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FORUM East · May 9-10, Atlanta Formerly  CDHC  Solutions

ISSUE  ||  January/February  2013

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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

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www.theihcc.com

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Healthcare is

Predictable

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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.


INSIDE

FEATURES

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

David Urbaniak

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

3


INSIDE

DEPARTMENTS

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

Greg Scandlen

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

Events

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


WHAT’S HAPPENING AT THE THE CEO’S DESK members  speak  out The industry is currently at a tipping point where we’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 you’re reading this magazine and have not yet signed up for your membership to The Institute for HealthCare Consumerism online, you’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, you’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  this  week,  Boston  the  next,  a  layover  in  Atlanta   and  then  it’s  off  to  Dallas  and  a  West  Coast  swing  for  meetings   in  Phoenix,  Los  Angeles  and  Seattle.

airports  and  company  board  rooms  than   probably  any  other  person  in  the  health   care  industry.

That  is  not  the  itinerary  for  the  last  leg  of  the  latest  U2  tour.  It   is  just  another  business  week  in  the  life  of  John  Young,  who  has   been  honored  by  The  Institute  for  HealthCare  Consumerism   with  the  2012  John  J.  Robbins  Senior  Memorial  HealthCare   Consumerism  Leadership  Award.

<RXQJ¶VWUDYHOVKDVPDGHKLPD¿[WXUH as  a  speaker  and  moderator  at  The   Institute  for  HealthCare  Consumerismâ&#x20AC;&#x2122;s   FORUM  conference  series.  Young   blends  educational  and  insightful  tools   into  an  informative  and  entertaining   presentation.  He  has  been  an  attendee   favorite  when  he  takes  the  stage.

For  more  than  a  decade,  Young  has  been  a  tour  de  force  in  the   health  care  consumerism  movement.  It  is  not  only  a  job  but  a   passion  and  way  of  life  for  Young,  who  has  been  involved  with   this  megatrend  since  2000. During  his  professional  career,  Young  has  logged  several   miles  on  the  odometer  of  countless  rental  cars,  accumulated   WKRXVDQGVRIIUHTXHQWÃ&#x20AC;\HUSRLQWVDQGVSHQWPRUHWLPHLQ 6 January/February 2013 I HealthCare Consumerism Solutionsâ&#x201E;¢ I www.TheIHCC.com

John Young, 2012 John J. Robbins Senior Memorial HealthCare Consumerism Leadership Award winner

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INSTITUTE?

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online  exclusives

DISCUSSIONS

Costco Offers Pharmacy Benefit Management Services Costco  Wholesale,  the  business  known  for  

Three Tips to Integrate Physical and Financial Wellness -HQQLIHU%HQ]

its  low  prices  and  oversized  products,  has  entered  in   WKHSKDUPDF\EHQH¿WPDQDJHPHQW 3%0 PDUNHW ZLWK&RVWFR+HDOWK6ROXWLRQV &+6 &RVWFRLV looking  to  drive  demand  and  increase  revenues  from   their  pharmacies  and  prescription  drug  sales.  Costco  is  leveraging  their  brand  name,   going  after  the  6.4  million  business  members  that  are  already  with  Costco  Wholesale   and  bringing  them  over  to  CHS.  This  strategy  of  focusing  on  existing  business   members,  and  businesses  located  near  Wholesale  stores,  means  Costco  is  focusing  on   the  mid-­market,  businesses  with  under  20,000  employees  being  covered.  Costco  is  able   to  separate  itself  from  the  competition  by  following  the  same  business  model  that  has   made  Costco  Wholesale  a  success;͞  selling  their  products  a  modest  margin  above  cost.   CHS  offers  prescriptions  through  Costco  in-­warehouse  pharmacies  and  an  extensive   network  of  64,000  independent  pharmacies  working  with  Costco  to  offer  low  cost   prescriptions.  Participants  of  the  plan  also  receive  other  exclusive  services  from  in-­ warehouse  pharmacies  including  clinical  services,  walk-­up  immunization  services  and   free  health  screenings.

Your  wellness  campaign  may  be  missing  a  huge   RSSRUWXQLW\$QGLWÂśVDOOEHFDXVHRIKRZ\RXGHÂżQHWKH ZRUGÂłZHOOQHVV´2UUDWKHUKRZ\RXGRQÂśWGHÂżQHLW Employers  use  it  in  their  communication  as  their  go-­to   term  for  physical  health.  Thereâ&#x20AC;&#x2122;s  nothing  wrong  with   that.  But  for  your  employees  and  their  families,  a  healthy   life  is  about  much  more  than  a  healthy  Body  Mass  Index   %0, *RRGKHDOWKPHDQVQRWVWUHVVLQJDERXWELOOV or  retirement  and  having  enough  money  to  enjoy  the   weekends  with  the  kids.  Your  campaign  should  address   WKHZKROHSHUVRQ,WVKRXOGSURPRWHÂżQDQFLDOOLWHUDF\ as  equal  to  physical  health.  That  means  encouraging   HPSOR\HHVWRFRQWULEXWHWRWKHLU N RSHQLQJDWD[ DGYDQWDJHGKHDOWKVDYLQJVDFFRXQW +6$ WRSD\IRU HOLJLEOHPHGLFDOH[SHQVHV LIWKH\KDYHDKLJKGHGXFWLEOH SODQ DQGSDUWLFLSDWLQJLQWKHÂżQDQFLDOSURJUDPVWKDW\RX offer.

Whole Foods CEO Mackey Continues Leadership in Free Market Health Reform John  Mackey,  Whole  Foods  CEO  and  Co-­founder,  has   received  a  lot  of  publicity  lately  for  his  brazen  comments   about  PPACA  and  the  state  of  the  nationâ&#x20AC;&#x2122;s  health  care   system.  But,  while  some  have  criticized  him  for  poor   word  choice,  Mackey  has  been  a  consistent  innovator   and  leader  in  the  free  marketâ&#x20AC;&#x2122;s  approach  to  health   reform.  While  health  care  costs  have  sky-­rocketed  in   UHFHQW\HDUVDQGFRPSDQLHVKDYHVWUXJJOHGWRÂżQGZD\V to  keep  costs  down,  Mackey  has  personally  taken  the   role  of  curbing  health  costs  and  improving  employeesâ&#x20AC;&#x2122;  health  to  heart.  And  he  has   done  it  not  by  mandates,  but  through  incentivizing  wellness,  engaging  employees  and   offering  innovative  health  plans.  In  December  of  2011,  The  Institute  for  HealthCare   Consumerismâ&#x20AC;&#x2122;s  Editorial  Advisory  Board  selected  John  Mackey  for  the  cover  of  the   annual  HealthCare  Consumerism  Superstars  issue.  In  the  cover  story,  the  Institute   published  a  piece  written  by  Mackey  simply  entitled  â&#x20AC;&#x153;Health  Care  Reform,â&#x20AC;?  wherein  he   OD\VRXWKLVWKRXJKWVRQÂż[LQJWKH86KHDOWKFDUHV\VWHP

Why I Am More Egalitarian Than Most Liberals on Health Care -RKQ*RRGPDQ

Most  people  would  place  me  on  the  political  right.  Yet   when  it  comes  to  health  care,  I  am  more  egalitarian  than   almost  everybody  on  the  left.  I  always  have  been.  By  that   I  mean  I  am  more  egalitarian  than  the  defenders  of  the   %ULWLVK1DWLRQDO+HDOWK6HUYLFH 1+6 DQGWKHGHIHQGHUV of  Canadaâ&#x20AC;&#x2122;s  system  of  socialized  medicine.  Iâ&#x20AC;&#x2122;m  also  more   egalitarian  than  Paul  Krugman  and  the  leaders  of  the   Physicians  for  a  National  Health  Program.  Not  only  that,   but  a  great  many  Republicans  agree  with  my  approach  to   health  care  â&#x20AC;&#x201D;  even  as  they  oppose  ObamaCare.  

events

Transparency + Accountability

5D\)DELXV0'7UXYHQ+HDOWK$QDO\WLFV I  celebrate  the  efforts  of  the  state  of  Massachusetts  to   advance  price  transparency  within  health  care.  With  the   ZLGHYDULHW\RIKHDOWKSODQDOWHUQDWLYHVDQGEHQH¿WGHVLJQV it  has  never  been  easy  for  consumers  to  estimate  what  their  out  of  pocket  costs  will   be  before  accessing  elective  care.  In  many,  maybe  most  cases,  the  information  is  not   available.  Truven  Health  data  analysis  has  shown  wide  and  unexplained  variation  in  the   cost  of  the  same  service  within  metropolitan  service  areas  -­  sometimes  this  variation   can  be  three  fold  or  more,  and  patients  are  generally  unaware  of  this.  Providing   online  tools  to  disclose  a  price  is  a  good  start.  Enhancing  these  tools  to  allow  for  price   comparisons  is  the  next  step.  Studies  show  that  tools  like  our  Treatment  Cost  Calculator   KDYHWKHSRWHQWLDOWRVLJQL¿FDQWO\UHGXFHWRWDOKHDOWKFDUHFRVWVIRUHPSOR\HUVE\ providing  their  workers  the  ability  to  compare  prices.

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2013 Register Now and Save

Donâ&#x20AC;&#x2122;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

The offical publication of the Institute for HealthCare Consumerism

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LETTER

EDITOR & PUBLISHER www.theihcc.com VOLUME  9  NO.  1  |  JANUARY/FEBRUARY  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&#x20AC;&#x201D;and the multi-stakeholders working with themâ&#x20AC;&#x201D;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&#x20AC;&#x153;HealthCare Exchange Solutions,â&#x20AC;? 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&#x20AC;&#x153;HealthCare Exchange Solutions.â&#x20AC;? 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&#x20AC;&#x2122;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&#x20AC;&#x2122; convenience.

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Kellie  Frissell H[WÄ NIULVVHOO#ÂżHOGPHGLDFRP CHAIRMAN  OF  IHC  ADVISORY  BOARD

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

Kim  Adler,  Allstate;Íž  Diana  Andersen,  Zions  Bancorporation;Íž   Bill  Bennett;Íž  Doug  Bulleit,  DCS  Health;Íž  Jon  Comola,  Wye  River   *URXS-RKQ+LFNPDQ$OVWRQ%LUG//37RQ\+ROPHV0HUFHU +HDOWK %HQHÂżWV0DUF.XWWHU$Ă&#x20AC;DF6DQGHUV0F&RQQHOO0\ HSA  Rewards;Íž  Roy  Ramthun,  HSA  Consulting  Services  LLC;Íž   -RKQ<RXQJ&,*1$ WEBMASTER  

Kevin  Carnegie NFDUQHJLH#¿HOGPHGLDFRP Tom  Becher ZHEPDVWHU#¿HOGPHGLDFRP REPRINTS

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Register for Forum and Save After visiting The IHC website, browse the Exchange Solutions community and read the â&#x20AC;&#x153;HealthCare Consumerism Exchange Solutions,â&#x20AC;? 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  Raudabaugh H[WÄ NUDXGDEDXJK#ÂżHOGPHGLDFRP +HDOWK&DUH&RQVXPHULVP6ROXWLRQVâ&#x201E;˘  Volume  9  Issue  1 Copyright  Š 2013  by  FieldMedia  LLC.  All  rights  reserved. +HDOWK&DUH &RQVXPHULVP 6ROXWLRQVâ&#x201E;˘   is   a   trademark   of   FieldMedia   LLC.   +HDOWK&DUH &RQVXPHULVP 6ROXWLRQVâ&#x201E;˘   is   published   eight   times   yearly   by   FieldMedia   LLC  6RXWK 0DLQ 6WUHHW 6XLWH  $OSKDUHWWD *$  3HULRGLFDOSRVWDJHSDLGDW$OSKDUHWWD*$DQGDGGLWLRQDOPDLOLQJRIÂżFHV TO   SUBSCRIBE:   Make   checks   and   money   orders   payable   to   +HDOWK&DUH Consumerism  Solutions â&#x201E;˘  magazine  292  S.  Main  Street,  Suite  400,  Alpharetta,   *$  RU YLVLW ZZZWKHLKFFFRP 1RQTXDOLÂżHG SHUVRQV PD\ VXEVFULEH at   the   following   rates:   single   copy   $7.50;Íž   $75.00/yr   in   the   U.S.,   $105/yr   in   Canada  and  $170/yr  international.  Please  contact  FieldMedia  at  404.671.9551   RUVXEVFULEHUVHUYLFH#ÂżHOGPHGLDFRPIRUQDPHDGGUHVVFKDQJHV PRINTED  IN  THE  U.S.A.

Todd Callahan Editorial Director tcallahan@fieldmedia.com 8 January/February 2013 I HealthCare Consumerism Solutionsâ&#x201E;˘ I www.TheIHCC.com

Doug Field CEO/Publisher dfield@fieldmedia.com

+HDOWK&DUH&RQVXPHULVP6ROXWLRQVâ&#x201E;˘  is  designed  to  provide  both  accurate  and   authoritative  information  with  regard  to  the  understanding  that  the  publisher   LV QRW HQJDJHG LQ UHQGHULQJ OHJDO ÂżQDQFLDO RU RWKHU SURIHVVLRQDO VHUYLFH ,I legal  advice  is  required,  the  services  of  a  professional  adviser  should  be  sought.   The   magazine   is   not   responsible   for   unsolicited   manuscripts   or   photographs.   Send   letters   to   the   editor   and   editorial   inquiries   to   the   above   address   or   to   WFDOODKDQ#ÂżHOGPHGLDFRP 3HUPLVVLRQ WR UHXVH FRQWHQW VKRXOG EH VHQW WR WFDOODKDQ#ÂżHOGPHGLDFRP


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BY GREG SCANDLEN FOUNDER CONSUMERS FOR HEALTH CARE CHOICES

GUEST COMMENTATOR

Fifty-­two  Card  Pickup

R

emember when you were a kid and someone asked you if you wanted to play â&#x20AC;&#x153;fifty-two pickupâ&#x20AC;? 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&#x20AC;&#x153;health reformsâ&#x20AC;? as envisioned by Washington, but about what is happening in the market. The â&#x20AC;&#x153;reformsâ&#x20AC;? 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&#x20AC;&#x2122; latest issue of â&#x20AC;&#x153;Consumer Driven Market Report.â&#x20AC;? (For subscription information, e-mail Bill Boyles at Interpro Publications editor@xintrak.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&#x20AC;&#x153;allied professionals,â&#x20AC;? labs and drug stores. And that was the â&#x20AC;&#x153;system.â&#x20AC;? All this began to change with the advent of cash accounts in health care financingâ&#x20AC;&#x201D;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&#x20AC;&#x153;new configurationâ&#x20AC;? is â&#x20AC;&#x153;ACCOUNTSCARDS-INCENTIVES,â&#x20AC;? all powered by technology. Notice that he gives insurers barely a mention. 6XGGHQO\WKHEDQNVZHUHLQYROYHGLQÂżQDQFLQJKHDOWK FDUH7KHUHPD\QRWKDYHEHHQPXFKFRPSHWLWLRQEHWZHHQ LQVXUHUV DOORIIHULQJYLUWXDOO\LGHQWLFDOSURGXFWVDWYLUWXDOO\ LGHQWLFDOSULFHV EXWWKHQHZSOD\HUV EDQNV 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&#x20AC;&#x153;Lookoutsâ&#x20AC;? (not â&#x20AC;&#x153;outlooksâ&#x20AC;?) 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

KH>%LOO%R\OHV@H[SHFWVWKDWVRPHEUHDNWKURXJKLQQRYDWLRQV ZLOOEHFRPHVWDQGDUGDFURVVDOORIWKHPDUNHW   HQKDQFLQJHYHU\RQHœVPDUNHWSRVLWLRQ

as they can no longer ask medical questions of applicants. He concludesâ&#x20AC;&#x201D; 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&#x20AC;&#x201D;Everybody will be looking for relief from the incredible complexity of the â&#x20AC;&#x2DC;newâ&#x20AC;&#x2122; 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&#x20AC;&#x2122;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&#x20AC;&#x2122;s market position. I havenâ&#x20AC;&#x2122;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&#x20AC;&#x2122;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&#x201E;˘ I January/February 2013

11


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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

2013

MAKING HEALTHCARE CONSUMERISM WORK In the Year Ahead and Beyond FEATURED SPEAKERS: Ron Bachman

Roy Ramthun

FSA,  MAAA,  Sr.   President,  Healthcare  Visions;͞   Chairman  of  The  Institute   For  HealthCare  Consumerism   Editorial  Advisory  Board

An  expert  on  health  savings   accounts  and  consumer  directed   health  care  issues

Wendy Lynch

Partner Alston+Bird  LLP

Co-­director,  Altarum  Center  for   Consumer  Choice  in  Health  Care

Chris Covill Exchange  Product  Leader  and  Partner Mercer

Dawn Bading Vice  President,  Human  Resources Kaiser  Permanente

John Hickman

Cindy Gillespie Senior  Managing  Director McKenna  Long  &  Aldridge  LLP

Patti Taylor 'LUHFWRU*OREDO%HQH¿WV Newell  Rubbermaid

Steve Lafferty, Sr. Director  of  Clinics  and  Health   Partnerships,  Target )RUPHU'LUHFWRU7DUJHW%HQH¿WV

WHO SHOULD ATTEND? CEOs/Presidents/CFOs +5DQG%HQH¿WV([HFXWLYHV Health  Plan  Administrators Corporate  Wellness  and  Medical  Directors

%HQH¿W%URNHUV Third  Party  Administrators %HQH¿W&RQVXOWDQWV %DQNHUV

WWW.THEIHCCFORUM.COM


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&#x2030;)FBSXIBUIBTXPSLFEGPS UIFNBOETIBSFZPVSTVDDFTTFT

WHAT YOUâ&#x20AC;&#x2122;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&#x2030;-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&#x20AC;&#x201D; uncensoredâ&#x20AC;&#x201D;with your professional counterparts. IF YOU CANâ&#x20AC;&#x2122;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

WWW.THEIHCCFORUM.COM

LAS VEGAS

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&#x20AC;&#x201C; 5:15 pm

Pre-Conference: Employee Benefits Forum 2013

1:00 pm â&#x20AC;&#x201C; 5:00 pm

Pre-Conference: A Roadmap for Making Healthcare Consumerism Work

12:00 pm â&#x20AC;&#x201C; 7:00 pm

Exhibitor Set Up

THURSDAY, MAY 9, 2013 7:30 am

Registration

7:30 am â&#x20AC;&#x201C; 8:45 am

Networking Breakfast / Exhibits Open

8:45 am â&#x20AC;&#x201C; 9:00 am

Welcome by Doug Field, CEO, The Institute for HealthCare Consumerism

9:00 am â&#x20AC;&#x201C; 10:30 am

Opening General Session: â&#x20AC;&#x153;Making Health Care Consumerism Workâ&#x20AC;?

10:30 am â&#x20AC;&#x201C; 11:00 am

Networking Break / Exhibits Open

11:00 am â&#x20AC;&#x201C; Noon

Track No. 1 Workshops (Choose One) Âą$FKLHYLQJ0\*RDOV$7ULS7KURXJKWKH)LQDQFLDO:HOOQHVV:RUNVKRS 102  â&#x20AC;&#x201C;  HSAs:  A fter  2014 Âą6+$5(6(66,21(YROYLQJ5HODWLRQVKLS%HWZHHQ%URNHUDQG(PSOR\HUDQG+RZWR%HQHÂżWWKHPRVWIURP a  Partnership Âą&RQWUROOLQJ&RVWVDQG([SDQGLQJ&KRLFH8VLQJ'HÂżQHG&RQWULEXWLRQ+HDOWK&DUH 105  â&#x20AC;&#x201C;  Health  Pays:  Using  Incentives  to  Drive  Wellness  and  Behavior  Change 106  â&#x20AC;&#x201C;  The  R ight  Care  (Not  Just  Cost)! 107  â&#x20AC;&#x201C;  Pre-­Paid  Card  Programs  to  Engage  Consumers  and  Help  Employers  Manage  Costs  in  2014  &  Beyond Âą%HDWLQJWKH(QUROOPHQW%OLW]+RZWR'HOLYHU<HDU5RXQG%HQHÂżWV&RPPXQLFDWLRQ

Noon â&#x20AC;&#x201C; 1:00 pm

Table Topic Lunch Discussion

Noon â&#x20AC;&#x201C; 1:30 pm

Lunch / Exhibit Open

1:30 pm â&#x20AC;&#x201C; 2:45 pm

Afternoon General Session: â&#x20AC;&#x153;HealthCare Consumerism is Here to Stay!â&#x20AC;?

2:45 pm â&#x20AC;&#x201C; 3:00 pm

Networking Break / Exhibits Open

3:00 pm â&#x20AC;&#x201C; 4:00 pm

Track No. 2 Workshops (Choose One) Âą$GYDQFHG%URNHU&RXUVH 202  â&#x20AC;&#x201C;  Ownership  and  Incentives:  Creating  Multiple  Incentive  Channels Âą7KH9DOXHRI&RQQHFWLQJ&RQVXPHU1HHGVZLWK%HQHÂżWVWKURXJK(QUROOPHQW7HFKQRORJ\ 204  â&#x20AC;&#x201C;  SHARE  SESSION:  Health  Care  Access  When  You  Want  It,  How  You  Want  It 205  â&#x20AC;&#x201C;  The  MedEncentive  Solution:  Achieving  the  Triple  A im  by  Triangulating  the  Interests  of  Payors,  Providers   and  Patients 206  â&#x20AC;&#x201C;  SHARE  SESSION:  How  to  More  Effectively  Engage  Consumers  and  get  Increased  Participation  from  your   Employee  Population  207  â&#x20AC;&#x201C;  Consumer  Engagement:  The  Key  to  a  Successful  Exchange  208  â&#x20AC;&#x201C;  Ten  Steps  to  Delivering  on  the  Promise  to  Employers:  ACOs  Enhance  Quality  of  Care,  Improve  Patient   2XWFRPHVDQG'ULYH&RVWHIÂżFLHQF\

4:00 pm â&#x20AC;&#x201C; 4:15 pm

Networking Break / Exhibits Open

4:15 pm â&#x20AC;&#x201C; 5:15 pm

Closing General Session: Defined Contribution and Public/Private Exchanges: A Panel Discussion with Leading Experts

5:15 pm â&#x20AC;&#x201C; 7:15 pm

Opening Night Reception / Exhibits Open


2013 FORUM EAST AGENDA CONTINUED FRIDAY, MAY 10, 2013 7:30 am â&#x20AC;&#x201C; 8:30 am

Networking Breakfast / Exhibits Open

8:30 am â&#x20AC;&#x201C; 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&#x20AC;&#x201C; 10:30 am

Networking Break / Exhibits Open

10:30 am â&#x20AC;&#x201C; 11:30 am

Track No. 3 Workshops (Choose One) Âą0DNLQJWKH+HDOWK&RPPLWPHQW 302  â&#x20AC;&#x201C;  The  Economics  of  Healthy  Sleep Âą6+$5(6(66,21([FKDQJHVRU0DUNHWSODFH":KDWHYHULWÂśV&DOOHG*HWWR.QRZLW 304  â&#x20AC;&#x201C;  Improving  Consumer  Health  Through  Value-­Based  Plan  Design Âą*HWWLQJWKH0RVWIURP\RXU%URNHU5HODWLRQVKLSDQG+RZWKDWLV&KDQJLQJ 306  â&#x20AC;&#x201C;  The  Role  of  Mobile  Health  in  Changing  Behavior Âą*DPH0HFKDQLFVDQG2WKHU*DPH&KDQJHUVLQ%HQHÂżWV(GXFDWLRQ 308  â&#x20AC;&#x201C;  SHARE  SESSION:  Building  Better  Consumers  of  Health  Care  and  Health

11:30 am â&#x20AC;&#x201C; Noon

Final Break and Sponsor/Exhibitor Drawings

Noon â&#x20AC;&#x201C; 1:00 pm

Closing General Session: Employer Panel: â&#x20AC;&#x153;What leading Employers are doing to Make HealthCare Consumerism Work

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Hotel Information Renaissance  Waverly  Hotel   *DOOHULD3DUNZD\ 800.228.9290  or  770.953.4500 Special  FORUM  Rate  $153  (Cutoff  Date  4/17/13)  

Conference Location Cobb  Galleria  Center 7ZR*DOOHULD3DUNZD\ Atlanta,  GA  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.

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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

Standard Rates

Onsite Rates

Attendee Type

(ends 2/28/13)

(ends 4/30/13)

(ends 5/09/13)

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PEOPLE ON THE MOVE MedConnections, one of the worldâ&#x20AC;&#x2122;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&#x20AC;&#x2122;s flagship application, iPharmacy, has already helped more

HEALTHCARE CONSUMERISM SOLUTIONS

Aetna Consumer-directed Health Plans Continue to Save Millions for Employers The   ninth   annual   Aetna   HealthFund   study   shows   that   employers   UHSODFLQJ WKHLU WUDGLWLRQDO KHDOWK EHQHÂżWV SODQV ZLWK $HWQD +HDOWK)XQG consumer-­directed   plans   saved   nearly   $350   per   member   per   year.   The   lower   health   care   costs   result   in   savings   of   $20.8   million   over   a   six-­ year   period   for   every   10,000   members.   The   Aetna   HealthFund   study   is   the   longest   running   review   of   consumer-­directed   plans   in   the   industry,   drawing  experience  from  a  decade  of  claims  data. Members   with   Aetna   HealthFund   plans   spent   less   on   most   types   of   health   care   services,   including   specialist   doctorâ&#x20AC;&#x2122;s   visits,   emergency   room   visits   and   total   pharmacy   costs.   Despite   lower   overall   health   care   costs,  members  with  Aetna  HealthFund  plans  received  routine  preventive   care   from   their   primary   care   doctors   11   percent   more   than   members   ZLWK WUDGLWLRQDO 3UHIHUUHG 3URYLGHU 2UJDQL]DWLRQ 332  SODQV $HWQD HealthFund   members   also   had   higher   rates   of   screenings   for   cervical   FDQFHU QHDUO\  SHUFHQW KLJKHU  FRORUHFWDO FDQFHU  SHUFHQW  DQG SURVWDWH FDQFHU  SHUFHQW  DV ZHOO DV PDPPRJUDPV  SHUFHQW  DQG LPPXQL]DWLRQV SHUFHQW  â&#x20AC;&#x153;Employers  are  trying  to  control  rising  health  care  costs  by  getting   their   employees   to   be   more   empowered   when   making   health   care   decisions,â&#x20AC;?  says  Tom  Mafale,  head  of  national  accounts  sales  operations   for  Aetna.  â&#x20AC;&#x153;Aetna  HealthFund  plans  continue  to  be  a  proven  solution  to   achieve  that  important  goal.  Encouraging  people  to  receive  the  right  care   at  the  right  time  is  one  important  way  to  help  reduce  health  care  costs  for   both  employers  and  individuals.  Health  care  reform  has  increased  access   to  preventive  care,  but  Aetna  HealthFund  members  still  use  this  type  of   care  more  frequently  than  other  members.â&#x20AC;? Employers   that   completely   transitioned   their   employees   to   Aetna   HealthFund   plans   saw   the   most   dramatic   cost   savings.   However,   HPSOR\HUV ZKR XVHG VHYHUDO ÂłEHVW SUDFWLFHV´ LGHQWLÂżHG WKURXJK WKH study   had   cost   savings   that   were   almost   as   high   as   the   employers   who   completely  switched  over  to  HealthFund  plans.  

Truven Health Analytics Develops Solution to Evaluate Wellness Program Effectiveness Truven   Health   Analytics,   formerly   the   health   care   business   of   Thomson   Reuters,   announced,   in   collaboration   with   Emory   University,   WKH UHOHDVH RI D QHZ PRGHO WR HYDOXDWH WKH UHWXUQ RQ LQYHVWPHQW 52,  of   population   health   and   wellness   programs.   The   Truven   Health   ROI   18 January/February 2013 I HealthCare Consumerism Solutionsâ&#x201E;˘ 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&#x20AC;&#x2122;s most

AETNA  TRUVEN HEALTH ANALYTICS  UNI Model   is   designed   to   help   organizations   identify   which   health   risks   are   most   prevalent   and   costly   to   their   company,   quantify   the   relationships   EHWZHHQ PRGL¿DEOH ULVN IDFWRUV DQG PHGLFDO H[SHQGLWXUHV DQG GHYHORS FRVWEHQH¿FLDOKHDOWKSURPRWLRQDQGGLVHDVHSUHYHQWLRQSURJUDPVEDVHG on  the  results. 7KH 7UXYHQ +HDOWK 52, 0RGHO LQFRUSRUDWHV RUJDQL]DWLRQVSHFL¿F demographic,  health  risk,  and  program  impact  data,  plus  data  from  peer-­ reviewed  studies.  It  shows  the  relationship  between  health  risk  and  cost,   DQGSUHGLFWVFRVWVDYLQJVIURPSURJUDPVGHVLJQHGWRDGGUHVVPRGL¿DEOH health  risks:  high  blood  glucose,  obesity,  physical  inactivity,  depression,   poor   nutrition/eating   habits,   tobacco   use,   high   total   cholesterol,   high   stress,   high   blood   pressure,   and   high   alcohol   consumption.   The   model   incorporates  both  prospective  and  retrospective  estimates  to  calculate  the   ¿QDQFLDOUHWXUQRIDFRPSDQ\œVZHOOQHVVSURJUDP ³:HNQRZWKDWLQGLYLGXDOVZLWKRQHULVNIRUDVSHFL¿FSUREOHPRIWHQ have   additional   risks   also   associated   with   that   problem.   For   example,   there   are   seven   combined   risk   factors   that   contribute   to   heart   disease:   obesity,  high  stress,  tobacco  use,  high  blood  pressure,  high  blood  glucose,   KLJKWRWDOFKROHVWHURODQGSK\VLFDOLQDFWLYLW\´VD\V5RQ*RHW]HO3K' research   professor   at   Emory   University,   director   of   the   Institute   for   Health   and   Productivity   Studies,   and   vice   president   of   consulting   and   applied  research  at  Truven  Health  Analytics.  

United Airlines Opens Free Workplace Health Clinic at Oâ&#x20AC;&#x2122;Hare United  Airlines  announced  the  opening  of  the  airlineâ&#x20AC;&#x2122;s  new  employee   health   clinic   at   Oâ&#x20AC;&#x2122;Hare   International   Airport.   The   clinic,   managed   by   Walgreens,  will  serve  a  broad  scope  of  employeesâ&#x20AC;&#x2122;  health  needs,  such  as   urgent  care  for  routine  illness,  travel  and  other  immunizations  including   Ă&#x20AC;XVKRWVSUHSDFNDJHGPHGLFDWLRQVMREUHODWHGSK\VLFDOWUDLQLQJDQGSUH employment  physicals,  at  no  cost  to  employees.   The   convenient   access   to   these   and   other   health   care   services   is   available   to   all   United   employees,   including   the   more   than   10,000   co-­workers  in  the  Chicago  area. Âł:HÂśUHFRQWLQXLQJWRPDNHVLJQLÂżFDQWLQYHVWPHQWVLQ8QLWHGLQFOXGLQJ investments   in   our   co-­workers,â&#x20AC;?   said   Unitedâ&#x20AC;&#x2122;s   Chairman,   President   and   CEO   Jeff   Smisek.   â&#x20AC;&#x153;This   clinic   will   offer   convenient   health   services   at   no   charge  to  keep  our  co-­workers  feeling  and  performing  well.â&#x20AC;? The   5,200-­square-­foot   facility,   located   in   the   airportâ&#x20AC;&#x2122;s   Terminal   2   arrivals  area,  is  the  only  one  of  its  kind  for  any  airline  at  Oâ&#x20AC;&#x2122;Hare.  United  


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&#x20AC;&#x2122;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&#x20AC;&#x2122;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  offers  health  care  clinics  for  its  employees  at  its  Cleveland,  Houston,   *XDPDQG1HZDUN1HZ<RUNKXEV Âł0RUH HPSOR\HUV DUH UHFRJQL]LQJ WKH EHQHÂżWV RI ZRUNVLWH KHDOWK centers  and  wellness  programs  to  improve  the  overall  health,  satisfaction   and   productivity   of   their   employees,   while   also   reducing   costs,â&#x20AC;?   says   :DOJUHHQV3UHVLGHQWDQG&(2*UHJ:DVVRQÂł7KLVSURMHFWEULQJVWRJHWKHU two   companies   with   deep   Chicago   roots   to   make   health   and   wellness   a   top  priority.â&#x20AC;? 7KLVPDUNVWKHÂżIWKZRUNSODFHKHDOWKFOLQLFIRU8QLWHGDOOPDQDJHG by   Walgreens.   Unitedâ&#x20AC;&#x2122;s   Oâ&#x20AC;&#x2122;Hare   facility   adds   to   the   more   than   370   employer-­based   worksite   health   and   wellness   centers   managed   and   RSHUDWHGE\:DOJUHHQV(PSOR\HU6ROXWLRQV*URXS

Mercer Selects Benefitfocus to Provide Technology Platform for Private Exchange %HQHÂżWIRFXVWKHQDWLRQÂśVODUJHVWSURYLGHURIKHDOWKFDUHDQGEHQHÂżWV technology,   announced   it   will   provide   the   technology   platform   for   the   SULYDWH EHQHÂżWV H[FKDQJH WR EH RIIHUHG E\ 0HUFHU D JOREDO FRQVXOWLQJ leader  in  talent,  health,  retirement  and  investments.  Mercer  Marketplace   is   a   cloud-­based   private   exchange   designed   to   lower   employer   costs   DVVRFLDWHGZLWKFRPSHWLWLYHHPSOR\HHEHQHÂżWSDFNDJHV 7KH %HQHÂżWIRFXV 3ODWIRUP ZKLFK VXSSRUWV WKH SULYDWH EHQHÂżWV exchange,   will   provide   Mercerâ&#x20AC;&#x2122;s   clients   the   convenience   of   an   online   retail  marketplace  where  they  can  shop,  enroll,  manage  and  exchange  all   EHQHÂżWVUHODWHGLQIRUPDWLRQ â&#x20AC;&#x153;Mercer   Marketplace   is   an   important   addition   to   the   suite   of   solutions   that   Mercer   provides   to   clients,â&#x20AC;?   says   Sharon   Cunninghis,   1RUWK$PHULFD+HDOWK %HQHÂżW5HJLRQ/HDGHURI0HUFHUÂł,WZLOODOORZ HPSOR\HUV WR FRQWLQXH RIIHULQJ FRPSHWLWLYH EHQHÂżWV WR WKHLU HPSOR\HHV which   is   an   important   attraction   and   retention   tool,   while   actively   managing   spending   and   reducing   their   administrative   responsibilities.   (PSOR\HHVZLOOKDYHDFFHVVWRDEURDGHUDUUD\RIEHQHÂżWVDVZHOODVWKH DELOLW\WRWDLORUWKRVHEHQHÂżWVWRWKHLUSDUWLFXODUQHHGVZLWKWKHQHFHVVDU\ support  to  make  appropriate  decisions.â&#x20AC;? 'HYHORSHG ZLWK %HQHÂżWIRFXV WHFKQRORJ\ 0HUFHU 0DUNHWSODFH GHOLYHUVWKHĂ&#x20AC;H[LELOLW\DQGFXVWRPL]DWLRQUHTXLUHGIRUQDYLJDWLQJFRPSOH[ EHQHÂżWSRUWIROLRV$GGLWLRQDOO\WKH%HQHÂżWIRFXV3ODWIRUPHQDEOHV0HUFHU 0DUNHWSODFHWRVXSSRUWGHÂżQHGFRQWULEXWLRQPRGHOVEDVHGRQDSHUFHQWDJH of  an  employeeâ&#x20AC;&#x2122;s  income  or  a  standard  amount  set  by  the  employer,  further   VLPSOLI\LQJEHQHÂżWDGPLQLVWUDWLRQIRU0HUFHUÂśVFOLHQWEDVH

Texas Health Resources, Healthways Advance Physiciandirected Population Health Initiatives Supporting Commercial ACO Design and Deployment Texas   Health   Resources   and   Healthways   announced   the   launch   of   two  initiatives  in  their  ongoing  strategic  alignment  to  deploy  an  integrated   physician-­directed   population   health   solution   to   drive   health   outcomes   and  cost  savings.   7KH ÂżUVW LQLWLDWLYH LV LPSOHPHQWDWLRQ RI D FRQVLVWHQW V\VWHPZLGH approach  to  optimize  the  care  of  inpatients  with  diabetes  and  improve  coor-­ dination  of  care  after  the  patient  is  discharged.  Texas  Health  launched  the   GLDEHWHVFDUHFRRUGLQDWLRQLQLWLDWLYHLQ-DQXDU\DWÂżYH7H[DV+HDOWKKRV-­ pitals  in  Dallas,  Plano,  Arlington,  Hurst-­Euless-­Bedford  and  Fort  Worth.   7KHVHFRQGLQLWLDWLYHLGHQWLÂżHVLQSDWLHQWVZKRDUHPRVWDWULVNIRU readmissions,  and  aligns  inpatient  and  post-­hospital  care  teams  around   the   patientâ&#x20AC;&#x2122;s   needs.   Effective   coordination   of   care   after   the   patient   is   discharged   can   improve   quality   and   patient   safety,   lower   cost,   improve   patient   outcomes   and   help   prevent   costly   readmissions.   Coordination   of  care  across  the  continuum  of  services  is  part  of  Texas  Healthâ&#x20AC;&#x2122;s  overall   strategy   to   integrate   health   services   and   help   patients   navigate   through   the  complex  environment  of  care.   Both   approaches   involve   the   patientâ&#x20AC;&#x2122;s   primary   care   provider   to   facilitate  monitoring  and  timely  interventions.  These  initiatives  are  critical   elements   supporting   the   construct   of   the   accountable   care   agreement   announcement  made  by  Texas  Health  last  week  and  the  ACO  agreement   announced   in   mid-­January   between   Texas   Health   and   Blue   Cross   and   Blue  Shield  of  Texas.   â&#x20AC;&#x153;Texas  Health  is  collaborating  with  physicians,  commercial  insurers   and  employers  to  develop  an  accountable  care  model  that  not  only  cares   for  people  when  they  are  ill,  but  also  focuses  on  keeping  people  healthy   and   out   of   the   hospital   unless   they   are   acutely   sick   or   injured,â&#x20AC;?   Doug   Hawthorne,   CEO   of   Texas   Health   Resources,   says.   â&#x20AC;&#x153;Beginning   with   the   physicians,   nurse   practitioners   and   physician   assistants   of   Texas   +HDOWK 3K\VLFLDQV *URXS ZH DUH OHDGLQJ WKH ZD\ LQ WUDQVIRUPLQJ IURP the   fee-­for-­service   model   to   a   value-­based   model.   We   are   creating   a   physician-­directed   care-­team   approach   that   we   believe   will   foster   more   accountability  across  the  continuum  of  care,  from  the  individual  patient   to  the  physician  to  every  other  provider  on  the  team.  Our  ultimate  goal   is  to  help  physicians  manage  the  health  of  their  patient  populations  and   improve  their  health  and  well-­being.â&#x20AC;?   FRQWLQXHGRQSDJH www.TheIHCC.com I HealthCare Consumerism Solutionsâ&#x201E;˘ I January/February 2013 19


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underwriting and product delivery, as well as maintaining customer relationships. In addition, he will be responsible for the development of Empireâ&#x20AC;&#x2122;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&#x20AC;&#x2122;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&#x20AC;&#x2122;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&#x20AC;&#x2122;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

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REGULATORY & COMPLIANCE

Development of Private Health Insurance Exchanges Predate PPACA Who:   Individuals,   small   employers   and   large   groups.   Private   exchanges   target: Â&#x2021; Employers  who  want  to  better  control  their  health  care  costs, Â&#x2021; (PSOR\HHVZKRZDQWWRFKRRVHWKHEHQHÂżWSURJUDPWKDWZRUNVEHVW for  their  own  families, Â&#x2021; The  need  for  portability  as  workers  move  between  jobs,  and Â&#x2021; The  need  for  two-­income  families  to  combine  their  resources  into  a   VLQJOHEHQHÂżWVSURJUDPIRUWKHZKROHIDPLO\ When:   Some   local   exchanges   have   been   operating   for   many   years.   New   regional   and   national   private   exchanges   may   start   operating   in   2013   and   2014.  PPACA  increased  awareness  and  the  need  for  a  new  health  insurance   purchasing   system.   In   addition,   some   of   the   private   exchange   developers   KRSH WR JHW D VKDUH RI WKH 33$&$ IHGHUDO H[FKDQJH EXVLQHVV *RYHUQPHQW GHÂżQHG33$&$H[FKDQJHVDUHVFKHGXOHGWREHJLQ-DQ What:   The   development   of   private   exchanges   predates   PPACA   and   is   growing   independent   of   PPACA.   Exchanges   produce   a   new   process   of   shopping  for  health  insurance.  Like  any  business,  consumers  seeking  value   will  ultimately  decide  which  exchanges  will  succeed.  Exchanges  will  process   traditionally   funded   health   insurance.   However,   an   important   impetus   for   exchanges   is   the   potential   use   of   health   reimbursement   arrangements   +5$V  WKDW DOORZ HPSOR\HUV WR GHVLJQDWH D VXP RI PRQH\ WR SD\ IRU WKH health   care   needs   of   employees,   whether   through   an   insurance   program   or   through   the   direct   payment   of   medical   services.   Private   exchanges   can   combine  employer-­paid  HRA  contributions  with  employee-­paid  Section  125   contribution  to  allow  for  individual  health  plans  to  be  paid  on  a  tax-­free  basis.   Executive  Summary:  Developing  private  exchanges  may  be  grouped  into   three   categories.   Some   are   focused   on   the   small   group   market,   others   on   ODUJHJURXSVDQGVWLOORWKHUVRQUHWLUHHKHDOWKEHQHÂżWV Business   group   exchanges:   Developed   from   existing   employer   associations.   They   typically   will   ensure   portability   for   employees,   but   only   when  the  employee  moves  between  participating  employers  and  health  plans. Insurer-­sponsored   exchanges:   Developed   for   insured   policyholder,   making  it  easy  to  move  current  small  employers  into  an  exchange  and  allow   individual   employees   a   wider   choice   of   health   plan   design.   The   portability   WKHDELOLW\RIDFRQVXPHUWRNHHSWKHVDPHFRYHUDJHDVWKH\PRYHEHWZHHQ MREV  LV DYDLODEOH WR LQGLYLGXDOV PRYLQJ DPRQJ FRPSDQLHV FRYHUHG E\ WKH same  insurer.   Independent  companies:  Developed  with  various  sponsorships,  existing   relationships,   and   business   models.   These   companies   include   existing  

information   technology   vendors,   consultants/brokers,   and   entrepreneurs.   These  players  seek  to  meet  the  needs  of  existing  health  industry  customers,   employer   groups,   and   broker   clients.   They   see   the   opportunity   to   expand   on   existing   services   and   technology   to   create   new   businesses   in   a   growing   market.   The   potential   for   private   exchanges   comes   from   the   mid-­   and   large-­ group   markets   that   will   not   be   involved   in   the   state-­based   federal   PPACA   exchanges. Private   exchanges   can   address   some   of   the   existing   problems   in   our   current  system. Â&#x2021; (PSOR\HUFRVWVZLOOEHÂż[HGDQGFRQWUROODEOH$QHPSOR\HUZLOOEH able  to  contribute  only  what  it  can  afford. Â&#x2021; Employees   will   be   able   to   choose   their   plan   design,   the   one   that   works  best  for  their  own  family. Â&#x2021; Coverage   will   eventually   be   portable,   so   employees   can   keep   the   same  coverage  as  they  change  jobs,  or  lose  their  job  altogether. Â&#x2021; Unlike  individual  coverage  today,  the  employee  contribution  may  be   tax  free  through  using  a  Section  125  payroll  deduction.   Â&#x2021; Two-­income  families  may  be  able  to  use  contributions  from  different   employers  to  purchase  a  single  plan  for  the  whole  family. Private  exchanges  can  move  health  insurance  to  a  system  of  individual   choice   and   ownership   and   allow   employers   to   concentrate   on   their   core   EXVLQHVV7KHUHPD\EHOHJDORUUHJXODWRU\FODULÂżFDWLRQVWRDFFRPPRGDWHWKH effective  uses  of  private  exchanges.   :LWKRUZLWKRXW33$&$HPSOR\HUVDUHÂżQGLQJZD\VWRPDNHÂłFRQVXPHU empowermentâ&#x20AC;?  a  reality.  People  want  to  have  more  control  over  their  own   lives.  They  are  demanding  choice  and  individual  ownership  of  their  health   EHQHÂżWVDVWKH\DUHLQHYHU\RWKHUDVSHFWRIWKHLUOLYHV+5$VDQG'HÂżQHG Contribution  plans  with  personal  choice  and  ownership  of  health  coverage  is   the  latest  iteration  of  this  demand  for  health  care  consumerism. Actions:  Employers  will  need  to  determine  the  value  of  considering  private   H[FKDQJHVDVDQDOWHUQDWLYHWRWKHLUFXUUHQWKHDOWKEHQHÂżWSODQV(PSOR\HUV will  need  to  determine  the  economics  and  employee  attitudes  in  moving  to  a   GLIIHUHQWV\VWHPRIKHDOWKLQVXUDQFHSXUFKDVLQJ7KHUHDUHPDQ\EHQHÂżWVDQG some  drawbacks  that  need  to  be  considered.  Employers  should  check  with   their   compliance   and   legal   teams,   insurance   brokers,   agents,   consultants,   and  insurers  before  reviewing  or  deciding  to  use  a  private  health  insurance   exchange  approach  to  health  coverages.   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&#x201E;˘ I January/February 2013

21


BY J. KEVIN A. McKETCHNIE EXECUTIVE DIRECTOR AMERICAN BANKERS ASSOCIATIONâ&#x20AC;&#x2122;S HSA COUNCIL

HSAs

Evolutionary Health Care Financing: The Global Switch to HSAs

W

inter  in  Edmonton,  Alberta  isnâ&#x20AC;&#x2122;t  for  the  weak  at  heart.  We  arrived     in  the  fall  of  2006  after  a  quick  layover  in  already  chilly  Chicago.   7KLVZDVWKHÂżQDOVWRSLQZKDWZDVDPXOWLFLW\PXOWLFRQWLQHQWDO tour  of  national  health  care  systems  and  their  weaknesses. The   provincial   government   invited   us   to   solve   a   problem   that   the   embarrassment   of   energy   riches   in   Alberta   was   making   acute:   How   to   operate   a   single-­payer   system   trying   to   serve   a   population   that   was   doublingâ&#x20AC;&#x201D;at  least  in  Red  Deerâ&#x20AC;&#x201D;every  18  months?   The   call   on   Albertaâ&#x20AC;&#x2122;s   treasury   was   enormous,   as   was   the   inability   of   what   remains   a   systemic   issue   in   the   provinceâ&#x20AC;&#x2122;s   health   care   delivery   V\VWHP $V WKH VHUYLFHVHOLJLEOH SRSXODWLRQ JUHZ ZLWK WKH RLO ÂżHOGV WKH infrastructure   of   hospitals,   doctors,   nurses   and   even   bedpans   remained   relatively  static.  Collapse  was  imminent. With   too   many   oil   sands   workers   pushing   through   the   doors   of   KRVSLWDOVHQHUJ\FRPSDQLHVZHUHEHJLQQLQJWRĂ&#x20AC;\ZRUNHUVWRQHLJKERULQJ provinces   or   even   out   of   Canada   to   the   United   States   for   care.   Once   the   other  Canadian  provinces  realized  they  were  treating  Albertaâ&#x20AC;&#x2122;s  workforce   without   gaining   Albertaâ&#x20AC;&#x2122;s   revenue   in   return,   the   other   provinces   tried   charging  a  fee.  They  quickly  discovered  such  charges  were  actually  illegal   in  Canada.  The  United  States  became  the  only  option. However,   the   challenge   in   America   was   a   foreign   worker,   even   a   Canadian,   doesnâ&#x20AC;&#x2122;t   have   access   to   American   health   insurance   products.   But   since   most   oil   workers   were   only   looking   for   routine   care,   energy   companies  negotiated  with  provider  networks  and  armed  their  employees   with   cash.   The   purpose   of   this   cash   was   to   be   used   for   health   care   in   newly  created  accounts.  Employees  could  keep  this  cash  and  it  would  be   replenished  every  year.

The  HSA  community  is  bracing  for  record  enrollments,  probably  up   by  as  much  as  30  percent,  insuring  around  16  million  Americans,  according   to  some  estimates.  And  thus  begins  the  new  class  war:  Americans  who  can   pay  for  health  care  with  cash  and  insurance  versus  Americans  who  have   to  rely  on  what  the  government  wants  to  pay  the  same  providers  through   entitlement  reimbursements.  

Sound Familiar?

It   means   that   the   administration   has   taken   the   positive   steps   the   HSA  Council  asked  them  to  make  to  ensure  the  most  affordable  plansâ&#x20AC;&#x201D; DOZD\V+6$TXDOLÂżHGSODQV²DUHDYDLODEOHLQWKHH[FKDQJHVDQGLQVXUDQFH companies  wonâ&#x20AC;&#x2122;t  be  penalized  in  their  MLR  performance  for  continuing  to   RIIHU+6$TXDOLÂżHGSODQV%XWLWDOVRPHDQV$PHULFDQVLQVXUHGLQWKHVH plans  will  not  only  have  a  way  to  save  for  future  care  but  also  will  have  a   ZD\WRFRPSHWHIRUFDUHZKHQWKHĂ&#x20AC;RRGJDWHVRSHQLQ The  regulatory  environment  remains  a  stormy  one.  But  at  least  the   millions   of   Americans   insured   with   HSAs   will   be   better   equipped   than   most  to  manage  the  coming  provider  shortage.    

7KH $IIRUGDEOH &DUH $FW $&$  PDNHV WKH DFFRXQWEDVHG ÂżQDQFLQJ system  even  more  attractive  to  American  government  than  the  oil  boom   makes  it  to  Alberta.  As  the  uninsured  gain  access  to  subsidized  health  care   ÂżQDQFLQJWKHFUXVKRQ$PHULFDQUHVRXUFHVZLOOEHOLNH5HG'HHUÂśV-XVW like  in  the  single-­payer  environment,  everyone  will  be  insured,  but  instead   of   relying   on   the   ever-­diminishing   reimbursements   of   an   entitlement   regime,  some  will  have  what  Albertaâ&#x20AC;&#x2122;s  oil-­workers  haveâ&#x20AC;&#x201D;cash.

Why is that Going to be Such an Advantage? The   ACA   marches   the   reach   of   Americaâ&#x20AC;&#x2122;s   entitlements   upward,   in   terms  of  Medicaid  eligibility  with  respect  to  income  and  downward,  in  terms   of  Medicare  eligibility  in  terms  of  age.  These  patients  canâ&#x20AC;&#x2122;t  have  an  HSAâ&#x20AC;&#x201D;at   least  not  yet;Íž  but  give  me  and  my  team  a  year  and  weâ&#x20AC;&#x2122;ll  seeâ&#x20AC;&#x201D;so  they  only   have  what  the  government  will  reimburse  to  offer  a  provider  for  care.   The   insured   marketplace,   largely   the   employer-­sponsored   space,   has   more   attractive   reimbursements   but   also   has   HSAs,   which   are   cash   accounts  earmarked  for  health  care.  A  lot  of  them.

Who Will Win? The  government  is  hedging  its  bets.  Before  the  Christmas  holidays,   two  major  changes  in  administration  regulatory  posture  gave  this  industry   DKXJHERRVW7KHÂżUVWDQGEHWWHUNQRZQRXWFRPHLVWKH$FWXDULDO9DOXH $9 UXOHZKLFKDVZULWWHQVHHPVXQKHOSIXOWR+6$VLVSDUWQHUHGZLWKD calculator  making  it  nearly  impossible  to  disqualify  an  HSA-­plan  from  sale   in  an  exchange. 8QEHOLHYDEO\WKHFDOFXODWRUZRUNVLQVXFKDZD\WKDW+6$TXDOLÂżHG plans,   without   any   contributions   to   the   account,   generally   qualify   as   bronze   plans.   If   contributions   are   made,   HSAs   score   higher,   sometimes   even  as  high  as  platinum  plans. /HVVQRWHGLVWKHWHVWLPRQ\RI*DU\&RKHQGLUHFWRURIWKH&HQWHUIRU Consumer  Information  &  Insurance  Oversight,  who  appeared  before  the   House  of  Representatives  on  Dec.  13,  2012.   â&#x20AC;&#x153;The   [MLR   Rule]   80/20   rule   says   insurance   companies   have   to   spend  80  cents  of  every  premium  dollar  on  care,â&#x20AC;?  says  Cohen  about  the   RSHUDWLRQRIWKHPHGLFDOORVVUDWLR 0/5 UXOHÂł7RWKHH[WHQWWKDWWKH+6$ dollars  are  actually  expended,  they  will  be  counted  toward  that  80  cents   that  the  insurance  company  has  to  spend.â&#x20AC;?

What Does this all Mean?

- .HYLQ $ 0F.HFKQLH LV ([HFXWLYH 'LUHFWRU RI WKH $PHULFDQ %DQNHUV $VVRFLDWLRQÂśV +6$&RXQFLOFRPSRVHGRILQGXVWU\OHDGHUVGUDZQIURPPHPEHUEDQNVLQVXUHUVDQG WKHLUWHFKQRORJ\SDUWQHUV 7KH +6$ &RXQFLO LV GHGLFDWHG WR SURWHFWLQJ DQG H[SDQGLQJ WKH +6$ LQGXVWU\ WR EHFRPHDPHPEHURUOHDUQPRUHDERXWXVKWWSZZZDEDFRP,VVXHV+6$3DJHV KVDFRXQFLODVS[

www.TheIHCC.com I HealthCare Consumerism Solutionsâ&#x201E;˘ I January/February 2013

23


POPULATION HEALTH MANAGEMENT

BY DR. DEE W. EDINGTON FOUNDER EDINGTON ASSOCIATES

Corporate Wellness: 2013 is Time for an Upgrade

D

DQ(OOLRWWRI5DOSK%HQHÂżWVLQFHQWUDO1HZ<RUN &RUSRUDWHDQGSROLWLFDO informs  individuals  of  potential  debilitating  chronic   disease   that   could   rob   them   of   their   health   and   meets   with   each   employee   and   their   spouse   GXULQJ EHQHÂżWV VHOHFWLRQ SHULRGV WR H[SODLQ OHDGHUVKDYHQHYHUEHHQ retirement  security.â&#x20AC;? $ÂżQDQFLDOWRROIRUIXOO\LQVXUHGFRPSDQLHVZDV their   options.   He   has   a   nearly   100   percent   client   retention   rate   and   close   to   100   percent   employer   VRLQWHUHVWHGLQKRZJRRG created  and  implemented  by  Chris  Hogan  and  Scott   :RRG DW WKH %HQHÂżW &RPPHUFH *URXS LQ 3KRHQL[ satisfaction  rates. KHDOWKFDQLPSDFWFRVWV Their   â&#x20AC;&#x153;Trend   Neutralizerâ&#x20AC;?   system   was   developed   )DFHWRIDFHWLPHEHWZHHQDEHQHÂżWVFRQVXOWDQW to   show   the   50-­250   employee   companies   the   role   and  employees  may  not  seem  like  a  wellness  strategy,   but  it  is  oneâ&#x20AC;&#x201D;if  not  the  bestâ&#x20AC;&#x201D;investment  in  engaging   DQGSURGXFWLYLW\PDNLQJ cost   trend   plays   in   the   calculation   of   future   costs.   HPSOR\HHV DQG WKHLU IDPLOLHV LQ WKHLU EHQHÂżWV DQG QRZDQRSSRUWXQHWLPHWR The  need  for  this  system  arose  from  the  inability  of   the  carriers  to  provide  the  utilization  cost  data.  The   their  health.  Elliottâ&#x20AC;&#x2122;s  approach  is  an  important  step  in   the  right  direction  as  we  strive  to  help  our  corporate   EULQJZHOOQHVVSURJUDPV Trend   Neutralizer   provides   the   underwriter   with   the  opportunity  to  retrospectively  evaluate  a  clientâ&#x20AC;&#x2122;s   clients   establish   a   culture   of   health   within   their   performance   in   seven   areas   that   all   parties   agree   organizations. WRDKLJKHUOHYHORI leads   to   better   outcomes.   If   the   client   performs   Corporate  wellness  initiatives  have  been  around   consistent  with  best  practice,  their  trend  factor  may   for   40   years,   beginning   in   the   early   1970s.   The   HQJDJHPHQW be  reduced  to  zero.  The  carrier  has  none  of  the  risks   early   wellness   programs   and   those   leading   up   to   of   a   prospectively   based   pricing   strategy;Íž   however,   2013   concentrated   on   tactical   individual   behavioral   change.  After  four  decades  of  programming,  it  is  clear  the  results  have  been   the  carrier  is  able  to  reward  the  groups  who  are  doing  what  the  carrier  wants   disappointing  and,  in  fact,  are  stuck  at  a  less-­than-­optimal  position  within   them  to  do  without  having  to  subsidize  the  expenses  for  groups  that  are  not   nearly  every  organization.  There  is  little  to  no  evidence  our  population  is   in  compliance. $ODQ :DQJ DW $),6%HQHÂżWV D EHQHÂżWV DQG ZHOOQHVV FRPSDQ\ LQ healthier  or  more  productive  today  than  when  the  programs  began.   However,  what  has  emerged  is  a  growing  awareness  of  the  potential   Emeryville,  Calif.,  in  considering  the  impact  of  PPACA  to  small  businesses,   of   a   healthy   workforce.   Corporate   and   political   leaders   have   never   been   came   to   the   conclusion   the   employer   will   never   be   absolved   of   the   so   interested   in   how   good   health   can   impact   costs   and   productivity,   responsibility  to  have  a  healthy  workforce  whether  the  employees  get  their   making   now   an   opportune   time   to   bring   wellness   programs   to   a   higher   insurance   from   the   exchanges   or   through   the   employer.   Regardless   the   level   of   engagement.   Realizing   this   opportunity   is   the   responsibility   of   HPSOR\HUZLOOZDQWWRFUHDWHDFXOWXUHRIKHDOWKDQGSURYLGHRWKHUEHQHÂżWVWR LQGLYLGXDOVZKRUHFRPPHQGZHOOQHVVKHDOWKDQGGLVDELOLW\EHQHÂżWGHVLJQV drive  down  costs  and  improve  workplace  effectiveness  because  the  employer   will   have   very   little   control   to   affect   premium   outcome   in   the   exchanges.   to  organizations.   Purchasing  insurance  in  the  traditional  sense  will  likely  result  in  lower  costs   when  the  employer  becomes  engaged  in  promotion  a  culture  of  health. New and Progressive Strategies for 2012 Âł*RRG +HDOWK LV *RRG %XVLQHVV´ KDV DOZD\V EHHQ RXU IRFXV ZKHQ Developing   low-­risk   maintenance   strategies   illustrates   the   type   of   widespread,   culture-­based   thinking   that   is   critical   as   companies   move   working  with  clients  says  David  Rearick  and  Stephen  Cherniak  at  Marsh  &   toward   the   successful   implementation   of   new,   inspired   approaches   to   McLennan  Agency  LLC  in  Atlanta.   We   achieve   that   by   assisting   our   clients   with   a   focus   on   vision   and   helping   individuals   and   the   workplace   thrive   in   a   sustainable   way.   That   opens  the  door  to  Elliottâ&#x20AC;&#x2122;s  approach  to  engaging  employees  in  their  health   environment.   A   vision   from   leadership   that   supports   the   principle   that   DQGEHQHÂżWVFKRLFHVZKLFKSURYLGHVDPDMRUFRPSHWLWLYHHGJHHYHQDJDLQVW â&#x20AC;&#x153;good  health  is  expectedâ&#x20AC;&#x201D;not  hoped  forâ&#x20AC;?;Íž  and  an  environment  that  focuses   on  and  is  supportive  of  the  workforceâ&#x20AC;&#x2122;s  ability  to  do  their  job  and  manage   less  expensive  programs.   An  idea  that  will  gain  traction  over  the  next  few  years  is  focusing  on  the   their  lifestyle.   Finally,  today  it  isnâ&#x20AC;&#x2122;t  about  wellnessâ&#x20AC;&#x201D;it  is  about  well-­being.  We  need   ÂżQDQFLDOZHOOQHVVRIHPSOR\HHV6LPSOLFLW\+HDOWK3ODQKDVGHYHORSHGDWRRO WRKHOSHPSOR\HHVXQGHUVWDQGWKHÂżQDQFLDOLPSOLFDWLRQVRIWKHLUKHDOWKDQG the   objective   data   like   biometrics;Íž   but   a   high   blood   pressure   or   BMI   is   EHQHÂżWVGHFLVLRQVLQDFRPSHOOLQJZD\7KHFRPSDQ\ÂśVKDQGKHOGPRELOHDQG often  the  result  of  an  unhappy  marriage,  someone  with  an  abuse  problem,   web-­based   applications   assess   an   individualâ&#x20AC;&#x2122;s   health   risks   and   behaviors,   ÂżQDQFLDOLQVHFXULW\RUPHQWDOLOOQHVV²WKHVHDUHWKHURRWFDXVHVDQGKXPDQ calculate  the  excess  costs  of  any  risks  and  demonstrate  potential  savings.   resource  challenges  that  every  health  enhancement  strategy  must  look  for   *UHJ +XPPHU 0' DQG &(2 VWDWHV ³WKH +HDOWK ,QGH[ &DOFXODWRU and  address.â&#x20AC;?   24

January/February 2013 I HealthCare Consumerism Solutionsâ&#x201E;˘ 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

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KH FRVW RI SURYLGLQJ DIIRUGDEOH KHDOWK EHQH¿WV WR HPSOR\HHV WRSV HYHU\H[HFXWLYH¶VOLVWRIZRUULHV7KDW¶VZK\FRQVXPHUGULYHQEHQH¿WV including  high-­deductible  health  plans  and  health  savings  accounts,  are   gaining  traction.  These  options  can  help  employers  drive  down  the  cost  of   PDMRUPHGLFDOFRYHUDJHEXWDGGLQJYROXQWDU\EHQH¿WVWRWKHPL[FDQRIIHU even  more  advantages  for  employers  and  employees.

High-deductible Plans are Growing in Popularity Statistics  from  the  Kaiser  Family  Foundation  and  Health  Research  &   Educational   Trust   show   the   number   of   workers   enrolled   in   HDHPs   grew   from  8  percent  in  2009  to  19  percent  in  2012.  These  plans  tend  to  be  more   SRSXODU DPRQJ VPDOOHU ¿UPV XQGHU  HPSOR\HHV  +'+3V DUH RIWHQ offered  in  conjunction  with  HSAs,  tax-­preferred  accounts  employees  can  use   WRSD\IRUTXDOL¿HGPHGLFDOH[SHQVHV How  large  is  the  average  deductible  for  employees  in  todayâ&#x20AC;&#x2122;s  world?   For  those  with  HDHPs,  it  was  nearly  $2,100  in  2012.  Overall,  34  percent   of   employees   have   an   average   deductible   of   $1,000   or   more   for   single   coverageâ&#x20AC;&#x201D;a  number  that  has  tripled  since  2006. Increasing  the  deductible  on  a  company  health  plan  can  help  employers   VLJQL¿FDQWO\ ORZHU WKHLU FRVW IRU PDMRU PHGLFDO FRYHUDJH %XW UDLVLQJ GHGXFWLEOHVSXWDGGLWLRQDO¿QDQFLDOEXUGHQRQHPSOR\HHV,IQRWPDQDJHG and  communicated  properly,  such  a  move  can  be  highly  unpopular  with  the   employee  population.  

Voluntary Products Can Pair Nicely With HDHPs To  help  offset  the  high  deductibles  workers  face  with  an  HDHP,  many   employers  have  turned  to  voluntary  products  for  a  much-­needed  solution.   Though   voluntary   products   are   typically   employee-­paid,   employers   often   ¿QGWKH\FDQSD\IRUDOORUSDUWRIWKHVHEHQH¿WVIURPWKHFRVWVDYLQJVWKH\ realize  from  redesigning  their  health  plans. No   matter   who   pays   the   premium,   voluntary   products   can   help   offset   the   deductibles,   co-­insurance   and   other   out-­of-­pocket   medical   and   nonmedical  costs  associated  with  hospital  stays,  injuries  and  illnesses.  By   offering  employees  a  soft  landing  with  a  voluntary  product,  employers  are   able  to  take  the  edge  off  the  increased  deductible  associated  with  an  HDHP.  

What Types of Voluntary Products Work well with High-deductible Health Plans There  are  several  types  of  voluntary  products  complementing  HDHPs,   and  many  of  these  plans  are  HSA-­compliant. Â&#x2021; +RVSLWDO FRQ¿QHPHQW LQGHPQLW\ LQVXUDQFH   Voluntary   KRVSLWDO FRQ¿QHPHQW FRYHUDJH KHOSV SD\ WKH QRQPHGLFDO DQG medical  out-­of-­pocket  expenses  related  to  a  hospital  stay. Â&#x2021; Cancer  and  critical  illness  insurance:  Employees  diagnosed   with  cancer  or  another  covered  critical  illness,  such  as  a  stroke  

RUKHDUWDWWDFNFDQXVHWKHSODQ¶VEHQH¿WVWRKHOSSD\IRUKHDOWK insurance   deductibles   and   copayments   as   well   as   nonmedical   expenses. Â&#x2021; Accident  insurance:$FFLGHQWLQVXUDQFHSD\VEHQH¿WVZKHQDQ insured   is   injured   as   a   result   of   a   covered   accident   â&#x20AC;&#x201D;   injuries   such   as   joint   dislocations,   broken   bones,   burns,   lacerations   DQGUXSWXUHGGLVFV(PSOR\HHVFDQXVHWKHEHQH¿WVWRKHOSSD\ for   nonmedical   and   medical   out-­of-­pocket   expenses   such   as   deductibles  and  copayments  resulting  from  a  covered  accident.

Donâ&#x20AC;&#x2122;t Overlook the Importance of Benefits Communication When  employees  are  faced  with  picking  up  the  tab  for  a  larger  portion   of  their  medical  expenses,  they  need  help  understanding  why  changes  were   made   and   how   their   coverage   is   impacted.   Thatâ&#x20AC;&#x2122;s   why   offering   clear   and   HIIHFWLYHEHQH¿WVFRPPXQLFDWLRQLVPRUHLPSRUWDQWWKDQHYHU Choosing   a   voluntary   carrier   offering   complimentary   one-­to-­one   counseling   as   part   of   its   enrollment   services   help   employees   understand   WKHFKDQJHVPDGHWRWKHLUEHQH¿WVDQGWKHQHZRSWLRQVDYDLODEOHWRWKHP$ SURYLGHUWKDWFDQHQUROODOOHPSOR\HHEHQH¿WVLQFOXGLQJFRUHEHQH¿WVDOVR removes  a  major  hassle  for  the  employer. ,Q IDFW VXUYH\V RI HPSOR\HHV ZKR PHHW LQGLYLGXDOO\ ZLWK EHQH¿WV counselors   during   their   enrollments   prove   the   effectiveness   of   the   one-­ WRRQH PHWKRG 9LUWXDOO\ DOO HPSOR\HHV  SHUFHQW  VXUYH\HG E\ &RORQLDO /LIHVD\SHUVRQDOEHQH¿WVFRXQVHOLQJLPSURYHGWKHXQGHUVWDQGLQJRIWKHLU EHQH¿WVDQGSURYLQJWKLVW\SHRIFRPPXQLFDWLRQLVLPSRUWDQW SHUFHQW  (PSOR\HUV DOVR ¿QG YDOXH LQ RQHWRRQH EHQH¿WV FRXQVHOLQJ $OPRVW  SHUFHQW RI HPSOR\HUV EHOLHYH SHUVRQDO EHQH¿WV FRXQVHOLQJ VHVVLRQV VWURQJO\LPSURYHHPSOR\HHV¶XQGHUVWDQGLQJRIWKHLUEHQH¿WVDQGFRYHUDJH needs.

The Role of Employers is Changing 7KH PRYH WRZDUG FRQVXPHUGULYHQ EHQH¿WV FKDQJHV WKH UROH RI employers.  No  longer  are  they  always  providing  and  paying  for  traditional   EHQH¿WV ,QVWHDG WRGD\¶V HPSOR\HUV PXVW QRZ SURYLGH DFFHVV WR DQ DUUD\ RITXDOLW\EHQH¿WV²ERWKFRUHDQGYROXQWDU\$QGWRNHHSHPSOR\HHVKDSS\ DQGHQJDJHGWKH\PXVWSURYLGHHIIHFWLYHEHQH¿WVFRPPXQLFDWLRQKHOSLQJ ZRUNHUVEHWWHUXQGHUVWDQGDQGDSSUHFLDWHWKHEHQH¿WVWKH\¶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\¶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&#x201E;¢ I January/February 2013

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PHARMACY BENEFIT MANAGEMENT

BY SUMIT DUTTO SENIOR VICE PRESIDENT AND OFFICER CATAMARAN

Pharmacy Benefit Management Business Adapting to Demand for Specialty Medications

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KHSKDUPDF\EHQH¿WVPDQDJHPHQW 3%0 EXVLQHVVFDQEHGLI¿FXOWWR understand.  This  is  especially  true  during  periods  of  transition,  like   now,  when  the  health  care  industry  is  adapting  to  dramatic  changes.   7KH PRVW VLJQL¿FDQW LQFOXGH LQFUHDVLQJ GHPDQG IRU VSHFLDOW\ SKDUPDF\ medications,  changes  stemming  from  the  Affordable  Care  Act,  and  shifts   toward   value/outcomes-­based   payment   models   and   dynamic   provider   care  delivery  models.  Employers,  TPAs  and  managed  care  executives  are   all   carefully   examining   these   areas   to   ensure   they   are   prepared   for   the   future  consumer-­centric  health  care  environment.

touch   clinical   programs.   BriovaRx   has   specialty   pharmacies   in   locations   throughout  the  United  States,  which  serve  to  promote  close  relationships   with  providers  and  patients  regionally.  

Outcomes Focus

The   United   States   spends   more   money   per   person   on   health   care   than   any   other   prosperous   nation   in   the   world,   yet   the   health   care   outcomes   are   not   necessarily   better.   This   situation   is   leading   a   push   toward   developing   new   payment   models   that   reward   positive   outcomes   or   penalize   negative   ones.   In   2012,   Medicare   &DWDPDUDQÂśVUHVSRQVHLVWR   began   adjusting   downward   reimbursement   Health Care Reform for   hospitalizations   for   three   conditions:   There  are  more  than  48  million  uninsured   IRFXVRQFOLQLFDORIIHULQJVWKDW rates   heart   attack,   heart   failure   and   pneumonia.   Americans   today.   Although   many   of   the   uninsured  are  working,  some  employers  may  not   DOORZĂ&#x20AC;H[LELOLW\IRUSKDUPDF\ Managed  care  organizations  are  experimenting   with   new   contracting   models   with   accountable   offer  health  insurance  or  employees  may  not  be   eligible.  We  know  the  uninsured  are  more  likely   EHQHÂżWVHUYLFHVWREHGHOLYHUHG care   organizations   to   reimburse   based   on   new   outcome   measures.   Catamaran   is   partnering   to  forego  health  care  services  when  they  are  ill,   but  starting  in  2014,  nearly  all  Americans  will  be   ZKHUHEHQHÂżFLDULHVFKRRVHWR with  its  clients  to  provide  pharmacy  information   and   reporting   to   their   membersâ&#x20AC;&#x2122;   physicians   to   required  to  obtain  health  care  insurance.  For  the   HQJDJHLQGHSHQGHQWRIGUXJ   support  these  new  contracts.   working   uninsured,   if   their   employer   does   not   As   we   move   forward   in   this   evolution   offer  a  plan,  employees  will  be  able  to  purchase   GLVWULEXWLRQFKDQQHOVXFKDV   of   health   care,   Catamaran   is   continuously   insurance  through  a  health  care  exchange.   focused   on   bringing   more   value   to   the   clients   7KLVLQĂ&#x20AC;X[RIQHZFRQVXPHUVRIKHDOWKFDUH UHWDLOLQGHSHQGHQW   we   serve.   Recent   investments   include   mobile   ZLOO DIIHFW KRZ KHDOWK FDUH LQVXUDQFH EHQHÂżWV technologies   that   provide   smart   phone   users   are   structured,   but   not   just   for   the   previously   FKDLQRUPDLOVHUYLFH   with   myriad   capabilities   such   as   medication   uninsured.   Catamaranâ&#x20AC;&#x2122;s   response   is   to   focus   adherence   reminders,   drug   interaction   alerts   RQ FOLQLFDO RIIHULQJV WKDW DOORZ Ă&#x20AC;H[LELOLW\ IRU SKDUPDFLHV and  information  on  cost-­effective  medications.   SKDUPDF\EHQHÂżWVHUYLFHVWREHGHOLYHUHGZKHUH We  also  utilize  patient  risk  scoring  models   EHQHÂżFLDULHV FKRRVH WR HQJDJH LQGHSHQGHQW RI drug   distribution   channel   such   as   retail,   independent,   chain   or   mail   in   order   to   better   allocate   our   clientsâ&#x20AC;&#x2122;   health   care   dollar   on   patient   engagement  that  is  more  likely  to  bring  near-­time  value.  Catamaran  offers   service  pharmacies. D WUXH DOWHUQDWLYH WR WKH VWDWXV TXR LQ SKDUPDF\ EHQHÂżW PDQDJHPHQW DQG GHOLYHUV LQQRYDWLRQ Ă&#x20AC;H[LELOLW\ DQG SRZHUIXO UHVXOWV $V ZH FRQWLQXH Specialty Trend For   many   payers,   specialty   drug   trend   exceeded   20   percent   in   to   closely   monitor   industry   dynamics,   our   focus   remains   on   building   a   2012,  and  this  included  drugs  where  the  average  annual  costs  are  tens  of   Ă&#x20AC;H[LEOH \HW FRPSUHKHQVLYH VHW RI SURJUDPV WR VXSSRUW WKH GHOLYHU\ RI thousands  of  dollars.  In  fact,  specialty  drugs  can  even  reach  hundreds  of   HVVHQWLDOKHDOWKEHQHÂżWVIRURXUFOLHQWV thousands   of   dollars   annually   on   the   extreme   end   of   the   cost   spectrum.   Large  PBMs  have  dedicated  specialty  pharmacy  divisions,  like  Catamaranâ&#x20AC;&#x2122;s   'U 6XPLW 'XWWD LV UHVSRQVLEOH IRU FOLQLFDO SURGXFWV VHUYLFHV DQG PHGLFDO DIIDLUV DQGOHDGVRYHUDOOKHDOWKFDUHVWUDWHJ\DW&DWDPDUDQ+HKHDGVWKHWHDPUHVSRQVLEOH BriovaRx  Specialty  Pharmacy,  to  help  payers,  providers  and  patients,  with   IRU WKH GHYHORSPHQW RI &DWDPDUDQÂśV FOLQLFDO SURJUDPV FOLQLFDO UHSRUWLQJ GUXJ LQIRUPDWLRQSXEOLFDWLRQVIRUPXODU\PDQDJHPHQWSURFHVVDQGSURIHVVLRQDOSUDFWLFHV the  complexities  involved  in  managing  these  expensive  medications.   The   strategies   employed   by   specialty   pharmacies   to   manage   rising   &DWDPDUDQ WKH LQGXVWU\ÂśV IDVWHVWJURZLQJ SKDUPDF\ EHQHILW PDQDJHU KHOSV drug   trends   include   narrowing   the   specialty   pharmacy   distribution   RUJDQL]DWLRQV DQG WKH FRPPXQLWLHV WKH\ VHUYH WDNH FRQWURO RI SUHVFULSWLRQ GUXJ FRVWV 0DQDJLQJ PRUH WKDQ  PLOOLRQ SUHVFULSWLRQV HDFK \HDU RQ EHKDOI RI  network,   prior   authorization   and   step   therapy,   determining   appropriate   PLOOLRQPHPEHUVWKHFRPSDQ\ÂśVIOH[LEOHKROLVWLFVROXWLRQVLPSURYHSDWLHQWFDUHDQG plan   design,   preferred   products   in   certain   specialty   classes   and   high   HPSRZHULQGLYLGXDOVWRWDNHFKDUJHRIWKHLUKHDOWK

26

January/February 2013 I HealthCare Consumerism Solutionsâ&#x201E;˘ 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

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Another  incentive  is  cash  rewards  for  proof  an  employee  has  had  his   ellness  programs  are  here  to  stay.  There  are  many  different  types   and  paths  to  follow,  each  company  needs  to  strongly  look  at  what   or  her  annual  physical  and  all  testing  associated  with  the  exam.  This  is   not  meant  to  be  invasive  or  intrude  on  someoneâ&#x20AC;&#x2122;s  privacy,  but  it  is  used   they  need  for  a  wellness  plan.  What  results  are  they  after? Telemedicine   also   is   an   up-­and-­coming   strategy   used   by   many   as  a  method  to  prove  the  employee  has  complied.   Staying  with  the  cash  theme,  we  have  seen  a  remarkable  employer   successful   companies   to   improve   employee   satisfaction   both   at   home   incentive   where   they   offered   $50   for   every   and   work.   A   major   question   is   how   you   get   pound  lost  and  kept  off  during  a  contest  time   employees  to  actively  engage  in  both  wellness   $QRWKHULQFHQWLYHLVFDVK frame.   One   employee   received   a   check   for   and   telemedicine   for   productive   results.   almost   $1600!   Now   thatâ&#x20AC;&#x2122;s   taking   wellness   One   of   the   most   successful   approaches   is   UHZDUGVIRUSURRIDQ seriously!  The  above  incentive  also  works  well   actually   having   a   wellness/telemedicine   team   where   the   employee   receives   a   gift   card   for   established  on-­site  at  the  employer  group. HPSOR\HHKDVKDGKLVRU completing  a  health  risk  assessment.  It  is  important  to  choose  individuals  who   Based   on   the   common   promotion   of   have   power   or   the   respect   of   the   employees.   KHUDQQXDOSK\VLFDODQGDOO health   reimbursement   accounts   within   group   Respect  is  the  key  factor.  In  this  way  it  is  easier   WHVWLQJDVVRFLDWHGZLWKWKH KHDOWK EHQHÂżWV ZH KDYH VHHQ HPSOR\HUV XVH to  engage  all  the  other  employees.  By  having  a   checklists   where   employees   get   points   for   team  of  employees  put  together  to  coordinate   H[DP7KLVLVQRWPHDQWWR completing   items.   The   more   points   they   get   activities,  it  becomes  a  more  managed  process.   the   greater   reimbursement   they   receive   from   Setting   up   schedules   for   the   months   EHLQYDVLYHRULQWUXGHRQ their   HRA.   Itâ&#x20AC;&#x2122;s   a   positive   program,   and   the   ahead   also   served   to   increase   engagement.   always  know  where  they  stand  with   Posters  in  the  lunch  rooms  or  common  meeting   VRPHRQHÂśVSULYDF\EXWLWLV employees   their  HRA  bank.   places   of   the   employees   should   be   placed   as   Telemedicine   has   and   will   continue   ZHOO DV QRWLFHV WKURXJK LQWHURIÂżFH PDLO $OO XVHGDVDPHWKRGWRSURYHWKH to   reduce   health   care   claims.   Therefore   this  correspondence  is  put  together  to  get  the   employers   use   incentives   here   as   well   to   word  out,  but  it  must  be  communicated  by  the   HPSOR\HHKDVFRPSOLHG increase  engagement.  Once  it  is  communicated   wellness/telemedicine  teams  to  the  employees.   properly   in   a   group   setting   and   through   Some  groups  have  actually  implemented  a  cost   written   communication,   employees   will   approach   whereas   the   employee   would   pay   more  if  they  donâ&#x20AC;&#x2122;t  comply  to  a  wellness  plan,  such  as  quitting  smoking   understand  this  method.  No  longer  will  they  need  to  leave  work  in  the   or   entering   into   a   weight   cessation   program.   This   may   be   seen   as   middle  of  the  day  to  take  a  sick  child  to  the  doctor.  When  used  properly,   FRXQWHUSURGXFWLYH WR WU\LQJ WR LQFUHDVH SDUWLFLSDWLRQ DQG EDFNÂżUH ZLWK most   employers   will   reimburse   a   portion   of   the   expense   to   utilize   this   technology  as  an  incentive  to  increase  usage.  We  have  seen  rewards  given   regard  to  results. Here   are   some   of   the   most   effective   methods   seen   to   engage   to  employees  at  the  end  of  the  year  when  they  can  see  the  reduction  in   employees   in   wellness   plans.   One   large   automotive   dealership,   emergency  room  visits.   As   you   can   see,   money   talks   and   will   continue   to   do   so   as   the   with   multiple   locations,   started   a   few   years   ago   by   installing   on-­site   gymnasiums   for   employee   use.   Not   a   full-­blown   gymnasium,   but   a   primary  incentive  to  engage  employees    in  these  phenomenal  programs.   treadmill,   exercise   bike   lightweights   and   basic   weight   training.   The   3URPRWLQJ D KHDOWKLHU DQG PRUH VDWLVÂżHG ZRUNIRUFH LQ DGGLWLRQ WR treadmill   is   even   equipped   with   a   platform   for   a   laptop   computer   to   reducing  stress,  will  go  a  long  way  toward  bending  the  health  cost  curve   and  reducing  health  care  expenses.   PD[LPL]HZRUNHIÂżFLHQF\

www.TheIHCC.com I HealthCare Consumerism Solutionsâ&#x201E;˘ I January/February 2013

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THE VA PRIVATE EX

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28 January/February 2013 I HealthCare Consumerism Solutions™ I www.TheIHCC.com


LUE OF XCHANGES

G&RQWULEXWLRQ

BY ERNIE HARRIS » CHIEF STRATEGY OFFICER WORKABLE SOLUTIONS

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uch   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   FRVWHIIHFWLYH DQG KDYH EHQH¿WHG HPSOR\HUV DQG HPSOR\HHV DOLNH ZLWKRXW burdening  taxpayers. The   value   of   an   exchange,   public   or   private,   goes   well   beyond   the   LQWURGXFWLRQ RI D GH¿QHG FRQWULEXWLRQ DFFRXQW WKDW DOORZV HPSOR\HUV WR better  manage  their  portion  of  health  care  costs.  Exchanges,  or  perhaps  a   PRUHDSSURSULDWHWHUPZRXOGEHRQOLQHEHQH¿WVPDUNHWSODFHVRIIHUYDOXH WRPXOWLSOHSDUWLHVLQDGGLWLRQWRGH¿QHGFRQWULEXWLRQDFFRXQWV www.TheIHCC.com I HealthCare Consumerism Solutionsâ&#x201E;¢ I January/February 2013

29


Costs are on the rise Controlling  health  care  costs  is  a  responsibility  that  falls  on  all  of  us:   individuals,   employers   and   insurance   carriers.   Similar   to   the   process   of   managing   budgets   for   your   department,   your   company   or   your   personal   household,  two  of  the  foundational  requirements  for  managing  health  care   FRVWVDUHDFFHVVWRLQIRUPDWLRQDQGHI¿FLHQF\

Online Benefits Marketplace Values Employer Benefits

s /NLINE ENROLLMENT FOR ALL EMPLOYERS FROM TWO TO  MILLION LIVES s #ONSOLIDATED BILLING FOR ALL BENElTSÂ&#x2C6; ONE INVOICE ONE PAYMENT s 2EDUCED BENElTS ADMINISTRATION COSTS

Employee Benefits

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

Carrier Benefits

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  target  employers  with  more  than  1,000  employees.  This  is  due   in   large   part   to   the   inherent   complexity   of   these   systems   and   the   costs   associated  with  implementing  them.   3ULYDWHEHQHÂżWVPDUNHWSODFHVDOVRSURYLGHDFRVWHIIHFWLYHDOWHUQDWLYH IRUVPDOODQGPLGVL]HGHPSOR\HUVZKRGHVSHUDWHO\ZDQWWKHHIÂżFLHQFLHV of  an  electronic  system  but  cannot  afford  the  high  costs  of  the  solutions   JHQHUDOO\DYDLODEOHLQWKHPDUNHW %\ DJJUHJDWLQJ EHQHÂżWV RIIHULQJV DFURVV D ODUJH SRSXODWLRQ RI HPSOR\HUVSULYDWHEHQHÂżWVPDUNHWSODFHVSURYLGHPXFKWKHVDPHĂ&#x20AC;H[LELOLW\ available  today  for  large  employers  for  a  fraction  of  the  cost.   According  to  the  U.S.  Census  Bureauâ&#x20AC;&#x2122;s  2010  report,  there  are  more   than  5.734  million  employers  in  the  U.S.â&#x20AC;&#x201D;5.725  million  of  them  employ   fewer   than   1,000.   These   employers   represent   99.8   percent   of   the   total   number  of  employers  in  the  U.S.  and  employ  60.9  million  individuals  or   SHUFHQWRIWKHZRUNIRUFH $V DQ HPSOR\HU RXWVRXUFLQJ EHQHÂżWV HOLJLELOLW\ HQUROOPHQW maintenance  and  billing  saves  an  average  of  $165  per  employee  per  year.   1DWLRQDOO\ VPDOO DQG PLGPDUNHW HPSOR\HUV VWDQG WR VDYH a%1 DQQXDOO\E\PRYLQJWREHQHÂżWVPDUNHWSODFHV

Show Me the Money Employers   can   save   13   percent   or   more   by   moving   to   a   private   EHQHÂżWV PDUNHWSODFH LQ SHU HPSOR\HH EHQHÂżWV DGPLQLVWUDWLRQ IHHV DQG SURYLGHWKHLUHPSOR\HHVZLWKDPRGHUQDQGLQIRUPDWLYHEHQHÂżWVVKRSSLQJ and   management   experience.   For   the   average   company   employing   100   people,   thatâ&#x20AC;&#x2122;s   a   savings   of   almost   $2,000   per   year   in   administrative   FRVWV IRU GRLQJ VRPHWKLQJ WKDW \RXU HPSOR\HHV ZLOO VHH DV D PDUNHG improvement  over  the  traditional  paper  enrollment  process.

Convenience %H\RQG WKH VDYLQJV DVVRFLDWHG ZLWK EHQHÂżWV DGPLQLVWUDWLRQ WKH SULYDWH EHQHÂżWV PDUNHWSODFH DOVR FDQ RIIHU D FRQVROLGDWHG LQYRLFH IRU DOO 30

January/February 2013 I HealthCare Consumerism Solutionsâ&#x201E;˘ I www.TheIHCC.com

PDQDJHG EHQHÂżWV DOORZLQJ WKH HPSOR\HU WR PDNH D VLQJOH SD\PHQW )RU most   small   employers   remitting   payment   to   multiple   providers   monthly   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,  all  activity  can  be  monitored  and  all  participants  can  be  managed  in   a  single  place  providing  consolidated  access  to  all  the  information  required   by  the  employerâ&#x20AC;&#x2122;s  leadership  team.

Employee Benefits Individuals   continue   to   feel   the   costs   associated   with   increased   insurance  premiums  every  year.  According  to  the  Kaiser  Family  Foundation    $QQXDO 5HSRUW RQ (PSOR\HU +HDOWK %HQHÂżWV HPSOR\HHV KDYH experienced  a  102  percent  increase  in  premium  costs  since  2002.  Although   heath   care   insurance   providers   often   are   maligned   as   being   driven   only   by   cost   and   not   by   compassion,   they   too   have   serious   challenges.   An   LQVXUDQFH FRPSDQ\ LV LQ WKH EXVLQHVV RI PDQDJLQJ ULVN DQG SURYLGLQJ protection   to   the   insured   against   unforeseen   events   that   may   occur   at   some  point  in  the  future.  This  is  where  the  individual  can  help  themselves,   their  employers  and  even  their  insurance  providers. Fifty  years  ago,  individuals  bought  health  insurance  in  much  the  same   manner  as  they  did  auto,  life  or  disability.  They  purchased  pure  insurance   which,  according  to  Merriam-­Webster  is:  ³FRYHUDJHE\FRQWUDFWZKHUHE\ RQHSDUW\XQGHUWDNHVWRLQGHPQLI\RUJXDUDQWHHDQRWKHUDJDLQVWORVVE\ DVSHFLÂżHGFRQWLQJHQF\RUSHULO´ Insurance   is   not   a   vehicle   to   manage   the   day-­to-­day   expenditures   DVVRFLDWHGZLWKWKHÂłQRUPDOFRXUVHRIDFWLRQ´+RZHYHUWKLVLVZKDWKHDOWK insurance  has  evolved  into  over  the  past  50  yearsâ&#x20AC;&#x201D;a  payment  plan  more   WKDQDPDQDJHURIULVN

General Insurance

s ! TOOL TO PROTECT AGAINST FUTURE UNFORSEEN EVENTS s !UTO s (OME s ,IFE s $ISABILITY

Health Insurance

s ! TOOL COMMONLY USED TO EQUALIZE THE PAYMENT FOR ALL HEALTH CARE ACTIVITY FROM ROUTINE TO UNFORSEEN

6RZKDWFDQDQLQGLYLGXDOGRWRXQZLQGÂżYHGHFDGHVRIFKDQJH",WÂśV simple;Íž  be  an  active  consumer  of  health  care. Consumerism   is   the   fundamental   force   that   aligns   commercial   SURYLGHUVZLWKWKHPDUNHW V WKH\VHUYH7RGD\PRVWSHRSOHGRQÂśWNQRZ how  much  health  care  actually  costsâ&#x20AC;&#x201D;itâ&#x20AC;&#x2122;s  funny  money  because  under  the   PDQDJHGFDUHPRGHOZHDVDVRFLHW\DUHQRWUHTXLUHGWRNQRZ$OOZHNQRZ is   that   we   need   health   insurance   and   it   should   cover   whatever   we   need.   ,I LW GRHVQÂśW ZH WKLQN LW LV EHFDXVH WKH LQVXUDQFH FRPSDQLHV DUH JUHHG\ Insurers   are   not   necessarily   greedy   but   they   are   businesses   that   must   SURYLGHDVHUYLFHWKDWLVÂżQDQFLDOO\YLDEOHRUWKH\FHDVHWRH[LVW A   2011   survey   of   hospital   emergency   room   costs   reported   the   cost   RI DQ (5 YLVLW UDQJHG IURP  WR  RU PRUH  GHSHQGLQJ RQ WKH severity.  The  report  divided  the  range  of  visits  into  three  categories,  low-­ level,   moderate-­level   and   high-­level   with   no   hospital   reporting   a   cost   of   less   than   $150   for   a   low-­level   visit.   For   those   with   a   comprehensive   PHGLFDOSODQDQ(5YLVLWPLJKWUHTXLUHDRUFRSD\ZLWKDQ\FRVW beyond  that  paid  for  by  the  insurance  company  and  seen  as  â&#x20AC;&#x153;freeâ&#x20AC;?  by  the   consumer.  A  great  plan  for  the  consumer,  but  not  necessarily  a  long-­term   ÂżQDQFLDOO\YLDEOHVROXWLRQIRUWKHLQVXUHU


What are the Alternatives? <RXFDQÂśWJRZLWKRXWWKHFDUH\RXQHHG$ÂżYHPLQXWHUHVHDUFKSURMHFW revealed   two   alternatives   for   low-­level   needs   in   my   area,   both   of   which   happen  to  be  national  programs.  CVS  and  Walgreens  both  offer  in-­store   health  clinic  services  with  many  open  24  hours.  Fees  range  from  $79  to   $89   for   a   â&#x20AC;&#x153;routineâ&#x20AC;?   visitâ&#x20AC;&#x201D;nearly   half   of   the   lowest   reported   cost   to   visit   DQ(5)RUWKRVHZLWKDKLJKGHGXFWLEOHKHDOWKSODQWKLVZRXOGEHDPRUH FRVWHIIHFWLYHDSSURDFKIRUURXWLQHQHHGVRYHUWKH(5

Managing Out-of-pocket Costs (YHQ ZLWK PRUH FRVWHIIHFWLYH RSWLRQV DYDLODEOH PDQ\ RI XV MXVW canâ&#x20AC;&#x2122;t  afford  to  bear  the  cost  of  health  care  needs  as  budgets  are  tight  in   a   down   economy;Íž   another   reason   many   families   gravitate   toward   more   comprehensive  health  plans.  There  are  other  options  though,  some  which   may  surprise  you. The  Kaiser  annual  report  provides  estimates  for  the  national  average   cost  of  health  care  by  plan  type.  In  2012,  a  family  paid  an  estimated  $4,563   SHU\HDUIRUDWUDGLWLRQDO+02ZKHUHDVWKHVDPHIDPLO\ZRXOGKDYHSDLG DQ HVWLPDWHG  IRU D TXDOLÂżHG KLJKGHGXFWLEOH SODQ +'+3 ²D GLIIHUHQFH RI  SHU \HDU )RU WKRVH IDPLOLHV WKDW HQUROO LQ TXDOLÂżHG high-­deductible  plans,  they  also  can  participate  in  a  health  savings  account   RU +6$ ,Q  IDPLOLHV FDQ FRQWULEXWH XS WR  SUHWD[ WR WKHLU +6$)RUDUHODWLYHO\KHDOWK\IDPLO\HQUROOLQJLQDQ+'+3DQGDQ+6$ would  allow  that  family  to  save  potentially  $843  per  year  with  no  change   LQ KLVWRULFDO RXWRISRFNHW IHHV 6LQFH PRVW +'+3V FRYHU SUHYHQWDWLYH U.S. Employer Data - Number and Size 2010 U.S. Census Data 4,000,000

40,000,000

3,500,000

35,000,000

3,000,000

# of Employers

30,000,000

2,500,000

25,000,000

2,000,000

20,000,000

Benefits Marketplaces )LJXULQJRXWDOOWKHRSWLRQVDQGSLFNLQJWKHEHVWKHDOWKSODQIRU\RXU VLWXDWLRQLVQRHDV\WDVN7KDWœVZKHUHEHQH¿WVPDUNHWSODFHVFDQKHOSWKH individual  employee.  They  provide  a  consolidated  health  portal  integrating   GHFLVLRQVXSSRUW WRROV WDLORUHG WR DQ LQGLYLGXDOœV VSHFL¿F QHHGV SODQ comparison   tools   and   integrated   access   to   health   care   reimbursement   DFFRXQWVOLNH+6$VDQG)6$V7KHVHPDUNHWSODFHVDUHDRQHVWRSVKRSIRU DOOWKHQHHGVDQLQGLYLGXDOPD\KDYHDQGLWJRHVEH\RQGPDMRUPHGLFDO 0DQ\ EHQH¿WV PDUNHWSODFHV DOVR DOORZ LQGLYLGXDOV WR UHYLHZ DQG HQUROO LQDQFLOODU\EHQH¿WVDVZHOOVXFKDVGHQWDOYLVLRQGLVDELOLW\DQGHYHQSHW insurance.

Carrier Benefits :KLOHWKHEHQH¿WVIRUHPSOR\HUVDQGHPSOR\HHVDUHVLJQL¿FDQWWKHUHœV VRPHWKLQJ IRU LQVXUDQFH FDUULHUV DV ZHOO :LWK QHZ OHJLVODWLRQ PHGLFDO ORVVUDWLRRU0/5UXOHV UHTXLULQJFDUULHUVWR¿[WKHLUDGPLQLVWUDWLYHFRVWV coming   online,   many   providers   are   searching   for   ways   to   reduce   costs.   3ULYDWH EHQH¿WV PDUNHWSODFHV RIIHU UHOLHI IRU VRPH RI WKH URXWLQH FRVWV currently  born  by  the  carrier.

Universal Electronic Enrollment 7RGD\ PRVW FDUULHUV SURYLGH HOHFWURQLF HQUROOPHQW WR ODUJH PDUNHW employers   but   the   relationship   is   typically   one-­to-­one   between   the   employer   and   the   carrier.   As   such,   carriers   have   been   reluctant   to   offer   WKLV VHUYLFH GRZQPDUNHW EHFDXVH RI WKH LQFUHDVH LQ VXSSRUW FRVWV associated   with   managing   thousands   if   not   hundreds   of   thousands   of   HQUROOPHQWIHHGV7KLVLVZKHUHWKHEHQH¿WVPDUNHWSODFHKHOSVWKHPRVW 7KHPDUNHWSODFHDFWVDVDQDJJUHJDWRURIHQUROOPHQWDFWLYLW\SUHVHQWLQJ LWVHOIDVDMXPERHPSOR\HUWRWKHFDUULHU7KLVDOORZVWKHFDUULHUWRVKLIW the   responsibility   of   managing   the   hundreds   of   thousands   of   individual   UHODWLRQVKLSV WR WKH PDUNHWSODFH DQG UHDS WKH EHQH¿W RI VXEVWDQWLDOO\ increased  electronic  enrollment. )RUWKHLUSDUWWKHPDUNHWSODFHDOUHDG\KDVWKHH[SHUWLVHWRPDQDJH this  type  of  interaction  and  delivers  value  to  the  employer  in  the  form  of   an  online,  electronic  shopping  and  enrollment  experience.

Billing and Commissions Payments 1,500,000

15,000,000

1,000,000

10,000,000

500,000

5,000,000

-

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   events   that   may   arise.   Families   also   have   the   option   to   contribute   additional  monies  above  the  $833  to  cover  routine  costs  that  are  covered   WRGD\E\Ă&#x20AC;H[LEOHVSHQGLQJDFFRXQWV )6$ DQGVDYHXSWRSHUFHQW7KLV LV MXVW RQH RSWLRQ DQG RQH VFHQDULR 1RW DOO LQGLYLGXDOV ZLOO UHFHLYH WKH VDPHÂżQDQFLDOEHQHÂżWVDVHDFKVLWXDWLRQLVXQLTXH

7KHPDUNHWSODFHDOVRDFWVDVWKHFHQWUDOL]HGELOOLQJVROXWLRQIRUDOO providers.  It  provides  a  single  invoice  to  the  group  and  remits  premium   SD\PHQWV WR WKH EHQH¿WV SURYLGHU V  0DQ\ PDUNHWSODFHV DOVR KDYH WKH DELOLW\ WR GLVEXUVH EURNHU FRPPLVVLRQ SD\PHQWV 3UHPLXP ELOOLQJ DQG commissions  payments  are  two  large  cost  items  in  any  carriers  operating   EXGJHWERWKRIZKLFKFDQEHKDQGOHGE\WKHEHQH¿WVPDUNHWSODFH

The Good, the Bad and the Healthy 5HJDUGOHVV RI \RXU LQGLYLGXDO SRVLWLRQ RQ KHDOWK FDUH UHIRUP RQH thing  is  clear:  individuals  and  their  employers  continue  to  feel  the  crunch   of  increasing  health  care  costs.  There  are  certainly  many  potential  options   WRPDQDJHWKHVHLQFUHDVHVRYHUWLPHEXWSULYDWHEHQHÂżWVPDUNHWSODFHVDUH available  today  and  promise  to  deliver  at  least  some  relief.  As  the  ancient   proverb  says,  â&#x20AC;&#x153;A  bird  in  the  hand  is  worth  two  in  the  bush.â&#x20AC;?    

Employer Size

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Defined Contribution Model, Private Exchanges Shifting Power to Consumers BY DAVID URBANIAK » PRODUCT MANAGER » EVOLUTION1

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January/February 2013 I HealthCare Consumerism Solutions™ I www.TheIHCC.com


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KDOOHQJLQJ HFRQRPLF WLPHV LQ WKH 8QLWHG 6WDWHV KDYH KDG DQ LPSDFW RQ QHDUO\ HYHU\ $PHULFDQ )RU PLOOLRQV RI SHRSOH KHDOWK FDUH²DQG LWV UHODWHG FRVWV²DUH D VLJQL¿FDQW ¿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 GH¿QHG FRQWULEXWLRQPRGHOZKHUHWKHHPSOR\HUPDNHVD¿[HGGROODUFRQWULEXWLRQ WRHDFKHPSOR\HH(PSOR\HHVWKHQXVHWKDWPRQH\WRSXUFKDVHLQVXUDQFH PDNLQJLQGLYLGXDOFRVWEDVHGGHFLVLRQVDERXWWKHW\SHRILQVXUDQFHWKDW EHVWPHHWWKHLUXQLTXHQHHGV 7KHGH¿QHGFRQWULEXWLRQPRGHODOORZVHPSOR\HUVWRVHWWKHLUDQQXDO EHQH¿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 FRYHUUHPDLQLQJSUHPLXPDPRXQWVDVZHOODVRWKHUHOLJLEOHRXW±RISRFNHW H[SHQVHV 6RXQGVUHYROXWLRQDU\ULJKW"1RWHQWLUHO\ Defined Contributionâ&#x20AC;&#x201D;Why Now? $ GH¿QHG FRQWULEXWLRQ PRGHO LV QRW D QHZ LGHD 7KH FRQFHSW KDV EHHQ DURXQG IRU PRUH WKDQ  \HDUV EXW WKH FXUUHQW PDUNHW FRQGLWLRQV resulting  from  the  passing  of  the  Patient  Protection  and  Affordable  Care   $FW 33$&$ DQGJXDUDQWHHGLVVXHFRXSOHGZLWKWKHFRQWLQXHGULVLQJFRVW of  health  care,  have  been  catalysts  for  businesses  to  reexamine  their  health   EHQH¿WPRGHOVLQDQDWWHPSWWR¿JXUHRXWWKHLUUROHLQWKHFKDQJLQJKHDOWK care  ecosystem.   Another   factor   to   consider   is   an   emerging,   technology-­rich   environment  enabling  new  and  effective  ways  for  consumers  to  shop  for   DQGFRPSDUHKHDOWKFDUHSODQVDVZHOODVPDQDJHWKH¿QDQFLDODFFRXQWV used  to  pay  for  these  plans.  Consider  this: Â&#x2021; More  than  85  percent  of  the  worldâ&#x20AC;&#x2122;s  online  population  has  used   WKH,QWHUQHWWRPDNHDSXUFKDVH 1LHOVHQ  Â&#x2021; Four  out  of  10  large  companies  offer  a  single  web-­based  portal   access  to  employees  for  a  wide  variety  of  informationâ&#x20AC;&#x201D; LQFOXGLQJEHQH¿WVSD\VWXEVWLPHDQGDWWHQGDQFHWD[ ZLWKKROGLQJDQGPRUH 7RZHUV:DWVRQ  Â&#x2021; Ninety-­one  percent  of  consumers  said  researching  products   RQOLQHPDGHWKHPIHHOPRUHFRQ¿GHQWDERXWWKHLUSXUFKDVHV 3ULFH*UDEEHUFRP  Since   the   concept   of   using   dollars   provided   by   an   employer   to   VKRS IRU KHDOWK FDUH LQVXUDQFH LV D UHODWLYHO\ QHZ ZD\ WR WKLQN DERXW GHOLYHULQJ DQG HQUROOLQJ LQ HPSOR\HHEHQH¿WV XVHUIULHQGO\ WRROV WKDW help   consumers   navigate   their   insurance   plan   will   be   critical.   The   tools   need  to  illustrate  the  employeeâ&#x20AC;&#x2122;s  coverage  options,  while  at  the  same  time   SURYLGLQJFOHDUYLVLELOLW\LQWRWKHLUFRPSOHWH¿QDQFLDOKHDOWKFDUHSLFWXUH Technology  offerings  that  include  planning,  budgeting,  consumer-­decision   support  tools  and  the  facilitation  of  electronic  premium  payments,  all  in   DPXOWLFKDQQHOHQYLURQPHQWZLOOEHWKHEDVHOHYHOIRUFRQVXPHUPDUNHW entry.

7KH GH¿QHG FRQWULEXWLRQ PRGHO LV an  evolution  of  consumer-­directed  health   care  plans  such  as  a  health  savings  account   +6$ RUÃ&#x20AC;H[LEOHVSHQGLQJDFFRXQW )6$  that   exist   and   are   widely   available   today.   Accessing   consumer-­driven   health   care   information  is  increasingly  common,  with   85   percent   of   companies   providing   such   access.   At   the   same   time,   the   need   for   technology   to   facilitate   and   service   these   new   distribution   channels   creates   both   D PDUNHW JDS DQG DQ RSSRUWXQLW\ IRU DGPLQLVWUDWLRQ WRROV UHFRUGNHHSLQJ DQG reporting  features  for  administrators  and   HPSOR\HUV $V WKH GH¿QHG FRQWULEXWLRQ PRYHPHQWFRQWLQXHVWRJURZWKHPDUNHW can   expect   to   see   even   more   advanced   technology   solutions.   This   is   good   QHZV IRU WKH FRQVXPHU ZKR LV WDNLQJ RQ LQFUHDVHG ¿QDQFLDO DQG EHQH¿W SODQ GHFLVLRQPDNLQJUHVSRQVLELOLW\ According   to   health   care   insurer   :HOO3RLQW ,QF GH¿QHG FRQWULEXWLRQ plans   will   be   mainstream   within   two-­ to-­three   years.   The   company   is   close   to   signing   30   midsize   and   large   employers,   including   one   with   more   than   50,000   ZRUNHUV 6LPLODUO\ 0HUFHU D JOREDO FRQVXOWLQJ OHDGHU LQ WDOHQW KHDOWK retirement,   and   investments,   found   56   percent   of   employers   are   FRQVLGHULQJ D SULYDWH H[FKDQJH WR SURYLGH EHQH¿WV WR HLWKHU FXUUHQW employees  and/or  retirees.   7ZRODUJHUHPSOR\HUV6HDUV+ROGLQJV&RUSDQG'DUGHQ5HVWDXUDQWV ,QF²WKH SDUHQW FRPSDQ\ IRU UHVWDXUDQW FKDLQV LQFOXGLQJ 2OLYH *DUGHQ 5HG /REVWHU DQG PDQ\ RWKHUV²PRYHG WR GH¿QHG FRQWULEXWLRQ SODQV IRU their  full-­time  employees  on  Jan.  1,  2013.   ,IWKLVQHZPHWKRGRIRIIHULQJDGH¿QHGFRQWULEXWLRQSODQWRIDFLOLWDWH KHDOWKEHQH¿WVSURYHVWREHHIIHFWLYHDQGDFRVWVDYHUIRUHPSOR\HUVPDQ\ PRUH RUJDQL]DWLRQV ZLOO OLNHO\ PDNH WKH VZLWFK ZLWKLQ WKH QH[W  WR  months.  A  2011  McKinsey  survey  of  1,300  employers  found  30  percent  will   GH¿QLWHO\RUSUREDEO\VWRSRIIHULQJHPSOR\HUVSRQVRUHGJURXSLQVXUDQFH in  the  years  after  2014.  

Health Insurance Exchanges: A New Household Term 'H¿QHG FRQWULEXWLRQ SODQV DQG SULYDWH H[FKDQJHV DUH WZR VLGHV RI the   same   coin.   Private   health   insurance   exchanges   as   a   component   to   GH¿QHGFRQWULEXWLRQSODQVDUHVSULQJLQJXSLQUHVSRQVHWRWKHSDVVDJHRI WKHKHDOWKFDUHODZDQGWKHFKDQJHLQKHDOWKEHQH¿WPDUNHWFRQGLWLRQV A   private   exchange   is   a   private   business   owned   and   operated   by   EURNHUV SD\HUV RU WKLUG SDUW\ DGPLQLVWUDWRUV 73$V  $ SULYDWH H[FKDQJH generally  consists  of  an  online  shopping  experience  for  health  care,  dental,   YLVLRQDQGRWKHUEHQH¿WV7KHSULYDWHH[FKDQJHDOORZVFRQVXPHUVWRVKRS and  compare  servicesâ&#x20AC;&#x201D;similar  to  how  consumers  today  shop  and  compare   DLUIDUH SXUFKDVHV :KHQ SXUFKDVLQJ D SODQH WLFNHW FRQVXPHUV DOPRVW H[FOXVLYHO\XVHWKH,QWHUQHWWRFRPSDUHWLFNHWSULFHVDLUOLQHVDQGGHSDUWXUH and   arrival   times.   With   an   exchange,   consumers   are   able   to   select   and   compare   critical   insurance   plan   factors   to   suite   their   particular   familyâ&#x20AC;&#x2122;s   QHHGVVXFKDVSURYLGHUQHWZRUNEHQH¿WVFRYHUHGTXDOLW\RIFDUHDQGSULFH www.TheIHCC.com I HealthCare Consumerism Solutionsâ&#x201E;¢ I January/February 2013

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,Q UHVSRQVH WR WKH PDUNHW Currently, public exchanges at be  worth  nearly  $60  billion  in  premium   revenues   in   2014,   according   to   PwC   opportunity,   a   variety   of   business   the state level appear to be +HDOWK5HVHDUFK,QVWLWXWHHVWLPDWHV7KH entities   are   launching   their   own   private   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   to   get   a   true   sense   of   how   EHLQJRIIHUHGLQVWDWHVZKLOHEHQHÂżWV exchange plan into action while are   exchanges  will  operate.   consulting   firm   Mercer   announced   ,Q -DQXDU\ WKH 86 'HSDUWPHQW in   January   it   was   building   a   health   others are just beginning to RI+HDOWKDQG+XPDQ6HUYLFHV '++6  insurance  exchange  for  employers.   gave  four  more  states  the  approval  to  set   Wal-­Mart   also   is   investigating   consider how they will get up  their  own  exchanges.  Idaho,  Nevada,   the   idea   of   building   a   private   health   their arms around an 1HZ 0H[LFR DQG 8WDK MRLQHG  VWDWHV insurance   exchange,   which   would   be   DVZHOODVWKH'LVWULFWRI&ROXPELDWKDW geared   toward   small   businesses.   Wal-­ all-encompassing regulation. have   been   granted   approval   to   set   up   Mart   would   use   its   size   as   leverage   state-­run   exchanges.   So   far   temporary   WR PDNH DQ LQVXUDQFH PDUNHWSODFH federal   grants,   totaling   $964   million,   competitive   and   available   to   a   broader   KDYH EHHQ GLVWULEXWHG WR VWDWHV +RZHYHU VWDWH UXQ H[FKDQJHV PXVW EH base  of  companies  and  individuals.   1R WZR SULYDWH H[FKDQJHV DUH DOLNH KDYLQJ D YDU\LQJ OHYHO RI VHOIVXIÂżFLHQWE\-DQXDU\ Currently,  public  exchanges  at  the  state  level  appear  to  be  in  various   capabilities  within  the  individual,  small  group,  large  group,  and/or  retiree   PDUNHWV3ULYDWHH[FKDQJHVGLIIHUHQWLDWHWKHPVHOYHVLQDYDULHW\RIZD\V phases,  with  some  states  already  putting  their  exchange  plan  into  action   including   distribution   channel   strategy,   product   offerings,   and   robust   ZKLOHRWKHUVDUHMXVWEHJLQQLQJWRFRQVLGHUKRZWKH\ZLOOJHWWKHLUDUPV tools  that  integrate  with  wellness,  educational  materials,  and  consumer-­ around  an  all-­encompassing  regulation.   Minnesota,  for  example,  recently  unveiled  legislation  that  will  lay  the   driven  health  care  account  platforms.  Common  ways  to  segment  are: JURXQGZRUNIRUKHDOWKLQVXUDQFHH[FKDQJHVDOORZLQJPLOOLRQUHVLGHQWV Â&#x2021; 6LQJOHFDUULHU([FKDQJHV  These  exchanges  are  generally   RI WKH VWDWH WR VKRS FRPSDUDWLYHO\ IRU KHDOWK LQVXUDQFH HIIHFWLYH 2FW  promoted  by  a  single  carrier  such  as  BlueCross  BlueShield    +RZHYHU 0LVVLVVLSSL KDG DSSOLHG IRU DSSURYDO WR EHJLQ PRYLQJ and  target  employers  who  wish  to  continue  to  play  an  active   role  in  both  the  selection  of  insurance  carrier  and  plan  design.   forward  on  its  state  exchange,  but  faced  a  disagreement  over  how  much   DXWKRULW\VWDWHRIÂżFLDOVVKRXOGZLHOGRYHUWKHRSHUDWLRQV 'HSHQGLQJRQWKHOHYHORIHPSOR\HUHQJDJHPHQWLQWKH 6RPHVWDWHV²VXFKDV$UNDQVDVDQG'HODZDUH²KDYHGHFLGHGWRRSW EHQHÂżWGHVLJQLQVXUDQFHSURGXFWVPD\EHFXVWRPL]HGIRUWKH out  of  a  state  exchange  and  instead  have  chosen  to  participate  in  a  federal   employee  group  or  individuals. SDUWQHUVKLS H[FKDQJH 7KH IHGHUDO JRYHUQPHQW DQWLFLSDWHV LW ZLOO OLNHO\ Â&#x2021; 0XOWLFDUULHU([FKDQJHVThese  exchanges  typically  offer   end  up  operating  exchanges  in  at  least  32  states.  The  deadline  for  states  to   DUDQJHRILQVXUDQFHFDUULHUVSURPRWHGE\DEURNHUEHQHÂżW declare  their  intentions  to  participate  in  the  federal  partnership  exchange   consultant  or  administrator.  These  exchanges  offer  a  broad   was  Feb.  15. array  of  insurance  plan  types  and  plan  designs.  Employers,   ZKRZLVKWRWDNHDPRUHKDQGVRIIDSSURDFKWREHQHÂżW selection  for  their  employees,  gravitate  to  this  model. In Conclusion ,I HGXFDWLQJ FRQVXPHUV DERXW WRGD\ÂśV KHDOWK FDUH EHQHÂżWV LV challenging,   trying   to   ensure   every   American   fully   understands   and   Private Versus Public Exchanges The  private  exchange  world  is  fully  functioning  today,  and  is  not  to   JUDVSV²DQG LQ WXUQ IXOO\ XWLOL]HV²WKHLU EHQHÂżW RIIHULQJ LV HTXDOO\ be  confused  with  the  public  exchanges  that  are  still  being  created  due  to   demanding.  In  the  coming  months  and  years,  employers  and  consumers   mandates  by  PPACA.  In  the  â&#x20AC;&#x153;pay  or  playâ&#x20AC;?  concept,  private  exchanges  allow   will  face  many  education  hurdles.   7KH KHDOWK EHQHÂżWV LQGXVWU\ LV PRELOL]LQJ YHU\ TXLFNO\ LQ SDUDOOHO DQHPSOR\HUWRFRQWLQXHWRÂłSOD\´DQGRIIHUEHQHÂżWVWRWKHLUHPSOR\HHV Whereas   the   public   exchange   will   support   government-­funded   health   ZLWKGHIHQVHRIRULQVSLWHRIWKH33$&$$VWKHFROOHFWLYHKHDOWKEHQHÂżWV LQVXUDQFHDQGWKHVXEVLG\ÂłSDLG´E\HPSOR\HUVZKRRSWRXWRIWKHEHQHÂżWV industry   begins   to   plan   and   respond   to   the   mandates   found   within   the   UHJXODWLRQRQHWKLQJLVFHUWDLQ([FKDQJHVDQGWKHGHÂżQHGFRQWULEXWLRQ game.   The   PPACA   mandates   the   creation   of   government-­funded   health   health   insurance   model   will,   without   a   doubt,   shift   the   entire   industry   insurance   exchanges.   A   public   exchange   is   a   health   insurance   exchange   DV ZH NQRZ LW :KHWKHU KHDOWK LQVXUHU WHFKQRORJ\ SURYLGHU WKLUG SDUW\ run   by   a   government   or   government   contracted   agency.   These   â&#x20AC;&#x153;publicâ&#x20AC;?   DGPLQLVWUDWRUHPSOR\HURUFRQVXPHUZHFDQDOOEHQHÂżWIURPWKLVVKLIWLI exchanges   will   allow   individuals,   families,   and   small   employers   to   we  educate  ourselves  and  fully  understand  the  impacts  of  this  model.   purchase  health  insurance  and,  for  those  with  incomes  between  133  and   SHUFHQWRIWKHIHGHUDOSRYHUW\OHYHO )3/ WRKDYHDFFHVVWRSUHPLXP 'DYLG 8UEDQLDN LV D 3URGXFW 0DQDJHU IRU (YROXWLRQÂ&#x152; WKH OHDGLQJ SURYLGHU RI FRPSUHKHQVLYHHOHFWURQLFFDUGSD\PHQWRQSUHPLVHDQGFORXGFRPSXWLQJVROXWLRQV and  cost-­sharing  government  subsidies.   IRUWKHDGPLQLVWUDWLRQRIIOH[LEOHVSHQGLQJDFFRXQWV )6$V KHDOWKVDYLQJVDFFRXQWV By   Jan.   1,   2014,   public   run   exchanges   are   scheduled   to   begin   +6$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  revenue  stream  for  insurers.  Public  health  insurance  exchanges  will  

34

January/February 2013 I HealthCare Consumerism Solutionsâ&#x201E;˘ 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 EHQH¿W H[FKDQJHV +%(  that   are   to   manage   standardized,   state-­regulated   U.S.   health   care   SODQVDQGEHIXOO\FHUWL¿HGDQGRSHUDWLRQDOE\-DQ7KDWLVD rather  demanding  ramp-­up  deadline,  considering  the  combination  of   new  processes,  technologies  and  human  resources  that  must  be  aligned  and   ready  to  navigate  the  uncharted  territory.   7KH HPHUJLQJ RQOLQH PDUNHWSODFH IRU XQLQVXUHG DQG XQGHULQVXUHG will  offer  information  and  resources  for  individuals  and  small  businesses  to   compare  policies  and  premiums,  and  buy  affordable  insurance  directly  or   with  a  government  provided  subsidy  when  eligible;͞  qualifying  income  levels   DUHQRWWRH[FHHGSHUFHQWRIWKHSRYHUW\OHYHO )3/ 6PDOOEXVLQHVVHV will  be  eligible  for  subsidies  as  well.  But  how  much  can  be  really  processed   RQOLQH"

The Role of a Customer Service Center Information   from   existing   private   exchanges   indicates   less   than   half   of   insurance   plan   shopping   and   enrollment   activities   are   fully   transacted   RQOLQH,QWKHPDMRULW\RISXUFKDVLQJLQWHUDFWLRQVFXVWRPHUVZLOOEHJLQRQ an  exchange  website  but  ultimately  call  a  customer  service  representative.   In  terms  of  ongoing  costs,  customer  service  center  operations,  not  technol-­ RJ\ZLOOEHWKHODUJHVWSHUFHQWDJHRIRSHUDWLQJFRVWVVLJQLÂżFDQWO\DIIHFWLQJ WKHÂżQDQFLDOVXVWDLQDELOLW\RIVWDWHH[FKDQJHV,QIDFWFXVWRPHUFRQWDFWZLOO represent  the  largest  ongoing  expenditure  after  the  development  and  imple-­ mentation  of  the  technology  and  initial  launch  cost.   7KDW LV VLJQLÂżFDQW EXW HYHQ WKRXJK WKH GHDGOLQH IRU WKH SURJUDP start  is  approaching,  many  exchanges  have  yet  to  consider  how  best  to  staff   service   centers   with   experienced   customer   service   agents   who   can   ensure   the  programs  indeed  provide  broader  coverage  for  the  eligible  population. 7REHIXOO\RSHUDWLRQDOE\DQGÂżQDQFLDOO\VHOIVXVWDLQDEOHE\ exchanges  must  rapidly  orchestrate  the  implementation  of  both,  enrollment   enabling   technology   and   personalized   multi-­channel   service   center   sup-­ port.  State-­operated  programs  must  strive  to  perform  with  administrative   RSHUDWLQJ HIÂżFLHQFLHV WKDW FRPSDUH IDYRUDEO\ ZLWK WKH SURJUDPV RSHUDWHG in   the   private   sector.   Most   of   the   general   public   doesnâ&#x20AC;&#x2122;t   understand   each   state-­based  exchange  needs  to  be  completely  self-­sustainable  with  no  state   or  federal  funding  effective  Jan.  1,  2015.   In   order   to   remain   viable   long-­term   exchange   each   state   needs   to   FRPSHWHLQWKHFRPPHUFLDOKHDOWKFDUHPDUNHWSODFHDQGWKHFRVWVWRRSHUDWH WKHVWDWHH[FKDQJHVZLOOQHHGWREHHIÂżFLHQWVRWKDWLWZLOOEHDEOHWRSURYLGH FRPSHWLWLYHLQVXUDQFHSURGXFWVWKURXJKTXDOLÂżHGKHDOWKSODQVWRLQGLYLGX als  and  small  group  businesses.   Â&#x2021; Software  solutions  will  integrate  many  aspects  of  health   insurance  deliveryâ&#x20AC;&#x201D;including  a  consumer  portal,  eligibility  

determinations,   ÂżQDQFLDOVHUYLFHVSODQ enrollment,  and  billing   administration.   Â&#x2021; Service  centers  have  the   potential  to  greatly   LQĂ&#x20AC;XHQFHWKHSXEOLFÂśV perception  of  the   new  law.  They  must   include  an  integrated   &50SODWIRUPLQRUGHUWR provide  effective  personalized  support  to  facilitate  enrollments   DQGHIIHFWLYHO\HGXFDWHLQGLYLGXDOVHPSOR\HUVDQGÂżHOGEDVHG resources  assisting  consumers  on  all  aspects  of  the  Affordable   Care  Act.  As  in  so  many  other  cases,  the  technology  is  merely   a  complement  to  the  human  resources  that  will  ultimately   determine  the  exchangeâ&#x20AC;&#x2122;s  effectiveness.  U.S.  residents  who   live Â��at  or  near  poverty  level  may  not  have  self-­service  access  or   experience  with  Web-­based  tools  and  technologies.  For  many   RIWKHPLWDOVRPD\EHDÂżUVWWLPHH[SHULHQFHEX\LQJDKHDOWK care  -­  or  in  fact  any  -­  insurance  product.  These  prospective   insurance  purchasers  will  require  assistance  with  understanding   the  health  insurance  terminology,  how  to  determine  eligibility   or  proceed  with  their  enrollment  and  will  require  an  educated   customer  service  professional  to  help  them  through  the  plan   evaluation  and  selection  process.  The  impact  of  the  customer   service  teams  is  unquestionably  profound. *XLGDQFHRQSDUWLFLSDWLRQLQDOWHUQDWHSURJUDPVVXFKDV0HGLFDLGDQG &KLOGUHQÂśV +HDOWK ,QVXUDQFH 3URJUDPV &+,3  UHSUHVHQWV DQRWKHU FULWLFDO contact   center   responsibility.   The   service   staff   must   develop   seamless   integration   strategies   with   existing   state   agencies   supporting   consumers   with  multiple  program  eligibility.  There  will  be  considerable  overlap  with   existing   assistance   programs,   and   service   center   staff   will   need   to   bring   clarity  to  the  confusion  many  residents  will  experience.  Additionally,  with   the   anticipated   policy   changes   that   will   occur   as   these   programs   mature,   the   caliber   of   the   staff   and   performance   of   the   service   center   will   largely   determine  customer  acceptance  and  satisfaction  with  the  entire  exchange   concept. Many   states   are   contemplating   tiered   levels   of   agent   support,   combining   resources   who   are   trained   to   effectively   educate   and   inform   FDOOHUV DERXW WKH EHQHÂżWV RI WKH H[FKDQJH ZLWK RWKHU PRUH KLJKO\ VNLOOHG personnel  who  can  assist  with  the  eligibility  and  enrollment  processes.   www.TheIHCC.com I HealthCare Consumerism Solutionsâ&#x201E;˘ I January/February 2013

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Tightly Integrated Customer Contact Just in Time State   exchanges   must   ensure   the   service   center   is   a   â&#x20AC;&#x153;designed   inâ&#x20AC;&#x153;   rather   than   â&#x20AC;&#x153;bolted   onâ&#x20AC;?   component   of   the   solution,   and   it   is   managed   to   perform  at  or  above  the  level  of  commercial  contact  centers  to  enable  long-­ term  sustainability.  Established  customer  care  providers  will  leverage  years   of  experience  with  multi-­channel  contact  management,  tightly  embedded  in   insurance  customer  acquisition  and  retention  systems.   'XHWRWKHWLPHIUDPHVIRUFXUUHQWVWDWHGEDVHGH[FKDQJHVWREHIXOO\ RSHUDWLRQDOE\2FWWKH\KDYHGHFLGHGWRLQLWLDOO\ODXQFKWKHLUVHUYLFH center  operations  with  an  outsourced  service  center  solution.  The  states  will   OHYHUDJHWKHRXWVRXUFHUWRDFTXLUHDQH[SHULHQFHGVFDODEOHZRUNIRUFHZLWK built-­in  quality  control  mechanisms.  Failing  to  identify  the  right  customer   service  center  strategy  and  partner  early  in  the  process  will  increase  costs   DQGLPSDFWTXDOLW\ZKLOHUHGXFLQJĂ&#x20AC;H[LELOLW\IRUH[FKDQJHVDQGXOWLPDWHO\ compromising  their  solution.

Selecting the Right Outsourced Service Center 'XHWRWKHFXVWRPHUVHUYLFHDQGWHFKQRORJ\UHTXLUHPHQWVWKHH[FKDQJH service  centers  may  not  easily  integrate  into  current  state-­managed  contact   center  operations.  The  right  outsourced  service  center,  when  selected  and   PDQDJHGFDUHIXOO\FDQUHPRYHULVNWRODXQFKLQDWLPHO\PDQQHUDQGDOORZ IRU ZRUNIRUFH VFDODELOLW\ ZKLOH OHYHUDJLQJ H[LVWLQJ RSHUDWLRQDO SURFHVVHV and  technologiesâ&#x20AC;&#x201D;tight  performance  and  quality  control  with  visibility  into   status,  progress  and  performance  trends  are  typically  already  built  into  their   processes  through  best  practices  across  multiple  industries.   6WDWHSURFXUHPHQWWHDPVZLOOQHHGWRPDNHDQLQIRUPHGFKRLFHIURP DYDULHW\RIDYDLODEOHRSWLRQVFRQVLGHULQJTXDOLWLHVWKDWDUHPRVWOLNHO\WR impact  the  success  of  the  stateâ&#x20AC;&#x2122;s  exchange:   Â&#x2021; 7UDFNUHFRUGRIZHOOUXQFRVWHIIHFWLYHRSHUDWLRQWKDWFRQVLVWHQWO\ meets  contractual  service  levels Â&#x2021; Proven  contact  center  communication  technologies  in  place  to   ensure  capacity  and  reliability   Â&#x2021; 9HULÂżDEOHGLVDVWHUUHFRYHU\DQGEXVLQHVVFRQWLQXLW\SODQ Â&#x2021; 6\VWHPVDQGSURFHVVHVIRULQWHJUDWHG&XVWRPHU5HODWLRQVKLS 0DQDJHPHQW &50 4XDOLW\3URJUDPVDQG7UDLQLQJ Â&#x2021; 6WURQJ4XDOLW\&RQWUROSURJUDPZLWKH[FHOOHQW)LUVW&RQWDFW 5HVROXWLRQSHUIRUPDQFHUHVXOWV Â&#x2021; (IÂżFLHQW&RPPDQG&HQWHU2SHUDWLRQVWRIRUHFDVWPRQLWRUDQG UHSRUWRQNH\SHUIRUPDQFHLQGLFDWRUVWRUXQDQHIÂżFLHQWDQG cost-­effective  operations.   Â&#x2021; Transparency  and  visibility  into  real-­time  reporting  and  historical   SHUIRUPDQFHVWDWXVUHVXOWVDQGWUHQGVDQGWKHDELOLW\WRTXLFNO\ analyze  data  for  this  new  program.  The  ability  to  adapt  and   OHDUQIURPWKHÂżUVWRSHQHQUROOPHQWSHULRGDQGPDNHWKH necessary  changes  prior  to  the  second  open  enrollment  period   LQ2FWZLOOEHWKHGLIIHUHQFHWRGULYHWRZDUGWKHLUORQJ term  sustainability  that  will  be  required  by  Jan.  1,  2015 Â&#x2021; 2SWLRQVIRULQVWDWHFRQWDFWFHQWHUWRKHOSZLWKORFDOMREFUHDWLRQ and  direct,  face-­to-­face  customer  service Ease  of  doing  business  through  contracting  and  ongoing  operations  is   critical  to  a  great  outsourcing  relationship.

Establishing Partner Relationships In  the  event  you  have  decided  to  move  in  the  direction  of  an  outsourced   SURYLGHU WKHUH DUH VRPH NH\ IDFWRUV WR HQVXUH WKH ULJKW RXWFRPH DW WKH HQG RI WKH SURFHVV 7KH SURFHVV RI LGHQWL¿FDWLRQ HYDOXDWLRQ FRQWUDFWLQJ and   management   of   your   service   center   partner   will   include   the   following   elements: 36

January/February 2013 I HealthCare Consumerism Solutionsâ&#x201E;˘ I www.TheIHCC.com

Â&#x2021; $VVHPEOHDQGSXEOLVKVHOHFWLRQFULWHULDLQDIRUPRI5)3 solicitation Â&#x2021; Understand  your  strategy  around  the  technology  to  enable  the   VHUYLFHFHQWHU'R\RXZDQWWRRZQDQGPDQDJHWKHWHFKQRORJ\ RUOHYHUDJHWKHRXWVRXUFHUÂśVFDSDELOLWLHV" Â&#x2021; Evaluate  multiple  vendors  with  the  right  selection  criteria  and   weightings  based  on  costs,  technology,  quality,  operations   performance  and  culture  that  must  be  validated  through   site  visits  with  comprehensive  review  of  stated  capabilities.   0DNHVXUHWKHHYDOXDWLRQWHDPKDVH[WHQVLYHRSHUDWLRQVDQG technology  experience  and  ideally  has  negotiated  previous   outsourcing  contracts. Â&#x2021; 0RGHOWKHHVWLPDWHGODXQFKFRVWVUXQFRVWVDQGULVNUHZDUG pricing  impacts  in  order  to  gain  visibility  into  the  investment   required  to  maintain  long-­term  sustainability Â&#x2021; 1HJRWLDWHDQGRSWLPL]HWKHULJKWFRQWUDFWXDOWHUPV 06$  62: FRVWVWUXFWXUHV6/$ÂśVDQG.3,ÂśVWKDWZLOOGULYHWKHULJKW behaviors  and  desired  outcomes.   Â&#x2021; 'HYHORSDQLQWHJUDWHG3URMHFW0DQDJHPHQW2IÂżFHWKDWLVHQJDJHG IURP5)3WKURXJKLPSOHPHQWDWLRQ Â&#x2021; 'HÂżQHYHQGRUPDQDJHPHQWVWUDWHJ\IRUODXQFKDQGRQJRLQJ service  delivery   'HVLJQLQJ DQG EXLOGLQJ DQ H[FKDQJH FRQWDFW FHQWHU FDSDELOLW\ LV a   critically   important   step   to   ensuring   long-­term   program   success   and   acceptance.  If  your  exchange  does  not  have  the  right  in-­house  expertise  to   start  and  manage  this  process,  consider  hiring  third  party  help.   When   considering   the   very   personal   nature   of   health   care   and   the   LQWHQVLW\RIWKHQDWLRQDOGHEDWHDURXQGWKHUHIRUPOHJLVODWLRQWKHVWDNHVDUH high  and  the  importance  of  delivering  a  comprehensive  and  well  planned   customer  service  solution  cannot  be  overstated.  By  collaborating  with  other   states   and   incorporating   proven   technology   solutions   and   best   practices   from   established,   best-­in-­class   service   providers,   the   customer   contact   centers  will  be  in  a  great  position  to  help  the  exchanges  ensure  long-­term   success  and  realize  their  full  potential.   (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 » DIRECTOR OF MEMBERSHIP & COMMUNICATIONS » NATIONAL ASSOCIATION OF DENTAL PLANS

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KHQWKH¿UVWSURYLVLRQVRIWKH$IIRUGDEOH&DUH$FW $&$ JRLQWRHIIHFWLQ GHQWDOEHQH¿WVLQWKHLQGLYLGXDODQGVPDOOJURXSPDUNHWVZLOOEH GLIIHUHQW:LWKWKHVHFKDQJHVFRPHQHZFKDOOHQJHVDQGRSSRUWXQLWLHVIRU EURNHUVZKRXQGHUVWDQGDQGDUHSUHSDUHGIRUWKHIROORZLQJLPSDFWVRIERWKWKH SURSRVHGDQG¿QDOSURYLVLRQVRIWKH$&$ 7KLVLVWKH¿UVWDUWLFOHLQDWKUHHSDUWVHULHVH[SORULQJWKHLPSDFWRIWKH$&$RQ GHQWDOEHQH¿WV7KLVDUWLFOHSUHVHQWVDQ $&$PDUNHWRYHUYLHZLQFOXGLQJVRPH NQRZQDQGSURSRVHGDVSHFWVRIWKH HVVHQWLDOKHDOWKEHQH¿WV7KHVHFRQG DUWLFOHZLOOH[DPLQHYDULRXVH[FKDQJH PRGHOVDQGWKH¿QDOZLOOIRFXVRQ FRVWVKDULQJVFHQDULRV

www.TheIHCC.com I HealthCare Consumerism Solutionsâ&#x201E;¢ I January/February 2013

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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 ,QWKHFXUUHQWEXVLQHVVODQGVFDSHSHUFHQWRIDOOGHQWDOEHQH¿WV VROG DUH RIIHUHG XQGHU VHSDUDWH SROLFLHV )LIW\¿YH SHUFHQW RI SODQV DUH offered  through  large  group  employers  while  small  group  employers,  with   OHVVWKDQHPSOR\HHVPDNHXSSHUFHQWRIWKHPDUNHW2QO\SHUFHQW are  covered  under  individual  dental  policies;͞  the  rest  are  covered  through   SXEOLF SURJUDPV OLNH 0HGLFDLG DQG WKH &KLOGUHQœV +HDOWK ,QVXUDQFH 3URJUDP &+,3 

Overview of Dental Marketsâ&#x20AC;&#x201D; A Work Still in Progress :KDWZLOOEHGLIIHUHQWLQ" Â&#x2021; )LUVWHYHU\RQHPXVWHQUROOLQDKHDOWKSODQRUSD\DWD[ penalty.  For  large  groups  and  public  programs,  there  are  no   PDQGDWHGFKDQJHVLQEHQHÂżWV Â&#x2021; +RZHYHUKHDOWKSODQVLQWKHVPDOOJURXSPDUNHWPXVW LQFOXGHDGHÂżQHGVHWRIEHQHÂżWVUHIHUUHGWRDVHVVHQWLDOKHDOWK EHQHÂżWV (+% ZKLFKLQFOXGHGHQWDOEHQHÂżWVIRUFKLOGUHQ Â&#x2021; 7KHSHGLDWULFGHQWDOEHQHÂżWVZLOOEHRIIHUHGWKURXJKWKHQHZ exchanges  and  with  all  small  group  or  individual  policies.   Â&#x2021; $GXOWGHQWDOFRYHUDJHLVQRWLQFOXGHGDVSDUWRIWKH(+% requirement.   +HUHÂśV DQ DGGHG WZLVW $V WKH ODZ VWDQGV LQ )HEUXDU\  ERWK medical   plans   and   separate   dental   plans   may   provide   the   required   pediatric   coverage   inside   the   exchanges;Íž   however,   the   law   is   unclear   if   a   medical   plan   can   omit   the   required   pediatric   oral   services   outside   the   exchange.   Until   this   question   is   answered,   small   group   and   individual   dental   coverage  offered  by  a  stand-­alone  dental  plan  outside  the  exchange  could   duplicate   coverage   included   with   a   medical   policy.   This   will   affect   1.65   million   small   employers   who   today   provide   dental   coverage   for   43.7   million  consumers,  including  22.9  million  children. States   will   decide   many   of   the   parameters   for   small   group   and   individual   coverage   offered   through   the   exchange,   such   as   scope   of   EHQHÂżWVDQGWKHDJHOLPLWIRUSHGLDWULFFRYHUDJH,QVWDWHVKDYHRSWHG WR GHÂżQH VPDOO JURXSV DV  RU IHZHU HPSOR\HHV %\  VWDWH VPDOO JURXSGHÂżQLWLRQVDUHUHTXLUHGWRFRQIRUPWRWKHIHGHUDOGHÂżQLWLRQRI or   less   employees.   This   will   move   an   additional   9   percent   of   the   dental   PDUNHWXQGHUWKH(+%UHTXLUHPHQW At   press   time,   19   is   the   proposed   federal   minimum   age   for   the   pediatric   dental   coverage   provisions   of   ACA.   Unless   regulatory   changes   DUHPDGHGHQWDOSROLFLHVLQWKHVPDOOJURXSPDUNHWPD\GXSOLFDWHEHQHÂżWV LQPHGLFDOFRYHUDJHIRUFKLOGUHQ7KHEHQFKPDUNIRUWKHVFRSHRIGHQWDO EHQHÂżWV LV GHÂżQHG E\ HLWKHU WKH )HGHUDO (PSOR\HHV 'HQWDO DQG 9LVLRQ ,QVXUDQFH3URJUDPRU&+,3 ,QDGGLWLRQWRVFRSHRIEHQHÂżWVWKHUHDUHSURYLVLRQVLQWKH$&$ZKLFK OLPLWGHGXFWLEOHVDQGHVWDEOLVKDQHZFRQVXPHURXWRISRFNHW 223 OLPLW in   medical   coverage.   There   also   are   proposed   rules   which   establish   a   GLIIHUHQWFRQVXPHURXWRISRFNHWPD[LPXPIRUGHQWDOFRYHUDJH7KH$&$ limit   on   deductibles   for   medical   policies   is   $2,000   for   individuals   and   IRUIDPLOLHV7KHPHGLFDOFRQVXPHU223OLPLWLVSHJJHGWRWKHRXW RISRFNHWOLPLWVIRUKLJKGHGXFWLEOHKHDOWKSODQV DVGHÂżQHGE\WKHKHDOWK VDYLQJV DFFRXQW SURYLVLRQV RI WKH ,56 &RGH  )RU  WKLV LV  annually   for   a   family   of   four   and   $6,250   annually   for   an   individual   and   OLNHO\WREHLQFUHDVHGIRU7KHGHQWDOFRQVXPHU223OLPLWLVUHTXLUHG to  be  â&#x20AC;&#x153;reasonableâ&#x20AC;?  and  is  proposed  to  be  $1000.  

ACA QUICK FACTS Markets affected: t 4NBMMHSPVQJOEJWJEVBM 4NBMM(SPVQEFmOJUJPO t 4UBUFNBLFTEFDJTJPOÂ&#x2030;XBUDIGPSVQEBUFT t PSMFTTFNQMPZFFT 

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1FEJBUSJD#FOFmU t 4UBUFEFDJEFTBHFMJNJUXBUDIGPSVQEBUFT t QSPQPTFEBHFMJNJUGPS&)# t .BZCFEVQMJDBUJWFPGCFOFmUTVOEFSTFQBSBUFQPMJDJFTJO TNBMMHSPVQBOEJOEJWJEVBMNBSLFUT t /"%1JTBEWPDBUJOHGPSBDIBOHFXBUDIGPSVQEBUFT About  98  percent  of  children  have  dental  claims  of  less  than  $1,000   per  year.  Under  a  dental  plan,  they  will  have  only  a  few  hundred  dollars   RIFRVWVKDULQJ+RZHYHULIPHGLFDOSODQVPDNHSHGLDWULFGHQWDOEHQH¿WV VXEMHFW WR PHGLFDO GHGXFWLEOHV DQG RXWRISRFNHW PD[LPXPV WKH FRVW sharing  could  be  substantially  higher.  

Challenges and Opportunities ,Q WKH VPDOO JURXS DQG LQGLYLGXDO PDUNHW EURNHUV IDFH WKH WDVN RI selling  dental  coverage,  and  sorting  out  when  such  coverage  is  duplicative   of  the  required  pediatric  dental  coverage  offered  as  part  of  medical  plans   DV(+%6RPHGHQWDORQO\FRPSDQLHVPD\DGDSWE\DOWHULQJWKHLUFRYHUDJH VRDVWRPLQLPL]HGXSOLFDWLRQDQGVWLOOSURYLGHDYDOXHDGGHGEHQH¿WIRU FKLOGUHQ,QHLWKHUHYHQWEURNHUVZLOOFHUWDLQO\KDYHDQRSSRUWXQLW\WRVHOO GHQWDOEHQH¿WVIRUWKHDGXOWVQRWFRYHUHGE\WKHLU(+%PHGLFDOSROLFLHV Because   there   will   be   potential   overlap   and   gaps   in   policies,   small   HPSOR\HUVDQGLQGLYLGXDOVZLOOWXUQWREURNHUVWRKHOSWKHPGHWHUPLQHWKH RSWLPXPGHQWDOEHQH¿WVSDFNDJHWRRIIHUWKHLUHPSOR\HHV At  the  beginning  of  2013,  many  questions  still  remain.  The  National   $VVRFLDWLRQRI'HQWDO3ODQV 1$'3 LVZRUNLQJWRZDUGFODUL¿FDWLRQVDQG UHVROXWLRQV RI WKHVH LVVXHV )RU XSGDWHV UHJDUGLQJ GHQWDO EHQH¿WV XQGHU WKH$&$YLVLW1$'3RUJDQGZDWFKIRUPRUHDUWLFOHVLQWKHQH[WLVVXHRI +HDOWK&DUH&RQVXPHULVP6ROXWLRQV.   7KH 1DWLRQDO $VVRFLDWLRQ RI 'HQWDO 3ODQV 1$'3  D 7H[DV QRQSUR¿W FRUSRUDWLRQ ZLWK KHDGTXDUWHUV LQ 'DOODV 7H[DV LV WKH ³UHSUHVHQWDWLYH DQG UHFRJQL]HG UHVRXUFH RI WKH GHQWDO EHQH¿WVLQGXVWU\´1$'3LVWKHRQO\QDWLRQDOWUDGHRUJDQL]DWLRQWKDWLQFOXGHVWKHIXOOVSHFWUXP RIGHQWDOEHQH¿WVFRPSDQLHVRSHUDWLQJLQWKH8QLWHG6WDWHV1$'3œVPHPEHUVSURYLGH'HQWDO +02'HQWDO332'HQWDO,QGHPQLW\DQG'LVFRXQW'HQWDOSURGXFWVWRPLOOLRQ$PHULFDQV  SHUFHQW RI DOO $PHULFDQV ZLWK GHQWDO EHQH¿WV )RU PRUH XSGDWHV RQ WKH GHQWDO EHQH¿WV LQGXVWU\VXEVFULEHWRWKHZHHNO\HQHZVOHWWHU1$'36PDUW%ULHIYLDZZZQDGSRUJ

www.TheIHCC.com I HealthCare Consumerism Solutionsâ&#x201E;˘ I January/February 2013

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How Health Care Reform

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KDWœVWKH¿UVWWKRXJKWWKDWFRPHVWR\RXUPLQG ZKHQ\RXKHDUWKHWHUP³KHDOWKFDUHUHIRUP´" ,I \RXœUH OLNH PRVW +5 RU EHQHILW professionals,  your  mind  probably  darts  to  the  impact  of  the   KHDYLO\ GHEDWHG OHJLVODWLRQ RQ HPSOR\HH PHGLFDO EHQH¿WV 7KDWPDNHVDORWRIVHQVHDIWHUDOOKHDOWKFDUHUHIRUPZLOO have  its  greatest  effect  in  this  area.  

+RZHYHU WKH 3DWLHQW 3URWHFWLRQ DQG $IIRUGDEOH &DUH $FW 33$&$  DOVR ZLOO WULJJHU D ³ULSSOHHIIHFW´IRUDQFLOODU\EHQH¿WV,QWKHFDVHRI vision,  for  example,  employers  are  already  starting   WR DVN TXHVWLRQV DERXW ZKHWKHU WKHLU HPSOR\HH vision   plans   will   need   to   change   in   terms   of   structure,   coverage   and   costs   to   both   them   and   WKHLUZRUNIRUFH7KLVDUWLFOHSURYLGHVDQRYHUYLHZRI the  anticipated  impact  of  health  care  reform  on  the   YLVLRQ EHQH¿W LQGXVWU\ DQG ZKDW HPSOR\HUV QHHG WRNQRZLQRUGHUWRHQVXUHWKHLUZRUNIRUFHUHWDLQV access  to  this  highly-­valued  coverage  that  can  help   lower  medical  costs  and  boost  productivity,  as  well   as  increase  employee  attraction  and  retention.

The Impact of Pediatric Vision Coverage as an Essential Health Benefit The   PPACA   designates   pediatric   vision   VHUYLFHV DV RQH RI WKH  HVVHQWLDO KHDOWK EHQHÂżWV WKDWDOOTXDOLÂżHGKHDOWKSODQVQHHGWRRIIHULIWKH\ intend   to   sell   in   the   health   insurance   exchanges,   which  will  be  used  by  individuals  and  small  groups   to  shop  for  coverage  beginning  next  year.   In   short,   beginning   in   January   2014,   all   individual   and   small   groups   with   50   or   fewer   employees   must   provide   pediatric   vision   care   FRYHUDJH²HPEHGGHG LQ D PHGLFDO EHQHÂżW²IRU children   up   to   age   19.   In   January   2016,   this   will   extend  to  individual  and  small  groups  with  100  or   fewer   employees.   Self-­insured   plans,   large   group   SODQV DQG JUDQGIDWKHUHG SODQV SXUFKDVHG RQ RU EHIRUH 0DUFK    DUH QRW UHTXLUHG WR RIIHU essential   pediatric   vision   care,   but   if   they   do,   the   coverage  must  be  embedded  in  their  medical  plan   and  cannot  have  annual  or  lifetime  dollar  limits.   :KDWLVWKHVWLFNLQJSRLQW" 7KH86JRYHUQPHQWKDVFKRVHQQRWWRGHÂżQH â&#x20AC;&#x153;pediatric  vision  careâ&#x20AC;?  but  has  left  it  to  the  discretion   RILQGLYLGXDOVWDWHVWRGHÂżQHWKHFRYHUDJHWKURXJK WKH VHOHFWLRQ RI D EHQFKPDUN YLVLRQ SODQ RU E\ 40

BY JEFF SPAHR Âť PRESIDENT, VISION BUSINESS Âť WELLPOINT

defaulting   to   a   federal   plan.   Whatâ&#x20AC;&#x2122;s   covered   by   these   plans   varies   VLJQLÂżFDQWO\IURPVWDWH to  state.   For   example,   &RORUDGRÂśV EHQFKPDUN medical   plan   includes   a   pediatric   eye   exam,   but   no  eyewear  materials.  Connecticut  has  decided  on   much   more   robust   coverage,   including   an   annual   exam  for  children  and  adults,  plus  annual  eyeglasses   or  contacts  for  children  as  well.  Employers  will  have   WRIROORZWKHVSHFLÂżFUHTXLUHPHQWVIRUWKHLUVWDWHV FORVHO\ 3OHDVH1RWH7KHVHDUHÂľLQLWLDOLQGLFDWLRQVÂś DQGQRWQHFHVVDULO\ÂżQDOJXLGDQFH

A Game Changer for the Allowance-based Model Aside   from   mandatory   pediatric   vision   coverage,   health   care   reform   also   will   have   a   VLJQLÂżFDQW LPSDFW RQ WKH YLVLRQ SODQ PRGHO employers,   employees   and   eyecare   professionals   are  used  to,  which  has  traditionally  been  allowance-­ based  on  the  materials  side.   Through  an  allowance-­based  model,  employ-­ ees   are   given   an   allotted   amount   to   apply   toward   eyewear   and/or   contactsâ&#x20AC;&#x201D;allowing   freedom   of   choice,   but   placing   a   limit   on   the   total   exposure   for   the   plan.   Consider   that   PPACA   mandates   no   DQQXDOPD[LPXPRQHVVHQWLDOKHDOWKEHQHÂżWV7KLV requirement   could   really   stir   things   up   if   materi-­ DOV DUH LQFOXGHG LQ WKH SHGLDWULF YLVLRQ EHQHÂżW $ ÂłQR RXWRISRFNHW OLPLW´ UXOH IRU PDWHULDOV FRXOG be  interpreted  as  meaning  patients  will  have  their   SLFNRIWKHKLJKHVWHQGIUDPHVDQGOHQVHVZLWKDOO the  trimmings.   %XWEHIRUH\RXSODQWKDWWULSWRJHWDOOWKHNLGV *XFFLIUDPHVNQRZWKDW²ZLWKRXWDGROODUOLPLWRQ WKHH\HZHDUVLGH²KHDOWKSODQVDOUHDG\DUHORRNLQJ DWRWKHUEHQHÂżWGHVLJQVWKDWZRXOGSURYLGHDJRRG selection   of   quality   glasses,   but   would   limit   the   ability  of  patients  to  buy  high-­end  designer  frames.   $QRWKHU FKDOOHQJH IRU WKH YLVLRQ EHQHÂżWV industryâ&#x20AC;&#x201D;one   that   you   may   have   heard   about   recentlyâ&#x20AC;&#x201D;is   the   debate   over   whether   and   how   stand-­alone   vision   plans   can   participate   in   the   exchanges.  Under  PPACA,  pediatric  essential  health   EHQHÂżWVPXVWEHHPEHGGHGLQDPHGLFDOSODQDQG

January/February 2013 I HealthCare Consumerism Solutionsâ&#x201E;˘ I www.TheIHCC.com

RXWRISRFNHW YLVLRQ H[SHQVHV KDYH WR DFFXPXODWH as  part  of  an  employeeâ&#x20AC;&#x2122;s  medical  plan  deductible.   Many   medical   carriers   are   planning   buy-­up   options   so   materials   coverage   for   children   and   all   vision   coverage   for   adults   can   be   included   in   WKH PHGLFDO SODQ EH\RQG MXVW ZKDW LV GHÂżQHG DV â&#x20AC;&#x153;essentialâ&#x20AC;?.   This   will   help   ensure   a   family   can   KDYH FRQVLVWHQW FRYHUDJH LQFOXGLQJ WKH QHWZRUN RIH\HGRFWRUVDQGEHQHÂżWVEHWZHHQWKHFKLOGUHQÂśV pediatric   vision   coverage   and   adult   coverage.   Without  these  options,  the  adults  in  the  family  may   have   to   go   to   one   eye   doctor   while   their   children   KDYHEHQHÂżWVDWDGLIIHUHQWH\HGRFWRU In   addition,   several   employers   have   already   raised  questions  about  whether  the  new  minimum   age   of   covered   dependents   under   PPACA   will   LPSDFWWKHYLVLRQEHQHÂżWDVZHOO Under   the   law,   medical   plans   must   allow   dependent   children   to   remain   on   their   parentsâ&#x20AC;&#x2122;   medical  plan  until  age  26,  though  they  lose  access   WRWKHSHGLDWULFEHQHÂżWDWDJH9LVLRQSODQVKDYH traditionally  had  similar  dependent  rules  to  medi-­ FDO SODQV DQG VHHP OLNHO\ WR FRQWLQXH WKLV WUHQG modifying   coverage   rules   to   allow   an   employeeâ&#x20AC;&#x2122;s   dependent  children  to  be  covered  on  the  vision  plan   until  age  26  to  stay  parallel  to  the  medical  coverage.  

A Silver Lining Ahead There   is   no   doubt   health   care   reform   will   add  a  layer  of  complexity  when  it  comes  to  vision   coverage   for   individuals   and   small   groups.   There   are  still  several  parties  who  are  advocating  entirely   different   approaches   to   providing   pediatric   vision   EHQHÂżWV DOWKRXJK WKH WLPLQJ UHTXLUHG WR ÂżQDOL]H EHQHÂżWGHVLJQVDQGÂżOHSURGXFWVWREHUHDG\IRUDQ 2FWREHURSHQHQUROOPHQWIRUSODQVHIIHFWLYH-DQ PDNHLWXQOLNHO\WKDWFKDQJLQJFRXUVHDWWKLV point  is  a  practical  option.   While  we  have  yet  to  see  the  result  of  efforts   OLNHWKHVHDQLPSRUWDQWSLHFHRIDGYLFHWRHPSOR\HUV DQGEHQHÂżWVSURIHVVLRQDOVLVWRUHPDLQĂ&#x20AC;H[LEOHDQG patient   while   some   of   the   issues   raised   by   the   SHGLDWULF HVVHQWLDO YLVLRQ EHQHÂżW DUH GHÂżQHG DQG ÂżQDOL]HG Plus,   a   silver   lining   to   consider   is   that   more   DWWHQWLRQ LV EHLQJ SODFHG RQ WKH YLVLRQ EHQHÂżW²D powerful   wellness   tool   and   way   for   employers   to   improve  their  bottom  line.  


Will Impact Vision Benefits

)DFWVLQWR)RFXV With   health   care   reform   designating   vision   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-­related  health  issues  that  can  negatively  impact   their  physical,  social  and  educational  development.   Many   eye   and   even   systemic   diseases   can   be   detected  through  an  eye  exam  before  symptoms  are   QRWLFHDEOHDQGZKHQVWHSVFDQEHWDNHQWRSUHYHQW or  delay  these  conditionsâ&#x20AC;&#x201D;before  permanent  vision   loss  or  other  side  effects  occur.   (PSOR\HUV KRSHIXOO\ NQRZ LWÂśV LPSRUWDQW WR NHHS XS ZLWK HPSOR\HH H[SHFWDWLRQV LQ WHUPV RI being   able   to   provide   quality   vision   coverage   for   themselves  and  their  children.  After  all,  according   WRDQDQQXDOVXUYH\E\7UDQVLWLRQV2SWLFDOSURYLG-­

ing  eye  care  for  their  family  is  one  of  the  top  reasons   why  employees  enroll  in  their  vision  plan,  and  three   in  four  full-­time  parents  with  access  to  their  com-­ SDQ\ÂśVFXUUHQWYLVLRQEHQHÂżWFKRRVHWRHQUROOLQLW The   bottom   lineâ&#x20AC;&#x201D;employers   should   remain   committed   to   do   whatâ&#x20AC;&#x2122;s   right   in   terms   of   offering   quality   vision   care   and   vision   wear   to   employees  

and   their   children,   regardless   of   the   outcome   of   health  care  reform  measures.   7KH\ DOVR VKRXOG WDNH VWHSV WR HQFRXUDJH HPSOR\HHVWRVHHNUHJXODUSUHYHQWDWLYHH\HH[DPV IRU WKHPVHOYHV DQG WKHLU FKLOGUHQ DQG WR WDNH WKH time   to   truly   understand   what   is   covered   in   their   vision  policy.    

Vision for Tomorrow: Insights from the Transitions Academy HR / Broker Panel Discussion By Smith Wyckoff, Transitions Optical, Inc.

F

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.    

www.TheIHCC.com I HealthCare Consumerism Solutionsâ&#x201E;˘ I January/February 2013

41


BRIEFS

PEOPLE ON THE MOVE

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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.  Most recently, Dr. Compton served as vice president of business intelligence for DentaQuest, one of the nationâ&#x20AC;&#x2122;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&#x20AC;&#x2122;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

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Florida Blue and Cleveland Clinic Florida Create Accountable Care Arrangement Florida   Blue,   Floridaâ&#x20AC;&#x2122;s   Blue   Cross   and   Blue   Shield   company,   and   Cleveland  Clinic  Florida  are  proud  to  announce  the  execution  of  a  Letter   RI,QWHQWZKLFKVLJQLÂżHVWKHLUFRPPLWPHQWWRFUHDWHDQDFFRXQWDEOHFDUH program. The  overall  goals  of  accountable  care  arrangements  are  to  improve   individual   patient   care   and   overall   health,   as   well   as   decrease   medical   costs.  Florida  Blue  and  Cleveland  Clinic  Florida  will  strive  to  accomplish   WKHVHJRDOVE\LQFUHDVLQJFROODERUDWLRQDQGHIÂżFLHQF\ In   addition,   the   program   will   aim   to   increase   patient   satisfaction   by  improving  partnerships  between  patients  and  their  doctors,  allowing   them   to   make   health   care   decisions   together.   It   also   will   improve   the   overall   health   of   the   population   by   enhancing   the   coordination   of   care   among  providers  in  the  health  care  delivery  system. â&#x20AC;&#x153;Cleveland   Clinic   has   been   a   leader   in   providing   high-­quality   health   care   at   a   lower   cost,â&#x20AC;?   says   Bernie   Fernandez,   M.D.,   CEO   of   Cleveland  Clinic  Florida.  â&#x20AC;&#x153;Our  organization  is  structured  around  quality   DQG HIÂżFLHQF\ DQG ZH DUH SOHDVHG WR SDUWQHU ZLWK )ORULGD %OXH RQ WKLV initiative.â&#x20AC;? The  accountable  care  program  between  Cleveland  Clinic  and  Florida   Blue   will   utilize   a   value-­based   compensation   structure   and   serve   as   another   example   of   Florida   Blueâ&#x20AC;&#x2122;s   payment   innovation   efforts   being   deployed   in   the   south   Florida   market.   It   will   decrease   medical   costs   by   rewarding   the   right   combination   of   goals,   including   transparency,   care   coordination,  consumer  power  and  lack  of  redundancy.  

HighRoads Solves Health Plan Data Management for Health Care Payers HighRoads,   the   industry   leader   in   health   care   compliance   and   benefits   management,   launched   the   HighRoads   Benefits   Plan   42

January/February 2013 I HealthCare Consumerism Solutionsâ&#x201E;˘ 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&#x20AC;&#x2122;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. 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.  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   System.   The   new,   SaaS-­based   solution   automates   plan   design  management  and  eases  the  compliance  burden  for  todayâ&#x20AC;&#x2122;s  health   insurance  payers.  â&#x20AC;&#x153;Health  Care  Reform  has  created  new  complexities  for  health  care   payers   who   have   been   charged   with   communicating   new   regulations   in   an  easy-­to-­understand  language  to  their  customers,â&#x20AC;?  says  Michael  Byers,   CEO,  HighRoads.  â&#x20AC;&#x153;The  challenge  is  that  typical  payer  technologies  have   not   been   built   to   accommodate   the   plan   management   requirements   needed  to  easily  deliver  these  critical  compliance  documents.  HighRoads   has  been  a  leader  in  managing  health  plan  data  for  complex  environments   and  employers  for  over  a  decade.  We  are  now  bringing  this  technology  to   the  payer  market  with  a  customized  solution  designed  to  ease  the  burden   of  developing  compliant  materials  for  the  health  insurance  consumer.â&#x20AC;? Todayâ&#x20AC;&#x2122;s   health   insurance   payer   has   complex   plan   data   residing   in   multiple   systems   and   in   multiple   formats.   To   combine   this   information   to   deliver   health   care   reform-­compliant   SBC   materials,   often   requires   PDVVLYHPDQXDOSURFHVVHVZLWKOLPLWHGRUQRDXWRPDWHGZRUNĂ&#x20AC;RZ 7KH +LJK5RDGV %HQHÂżWV 3ODQ 0DQDJHPHQW 6\VWHP LV D SDWHQWHG technology   that   enables   payers   to   become   more   competitive   and   adapt   to   the   frequent   changes   expected   in   the   consumer-­focused   health   care   market.   By   helping   payers   manage   data   holisticallyâ&#x20AC;&#x201D;rather   than   managing  individual  documentsâ&#x20AC;&#x201D;HighRoads  enables  payers  to  generate   EHQHÂżWVGRFXPHQWVPRUHHDVLO\EDVHGRQWKHLUXQLTXHEXVLQHVVUXOHV

Blue Zones Project Demonstration Sites Named Wellmark   Blue   Cross   and   Blue   Shield   and   Healthways   announced   six   additional   communities   have   been   named   as   Blue   Zones   Project   demonstration  sites  in  Iowa.  The  communities   are:  Cedar  Rapids,  Iowa   City,  Marion,  Muscatine,  Oskaloosa  and  Sioux  City. These   communities   join   Cedar   Falls,   Mason   City,   Spencer   and   :DWHUORRZKLFKZHUHQDPHGLQ0D\DVWKH¿UVW%OXH=RQHV3URMHFW demonstration   site   communities   in   Iowa   with   populations   greater   than   10,000  citizens.  Nine  additional  communities  with  populations  less  than  


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Dental of Minnesotaâ&#x20AC;&#x2122;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&#x20AC;&#x201D;the first state to allow for this new type of providerâ&#x20AC;&#x201D;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&#x20AC;&#x2122;s policyholders. He also will be the clinical executive responsible for the strategy and oversight of the companyâ&#x20AC;&#x2122;s medical policies, quality improvement, and performance measurement programs delivered by HCSCâ&#x20AC;&#x2122;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&#x20AC;&#x2122;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   citizens   were   named   demonstration   sites   in   October   2012   for   a   total  of  19  communities  currently  working  formally  towards  Blue  Zones   &RPPXQLW\FHUWLÂżFDWLRQ Âł:H DUH WKULOOHG WR DQQRXQFH WKH ÂżQDO VL[ GHPRQVWUDWLRQ VLWHV IRU the   Blue   Zones   Project   in   Iowa,â&#x20AC;?   says   Ben   R.   Leedle,   Jr.,   Healthways   president  and  CEO.  â&#x20AC;&#x153;The  commitment  to  improved  well-­being  exhibited   by  all  of  the  communities  participating  in  the  selection  process  has  been   inspiring,  and  we  look  forward  to  working  with  the  demonstration  sites   to  transform  the  lives  of  their  residents  through  the  application  of  Blue   Zones  principles.â&#x20AC;? The   selected   communities   will   receive   assistance   from   experts   to   develop  and  implement  a  Blueprint  for  making  permanent  environmental,   social  and  policy  changes  that  transition  people  into  healthier  behaviors   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.  The  progress  of  all  the  large  demonstration  site  communities  will  be   PHDVXUHGXVLQJWKH*DOOXS+HDOWKZD\V:HOO%HLQJ,QGH[Â&#x160;WKHÂżUVWHYHU daily  assessment  of  U.S.  residentsâ&#x20AC;&#x2122;  health  and  well-­being.

Harvard Pilgrim Health Care Selects Castlight Health to Help Find High-quality, Affordable Health Care &DVWOLJKW +HDOWK DQQRXQFHG WKDW IXOOVHUYLFH KHDOWK EHQHÂżWV company  Harvard  Pilgrim  Health  Care  has  selected  Castlight  as  its  health   care  transparency  partner.   Through   the   partnership,   600,000   Harvard   Pilgrim   plan   participants  will  gain  access  to  a  customized  version  of  Castlightâ&#x20AC;&#x2122;s  health   care   management   suite,   providing   them   critical   insight   into   cost   and   quality   information   for   health   care   providers   and   common   procedures.   Castlight   is   the   leading   provider   of   Health   Care   Transparency   solutions   for  employers  and  payers. +DUYDUG 3LOJULP LV D QRWIRUSURÂżW KHDOWK SODQ WKDW SURYLGHV D YDULHW\ RI EHQHÂżW RSWLRQV DQG IXQGLQJ DUUDQJHPHQWV WR PRUH WKDQ RQH

million  members  in  Massachusetts,  Maine  and  New  Hampshire.  For  the   past  nine  years,  Harvard  Pilgrim  has  been  named  the  top  private  health   plan   in   the   country   by   the   National   Committee   for   Quality   Assurance   1&4$  Amid   recently   passed   legislation   in   Massachusetts   calling   for   increased   health   care   transparency,   Harvard   Pilgrim   is   dedicated   to   staying  ahead  of  the  regulatory  curve  and  maintaining  its  reputation  as   the  countryâ&#x20AC;&#x2122;s  leading  health  plan.   After   an   extensive   evaluation   process,   Harvard   Pilgrim   selected   Castlight   for   its   innovative   platform,   robust   data   and   intuitive   user   interface.  Through  the  partnership,  Harvard  Pilgrim  members  will  receive   access   to   a   specialized   version   of   Castlightâ&#x20AC;&#x2122;s   health   care   management   suite   that   features   out-­of-­pocket   pricing   and   quality   measures   for   all   in-­network  health  care  providers.

Towers Watson Announces OneExchange, a Health Benefit Solution for Full- and Part-time Employees Towers  Watson,  a  global  professional  services  company,  announced   the  launch  of  OneExchange.  Building  on  Towers  Watsonâ&#x20AC;&#x2122;s  2012  acquisition   of  Extend  Health,  OneExchange  offers  employers  both  private  and  public   exchange-­based   health   insurance   options   for   their   full-­   and   part-­time   workers,  and  for  all  retirees. OneExchange  makes  it  easy  for  employers  to  manage  the  coverage,   quality  and  cost  of  private  and  public  health  plan  choices  for  all  segments   of   their   workforce   and   retiree   populations   through   a   single   exchange   platform. â&#x20AC;&#x153;Starting   in   2014,   the   Affordable   Care   Act   establishes   guaranteed   issue  and  standard  plan  designs  for  all  individuals,  and  federal  subsidies   for  those  who  meet  certain  eligibility  requirements,â&#x20AC;?  says  Bryce  Williams,   managing   director   for   Exchange   Solutions   at   Towers   Watson.   â&#x20AC;&#x153;It   also   creates  public  exchanges,  or  marketplaces,  as  a  mechanism  for  individuals   to  obtain  health  plans.â&#x20AC;?  

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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, healthcare@tsys.com financial institutions, health plans, and software providers to navigate all aspects of HSAs, HRAs, FSAs, transportation accounts, cash reimbursements, and lines of credit. TSYS Healthcare cards offer participants the security they expect along with the ability to conveniently access funds from multiple accounts and manage their benefits payments with simplified single-card access. Clients and partners benefit from simplified processes, reduced paperwork and cost savings that can contribute to improved return on investment.

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

WageWorks helps employers

WAGEWORKS

support consumer directed

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

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

888-9905099 www.wageworks.com

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

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 sales@evolution1.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

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$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.

DATAPATH, INC.

1601 WestPark Drive, Suite 9 Little Rock, AR 72204 501.296.9990 www.dpath.com

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

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

HSA/HRA/FSA TECHNOLOGY: ADMINISTRATION & MANAGEMENT

At Flex, we believe in making health FLEXIBLE BENEFIT SERVICE benefits more affordable for everyone. CORPORATION (FLEX) For 25 years, we have enabled thousands of clients to make their health care 10275 W. Higgins Road, Suite 500 dollars go further with our consumer Rosemont, IL 60018 driven plans and benefits administration +1-888-353-9178 services, including: fpsales@flexiblebenefit.com 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

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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 efgsales@eflexgroup.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.

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

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Giovanni Colella, M.D. CEO and Co-Founder, Castlight Health HEALTHCARE DATA ANALYTICS

Med-Vision delivers health-plan risk MED-VISION LLC management and wellness strategies to Connie Gee, Vice President help employer groups achieve optimal connie.gee@med-vision.com employee health. Med-Vision’s healthcare 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


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$FFHVVWKHVHSUR¿OHVRQOLQHDWZZZ7KH,+&&FRP HEALTH INCENTIVES

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

MEDENCENTIVE

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

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

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

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

embraced by users. SUPPLEMENTAL HEALTH

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

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 raegan.garber@wecaretlc.com

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

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

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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.

ORRIANT

9980 South 300 West Ste. 100 Sandy, Utah 84070 801.574.2603 www.orriant.com suzanne.viehweg@orriant.com

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

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

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.

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$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 john.reynolds@cielostar.com easy for employers and employees by offering comprehensive benefits administration solutions with a high-touch, high technology model—most recently launching a proprietary private health insurance exchange.

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

TOTAL POPULATION HEALTH MANAGEMENT

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

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

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WHO’S WHO PROFILES

WWW.THEIHCC.COM

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. solutions@codebaby.com Benefits advisor offers guidance and selfservice options that help consumers and organizations alike to make better decisions about benefits selection. Health advisor engages new patient visitors on hospital or office websites or existing patients on wellness, prevention & disease management platforms.

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

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

202.276.3074

selection & shared decision support

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

platform that helps patients make evidence-based, cost effective

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

R E S O U R C E

— Praveen Mooganur, COO

G U I D E

ADVERTISING INDEX AHIP ........................................................ 46

IHC Membership .........................................10

Allstate ........................................................5

Level1Diagnostics ......................................49

Best Buy Reward Zone ........Inside Back Cover

LifeSynch ...................................................45

Carena .......................................................48

MasterCard ................................................48

Castlight Health .........................................46

MedEncentive ............................................47

CieloStar ....................................................49

MedVision ..................................................46

CDHCentric ............................................... 47

Orriant .......................................................48

CodeBaby ................................................. 50

Transitions ......................................... 38, 47

DataPath .................................................. 45

Truven Health Analytics....................... 12, 49

eflexgroup ................................................ 46

TSYS Healthcare ................................... 9, 44

Evolution1 ..................................................44

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

ACCOUNT  MANAGERS

Flexible Benefit Service Corporation ...........45

WageWorks................................................44

Joni  LipsonMOLSVRQ#¿HOGPHGLDFRP

FSA Store ...................................................49

WeCare TLC ............................................. 47

healthPERX............................................... 45

Wiser Together ................................... 20, 50

REPRINTS

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

Workable Solutions ....................................48

Rogers  BeasleyUEHDVOH\#¿HOGPHGLDFRP

HSA Bank ........................................... 22, 44

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ADVERTISING CONTACTS 404.671.9551   CEO/PUBLISHER

Doug  Field    G¿HOG@¿HOGPHGLDFRPāH[W MANAGING  DIRECTOR

Brent  MacyEPDF\#¿HOGPHGLDFRPāH[W

Rogers  BeasleyUEHDVOH\#¿HOGPHGLDFRP

50

Praveen Mooganur

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™.

WISER TOGETHER

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.

INCENTIVE POINTS


Engaging consumers to make informed health care decisions UnitedHealthcareâ&#x20AC;&#x2122;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&#x20AC;&#x2122;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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5PPMTMJLFUIFTFIFMQFNQMPZFFTCFDPNFBDUJWFJOUIFJSPXOIFBMUIDBSFEFDJTJPOT8FBMTPPÄ&#x160;FSUIFFNQMPZFSSFBEZUPVTF 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. Š2012 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


HealthCare Consumerism Solutions Jan/Feb '13