â FDOOHUV DERXW WKH EHQHÂżWV RI WKH H[FKDQJH ZLWK RWKHU PRUH KLJKO\ VNLOOHG personnel Â who Â can Â assist Â with Â the Â eligibility Â and Â enrollment Â processes. Â www.TheIHCC.com I HealthCare Consumerism Solutionsâ„˘ I January/February 2013
Tightly Integrated Customer Contact Just in Time State Â exchanges Â must Â ensure Â the Â service Â center Â is Â a Â â€œdesigned Â inâ€œ Â rather Â than Â â€œbolted Â onâ€? Â component Â of Â the Â solution, Â and Â it Â is Â managed Â to Â perform Â at Â or Â above Â the Â level Â of Â commercial Â contact Â centers Â to Â enable Â long-Â term Â sustainability. Â Established Â customer Â care Â providers Â will Â leverage Â years Â of Â experience Â with Â multi-Âchannel Â contact Â management, Â tightly Â embedded Â in Â insurance Â customer Â acquisition Â and Â retention Â systems. Â 'XHWRWKHWLPHIUDPHVIRUFXUUHQWVWDWHGEDVHGH[FKDQJHVWREHIXOO\ RSHUDWLRQDOE\2FWWKH\KDYHGHFLGHGWRLQLWLDOO\ODXQFKWKHLUVHUYLFH center Â operations Â with Â an Â outsourced Â service Â center Â solution. Â The Â states Â will Â OHYHUDJHWKHRXWVRXUFHUWRDFTXLUHDQH[SHULHQFHGVFDODEOHZRUNIRUFHZLWK built-Âin Â quality Â control Â mechanisms. Â Failing Â to Â identify Â the Â right Â customer Â service Â center Â strategy Â and Â partner Â early Â in Â the Â process Â will Â increase Â costs Â DQGLPSDFWTXDOLW\ZKLOHUHGXFLQJĂ€H[LELOLW\IRUH[FKDQJHVDQGXOWLPDWHO\ compromising Â their Â solution.
Selecting the Right Outsourced Service Center 'XHWRWKHFXVWRPHUVHUYLFHDQGWHFKQRORJ\UHTXLUHPHQWVWKHH[FKDQJH service Â centers Â may Â not Â easily Â integrate Â into Â current Â state-Âmanaged Â contact Â center Â operations. Â The Â right Â outsourced Â service Â center, Â when Â selected Â and Â PDQDJHGFDUHIXOO\FDQUHPRYHULVNWRODXQFKLQDWLPHO\PDQQHUDQGDOORZ IRU ZRUNIRUFH VFDODELOLW\ ZKLOH OHYHUDJLQJ H[LVWLQJ RSHUDWLRQDO SURFHVVHV and Â technologiesâ€”tight Â performance Â and Â quality Â control Â with Â visibility Â into Â status, Â progress Â and Â performance Â trends Â are Â typically Â already Â built Â into Â their Â processes Â through Â best Â practices Â across Â multiple Â industries. Â 6WDWHSURFXUHPHQWWHDPVZLOOQHHGWRPDNHDQLQIRUPHGFKRLFHIURP DYDULHW\RIDYDLODEOHRSWLRQVFRQVLGHULQJTXDOLWLHVWKDWDUHPRVWOLNHO\WR impact Â the Â success Â of Â the Â stateâ€™s Â exchange: Â Â‡ 7UDFNUHFRUGRIZHOOUXQFRVWHIIHFWLYHRSHUDWLRQWKDWFRQVLVWHQWO\ meets Â contractual Â service Â levels Â‡ Proven Â contact Â center Â communication Â technologies Â in Â place Â to Â ensure Â capacity Â and Â reliability Â Â‡ 9HULÂżDEOHGLVDVWHUUHFRYHU\DQGEXVLQHVVFRQWLQXLW\SODQ Â‡ 6\VWHPVDQGSURFHVVHVIRULQWHJUDWHG&XVWRPHU5HODWLRQVKLS 0DQDJHPHQW&50 4XDOLW\3URJUDPVDQG7UDLQLQJ Â‡ 6WURQJ4XDOLW\&RQWUROSURJUDPZLWKH[FHOOHQW)LUVW&RQWDFW 5HVROXWLRQSHUIRUPDQFHUHVXOWV Â‡ (IÂżFLHQW&RPPDQG&HQWHU2SHUDWLRQVWRIRUHFDVWPRQLWRUDQG UHSRUWRQNH\SHUIRUPDQFHLQGLFDWRUVWRUXQDQHIÂżFLHQWDQG cost-Âeffective Â operations. Â Â‡ Transparency Â and Â visibility Â into Â real-Âtime Â reporting Â and Â historical Â SHUIRUPDQFHVWDWXVUHVXOWVDQGWUHQGVDQGWKHDELOLW\WRTXLFNO\ analyze Â data Â for Â this Â new Â program. Â The Â ability Â to Â adapt Â and Â OHDUQIURPWKHÂżUVWRSHQHQUROOPHQWSHULRGDQGPDNHWKH necessary Â changes Â prior Â to Â the Â second Â open Â enrollment Â period Â LQ2FWZLOOEHWKHGLIIHUHQFHWRGULYHWRZDUGWKHLUORQJ term Â sustainability Â that Â will Â be Â required Â by Â Jan. Â 1, Â 2015 Â‡ 2SWLRQVIRULQVWDWHFRQWDFWFHQWHUWRKHOSZLWKORFDOMREFUHDWLRQ and Â direct, Â face-Âto-Âface Â customer Â service Ease Â of Â doing Â business Â through Â contracting Â and Â ongoing Â operations Â is Â critical Â to Â a Â great Â outsourcing Â relationship.
Establishing Partner Relationships In Â the Â event Â you Â have Â decided Â to Â move Â in Â the Â direction Â of Â an Â outsourced Â SURYLGHU WKHUH DUH VRPH NH\ IDFWRUV WR HQVXUH WKH ULJKW RXWFRPH DW WKH HQG RI WKH SURFHVV 7KH SURFHVV RI LGHQWLÂżFDWLRQ HYDOXDWLRQ FRQWUDFWLQJ and Â management Â of Â your Â service Â center Â partner Â will Â include Â the Â following Â elements: 36
January/February 2013 I HealthCare Consumerism Solutionsâ„˘ I www.TheIHCC.com
Â‡ $VVHPEOHDQGSXEOLVKVHOHFWLRQFULWHULDLQDIRUPRI5)3 solicitation Â‡ Understand Â your Â strategy Â around Â the Â technology Â to Â enable Â the Â VHUYLFHFHQWHU'R\RXZDQWWRRZQDQGPDQDJHWKHWHFKQRORJ\ RUOHYHUDJHWKHRXWVRXUFHUÂśVFDSDELOLWLHV" Â‡ Evaluate Â multiple Â vendors Â with Â the Â right Â selection Â criteria Â and Â weightings Â based Â on Â costs, Â technology, Â quality, Â operations Â performance Â and Â culture Â that Â must Â be Â validated Â through Â site Â visits Â with Â comprehensive Â review Â of Â stated Â capabilities. Â 0DNHVXUHWKHHYDOXDWLRQWHDPKDVH[WHQVLYHRSHUDWLRQVDQG technology Â experience Â and Â ideally Â has Â negotiated Â previous Â outsourcing Â contracts. Â‡ 0RGHOWKHHVWLPDWHGODXQFKFRVWVUXQFRVWVDQGULVNUHZDUG pricing Â impacts Â in Â order Â to Â gain Â visibility Â into Â the Â investment Â required Â to Â maintain Â long-Âterm Â sustainability Â‡ 1HJRWLDWHDQGRSWLPL]HWKHULJKWFRQWUDFWXDOWHUPV06$ 62: FRVWVWUXFWXUHV6/$ÂśVDQG.3,ÂśVWKDWZLOOGULYHWKHULJKW behaviors Â and Â desired Â outcomes. Â Â‡ 'HYHORSDQLQWHJUDWHG3URMHFW0DQDJHPHQW2IÂżFHWKDWLVHQJDJHG IURP5)3WKURXJKLPSOHPHQWDWLRQ Â‡ 'HÂżQHYHQGRUPDQDJHPHQWVWUDWHJ\IRUODXQFKDQGRQJRLQJ service Â delivery Â 'HVLJQLQJ DQG EXLOGLQJ DQ H[FKDQJH FRQWDFW FHQWHU FDSDELOLW\ LV a Â critically Â important Â step Â to Â ensuring Â long-Âterm Â program Â success Â and Â acceptance. Â If Â your Â exchange Â does Â not Â have Â the Â right Â in-Âhouse Â expertise Â to Â start Â and Â manage Â this Â process, Â consider Â hiring Â third Â party Â help. Â When Â considering Â the Â very Â personal Â nature Â of Â health Â care Â and Â the Â LQWHQVLW\RIWKHQDWLRQDOGHEDWHDURXQGWKHUHIRUPOHJLVODWLRQWKHVWDNHVDUH high Â and Â the Â importance Â of Â delivering Â a Â comprehensive Â and Â well Â planned Â customer Â service Â solution Â cannot Â be Â overstated. Â By Â collaborating Â with Â other Â states Â and Â incorporating Â proven Â technology Â solutions Â and Â best Â practices Â from Â established, Â best-Âin-Âclass Â service Â providers, Â the Â customer Â contact Â centers Â will Â be Â in Â a Â great Â position Â to Â help Â the Â exchanges Â ensure Â long-Âterm Â success Â and Â realize Â their Â full Â potential. Â (YHQWXVLVDSUHPLHUSURYLGHURIDGYDQFHGFRPSUHKHQVLYHVROXWLRQVIRU&XVWRPHU2SHUDWLRQV 0DQDJHPHQW2XUYDQJXDUGWHFKQRORJLHVFRQVXOWLQJDQGFORXGRSHUDWLRQVPDQDJHGVHUYLFHV KHOSRUJDQL]DWLRQVPRGHUQL]HDQGRSWLPL]HWKHLU&XVWRPHU2SHUDWLRQVZLWKWKHULJKWVROXWLRQ WKDWWDUJHWVEXVLQHVVRXWFRPHVDQGVWUHQJWKHQVFXVWRPHUOR\DOW\
Are You Ready to Sell Dental Benefits in New Health Care Reform Environment? 3DUWRQHRIDWKUHHSDUWVHULHV BY RENE CHAPIN Â» DIRECTOR OF MEMBERSHIP & COMMUNICATIONS Â» NATIONAL ASSOCIATION OF DENTAL PLANS
KHQWKHÂ¿UVWSURYLVLRQVRIWKH$IIRUGDEOH&DUH$FW$&$ JRLQWRHIIHFWLQ GHQWDOEHQHÂ¿WVLQWKHLQGLYLGXDODQGVPDOOJURXSPDUNHWVZLOOEH GLIIHUHQW:LWKWKHVHFKDQJHVFRPHQHZFKDOOHQJHVDQGRSSRUWXQLWLHVIRU EURNHUVZKRXQGHUVWDQGDQGDUHSUHSDUHGIRUWKHIROORZLQJLPSDFWVRIERWKWKH SURSRVHGDQGÂ¿QDOSURYLVLRQVRIWKH$&$ 7KLVLVWKHÂ¿UVWDUWLFOHLQDWKUHHSDUWVHULHVH[SORULQJWKHLPSDFWRIWKH$&$RQ GHQWDOEHQHÂ¿WV7KLVDUWLFOHSUHVHQWVDQ $&$PDUNHWRYHUYLHZLQFOXGLQJVRPH NQRZQDQGSURSRVHGDVSHFWVRIWKH HVVHQWLDOKHDOWKEHQHÂ¿WV7KHVHFRQG DUWLFOHZLOOH[DPLQHYDULRXVH[FKDQJH PRGHOVDQGWKHÂ¿QDOZLOOIRFXVRQ FRVWVKDULQJVFHQDULRV
www.TheIHCC.com I HealthCare Consumerism Solutionsâ„¢ I January/February 2013
Help employees see their best. Learn more and find free vision savings calculators and employee education materials at HealthySightWorkingforYou.org.
Brought to you by Transitions Healthy Sight Working for You®, a public education program to raise awareness of the value of quality vision benefits.
©2013 Transitions Optical, Inc. All Rights Reserved. Transitions, the swirl, and Transitions Healthy Sight Working For You are registered trademarks of Transitions Optical, Inc. Photochromic performance is influenced by temperature, UV exposure and lens material.
38 September/October 2012 I HealthCare Consumerism Solutions™ I www.TheIHCC.com
Current Market Overview ,QWKHFXUUHQWEXVLQHVVODQGVFDSHSHUFHQWRIDOOGHQWDOEHQHÂżWV VROG DUH RIIHUHG XQGHU VHSDUDWH SROLFLHV )LIW\ÂżYH SHUFHQW RI SODQV DUH offered Â through Â large Â group Â employers Â while Â small Â group Â employers, Â with Â OHVVWKDQHPSOR\HHVPDNHXSSHUFHQWRIWKHPDUNHW2QO\SHUFHQW are Â covered Â under Â individual Â dental Â policies;Íž Â the Â rest Â are Â covered Â through Â SXEOLF SURJUDPV OLNH 0HGLFDLG DQG WKH &KLOGUHQÂśV +HDOWK ,QVXUDQFH 3URJUDP&+,3
Overview of Dental Marketsâ€” A Work Still in Progress :KDWZLOOEHGLIIHUHQWLQ" Â‡ )LUVWHYHU\RQHPXVWHQUROOLQDKHDOWKSODQRUSD\DWD[ penalty. Â For Â large Â groups Â and Â public Â programs, Â there Â are Â no Â PDQGDWHGFKDQJHVLQEHQHÂżWV Â‡ +RZHYHUKHDOWKSODQVLQWKHVPDOOJURXSPDUNHWPXVW LQFOXGHDGHÂżQHGVHWRIEHQHÂżWVUHIHUUHGWRDVHVVHQWLDOKHDOWK EHQHÂżWV(+% ZKLFKLQFOXGHGHQWDOEHQHÂżWVIRUFKLOGUHQ Â‡ 7KHSHGLDWULFGHQWDOEHQHÂżWVZLOOEHRIIHUHGWKURXJKWKHQHZ exchanges Â and Â with Â all Â small Â group Â or Â individual Â policies. Â Â‡ $GXOWGHQWDOFRYHUDJHLVQRWLQFOXGHGDVSDUWRIWKH(+% requirement. Â +HUHÂśV DQ DGGHG WZLVW $V WKH ODZ VWDQGV LQ )HEUXDU\ ERWK medical Â plans Â and Â separate Â dental Â plans Â may Â provide Â the Â required Â pediatric Â coverage Â inside Â the Â exchanges;Íž Â however, Â the Â law Â is Â unclear Â if Â a Â medical Â plan Â can Â omit Â the Â required Â pediatric Â oral Â services Â outside Â the Â exchange. Â Until Â this Â question Â is Â answered, Â small Â group Â and Â individual Â dental Â coverage Â offered Â by Â a Â stand-Âalone Â dental Â plan Â outside Â the Â exchange Â could Â duplicate Â coverage Â included Â with Â a Â medical Â policy. Â This Â will Â affect Â 1.65 Â million Â small Â employers Â who Â today Â provide Â dental Â coverage Â for Â 43.7 Â million Â consumers, Â including Â 22.9 Â million Â children. States Â will Â decide Â many Â of Â the Â parameters Â for Â small Â group Â and Â individual Â coverage Â offered Â through Â the Â exchange, Â such Â as Â scope Â of Â EHQHÂżWVDQGWKHDJHOLPLWIRUSHGLDWULFFRYHUDJH,QVWDWHVKDYHRSWHG WR GHÂżQH VPDOO JURXSV DV RU IHZHU HPSOR\HHV %\ VWDWH VPDOO JURXSGHÂżQLWLRQVDUHUHTXLUHGWRFRQIRUPWRWKHIHGHUDOGHÂżQLWLRQRI or Â less Â employees. Â This Â will Â move Â an Â additional Â 9 Â percent Â of Â the Â dental Â PDUNHWXQGHUWKH(+%UHTXLUHPHQW At Â press Â time, Â 19 Â is Â the Â proposed Â federal Â minimum Â age Â for Â the Â pediatric Â dental Â coverage Â provisions Â of Â ACA. Â Unless Â regulatory Â changes Â DUHPDGHGHQWDOSROLFLHVLQWKHVPDOOJURXSPDUNHWPD\GXSOLFDWHEHQHÂżWV LQPHGLFDOFRYHUDJHIRUFKLOGUHQ7KHEHQFKPDUNIRUWKHVFRSHRIGHQWDO EHQHÂżWV LV GHÂżQHG E\ HLWKHU WKH )HGHUDO (PSOR\HHV 'HQWDO DQG 9LVLRQ ,QVXUDQFH3URJUDPRU&+,3 ,QDGGLWLRQWRVFRSHRIEHQHÂżWVWKHUHDUHSURYLVLRQVLQWKH$&$ZKLFK OLPLWGHGXFWLEOHVDQGHVWDEOLVKDQHZFRQVXPHURXWRISRFNHW223 OLPLW in Â medical Â coverage. Â There Â also Â are Â proposed Â rules Â which Â establish Â a Â GLIIHUHQWFRQVXPHURXWRISRFNHWPD[LPXPIRUGHQWDOFRYHUDJH7KH$&$ limit Â on Â deductibles Â for Â medical Â policies Â is Â $2,000 Â for Â individuals Â and Â IRUIDPLOLHV7KHPHGLFDOFRQVXPHU223OLPLWLVSHJJHGWRWKHRXW RISRFNHWOLPLWVIRUKLJKGHGXFWLEOHKHDOWKSODQVDVGHÂżQHGE\WKHKHDOWK VDYLQJV DFFRXQW SURYLVLRQV RI WKH ,56 &RGH )RU WKLV LV annually Â for Â a Â family Â of Â four Â and Â $6,250 Â annually Â for Â an Â individual Â and Â OLNHO\WREHLQFUHDVHGIRU7KHGHQWDOFRQVXPHU223OLPLWLVUHTXLUHG to Â be Â â€œreasonableâ€? Â and Â is Â proposed Â to Â be Â $1000. Â
ACA QUICK FACTS Markets affected: t 4NBMMHSPVQJOEJWJEVBM 4NBMM(SPVQEFmOJUJPO t 4UBUFNBLFTEFDJTJPOÂ‰XBUDIGPSVQEBUFT t PSMFTTFNQMPZFFT
1FEJBUSJD#FOFmU t 4UBUFEFDJEFTBHFMJNJUXBUDIGPSVQEBUFT t QSPQPTFEBHFMJNJUGPS&)# t .BZCFEVQMJDBUJWFPGCFOFmUTVOEFSTFQBSBUFQPMJDJFTJO TNBMMHSPVQBOEJOEJWJEVBMNBSLFUT t /"%1JTBEWPDBUJOHGPSBDIBOHFXBUDIGPSVQEBUFT About Â 98 Â percent Â of Â children Â have Â dental Â claims Â of Â less Â than Â $1,000 Â per Â year. Â Under Â a Â dental Â plan, Â they Â will Â have Â only Â a Â few Â hundred Â dollars Â RIFRVWVKDULQJ+RZHYHULIPHGLFDOSODQVPDNHSHGLDWULFGHQWDOEHQHÂżWV VXEMHFW WR PHGLFDO GHGXFWLEOHV DQG RXWRISRFNHW PD[LPXPV WKH FRVW sharing Â could Â be Â substantially Â higher. Â
Challenges and Opportunities ,Q WKH VPDOO JURXS DQG LQGLYLGXDO PDUNHW EURNHUV IDFH WKH WDVN RI selling Â dental Â coverage, Â and Â sorting Â out Â when Â such Â coverage Â is Â duplicative Â of Â the Â required Â pediatric Â dental Â coverage Â offered Â as Â part Â of Â medical Â plans Â DV(+%6RPHGHQWDORQO\FRPSDQLHVPD\DGDSWE\DOWHULQJWKHLUFRYHUDJH VRDVWRPLQLPL]HGXSOLFDWLRQDQGVWLOOSURYLGHDYDOXHDGGHGEHQHÂżWIRU FKLOGUHQ,QHLWKHUHYHQWEURNHUVZLOOFHUWDLQO\KDYHDQRSSRUWXQLW\WRVHOO GHQWDOEHQHÂżWVIRUWKHDGXOWVQRWFRYHUHGE\WKHLU(+%PHGLFDOSROLFLHV Because Â there Â will Â be Â potential Â overlap Â and Â gaps Â in Â policies, Â small Â HPSOR\HUVDQGLQGLYLGXDOVZLOOWXUQWREURNHUVWRKHOSWKHPGHWHUPLQHWKH RSWLPXPGHQWDOEHQHÂżWVSDFNDJHWRRIIHUWKHLUHPSOR\HHV At Â the Â beginning Â of Â 2013, Â many Â questions Â still Â remain. Â The Â National Â $VVRFLDWLRQRI'HQWDO3ODQV1$'3 LVZRUNLQJWRZDUGFODULÂżFDWLRQVDQG UHVROXWLRQV RI WKHVH LVVXHV )RU XSGDWHV UHJDUGLQJ GHQWDO EHQHÂżWV XQGHU WKH$&$YLVLW1$'3RUJDQGZDWFKIRUPRUHDUWLFOHVLQWKHQH[WLVVXHRI +HDOWK&DUH&RQVXPHULVP6ROXWLRQV. Â 7KH 1DWLRQDO $VVRFLDWLRQ RI 'HQWDO 3ODQV 1$'3 D 7H[DV QRQSURÂżW FRUSRUDWLRQ ZLWK KHDGTXDUWHUV LQ 'DOODV 7H[DV LV WKH ÂłUHSUHVHQWDWLYH DQG UHFRJQL]HG UHVRXUFH RI WKH GHQWDO EHQHÂżWVLQGXVWU\Â´1$'3LVWKHRQO\QDWLRQDOWUDGHRUJDQL]DWLRQWKDWLQFOXGHVWKHIXOOVSHFWUXP RIGHQWDOEHQHÂżWVFRPSDQLHVRSHUDWLQJLQWKH8QLWHG6WDWHV1$'3ÂśVPHPEHUVSURYLGH'HQWDO +02'HQWDO332'HQWDO,QGHPQLW\DQG'LVFRXQW'HQWDOSURGXFWVWRPLOOLRQ$PHULFDQV SHUFHQW RI DOO $PHULFDQV ZLWK GHQWDO EHQHÂżWV )RU PRUH XSGDWHV RQ WKH GHQWDO EHQHÂżWV LQGXVWU\VXEVFULEHWRWKHZHHNO\HQHZVOHWWHU1$'36PDUW%ULHIYLDZZZQDGSRUJ
www.TheIHCC.com I HealthCare Consumerism Solutionsâ„˘ I January/February 2013
How Health Care Reform
KDWÂśVWKHÂżUVWWKRXJKWWKDWFRPHVWR\RXUPLQG ZKHQ\RXKHDUWKHWHUPÂłKHDOWKFDUHUHIRUPÂ´" ,I \RXÂśUH OLNH PRVW +5 RU EHQHILW professionals, Â your Â mind Â probably Â darts Â to Â the Â impact Â of Â the Â KHDYLO\ GHEDWHG OHJLVODWLRQ RQ HPSOR\HH PHGLFDO EHQHÂżWV 7KDWPDNHVDORWRIVHQVHDIWHUDOOKHDOWKFDUHUHIRUPZLOO have Â its Â greatest Â effect Â in Â this Â area. Â
+RZHYHU WKH 3DWLHQW 3URWHFWLRQ DQG $IIRUGDEOH &DUH $FW 33$&$ DOVR ZLOO WULJJHU D ÂłULSSOHHIIHFWÂ´IRUDQFLOODU\EHQHÂżWV,QWKHFDVHRI vision, Â for Â example, Â employers Â are Â already Â starting Â WR DVN TXHVWLRQV DERXW ZKHWKHU WKHLU HPSOR\HH vision Â plans Â will Â need Â to Â change Â in Â terms Â of Â structure, Â coverage Â and Â costs Â to Â both Â them Â and Â WKHLUZRUNIRUFH7KLVDUWLFOHSURYLGHVDQRYHUYLHZRI the Â anticipated Â impact Â of Â health Â care Â reform Â on Â the Â YLVLRQ EHQHÂżW LQGXVWU\ DQG ZKDW HPSOR\HUV QHHG WRNQRZLQRUGHUWRHQVXUHWKHLUZRUNIRUFHUHWDLQV access Â to Â this Â highly-Âvalued Â coverage Â that Â can Â help Â lower Â medical Â costs Â and Â boost Â productivity, Â as Â well Â as Â increase Â employee Â attraction Â and Â retention.
The Impact of Pediatric Vision Coverage as an Essential Health Benefit The Â PPACA Â designates Â pediatric Â vision Â VHUYLFHV DV RQH RI WKH HVVHQWLDO KHDOWK EHQHÂżWV WKDWDOOTXDOLÂżHGKHDOWKSODQVQHHGWRRIIHULIWKH\ intend Â to Â sell Â in Â the Â health Â insurance Â exchanges, Â which Â will Â be Â used Â by Â individuals Â and Â small Â groups Â to Â shop Â for Â coverage Â beginning Â next Â year. Â In Â short, Â beginning Â in Â January Â 2014, Â all Â individual Â and Â small Â groups Â with Â 50 Â or Â fewer Â employees Â must Â provide Â pediatric Â vision Â care Â FRYHUDJHÂ˛HPEHGGHG LQ D PHGLFDO EHQHÂżWÂ˛IRU children Â up Â to Â age Â 19. Â In Â January Â 2016, Â this Â will Â extend Â to Â individual Â and Â small Â groups Â with Â 100 Â or Â fewer Â employees. Â Self-Âinsured Â plans, Â large Â group Â SODQV DQG JUDQGIDWKHUHG SODQV SXUFKDVHG RQ RU EHIRUH 0DUFK DUH QRW UHTXLUHG WR RIIHU essential Â pediatric Â vision Â care, Â but Â if Â they Â do, Â the Â coverage Â must Â be Â embedded Â in Â their Â medical Â plan Â and Â cannot Â have Â annual Â or Â lifetime Â dollar Â limits. Â :KDWLVWKHVWLFNLQJSRLQW" 7KH86JRYHUQPHQWKDVFKRVHQQRWWRGHÂżQH â€œpediatric Â vision Â careâ€? Â but Â has Â left Â it Â to Â the Â discretion Â RILQGLYLGXDOVWDWHVWRGHÂżQHWKHFRYHUDJHWKURXJK WKH VHOHFWLRQ RI D EHQFKPDUN YLVLRQ SODQ RU E\ 40
BY JEFF SPAHR Âť PRESIDENT, VISION BUSINESS Âť WELLPOINT
defaulting Â to Â a Â federal Â plan. Â Whatâ€™s Â covered Â by Â these Â plans Â varies Â VLJQLÂżFDQWO\IURPVWDWH to Â state. Â For Â example, Â &RORUDGRÂśV EHQFKPDUN medical Â plan Â includes Â a Â pediatric Â eye Â exam, Â but Â no Â eyewear Â materials. Â Connecticut Â has Â decided Â on Â much Â more Â robust Â coverage, Â including Â an Â annual Â exam Â for Â children Â and Â adults, Â plus Â annual Â eyeglasses Â or Â contacts Â for Â children Â as Â well. Â Employers Â will Â have Â WRIROORZWKHVSHFLÂżFUHTXLUHPHQWVIRUWKHLUVWDWHV FORVHO\3OHDVH1RWH7KHVHDUHÂľLQLWLDOLQGLFDWLRQVÂś DQGQRWQHFHVVDULO\ÂżQDOJXLGDQFH
A Game Changer for the Allowance-based Model Aside Â from Â mandatory Â pediatric Â vision Â coverage, Â health Â care Â reform Â also Â will Â have Â a Â VLJQLÂżFDQW LPSDFW RQ WKH YLVLRQ SODQ PRGHO employers, Â employees Â and Â eyecare Â professionals Â are Â used Â to, Â which Â has Â traditionally Â been Â allowance-Â based Â on Â the Â materials Â side. Â Through Â an Â allowance-Âbased Â model, Â employ-Â ees Â are Â given Â an Â allotted Â amount Â to Â apply Â toward Â eyewear Â and/or Â contactsâ€”allowing Â freedom Â of Â choice, Â but Â placing Â a Â limit Â on Â the Â total Â exposure Â for Â the Â plan. Â Consider Â that Â PPACA Â mandates Â no Â DQQXDOPD[LPXPRQHVVHQWLDOKHDOWKEHQHÂżWV7KLV requirement Â could Â really Â stir Â things Â up Â if Â materi-Â DOV DUH LQFOXGHG LQ WKH SHGLDWULF YLVLRQ EHQHÂżW $ ÂłQR RXWRISRFNHW OLPLWÂ´ UXOH IRU PDWHULDOV FRXOG be Â interpreted Â as Â meaning Â patients Â will Â have Â their Â SLFNRIWKHKLJKHVWHQGIUDPHVDQGOHQVHVZLWKDOO the Â trimmings. Â %XWEHIRUH\RXSODQWKDWWULSWRJHWDOOWKHNLGV *XFFLIUDPHVNQRZWKDWÂ˛ZLWKRXWDGROODUOLPLWRQ WKHH\HZHDUVLGHÂ˛KHDOWKSODQVDOUHDG\DUHORRNLQJ DWRWKHUEHQHÂżWGHVLJQVWKDWZRXOGSURYLGHDJRRG selection Â of Â quality Â glasses, Â but Â would Â limit Â the Â ability Â of Â patients Â to Â buy Â high-Âend Â designer Â frames. Â $QRWKHU FKDOOHQJH IRU WKH YLVLRQ EHQHÂżWV industryâ€”one Â that Â you Â may Â have Â heard Â about Â recentlyâ€”is Â the Â debate Â over Â whether Â and Â how Â stand-Âalone Â vision Â plans Â can Â participate Â in Â the Â exchanges. Â Under Â PPACA, Â pediatric Â essential Â health Â EHQHÂżWVPXVWEHHPEHGGHGLQDPHGLFDOSODQDQG
January/February 2013 I HealthCare Consumerism Solutionsâ„˘ I www.TheIHCC.com
RXWRISRFNHW YLVLRQ H[SHQVHV KDYH WR DFFXPXODWH as Â part Â of Â an Â employeeâ€™s Â medical Â plan Â deductible. Â Many Â medical Â carriers Â are Â planning Â buy-Âup Â options Â so Â materials Â coverage Â for Â children Â and Â all Â vision Â coverage Â for Â adults Â can Â be Â included Â in Â WKH PHGLFDO SODQ EH\RQG MXVW ZKDW LV GHÂżQHG DV â€œessentialâ€?. Â This Â will Â help Â ensure Â a Â family Â can Â KDYH FRQVLVWHQW FRYHUDJH LQFOXGLQJ WKH QHWZRUN RIH\HGRFWRUVDQGEHQHÂżWVEHWZHHQWKHFKLOGUHQÂśV pediatric Â vision Â coverage Â and Â adult Â coverage. Â Without Â these Â options, Â the Â adults Â in Â the Â family Â may Â have Â to Â go Â to Â one Â eye Â doctor Â while Â their Â children Â KDYHEHQHÂżWVDWDGLIIHUHQWH\HGRFWRU In Â addition, Â several Â employers Â have Â already Â raised Â questions Â about Â whether Â the Â new Â minimum Â age Â of Â covered Â dependents Â under Â PPACA Â will Â LPSDFWWKHYLVLRQEHQHÂżWDVZHOO Under Â the Â law, Â medical Â plans Â must Â allow Â dependent Â children Â to Â remain Â on Â their Â parentsâ€™ Â medical Â plan Â until Â age Â 26, Â though Â they Â lose Â access Â WRWKHSHGLDWULFEHQHÂżWDWDJH9LVLRQSODQVKDYH traditionally Â had Â similar Â dependent Â rules Â to Â medi-Â FDO SODQV DQG VHHP OLNHO\ WR FRQWLQXH WKLV WUHQG modifying Â coverage Â rules Â to Â allow Â an Â employeeâ€™s Â dependent Â children Â to Â be Â covered Â on Â the Â vision Â plan Â until Â age Â 26 Â to Â stay Â parallel Â to Â the Â medical Â coverage. Â
A Silver Lining Ahead There Â is Â no Â doubt Â health Â care Â reform Â will Â add Â a Â layer Â of Â complexity Â when Â it Â comes Â to Â vision Â coverage Â for Â individuals Â and Â small Â groups. Â There Â are Â still Â several Â parties Â who Â are Â advocating Â entirely Â different Â approaches Â to Â providing Â pediatric Â vision Â EHQHÂżWV DOWKRXJK WKH WLPLQJ UHTXLUHG WR ÂżQDOL]H EHQHÂżWGHVLJQVDQGÂżOHSURGXFWVWREHUHDG\IRUDQ 2FWREHURSHQHQUROOPHQWIRUSODQVHIIHFWLYH-DQ PDNHLWXQOLNHO\WKDWFKDQJLQJFRXUVHDWWKLV point Â is Â a Â practical Â option. Â While Â we Â have Â yet Â to Â see Â the Â result Â of Â efforts Â OLNHWKHVHDQLPSRUWDQWSLHFHRIDGYLFHWRHPSOR\HUV DQGEHQHÂżWVSURIHVVLRQDOVLVWRUHPDLQĂ€H[LEOHDQG patient Â while Â some Â of Â the Â issues Â raised Â by Â the Â SHGLDWULF HVVHQWLDO YLVLRQ EHQHÂżW DUH GHÂżQHG DQG ÂżQDOL]HG Plus, Â a Â silver Â lining Â to Â consider Â is Â that Â more Â DWWHQWLRQ LV EHLQJ SODFHG RQ WKH YLVLRQ EHQHÂżWÂ˛D powerful Â wellness Â tool Â and Â way Â for Â employers Â to Â improve Â their Â bottom Â line. Â
Will Impact Vision Benefits
)DFWVLQWR)RFXV With Â health Â care Â reform Â designating Â vision Â FDUH DV DQ HVVHQWLDO SHGLDWULF EHQHÂżW ZH DOVR ZLOO VHH PRUH FRYHUDJH IRU FKLOGUHQ VSHFLÂżFDOO\ ZKR DUH DW KLJKHU ULVN IRU ERWK YLVLRQ SUREOHPV DQG eye-Ârelated Â health Â issues Â that Â can Â negatively Â impact Â their Â physical, Â social Â and Â educational Â development. Â Many Â eye Â and Â even Â systemic Â diseases Â can Â be Â detected Â through Â an Â eye Â exam Â before Â symptoms Â are Â QRWLFHDEOHDQGZKHQVWHSVFDQEHWDNHQWRSUHYHQW or Â delay Â these Â conditionsâ€”before Â permanent Â vision Â loss Â or Â other Â side Â effects Â occur. Â (PSOR\HUV KRSHIXOO\ NQRZ LWÂśV LPSRUWDQW WR NHHS XS ZLWK HPSOR\HH H[SHFWDWLRQV LQ WHUPV RI being Â able Â to Â provide Â quality Â vision Â coverage Â for Â themselves Â and Â their Â children. Â After Â all, Â according Â WRDQDQQXDOVXUYH\E\7UDQVLWLRQV2SWLFDOSURYLG-Â
ing Â eye Â care Â for Â their Â family Â is Â one Â of Â the Â top Â reasons Â why Â employees Â enroll Â in Â their Â vision Â plan, Â and Â three Â in Â four Â full-Âtime Â parents Â with Â access Â to Â their Â com-Â SDQ\ÂśVFXUUHQWYLVLRQEHQHÂżWFKRRVHWRHQUROOLQLW The Â bottom Â lineâ€”employers Â should Â remain Â committed Â to Â do Â whatâ€™s Â right Â in Â terms Â of Â offering Â quality Â vision Â care Â and Â vision Â wear Â to Â employees Â
and Â their Â children, Â regardless Â of Â the Â outcome Â of Â health Â care Â reform Â measures. Â 7KH\ DOVR VKRXOG WDNH VWHSV WR HQFRXUDJH HPSOR\HHVWRVHHNUHJXODUSUHYHQWDWLYHH\HH[DPV IRU WKHPVHOYHV DQG WKHLU FKLOGUHQ DQG WR WDNH WKH time Â to Â truly Â understand Â what Â is Â covered Â in Â their Â vision Â policy. Â Â
Vision for Tomorrow: Insights from the Transitions Academy HR / Broker Panel Discussion By Smith Wyckoff, Transitions Optical, Inc.
inalists for the Transitions HR Visionary of the Year (co-founded by The Institute for HealthCare Consumerism) and the Transitions Vision Benefits Broker of the Year recently weighed in on the future of vision benefits, as part of a panel discussion at the sixth annual Transitions Academy managed vision care track in Orlando. On the employer side, the HR panelists felt health care reform would do little to change their commitment to providing high-quality vision plans that lower medical costs, and boost employee productivity, attraction and retention. However, they alluded to coming questions about aligning coverage for dependents between vision and health plans.
benefits to comply with new standards and therefore cut costs or raise prices elsewhere. t Maurice Evans, Jr., Director of HR, Integral Group LLC (award winner): Evans is not changing his already robust vision plan, and says health care reform reminds him that he needs to maintain quality benefit offerings to keep employees satisfied so they are using the plans and see the health benefits of preventative care. Evans also questioned whether vision benefits will change in the future to cover dependents up to age 26.
t Cyndee Blue, HR Director, Everence Financial: Blue is keeping her robust vision coverage for 2013, but recently updated the plan structure to cover dependents up to age 26 to coincide with the age 26 health care reform change. t Steve Browne, VP, Director of HR, Wiginton Fire Systems: Browne was already offering robust medical and vision plans, so believes his company will have a competitive advantage as competitors are forced to upgrade their
Meanwhile, the broker panelists said they anticipate health care reform and the move to defined contribution plans will create a shift in their role to a more consultative approach. They predict a greater focus on education, helping clients understand regulations and their benefits options, and they expect more brokers to step up their ancillary product promotion as a way to offer increased value while providing additional income. t Anthony Glaub, President, Professional Insurance Enrollers (award winner): Glaub believes health care reform is
pushing brokers to find new revenue streams, such as in voluntary products. He reports seeing more bundling of vision and dental and other voluntary benefits. t Todd Hester, Account Executive, Neace Lukens: Hester started placing his focus on ancillary benefits a few years ago, recognizing product like vision and dental can provide a value add to employees amidst medical coverage cuts and increased employee cost sharing. t Mark Lambert, Senior Business Advisor, Conner Benefits: Lambert has already moved toward a more consultative approach, including in-house compliance and wellness departments, and an increased focus on employee education. He believes that vision benefits will have a significant role because of their importance to preventative health and high ROI for employers. Additional perspectives from panel members on the future of vision benefits can be found in the Videos section of the Tools page of HealthySightWorkingForYou.org. Â Â
www.TheIHCC.com I HealthCare Consumerism Solutionsâ„˘ I January/February 2013
PEOPLE ON THE MOVE
and disease management in dental care delivery. Dr. Compton is a nationally recognized leader on issues of dental quality, dental reimbursement, dental analytics and oral health. Â Most recently, Dr. Compton served as vice president of business intelligence for DentaQuest, one of the nationâ€™s leading oral health companies. Dr. Compton also will serve as president of the DentaQuest Oral Health Center, a model dental office committed to prevention-focused care, which is co-located with the DentaQuest Institute in Westborough, Mass. Health Catalyst (www.healthcatalyst.com), the leader in health care data warehousing and analytics, announced the appointment of John Haughom, M.D. as chief medical officer and senior vice president. Haughomâ€™s appointment comes at a key time of substantial growth for Health Catalyst. Trained in the same principles and methodologies Health Catalyst espouses, Haughom has decades of experience leading improvement efforts. While a senior executive at PeaceHealth for 18 of the last 20 years in various clinical and IT executive roles including SVP of Quality and CIO, Haughom led integrated clinical, IT and financial teams to realize a 20 percent reduction in harm across the entire system over three years.
HEALTHCARE CONSUMERISM SOLUTIONS
Florida Blue and Cleveland Clinic Florida Create Accountable Care Arrangement Florida Â Blue, Â Floridaâ€™s Â Blue Â Cross Â and Â Blue Â Shield Â company, Â and Â Cleveland Â Clinic Â Florida Â are Â proud Â to Â announce Â the Â execution Â of Â a Â Letter Â RI,QWHQWZKLFKVLJQLÂżHVWKHLUFRPPLWPHQWWRFUHDWHDQDFFRXQWDEOHFDUH program. The Â overall Â goals Â of Â accountable Â care Â arrangements Â are Â to Â improve Â individual Â patient Â care Â and Â overall Â health, Â as Â well Â as Â decrease Â medical Â costs. Â Florida Â Blue Â and Â Cleveland Â Clinic Â Florida Â will Â strive Â to Â accomplish Â WKHVHJRDOVE\LQFUHDVLQJFROODERUDWLRQDQGHIÂżFLHQF\ In Â addition, Â the Â program Â will Â aim Â to Â increase Â patient Â satisfaction Â by Â improving Â partnerships Â between Â patients Â and Â their Â doctors, Â allowing Â them Â to Â make Â health Â care Â decisions Â together. Â It Â also Â will Â improve Â the Â overall Â health Â of Â the Â population Â by Â enhancing Â the Â coordination Â of Â care Â among Â providers Â in Â the Â health Â care Â delivery Â system. â€œCleveland Â Clinic Â has Â been Â a Â leader Â in Â providing Â high-Âquality Â health Â care Â at Â a Â lower Â cost,â€? Â says Â Bernie Â Fernandez, Â M.D., Â CEO Â of Â Cleveland Â Clinic Â Florida. Â â€œOur Â organization Â is Â structured Â around Â quality Â DQG HIÂżFLHQF\ DQG ZH DUH SOHDVHG WR SDUWQHU ZLWK )ORULGD %OXH RQ WKLV initiative.â€? The Â accountable Â care Â program Â between Â Cleveland Â Clinic Â and Â Florida Â Blue Â will Â utilize Â a Â value-Âbased Â compensation Â structure Â and Â serve Â as Â another Â example Â of Â Florida Â Blueâ€™s Â payment Â innovation Â efforts Â being Â deployed Â in Â the Â south Â Florida Â market. Â It Â will Â decrease Â medical Â costs Â by Â rewarding Â the Â right Â combination Â of Â goals, Â including Â transparency, Â care Â coordination, Â consumer Â power Â and Â lack Â of Â redundancy. Â
HighRoads Solves Health Plan Data Management for Health Care Payers HighRoads, Â the Â industry Â leader Â in Â health Â care Â compliance Â and Â benefits Â management, Â launched Â the Â HighRoads Â Benefits Â Plan Â 42
January/February 2013 I HealthCare Consumerism Solutionsâ„˘ I www.TheIHCC.com
Liazon Corporation, operator of the market-leading private benefits exchange for businesses, announced the appointment of David Finkel as its chief operating officer, effective immediately. Finkel is a dynamic leader who brings 26 years of operations and business development experience in the health care and employee benefits market to Liazon. His objective is to scale the companyâ€™s operations to support its rapid growth and services to brokers, carriers and employers. Finkel joins Liazon from Inovalon, a health care data analytics firm, where he served as chief operating officer responsible for managing day-to-day operations of all business units. Earlier he held senior positions at WellPoint, Coventry Health Care, CIGNA, Deloitte & Touche and Oxford Health Plans.Â Finkel earned a Bachelor of Arts degree in Community Health at the University of Rochester and an M.B.A. in Health Care Administration from Baruch College/ Mount Sinai School of Medicine in New York.Â Delta Dental of Minnesota Foundation has hired a new employee, Sharon Oswald, to manage and implement its programming. Oswald will manage philanthropic and community affairs related activities for Delta Dental of Minnesota. Delta Dental of Minnesota Foundation is designed to support Delta
FLORIDA BLUE Âť CLEVELAND CLINIC FLORIDA Âť HIGHROA Management Â System. Â The Â new, Â SaaS-Âbased Â solution Â automates Â plan Â design Â management Â and Â eases Â the Â compliance Â burden Â for Â todayâ€™s Â health Â insurance Â payers. Â â€œHealth Â Care Â Reform Â has Â created Â new Â complexities Â for Â health Â care Â payers Â who Â have Â been Â charged Â with Â communicating Â new Â regulations Â in Â an Â easy-Âto-Âunderstand Â language Â to Â their Â customers,â€? Â says Â Michael Â Byers, Â CEO, Â HighRoads. Â â€œThe Â challenge Â is Â that Â typical Â payer Â technologies Â have Â not Â been Â built Â to Â accommodate Â the Â plan Â management Â requirements Â needed Â to Â easily Â deliver Â these Â critical Â compliance Â documents. Â HighRoads Â has Â been Â a Â leader Â in Â managing Â health Â plan Â data Â for Â complex Â environments Â and Â employers Â for Â over Â a Â decade. Â We Â are Â now Â bringing Â this Â technology Â to Â the Â payer Â market Â with Â a Â customized Â solution Â designed Â to Â ease Â the Â burden Â of Â developing Â compliant Â materials Â for Â the Â health Â insurance Â consumer.â€? Todayâ€™s Â health Â insurance Â payer Â has Â complex Â plan Â data Â residing Â in Â multiple Â systems Â and Â in Â multiple Â formats. Â To Â combine Â this Â information Â to Â deliver Â health Â care Â reform-Âcompliant Â SBC Â materials, Â often Â requires Â PDVVLYHPDQXDOSURFHVVHVZLWKOLPLWHGRUQRDXWRPDWHGZRUNĂ€RZ 7KH +LJK5RDGV %HQHÂżWV 3ODQ 0DQDJHPHQW 6\VWHP LV D SDWHQWHG technology Â that Â enables Â payers Â to Â become Â more Â competitive Â and Â adapt Â to Â the Â frequent Â changes Â expected Â in Â the Â consumer-Âfocused Â health Â care Â market. Â By Â helping Â payers Â manage Â data Â holisticallyâ€”rather Â than Â managing Â individual Â documentsâ€”HighRoads Â enables Â payers Â to Â generate Â EHQHÂżWVGRFXPHQWVPRUHHDVLO\EDVHGRQWKHLUXQLTXHEXVLQHVVUXOHV
Blue Zones Project Demonstration Sites Named Wellmark Â Blue Â Cross Â and Â Blue Â Shield Â and Â Healthways Â announced Â six Â additional Â communities Â have Â been Â named Â as Â Blue Â Zones Â Project Â demonstration Â sites Â in Â Iowa. Â The Â communities Â are: Â Cedar Â Rapids, Â Iowa Â City, Â Marion, Â Muscatine, Â Oskaloosa Â and Â Sioux Â City. These Â communities Â join Â Cedar Â Falls, Â Mason Â City, Â Spencer Â and Â :DWHUORRZKLFKZHUHQDPHGLQ0D\DVWKHÂżUVW%OXH=RQHV3URMHFW demonstration Â site Â communities Â in Â Iowa Â with Â populations Â greater Â than Â 10,000 Â citizens. Â Nine Â additional Â communities Â with Â populations Â less Â than Â
Dental of Minnesotaâ€™s mission of improving the oral health of the people in Minnesota. Delta Dental of Minnesota Foundation was formed out of the proceeds of the 2009 sale of the dental benefit management company, DeCare Dental. Oswald has been involved Oswald in oral health issues in Minnesota since 2004, when at Greater Twin Cities United Way, she was a leader in developing their Bright Smiles initiative to address oral health disease among young children and pregnant women. Through Bright Smiles Oswald helped advocate for and organize the Minnesota effort that led to the passing of legislation enabling dental therapyâ€”the first state to allow for this new type of providerâ€”to expand the availability of dental care in underserved areas. Health Care Service Corporation (HCSC) announced that Stephen Ondra, M.D., a nationally recognized leader in health care quality and policy, will join its executive management team. Effective April 1, Dr. Ondra will serve as senior vice president and chief medical officer reporting to Patricia Hemingway Hall, president and CEO of HCSC. In his new position Dr. Ondra will replace Dr. Paul Handel who announced his retirement last year. In his
new role Dr. Ondra will be a key national spokesperson for HCSC and a health policy advocate for HCSCâ€™s policyholders. He also will be the clinical executive responsible for the strategy and oversight of the companyâ€™s medical policies, quality improvement, and performance measurement programs delivered by HCSCâ€™s Blue Cross and Blue Shield health plans in Illinois, New Mexico, Oklahoma and Texas. Health Catalyst (www.healthcatalyst.com), the leader in health care data warehousing and analytics, announced the appointment of John Haughom, M.D. as chief medical officer and senior vice president. Haughomâ€™s appointment comes at a key time of substantial growth for Health Catalyst. Trained in the same principles and methodologies Health Catalyst espouses, Haughom has decades of experience leading improvement efforts. While a senior executive at PeaceHealth for 18 of the last 20 years in various clinical and IT executive roles, including SVP of Quality and CIO, Haughom led integrated clinical, IT and financial teams to realize a 20 percent reduction in harm across the entire system over three years.
Âť WELLMARK BLUE CROSS BLUE SHIELD Âť HEALTHWAYS Âť HARVARD PILGRIM Âť CASTLIGHT Âť TOWERS WATSON 10,000 Â citizens Â were Â named Â demonstration Â sites Â in Â October Â 2012 Â for Â a Â total Â of Â 19 Â communities Â currently Â working Â formally Â towards Â Blue Â Zones Â &RPPXQLW\FHUWLÂżFDWLRQ Âł:H DUH WKULOOHG WR DQQRXQFH WKH ÂżQDO VL[ GHPRQVWUDWLRQ VLWHV IRU the Â Blue Â Zones Â Project Â in Â Iowa,â€? Â says Â Ben Â R. Â Leedle, Â Jr., Â Healthways Â president Â and Â CEO. Â â€œThe Â commitment Â to Â improved Â well-Âbeing Â exhibited Â by Â all Â of Â the Â communities Â participating Â in Â the Â selection Â process Â has Â been Â inspiring, Â and Â we Â look Â forward Â to Â working Â with Â the Â demonstration Â sites Â to Â transform Â the Â lives Â of Â their Â residents Â through Â the Â application Â of Â Blue Â Zones Â principles.â€? The Â selected Â communities Â will Â receive Â assistance Â from Â experts Â to Â develop Â and Â implement Â a Â Blueprint Â for Â making Â permanent Â environmental, Â social Â and Â policy Â changes Â that Â transition Â people Â into Â healthier Â behaviors Â WKDWFDQOHDGWRORQJHUKDSSLHUOLYHV7KUHHRIWKHFRPPXQLWLHV&HGDU 5DSLGV 0XVFDWLQH DQG 6LRX[ &LW\ ZLOO EHJLQ WKLV ZRUN LPPHGLDWHO\ ZKLOH WKUHH ,RZD &LW\ 0DULRQ DQG 2VNDORRVD ZLOO EHJLQ WKHLU ZRUN LQ 2014. Â The Â progress Â of Â all Â the Â large Â demonstration Â site Â communities Â will Â be Â PHDVXUHGXVLQJWKH*DOOXS+HDOWKZD\V:HOO%HLQJ,QGH[ÂŠWKHÂżUVWHYHU daily Â assessment Â of Â U.S. Â residentsâ€™ Â health Â and Â well-Âbeing.
Harvard Pilgrim Health Care Selects Castlight Health to Help Find High-quality, Affordable Health Care &DVWOLJKW +HDOWK DQQRXQFHG WKDW IXOOVHUYLFH KHDOWK EHQHÂżWV company Â Harvard Â Pilgrim Â Health Â Care Â has Â selected Â Castlight Â as Â its Â health Â care Â transparency Â partner. Â Through Â the Â partnership, Â 600,000 Â Harvard Â Pilgrim Â plan Â participants Â will Â gain Â access Â to Â a Â customized Â version Â of Â Castlightâ€™s Â health Â care Â management Â suite, Â providing Â them Â critical Â insight Â into Â cost Â and Â quality Â information Â for Â health Â care Â providers Â and Â common Â procedures. Â Castlight Â is Â the Â leading Â provider Â of Â Health Â Care Â Transparency Â solutions Â for Â employers Â and Â payers. +DUYDUG 3LOJULP LV D QRWIRUSURÂżW KHDOWK SODQ WKDW SURYLGHV D YDULHW\ RI EHQHÂżW RSWLRQV DQG IXQGLQJ DUUDQJHPHQWV WR PRUH WKDQ RQH
million Â members Â in Â Massachusetts, Â Maine Â and Â New Â Hampshire. Â For Â the Â past Â nine Â years, Â Harvard Â Pilgrim Â has Â been Â named Â the Â top Â private Â health Â plan Â in Â the Â country Â by Â the Â National Â Committee Â for Â Quality Â Assurance Â 1&4$ Amid Â recently Â passed Â legislation Â in Â Massachusetts Â calling Â for Â increased Â health Â care Â transparency, Â Harvard Â Pilgrim Â is Â dedicated Â to Â staying Â ahead Â of Â the Â regulatory Â curve Â and Â maintaining Â its Â reputation Â as Â the Â countryâ€™s Â leading Â health Â plan. Â After Â an Â extensive Â evaluation Â process, Â Harvard Â Pilgrim Â selected Â Castlight Â for Â its Â innovative Â platform, Â robust Â data Â and Â intuitive Â user Â interface. Â Through Â the Â partnership, Â Harvard Â Pilgrim Â members Â will Â receive Â access Â to Â a Â specialized Â version Â of Â Castlightâ€™s Â health Â care Â management Â suite Â that Â features Â out-Âof-Âpocket Â pricing Â and Â quality Â measures Â for Â all Â in-Ânetwork Â health Â care Â providers.
Towers Watson Announces OneExchange, a Health Benefit Solution for Full- and Part-time Employees Towers Â Watson, Â a Â global Â professional Â services Â company, Â announced Â the Â launch Â of Â OneExchange. Â Building Â on Â Towers Â Watsonâ€™s Â 2012 Â acquisition Â of Â Extend Â Health, Â OneExchange Â offers Â employers Â both Â private Â and Â public Â exchange-Âbased Â health Â insurance Â options Â for Â their Â full-Â Â and Â part-Âtime Â workers, Â and Â for Â all Â retirees. OneExchange Â makes Â it Â easy Â for Â employers Â to Â manage Â the Â coverage, Â quality Â and Â cost Â of Â private Â and Â public Â health Â plan Â choices Â for Â all Â segments Â of Â their Â workforce Â and Â retiree Â populations Â through Â a Â single Â exchange Â platform. â€œStarting Â in Â 2014, Â the Â Affordable Â Care Â Act Â establishes Â guaranteed Â issue Â and Â standard Â plan Â designs Â for Â all Â individuals, Â and Â federal Â subsidies Â for Â those Â who Â meet Â certain Â eligibility Â requirements,â€? Â says Â Bryce Â Williams, Â managing Â director Â for Â Exchange Â Solutions Â at Â Towers Â Watson. Â â€œIt Â also Â creates Â public Â exchanges, Â or Â marketplaces, Â as Â a Â mechanism Â for Â individuals Â to Â obtain Â health Â plans.â€? Â
www.TheIHCC.com I HealthCare Consumerism Solutionsâ„˘ I January/February 2013
WHO’S WHO PROFILES
6ROXWLRQVWRKHOS\RXULQQRYDWLYHKHDOWKDQGEHQH¿WSURJUDPV HSA/HRA/FSA TECHNOLOGY: ADMINISTRATION & MANAGEMENT
TSYS Healthcare® provides end-toTSYS HEALTHCARE end strategic payment solutions for 706.649.5080 consumer directed healthcare. We www.tsyshealthcare.com partner with benefits administrators, firstname.lastname@example.org financial institutions, health plans, and software providers to navigate all aspects of HSAs, HRAs, FSAs, transportation accounts, cash reimbursements, and lines of credit. TSYS Healthcare cards offer participants the security they expect along with the ability to conveniently access funds from multiple accounts and manage their benefits payments with simplified single-card access. Clients and partners benefit from simplified processes, reduced paperwork and cost savings that can contribute to improved return on investment.
“We built the TSYS Healthcare platform to meet the market demand for reliable, configurable and intelligent solutions. Understanding the dynamic U.S. healthcare market, our customers rely on our option-driven system to prepare them for the future.” — Trey Jinks, Group Executive, TSYS Healthcare HSA / HRA / FSA ADMINISTRATION AND FINANCE
WageWorks helps employers
support consumer directed
1100 Park Place, 4th Floor San Mateo, California 94403 United States of America
pre-tax benefit programs, including health care (FSA, HSA, HRA), wellness programs, commuting and
child and elder care. Wage Works also offers retiree health care and COBRA Services. More than 100 of America’s Fortune 500 employers and millions of their employees use WageWorks.
HSA ADMINISTRATION & FINANCE
At HSA Bank, we’ve been helping businesses HSA BANK optimize their health care spending for over 605 N. 8th Street Suite 320 15 years. We offer unmatched service and Sheboygan, Wisconsin 53081 expertise when it comes to health-based United States of America savings accounts. You can count on our 800.357.6246 dedicated business relations team for turnkey www.hsabank.com solutions and ongoing support that help your business and workforce save for a healthy future. To connect with your regional representative, call 866.357.5232 or visit hsabank.com.
“When implementing one of the first Medical Savings Account programs in the country, I had a belief that health care could be fixed with free-market principles. I still do. By adopting flexible and transparent practices that manifest core attributes of consumerism such as private exchanges, defined contributions, and self-funding; we will reform health care in our nation.” — Kirk Hoewisch, Co-Founder and President, HSA Bank, a division of Webster Bank, N.A. HSA / HRA / FSA ADMINISTRATION AND FINANCE
Evolution1 and our Partners serve more than 8 million consumers, making us the nation’s largest electronic payment, on-premise and cloud computing healthcare solution that administers reimbursement accounts, including HSAs, HRAs, FSAs, VEBAs, PRAs, Wellness, Transit and Defined Contribution Health Plans.
EVOLUTION1, INC. 952.908.9056 www.evolution1.com email@example.com
It is the only solution that offers a single end-to-end user experience, provides innovative auto-substantiation technologies, and automates workflow for Partners, employers, and consumers.
“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
January/February 2013 I HealthCare Consumerism Solutions™ I www.TheIHCC.com
WHO’S WHO PROFILES
$FFHVVWKHVHSUR¿OHVRQOLQHDWZZZ7KH,+&&FRP HEALTHCARE ACCESS
HealthPerx is a health and wellness marketing company specializing in creative non-insurance benefit solutions that reduce absenteeism, increase productivity and decrease healthcare costs. Consultants: These benefits differentiate you from competitors.
HSA/HRA/FSA TECHNOLOGY: ADMINISTRATION & MANAGEMENT
HEALTHPERX Jeff Marks, CEO Jmarks@hperx.com Direct: 205 222-4062 Toll Free: 888 417-6187 www.hperx.com
Corporations: These will give you a far greater ROI than your wellness program while saving your employees thousands of dollars a year. Differentiator: Q Telemedicine Services: offering the entire family unlimited calls with no consult fees 24/7/365—anytime from anywhere Q Additional Health Benefits: offering significant savings for pharmacy, dental, vision, medical advocacy, travel assistance, telephonic counseling (EAP) and more Q Turnkey Program: billing, administration, fulfillment, call center, marketing HealthPerx benefits complement any and all existing benefit plans. — Jeff Marks, CEO
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: Q Proven methods that lead to increased Q Customizable programs that easily engagement and sustained behavior incorporate into existing benefits and change. services. Q Clinicians and coaches who provide Q Scientifically proven best-practice personalized attention and form trusted guidelines to proactively manage care. relationships with members. Q 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,
DataPath, Inc., is one of nation’s largest providers of CDH solutions specializing in account-based administration systems.
1601 WestPark Drive, Suite 9 Little Rock, AR 72204 501.296.9990 www.dpath.com
Since 1984, service providers using DataPath systems have provided administrative solutions for over 1 million participants of FSA, HRA, HSA, and COBRA. DataPath is the only solutions provider to design and deliver a full Suite of systems for handling 125, 105, 132, COBRA, HSAs, Credit and Debit Cards all delivered to account holders through a single Internet portal, myRSC.com.
“With the significant changes in healthcare today, our software solutions allow users to create custom plans for clients that benefit both the employer and employee. Not only have we created a single platform for all systems with myRSC.com, with the integration of our mySourceCard Debit Card at Wal-Mart and other retailers, our clients are able to offer a hassle-free solution with 100% compliance.” ®
HSA/HRA/FSA TECHNOLOGY: ADMINISTRATION & MANAGEMENT
At Flex, we believe in making health FLEXIBLE BENEFIT SERVICE benefits more affordable for everyone. CORPORATION (FLEX) For 25 years, we have enabled thousands of clients to make their health care 10275 W. Higgins Road, Suite 500 dollars go further with our consumer Rosemont, IL 60018 driven plans and benefits administration +1-888-353-9178 services, including: firstname.lastname@example.org Q Flexible Spending Accounts (FSAs) www.flexiblebenefit.com Q Health Reimbursement Arrangements (HRAs) Q Health Savings Accounts (HSAs) Q Transit/Parking Reimbursement Accounts (TRAs) Q COBRA Administration Q And more! Flex continues to evolve and enhance our product portfolio with the addition of our scalable private insurance exchange, InsureXSolutions™. This latest innovation promotes a defined contribution funding model that allows employers to provide health and retiree benefits at a fixed cost, while offering employees with access to coverage options through our online insurance marketplace All Flex clients receive our personalized customer service and a wealth of resources that make our plans easy to use. Each plan we administer comes with online account access, simple transaction tools like debit cards, custom educational resources and unrivaled plan design expertise to keep you in compliance every step of the way. www.TheIHCC.com I HealthCare Consumerism Solutions™ I January/February 2013
WHO’S WHO PROFILES
6ROXWLRQVWRKHOS\RXULQQRYDWLYHKHDOWKDQGEHQH¿WSURJUDPV FSA/HRA/HSA/TRANSIT/COBRA: ADMINISTRATION & MANAGEMENT
HEALTH DECISION SUPPORT TOOLS
eflexgroup (eflex) is a nationwide eflexgroup administrator of pre-tax benefits 2740 Ski Lane and COBRA. Committed to providing Madison, WI 53713 fast answers, fast claims, and web 877.933.3539 ext 300 self-service, we set the industry www.eflexgroup.com standards for service. With a email@example.com customer focus and Lean Six Sigma methodology, we don’t talk about service, we prove it. See our metrics at eflexgroup.com.
Castlight Health enables employers, their CASTLIGHT HEALTH 85 Market Street, Suite 300 employees, and health plans to take San Francisco, CA 94105 control of health care costs and improve care. Named #1 on The Wall Street 415.829.1400 Journal’s list of “The Top 50 Venturewww.castlighthealth.com Backed Companies” for 2011 and one of Dow Jones’ 50 Most Investment-Worthy Technology Start-Ups, Castlight Health helps the country’s self-insured employers and health plans empower consumers to shop for health care. Castlight Health is headquartered in San Francisco and backed by prominent investors including Allen & Company, Cleveland Clinic, Maverick Capital, Morgan Stanley Investment Management, Oak Investment Partners, Redmile Group, T. Rowe Price, U.S. Venture Partners, Venrock, Wellcome Trust and two unnamed mutual funds.
“eflexgroup’s customer service department should be a model for ALL customer service departments. The courtesy, professionalism and knowledge surpass ANY customer service department I’ve encountered! I feel the outstanding, exemplary customer service of eflexgroup is simply the best!” — Kimberly Adams, Southeast Energy Assistance [testimonial] 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 firstname.lastname@example.org www.ahip.org/courses
January/February 2013 I HealthCare Consumerism Solutions™ I www.TheIHCC.com
Giovanni Colella, M.D. CEO and Co-Founder, Castlight Health HEALTHCARE DATA ANALYTICS
Med-Vision delivers health-plan risk MED-VISION LLC management and wellness strategies to Connie Gee, Vice President help employer groups achieve optimal email@example.com employee health. Med-Vision’s healthcare data analysis tool, Med-View, guides 813-205-1577 www.med-vision.com employers in mitigating health risks. With www.med-view.net Med-Vision’s help, self-funded employers, healthcare facilities, municipalities, and school districts have reversed trends and decreased healthcare costs while enhancing care.
“You can’t change what you can’t measure. That’s why Med-Vision leverages Med-View’s analytics tool to investigate employee-health data and determine actionable solutions for employers. Med-Vision uses the data to implement innovative and customized plans for strategic wellness and disease management. Results include healthier employees, greater productivity, and drastically lower healthcare costs.” — Connie Gee, Vice President, Wellness Strategist & Health Data Analyst
WHO’S WHO PROFILES
$FFHVVWKHVHSUR¿OHVRQOLQHDWZZZ7KH,+&&FRP HEALTH INCENTIVES
MedEncentive offers a patented, web-based incentive system that’s been independently validated
Cecily Hall Executive Vice President medencentive.com firstname.lastname@example.org
to control healthcare costs. Doctors and patients earn financial rewards for declaring adherence to best practices and healthy behaviors, provided they agree to be accountable to the other party for doing so. Easy to implement and
ExperienceLab has created a breakthrough, CDHCENTRIC patented communication program that saves 507 S. 8th Ave. Bozeman, employers money by increasing adoption and Montana 59715 usage of consumer directed health (CDH) 617.224.6223 insurance plans among their employees. www.experiencelab.com CDHCentric, sold on a subscription basis, email@example.com delivers regular, multi-media communications that are tailored based on seven unique attitudinal segments developed from proprietary research.
Traditional health plans protect employees from having to learn the basic skills for making cost-effective healthcare decisions. Our segmentation research, which is based on 20 years of behavioral marketing, found 7 unique personality types, and each makes healthcare decisions differently. The result is that, when employee messages are correctly tailored to their personalities, employees become health care consumers! — Roger Travis, President
embraced by users. SUPPLEMENTAL HEALTH
Transitions Optical, Inc. is the maker of Transitions® lenses, the #1-eyecare professional recommended photochromic lenses worldwide.
EMPLOYEE COMMUNICATION AND EDUCATION
TRANSITIONS OPTICAL 9251 Belcher Road Pinellas Park, FL 33782
800.533.2081 ext. 2262 www.healthysightworkingforyou.org
Transitions Healthy Sight Working for You® is an education initiative that helps HR professionals and benefits professionals communicate the value of the vision benefit to employees. More information and complimentary education tools are available at HealthySightWorkingForYou.org.
“Don’t overlook your employees’ healthy sight when thinking about your business goals. A vision benefit that includes an eye exam and sight-optimizing eyewear helps ensure that employees see their best, so they can do their best work, directly affecting your business.”
HEALTH ACCESS ALTERNATIVES
WeCare TLC is a medical risk management company that leverages onsite primary care clinics to provide solutions to rising healthcare costs while improving patient health and wellness.
WE CARE TLC
120 Crown Oak Centre Dr Longwood, FL 32750 800.941.0644 www.wecaretlc.com firstname.lastname@example.org
Our holistic approach to care empowers the clinic staff to act as patient advocates, which increases compliance and decreases unnecessary expensive services.
“Healthcare is now a right and employers are faced with the challenge of truly managing their healthcare costs. We have created a unique medical home clinic model that properly addresses quality of care and cost. This requires constant, aggressive, creative, and directed attention to accomplish but it can be done.” — Lynn Jennings, CEO, WeCare TLC
www.TheIHCC.com I HealthCare Consumerism Solutions™ I January/February 2013
WHO’S WHO PROFILES
6ROXWLRQVWRKHOS\RXULQQRYDWLYHKHDOWKDQGEHQH¿WSURJUDPV HSA/HRA/FSA TECHNOLOGY: ADMINISTRATION & MANAGEMENT
MasterCard (NYSE: MA), is a global payments and technology company.
MASTERCARD WORLDWIDE 2000 Purchase St. Purchase, NY 10577-2509
It operates the world’s fastest payments processing network, connecting consumers, financial institutions, merchants, governments and businesses in more than 210 countries and territories. MasterCard’s products and solutions make everyday commerce activities—such as shopping, traveling, running a business and managing finances—easier, more secure and more efficient for everyone.
HEALTH ACCESS ALTERNATIVES
Carena provides 24/7, on-demand access to CARENA, INC. health care by phone, webcam, and house 1525 4th Avenue, Suite 300 call. Seattle-based Carena is committed to Seattle, WA 98101 delivering the best health care experience 800.572.2103 possible. Its technology-enabled care delivery www.CarenaMD.com model provides on-demand access to health James.Taylor@CarenaMD.com care 24/7, via phone, secure video, and house call. Carena provides health care solutions to patients through employers, health systems and through its consumer service, CareSimple.
“People are paying more out of pocket for care than ever—through higher co-pays and deductibles, reduced benefits, and in the rising costs of goods and services. Taken together, health care has become more expensive and less accessible. Our goal is to make health care more affordable by providing the right care at the right time for the right cost; to help people live healthier lives by removing the barriers to people taking control of their health care.” — Ralph C. Derrickson, President & CEO, Carena
TOTAL POPULATION HEALTH MANAGEMENT
Orriant helps businesses produce a better, more profitable product by creating a workforce that is healthier, more productive, and less expensive to insure.
9980 South 300 West Ste. 100 Sandy, Utah 84070 801.574.2603 www.orriant.com email@example.com
Orriant’s proven strategy is to hold people accountable for improving their health as an integral part of your benefit strategy in a way that is fair and compassionate to all.
“Employers can fight back to control rising health care costs. Orriant’s strategies have helped major employers from almost every industry cut the cost of health care, improve the health and productivity of their workforce, and push hundreds of thousands of dollars to their bottom lines.” — Darrell Moon, Orriant CEO
HSA/HRA/FSA TECHNOLOGY: ADMINISTRATION & MANAGEMENT/PRIVATE EXCHANGE
Workable Solutions is based in WORKABLE SOLUTIONS, LLC Orlando, FL and provides a full array of 7120 Lake Ellenor Dr. employee benefit solutions including Orlando, FL 32809 HSA, HRA, FSA and commuter accounts, COBRA administration, and benefits 800.946.6342 administration outsourcing. They offer Fax: 407.540.1749 a comprehensive benefit exchange www.workablesolutions.com application, Workable Choice, which provides plan selection assistance, comparison-shopping technology, eligibility management, enrollment, consolidated billing, and more. Workable also offers a myriad of defined contribution options, which allow employers to control their employee health care costs while giving their employees greater choice and flexibility.
“As a small business, we understand first-hand what challenges a small business faces. At Workable Solutions, we can help you control the cost of employee benefits. Workable Choice is a private exchange solution that makes offering defined contribution and a multitude of consumer-driven products easy and affordable.” — Terry McCorvie, President/CEO, Workabe Solutions, Inc.
January/February 2013 I HealthCare Consumerism Solutions™ I www.TheIHCC.com
WHO’S WHO PROFILES
$FFHVVWKHVHSUR¿OHVRQOLQHDWZZZ7KH,+&&FRP HEALTH DECISION SUPPORT TOOLS
FSAstore.com is the only one-stop-shop FSASTORE.COM exclusively stocked with FSA eligible 244 5th Avenue, Suite J-257 products and services. At FSAstore.com, New York, NY 10001 consumers have access to more than 4,000 888.FSA.1450 (372-1450) FSA eligible products, a national database of FSA eligible services, and much-needed information through the FSA Learning Center. FSAstore accepts all FSA and major credit cards, offers 24/7 customer service, one-to-two-day turnaround for all orders, and free shipping on orders over $50.
“Each year consumers lose hundreds of millions of dollars simply because they do not deplete all of the pre-tax funds available to them in their FSA. But this year, more consumers than ever are realizing that they can use that money to buy many of the daily health products they need, and without a prescription. FSAstore.com strives to make it easy for participants to use and understand their FSAs.” — Jeremy Miller, Founder and President, FSAstore.com
BENEFIT ADMINISTRATION/PRIVATE EXCHANGES
Since 1988, CieloStar (formerly OutsourceOne) CIELOSTAR has helped brokers, employers and employees 530 U.S. Trust Building navigate the ever-changing world of benefits. 730 Second Avenue South Now, with the dawn of “Defined Contribution Minneapolis, MN 55402 Health Care” we are again on the leading edge. With a team of industry thought leaders, CieloStar 612.436.2706 makes navigating healthand benefits choices firstname.lastname@example.org easy for employers and employees by offering comprehensive benefits administration solutions with a high-touch, high technology model—most recently launching a proprietary private health insurance exchange.
“Fueled by the far-reaching impact and complexities of health care reform taking effect in 2013 and 2014, employers and employees increasingly find themselves in a ‘farmer’s market’ of benefits choices. Cielostar is uniquely positioned with enabling technology that helps purchasers and consumers make the best possible decisions and create a best-in-class benefits administration process. Our unique comprehensive approach to benefits offers everything from back room technology for enrollment, data, billing and call centers to complete solutions for COBRA, CDHP and health insurance exchanges.” — John Reynolds, CEO, Cielostar
TOTAL POPULATION HEALTH MANAGEMENT
Dr. tools Steven Level1Diagnostics uses new to M. Helschien LEVEL1DIAGNOSTICS Founderhealth and CC&BW evaluate employees’ cardiovascular 11722 Lightfall Court Heart disease is the number one killer Columbia, MD 21044 www.level1diagnostics.com in the U.S. and costs millions of dollars 410-707-5667 ◆ email@example.com Dr. Steven Helschien, Founder in medical care and time lost from Sales: Penny Aleo, Executive VP work. Detection and prevention is the 443.878.3087 key to heart health. Level1Diagnostics firstname.lastname@example.org is an innovative program that, unlike conventional cardiology tests, provides new advanced technology testing and methods to detect and prevent the earliest signs of cardiovascular disease and encourage optimal health. “The biggest problem with traditional cardiology is that it is not preventive—there isn’t a testing program to evaluate people who don’t have any symptoms of heart disease, but may be at significant risk. Drugs and surgery are offered to patients instead of lifestyle change programs and supplements.”
HEALTH DECISION SUPPORT TOOLS
Truven Health Analytics, formerly Healthcare at Thomson Reuters, delivers unbiased information, analytic tools, benchmarks, and services to the health care industry.
TRUVEN HEALTH ANALYTICS 6200 S Syracuse Way, Suite 300 Greenwood Village, CO 80111 734.913.3000
Hospitals, government agencies, employers, health plans, clinicians, and life sciences companies have relied on us for more than 30 years. We combine deep clinical, financial, and health care management expertise with innovative technology platforms and information assets to make health care better by collaborating with our customers to uncover and realize opportunities for improving quality, efficiency, and outcomes.
—Dr. Steven Helschien, Founder, Level1Diagnostics
www.TheIHCC.com I HealthCare Consumerism Solutions™ I January/February 2013
WHO’S WHO PROFILES
6ROXWLRQVWRKHOS\RXULQQRYDWLYHKHDOWKDQGEHQH¿WSURJUDPV HEALTH DECISION SUPPORT AND COST-SAVING TOOLS
EMPLOYEE ENGAGEMENT TOOLS
Under the CIVA (CodeBaby Intelligent Virtual CODEBABY CIVA Assistant) brands of benefits and health 111 S. Tejon St. Suite 107 advisor, CodeBaby improves the healthcare Colorado Springs, CO 80903 consumer experience and optimizes online 877.334.3465 self-service on any web-based platform codebaby.com/online-solutions or device with absolutely no IT disruption. email@example.com Benefits advisor offers guidance and selfservice options that help consumers and organizations alike to make better decisions about benefits selection. Health advisor engages new patient visitors on hospital or office websites or existing patients on wellness, prevention & disease management platforms.
“With the rapid changes in health care, our solutions provide organizations innovative ways to optimize their current platform while meeting the demand for an enhanced online experience. CIVA benefits and health advisor solutions are industryleading models that help consumers and organizations more efficiently navigate complex health benefit exchanges and patient portals. “
WiserTogether Inc., helps patients choose the right care at the time. It
selection & shared decision support
platform that helps patients make evidence-based, cost effective
treatment decisions across musculoskeletal, cardiovascular, mental health, diabetes, pregnancy and respiratory illnesses saving payers money. Currently 1.5 million members have access to the platform through employers and health plans in the country. WiserTogether was founded in 2008 and is based in Washington, DC.
R E S O U R C E
— Praveen Mooganur, COO
G U I D E
ADVERTISING INDEX AHIP ........................................................ 46
IHC Membership .........................................10
Best Buy Reward Zone ........Inside Back Cover
Castlight Health .........................................46
CDHCentric ............................................... 47
CodeBaby ................................................. 50
Transitions ......................................... 38, 47
DataPath .................................................. 45
Truven Health Analytics....................... 12, 49
eflexgroup ................................................ 46
TSYS Healthcare ................................... 9, 44
UnitedHealthCare ......................... Back Cover
Flexible Benefit Service Corporation ...........45
FSA Store ...................................................49
WeCare TLC ............................................. 47
Wiser Together ................................... 20, 50
HealthStat ........................ Inside Front Cover
Workable Solutions ....................................48
HSA Bank ........................................... 22, 44
ADVERTISING CONTACTS 404.671.9551 CEO/PUBLISHER
Doug Field G¿HOG@¿HOGPHGLDFRPāH[W MANAGING DIRECTOR
offers an innovative online treatment
-Dennis McGuire, CEO
If you use the services of our solutions providers, please tell them you saw their ad in +HDOWK&DUH&RQVXPHULVP6ROXWLRQV™.
January/February 2013 I HealthCare Consumerism Solutions™ I www.TheIHCC.com
THEY JUST MIGHT WHISTLE WHILE THEY WORK Positivity is contagious. So create some good vibes with Reward Zone® Incentive Points, which allows you to easily motivate, thank and reward your employees. There’s an online tool that allows you to manage and track your account as you award Best Buy® Reward Zone points in amounts of your choosing. It’s easy for you to use and easy for them to love. Learn more at RewardZoneIncentivePoints.com/CDHC.
© 2012 BBY Solutions, Inc.
Engaging consumers to make informed health care decisions UnitedHealthcareâ€™s 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, and greater transparency to help drive better decisions. Thatâ€™s why our plans offer: t NZ)FBMUIDBSF$PTU&TUJNBUPS BUPPMUIBUHJWFTNFNCFSTVMUSBTQFDJmDFTUJNBUFTCBTFEPOMPDBUJPO QSPDFEVSF and even doctor; as well as expenses related to possible care paths
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5PPMTMJLFUIFTFIFMQFNQMPZFFTCFDPNFBDUJWFJOUIFJSPXOIFBMUIDBSFEFDJTJPOT8FBMTPPÄŠFSUIFFNQMPZFSSFBEZUPVTF tools to implement and successfully maintain its consumer-driven health plans.
'PSNPSFJOGPSNBUJPOPO6OJUFE)FBMUIDBSFT$%)QMBOT WJTJUuhctogether.com/CDH or call 1.866.438.5651.
READY. SET. GROW HEALTHY. UHCTOGETHER.COM/CDH
myHealthcare Cost Estimator is currently available to many UnitedHealthcare members, and will launch in additional markets throughout the remainder of the year. ÂŠ2012 United HealthCare Services, Inc. Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by United HealthCare Services, Inc. or their affiliates. Health plan coverage provided by or through a UnitedHealthcare company. UHCEW506202-002