CDHC Solutions Jan/Feb 11 by The Institute for HealthCare Consumerism

Spotlight on CDHC Solutions Forum East and West Conferences

WWW.CDhCsOLUTiONsMag.COM

JaNUary/FEbrUary 2011

VOL 7 NO. 1

$7 Usa

Where Do Your Pharmacy Dollars Go? Milliman Study Confirms Fee-for-Service PBM Strategy Saves Employers Millions Good Health is Contagious: embracing social networks to empower, engage employees for Healthier Lifestyle Impact of evidence-based dentistry, risk based disease Management on dental benefits Vision Benefits: How Much education is enough?

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Features

Inside 32 Considering Impact of

Evidence-Based Dentistry, Risk Based Disease Management on Dental Benefits Using a new approach to oral health care called evidence-based dentistry, which uses scientific evidence to deliver the most effective treatment and disease prevention for patients, Delta Dental is working on using data to incorporate risk assessment into a dental benefit program. S By John Yamamoto, DDS, MPH

29 Vision Benefits: How Much

Education is Enough?

Employers recognize the importance of offering a vision benefit plan as part of the overall comprehensive health benefits package. However, many are missing out on the full value of what their vision plan can do because employees aren’t taking advantage of the program. The main culprit, according Transitions Optical, is a lack of education being provided by the employer about the vision plan. S By Paul Huot

35 Good Health is Contagious Proving Facebook and Twitter have a dramatic impact on individual behaviors when it comes to health, RedBrick Health and the Alliance for a Healthier Minnesota used the power of social networks to engage seven of the state’s largest employers to participate in a healthy competition called, “The Biggest Loser Summer Challenge.” By Kyle Rolfing

38 Where Do Your Pharmacy

Dollars Go?

One of the largest increases in health care costs is prescription drugs. However, according to an independent study by Milliman and commissioned by Restat, employers can save millions of dollars by using a fee-for-service PBM Strategy. By David Kwasny

COMING UP NEXT … Former Speaker of the House Newt Gingrich leads and impressive list of thought leaders and also provides the overall outlook on health care and health care consumerism in our annual Solutions Outlook issue. On the Cover … Restat President David Kwasny stands at the conference table at company’s home office in Milwaukee Wis. Restat calls its new Align pharmacy benefit program, “Health care reform without legislation.” Cover art by Lila Aryan Photography (lilaaryan.com) www.cdhcsolutionsmag.com I CDHC Solutions™ I January/February 2011

dePARTMenTs 6

editor and Publisher’s Letter

Health Care Consumerism

oNlINe CdhC solutions online brings you Web 2.0 at its best—a social networking site dedicated to providing expert advice, trends, and information about consumer-directed health care using a 24/7, virtual, portable format.

As the Health Care Reform Debate Continues, Let Us be Your Guide Bipartisan Change Should Include Fixing Minimum Loss Ratio

health care delivery and benefit design are changing at a frenetic pace. are you successfully navigating the shifting paradigm? learn how on CdhCsolutionsMag.com.

By Ronald e. Bachman

11 CdHC solutions Forum n n

Agenda for Forum East in Atlanta Registration for Forum

Web-oNly Features Health Care Consumerism

17 People on the Move/Briefs 18 Innovations

It’s Insurance?

By Alan Cohen, Liazon

Intelispend Prepaid solutions launches MasterCard Prepaid Wellness Card n Integreated Premera blue Cross Member Portal enhances Member engagement n

employee Communication & education

Improving Member Experience Through Effective, Efficient Communications By Doug Cox, gMC Software Technology

20 solutions spotlight

Encourage Engagement with Powerful Incentives

Population Health and Wellness

Take Advantage of New Year’s Resolutions

Best Buy

By Jennifer Benz, Benz Communications

23 Ask Your Broker

Broker Compensation Arrangements to Change with PPACA

social networking LinkedIn

By Martin Trussell

Make sure to join our group on linkedIn, CdhC solutions, and participate in the latest discussions on CdhPs and health care in general.

25 HsA/HRA/FsA Administration & Finance

Tweet Tweet

Follow CdhC solutions on twitter, @ cdhcsolutions, to stay in the loop with latest health care reform news and industry updates.

hsas under obamaCare

By dan Perrin

26 self-Funding Health Plans

Facebook

Health Care Reform Prompts more Employers to Investigate Self-Funding

Fan CdhC solutions on Facebook to connect with other CdhC followers and get recent site postings from our wall feeds.

By Matt Leming

43 Ask the expert

Featured Blog

Winning the Health Care Game By Lighthouse1

The Worst Health Care System in the World is … By Evan Falchuk

event

44 stats & data

The 2011 CdHC solutions Forum Our Conference has expanded with Forum EAST in Atlanta, GA., May 11-12, and our inaugural Forum WEST in Denver, CO., on Sept. 15. www.cdhcsolutionsmag.com/forum/

Comparing Account Balances, Rollover Amounts for Individuals with HRAs, HSAs

46 Who’s Who Profiles 49 Resource Guide/Ad Index

have something to share? Post a blog or forum on www.cdhcsolutionsmag.com today!

PRInT And OnLIne KeY Connect with CdhC experts and community members online at www.CdhCsolutionsMag.com by looking for the following symbols at the end of each article: blog

MEMBER

BLOG

WHO’S WHO PROFILE

BROKER/ADVISOR/ CONSULTANT

EMPLOYEE COMMUNICATION & EDUCATION

HEALTH PLANS

HSA/HRA/FSA ADMIN & FINANCE

S TOTAL POPULATION HEALTH & WELLNESS

PHARMACY BENEFITS MGMT

January/February 2011 I CDHC Solutions™ I www.cdhcsolutionsmag.com

POLICY & LEGIS PERSPECTIVE

SUPPLEMENTAL BENEFITS MGMT

TOOLS AND TECHNOLOGY

MEDICAL TOURISM

Can you see what you could be throwing away?

Use the Healthy Sight Calculator. If your workers aren’t taking advantage of a premium vision benefit, you could be paying a hefty price in avoidable healthcare costs and productivity loss. Find out for yourself. Take the “See the Savings Challenge” and calculate the cost avoidance possible for your workforce. Just for using the Healthy Sight Calculator at www.HealthySightWorkingForYou.org, you’ll be entered into a drawing to win one of two $500 prizes.

L e tt e r

Editor & Publisher

As the Health Care Reform Debate Continues, Let Us be Your Guide

Three days after the 112th session of Congress convened, the U.S. House of Representatives, led by Republicans, voted 236-182 in favor to repeal the Patient Protection and Affordable Care Act (PPACA). As the repeal moves to the Democratic controlled Senate—Democrats and the two Independents hold a 53-47 voting majority—speculation is it will be killed. Even if it passes the Senate, President Obama stated he plans to veto the repeal. The president also promised to work for a bipartisan solution on health care reform in his State of the Union address. Either way, the debate is starting to brew again and change is on the horizon.

Let Navigator Guide Health Reform Actions

With the constant change, there is no better way to stay on top of health care reform news than the Health Reform Navigator, that CDHC Solutions has launched, providing aggregation and easy point-and- click navigation to the Health Care Law (PPACA). Features include: 1. (PPACA) – Direct point-and-click access to “Insurance” and “Taxes & Penalties” specific sections of the law. Locate immediately the actual language of PPACA for each topic you are interested in (e.g. grandfather clause, small group subsidy, child coverage). 2. Timelines – “Navigator” Legislative Timelines with links to all insurance and taxes/penalties in PPACA. In addition, there are multiple timelines provided by national organizations (i.e. National Federation of Independent Business, Kaiser). 3. Regulations-Direct – point-and-click access to Department of Labor, Health and Human Services, and IRS health reform regulations and related information (FAQ, model notices, videos, and more). 4. Surveys – Direct point and click access to national surveys on what employers are doing in response to PPACA. 5. Hot Topics – As regulations are announced, special attention is provided for easy viewing of “What’s New?” including FAQ, fact sheets, and videos 6. Updates – For $99, you can buy the current updated Navigator for PPACA and the access code to any updates provided at this same website for 12 months.

Let CDHC Solutions be the Facebook of Health Care Consumerism

With the changing health care laws affecting every company’s benefit management and HR reps, employers are facing similar challenges of aiding their employee population and still maintain a profit. Through our websites, www.cdhcsolutionsmag.com and www.employersweb.com, we not only provide a bevy of information, as the collective voice of health care consumerism, but also offer an avenue for you to reach out to your peers, who face the challenges your firm battles on a daily basis. Have you come up with a solution for lowering the cost of your employees’ health care needs or want to comment on an article on our site? We invite you to share with your peers at the only 24/7 social networking community dedicated to innovative health and benefit management. Not only are we a virtual social networking community, we also provide real-life, face-to-face networking at our CDHC Solutions Forum EAST and WEST, the only conference series devoted exclusively to consumer-directed health care and the health care law. Please see our spotlight on Forum ad on pages 11-15 or online at www.cdhcsolutionsforum.com. Sincerely,

www.cdhcsolutionsmag.com VOLUME 7 NO. 1 January/February 2011

Published by FieldMedia LLC 292 South Main Street, Suite 400 Alpharetta, GA 30009 Tel: 404.671.9551 Fax: 770.663.4409 ceo/ P u b l i s h e r/E d i to r-In-C h i ef

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Jonathan Field jfield@fieldmedia.com S a le s A s s oc i a te s N a t i o n a l Acc o u n t M a n a g e r

Brent Macy 404.671.9551 ext. 103 · bmacy@fieldmedia.com V ic e P r e s i d e n t o f B u s in e s s D e v e l o pm e n t

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Kellie Frissell 404.671.9551 ext. 107 · kfrissell@fieldmedia.com Chairman of CDHC Solutions Editorial Advisory Board

Ronald E. Bachman, CEO, Healthcare Visions E d i to r i a l Adv i s o r y Bo a r d

Ronald E. Bachman, Healthcare Visions G.J. Domis, Procter & Gamble Tracy Grunsfeld, Medco Health Solutions Karen Kirkpatrick, Infinisource Mike McCue, former editor-in-chief, Managed Health Care Executive Joseph Paduda, Health Strategy Associates David Randall, CDHCI Janet Trautwein, National Association of Health Underwriters Neil Trautwein, National Retail Federation Andrew Webber, National Business Coalition on Health O nl i ne C ontent M a n a g e r

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Benjamin Pfohl webmaster@fieldmedia.com CDHC Solutions ™ Volume 7 Issue 1 Copyright ©2010 by FieldMedia LLC. All rights reserved. CDHC Solutions ™ is a trademark of FieldMedia LLC. CDHC Solutions ™ is published eight times yearly by FieldMedia, Inc., 292 South Main Street, Suite 400, Alpharetta, GA 30009. Periodical postage paid at Alpharetta, GA and additional mailing offices. TO SUBSCRIBE: Make checks and money orders payable to CDHC Solutions ™ magazine 292 S. Main Street, Suite 400, Alpharetta, GA 30009 or visit www.cdhcsolutionsmag.com. Non-qualified persons may subscribe at the following rates: single copy $7.50; $75.00/yr in the US, $105/yr in Canada and $170/yr international. Please contact FieldMedia at 404.671.9551 or subscriberservice@fieldmedia.com for name/address changes.

Todd Callahan Managing Editor tcallahan@fieldmedia.com

January/February 2011 I CDHC Solutions™ I www.cdhcsolutionsmag.com

Doug Field CEO/Publisher dfield@fieldmedia.com

PRINTED IN THE U.S.A. CDHC Solutions ™ is designed to provide both accurate and authoritative information with regard to the understanding that the publisher is not engaged in rendering legal, financial or other professional service. If legal advice is required, the services of a professional adviser should be sought. The magazine is not responsible for unsolicited manuscripts or photographs. Send letters to the editor and editorial inquiries to the above address or to mbolch@fieldmedia.com. Requests for Permissions to reuse content contact Copyright Clearance Center at info@copyright.com.

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FIN A N C I A L S O LU T I O NS

•

PA YME NT S OL UT I O N S H E ALT H CA R E

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B U S I N E S S C O N S U LT I N G

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T E C H N O L O G Y S E RV I C ES

Health Care Consumerism

By Ronald E. Bachman FSA, MAAA, President and CEO » Healthcare Visions

Bipartisan Change Should Include Fixing Minimum Loss Ratio

he Minimum Loss Ratio (MLR) mandate was rejected by vote in the Senate Finance Committee’s version of Health Reform, but it managed to creep into the Patient Protection and Affordable Care Act (PPACA) when a new Senate bill was developed, bypassing the normal process. It is a key item in need of bipartisan repeal. The recent Department of Health & Human Services (HHS) regulations on MLR follow recommendations made by the National Association of Insurance Commissioners (NAIC). The NAIC relied heavily on a technical study by Milliman, a nationally recognized actuarial company. Unfortunately, the NAIC recommendations ignored the most important aspects of the Milliman study that recognized the uniqueness of consumer-driven health care (CDHC) plans. The end result is that the federally mandated MLR could negatively impact the growth of CDHC plans and the development of health care consumerism.

Minimum Loss Ratio Defined

MLR is an attempt to maximize the portion of insurance premiums paid for medical care. The MLR calculation is used to determine if a rebate is required. A rebate is money returned to enrollees from insurers as a partial refund of premiums. MLR rebate calculations are made on a state by state basis. A rebate is generated if medical payments for insurance falls below 85 percent (80 percent for plans covering small businesses and individuals) of the premium. Viewed another way, rebates are generated if plan expenses exceed 15 percent of the premium (20 percent for plans covering small businesses and individuals). In essence, the MLR is an attempt to control premiums by limiting administrative expenses and minimizing risk premiums (profit). However, it also will inhibit the growth of new companies and investments in new products and services.

CDHC and Insurance Expenses

Let’s understand insurance expenses. First, every plan has fixed administrative costs (computer systems, property rent/lease/mortgage, utilities, customer service, etc.). These costs are incurred regardless of whether the insurance company sells plans with higher premium PPOs, lower premium CDHCs, or a mix of plans. Second, with CDHC and higher deductible plans, insurers must process claims submitted to account for deductible accumulations. Third, CDHC plans and high deductible plans have higher risk charges due to more volatile claims experience. There are two reasons for CDHC volatility: n Selection bias. Individuals with chronic poor health and/or known diseases tend to seek high premium plans with low deductibles. Healthier individuals tend to choose higher deductible plans. n Accidental claims. Higher deductible plans are designed to provide protection against large claims, many of which are the result of unexpected illnesses (e.g. cancer, heart disease) or accidental injuries. Unexpected claims have a greater degree of volatility and cost uncertainty.

The above characteristics of CDHC plans produce expenses that are a higher percentage of premiums than other plans. In the regulations, there is an adjustment factor to recognize higher deductible plan designs. However, contrary to the Milliman study, the MLR regulations zero out the higher deductible adjustment on plans sold by insurers with more than 75,000 members.

Unintended Consequences

n The MLR encourages consolidation over increased competition.

Only large national companies have sufficient revenue to spread their fixed costs. n Plans sold to younger adults are particularly discriminated against in the legislation. PPACA pricing mandates require purchasers under age 30 cannot be charged less than 33 percent of what older adults pay. Traditional pricing would allow young adults to be charged only 20 percent of the total older adults pay. n Related to MLR is the PPACA requirement for insurers to establish a “single risk pool.” With a single risk pool, lower renewal premiums are not allowed for insured plans that encourage lower claims through behavior change and increased personal responsibility. All plans in the pool will have to be given similar or equal renewal rate increases. n An employer can avoid the MLR mandates, single risk pool pricing, price restrictions by age and other factors by implementing a selfinsured arrangement. Self-insured plans avoid the added PPACA insurance taxes and have the advantages of holding reserves, eliminating state premium taxes, and avoiding state mandates n National carriers will likely aggressively promote self-insurance. Carriers will shift to more profitable services of enrollment, billing, claims processing, and other self-insured revenue streams.

Impact of MLR on Consumers

For consumers, the MLR may limit plan choices, limit access to brokers, promote higher premiums, and force separate purchase of services previously covered by insurance. n Limited Plan Designs. There may be a movement to eliminate outof-network benefits. n Limited Access to Brokers. Some carriers have already announced the elimination of commissions for groups above 100 lives. n Limited Access to Physicians. The MLR rules encourage a move to capitation arrangements with providers. Consumers beware. The MLR and rebate calculations are complex and produce unintended consequences. Unless changes are made by the new bipartisan Congress, it will negatively affect your ability to find affordable CDHC options. It would be a good faith move by HHS to grant a two-year waiver to all states while bipartisanship is given a chance to make rational changes. www.cdhcsolutionsmag.com I CDHC Solutions™ I January/February 2011

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For the latest updates and to register, visit www.cdhcsolutionsforum.com or call 404.671.9551.

2 0 1 1 C o n fere n ce L ocat i o n s

E ast

a n d

west

CDHC Solutions Forum EAST 2011 MAY 11 - MAY 12 Cobb Galleria Centre 2nd Annual CDHC Solutions Forum conference series will be held in Atlanta, GA at the Cobb Galleria. The East will expand to a day and a half. Attendees will be those Employers, plus TPAs, Benefit Brokers, Consultants and Regional Health Plan Providers who work with them, who are focused on redesigning their health care benefit offering to include consumer-directed health care solutions and / or improve upon their current programs. FOR THE LATEST AGENDA AND TO GET OUR SUPER EARLY BIRD RATE - GO TO www.cdhcsolutionsforum.com New this year.... a single day event on the west coast.

CDHC Solutions Forum WEST 2011 SEPTEMBER 15 Marriott Tech Center Denver, CO

WHO

FOR THE LATEST AGENDA AND TO GET OUR SUPER EARLY BIRD RATE - GO TO www.cdhcsolutionsforum.com

Who Should Attend: • CEOs/Presidents/CFOs • HR and benefits executives • Bankers

• Health plan administrators • Corporate wellness and medical directors

• Benefit brokers • Third party administrators • Benefit consultants

Dress for conference is business casual. Attendees receive a Show Guide Notebook including copies of all the presentations.

For the latest updates and to register, visit www.cdhcsolutionsforum.com or call 404.671.9551.

Led by Top Industry Leaders CDHC Solutions magazine (www.CDHCSolutionsmag. com) has provided innovative health care benefit forum’s to help employers prepare for and manage changes that will occur A CONFERENCE SERIES FOR INNOVATIVE HEALTH & BENEFITS MANAGEMENT with the new health care law. Find out what those changes www.cdhcsolutionsforum.com mean for your company and/or clients’ health care benefits plans now and in the near future. Hear what leading experts are recommending, what your peers are doing to prepare, and what you can do now to make the transition easier and less costly. Also, health care consumerism will have a profound impact on your company and your employees. Whether your company has already implemented a consumer-directed health care plan or is considering it, you need to attend CDHC Solutions Forum to find out the best ways to prepare for the upcoming challenges facing your company or clients. Experts from top solution providers, consultants in the CDHC space, and employers facing the same challenges and opportunities that you do will present best practices in intimate forums that invite questions and ongoing dialog. 2nd Annual CDHC Solutions Forum conference series will be held in Atlanta, GA at the Cobb Galleria and West in Denver, CO. The East will expand to a day and a half, while the West will continue our single-day format. Attendees will be those Employers, plus TPAs, Benefit Brokers, Consultants and Regional Health Plan Providers who work with them, who are focused on redesigning their health care benefit offering to include consumer-directed health care solutions and /or improve upon their current programs. We are the only conference series devoted exclusively to Consumer-Directed Health Care and the Health Care Law. Our events offer affordable pricing, discount group rates and are accessible to most companies. With the industries top professionals giving you access to valuable information, you cannot afford to miss this opportunity to save your company time and money. CDHC Solutions Forum’s are designed for those new to consumer-directed health care and for those looking to enhance current offerings. It is focused solely on consumer-directed health care, including supplemental health benefits, pharmacy benefits management, population health and wellness strategies, incentives, HSA/HRA/FSA administration and finance, employee communication, and what companies are facing with the new health care law. It is our pleasure and our privilege to host this forum for our readers. We thank you for your support and continue to pledge unmatched dedication to integrity and knowledge in the industry. We look forward to seeing you there

Doug Field President, Publisher, CEO FieldMedia LLC

Ron Bachman, FSA, MAAA Chairman CDHC Solutions Editorial Advisory Board

S i l v er S po n sors & E x h i b i tors

P art n ered W i th

P rod u ced B y 292 S. Main Street | Suite 400 | Alpharetta, GA 30009 | info@fieldmedia.com

2 0 1 1 C o n fere n ce E A S T A g e n da

WEDNESDAY MAY 11 8:30 – 12:00 p.m. 8:00 – 1:00 p.m. 1:00 – 2:45 p.m. 2:45 – 3:00 p.m. 3:00 – 4:00 p.m. 4:15 – 5:15 p.m.

5:15 – 7:00 p.m.

Pre-Conference Hands-On Workshops (additional fee) 1 – Health Care Reform: What Happened, What is to Come and What is Still Needed 2 – CDHC Certification Course Registration Opening RemarksOpening General Session”The Expanding Future of Health Care Consumerism” Afternoon Break and Exhibits Open Track #1 Workshop – Choose one (1) A – Missing the Mark in Specialty Health Benefits Education B – Consumer-centric Employee Benefits: Economics 101 C – Who Survives? How Benefit Costs are Killing your Company D – Utilizing Rewards and Incentives to Influence Decisions on Improved Health E – How to Educate, Engage and Empower Health Care Consumers while Achieving Corporate Finance and Wellness Objectives F – CDHP and Health Reform Strategy – A Total Replacement HSA Case Study Closing General Session Day One – “Implementing Health Care Reform: “Implementing Health Care Reform: The Year in Review and What’s on the Horizon for CDHC” Opening Night Reception in Main Ballroom

THURSDAY MAY 12 7:30 – 9:00 a.m. 9:00 – 10:30 a.m. 10:30 – 11:00 a.m. 11:00 – 12:00 p.m. 12:00 – 1:30 p.m. 1:30 – 2:30 p.m. 2:30 – 2:45 p.m. 2:45 – 3:45 p.m. 3:45 – 4:15 p.m. 4:15 – 5:15 p.m.

Registration and Continental Breakfast, Exhibits Open General Session – “Impact of Health Reform on Health Care Consumerism: A Multi Stakeholder View” Morning Break and Exhibits Open Track #2 Workshops – Choose one (1) G – Personal. Social. Financial. How to Drive Sustained Engagement in Health H – Cost Transparency: What Can Make CDHC Truly Work I – How CDHC Positioned Zions Bancorp Well Under Health CareReform aka PPACA J – Consumer-Centric Behavior Treatments K – Improving Employee Participation and Engagement L – Value Based Design Fuels Patient Engagement Lunch in Main Ballroom, Exhibits Open Afternoon General Session – “Population Health & Wellness Panel” Beverage Break Track #3 Workshops – Choose one (1) M – Innovation for Self Funded Plans, Ways to Save Money on RX and Recapture Provider Overpayments on Claims N – The ABC’s of HRA to Predict and Manage Medical Risk O – Upgrading Health and Wellness Incentive Programs P – What Health Reform Means to COBRA Q – 5 Questions You Should be Asking about your Current or Planned BenAdmin R – CDHP: Advanced Plan Design Afternoon Break and Exhibits Open Closing General Session – Employer Panel “How Employers are Moving to Health Care Consumerism and Addressing the Health Care Law”

For the latest updates and to register, visit www.cdhcsolutionsforum.com or call 404.671.9551.

Type

Early Bird • 3/31/11

Standard • 5/10/11

Onsite

Employer: Government

$395

$495

$695

Employer: Private Sector

$495

$595

$895

TPAs, Benefit Brokers, Consultants

$695

$795

$1,095

Solution Providers

$995

$1,095

$1,295

*Group Rates Available 25% off – Two or More

Attendee Pricing Includes • Continental Breakfast, all-day breaks and Boxed Lunch • Three Innovative Workshops of your choice • Four General Sessions with the Top Industry Leaders • Opening Night Reception • Conference Notebook with all Presentations

Tom Torre SVP/General Manager, FIS Consumer Driven Healthcare Solutions FIS Global John Young Vice President-Consumerism, CIGNA HEALTHCARE

Roy Ramthun An expert on Health Savings Accounts and consumerdirected health care issues. Jon Comola CEO and Chairman, Wye River Group and Founder of Foundation for American Healthcare Leadership

John Hickman Partner, Alston+Bird LLP

Doug Field CEO, FieldMedia LLC, Publisher of CDHC Solutions and Producers of CDHC Solutions Forum

Josh Hilgers An expert in consumerdriven health care and the communication of these plan designs and owner of Innovative Benefits Consulting. Diana M. Andersen SVP & Director of Corporate Benefits, Zions Bancorporation

Workshop Speakers: David Merritt Vice President and National Policy Director, Center for Health Transformation and the Gingrich Group Wayne Oliver Vice President, Center for Health Transformation

Niteesh K. Choudhry, MD, PhD, Harvard Medical School

Mike Seethaler Vice President of Business Development for TSYS Healthcare. industries.

Vincent Frakes Project Manager, Center for Health Transformation

Featured Speakers

Ron Bachman FSA, MAAA, Sr. Fellow Center for Health Transformation, President of Healthcare Visions & Chairman of CDHC Solutions Editorial Advisory Board

Early Bird rates

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People on the move

People on the move Blue Cross Blue Shield of Massachusetts announced that Bruce M. Bullen has joined the company as Chief Operating Officer, effective Jan. 17, 2011. As COO, Bullen works directly with President and CEO Andrew Dreyfus to advance the company’s Bullen highest priority of making quality health care affordable. He will have responsibility for the company’s key operational divisions, including sales, member services, health management, information technology, and contracting with physicians and hospitals. He will serve on the company’s Executive Management Team and report directly to Dreyfus. Bullen joins BCBSMA after more than a decade in senior management positions at Harvard Pilgrim Health Care, serving as the company’s interim CEO from 2009-2010. As its Chief Operating Officer from 1999-2009, Bullen helped lead Harvard Pilgrim’s extraordinary financial and operational turnaround. Prior to Harvard Pilgrim, Bullen spent two decades in senior roles in Massachusetts state government, including 10 years as the commissioner of the Medicaid program. In that role, he eliminated a $300 million deficit and led the design and implementation of a groundbreaking health reform initiative that extended health coverage to 300,000 uninsured residents. CareFirst BlueCross BlueShield (CareFirst) has named Cindy S. Friend as Vice President of Regional Care Coordination for its Primary Care Medical Home (PCMH) program. Friend is a registered nurse with more than 20 years of combined Friend experience in health information technology, provider outreach, disease/case management and nursing. Prior to joining CareFirst, Friend served as Chief of Health Information Technology for the Maryland Health Care Commission (MHCC). Friend will provide leadership for a key strategic arm of the PCMH program and oversee 18 Regional Care Coordinators, registered nurses who will work closely with primary care providers to establish and monitor care plans for CareFirst members in Maryland, Washington, D.C., and northern Virginia. Friend holds Master’s degrees in Nursing and Business Administration from the University of Phoenix, as well as undergraduate nursing degrees from the University of Phoenix, Anne Arundel Community College and Harford Community College. She is a resident of Carroll County, Maryland. In addition to working for the State of Maryland, Friend has worked for BlueCross BlueShield of Massachusetts, Healthways, and Holy Cross Hospital. CareFirst’s PCMH program is designed to address the rising costs associated with health care delivery, which make coverage increasingly unaffordable for families and individuals, by improving care quality and efficiency. PCMH meaningfully compensates providers for placing an increased emphasis on caring for their sickest patients, many of who are diagnosed with multiple chronic conditions such as heart disease and Type 2 diabetes. Coupled with HealthyBlue, a portfolio of health insurance products that provide financial incentive for members to actively improve their overall wellness, CareFirst has launched a broad strategy designed to meet the needs of the whole patient and treat their health risks before they become ill. Regence BlueCross BlueShield of Oregon President Jared Short is proud to announce the appointment of Alison Goldwater to Vice President of Provider Services in Oregon. In this role, Goldwater will be responsible for enhancing provider relationships throughout our communities and evolving Regence’s broad provider networks to help make health care more sustainable Goldwater for our members. Goldwater moves into this position from her role as Regence Director of Network Strategy and Reimbursement Management. Among her successes at Regence, Goldwater led the development and execution of

briefs

the company’s radiology management strategy, resulting in significant cost savings for Regence’s employers and members; as well as the development of Regence’s medical home strategy and pilot programs. Before moving to Regence, Goldwater held several impressive roles in the Midwest, most recently serving as a senior consultant to physician practices, resulting in significant increases in revenue. Additionally, Goldwater worked with Humana Health Care Plans for 10 years in the Provider Contracting division. As Director of Provider Contracting, Goldwater was successful in maintaining strong and positive relationships with providers, while working with them on key strategic reimbursement changes that ultimately produced an annual savings to the organization. She earned a master’s degree in business administration from the University of Illinois at Chicago, and a Bachelor of Science from the University of New Hampshire. Kinetic Concepts, Inc. PowerRating has announced David Lillback has been named senior vice president, global human resources. Lillback is responsible for leading global human resources, including initiatives to support the company’s key pillars of innovation, global expansion, diversification and organizational readiness. Lillback most recently served as senior vice president of human resources at Mylan, Inc. He has also held senior executive positions with Sanofi-aventis, LaRoche and Kaiser Chemicals. Lillback has a wealth of executive experience in overseeing highly effective HR organizations. This work includes architecting programs on a strategic level around total rewards and benefits, talent development and acquisition, continuous learning and workplace environment. Community Health Accreditation Program, Inc. (CHAP, Inc.) announced the appointment of five new three-year term members and two one-year Sphere of Influence members to the CHAP Board of Directors. The new appointees represent community-based health care sectors and were appointed at CHAP’s November 2010 Board meeting. Appointees include: Jane L. Delgado, PhD, MS, President and CEO, National Alliance for Hispanic Health; Katheen J. Dodd, BSN, MA, Founder and CEO, Corridor International; Warren Hebert, RN, BSN, CAE, Chief Executive Officer, HomeCare Association of Louisiana; Daniel L. Maison, MD, FAAHPM, Palliative Care Physician, Spectrum Health Care; and Kevin P. McQueen, Partner, BWB Solutions, LLC. In addition to the three-year term appointments, CHAP has appointed two Sphere of Influence members to the Board. Sara Wentworth Adams, Managing Principal, Health Care Information Consultants, LLC, and Jack E. Rydell, Assistant Professor, Concordia College, begin one-year terms in 2011. Lisa M. Guertin was named president and general manager of Anthem Blue Cross and Blue Shield in New Hampshire. Her appointment began Jan. 1, 2011. Guertin, who previously served as New Hampshire’s state plan president from 2004-2008, assumes responsibility for the management of all group health business in New Hampshire. She is involved in corporate strategy, planning and execution, and serves as the primary contact for state regulators and elected officials. For the past three years, Guertin has served as senior vice president of Commercial Marketing and Product for Anthem’s parent company. In that role, she was responsible for product management, product development, and marketing for the local group, national accounts, specialty and UniCare customers, representing more than 80 percent of the company’s membership. Aetna announced it has named Michael J. Guyette as the new head of National Accounts. Guyette will lead the National Accounts organization in delivering innovative, customer focused benefit solutions designed to help large employers adapt to a rapidly changing and dynamic marketplace. He continued on page 18 www.cdhcsolutionsmag.com I CDHC Solutions™ I January/February 2011

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assumed his new role on Jan. 3, 2011. Since joining Aetna in May, Guyette has served as head of the Southeast region where he led local market efforts to control medical costs, improve quality and strengthen customer and broker relationships. Prior to joining Aetna, Guyette held senior leadership positions at Blue Guyette Cross Blue Shield of Florida, including senior vice president of the company’s diversified business unit. He also served as the chief sales officer and group vice president for their national business unit. In addition, Guyette held a variety of senior sales and marketing positions with Independence Blue Cross and AmeriHealth in both Philadelphia and Houston. He also worked for Prudential Healthcare and Continental Insurance in various Texas and Oklahoma markets. Guyette graduated from the University of North Texas with a bachelor’s degree in finance and also earned an MBA from Villanova University. David Queller, a long-time Aetna executive with nearly two decades of health insurance industry experience, has been named head of the company’s Southeast Region, responsible for managing business operations in the District of Columbia and the states of Alabama, Arkansas, Florida, Georgia, Louisiana, Maryland, Mississippi, North Carolina, South Carolina, Tennessee, Virginia, and West Virginia. He began his new duties Jan. 3, 2011. Queller replaces

CDHC Innovations

InteliSpend Prepaid Solutions announced the company will offer the MasterCard Wellness Prepaid Card. The card will be available in January 2011 to help companies motivate their employees to participate in corporate wellness programs. “As health care costs continue to rise, the wellness market is poised for significant future growth,” said Darryl Hutson, InteliSpend chief executive officer. “We are pleased to work with MasterCard and bring to market the MasterCard Wellness Prepaid Card, which is designed to invigorate employee participation in wellness initiatives.” The InteliSpend MasterCard Wellness Prepaid Card offers companies a turnkey solution to help maximize participation within corporate wellness programs. According to a survey conducted by MasterCard and Harris Interactive in the fourth quarter of 2009, 78 percent of employees work at a company offering some type of wellness program and participation increases dramatically when incentives are offered. Within companies that offer incentives for program participation, 61 percent of employees choose to participate, compared to only 26 percent of employees who participate in programs at companies that do not provide incentives for participation. About half of non-participants indicated they would participate in a wellness program if a prepaid card was offered as an incentive, according to the survey

Integrated Premera Blue Cross Member Portal Enhances Member Engagement Premera Blue Cross announced the successful integration of medical, pharmacy, and lab data into the Premera Blue Cross member portal, premera.com, powered by WorldDoc. The portal plays a critical role by connecting Premera members to a personalized health and wellness information site and elevating their interest and engagement in their own health and wellness. By importing member records from multiple data sources, World Doc makes it possible for Premera to pre-populate an individual’s health portal with meaningful information, including their Health Risk Assessment and Personal Health Record. The imported data, combined with member reported information, provide a more complete health picture for each member that can be shared with doctors, pharmacists and other caregivers. Personalized messages that include consumer-friendly health and wellness tips relevant to that individual member can drive improved consumer engagement. By encouraging and engaging members to take a more active role in their own health and January/February 2011 I CDHC Solutions™ I www.cdhcsolutionsmag.com

Humana Inc. has named Rhonda Bagby president of its Louisiana commercial operations. As Humana’s senior commercial executive for Louisiana, based in New Orleans, Bagby is responsible for the state’s overall commercial continued on page 22

Intelispend » Premera Blue Cross » AlwaysCare »

InteliSpend Prepaid Solutions Launches MasterCard Prepaid Wellness Card

Michael Guyette, who recently was promoted to head of Aetna’s National Accounts business. He will continue to be based in Alpharetta, Ga. Queller will have managerial responsibility for sales, marketing, network development and medical economics operations, and will lead local market efforts to control medical costs, improve quality and strengthen customer and broker relationships. Queller currently serves as head of Aetna’s Northeast and Southeast Region National Accounts organization. National Accounts teams under his leadership are jointly responsible for more than 6 million medical members, nearly 5 million dental members, 2 million pharmacy members and more than 200 client engagements throughout the 22 states that make up the regions. Before assuming expanded responsibilities for the East Region, Queller led the Southeast and Mid-Atlantic National Accounts teams for five years. Previously, he was vice president of sales and service for the North Texas market, based in Dallas.

wellness, it is possible to improve members overall health which can lead to lower health care costs and reduce the number of medication-related problems. Initially launched in 2009, the updated portal provides a seamless, streamlined user experience. The site integrates traditional services like finding a doctor; reviewing medical claims and Explanations of Benefits (EOB); and ordering an ID card.

AlwaysCare Launches Fully Insured Safety Eyewear Program Large employers looking for this sight-saving benefit now have a new vision plan option from AlwaysCare Benefits, Inc., one of the fastest growing group insurance providers in the country. AlwaysCare launched a fully insured Safety Eyewear program as an add-on for group vision plan clients with 500 employees or more on Jan. 1, 2011. Members whose employers opt to participate in this new program will be able to obtain safety eyewear in addition to either their contact lenses or normal vision-correction ‘dress wear’ eyeglasses. Up to 70 percent of working Americans require prescription eyewear, and 2,000 Americans suffer from an eye injury at work every day, according to the National Institute for Occupational Safety and Health. Sixty percent of these injuries occur because the employees were not wearing protective eyewear. Experts believe by wearing the correct protective eyewear, Americans can avoid 90 percent of all eye injuries. With flexible, affordable vision benefits that fit various budgets and group needs, AlwaysCare is committed to helping employers and their employees improve and maintain their vision health and overall quality of life. All AlwaysCare vision plans include access to comprehensive eye exams through a national vision network of more than 20,000 provider access points, including national and regional chains, and independent eye care professionals across the country. Plans include set pricing for lenses, and special discounts on optical materials for extra purchases of lenses and coatings, frames, contact lenses and other products.

HealthPartners Extend Availability of Online Clinic to Wisconsin HealthPartners extended the availability of virtuwell.com, the new 24/7 online clinic, to Wisconsin. Introduced to Minnesota in late October, virtuwell offers online diagnosis, continued on page 22

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Encourage Engagement with Powerful Incentives The start of a new year invites us to set goals, improve ourselves and accomplish more than we did in the previous year. For human resources professionals, the New year also requires goal setting for their entire organizations. These professionals know the New year by another name: enrollment season. enrollment is an opportunity to start programs encouraging healthier lifestyles, more environmentally friendly behavior or a more productive workplace. Finding the right incentive to encourage joining these programs is an integral part of the planning process. The best incentive will excite employees during enrollment and maintain engagement throughout the program. Considering the following suggestions can help you lead a successful enrollment season. Inform, remind, repeat. Continually emphasize the benefits of the program when you’re motivating employees. reminding coworkers about the positive results of better health, a more engaged workplace or of the tangible rewards available can excite them and move them to enroll. additionally, positive reinforcement makes an organization a more enjoyable place to work. Choose incentives that inspire enrollment. When you start an incentive program, choose a reward that raises excitement throughout enrollment and fits your program’s objectives. determine specific goals for that program and offer an incentive that helps you achieve those objectives. a fast food gift card can be a motivational incentive, but might not be consistent with your organization’s wellness goals. Incentives that match your organization’s objectives can attract enthusiastic supporters who will help your program succeed. These are the kinds of incentives that give your employees a unifying goal to gather around and actively pursue. Personalize your program. hr managers are finding that a personal approach works better than a one-size-fits-all program. a tailored message of encouragement to your employees can be more appealing and can also help maintain program participation. In a program requiring long-term dedication, engagement is necessary for success. anticipating needs as the program develops will also help you sustain enthusiasm. More importantly, you can demonstrate this personal encouragement with a tangible, worthy incentive that appeals to all of your employees. Your encouragement and continual support also play a role in the process. how you communicate with employees, the reward you offer and the structure of the program can all increase participation when done properly. ultimately, offering something your employees can hold onto and admire with a sense of accomplishment raises the excitement around enrollment. a truly meaningful incentive can encourage enrollment in any kind of program that aims for a safer, healthier, more engaged or motivated workplace. Taking the process out of your program during enrollment, one way to keep your program simple is by offering incentives that are easy to use and share. best buy® Gift Cards are available through quick and easy online ordering, in any denomination starting at $5. you could even choose the best buy Green Gift Card to reward your employees and help reward the planet. Made from recycled materials, the Green Gift Card is environmentally friendly, reloadable and appropriate for any kind of sustainability initiatives.

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operations, including medical and specialty benefits. She reports to Humana’s southeast commercial operations CEO Craig Drablos. Bagby has been with Humana since 2005, most recently as the company’s interim commercial president for Louisiana, and prior to that as the company’s southeast region chief financial officer, responsible for commercial plan oversight for Florida, Georgia, Louisiana, Mississippi and Tennessee. Prior to joining Humana, Bagby held various positions with UnitedHealthCare, including a national role in medical economics in 2004-2005 and as chief financial officer of the Gulf States Region from 1999-2004. Bagby, a resident of Madisonville, La., is a Certified Public Accountant, Certified Internal Auditor and a Certified Financial Examiner in insurance. She received her bachelor’s degree in accounting and a master’s degree in business administration from Delta State University in Cleveland, Miss.

Healthstat, Inc., one of the country’s largest and fastest-growing providers of employer-based on-site health clinics, has hired R. John Kaegi, one of the health care industry’s most experienced solutions innovation experts, to fill the newly appointed role of chief corporate strategist. In this capacity, Kaegi is responsible for identifying new avenues of opportunity for Healthstat and formulating the strategy for its Kaegi effective pursuit. Kaegi comes to Healthstat from Blue Cross and Blue Shield of Florida (BCBSF) where he served as chief strategy officer. His role included facilitation of the processes and meetings of the BCBSF corporate strategy committee, which was charged with the development of critical business strategies, and he was also deeply involved in shaping health care reform. Kaegi also provided corporate leadership over solutions innovation to continued on page 50

CDHC Innovations

Health Partners » Covenant » UPMC » Cleveland Clinic

Continued from page 18

treatment, and even prescriptions for 30 common conditions, all in about 30 minutes. Experienced nurse practitioners are available day and night to treat adults and children for conditions such as cold, cough and allergy, sinus infections, ear pain, yeast and urinary tract infections, and minor skin conditions like acne and dermatitis. The service is now available to all living in, working in or traveling to Wisconsin or Minnesota. No appointment is necessary and you do not need to be a HealthPartners health plan member. Each visit costs $40 or less, depending on the customers insurance coverage. The list of participating insurers will be updated regularly at virtuwell.com. A longtime leader in health care in Wisconsin, HealthPartners owns and operates Hudson Hospital and Clinics in Hudson, Wis., and Westfields Hospital in New Richmond, Wis.

Covenant Services Group Launches Covenant Advantage for Employer Groups Covenant Services Group, a premier provider of health benefits risk management and administrative services, has launched Covenant Advantage, a multi-year rate guarantee health program for employer groups with 200+ employees. This is the first program of its kind in the nation to address the single largest challenge facing employer-based health plans of uncontrolled costs by allowing employers to reduce risk and manage budgets by locking in health care rates on a multi-year basis. Industry statistics state that more than 75 percent of every dollar spent in health care is spent treating conditions that are lifestyle related and largely preventable. Covenant Advantage addresses the problem of uncontrolled variable costs by targeting unhealthy lifestyles, the core issue driving health plan expenditures. By creating a synergistic partnership between the employer and the employee, Covenant Advantage addresses the root cause by providing employees the tools needed to actively monitor and manage healthy living choices. Covenant Services Group and its insurance carrier partner offer employers a guarantee of a maximum rate increase of no more than an 8 percent in total plan costs from one year to the next. As an industry leader, Covenant has assisted employers to address health care costs as a risk management challenge, NOT a pricing issue.

UPMC introduces first Web-browser Mobile Application UPMC Health Plan is introducing UPMC MyHealth Connect, its first web-browser mobile application and the first in the region to provide access to all members and nonmembers regardless of the brand of smartphone they use. MyHealth Connect will provide most users with immediate access to UPMC Health Plan’s network of doctors, hospitals, facilities and urgent care centers. UPMC MyHealth Connect is the latest step in UPMC Health Plan’s ongoing expanded presence on social marketing sites, including YouTube, Facebook and Twitter. In November 2010, UPMC Health Plan became the first health 22

January/February 2011 I CDHC Solutions™ I www.cdhcsolutionsmag.com

insurer in western Pennsylvania to offer its members access via social media. Access to UPMC Health Plan’s provider directory was selected as its first mobile application because that information is the most frequently accessed by visitors to UPMC Health Plan’s website. Future applications will include a virtual ID card and members’ access to their personal health record. UPMC Health Plan anticipates that in the future more of its members will want to have access to health care information via so-called “smartphones”—i.e., mobile phones that offer advanced computing ability.

Cleveland Clinic Establishes Center for Personalized Healthcare In an effort to provide a more targeted approach to patient care, Cleveland Clinic has established the Center for Personalized Healthcare, which will offer health care providers the tools they need to tailor care plans to the individual characteristics of each patient. The new center will operate as the Cleveland Clinic’s focal point for the identification, analysis, adoption and integration of select new services and technologies that will allow for personalized care of patients. Kathryn Teng, M.D., a primary-care physician at Cleveland Clinic, will lead the new center and its efforts to incorporate personalized health care across all facets of patient care within Cleveland Clinic. In its initial phase, the center will provide physicians and nurses with the guidance and resources needed to create personalized care plans based on their patients’ unique characteristics, such as genetics, environmental exposures, cultures and beliefs

Cleveland Clinic, MetroHealth Link Emergency Departments’ Electronic Medical Records Cleveland Clinic and MetroHealth have joined forces to eliminate a traditional barrier to seamless patient care by linking their emergency departments’ electronic medical records (EMRs), the first connection of its kind in Northeast Ohio. This pilot project—which is the first step toward connecting the EMRs throughout the two health systems—began Oct. 20, 2010. Medical team members at Cleveland Clinic and MetroHealth involved in approximately 200 patient cases where patient data has been shared electronically thus far, say it has improved patient care by immediately providing more complete medical histories, eliminating the need for unnecessary diagnostic tests and allowing for faster, more accurate diagnoses. This connection is possible because both Cleveland Clinic and MetroHealth have an EMR system through the Epic Corporation. Epic created a program called CareEverywhere, which allows hospital systems with its EMR system to share records through proper patient authorization. Through this program, Cleveland Clinic and MetroHealth now have access to a nationwide network of 43 health care organizations, representing more than 240 hospitals and 2,000 clinics. Wherever the patient goes—between health care systems in the same town or across state and national borders—the clinicians providing care can have the authorized information they need, as long as the other hospital is part of the CareEverywhere network, too.

By Martin Trussell, Senior Vice President, Business Development, First Horizon Msaver, Inc.

Ask Your Broker

Broker Compensation Arrangements to Change with PPACA

he Affordable Care Act, the legislative package the includes Some other carriers have announced cuts in commission rates the Patient Protection and Affordable Care Act (PPACA), of up to 50 percent, which could prompt brokers to ask employers will bring changes to almost every aspect of the health for a separate fee to help compensate them for their work. insurance market—even down to the way brokers and agents are Either way, this change will bring added transparency to the compensated for their services. broker/employer relationship. Much like lawyers, accountants and Traditionally, the insurance broker or agent who works with other professionals who help guide employers through specialty employers to help them select and manage an employee health areas of expertise, the insurance broker and employer will need to benefits program has been compensated by the insurance carrier. come to some defined business agreement around services to be Typically, the carrier would pay the broker a percentage (3 to 4 rendered and the compensation to be paid. percent) of the total premium necessary Employers need to be asking their to purchase the coverage. This broker brokers what, if any, changes they will be On Nov. 22, 2010, the compensation often would go unnoticed making to their practice as a result of the by the employers who were paying it. changes in commissions levels produced Department of Health and This is all about to change. by PPACA. Human Services released One of the provisions in the Some services currently provided PPACA regulations requires health may no longer be offered or will come interim final regulations insurers to spend a certain amount of with a price. Now is a good time to health insurance premiums on actual make an assessment of all the services the implementing the MLR medical care, thus limiting the amount broker provides and determine what, if requirements and making it of premium dollars that can be allocated any, value they provide. to administrative expenses, including Shopping health plans to find the clear that marketing expenses commissions, and profits. best deal each year is probably the most The portion of premiums used for highly visible role the broker plays, are not to be included in the medical expenses is called the Medical but there also are a number of services definition of “activities that Loss Ratio (MLR). For individuals and performed throughout the year that are small groups, the law calls for carriers to not so obvious. improve health care quality.” use at least 80 percent of the premiums For example, attending enrollment for medical expenses. Large groups must meetings to explain the benefit plan is a use 85 percent of the premium for medical care. big job as is helping with the enrollment process. During the year, On Nov. 22, 2010, the Department of Health and Human many brokers serve as the buffer between the employer and health Services released interim final regulations implementing the MLR plan when there are issues involving premiums or claims. The list requirements and making it clear that marketing expenses are not to can get quite large. be included in the definition of “activities that improve health care Now is the time to inventory and place a value on all the quality.” services the broker provides. This means that broker commissions along with costs such as maintaining the claims system, credentialing medical providers, Martin Trussell, SVP of Business Development & National Accounts First Horizon Msaver, has more than 25 years of experience in the health benefits industry. His career includes senior marketing managing the provider network, utilization review, and other costs and sales roles with third party benefits administrators, HMOs, and—for over 12 years—the of doing business, including making a profit, must come out of the corporate offices of Humana, Inc. He has also been the president of a marketing communications remaining 15 to 20 percent of premiums. firm specializing in health care. Marty is a member of the senior management team that has propelled It is no wonder that insurance carriers have been moving First Horizon Msaver to become one the nation’s leading HSA administrators, recognized for its quickly to redefine how they will compensate their brokers going innovation and as a model for banks wishing to achieve success in the HSA marketplace. Marty, a graduate of The Ohio State University is an avid social networker and writes a well-followed blog forward. covering innovations in health care: healthplaninnovation.com. In his spare time, you might find For example, Aetna, in a letter to its brokers, said beginning Marty on LinkedIn, Facebook, Twitter, or at the gym. Marty is married and he and his wife, Nancy, Feb. 1, brokers will be compensated based on a “services fee.” This have four children. Martin can be reached at mtrussell@firsthorizon.com essentially means employers will compensate their brokers directly.

www.cdhcsolutionsmag.com I CDHC Solutions™ I January/February 2011

Proud Partners in HSA Outreach The HSA Council and CDHC Solutions

The HSA Council proudly supports the CDHC Solutions magazine and its conference, the CDHC Solutions Forum, giving employers the information they need to successfully implement consumer-driven health plans such as health savings accounts (HSAs) â&#x20AC;&#x201D; one of the most innovative and fastest-growing segments of health care benefits. A joint effort of the American Bankers Association and the American Bankers Insurance Association, the HSA Council brings together banks, insurers, administrators and technology companies committed to promoting affordable choices in health care, educating Congress and the regulators, and expanding the use of HSAs. To learn more about how HSAs can help your employees or client companies, or to get more information about the HSA Councilâ&#x20AC;&#x2122;s membership benefits, contact Renee Galbraith at rgalbraith@aba.com or visit aba.com/ABA/hsa_membership.

AMERICAN BANKERS INSURANCE ASSOCIATION American Bankers Association

By Dan Perrin, President, HSA Coalition

HSA / HRA / FSA Admin & Finance

HSAs Under ObamaCare

ealth Savings Accounts will enjoy a sunny disposition under The central question is, given that bureaucrats in Washington ObamaCare. That is, if they are not gutted by regulations or have the power to change the marketplace based on their view of the dictates from the Health and Human Services Secretary who world, will they make that change? will, as long as the law exists, enjoy the role of playing God within states In my experience, bureaucrats use their powers for several reasons. and in the health care market place. One, it keeps them busy and in a job; two, because they can; and three, The Secretary’s 1,968 new powers are amply illustrated in this because their view of what is going on in the marketplace is highly chart [see www.cdhcsolutionsmag.com to view the pdf]. prejudiced by their political views, which is that the government should In short, ObamaCare will spike the be in charge. cost of health care, increase the government It is possible HSAs will become the lowAmericans are not used deficit and debt, and reduce choices for all cost choice of state exchanges. However, the to nor comfortable with Americans, while subjecting the remaining darker world of government interference or choices to a set of one-size-fits-all dictates. by bureaucrats could just as easily be other’s making their health care control In this world of health-care-choicesthe reality. managed-by-bureaucrats, the Health Savings The answer, quite simply, depends on the choices for them… Account will take on its current role of the interaction of market and political forces with lowest cost plan. Since Americans will be forced to purchase health the rule-making and bureaucracy of ObamaCare, and to a larger extent, insurance, at least for now, HSAs will be chosen by tens of millions of Congress. The outcome of the 2012 Congressional and Presidential Americans. elections also will play a key role in the future of HSAs. The real question is whether the new regulations and the HHS Clearly there is a huge opportunity for HSAs to be the default Secretary’s ability to issue damaging edicts to HSAs (or any other type choice of the majority of Americans, who will be forced to purchase of health insurance) with the flick of a pen is a world any market should health insurance in the ObamaCare exchanges. live under? However, the possibility of government interference and regulations further diminishing choice and jacking up the cost of health care is a clear and present danger. The HSA Council and the HSA Coalition is working hard to prevent the bureaucracy and rule-making regime from destroying HSAs and the market. Readers, who know me or the Coalition, understand clearly that if the bureaucracy harms HSAs, we will forcefully and successfully act. But as decisions are made by those currently in power that will impact the future of HSAs, you the consumer should understand we will do everything we can to ensure those decisions are made in the best Americans are not used to nor comfortable with others making interest of consumers who need the low premium health plans that their health care choices for them; even when those choices are made HSAs provide. by the private sector, Americans rebel. This is what happened to the “staff model” HMOs. The business model worked, but Americans Dan Perrin is a former U.S. Committee on Foreign Relations staff member where he served for more could not stand it. As a result, HMOs were forced by the marketplace than seven years, as well as staff to the U.S. Senate Steering Committee. Mr. Perrin was the founder and editor-in-chief of the website HSA Insider, and sole contributor to its content until it was sold, while he was to change. Under ObamaCare, these market forces, that normally would running the site, it was the number one website in the world on Health Savings Accounts. Mr. Perrin is also react to consumer demands, will have to organize into political forces to the author of HSA Road Rules, considered by bankers and insurers to be the “bible” of the HSA industry. get the bureaucracy, or Congress, to change the law or the regulations Dan Perrin is currently the President of the HSA Coalition (www.hsacoalition.org). preventing companies from appealing to the consumers’ needs. www.cdhcsolutionsmag.com I CDHC Solutions™ I January/February 2011

Self-Funding Health Plans

By Matt Leming, Employer Stop Loss unit, Swiss Re

Health Care Reform Prompts more Employers to Investigate Self-funding

he recent Health Care Reform a company elects to self-fund its Overcoming the obstacles healthWhen (HCR) legislation has prompted plan, it can purchase excess insurance many corporate CFOs and HR to switching to a self-funded coverage to protect itself from extreme claims managers to review their health plans and and utilization levels. This excess insurance is explore replacing their fully insured plan model … Swiss Re’s offering called employer stop loss (ESL) coverage. with the self-funded option as a way to gain In addition to covering the potential makes it easier greater control over premium and vendor losses inherent with any group benefit plan, expenditures. ESL coverage provides protection for the Self-funded health plans can be an effective alternative for firms entire covered group, reimbursement for medical expenses above a that want to reduce and manage health plan costs and improve cash specified dollar amount, and cover for catastrophic and high dollar flow, while still delivering dynamic coverage for their workforce. claims such as transplants, dialysis, or premature births. Under self-funded plans, the employer takes on the financial To obtain ESL coverage, employers should be prepared to risk of funding the health plan from their own assets, and maintains provide the following information to an insurer: n A census of all covered employees (noting age, gender, dependent responsibility for managing and administering the benefit plan. Selfstatus and location). funded plans are governed by the Employer Retirement Income n Claim history, with two years of group-level history and two years Security Act (ERISA), and are especially appealing to employers of individual catastrophic claims history. due to the substantial level of flexibility available to tailor medical n Current and proposed plan of benefits. benefits that fit their needs while avoiding most state-mandated requirements. Once the employer secures excess coverage from an insurance While firms take on the financial risk of funding a health plan, they are able to limit the total risk through the purchase of a stop loss carrier, it may contract with a third party administrator (TPA) policy. Savings generated from self-funding is just one of the benefits for claims adjudication, benefit plan administration, oversight of managed care networks (e.g. PPOs) and management of service typical of the self-funded model. Recent statistics indicate self-funded plans are growing in vendors such as utilization and case management review, pharmacy popularity and considered a robust option especially in light of HCR. benefit managers and disease management firms. According to the 2009 Kaiser/HRET Survey of Employer-Sponsored Health Plans, 48 percent of employees in firms with 200 to 999 Fully Insured Plans vs. Self-Funded Plans Individual employer needs and circumstances will determine the workers are self-funded. The survey also found that a much higher percentage of workers right health coverage for each company. However, in most instances in a preferred provider organization (PPOs) are in a self-funded plan changing from a fully insured plan to a self-funded plan can allow a (67 percent), compared to those in conventional “fully insured” company to quickly gain more control over its insurance obligations plans such as health maintenance organizations (HMOs), high- and benefit requirements. Historically, the requirement for two years of detailed claims deductible health plans (HDHPs) and point of service (POS) plans. These figures suggest interest from all types of employers in history has severely limited the ability of organizations to move to a alternative funding mechanisms and different ways to manage health self-funded health plan. However, recently some carriers, including Swiss Re, will provide quotes to employer groups with as low as 100 care programs. covered lives with minimal historical claims information. Self-Funding 101 Swiss Re has developed new analytical capabilities enabling it to Under a self-funded arrangement, the employer assumes the quote fully-insured accounts for employers, with up to 1,000 covered health plan liability and risk in exchange for more significant control employees, which are unable to provide detailed claims history. Swiss over the plan’s administration and funding levels. This differs from Re has created an easy-to-use comparative scenario modeling tool conventional, fully-insured plans where the insurance company enabling employers to evaluate the cost differential between fullyassumes all the risk, controls the plan administration, establishes insured and self-funded plans. reserve capital levels and manages all other major decisions “The ability to now provide stop loss quotes on fully-insured concerning the health care coverage provided to company employees business that otherwise would have been turned away is a huge breakand dependents. through,” commented Karrie Andes, SPHR, Sr. Benefits Manager 26

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for PGi and founder of The Savvy SelfFunding Healthcare Networking Group on LinkedIn. “By overcoming this quoting hurdle, it opens up more opportunities for employers and plan sponsors to consider self-funding.”

Characteristics of Fully Insured Plans

Characteristics of Self-Funded Plans

Insurer accepts full risk

Employer accepts the full risk; however, risks can be mitigated through the purchase of employer stop loss coverage

Employer has limited plan design flexibility

ERISA overrides state mandated benefits The employer customizes plan design specific to their needs

Nationally, fully insured groups are subject to nearly 2,000 state mandated benefits; often restricting the plan design due to mandates

Premium taxes on excess coverages are significantly reduced under a self-funded plan

Employer is subject to premium tax paid to fully insured carrier. And tax is based on first dollar of the fully insured premium

Employer determines reserve levels with guidance from its employer stop loss provider

Insurer determines reserve levels and manages the reserve capital

Employer manages the reserve capital; employer stop loss coverage can be purchased to mitigate catastrophic, specific or aggregate exposures

Insurer retains excess reserve and capital at year’s end

Employer retains excess reserves

Insurer manages and oversees all the service vendors

Employer manages and oversees all service vendors, thereby exercising more control over the type and quality of care, as well as the cost of care provided by the service vendors

Lower Costs, More Control Below are some common key objectives for companies seeking to self-fund their health care plans: n Gain more control over how insurance premiums are spent, improve cash flow and maintain company health plan reserves for investment. n Reduce plan operating costs and eliminate most premium taxes. n Tailor a health benefit plan to the needs of the company, thus equipping it to attract and retain employees. Self-funded plans offer employers the ability to manage and better control health care spending while maintaining a tailormade plan with features best suited for its workforce. If your company shares these objectives, talk to your insurance broker for more details on the potential of a selffunded plan for your company.

Matt Leming is the sales leader for the Swiss Re’s Employer Stop Loss unit. For more information about our offering or to access our proprietary underwriting model to evaluate if self-funding is for your organization, please visit us at www.swissre. com/esl or email Matt Leming at matt_leming@ swissre.com. Swiss Re is one of the world’s largest and most diversified reinsurance companies. Products are underwritten by Westport Insurance Corporation, a member of the Swiss Re Group, based in Overland Park, Kansas and licensed to operate in all 50 states.

www.cdhcsolutionsmag.com I CDHC Solutions™ I January/February 2011

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Supplemental Health Benefits

Photos courtesy of Transitions Optical, Inc.

By Pat Huot, Director of Managed Vision Care, Transitions Optical, Inc.

Vision Benefits:

How Much Education is Enough?

ot vision? Probably so, since more employers today are recognizing that a vision benefit deserves a seat at the table when it comes to offering employees a comprehensive health benefits package. However, many employers are missing out on the full value of what their benefit plan can do for the workforce because their employees aren’t taking advantage of the program. Research confirms the likely culprit is lack of education. There is a real disconnect between how much employers think their employees know about their eye health needs and vision benefit plan and the reality of what these employees actually know.

Why Care About Vision Care and Vision Wear? Through a comprehensive eye exam, eye doctors can provide early detection of costly eye-related and systemic diseases, such as diabetes. In addition, today’s eyewear products that protect and enhance eyesight also support productivity, by helping employees see more clearly and comfortably. For example, photochromic lenses block damaging ultraviolet rays and help prevent eyestrain and headaches caused by light and glare. Did you know eye focusing problems can cause employees to lose 15 minutes of productivity each day?

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Supplemental Health Benefits

“I feel that vision deserves a more prominent place in medical care … After seeing how much chronic diseases were on the rise among our employees—and how many employees’ children hadn’t had a recent eye exam, we knew we had to make a change, and that a low-cost, voluntary vision benefit could help.” Research Spotlights Low Awareness Results of the annual “Employee Perceptions of Vision Benefits” study, just

Voluntary Vision Requires Extra Education Did you know? Employees who have voluntary vision plans are n

Less likely to enroll (50 percent vs. 86 percent enrollment in employer-paid plans)

Less likely to use their plan to receive an eye exam for their children than those with employer-paid plans (49 percent, vs. 55 percent)

Less likely to recognize all the advantages of a vision plan than employees who have an employer-paid plan. ~ Transitions Optical 2011 Employee Perceptions of the Vision Benefit Survey

What does this say about employer education? Remember—just because a vision plan is voluntary, it can still hold great value for your workplace, but employers need to take the time to explain the value to employees, to help them perceive vision care as a supplemental health tool, as opposed to a “just in case” benefit.

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released by Transitions Optical, provide insight into the limited awareness and usage of a vision benefit package among employees, including certain subgroups who should be taking the greatest advantage of their plan, but just don’t “get” it. Despite respectable overall enrollment (76 percent), utilization of the plans (68 percent), is lower than you would expect, particularly for certain high-risk groups. This suggests there must be low awareness of the importance of following through on benefit usage. Consider the surprising case of employees with children, keeping in mind that children are especially a high-risk group for vision problems: n While 68 percent of parents say they enrolled in their vision plan to “provide eye care for their family,” nearly half don’t use their plan to get a comprehensive eye exam for their children. This is shocking, given how important proper vision is for a child’s learning and development, and something of obvious importance to parents. n Thirty-five percent of parents also don’t use their plan to get an eye exam for themselves—less than non-parents. n Parents are more likely to take steps to protect their own eyes from UV damage—such as wearing sunglasses or photochromic lenses—than to protect their children’s eyes, although children are three times more susceptible.

Is a Lack of Education to Blame? Considering only one-fourth of employees agreed that “diagnosing or managing chronic disease” was a reason they enrolled in their vision plan, this indicates they probably aren’t aware of the full capability of the eye exam. Additionally, less than half of employees knew what eyeglass lens options are included in their benefit plan.

Many blame their employers for their lack of education. More than 40 percent of employees surveyed did not agree that their employer takes appropriate steps to make sure employees understand their vision benefit package.

Reality Check: How Well do HR Pros know their Employees? Without a doubt, HR managers have the power to influence their employees’ health care decisions. Unfortunately, research by Transitions Optical suggests HR managers overestimate employee knowledge of their vision plan. In the HR study, 44 percent think their employees are aware an eye exam can detect chronic conditions, but only 27 percent actually are, according to the employee study. HR managers also report they are educating their workforce on vision more than employees report they are. n Ninety-four percent of employers say they educate on vision. Yet, one-fourth of employees say their employer does not communicate to them about their vision benefit plan at all. n The majority of employees say their employer only educates about the vision benefit plan during the annual enrollment period. Even then, only a fraction said their employers included information on the importance of eye health and vision correction. These responses suggest that employees either don’t take advantage of available education, or that the education isn’t as comprehensive or pervasive as it needs to be for it to sink in. Either way, education efforts need to be re-energized.

Case Study: Championing Vision is Well Received by Employees Many HR managers are already taking action. As manager of benefits and

compensation for Bibb County government in Georgia, Jenny Burdeshaw introduced a voluntary vision benefit in 2010, as part of the organization’s wellness initiative. “I feel that vision deserves a more prominent place in medical care,” Burdeshaw said. “After seeing how much chronic diseases were on the rise among our employees—and how many employees’ children hadn’t had a recent eye exam, we knew we had to make a change, and that a low-cost, voluntary vision benefit could help.” Burdeshaw used on-site meetings and educational newsletters to pique employees’ interest about the new vision plan. The result—a “win, win,” she added. While the national average for enrollment in voluntary vision plans is only 50 percent, Burdeshaw saw about 60 percent enrollment in the plan and received positive feedback from employees throughout the year. Burdeshaw added that the vision plan enrollment and communication opened the door for employees and their dependents to explore and ask questions about preventative eye care and safety. The organization noticed enrolled employees began taking greater steps to protect their eye health, as well as

employees with children taking them to the eye doctor for the first time.

Education at your Finger Tips Educating employees doesn’t have to be difficult. Look for ready-set-serve education materials from your vision plan provider, local eye doctor or other organizations that specialize in vision health. HealthySightWorkingForYou.org, for example, includes web-based newsletters, posters, brochures and videos to help employees and HR managers expand their understanding of the need for regular vision care and vision wear. These tools can be shared during annual enrollment, or regularly throughout the year to make sure employees don’t forget about making that eye exam appointment, or finally getting the right eyewear to address a lingering vision issue. Remember having a vision benefit plan in place isn’t enough if employees aren’t fully taking advantage of it. This leaves potential savings on the table, and it leaves employees’ health and well-being unprotected. Set your sights on more vision benefit education this year and see the difference for your workforce. S

As director, managed vision care, for Transitions Optical, Inc., Pat Huot is responsible for Transitions’ partnerships within this channel and for the strategic direction of all related initiatives and programming. The Transitions managed vision care initiative is aimed at elevating the importance of vision care and vision wear within the overall health and wellness arena through the development of educational programs and tools for vision plan providers, HR managers and consumers. Throughout his nine years with Transitions, Huot served several roles across industry channels including regional management of the Transitions Solutions Team and national account management. He is currently based at Transitions’ global headquarters in Pinellas Park, Fla. Prior to joining Transitions, Huot spent seven years in sales and marketing through several positions with an industry leader in consumer product sales, Mars Incorporated. Huot graduated from the University of New Hampshire with a B.S. in marketing and holds an M.B.A. from New Hampshire College. Pat resides in Palm Harbor Fla. with his wife, Sara, and their children, Emily, Jake and Madison. Transitions Optical is maker of Transitions® lenses, the #1- doctor recommended photochromic lens. These lenses are clear indoors and become sunglass dark outdoors. By blocking UV radiation and glare, they help reduce eye strain and fatigue, while protecting eye health.

www.cdhcsolutionsmag.com I CDHC Solutions™ I January/February 2011

Considering the impact of evidence-based Dentistry and Risk Based Disease Management on Dental Benefits

vidence-based dentistry (EBD) is a comparatively new approach to oral health care that is getting incorporated into dental school curricula throughout the nation. It is supported by the American Dental Association and is beginning to gain the attention of practicing dentists and within the dental benefits industry at large. Advocates proclaim EBD offers a new paradigm for the delivery of effective treatment and disease prevention by utilizing the best available scientific evidence, the dentist’s clinical skill and judgment, and an individual patient’s specific oral health needs and preferences to determine the appropriate course of treatment.

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By JoHn yamamoto, DDS, mpH Vice presiDent, professionaL serVices Delta Dental inSurance company

Others are more cautious in their assessment of EBD, asserting many obstacles remain before its widescale adoption and integration within a benefits program can occur. Skeptics argue that the “evidence” for risk based assessment and treatment of patients is not fully developed, and that most dentists are years away from accepting and integrating EBD into their practices. However, most agree EBD offers a promising new direction for the future of dentistry and dental benefits— albeit a future with an uncertain arrival time. As the name suggests, EBD focuses on evidence. It calls on practitioners to identify the best scientific evidence available and analyze and integrate it with their clinical experience along with the patient’s needs and preferences. The goal is to provide the best possible

Supplemental BenefitS

oral health outcome for each individual patient. In terms of patient care and dental benefits administration, dental decisions focused on prevention and based on evidence seem straightforward enough—hardly controversial. Medicine, for instance, has long embraced an evidence-based view, particularly when it comes to preventing, diagnosing and treating conditions exacerbated by harmful habits such as heart disease, diabetes, obesity and cancer. Delta Dental, the nation’s largest dental benefits system, is likewise interested in promoting dental benefit programs that better integrate the findings of recent scientific literature. Drawing on a tremendously large database of claims data, the Delta Dental Plans Association (DDPA) system also is working on incorporating data that suggest correlations between specific procedures and outcomes. As the development of risk assessment tools and outcome metrics for groups and individuals gain statistical validity and reliability, we aspire to be at the forefront of developing benefits customized for those who are at the greatest risk for dental disease. One major aspect of EBD is risk assessment. Here’s an example of how a dental benefit program might incorporate risk assessment: Upon their first dental office visit, enrollees would undergo a comprehensive evaluation, identifying the presence of risk factors that would predispose them toward developing periodontal disease. Evidence-based protocols suggest such a subset of enrollees could benefit from more frequent check-ups cleanings/ scaling and other preventive therapies than is typically covered under a standard dental program. Adjusting the schedule of benefits accordingly for only those who fit the evidence-based criteria could help substantially reduce the incidence of more advanced and costly periodontal treatment, but without subjecting the group purchaser to the cost impact providing a higher benefit

level that is inappropriate for all but this smaller at-risk group. The higher cost of providing more coverage for preventive services to this small subset of enrollees will be offset eventually by the lower incidence of advance periodontal disease that will occur as a result of the preventive intervention. “Evidence” will have documented the projected impacts of this approach on incidence and costs, so there is little guess work involved, so long as enrollees adhere to the treatment recommendations prescribed by their dentists. In turn, dentists must adhere to the evidence-based protocols that establish the appropriate type and frequency of preventive measures for the most effective outcome.

Balancing the eBD Hype with Reality Assertions about how EBD and risk based disease management might one day transform the current focus on a “surgical” model of dentistry—in which decay and periodontal disease are identified after the fact and then surgically treated—to a “medical” model are sometimes quite sweeping. However, one should be careful to separate the hype from reality. While this particular evidence-based approach holds tremendous promise, there also are practical limitations. These include the current quality, quantity and availability of pertinent research, doubts about how that research should be interpreted (and who should do the interpreting), and the fact established clinical study does not automatically or immediately translate into currently practiced dentistry. There also are legitimate concerns regarding privacy. Individuals identified as being at the greatest risk—and therefore eligible for a higher level of benefits— might worry they will be viewed by some employers as a liability. Privacy rights advocates worry how risk-based dental and medical data are to be exchanged and protected as enrollees change jobs, and/or as employers change carriers. Employers also have concerns. Risk based disease management by definition will apply benefits in a manner that is inconsistent

across an employee population. One subset of employees being eligible for more benefits than another subset is problematic. Will those at greatest risk become regarded as the “lucky ones,” when it comes to the application of coverage? Are those at minimal risk, who are entitled to fewer benefits, going to demand some additional form of compensation? Also from an employer’s perspective, there may appear to be no cost savings from EBD. This is a valid concern, as to date, “the evidence,” does not demonstrate lower costs, but only better targeted and more effective care for those who really need it.

Keeping eBD in Perspective Current dental plan designs are already largely effective at managing costs and delivering needed care, but the promise remains that EBD can take an affordable, highly valued benefit and make it better. Before putting the cart before the horse, it’s important to note many clinical questions remain unanswered: The profession is not yet fully signed on to the concept or practice of EBD, and employers have not reconciled the many challenges they and their employees could face regarding privacy or consistency with benefits in the workplace. Until these issues are more fully addressed, dental carriers will continue to work on developing new technology and administrative approaches toward improving the oral health of enrollees, facilitating strong partnerships with dentists, and better servicing purchasers so that they remain satisfied with the low-cost to high-value ratio of their current dental benefit programs. S

Dr. John Yamamoto is the Vice President of Professional Services and is responsible for the quality assessment, professional review, dental policy, and research for Delta Dental of California and its aﬃliates. Prior to his current position at Delta Dental, Dr. Yamamoto spent seven years in private practice and six years with the UCLA School of Dentistry, where he worked as both an adjunct assistant professor and as the director of the UCLA Venice Dental Center. While at UCLA, he focused much of his time on providing and teaching community-oriented dental care, developing programs to address access to dental care issues and conducting health services research. He also served for five years as a dental consultant to the California Department of Managed Health Care. Dr. Yamamoto holds a Doctor of Dental Surgery degree from UCSF, a Master’s in Public Health from UCLA, and a Dental Public Health residency certificate from UCSF.

www.cdhcsolutionsmag.com I CDHC Solutions™ I January/February 2011

Let your employees shop for the benefits they actually need.

Liazon’s Bright Choices® Benefits Exchange™ is the online benefits store where your employees shop for benefits using money you give them. On the “brimming shelves” of the Benefits Exchange, they find multiple medical plans—including traditional and consumer-driven options. Plus, a full complement of dental, vision, life, disability, supplemental health and other benefits. When you send them to Bright Choices, we’ll actually recommend the insurance that’s right for them. More than 2,500 companies already experience the cost savings and convenience of Liazon’s Bright Choices Benefits Exchange. You will too.

For more information or to join Bright Choices, please call Liazon at 716-803-6190, ext. 2 or visit www.liazon.com

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By Kyle rolfing, ceo, reDBricK HealtH

Good Health is Contagious Power of Social Media Spreads Healthy Lifestyle

he infectious nature of illness is a subject examined from nearly every angle. However, a reverse view is becoming increasingly more clear— healthy and unhealthy behavior is extremely contagious. Our social networks, online and off, have dramatic impact on our individual health status and behaviors. The Framingham Heart Study demonstrates how our likelihood of becoming obese increases 57 percent if we have an obese friend. We are 50 percent more likely to drink heavily if a friend is a heavy drinker. These are concerning outcomes of the company we keep, but here is the good news—our social networks also have a positive impact on health behavior. If a friend quits smoking, we are 36 percent more likely to quit smoking ourselves. Good health is contagious, and both healthy and unhealthy behaviors spread through social groups and networks, in and outside the workplace.

…our likelihood of becoming obese increases 57 percent if we have an obese friend. We are 50 percent more likely to drink heavily if a friend is a heavy drinker. The Alliance for a Healthier Minnesota demonstrated the power of social networks last summer when they engaged seven of Minnesota’s largest companies in a healthy social competition called, The Biggest Loser Summer Challenge. The Alliance, which believes employers can drive health care trans-

formation through health and wellness campaigns, harnessed RedBrick Health’s healthy social gaming technology to engage employees in getting leaner by working together with teammates in a friendly, social competition. Affiliated with NBC’s hit television show “The Biggest Loser,” and powered by RedBrick Health, the Summer Challenge invited employees to participate in team-based weight loss, physical activity and nutrition challenges over three months. Ten thousand employees from Blue Cross and Blue Shield of Minnesota, Cargill, General Mills, HealthPartners, Medtronic, Target and UnitedHealth Group partook in the Challenge—competing with teams within their office, while concurrently competing against the other companies. The social competition technology provided peer groups with the ability to share and motivate each other through leader and message boards, virtual awards, progress updates and mobile tracking. The results? Employees lost more than 37,000 pounds, and more than 16.5 million minutes

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of physical activity were logged. Of all the competing companies, Blue Cross and Blue Shield of Minnesota lost the greatest percentage of weight and UnitedHealth Group tracked the most minutes of exercise and nutrition activity.

it takes a Village: the Power of social engagement The power of social networks and social engagement has become the focus of much research as the rise of social media continues to change the way we interact with one another. The creation and growth of online social networking tools such as Facebook (500 million users), Twitter (175 million users) and social gaming developer, Zynga (more than 225 million monthly active users) have further evidenced the growing importance of online peer support and social pressure over the last decade. The online social phenomenon also has spread to health. More than 60 percent of Americans seek health information online. Of those, more than half are reading someone else’s commentary or experience about health or medical issues, creating new web-based social networks that are changing the way we manage our personal health. The power of social influences on health is now entering the workplace as well. With a growing number of employers turning to health improvement and wellness programs to help manage rising health care costs, the workplace is rapidly creating a new social health environment. However, a national survey of large employers found that many employee wellness programs yield disappointing sustained engagement rates of less than 20 percent year-over-year, and two-

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thirds of corporate decision makers characterize health improvement programs as “not” or “only slightly” effective at producing health behavior change.

enter the Power of social engagement. Leveraging existing social networks and peer groups within the workplace creates an environment of peer support and a culture of health. This approach taps into the natural social fabric of an organization – fueled by peer-to-peer support to engage, it unlocks the power of personal relationships and shared team goals to drive greater adoption of health-improving activities. The results create a new cultural context for positive health behaviors ranging from becoming more active to eating more healthy, to seeking preventative care and better management of chronic conditions. Research and analysis conducted by RedBrick Health using data from the Challenge confirmed participating within a team increased both an individual’s level of engagement (more frequent tracking of activities) and earned results (greater weight loss and minutes of physical activity) versus individuals who participated alone. The results also showed those who participated on teams had lost significantly more weight than those who participated as individuals. According to one of the participating organization’s HR benefits manager, the Challenge brought together groups of employees who encouraged and motivated each other throughout the competition. The organization already encourages employees to take personal responsibility for their health; however, in their eyes, the Challenge successfully increased that responsibility. Company and team leader boards on the RedBrick hosted website (CompeteForHealth.org) served as a reminder to keep up healthy habits and motivated participants not to fall behind in the competition.

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more deeply into populations to drive broadbased engagement. Employees are more likely to engage when personally invited by a trusted colleague or friend, rather than by simply seeing marketing materials from the HR department or hearing about it from company leadership. Case in point: sixtyfour percent of participants in the Summer Challenge stated this was their “first time” participating in a health and wellness program with their employers.

Looking Ahead

Challenge participants expressed the desire for peer support and engagement in managing personal health at both the individual and group or employer level. RedBrick’s Challenge follow-up research found that the top three reasons participants cited for joining were: to participate on a team, get support from others and pursue personal goals. These same factors served as the main reasons for employee motivation during the challenge. They point to how the level of accountability produced by social groups can drive behavioral change in powerful ways. Future team-based health campaigns or competitions may consider altering team composition to include individuals who already engage in positive health behaviors to maximize positive social influences, and thereby optimize program effectiveness. This recommendation also has been provided by researchers who found many

traditional weight management interventions fail because they target overweight and obese individuals without consideration of their surrounding cluster and wider social network. Rather, the researchers argue clusters will be most effective in developing social forces and driving lasting behavioral change when there is inclusion of both obese and normal weight individuals.

Creating a Culture of Health Social networks and engagement technology, such as that used in the Summer Challenge, can serve as a foundational element in fostering a culture of health. They also can promote a sense of shared responsibility for personal health and wellness. Employees are three times more likely to report taking action on their health in companies with a strong culture of health. Perhaps most importantly, the peerto-peer dynamics can help employers reach

These types of sentiments and participation swells prove social engagement is working. In 2011, RedBrick technology will power the expanded rollout of the Biggest Loser Challenge, which launched in January. In addition to last year’s participating organizations and their families, the Challenge will be available to individuals across the state of Minnesota. The social engagement strategy will embrace geographic teams, teams associated with other organizations, and teams formed around communities and media personalities. Innovations within the RedBrick website will aim to create more effective teams and simplified tracking online and through mobile applications. People pattern their behaviors after their friends and establish personal norms that reflect their social network. Friends and family members—and even co-workers— shape our choices. Light up or lace up? Hit the gym or beers at the bar? It often depends on what those around us are doing. As engagement in social networks continues to re-define our personal experiences, the time is right to leverage their power for healthy good. Kyle Rolfing is co-founder and CEO of RedBrick Health, a health technology and services company that drives sustained engagement in health improvement programs through constant innovation and deep consumer insight. The company’s health engagement platform blends a fresh, personalized consumer experience, impactful social networking tools and rewards that link individual financing to healthy behaviors. As a result, RedBrick Health delivers employers engagement rates far exceeding industry norms and the ability to fairly and responsibly control costs through increased employee accountability.

www.cdhcsolutionsmag.com I CDHC Solutions™ I January/February 2011

Where Do Your Pharmacy Dollars Go? Independent Study Confirms Fee-for-Service PBM Strategy Saves Employers Millions By David Kwasny, president, Restat

Wholesaler/ Distributor Traditional PBM Drug Stores Employer Rebates

Manufacturer

s the health care reform debate moves into 2011, U.S. health care costs continue to spiral out of control. Meanwhile, Americans spend twice as much as residents of other developed countries on health care, yet receive lower quality, less efficiency and have “the least equitable system,” according to the 2010 Commonwealth Fund report The cost to provide health care coverage has increased 41 percent from 2003 through 2009. Yet despite spending double what other developed countries spend on health care as a percent of gross domestic product (17.6 percent in 2009), Americans are not achieving quality health care outcomes. As one of the largest payers of health insurance coverage in the United States, employers are re-thinking their investment in this area. At a time when the troubled economy has caused increasing pressure for businesses and consumers to cut expenses, financial stress has resulted in tough choices for employers. Many employers are considering dropping health care benefits entirely or passing along more health care cost to employees in the form of higher deductibles and copay amounts. 38

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Pharmacy BenefitS Management

According to the Kaiser Family Foundation, the sharpest increase in costs related to health care can be attributed to prescription drugs, which account for 10 percent of total health care spending. In 2009 prescription drug costs rose by 3.4 percent compared to 2.5 percent the previous year before the recession. These costs are projected to continue to increase, with the Centers for Medicare and Medicaid estimating that the U.S. will spend $350 billion on pharmaceuticals by 2015. In spite of a down economy and everincreasing health care costs, some pharmacy benefit managers (PBMs) are making record profits while employers and their members struggle to pay for benefits and prescriptions. The PBM system was created to simplify the purchase of prescription benefits and reduce overall costs. However, in recent years, conflicts of interest among the parties making up the health care supply system have increased. Many PBMs have purchased mail order services and retail pharmacies. In addition, some PBMs are facing lawsuits filed by state and federal governments (as well as PBM clients) charging them with the practice of negotiating discounts and rebates from drug companies, and then not passing the discounts to consumers and their clients, as contractually obligated. This has earned the practices of some PBMs the “shell game” moniker.

In 2009 prescription drug costs rose by 3.4 percent compared to 2.5 percent the previous year before the recession. These costs are projected to continue to increase, with the Centers for Medicare and Medicaid estimating that the U.S. will spend $350 billion on pharmaceuticals by 2015. distribution components among drug manufacturers, wholesalers, drug stores and PBMs. The findings help explain why some pharmacies and PBMs could offer lower prices on prescription drugs and how an employer could obtain significantly lower costs by using preferred pharmacies. Further savings also were achieved by the option to increase generic utilization. Pharmacies in a preferred network offer lower drug prices and reduce dispensing fees to attract customers from competing drug stores and increase foot traffic from members enrolled in the employer’s pharmacy benefit

plan. That means employers can opt for a pharmacy benefit model that eliminates questionable PBM tactics like discount based pricing, manufacturer rebates and incentives for steering customers to in house pharmacies. Instead, the use of a transparent fee for service model can result in major savings, reversing the increasing cost trend. The Milliman study was commissioned by Restat—the largest privately-owned pharmacy benefits manager in the country— whose new Align program has achieved costsavings for its clients consistent with those identified by Milliman.

Aligning with Employers for Savings and Simplification Recently published reports discovered employers could experience significant annual cost savings by adopting a “preferred” pharmacy benefit strategy. The report, “The Value of Alternative Pharmacy Networks and Pass-Through Pricing,” was researched and written by the internationally recognized consulting firm of Milliman, Inc. and clearly outlined—for the first time—actuarial estimates of prescription drugs’ retail cost components. Milliman’s comprehensive analysis broke apart the traditional pharmacy benefit model. It studied the key cost and www.cdhcsolutionsmag.com I CDHC Solutions™ I January/February 2011

Changing the Game by Cutting the fat Align was created to reduce costs and help simplify the complexities involved in purchasing a prescription benefit by providing a simple fee for service approach. Align accomplishes what the Patient Protection and Affordable Care Act (PPACA) originally set out to do by providing complete transparency, clarifying where the dollars are going and helping to remove cost from the health care supply system. Complete transparency is achieved because the payer knows exactly what portion of their dollars goes to the PBM rather than bundling drug costs and channel costs together with the cost of administering the benefit.

What can an employer expect in terms of savings? Restat’s client data show that an employer with 6,000 employees can save up to $1 million annually if members choose the in-network options, and the savings potential is increased significantly by encouraging generic utilization. Restat’s data also showed by increasing the percentage of generic utilization from 68 to 73 percent the potential for savings is doubled to more than $2 million.

How Align Works Align’s success is tied to client satisfaction, charging a simple fee for services and accepting no hidden payments from pharmaceutical companies. Additionally, Restat’s Align model collects no revenue from manufacturer rebates or ‘spread’—the difference between the price the pharmacy collects from the PBM and the price the PBM charges employers, a common feature of traditional PBM contracts. Restat negotiates openly on behalf of its clients with a pool of pharmacies to find a provider whose offers best align with its client’s goals, then designs a plan that includes meaningful incentives to encourage employees to become smarter health care consumers, resulting in a more cost-effective 40

January/February 2011 I CDHC Solutions™ I www.cdhcsolutionsmag.com

Pharmacy BenefitS Management

prescription spend. The Align network currently includes nearly one-third of all pharmacies in the nation. “We’ve been a client of Restat’s since the early 1990s,” Caterpillar Inc. Pharmacy & Informatics Manager, Todd Bisping said. “Their program is consistent with Caterpillar’s goal to reduce complexity and provide transparent, cost plus prescription drug pricing that has enabled us to achieve significant savings this past year as a result.” Restat Vice President of Sales and Marketing Terry White said the Align client base has been growing steadily since its launch. “Milliman’s independent research confirmed what we already understood from our own client experience,” White added. “Employers are very receptive to Align’s more affordable and transparent cost-plus or preferred network approach. Our clients understand that it’s a win-win for everyone; employers, their members and the U.S.

The bottom line is that if everyone in the U.S. were covered by Align, $30 billion of health care cost could be cut from the U.S. health care system. We refer to it as health care reform without legislation.” health care supply system. The bottom line is that if everyone in the U.S. were covered by Align, $30 billion of health care cost could

be cut from the U.S. health care system. We refer to it as health care reform without legislation.” To read what the internationally recognized consulting firm Milliman has to say about Align visit align.restat.com to download the white paper. RESTAT is a member of the Dohmen family of companies, RESTAT simplifies the purchase and use of healthcare services through independent benefits management. As the largest independent PBM, RESTAT has no ownership ties to drug manufacturers or distribution channels, making it uniquely positioned to provide customers with unbiased benefit management solutions. With more than 25 years of experience managing pharmacy benefits, RESTAT is also one of the world’s most experienced benefit managers. Today, more than 4,200 companies, ranging in size from the Fortune 50 to small managed care organizations rely on RESTAT to manage the prescription benefit for over 7.5 million people nationwide. To learn more, visit www.restat.com or call 800.926.5858.

www.cdhcsolutionsmag.com I CDHC Solutions™ I January/February 2011

Center for InsuranCe eduCatIon and ProfessIonal develoPment

Learn. Achieve. Succeed.

Health Care Reform Implementation Courses CE Credits and a Special Price The AHIP Center for Insurance Education and Professional Development’s online courses, Health Insurance Advanced Studies, Parts A and B, focus on the impact of reform initiatives and specific health insurance products and policy options. Courses that fulfill Ce requirements In select states, students qualify for up to 14 CE credits by taking the Health Insurance Advanced Studies, Part A course and up to 7 CE credits for the Health Insurance Advanced Studies, Part B course.

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CIE_111_197_HealthCare_Reform_CDHC_Ad_2F.indd 1

1/31/11 10:48:36 AM

Lighthouse1 www.lighthouse1.com

Ask the Expert

Winning the Health Care Game

Decrease Costs and Improve Employee Wellness

s health care costs climb, so does your need to offer cost-saving, consumer-driven health care (CDHC) account solutions that help you—and your employees—contain costs and increase wellness. But what makes a true difference in a CDHC solution? The solution must address five key areas: 1) Reduce health care costs 2) Increase employee productivity and wellness 3) Offer anytime/anywhere mobile or Web access 4) Provide paperless claims processing 5) Get started quickly and cost-effectively

Reduce Health Care Costs

The first—and perhaps the most obvious—area a CDHC solution must address is to reduce health care costs. Because health savings accounts (HSAs), health reimbursement accounts (HRAs), and flexible spending accounts (FSAs ) are designed to be part of a comprehensive benefit package, employers, third party administrators (TPAs) and brokers can enjoy significant savings in health premiums. FICA and income tax savings also accompany HSAs and FSAs, while HRA accounts offer FICA tax savings only. The adoption of healthy habits also can drive additional savings as can efficiency gains on a CDHC technology platform such as Lighthouse1 OnDemand. This innovative Software-as-a-Services (Saas) solution enables more than 100 leading nationwide benefits administrators, financial institutions and health plans to serve more than 20,000 employers and 2.5 million consumers on a single, high performance platform.

Increase Employee Productivity and Wellness

Employers provide tools and processes in their companies every day to help increase employee productivity. Similarly, providing tools helping them make healthy lifestyle choices can improve their wellbeing while reducing long-term benefits costs. Lighthouse1 offers tools and services designed to help you deliver helpful, high-impact wellness programs. For example, Lighthouse1’s Learn CDHC offers an individualized interactive presentation explaining HSA, HRA, and FSA accounts. By using My Personal Health Suite, employees can complete a health and productivity assessment and choose from 13 different six-week, online, science and human behavior-based wellness programs.

Offer Anytime/Anywhere Mobile or Web Access

It’s becoming increasingly important and necessary for a CDHC solution to offer anytime/anywhere mobile or Web access. A fully integrated, customizable technology platform, such as Lighthouse1 OnDemand, enables employers’ third party benefits administrator to choose from 1,100 unique plan designs to tailor a solution meeting their specific needs. HR staffs, administrators and employees have 24/7/365 access to account information, claims entry screens, and helpful reports using secure, Web-based portals. Additionally, if your CDHC solution has mobile capabilities (such as Lighthouse1 Mobile), employees can check available account balances and manage their accounts via their mobile devices.

Provide Paperless Claims Processing

Equally important is to provide paperless claims processing. Employees need and deserve hassle-free processing, which also reduces the burden on HR and support staff. Look for a solution such as the Lighthouse1 OneCard where claims are substantiated and processed automatically, reducing the need for manual reimbursement requests and provider payments.

Get Started Quickly and Cost-Effectively

The final key area is for employers to look for a solution that enables them to get started quickly and cost-effectively. The technology platform should enable integration with leading health plans, data transmission from payroll and HR systems, single sign-on to other websites and automated enrollment processes.

Lighthouse1 and its partners serve more than 2.5 million consumers, making Lighthouse1 the nation’s largest web-based health care solution that manages HSAs, HRAs, FSAs, and Transit Plans. It is the only solution available today that meets more than 1,100 unique benefit plan designs, simplifies the user experience, and satisfies workflow management needs of administration partners, employers, and consumers. Visit www.lighthouse1.com for more information.

www.cdhcsolutionsmag.com I CDHC Solutions™ I January/February 2011

Statistics & Data

HRA and HSA Accounting

Comparing Account Balances and Rollover Amounts for Individuals With HRAs and HSAs

survey, conducted by Paul Fronstin of the Employee Benefit Research Institute (EBRI), examined average account balances and rollover amounts for owners with a consumer-driven health plan (CDHP) from 2006-10. The survey found that asset levels in health savings accounts (HSAs) and health reimbursement accounts (HRAs) have skyrocketed from $835.4 million in 2006 to 7.7 billion in 2010. The average account balance increased dramatically from $696 in 2006 to $1,419 in 2009. The average account balance dipped slightly in 2010 to $1,355, close to 2008 levels. The total rollover amount increased in 2010 to $4.2 billion, a slight increase compared to $4 billion in 2009. However, average rollover amounts per account decreased from $1,295 in 2009 to $1,029 in 2010. The survey found differences in account balance and rollover amount were based on certain individual characteristics: Gender: Men had higher account balances and rollover amounts than women. This may be because men tend to use health care less than women. Age: Persons below the age of 55 tended to have about the same account balance and rollover amount. Those in the 55-64 range tended to have more, despite the fact older individuals tend to use health care more often than younger ones. One possibility is older individuals are allowed to make larger contributions after the age of 55. Race: Minorities with HRAs or HSAs had higher account balances and rollover amounts than whites. Both experienced a decline in account balance between 2009 and 2010; however, the decline was larger among minorities. Conversely, minority rollover increased from 2009 to 2010, while it decreased for whites. Household Income: Account balances increased with household income. The average account balance was $1,166 among individuals with less than $50,000 in household income; $1,303 among individuals with $50,000−$99,999, and $1,742 among individuals with $100,000 or more. Account balances increased for those with less than $50,000 in household income; fell for those with $50,000−$99,999, and stayed the same for those with $100,000 or more. Education: Individuals with college degrees have a higher account balance and rollover amount than those with high school degrees or less, and those with graduate degrees have higher account balances, but not rollover amounts than those with just a bachelor’s. However, only those with a graduate degree experienced a decline in their account balance and rollover amounts in 2010. Type of Coverage: Interestingly, families have a lower account average and rollover amount than individuals even though they are allowed to contribute more to their plan per month. The fact families

January/February 2011 I CDHC Solutions™ I www.cdhcsolutionsmag.com

tend to use their health care more than single adults may explain that difference. Health Behaviors and Health Status: Nonsmokers and nonobese individuals had more money in their accounts and a higher rollover amount that smokers and obese individuals, but the difference is negligible. (These numbers were obtained through a self-reported health status by those surveyed). Use of Health Information Programs: Those who participate in health risk assessments and wellness programs had higher account balances and rollover amounts from year to year, though in regard to rollover amounts, the difference was not statistically significant. Cost-Conscious Behaviors: Very little differences were found between those who exhibited cost-conscious behaviors and those who did not with one exception; it was found that those asking their doctor for a less costly prescription drug had lower average account balances. Length of Time With Account: Those with an account for less than six months had an average account balance of $694. Those with an account for at least six months but less than a year, averaged $962. Those individuals with the same account between one and two years, averaged $1,324. Three to four years, averaged $2,231. Employer and Individual Contributions: Those in either an employer plan or an individual one tend to have more money in their accounts and have more of their balance rollover if they contribute more annually.

High Percentage of Americans Check for Health Information Online, Few Check the Source

The Internet has allowed millions if not billions of people around the world to access medical information from the convenience of their home computer, laptop, smartphone or other mobile device, and there is an abundance of information out there. The problem many people have is whether the information can be trusted, and if those seeking information are verifying their sources. According to new research released by Health Dialog, and commissioned by parent-company Bupa, 81 percent of Americans go online for health information, 72 percent look online for information about medicines, and 58 percent have looked for information online to make a self-diagnosis. Yet, surprisingly, only one in four people say they check the source of their online advice. The survey was conducted as part of Bupa Health Pulse 2010, a global study of health attitudes and behaviors of more than 12,000 individuals across 12 countries. For the entire report go to www.bupa.com/healthpulse/healthand wellbeing

Top Health Industry Issues

Statistics & Data

Results from PwC’s Top Health Industry Issues of 2011 Consumer Survey Consumer’s Use of Electronic Health Record

According to PricewaterhouseCoopers LLP ‘s (PwC) Top Health Industry Issues survey on electronic health records (EHR), about half of consumers have electronic access to their physician’s notes (48 percent), upcoming health care appointments (52 percent), and immunization records (53 percent). The numbers are slightly better for consumers’ prescription order/history (56 percent), and lab reports (58 percent). Twelve percent of consumers surveyed said they have no electronic access to their health information. As far as improving access and quality of EHRs, only 13 percent said they had been asked what they would like to see in their electronic medical records and how they would like to use them.

Consumers Who Would Trade their Health Benefits for a Raise

When PwC asked consumers if they would be willing to trade in their health insurance plans from their employer for a pay increase, 72 percent said they would trade, 16 percent said they would not, and 12 percent were not sure. Of the individuals who would trade, 53 percent of those with single coverage overestimated the value of their health insurance, and 27 percent underestimated it. Of those with family coverage, only 28 percent overestimated. Forty-three percent underestimated the value.

High-Deductible Enrollment Plans Gaining Popularity

One trend in employer health coverage is the percentage of employers whose highest enrollment plan is a high-deductible one. In 2008, only 6 percent of employers said their plan with the highest enrollment was a high-deductible plan. By 2010, that number had gone up to 13 percent, an increase of more than 100 percent. The survey indicated more employees are choosing to go with high-deductible plans, and then reduce utilization of their plan. This is done to shift the cost burden that has trickled down due to rising health care costs all around.

Consumer’s Use Online Tools as a Source of Information

One facet of health care PwC examined was where consumers go when looking for health care information. Overall, only 54 percent of consumers use online tools and resources, second only to consulting a physician (75 percent). Of those 54 percent, 56 percent use media information companies such as WebMD. Consumers also turn to both government websites and health service websites—such as Mayo Clinic—16 percent each. Twelve percent utilize a consumer-driven organization.

www.cdhcsolutionsmag.com I CDHC Solutions™ I January/February 2011

Seeking Direction About

Health Care Reform? Health Reform Navigator—Your complete Health Reform Information Center. It provides an aggregation and “point & click” navigation to information regarding the Patient Protection and Affordable Care Act (PPACA).

Health Reform Navigator includes: PPACA – Direct point and click access to Insurance- and Taxes and Penalties-specific sections of the law. Locate immediately the actual language of PPACA for each topic you are interested in (e.g. grandfather clause, small group subsidy, child coverage).

Timelines – Multiple timelines including a unique Navigator Legislative Timeline with links to all insurance and taxes/penalties in PPACA.

Regulations – Direct point and click access to DOL, HHS, and IRS health reform regulations and related information (FAQ, model notices, videos, and more).

Surveys – Direct point and click access to national surveys on what employers are doing in response to PPACA. HOT Topics – As regulations are announced, special attention is provided for easy viewing of What’s New (including FAQ, Fact Sheets, and Videos).

Updates – For a $99 charge you will buy the current updated Navigator for PPACA and the access code to any updates provided at this same website.

FREE BONUS – The Preventive Care Navigator is offered for a limited time as a free bonus. The Preventive Care Navigator uses the same easy “point & click” technology to answer specific questions about the January 1, 2011 mandate for benefit plans to include significant preventive care services at 100% coverage. It includes detailed explanations, exclusions, sample SDP language, and CPT codes applicable to each benefit.

For $99 you gain Instant Access to Health Reform Navigator AND Preventive Care Navigator (A $198 Combined Value).

Start navigating today. Download your Health Reform Navigator www.cdhcsolutionsmag.com

www.CDHCSolutionsMag.com

Who’s Who Profiles

Access these profiles online at www.CDHCSolutionsMag.com and www.EmployersWeb.com HSA/HRA/FSA Technology: Administration & Management

HSA/HRA/FSA Technology: Administration & Management

AmeriFlex

TSYS Healthcare®, provides end-toTSYS Healthcare end strategic payment solutions for 612.338.3871 consumer directed healthcare. We www.tsys.com/solutions/healthcare partner with benefits administrators, healthcare@tsys.com financial institutions and health plans and software providers to navigate all aspects of HSAs, HRAs, FSAs, 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 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 Technology: Administration & Management

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 Since 1984, service providers using www.dpath.com DataPath systems have provided John J. Robbins Sr., President, CEO administrative solutions for over 1 million participants of FSA, HRA, HSA, and COBRA. jrobbinssr@dpath.com 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.” ®

— John Robbins, CEO, President, DataPath, Inc.

302 Fellowship Road, Suite 100 Mount Laurel, NJ 08054 Internal Sales Support: 888.868.3539 (FLEX), option 4 Proposals and Marketing Inquiries: info@flex125.com www.flex125.com   Established in 1998, AmeriFlex is an independent benefits administrator providing technology-based, consumer-driven benefits and compliance solutions. n AmeriFlex

Convenience Card® Consolidated FSA/HRA/HSA/CRA Debit Card Platform n AmeriFlex Convenience Sleeve Consolidated FSA/HRA/HSA Healthcare Payment Solution n AmeriFlex Convenience Portal WebBased System for Streamlined Administration of CDHC Plans

n Mongoose®

Enterprise Class, Web-Based Solution for COBRA Administration n ePOP Instant POP Plan Online Document Ordering n Invoice Manager Paperless, Automated System for Group Claim Activity and Funding Administration

“At AmeriFlex, we are constantly looking for new ways to bring innovative and cost-effective payment solutions to the market in order to improve efficiency and simplify the delivery of healthcare products and services to all stakeholders.” — William Short, President & CEO, AmeriFlex HSA/HRA/FSA Technology: Administration & Management

No other solution available today has been so Lighthouse 1 deliberately designed to meet the benefit plan design, user experience and unique workflow 9800 Bren Road East, Suite 250 management needs of administrators, employers, Minneapolis, MN 55343 and consumers. As a web-based, real-time www.lighthouse1.com platform, Lighthouse1 OnDemand™ saves 952-908-9056 employers and consumers more than $1.2 billion a year in tax savings and administrative costs. Lighthouse1 OnDemand is the engine that combines technology, healthcare and banking to provide automation in the healthcare industry. Lighthouse1 and its partners serve more than 2.5 million consumers, making Lighthouse1 the nation’s largest web-based healthcare solution that manages HSAs, HRAs, FSAs, and Transit Plans.

“Rising healthcare costs, increased employer expectations and a challenging economy create tremendous opportunities in the CDH industry. Lighthouse1 is uniquely positioned to combine superior services and innovative technologies to administrators, employers and consumers. With the recent launch of Lighthouse1 Mobile, consumers now have even more access to their healthcare benefits and more control over their healthcare spending. Together with our strong network of partners, we are poised to keep reducing costs and simplifying the business of healthcare.” — Jeff Young, Chief Executive Officer for Lighthouse1 www.cdhcsolutionsmag.com I CDHC Solutions™ I January/February 2011

Who’s Who Profiles

www.cdhcsolutionsmag.com

Solutions to help your innovative health and benefit programs. Tools and Technology

As the premier provider of proven CDH technology solutions for benefits administrators, we know that your needs are many and varied.

T o ta l P o pu l at i o n H e a l th Car e Ma n a g e m e n t

314.439.5300

www.bemassoftware.com PayDirect CDH gives you all the functionality sales@bemassoftware.com that you need to administer your consumer driven healthcare benefits programs with ease and efficiency. PayDirect CDH... Is fully integrated with the industry’s leading benefits card that achieves the highest auto-substantiation rates n Administers complex HRAs with multiple tiered payouts and a variety of deductible arrangements n Handles specialized financial management and billing requirements n Provides access to an extensive range of reports with advanced functionality n

Automates repetitive processes. Imports and exports data to eliminate manual entry and allow integration with other business systems n Fulfills critical compliance requirements such as discrimination testing and CMS reporting n Includes an easy-to-use, customizable online portal n

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P har m a c e ut i c a l B e n e f i ts Ma n a g e m e n t

Envision Pharmeceutical Envision Pharmaceutical Services, Inc is a full service pharmacy benefits Services, Inc. management company that delivers! John Ewell, EVP Marketing We deliver because our business 925.487.3266 model is based on transparency www.envisionrx.com and full disclosure, guaranteeing jewell@envisionrx.com 100% pass through pricing of all pharmaceutical manufacturer rebates and administrative fees at the point-of-sale. Additionally, our affiliate, Envision Insurance Company, is a national Prescription Drug Plan which enables us to offer a variety of solutions for your retirees. Envision is truly a “different” PBM! “Envision is pleased to be recognized by its clients surveyed by the Pharmacy Benefits Management Institute for three consecutive years as the top performer in virtually every category evaluated. This solidifies our leadership position in providing transparency and full disclosure to the PBM marketplace while continuing to find innovative solutions.” — Kevin M. Nagle, President & CEO, Envision Pharmaceutical Services/Rx Options

January/February 2011 I CDHC Solutions™ I www.cdhcsolutionsmag.com

D e c i s i o n S upp o rt & C o st - S a v i n g s T o o l s

My HSA Rewards allows individuals My Hsa Rewards to earn cash rewards for purchases 12460 Crabapple Road made through merchants Suite 202-254 participating in the program. Alpharetta, GA 30009 At launch, the merchant network consists of hundreds of major online 404.551.5543 retailers representing thousands of www.myhsarewards.com brands. The program works like an sanders@myhsarewards.com airline mileage program, but, instead of earning miles, participants earn cash rewards that are directed to a health savings account (HSA). There is no cost to the employer or the employee to join.

“If you want to grow your Health Savings Account faster and with ease, My HSA Rewards is a smart and simple way to put real cash into your HSA from the purchases you make every day.” — Sanders McConnell, President, My HSA Rewards

www.CDHCSolutionsmag.com

Who’s Who Profiles

Access these profiles online at www.CDHCSolutionsMag.com and www.EmployersWeb.com tools and Technology

Liazon was founded in 2007 to tackle the myriad problems inherent in employee benefits for small and mid-sized employers. Liazon’s retail employee benefits solutions give employers a cost-saving defined contribution strategy for all benefits. Liazon’s Benefits Exchange™ is the online store where employees find, learn about and purchase health care and other insurance products.

I n t e g rat e d Car e : D i s e as e Ma n a g e m e n t / W e l l n e ss

Liazon 737 Main Street, Suite 200 Buffalo, NY 716.803.6190 708 Third Avenue New York, NY 212.209.3836 www.liazon.com

“Liazon’s Bright Choices Benefits Exchange is the online store where employees shop for their benefits. It brings an exciting new retail model to employee benefits that empowers benefits consumers and saves employers money. Think of it as the ‘amazon.com’ for employee benefits.”

eDocAmerica users receive the confidential decision support they need to effectively execute critical health decisions, avoid unnecessary office visits, and save time and money.

Requests for Permissions to reuse content contact Copyright Clearance Center at info@copyright.com.

— Dr. Charles W. Smith, Founder of eDocAmerica

Gu i d e

advertising index ABA/HSA Council...................................................24

Empowered Benefits............................................... 7

Aflac..............................................................................28

Envision Pharmaceutical Services.................................Inside Front Cover, 48

AmeriFlex....................................................................47

advertising contacts

866.525.3362 www.edocamerica.com

“In this era of managed care, we believe it’s important to give consumers the tools they need to make better healthcare decisions. That will help enable people to obtain the best value, quality and cost from each healthcare encounter.”

R e s o u r c e If you use the services of our solutions providers, please tell them you saw their ad in CDHC Solutions™ or EmployersWeb.com™ magazine.

11719 Hinson Road, Suite 130 Little Rock, Arkansas 72212

eDocAmerica gives employees and their families unlimited Internet access to board Robbie Linn, President certified physicians, licensed psychologists, 501.907.7117 pharmacists, dentists, dieticians and fitness rlinn@edocamerica.com experts who provide personal answers to all health related questions. In operation since 1997, eDoc-America has become the most effective medical information tool available! Users in all 50 states and 30+ foreign countries currently enjoy receiving the answers they need from professionals who know.

— Ashok Subramanian, Co-founder and CEO, Liazon

eDocAmerica

BEMAS Software Inc..............................................48

FIS Healthcare Solutions....................................... 8 Health Reform Navigator...................................46

C E O / P u b lisher Doug Field 404.671.9551 ext. 101 · dfield@fieldmedia.com

Best Buy................................................................ 20-21 CDHC Solutions Forum................................. 11-15

InteliSpend Prepaid Solutions.....................Inside Back Cover

Associate Publisher 404.671.9551 ext. 103 Brent Macy bmacy@fieldmedia.com

AHIP..............................................................................42

Liazon................................................................... 34, 49

ConnectYourCare...................................................10

Lighthouse1...............................................................47

DataPath............................................................. 19, 47

My HSA Rewards....................................................48

Discovery Benefits..................................................47

Transitions Optical.................................................. 5

DSS Research............................................................48

TSYS Healthcare............................................. 16, 47

eDocAmerica.............................................................49

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

Business Development Associates 404.671.9551 Rogers Beasley rbeasley@fieldmedia.com, ext. 109 David Cerri dcerri@fieldmedia.com, ext. 106 Susan Yakots syakots@fieldmedia.com, ext. 102 Reprints Drew Collins dcollins@fieldmedia.com, ext. 104

www.cdhcsolutionsmag.com I CDHC Solutions™ I January/February 2011

Briefs

People on the move

Continued from page 22

identify new opportunities in the marketplace. Kaegi’s background includes four decades of marketing, communications and strategic planning experience. He joined BCBSF in 2002 as chief marketing executive and introduced a disciplined marketing process with customer/market intelligence as its base that included customer segmentation and targeting. He also organized marketing around customers through cross-functional market segment teams and expanded the company’s multi-cultural efforts. Prior to joining BCBSF, Kaegi held leadership positions in marketing and strategic planning at Vytra Health Plans in New York, LaQuinta Inns in Texas, and Kindercare Learning Centers in Alabama. In 1994, he was named in Advertising Age magazine’s “Marketing 100,” recognizing his success in rebuilding the market value of LaQuinta Inns. Kaegi was also a member of the prestigious Harvard/Kennedy School Health Care Delivery Policy Program, a Harvard-based think tank that endeavored to reform health care delivery and financing Christine Higgins has been named vice president of underwriting at Anthem Blue Cross and Blue Shield in Connecticut. Higgins began her career at Anthem in 1991 when she served an internship with the Corporate Planning Department as part of her post-graduate course study. She joined the company officially in 1992 after she received her MBA from the University of Connecticut, from which she also holds a bachelor’s degree in Business Administration. Over the past 19 years, Higgins has held a variety of increasingly responsible positions within the Health Benefits Analysis, and Major and Commercial Accounts Underwriting, and Sales departments. Most recently, Higgins served as Director of Sales for Anthem’s public sector sales teams, where she was accountable for managing a team of 16 professional sales executives to deliver distinctive service and achieve membership goals. She served as chair for the Municipal Advisory Council ensuring that sales strategies, products and marketing strategies aligned with public sector marketplace demands. hCentive, Inc., a provider of technology solution to simplify health care, proudly announces the recent addition of health care leader Jim Parker to the company’s Board of Advisors. With more than 20 years in health care, Parker, president of Meridian Strategic Advisors, a firm dedicated to assisting emerging health care companies achieve growth and industry differentiation through effective industry and government stakeholder management, also served in a number of significant leadership roles within WellPoint, Inc., the nation’s largest health benefit company. These roles included Chief of Staff to Angela Braly, WellPoint Inc.’s President and CEO; Senior Vice President and President of WellPoint Inc.’s Federal Government Solutions Division; President of the Federal Employee Health Benefit Plans Business Unit; President of Anthem Blue Cross and Blue Shield’s Maine Business Unit; and Vice President of Public Affairs for Anthem Inc. Securian Financial Group, Inc. announced that Richard Fetter, a 22-year veteran of individual life insurance underwriting at Securian Financial Group, now directs that unit. According to a release, Fetter, who lives in Blaine, Minn., also retains his responsibilities as a chief underwriter, a position he has held since 2007. He works with the company’s medical department and actuaries to set medical underwriting guidelines and provides underwriting support to firms and advisors who market Securian and Minnesota Life Insurance Company products to individuals. Fetter joined Securian in 1988 as an underwriting assistant. HealthFitness has appointed Dennis Richling, M.D., to chief medical and wellness officer. Richling has more than 20 years of experience in health management services and corporate wellness programs. Richling is currently senior medical director at The Trustmark Companies, HealthFitness’ parent company. He will continue in his capacity at The Trustmark Companies while focusing on developing HealthFitness’ comprehensive suite of evidence-based solutions for health and wellness engagement throughout the complete 50

January/February 2011 I CDHC Solutions™ I www.cdhcsolutionsmag.com

health continuum. Prior to joining Trustmark, Richling served as senior vice president of product management at Alere, a specialized health management services organization. He also was chief medical officer and assistant vice president of health services for the Union Pacific Railroad, which received numerous awards and recognition, including the C. Everett Koop Award for its health management services. A graduate of Harvard Business School, Richling received his medical degree from Creighton University School of Medicine. He has served on numerous boards, including the American Heart Association, National Business Group on Health, Partnership for Prevention, Center for Disease Control’s Task Force for Community Preventive Service and the Surgeon General’s Interagency Committee on Smoking. The Health Information Partnership for Tennessee (HIP TN) has hired Keith Cox, a health IT veteran with 26 years of experience as an entrepreneur and corporate executive, to lead the creation of a statewide health information exchange (HIE) for providers, physicians, hospitals, other health care organizations and consumers. The HIP TN board selected Cox on as its chief executive officer with responsibility to oversee the $11.6 million federal grant for creating the health information exchange network. Cox will head up the not-for-profit, which is working to connect regional health information organizations (RHIOs) across Tennessee and create a network of networks, allowing health care providers to share information to improve patient care and outcomes. Cox was selected after a national search by the Buffkin Group, which was contracted by HIP TN for the recruitment and human resource services. Cox joins HIP TN after serving as Chief Technology Officer for A.D.A.M., Inc., a provider of health information and benefits technology solutions. Prior to A.D.A.M. he was with the Microsoft Corporation, where he was Director of Global Partner Business Development in Developer & Platform Evangelism, a division of Microsoft’s Server and Tools Organization. CareCentrix, Inc., the nation’s leading provider of home health benefits management services, announced Rex Adams will join the executive team reporting to Eric Reimer, chief executive officer. Adams will serve as chief operations officer, with oversight of core operations, including information technology, claims management and all regional customer centers. Previously the chief operating officer for WellCare Health Plans, Inc., Adams had full responsibility for all operations, data and technology activities at the company. He played an active role in growth initiatives and regulatory programs related to Medicaid and Medicare expansion, health care reform and infrastructure investments. Prior to WellCare, Adams was president and chief executive officer of AT&T East, a division of AT&T Inc., following its merger with BellSouth. During his previous 12 years with BellSouth, Adams held progressively larger leadership roles, including president of Long Distance, president of Wholesale Services, and roles within Information Technology, Product Development and Management, and Corporate Planning and Development. Adams began his career as a consultant at Monitor Company, a strategy-consulting firm founded by Harvard Business School professor, Michael Porter. Adams received his masters in business administration from the Harvard Business School and is a graduate of the United States Military Academy at West Point. WellPoint announced that Jai Bills has been named vice president of InterPlan and National Accounts Planning. Bills is an industry veteran with more than 15 years of experience in corporate finance, operations and project management. Bills most recently served as staff vice president of planning and sales for WellPoint’s National Accounts Business. He held several leadership roles at CIGNA before joining WellPoint in 2005. In his new role, Bills will serve as WellPoint’s InterPlan representative on several external Blue Cross and Blue Shield Association committees and workgroups and will be the direct liaison with other Blue plans for InterPlan issues.

Since 50%-80% of all diseases are linked to the behavior choices we make, isn’t it time we focus on changing these behaviors*? The majority of health problems are related to behavior. That means that if we can engage people with better information about health risks or opportunities, we can help them make informed decisions that can lead them to better health. That’s what UnitedHealthcare’s industry-leading consumer-driven health plans are all about. Consumer-driven health (CDH) plans are health benefits plans that let members choose their own providers, like a PPO, and manage their own health care dollars with a tax-exempt health account. We designed our plans to help employees get on the path to good health and improved health care usage habits. Our CDH plans actively engage members in their health care choices, with tools like: • Th e right information at the right time: about doctors, receiving care, accessing benefits and much more • 100% coverage for preventive care, so employees don’t delay visits • Information that helps employees evaluate and compare the quality and cost-efficiency of network physicians • Personalized treatment reminders • A Treatment Cost EstimatorSM that provides condition-specific cost estimates based on where care is received And there’s no shortage of benefits for employers, either These plans were designed to be easy for you to administer, too. All UnitedHealthcare CDH plans come with fully integrated banking services and turn-key implementation tools for both you and your employees.

For additional information on UnitedHealthcare’s CDH plans, visit uhctogether.com/CDH or call 1.866.438.5651.

UnitedHealthcare Insurance Company Source: Adapted from Department of Health and Human Services, Centers for Disease Control and Prevention.

©2011 United HealthCare Services, Inc. Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by or through UnitedHealthcare Insurance Company, United HealthCare Services, Inc. or their affiliates. Health plan coverage provided by or through a UnitedHealthcare company. UHCEW506202-000