FORUM East Wrap-up FORUM West Early Bird Sign-up
ISSUE || May/June 2013
MAKING WELLNESS HAPPEN Why Play Social Games at Work: It’s Healthy for Business The Case for Including Spouses in Employee Health Management Programs Charting the Unknown Waters of HSAs in the HIX
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FEATURES
37 The Case for Including Spouses in Employee Health Management Programs
INSIDE
39 Why Play Social Games at Work: It’s Healthy for Business Millions of people cannot access Facebook from work at this very moment, and just as many wish they had a multi-player game as simple as Words with Friends while at the office, that gave them a good reason to act on their impulse for wanting a more interactive way to connect with their co-workers. By harnessing the desire to play and connect, however, businesses can use social networking and gaming in the workplace to increase productivity, camaraderie and teamwork. By Josh Stevens, Chief Executive Officer, Keas
There is evidence that comprehensive communications, the use of incentives and a strong culture of health can all help drive increased participation in employee health management programs. An often overlooked element that also contributes to a program’s long-term success, however, is the role of family support — specifically spouses. In fact, it’s missing from the term itself: “Employee Health Management.” By Dan Gold, Ph.D., Member of the HERO Research Study Committee
INSIDE The Institute for HealthCare Consumerism Launches New Magazine Supplement HealthCare Exchange Solutions HealthCare Exchange Solutions helps you understand the choices in the health and benefit marketplace and make the best decisions among a complicated array of exchange solutions options.
COMING UP NEXT: Keep an eye out for the next issue of HealthCare Consumerism Solutions featuring articles on telehealth, patient health advisory, consumerism trends, defined contribution, compliance and more. www.TheIHCC.com I HealthCare Consumerism Solutions™ I May/June 2013
3
INSIDE 6
9
Editor and Publisher’s Letter
Following Successful FORUM East, the Institute Looks to Fall Open Enrollment, ACA Deadlines and FORUM West
Briefs & Innovations
t Obama Administration Releases Final Rules on Employmentbased Wellness Programs t IRS Releases New HSA Limits for 2014 t Latest Hospital Safety Scores Show Incremental Progress in Patient Safety t Jellyvision Announces Latest Virtual Employee Benefits Counselor t Teladoc Names Henry DePhillips, M.D. as Chief Medical Officer
11 FORUM East Photo Gallery 43 Corporate Member Profiles
DEPARTMENTS 8
Bachman’s Banter Premium Rate Reviews for Individual Policies and Small Group Plans By Ronald E. Bachman, FSA, MAAA, Chairman, Editorial Advisory Board, The Institute for HealthCare Consumerism
33 Supplemental Health Are You Ready to Sell Dental Benefits in New Health Care Reform Environment? (Part Three) By Rene Chapin, Director of Membership & Communications, National Association of Dental Plans
34 Health Savings Accounts Charting the Unknown Waters of HSAs in the Health Insurance Exchanges By Reed Erickson, VP of Compliance & Risk Management, SelectAccount
50 Resource Guide/Ad Index
Events The 2013 IHC FORUM West Save the Date! www.theihccforum.com We are excited to announce our dates for FORUM WEST. Join us December 5-6, 2013 in Las Vegas. We are back at the luxurious Red Rock Resort & Spa — a serene oasis set away from the hustle and bustle of the Las Vegas Blvd. The Resort’s exquisite rooms and breath-taking views of the canyon will make the perfect backdrop for our west coast event, not to mention all of the convenient amenities right there on-site (movie theater, bowling alley, restaurants, casino, spa, pools, and more). Registration will open soon. Come LEARN, CONNECT and SHARE with the top thought leaders in the rapidly growing health care consumerism megatrend.
Membership Become a Member, Reap the Rewards Have you become a member of The Institute for HealthCare Consumerism (www.theihcc.com)? Why wait? Visit The IHC website today and sign up for a premium membership. Got a story to tell about an innovative health and benefit program or best practice in health care consumerism? Share it with fellow members of The Institute for HealthCare Consumerism. Share a case study, white paper, article or post a blog at www.theihcc.com. Members of The IHC also receive special discounts to attend Institute events, such as IHC FORUM.
4 May/June 2013 I HealthCare Consumerism Solutions™ I www.TheIHCC.com
SPECIAL FORUM EAST WRAP-UP
Making HealthCare Consumerism Work in the Year Ahead and Beyond December 5-6, 2013, Las Vegas, NV Page 11
FORUM East Wrap-up
Page 13
FORUM West Early Rundown
The latest updates, program details, speaker bios, and registration information are available at www.theihccforum.com or call 404-671-9551.
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LETTER
PUBLISHER www.theihcc.com VOLUME 9 NO. 4 | MAY/JUNE 2013
Published by FieldMedia LLC 292 South Main Street, Suite 400 Alpharetta, GA 30009 Fax: 770.663.4409 CEO
Doug Field @ theihcc.com MANAGING DIRECTOR
Brent Macy
First, I want to thank everyone who helped us complete the largest ever FORUM in our history in early May. With nearly 700 attendees and over 50 sponsors, FORUM East was a resounding success. Yet exceeding our attendance goal was only the surface success. The real success was the collaborative energy in the exhibit hall and breakout sessions among all stakeholderes seeking positive solutions to industry changes in the upcoming open enrollment period and the following year. From discussions around ACA compliance, understanding defined contribution, transparency solutions, health incentives and education/engagement strategies, many innovative solutions were explored. Our goal is to continue to expand this dialogue — not only at our events — but throughout our media properties, including HealthCare Consumerism Radio, HealthCare Exchange Solutions magazine, The Institute for HealthCare Consumerism web communities and our array of e-newsletters. Within the pages of this magazine, we feature a number of great articles that continues this mission. Our cover feature by Keas CEO Josh Stevens looks at how to make wellness happen by creating a fun, engaging and social experience. And with recently released rules by the Obama administration on employee-based wellness programs, wellness will become increasingly important in the upcoming months. We also feature articles covering health savings accounts in the exchanges by Reed Erickson at SelectAccount, the case for including spouses in health management programs by Dan Gold at Mercer, and the keys to selling dental benefits in the age of health reform by Rene Chapin at NADP. We are also proud to house within this issue the second issue of HealthCare Exchange Solutions. If the aforementioned issues are directly impacting you, we urge you to stay connected with us throughout the year by becoming a member through the Institute’s website. We invite you to join and become a part of the discussion around innovative health and benefits management solutions in this fast-changing environment. And finally, we are now six months away from our next FORUM conference. We will be heading to the Red Rock Resort & Spa in Las Vegas from December 5-6. The timing of this FORUM will enable attendees to hear first hand the experiences of this critical open enrollment period and gather last-minute updates on 2014 ACA compliance issues. We hope to see you there. Sincerely,
MANAGING EDITOR
Jonathan Field
ASSOCIATE EDITOR
Kelvin Hosken
ACCOUNT MANAGERS
Joni Lipson Rogers Beasley
ART DIRECTOR
Kellie Frissell
ASSOCIATE DIRECTOR OF EDUCATION SERVICES AND PROGRAMS
Dusty Rhodes CHAIRMAN OF IHC ADVISORY BOARD
Ronald E. Bachman, CEO, Healthcare Visions EDITORIAL ADVISORY BOARD
Kim Adler, Allstate; Diana Andersen, Zions Bancorporation; Bill Bennett; Doug Bulleit, DCS Health; Jon Comola, Wye River
HSA Rewards; Roy Ramthun, HSA Consulting Services LLC; John Young, CIGNA WEBMASTERS
Kevin Carnegie Tom Becher
DIRECTOR OF CONFERENCE SPONSORSHIP/ CORPORATE MEMBERSHIP/REPRINTS
Rogers Beasley
BUSINESS MANAGER
Karen Raudabaugh
™ Volume 9 Issue 4 Copyright ©2013 by FieldMedia LLC. All rights reserved.
™ ™ is published eight times yearly by FieldMedia LLC., 292 South Main Street, Suite 400, Alpharetta, GA 30009.
Doug Field CEO/Publisher dfield@fieldmedia.com
™
magazine 292 S. Main Street, Suite 400, Alpharetta,
PRINTED IN THE U.S.A. ™
is designed to provide both accurate and
Send letters to the editor and editorial inquiries to the above address or to
6 May/June 2013 I HealthCare Consumerism Solutions™ I www.TheIHCC.com
ENGAGE AT EVERY STAGE
Ninety million consumers report having a hard time understanding their care choices, according to an Institute of Medicine study.* And as the healthcare landscape changes and insurance exchanges become available, consumers are likely to be more confused than ever. Though it remains to be seen what shape the new marketplace will take, it’s clear that consumers will require a range of tools to support their healthcare decision-making. From guiding individuals to their best-fit benefit plan to alerting them about gaps in care, Consumer Advantage from Truven Health Analytics™ provides a full array of solutions to engage consumers with personal, relevant, impactful information throughout the year. Consumer Engagement: The Key to a Successful Exchange Backed by more than 30 years of experience, our consumer experts, integrated platforms, and data management solutions have helped turn passive participants into active healthcare consumers. Recent successes include: Increasing adherence to colorectal cancer screenings by 22 percent Migrating 59 percent of employees from a PPO to a CDHP Reducing the number of “overinsured” employees by 14 percent Enrolling more than 1,000 new participants in a health savings account
Find the path to a healthier bottom line — visit booth #135 at AHIP Institute 2013 or go to truvenhealth.com/exchange
TRUSTED. PROVEN. ©2013 Truven Health Analytics Inc. All rights reserved.
Consumer confusion about their care choices is directly responsible for 3- to 6-percent higher healthcare expenditures.* * Source: Institute of Medicine Report Brief
BACHMAN’S BANTER
BY RONALD E. BACHMAN FSA, MAAA CHAIRMAN, EDITORIAL ADVISORY BOARD THE INSTITUTE FOR HEALTHCARE CONSUMERISM
WHO: Insurers offering individual policies and small group fully insured plans with fewer than 50 employees. Grandfathered plans and self-funded contracts are not subject to HHS rate reviews. WHEN: Beginning in 2014 HHS, in conjunction with the states, will monitor premium increases of health insurance coverages. On February 22, 2013 the Centers for Medicare & Medicaid (CMS) announced the final rule on rate reviews mandated by PPACA. HHS issued an amendment to the final rule making clear that coverages sold to individuals or small groups through an association are subject to rate review. PPACA rate reviews started September 1, 2011 with public disclosure and selective HHS reviews. WHAT: HHS will monitor rate increases across the markets. All rate increases must be reported with those that are 10 percent or higher subject to review. In subsequent years the threshold for review may be set on a Stateby-State basis using data that re ect insurance and health cost trends in each State. The final rule streamlines data collection for insurers and states and adds standards for assessing premium increases in Effective Rate Review Programs. A disclosure form explaining the proposed increases will also be made publicly available through HHS, State, and/or insurer websites.
t
t t t t t t t t t t t t t t t
t t
EXECUTIVE SUMMARY: HHS has established a process for the annual review of ‘‘unreasonable increases in premiums for health insurance coverage.’’ States with effective rate review systems must conduct reviews of proposed rates above the applicable threshold, but if a State lacks the resources or authority to conduct the required rate reviews, HHS will conduct them. An effective rate review system: To determine whether a State met the standards, HHS reviewed all available documentation, and met with State regulators and their staff to verify the information and obtain any updates. CMS can reevaluate the status in this list as changes are made in each State.
8
May/June 2013 I HealthCare Consumerism Solutions™ I www.TheIHCC.com
Must receive sufficient data and documentation concerning rate increases to conduct an examination of the reasonableness of the proposed increases. Must consider the factors below as they apply to the review: Medical cost trend changes by major service categories Changes in utilization of services (i.e., hospital care, pharmaceuticals, doctors office visits) by major service categories Cost-sharing changes by major service categories Changes in benefits Changes in enrollee risk profile Impact of over- or under-estimate of medical trend in previous years on the current rate Reserve needs Administrative costs related to programs that improve health care quality Other administrative costs Applicable taxes and licensing or regulatory fees Medical loss ratio (MLR); and The issuer’s capital and surplus. Must make a determination of the reasonableness of the rate increase under a standard set forth in State statute or regulation. Must post either rate filings under review or preliminary justifications on their websites or post a link to the preliminary justifications that appear on the CMS website. Must provide a mechanism for receiving public comments on proposed rate increases. Must report results of rate reviews to CMS for rate increases subject to review.
ACTIONS: Insurers will need to comply with the HHS data submittal and rate review process. Individual and small group employers should be aware of the additional information and reasons for any rate increases proposed for their plans. Ideally, the disclosure is intended to moderate and eliminate unnecessary rate increases (not supported by data and pooled claims experience). Employers should check with their insurance brokers, agents, consultants, and insurers to determine if plan rates are in compliance with HHS and State reviews.
HEALTHCARE CONSUMERISM SURVEYS, RESEARCH & STUDIES
Truven Health Analytics Study Finds Most ER Visits Made by Privately-Insured Patients Are Avoidable
Latest Hospital Safety Scores Show Incremental Progress in Patient Safety
attention in the emergency room or are preventable with proper out-patient care. The study, Avoidable Emergency Department
United States showed hospitals have made only incremental progress in
emergency room visits made by commercially insured individuals, patients required immediate attention in the emergency room.
National Survey Reveals U.S. Workforce Actively Forming Better Nutrition Habits
healthy nutrition habits, Keas also announced new content partnerships with My Healthy Dish and Noshtopia to bolster nutritional content and
New Employer Survey Finds Growing Use of OutcomesBased Incentives
or disincentives. There is also a growing interest in outcomes-based incentive strategies (i.e. reaching targeted biometric goals). The study was conducted by the Midwest Business Group on Health (MBGH), insured public and private employers.
HEALTHCARE CONSUMERISM NEWS BRIEFS
Obama Administration Releases Final Rules on Employment-based Wellness Programs
and health care institutions, based in Newton, Mass. This transaction
NBGH Honors 65 Employers With “Best Employers for Healthy Lifestyles” Awards wellness programs,” which generally are available without regard to an individual’s health status.
IRS Releases New HSA Limits for 2014 The Internal Revenue Service (IRS) has released Revenue Procedure awards spotlight those employers that have responded to the urgent (HSA) under Internal Revenue Code section 223. These deduction
CareHere Taps Benefitfocus for Health Data Analysis and Reporting Technology and reporting portal that allows CareHere to analyze, plan and monitor
WageWorks Acquires Crosby Benefit Systems to Further Its Leadership in Consumer-Directed Benefits CareHere centralizes abstract health data to help employers accurately
www.TheIHCC.com I HealthCare Consumerism Solutions™ I May/June 2013 9
HEALTHCARE CONSUMERISM INNOVATIONS
Keenan Launches Comprehensive Health Care Reform Website with Vital Information for Employers Keenan has launched a robust new website dedicated to providing school districts, public agencies and health care organizations. The
New Benefit Plan from PinnacleCare Guides Members through the Medical Maze in Times of Need employers and large organizations. It connects employees with top
Xerox Introduces BenefitWallet to Simplify Health Spending Account Administration guiding them through the medical maze and evidence-based treatment gives employers and health plans an easy way to manage multiple unnecessary health care procedures.
Mercer Launches Educational Tools to Help Employers & Employees Navigate Health Care System Mercer announced recently that it has launched two educational applications.
Transitions Optical Launches Revamped Vision Education Kit employees about the connection between eye and overall health, and
10 May/June 2013 I HealthCare Consumerism Solutions™ I www.TheIHCC.com
Making HealthCare Consumerism Work A Look Back at IHC FORUM East
Atlanta – Cobb Galleria Centre – May 9-10, 2013 Now in its fourth year, the Institute for HealthCare Consumerism’s FORUM East conference recently set record numbers of attendees, sponsors and exhibitors as the health care consumerism movement continues to achieve rapid industry growth and unprecedented interest from employer groups. The IHC FORUM is the only industry event exclusively dedicated to innovative health and benefits management. This year’s FORUM East featured 24 cutting-edge workshops and five general sessions that focused on the issues that matter most to employers today, including health reform, defined contribution, private exchanges, account-based plans, data analytics, wellness incentives and more. Workshops covered an array of pertinent topics including “HSAs: After 2014,” “Controlling Costs and Expanding Choice Using Defined Contribution Health Care,” “Five Chronic Wellness Program Problems and How to Beat Them,” “How to Deliver Year-Round Benefits Communication” and “Consumer Engagement: The Key to a Successful Exchange.” With the close of a successful FORUM East event, the industry now looks to deadlines for one of the most important open enrollments in the history of health benefits. And starting June 15, 2013, registration will open for the Institute’s fall event, IHC FORUM West, which will present up-to-date information on private/public exchange enrollment and key ACA regulatory deadlines. The IHC would like to thank all of our sponsors, exhibitors, speakers, moderators, partners and staff that helped make FORUM East 2013 a success.
www.TheIHCC.com I HealthCare Consumerism Solutions™ I May/June 2013 11
12 May/June 2013 I HealthCare Consumerism Solutions™ I www.TheIHCC.com
Couldn’t make it to FORUM East this year? Join us in Las Vegas For FORUM West 2013...
REGISTER TODAY AND SAVE FORUM WEST 2013
December 5-6
LAS VEGAS
Red Rock Casino Resort Spa
SUPER SAVER RATE OF $99 Until August 30, 2013
WWW.THEIHCCFORUM.COM
LEARN. CONNECT. SHARE. FieldMedia LLC is the parent company to HealthCare Consumerism Solutions magazine, EmployersWeb.com, IHC FORUM and The Institute for HealthCare Consumerism. 292 South Main St., Ste 400, Alpharetta, GA 30009
2013
www.theihccforum.com
5IF 0OMZ $POGFSFODF %FEJDBUFE UP *OOPWBUJWF )FBMUI BOE #FOFmU .BOBHFNFOU LEARN. CONNECT. SHARE. Whether you’re an HR professional, C-suite executive, consultant, broker, health plan, third party administrator or solution provider, the FORUM West experience includes workshops, general sessions and networking opportunities led by employers, Washington insiders, legal experts, and peers with thriving health care consumerism programs already in place to address your unique business needs and bottom line. Attendees will walk away from FORUM West with insights and solutions to the questions at the top of your minds including: t What are the 2013 enrollment stats on the usage of Exchanges with Defined Contribution offerings? t How is the adoption of full replacement HSA/High Deductible programs progressing? t What does the overall level of employee engagement in plan choices tell us, as an early indicator? t Is there a significant shift in focus toward wellness? t What can be learned from Employers as they budget for 2015? t How can you deal with last-minute compliance requirements related to Healthcare Reform? Plan to attend a day early for CEU-eligible pre-conference sessions on “Making HealthCare Consumerism Work: The Steps and Plan” or “The Institute for HealthCare Consumerism: Continuing Education Course for Brokers — HealthCare Consumerism in PPACA (includes updates on Health Care Reform Law) for Brokers, Advisors and Consultants.” Additional fees apply. Visit www.theihccforum.com for details.
/&8 "/% *.1307&% 130(3"..*/( The IHC listened to attendee feedback from FORUM East 2013 evaluations and our growing speaker demand — we’ve responded to both by adding a fourth Workshop Track and adjusting our workshop format. Starting with IHC FORUM West 2013, our workshop format will now mirror our mission statement: t LEARN collectively, think innovatively, and drive change cooperatively with actionable solutions. t CONNECT with forward-thinking experts and industry professionals on leading practices and successful strategies. t SHARE valuable insights and ideas, opinions and research, and more on the latest topics and current trends. Each of the four Workshop Tracks will now include: t Two LEARN sessions – for introducing innovative solutions (usually led by solution providers) t Two CONNECT sessions – for presenting industry strategies, best practices and case studies (usually led by users of the services or strategies being discussed) t Two SHARE sessions – for open discussions on current industry topics of interest (usually led by employers)
:PVS (VJEF UP .BLJOH )FBMUI$BSF $POTVNFSJTN 8PSL Our Opening General Session, “Making HealthCare Consumerism Work” led by Doug Field, 3PO #BDINBO BOE TFWFSBM MFBEJOH FNQMPZFS $&0 T XJMM FYBNJOF UIF OFYU TUFQT JO JNQMFNFOUJOH HealthCare Consumerism, now that the model has begun to gain wide-spread acceptance. What does it take to engage consumers in selecting high-value health care? Successful consumerism is not simply about who pays the bill; it is about a persistent search for better value. To be true consumers, we all need better information, more transparency, and permission to be in charge of our own care. Similarly, employers need to become actively involved as consumers of insurance plans, and how to design coverage that empowers its workers. In this session, learn about the ways consumers are changing the system, and where there is more work to do. Hear the latest results from employers using innovative approaches to motivate their employees to select safe, appropriately-priced services, procedures and hospitals. Specifically, attendees will hear: t 8BZT DPOTVNFST BSF BDUJWFMZ JOWPMWFE UPEBZ t 5IF FGGFDUT PG JOWPMWFNFOU PO DIPJDFT BOE DPTUT t 8IBU JOGPSNBUJPO DPOTVNFST TBZ UIFZ VTF UP NBLF DIPJDFT
FORUM WEST 2013
LAS VEGAS
Doug Field Founder and CEO, The Institute for HealthCare Consumerism Ron Bachman Chairman, Editorial Advisory Board, The Institute for HealthCare Consumerism
MAKING HEALTHCARE CONSUMERISM WORK Register Now and Save
:PVS SFHJTUSBUJPO QBDLBHF JODMVEFT
Don’t miss this opportunity to be at the forefront of the health and benefit management movement. Reserve your spot at FORUM West before August 30, 2013 for the BEST SUPER SAVER RATES.
t 'JWF HFOFSBM TFTTJPOT MFE CZ industry experts t :PVS DIPJDF PG GPVS IBOET PO workshop tracks t "QQSPYJNBUFMZ SFDFSUJmDBUJPO credit hours t #SFBLGBTU MVODI BOE BO PQFOJOH night reception t *OGPSNBUJPO QBDLFE DPOGFSFODF workbook t 0OMJOF BDDFTT UP BMM XPSLTIPQ presentations t " DIBODF UP XJO J1BET HJGU DBSET and more!
FORUM 8FTU t %FDFNCFS t 3FE 3PDL 3FTPSU t -BT 7FHBT No industry event offers you more for your money. Join The Institute for HealthCare Consumerism for free and save even more. Already an IHC member? Check your inbox for our weekly e-blast and save using your exclusive member discount code. Visit www.theihccforum.com for details.
REGISTRATION RATES FOR FORUM EAST – MAY 9-10, 2013 Attendee Type Government & Non-Profit Employer: Benefits/HR/Wellness Executives/CEO’s Brokers, Advisors, Consultants TPAs, Health Plans Solution Providers Pre-Conference
(ends 8/30/13)
Super Saver
Early Bird Rates (ends 10/31/13)
Standard Rates (ends 11/30/13)
(Starts Dec. 1)
Onsite Rates
$99
$295
$395
$595
$99 $99 $99 $595 $79
$395 $395 $395 $895 $99
$495 $495 $495 $995 $129
$795 $795 $795 $1195 $159
#&"65*'6- 3&% 30$, $"4*/0 3&4035 41" t +645 " '&8 .*-&4 '30. %08/508/ -"4 7&("4
Please Note: Rates above do not include member discount.
Top 10 Reasons to Attend FORUM West 2013 Don’t gamble with your company’s health and benefit budget. Here are just a few reasons to join us in Las Vegas:
1. 2. 3. 4. 5.
Find out, in real-time, what impact Exchanges are having during their initial open enrollment. Get the strategy and any trend forecasting information you may need to complete your 2015 budget planning this December. Gauge how prepared you are for complying with the new Health Care Reform laws, versus other companies. Participate in an unprecedented opportunity to network with professionals from across the health care consumerism spectrum—from HR professionals and c-suite executives to brokers and solution providers — and gain real-time feedback from several perspectives on recent 2014 Open Enrollment challenges and how DC/Exchanges have affected results. Learn about the latest, actionable solutions from peers who have successfully implemented health care consumerism initiatives, as you consider your budget for the upcoming year.
6. 7. 8. 9. 10.
Get the most recent updates to the Affordable Care Act, understand the requirements which impact your organization, and formulate a strategy for what your company should do next. Attend five cutting-edge general sessions and choose from 24 subject matter specific workshops to help you design and implement the best possible health plan for your business and your employees. In response to your FORUM East 2013 feedback, we have restructured our FORUM West 2013 programming so attendees can attend more workshops. Investigate an exhibit hall packed with industry-leading solutions, and spend time visiting with exhibitors eager to showcase the latest equipment and technology. Connect with industry professionals who know the skinny on corporate wellness, employee engagement, incentive programs, HSAs, HRAs, supplemental health and more. Share in the open discussions with the country’s leading health care consumerism thinkers and policy makers.
Produced by The Institute for HealthCare Consumerism
Visit www.theihccforum.com to preview the agenda and register for the conference.
NOMINATE & RECOGNIZE INNOVATIVE HEALTH & BENEFITS MANAGERS
3
HealthCare Consumerism Solutions Magazine
Do you know someone who goes the extra mile as a creative problem solver and innovator?
solutions to complex issues. Superstars will be published December 2013 in our annual issue and will be accessible to more than 70,000 readers.
Nominate a Superstar Today! ■
John J. Robbins Sr., Memorial CEO Leadership Award: To
■
munity. CEO Leadership Award organization, who embraces supports and endorsed an innovative
■
Most Innovative Plan Design Award
■
Most Effective Plan Implementation Award: To an HR/Ben-
■
Most Innovative Employee Empowerment Award: To an employer, who designed and implemented tools that had a high
-
■
-
program and exceeded goals or reaped unanticipated awards. Most Innovative Employee Education/Communication Award: their employees that exceeded plan participation.
■
program. Most Effective Population Health & Wellness Award: To an employer who uses the most innovative method to reduce absenteeism and chronic disease costs to improve overall employee health. Public Policy Leadership Award: An individual who encourages health care consumerism in public policy through legislation. Most Effective Solution Provider Award: To a solution provider
■
Most Innovative Partner-Consultant Award: To a consultant
■
■
■ Most Innovative Broker Award:
NOMINATION CATEGORIES:
For details, please visit www.theihcc.com. Nominations close October 1, 2013. E-mail your Superstar nomination to nominations@fieldmedia.com or nominate online.
-
ISSUE || May/June 2013
Exchange
The Next Frontier Defined Contribution & Health Care Consumerism The Current Acceleration of Change and Innovation in Health Care Potential Legal Issues with Private Exchanges Exchange Profile: Willis Advantage
www.theihcc.com
INSIDE
FEATURES 11 Defined Contribution: The Next Frontier of Health Care Consumerism With the acquisition of Workable Solutions, Alegeus created its innovative WealthCare Marketplace, believing exchanges to be the next evolution of the health care consumerism movement. Alegeus CEO Tom Torre covers the basics of defined contribution and how their exchange platform works with their existing CDHC business. By Tom Torre, CEO Alegeus Technologies
DEPARTMENTS 4
Publisher’s Letter
exchanges from a benefits broker and attorney specializing in insurance regulation
CEO Doug Field covers the latest in the private exchange and defined contribution industry and what’s happening at the Institute around exchanges
7
News Briefs & Innovations Keeping you up-to-date with the latest news, research and innovations in defined contribution and health insurance exchanges
8
Regulatory & Compliance: Potential Legal Issues Around Private Exchanges An update of potential state and federal legal issues for private
By Elena Merino, President/CEO, The Meridian Group & Trey Sivley, Associate, Locke Lord LLP
9
Exchange Profile: Willis Advantage With the announcement of their entrance to the private exchange game, Willis covers what employers, brokers, consultants and other industry stakeholders need to know about the Willis Advantage.
By Rob Harkins, VP of Private Exchanges, National Human Capital Practice, Willis Group
10 Tech Innovation: The Current Acceleration of Innovation in Health Care Shandon covers the technological fundamentals that will be essential for the continued success of any health insurance marketplace, including data analytics, decision support tools, cloud-based SaaS platforms and a consumer-centric experience. By Shandon Fowler, Director of Product Management, Marketplaces, Bene tfocus
15 Exchange Solutions Showcase
www.TheIHCC.com I HealthCare Exchange Solutions™ I May/June 2013 3
PUBLISHER Exchange www.theihcc.com VOLUME 1 NO. 2 | MAY/JUNE 2013
Published by FieldMedia LLC 292 South Main Street, Suite 400 Alpharetta, GA 30009 Fax: 770.663.4409 CEO
Doug Field @ theihcc.com MANAGING DIRECTOR
Brent Macy
In less than four months, the rubber will meet the road in regards to the execution of defined contribution plan and the performance of both public and private exchanges. Yet
MANAGING EDITOR
Jonathan Field
there remain many questions: will public exchanges even be ready? If so, how will they work?
ASSOCIATE EDITOR
Kelvin Hosken
The goal of HealthCare Exchange Solutions and its related properties — including the
ACCOUNT MANAGERS
Exchange Solutions e-newsletter and web community — is to provide you with answers to
Joni Lipson
your most pressing questions and help you find the right solution for your company or your
Rogers Beasley
clients and their employees. ART DIRECTOR
Kellie Frissell
In this second issue, we have a number of articles that work toward that goal, including the cover feature “Defined Contribution: The Next Frontier of HealthCare Consumerism” by Alegeus Technologies CEO Tom Torre. Alegeus, a market leader in consumer-directed health care solutions, recently announced its acquisition of Workable Solutions, a leading provider of private exchange technology.
ASSOCIATE DIRECTOR OF EDUCATION SERVICES AND PROGRAMS
Dusty Rhodes CHAIRMAN OF IHC ADVISORY BOARD
Ronald E. Bachman, CEO, Healthcare Visions EDITORIAL ADVISORY BOARD
The acquisition has allowed Alegeus to launch its integrated private exchange and defined contribution platform called WealthCare Marketplace. Torre discusses the reasons behind the acquisition and his beliefs about where benefit solutions are heading in the near future.
Kim Adler, Allstate; Diana Andersen, Zions Bancorporation; Bill Bennett; Doug Bulleit, DCS Health; Jon Comola, Wye River
HSA Rewards; Roy Ramthun, HSA Consulting Services LLC; John Young, CIGNA
We are also proud to feature Shandon Fowler, Director of Marketplaces, Benefitfocus,
WEBMASTERS
covering the necessary technological innovations that must drive change in health care.
Kevin Carnegie
Rob Harkins, VP of Private Exchanges, Willis Group, reveals the details of their newly
Tom Becher
launched private exchange, Willis Advantage. And Elena Merino and Trey Sivley look at potential legal issues around private exchanges on the state and federal levels.
DIRECTOR OF CONFERENCE SPONSORSHIP/ CORPORATE MEMBERSHIP/REPRINTS
Rogers Beasley
Sincerely,
BUSINESS MANAGER
Karen Raudabaugh
™ Volume 1 Issue 2 Copyright ©2013 by FieldMedia LLC. All rights reserved.
™
Doug Field CEO/Publisher dfield@fieldmedia.com
is published eight times yearly by FieldMedia LLC., 292 South Main Street, Suite 400, Alpharetta, GA 30009. Periodical postage ™
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PRIVATE EXCHANGES Employers Interested, Need Guidance On Integrating Insurance Exchanges InsureXSolutions recently announced the results of a poll conducted among employers and producers on public and private health insurance exchanges. Results showed that nearly 50 percent of responding employers believe that exchanges are going to be very or somewhat useful to their organizations, despite less than a onethird indicating that they have a good understanding of exchanges. On the other hand, two-thirds of health insurance producers and consultants that responded had a good understanding of exchanges. Nearly 100 percent of producers indicated that they plan on integrating them into their sales portfolio.
Alegeus Technologies Acquires Workable Solutions And Introduces Integrated Private Exchange Solution Alegeus Technologies, the market leader in health care and benefit payments, recently announced its acquisition of Workable Solutions, a leading provider of private health insurance exchange technology solutions, to fuel the launch of its integrated private exchange and defined contribution platform — which will be called WealthCare Marketplace. The new solution supports a market shift in how health benefits will be delivered, and offers distinct value for Alegeus clients — creating new opportunities for revenue expansion, cost savings and efficiency gains.
More Carriers to Provide Bene ts via Mercer Marketplace Private Exchange Mercer announced that several nationally known providers of dental, vision, life, disability, and other benefits have signed on to offer coverage through Mercer’s comprehensive benefits exchange for active employees and their families, Mercer Marketplace. Employers that make Mercer Marketplace available to their employees for the 2014 plan year will be able to offer a wide range of benefits in addition to medical coverage. The following insurers have agreed to partner with Mercer: Allstate Benefits, Delta Dental, EyeMed Vision Care, ING U.S., MetLife, Prudential Group Insurance, The Hartford, Unum and VSP® Vision Care.
CieloStar Adds Two to Executive Management Team CieloStar has added two senior executives to its management team. Paul Boemer has joined CieloStar as executive vice president, emerging markets and provider solutions and Frederic D. Thierbach has been named vice president of sales for the company. Boemer has over 25 years of payment solution experience in health care, banking prepaid, consumer, commercial and government markets. Thierbach is an accomplished technology, product management, marketing and sales executive with over 32 years of experience in the employee benefits and health plan administration markets.
Leading Health Insurers to Provide Health Plans on New Towers Watson Private Exchange
active employees: Aetna, Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Georgia, Empire Blue Cross Blue Shield, Kaiser Permanente and UnitedHealthcare. The offering is part of Towers Watson’s OneExchange, which delivers proven, end-to-end and seamlessly integrated exchange solutions for all employee and retiree populations. OneExchange’s active employee exchange solution will enroll participants this fall for Jan. 1, 2014 health plan start dates.
Bene tfocus Announces New Edition of Private Exchange Marketplace and Mobile Technology Benefitfocus recently revealed its latest benefits marketplace solutions and mobile apps including a new private exchange offering, BENEFITFOCUS HR INTOUCH MARKETPLACE® 2014 Edition. These new tools will be available for employers and insurance carriers as they prepare for the impacts of the Patient Protection and Affordable Care Act (PPACA) and rise in health care consumerism.
ConnectedHealth Expands Team, Company Growing Quickly in Evolving Marketplace ConnectedHealth, provider of a revolutionary health insurance exchange and decision-support platform for employers, health plans and consumers, is proud to announce and welcome David Shevock as its new Senior Vice President. Shevock will play a vital role, leading the development and operational teams that define the vision, technical architecture and roadmap for the company’s products.
Crawford Advisors Announces Private Exchange Partnership with bswift Crawford Advisors, LLC, a nationally recognized employee benefits firm, announced that they have selected bswift, a leader in software and services for employee benefits administration, to provide the exchange technology platform for Crawford Advisors’ private exchange. By providing choices to best meet the individual needs in a diverse workforce, Crawford Advisors’ exchange will reinforce the firm’s dedication to providing its clients with reduced health care costs, improved productivity, increased employee understanding and greater recruiting ability.
InsureXSolutions Private Exchange Adds Dental Bene t Plans from Aetna, Assurant and Delta Dental InsureXSolutions® has announced that dental plans from Aetna, Assurant, Inc. and Delta Dental have been added to their private insurance exchange. The dental products from these leading insurance companies offer a variety of price and benefit options for employees shopping in the online insurance marketplace. The InsureXSolutions private exchange features individual health, dental, Medicare, short-term and vision insurance plans in select markets throughout the U.S. InsureXSolutions offers businesses a viable option to the increasing cost of health care through the use of a defined contribution benefits strategy.
Towers Watson announced the first group of health insurers to agree to offer health plans on Towers Watson’s new private exchange for
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REGULATIONS & COMPLIANCE
BY ELENA MERINO » PRESIDENT/CEO » THE MERIDIAN GROUP AND TREY SIVLEY » ASSOCIATE » LOCKE LORD LLP
Private Exchanges: Regulatory Morass or Panacea?
I
f the consensus is affirmed, then private exchanges are the panacea to expanding plan options while relieving employers of administrative and regulatory burdens. Private exchanges are not new concepts, but with at least 56 percent of employers interested enough to consider a private exchange, private exchanges are experiencing a renaissance in the wake of the Affordable Care Act (ACA). Simply stated, a private exchange is where employees shop for health plans and pay for them from a defined contribution funded with either employer money or employee monies. Unlike the small employer health option exchange (SHOP) created under the ACA, a private exchange can be open to any size employer and can include benefits other than comprehensive qualified health plans, including ancillary benefits such as life, disability, critical illness, etc.
POTENTIAL LEGAL ISSUES FOR PRIVATE EXCHANGE Federal Law A private exchange may run afoul of antitrust laws or the Health Insurance Portability and Accountability Act (HIPPA), or be subject to the laws governing multiple employer benefit arrangements (MEWA).1 A private exchange is basically a collective of buyers that retrains trade insofar as it’s designed to purchase (or arrange for the purchase) of insurance, which can constitute a monopsony (i.e. buyer domination) or illegal pricing restraints. It is worth noting that exchanges that are organized and regulated under a specific state law may avoid federal antitrust law. For example, most states, including Georgia,2 adopted a version of the private health care voluntary purchasing alliance model act proposed by the National Association of Insurance Commissioners (NAIC).3 A private exchange will be authorized to handle private health information of individuals and will likely be subject HIPPA privacy rules, and depending on how it is organized, a private exchange may be MEWA.
State Law A private exchange may need to work though licensed agents, brokers, or consultants4, and the private exchange itself may be required to obtain licensure as a third-party administrator.5 Additionally, the private exchange will be subject to market conduct scrutiny by state insurance regulators. Finally, most states have unfair trade practices acts6 which include provisions that are analogous federal antitrust laws.7 In the case of Georgia, the unfair trade practices act was used to prohibit certain contractual 8
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provisions between insurers and health care providers.8
THE PRIVATE EXCHANGE — ADMINISTRATOR OR SOMETHING ELSE Generally, the plan administrator will be named in the plan document, and in the absence of administrator being named, the administrator will be the plan sponsor (generally the employer).9 A private exchange that restricts its activities to those that do not involve exercising discretion or control over the plan may avoid being deemed an administrator. Nevertheless, the determination of the “administrator” and “fiduciary” roles under ERISA can be complex, particularly given the novelty of many of the issues arising in the context of private exchanges. Given this circumstance, it is advisable to consult with legal counsel with both strong ERISA and state insurance law background prior to entering into an arrangement with a private exchange.
IS STATE REGULATION DESIRABLE? The absence of specific regulations or standards to govern private exchanges means that private exchanges can differ considerably, which is good for innovation. Unfortunately, lack of regulation opens the door for less than reputable actors which can result in reactionary overregulation and unwarranted scrutiny. Association groupings, professional employer organizations, and MEWA failures provide an object lesson in this regard. There is ample precedent for insurance and insurance-related industries working with NAIC and the National Conference of Insurance Legislators (NCOIL) to promulgate national regulations and standards, and doing so without a crisis, real or perceived, almost always yields a better regulatory result. ___________________________________________________________ 1 Health Insurance Exchanges: Legal Issues
PRIVATE EXCHANGE PROFILE
Willis Advantage Combines Robust Private Exchange Capabilities With Focus on Rewarding Healthy Lifestyles and Consulting Expertise BY ROB HARKINS » VP OF PRIVATE EXCHANGES » NATIONAL HUMAN CAPITAL PRACTICE, WILLIS GROUP
Employee benefit plans have come a long way in the past few years. The days when an employer selected one or two health plans, a few other benefits and paid a fixed percentage of the costs for participants is coming into question. More recently, defined contribution programs have gained increasing interest from employers and employees alike. The defined contribution approach is made more appealing when coupled with a private exchange. Yet for all of the publicity and initial success of private exchanges, the underlying cost of health care and the unsustainability of rising health care costs are not adequately addressed in this new environment. The Willis Advantage provides a private exchange solution that marries population health management with a proven strategy to increase member focus on health improvement. Further, The Willis Advantage allows an employer to incent member health improvement. These components provide for all of the advantages and benefits of a private exchange for employers and their members, while more thoroughly addressing the underlying cost drivers of health care. The result? A sustainable, long-term solution that provides increased participant choice and employer cost predictability. However, The Willis Advantage is not a one-size-fits-all solution. Rather, the Willis Advantage is a private exchange that offers a continuum of benefit solutions and wellness engagement levels. Finding the right combination for an employer’s organization of benefits, incentives and participant engagement in healthy behavior is achieved through the comprehensive consultative process of our Human Capital Practice Consultants. We start with a consultative process to determine an employer’s approach to health care, wellness and a total benefits approach. Based on this collaboration, we develop a multi-year strategy to incrementally improve the health of an employer’s population.
Working with the employer, Willis also designs a private exchange suite of benefits, partnering with insurance and service providers that best meet the unique needs of each employer. Of course, we also help to design a health outcomes solution that will most effectively improve the health of their population.
The Willis Advantage: Taking Consumerism to the Next Level The Willis Advantage exchange platform analyzes employees’ health care preferences, utilization, financial position and risk tolerance, and recommends a customized benefits solution. The platform includes educational tools to help employees understand their options. In addition, The Willis Advantage proactively engages employees to become better health care consumers and lead healthier lives by combining the exchange platform with innovative health management programs. The insurance exchange environment is moving quickly. We place our clients’ interests first so they can always be confident that their Willis consultants are prepared to assist them in evaluating all viable exchange options.
The result? A sustainable, long term solution that provides increased participant choice and employer cost predictability. www.TheIHCC.com I HealthCare Exchange Solutions™ I May/June 2013
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TECH INNOVATION BY SHANDON FOWLER DIRECTOR OF PRODUCT MANAGEMENT, MARKETPLACES BENEFITFOCUS
The Current Acceleration of Change and Innovation in Health Care
T
he Supreme Court’s decision to uphold the key tenets of the Affordable Care Act (ACA) has disrupted the American way of providing health coverage and care to its citizens. But what does that disruption mean? And which way will it lead us? Still early into one of the most profound moments of change in the history of the industry, consumers, providers and insurers alike are anxious to see what the future of health care holds. Luckily, there is plenty of room for optimism, even with the uncertainty that this year’s open enrollment promises as key provisions of the Affordable Care Act (ACA) kick in for individuals, employers and health insurance providers. Necessity is the mother of invention and new technologies are driving innovation throughout the industry at a record pace. For the rise in health care consumerism, that innovation has concentrated itself into the concept of purchasing coverage through private exchange marketplaces. For years, consumers have reaped the rewards of the socio-technological transformation brought on by the Internet and the constant connected world it creates. Amazon changed our attitude toward online shopping. A legion of travel websites convinced us that we could make our own travel arrangements while saving money for ourselves and the industry. Now, with pressures coming from all sides, it’s time for those innovations to take hold in health care benefits. For health insurance carriers, private exchange marketplaces represent an alternative to public marketplaces, allowing them to offer more flexibility, decision support and a diverse set of product offerings. For employers, private exchange marketplaces represent a combined ability to offer a more comprehensive benefits package in one place online for their employees while also providing streamlined, efficient administration for their HR administrators. And for consumers, whether they receive benefits through an employee or shop for benefits on their own, private exchange marketplaces represent the promise of health care consumerism, offering shoppers more transparency into health care costs, more choice and personalization in benefits and better tools to take charge of it all. We’re still early in the evolution of private exchange marketplaces 10
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and the great diversity of offerings, but the technological fundamentals that will lead to success remain consistent from marketplace to marketplace. Cloud-Based, Software as a Service Platforms. In addition to meeting the evolving needs of consumers, marketplaces need the flexibility to address changing regulations and requirements, many of which still haven’t been finalized! Data Analytics and Reporting. With the financial and regulatory pressures bearing down, it’s more important than ever to “measure twice and cut once”. Big data and the groundbreaking new tools being developed to manage it will lead employers and consumers alike into a future that we can more readily predict and control. Consumer-Centric Experiences and Support Tools. Perhaps the greatest shortcoming of many existing benefit administration systems is that they address administrative needs without equally addressing consumer needs. New tools are providing the greatest hope of optimism for the future. Decision support tools can harness big data to help consumers better understand their choices so they can make the right ones. Measurement tools help administrators refine and update far more rapidly to meet employee/consumer needs. The systems feed on themselves, which drives efficiencies that save everyone money and, naturally, making us all happier! Reliable, Secure and Compliant Infrastructure. We can argue about the impact that the ACA has had and will have on health care consumerism, but we can’t argue that compliance is at the forefront. Technology needs to be the driver of security and should facilitate managing health care to remain compliant. Thankfully, new platforms can remove much of that burden from HR administrators so that they can focus on making employees happy. With an emphasis on innovation in these areas, a picture is emerging for what the future will look like. That picture includes private marketplaces of all kinds — marketplaces that focus on the consumer by also addressing the challenges of employers and their HR administrators. The one certainty is that, in a generation, the uniquely American benefits and health care system will look nothing like it looks today. By focusing on technology and innovation, we can assure that it looks great for all of us.
Defined Contribution: The Next Frontier of Health Care Consumerism BY TOM TORRE » CHIEF EXECUTIVE OFFICER » ALEGEUS TECHNOLOGIES
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Defined Contribution in the News The significance of this market shift toward defined contribution was underscored last month when Alegeus Technologies, the market leader in consumer-directed health care solutions, announced its acquisition of Workable Solutions, a leading provider of private exchange technology. The Workable acquisition allows Alegeus to fuel the launch of its integrated private exchange and defined contribution platform called WealthCare Marketplace. The new solution allows Alegeus clients to capitalize on the market shift toward defined contribution — creating new opportunities for revenue expansion, cost savings and efficiency gains. This acquisition also reinforces Alegeus’ commitment to delivering industry-leading benefit solutions to help clients succeed as the market evolves. “We identified and met a market need in order to stay at the forefront of the industry and deliver the most complete solution to our clients,” said Bob Natt, Alegeus Executive Chairman. “The transaction with Workable Solutions delivers distinct value for our clients and stakeholders, and we’re excited for the continued growth it will bring to our business.” To fully understand the rationale for this acquisition, it’s best to start at the beginning. This article will provide a primer on the defined contribution market opportunity — including the changes private exchanges bring to the industry, the value it delivers for each stakeholder, and the importance of having the right solution to ensure success.
more choices to select the plan that is right for them versus a limited amount of options.
The Next Frontier of Consumer-Directed Health Care This movement toward defined contribution and private exchanges represents the next frontier in the health care consumerism movement — continuing to shift more responsibility for health care to the individual. Adoption of high-deductible health plans and related taxadvantaged benefit accounts (such as FSAs, HSAs, HRAs) has grown exponentially over recent years. These plans are designed to lower costs by shifting more financial responsibility to the consumer and increasing engagement in health care decision-making. Defined contribution takes the shift a step further by also giving individuals greater choice and greater responsibility for selecting and funding the plan design that is right for them. In fact, faced with a wider array of benefit choices, greater cost
Defined Contribution — Explained The defined contribution concept for health care benefits shares similar principles to the shift to defined contribution retirement benefits — from pension to 401(k). In a traditional defined benefit model, the employer bears the majority of the responsibility by selecting a few plan options and subsidizing the costs — often controlling costs by adjusting aspects of plan design such as deductibles and limitations on networks. In the defined contribution model, the employer designates a specific monetary amount toward their employee’s health benefits and the employee chooses how that money is spent from an array of plan options with ranging premiums and deductibles. Defined contribution benefit models will be enabled through private health insurance exchanges. An exchange is a web-based platform that consumers and employees use to evaluate plan options and enroll in plans/accounts (similar to how one might evaluate travel options through Expedia or Orbitz). Beyond plan selection and enrollment, exchanges also facilitate premium aggregation, billing, collection, reconciliation and other underlying financial and operational support processes. Defined contribution is an attractive option for employers and employees alike. Employers benefit from more predictable health costs, while ensuring higher employee satisfaction and talent retention through more competitive health benefit packages. Employees benefit from
transparency and more financial accountability for plan selection, a greater percentage of consumers will choose high-deductible plan types. Enrollment data from the Alegeus exchange platform supports this fact — with 63 percent of employees choosing a different plan design than they had the year before, with 51 percent making a significant change to a new plan type. Alegeus also believes that private exchanges will serve as a natural distribution channel for CDHC accounts — which further demonstrates why this acquisition is in perfect alignment with the core Alegeus CDHC business. Defined contribution and private exchanges are the next logical step for Alegeus, in order to continue to grow our existing CDHC business. Our new exchange platform will facilitate the next era of consumer-directed health care and benefit programs.
Private Exchange Myths – Debunked Although closely related, exchanges and defined contribution are not interchangeable terms — one enables the other. The employersponsored insurance market is moving toward private health insurance www.TheIHCC.com I HealthCare Exchange Solutions™ I May/June 2013
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exchanges in order to adopt this new defined contribution health benefit model. Public exchanges will also play a role in distribution of insurance moving forward — but most likely for the unemployed, uninsured “retail” market and those that are eligible for government subsidies. Consumers themselves will ultimately determine which distribution channel best meets their needs to acquire insurance coverage. Despite some popular misconceptions, exchanges can be quite flexible and accommodate multiple operational models. Exchanges can support both group and individual plans. They can support both large and small group employers. Exchanges can be linked to one or more carriers, and can include health benefits as well as other supplemental benefit options. Multi-carrier exchanges include multiple plan types through multiple carriers (Cigna, Aetna, etc.). Whereas, single-carrier exchanges, sometimes referred to as “walled-off” exchanges, offer multiple plan types through one single carrier. As the market shifts toward exchanges, employers will be faced with an interesting dilemma about how much involvement they want in defining and administering health benefits — but they need not fear losing control of their benefit offerings. Traditionally, employers have had deep involvement in selecting and designing group insurance policies for their employees. In this new world of exchanges, employers could theoretically choose to have no involvement in plan design/choice and provide no employee support beyond the monetary contribution — effectively driving a shift toward more of a retail model with individual insurance policies. The majority of employers will likely end up somewhere in the middle — continuing to offer health benefits to attract and retain talent, while controlling cost by dialing up or down the contribution levels. With the right exchange solution in place, employers can maintain as much or as little control/involvement as they desire. Exchanges don’t just benefit employers and employees — carriers benefit too. Exchanges make it easier for carriers to acquire and maintain subscribers, therefore reducing administrative overhead. And, by integrating with the carrier’s existing IT specifications, an effective exchange solution can further streamline carrier resources required to enter the marketplace.
The Anatomy of an Exchange Solution The benefits derived from a defined contribution model rely on the successful operation of private exchanges. There are several critical components of a complete, end-to-end exchange solution: t Plan selection/recommendation engine – collects personal data and integrates analytics and cost comparison tools to make consumerspecific plan recommendations t Online enrollment – enables combined benefit enrollment based on eligibility and risk adjustment and determines appropriate payroll deductions based on individual choices and contribution amounts t Eligibility maintenance – provides ongoing access to manage life events and changes , interfaces with appropriate carriers and systems to allow centralized profile management t Billing and payment – facilitates fund settlement between individuals, employers and carriers, performing premium billing, aggregation, reconciliation and contribution account administration t Underlying operational support (ex. call center, system of record) 14
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Not All Exchange Solutions Are Created Equal Many exchange solution providers have opted to focus heavily on the front-end consumer experience, at the expense of the back end. While the consumer experience must be intuitive and easy to use, the back-end functionality is equally critical, if not more so. If the exchange doesn’t also support the underlying customer service, funds movement and operational processes — then the solution is incomplete and the model doesn’t work in reality. For example, the exchange must function as a year-round tool for managing qualifying life event changes, not just an open enrollment solution. It must be the central warehouse for all benefits-related processes and information. It must deliver on-demand education in an easy-to-understand format. It must manage the money movement associated with premium aggregation, billing, collection and reconciliation. Without all of these foundational elements in place, the house cannot stand. “Working in the exchange business for over a decade, we have supported some of the industries longest running exchanges,” said Terry McCorvie, President of WealthCare Marketplace Solutions at Alegeus (and former founder and CEO of Workable Solutions). “As such, we understand the complexity of exchanges and the importance of having the proper back end to support this new model of care seamlessly. Without the back end, the solution is little more than a selection tool.”
Alegeus Answers the Call The new Alegeus private exchange solution is among the most comprehensive, end-to-end exchange platforms available in the market. The solution combines a powerful recommendation engine to facilitate benefit selection based on personal data input, an enrollment tool to capture elections and payroll deductions for all benefit options, robust payment settlement features to enable premium aggregation, billing, collection and reconciliation, and a maintenance interface to facilitate life event updates. Through integration with carriers, payroll systems, and benefit account platforms (including the Alegeus CDHC platform), the solution enables combined benefit enrollment, consolidated premium billing/payments, and centralized member account maintenance — all online, through one single interface and workflow. As the health reform takes full effect, we will see continuous changes within the industry; however, the shift toward health care consumerism is here to stay. Defined contribution and private exchanges are gaining momentum in the marketplace. With employer adoption expected to grow exponentially in coming years, industry intermediaries, such as health plans, third party administrators, brokers and other third party operators (who are already engaged in offering benefit-related services to the employer market), are scrambling to offer enabling solutions and services to capitalize on expected demand. Solution providers like Alegeus are answering the call – delivering a comprehensive solution to enable these intermediaries to differentiate and compete in a rapidly changing marketplace.
EXCHANGE SOLUTIONS SHOWCASE
HSA/HRA/FSA TECHNOLOGY: ADMINISTRATION & MANAGEMENT
TSYS HEALTHCARE TSYS Healthcare® provides end-toend strategic payment solutions for 706.649.5080 consumer directed healthcare. We www.tsys.com/healthcare partner with benefits administrators, healthcare@tsys.com financial institutions, health plans, and software providers to navigate all aspects of HSAs, HRAs, FSAs, transportation accounts, cash reimbursements, and lines of credit. TSYS Healthcare cards offer participants the security they expect along with the ability to conveniently access funds from multiple accounts and manage their benefits payments with simplified single-card access. Clients and partners benefit from simplified processes, reduced paperwork and cost savings that can contribute to improved return on investment. “We built the TSYS Healthcare platform to meet the market demand for reliable, configurable and intelligent solutions. Understanding the dynamic U.S. healthcare market, our customers rely on our option-driven system to prepare them for the future.” — Trey Jinks, Group Executive, TSYS Healthcare HSA / HRA / FSA ADMINISTRATION AND FINANCE
WageWorks helps employers
WAGEWORKS
support consumer directed
1100 Park Place, 4th Floor San Mateo, California 94403 United States of America
pre-tax benefit programs, including health care (FSA, HSA, HRA), wellness
888-9905099 www.wageworks.com
programs, commuting and child and elder care. Wage Works also offers retiree health care and COBRA Services. More than 100 of America’s Fortune 500 employers and millions of their employees use WageWorks.
BENEFIT ADMINISTRATION/PRIVATE EXCHANGES
Since 1988, CieloStar (formerly OutsourceOne) CIELOSTAR has helped brokers, employers and employees 530 U.S. Trust Building navigate the ever-changing world of benefits. 730 Second Avenue South Now, with the dawn of “Defined Contribution Minneapolis, MN 55402 Health Care” we are again on the leading edge. With a team of industry thought leaders, CieloStar 612.436.2706 makes navigating healthand benefits choices john.reynolds@cielostar.com easy for employers and employees by offering comprehensive benefits administration solutions with a high-touch, high technology model—most recently launching a proprietary private health insurance exchange.
“Fueled by the far-reaching impact and complexities of health care reform taking effect in 2013 and 2014, employers and employees increasingly find themselves in a ‘farmer’s market’ of benefits choices. Cielostar is uniquely positioned with enabling technology that helps purchasers and consumers make the best possible decisions and create a best-in-class benefits administration process. Our unique comprehensive approach to benefits offers everything from back room technology for enrollment, data, billing and call centers to complete solutions for COBRA, CDHP and health insurance exchanges.” — John Reynolds, CEO, Cielostar HSA / HRA / FSA ADMINISTRATION AND FINANCE
Evolution1 and our Partners serve more EVOLUTION1, INC. than 9 million consumers, making us 952.908.9056 the nation’s largest electronic payment, www.evolution1.com on-premise and cloud computing sales@evolution1.com healthcare solution that administers reimbursement accounts, including HSAs, HRAs, FSAs, VEBAs, Wellness and Transit Plans. It is the only solution that offers a single end-to-end user experience, provides innovative auto-substantiation technologies, and automates workflow for Partners, employers, and consumers. It does all this on one technology platform comprised of 1Cloud™, 1Direct™, 1Pay™, 1View™, 1Plan™, and 1Mobile™. Evolution1 and our Partners are dedicated to delivering value, reducing costs and simplifying the business of healthcare.
“The combination of our innovative products will further our leadership position in a rapidly changing healthcare market. Together with our Partners we are committed to reducing costs and simplifying the business of healthcare.” — Jeff Young Chairman and CEO, Evolution1
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HealthCare Consumerism: Helping Employers Move to a Partnering Approach FREE LIVE WEBINAR
5VFTEBZ +VOF t o 1. &5
In the move towards a Partnering Approach vs. a Parenting Approach, employers partner with their employees and offer true choice rather than dictate plans and carriers in a limited fashion. This webinar presented by a top broker, Brad Davis who represents Aflac, will provide insights and solutions that will make this process easier for everyone involved. Through this webinar you will learn: t
How Defined Contributions and “exchanges� are interconnected
t
The advantages of this model to employers related to controlling costs and the employee experience
t
The advantage of this model from the employee perspective and what employee feedback has been
t
The tools and strategies employers need to take in order to properly navigate employees through open enrollment
Brad is a Certified Employee Benefits Specialist (CEBS) at Wraith, Scarlett, and Randolph Insurance Services in Woodland, CA. He offers a wide range of skills as a tactician, economist, and educator for health, dental, vision, life, disability, and voluntary worksite insurance. Brad also advises clients in the area of retirement products including 401(k), Medicare, and long-term care. Education is vital to the success of an Employee Benefits package. Brad is able to communicate complex insurance strategies on a detailed yet simplified and personal level to both employers and employees. By offering choice and understanding, employees will appreciate their benefits package exponentially more and allow employers to recruit and retain effectively.
t
What employees need to learn about Voluntary Benefits and how to approach educating them about the importance of this kind of coverage
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How the right technology can make or break the enrollment and benefit management process for employers and employees, and the benefits of the right technologies for your company size
t
Aflac Case Studies: Company A (white collar employees), Company B (blue collar employees)
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Sign up for this FREE Live Webinar at www.theihcc.com/webinars/aflac
Brad Davis
Certified Employee Benefits Specialist (CEBS) Wraith, Scarlett, and Randolph Insurance Services Incoming President Sacramento chapter, National Association of Health Underwriters (NAHU)
Date: Tuesday, June 25, 2013 Time: 2:00 p.m. ET Info: webinars@theihcc.com Live & On-Demand: www.theihcc.com/webinars/aflac
To learn more, check out the Institute for Healthcare Consumerism’s website at www.theihcc.com
BY RENE CHAPIN DIRECTOR OF MEMBERSHIP & COMMUNICATIONS NATIONAL ASSOCIATION OF DENTAL PLANS
SUPPLEMENTAL HEALTH
Are You Ready to Sell Dental Benefits in New Health Care Reform Environment? (Part Three)
W
Stand-alone Pediatric Dental in Exchanges plus/minus two percent
exchange models. To understand possible cost-sharing scenarios relating to dental
2014.)
possibly impacted are: states must use either the Children’s Health Insurance Program (CHIP) or
a 24-month waiting period on child-only orthodontic coverage. CHIP is
Ratios (MLRs). Commissions on the pediatric dental in the Small Group and
What to Track
implants and is limited to medically-necessary orthodontic coverage. More details are available at InsureKidsNow.gov.
Consumer Cost-Sharing
by state
coverage embedded within a medical plan and stand-alone dental in
Pediatric Dental Coverage Embedded with Medical Plans medical plans include: provideDental HMO, Dental PPO, Dental Indemnity and Discount Dental 80, 90 ( plus/minus 2 percent)
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HSA/HRA/FSA
BY REED ERICKSON VP OF COMPLIANCE & RISK MANAGEMENT SELECTACCOUNT
Charting the Unknown Waters of HSAs in the Health Insurance Exchanges
M
exchanges have the potential to create real change in the health
What we know, and what we don’t know
Account-based health plans are expected to see growth within the exchanges because HSA plans have been proven to slow the growth
were in account-based plans, it’s estimated that health care costs would
Educating consumers about HSA compatible health plans
means there is a tremendous amount and health insurers to develop the purchasing system. And what worries many critics as well as supporters is
2012, 11.6 million people owned HSAs nationwide, according to
are new to purchasing health insurance will have to overcome a related to health insurance exchanges has centered around the health plan design and pricing. And while little has been publicly said about health compatible health plans. The HSA is a valuable complement to the high-deductible health plan (HDHP), because it allows and encourages individual consumers to set
This is important, because it’s anticipated that health care costs will
previously were uninsured. Although the health insurance exchanges will initially roll out without HSA selection as an option, some experts predict that employers and individuals will continue to choose the HDHP option because it will savings potential.
be no direct visibility on the exchanges. Here’s what individuals will need
How much the individual can contribute Contributions to the HSA reduce tax liability
administrator
Establishing transparency for long-term success within the exchanges.
plan option in 2012. That number is expected to increased to 80 percent in 2014. 34
May/June 2013 I HealthCare Consumerism Solutions™ I www.TheIHCC.com
needs to provide visibility into the available HSAs, their costs, their decisions. Educational tools Individuals should be able to connect to
choice possible. Available HSAs
help them understand how the HSA saves them money and contributes to long-term savings, in addition to instructional videos and tips on how to use the account.
by each company. Costs
that some HSA providers charge, such as account opening and deliver the best experience possible, because it will enable them to choose
now or in retirement), earning interest on account balances,
To your clients, a worthwhile health benefit. To you, a hassle-free business benefit. As a national leader in Health Savings Accounts for over 15 years, we can offer you unmatched service and expertise. When you come to us, you can rely on turnkey solutions that help you build strong relationships with your clients. For them, it’s an opportunity to customize a better health savings option. And for you, it’s a chance to partner with a dedicated support team that works hard to make sure your experience is hassle-free. To learn more, call 877-525-7118. PROVEN TRACK RECORD
r
DEDICATED SUPPORT TEAM
r
CUSTOMIZABLE SOLUTIONS
Visit us at hsabank.com/learnmore for information about our HSA programs.
© 2013 HSA Bank. HSA Bank is a division of Webster Bank, N.A. Member FDIC.
Agent/Broker “Worthwhile” Studio Number: 014552013 Ad Code: WFC-HSA-NA
3/29/13 GD: Jessie IHC
Size: 7” x 4.875” Color: 4C MM: Joanne Renna
©2013 Webster Bank, N.A. Member FDIC. All rights reserved.
www.TheIHCC.com I HealthCare Consumerism Solutions™ I May/June 2013
35
THE CASE FOR INCLUDING SPOUSES
T
in Employee Health Management Programs
here is evidence that comprehensive
Tobacco use is another area where social
BY DAN GOLD, PH.D. » MEMBER HERO RESEARCH STUDY COMMITTEE
health can all help drive increased participation in employee health management
Making the Case for Including Spouses
also contributes to a program’s long-term
Reducing health care costs is a primary
impact on an individual’s behavior with spouses
percent. While social support contributes to initial participation, it plays an even more important role in maintaining new behaviors and newly
health management programs. Ironically, while it is actually the spouses who have higher costs: the average spouse typically costs about 30 percent higher than the average employee.
have shown that having a supportive spouse can
were published in the in 2007 and 2008, demonstrated that social relationships and social norms are extremely important when it comes to the behaviors we adopt and that behaviors have over time.
This indicates that there is an even greater
Using the HERO Scorecard to Analyze the Impact of Spouses on Employee Health Management Programs Each year, HERO conducts an analysis Health Management Best Practice Scorecard in Collaboration with Mercer. In
become obese increased by 37 percent.
www.TheIHCC.com I HealthCare Consumerism Solutions™ I May/June 2013
37
were twice as high (28 percent versus 14 percent) as companies that did not include spouses. The average employee participation
in an employee health management strategy. program components available to spouses: 1) increased employee engagement; 2) improved
was higher in companies that included spouses in employee health management programs (10 percent participation) as compared to companies that did not include spouse (8 percent participation). As other research also suggests,
demonstrate savings. The analysis also examined whether including spouses in an overall employee health management strategy could be connected to illustrated by higher best-practice scores).
interventions than on initial participation.
The HERO research committee studied
a higher average score on the HERO Scorecard than did other employer groups (117 vs. 94). In addition:
medical costs, the research team also exam-
While this analysis suggests that including spouses in health management initiatives can lead to higher employee participation, it’s important to remember that there are other
to include spouses in their employee health management strategies, and employer size is related to the HERO score. In the end, the data suggests organizations Spouses Included in Key Components of EHM
Spouses not Included
Indicated a slight or significant improvement of health risks*
88%
81%
Indicated small or substantial positive impact on medical trend*
70%
64%
To assess the impact on
Highlights from the Data Analysis
What This Means for Employers
impact on medical costs achieved within orgaspouses and those that did not. The analysis
Scorecard respondents indicated
that include spouses in their overall employee health management strategy can realize increased employee participation, especially in the interventions that matter, such as annual health assessment, tobacco cessation
management program.
coaching program, about three-
included spouses in their strategy reported at least some improvement
improvement in health in their population and a reduction in medical cost trend. To learn more about the HERO Scorecard
spouses. spouses, visit www.the-hero.org. Spouses Included in Key Components of EHM1
Spouses not Included
52% 28% 10%
50% 14% 8%
Health assessment participation* Lifestyle coaching participation** Tobacco cessation
While spouse involvement had only a include spouses. assessment participation rates (52 percent in programs that included spouses and 50 percent in those that didn’t), a more dramatic impact was seen in the behavior change programs. Employers who included spouses management programs reported employee participation rates that
38
May/June 2013 I HealthCare Consumerism Solutions™ I www.TheIHCC.com
included spouses in their wellness program reported at least some improvement in medical trend respondents who did not include spouses.
WHY PLAY SOCIAL GAMES AT WORK:
It’s Healthy for Business
Why It’s Important
BY JOSH STEVENS CHIEF EXECUTIVE OFFICER » KEAS
creating a culture that actually motivates, cares many wish they had a multi-player game as might sound. that gave them a good reason to act on their
services are very engaging and have basically
adoption: that people want to connect with each other, and that connecting through the
time. But currently, the time loss equates to a
most businesses are not yet clear on how to measure the productivity losses or gains when it
By harnessing the desire to play and connect, however, businesses can
We can not only increase productivity,
among people who engaged with each other around wellness with those who don’t, the
PERSONAL RESULTS “I lost 4 pounds this week but the success came from my being able to tighten my belt another notch!!!” — James B. “This challenge has not only changed the way I view my lifestyle choices, but has helped me learn how to use other resources to help not only myself achieve my goals and help others be successful! Thanks Keas!” — Chele M. “I am sharing my goals and knowledge with my husband. We have started eating healthier and exercising more. Together we have lost almost 40 pounds, but the real key is we are getting healthier together!!!” — Tammy P. “Always wanted to start doing pushups again but couldn’t quite get started...then along came the KEAS challenge and here I am doing 50 per day!” — Dave K. www.TheIHCC.com I HealthCare Consumerism Solutions™ I May/June 2013
39
productivity among those who gravitated to wellness will silence the deniers.
Organizational Effects
American businesses that elect to create a
St. Lawrence College (SLC) consistently ranks as one of Ontario’s leading community colleges with 6,700 full-time students from more than 40 countries. SLC employs approximately 450 full-time and almost 1,000 part-time individuals including faculty, administrative and support staff.
small group to drive the change. It is now the
“With campuses in three different locations, as well as satellite offices, we needed to find something that could be made available to all of our employees,” said Stephen Holmgren, Director, Human Resources, SLC. “We wanted to implement a wellness initiative that gave all employees an opportunity to participate.”
impact. There were no economic drivers to incentivize people to buy running shoes or yoga mats, but there is a macroeconomic incentive to implementing wellness programs that achieve high engagement. Our country needs this to
health-related absenteeism and productivity losses. Now, we have a tool that can have a massive impact on this number by connecting
Keas has been very successful at SLC. So much so, that the college was awarded the Workplace Wellness Gold Award from Kingston, Lennox & Addington (KFL&A) Public Health for its commitment to and support of workplace wellness initiatives. At SLC 73 percent of eligible employees registered for the Keas program.
Among their results:
each other in being healthy.
How It Works
95 percent reported being more proactive regarding their health 88 percent said Keas improved their teamwork and collaboration 82 percent said Keas made them feel more positive about working for the college
www.TheIHCC.com I HealthCare Consumerism Solutions™ I May/June 2013
41
costs will go down and productivity will increase. While it may and they can get obsessed by interactive games. United States over the last decade. It is entirely possible to see the
FOUR. has two interrelated parts. Quizzes and FOUR challenges help people to continue exploring wellness ideas in tandem to the easy steps and social
ONE.
literature by behavioral economists and once per day, that’s pretty easy. TWO. easy steps social, then you get group
thru, television and video games, and the 64-ounce soda bottles banned by Mayor Bloomberg.
What’s Different This Time
THREE.
that productivity and other measurable results with have an economic
whatever it takes
health care costs means the time is now to reverse the trend towards a sustainable, healthy society. We’ve now got the tools to succeed at this:
and then some More dentists
Less out-of-pocket
Simpler process
At Delta Dental, we’re dedicated to keeping you happy. That’s why we work hard to give you more dentists, more savings and more satisfaction. Because we’ll do whatever it takes to see your healthy smile. For more information, contact Frazier Sherrill at 770-641-5196. deltadentalins.com
Dental insurance plans are underwritten by Delta Dental Insurance Company. 42
May/June 2013 I HealthCare Consumerism Solutions™ I www.TheIHCC.com
Where It’s Going
rare sight. Wellness will no longer be a nice-to-have program, but will
WWW.THEIHCC.COM
HSA/HRA/FSA TECHNOLOGY: ADMINISTRATION & MANAGEMENT
TSYS Healthcare® provides end-toTSYS HEALTHCARE end strategic payment solutions for 706.649.5080 consumer directed healthcare. We www.tsys.com/healthcare partner with benefits administrators, healthcare@tsys.com financial institutions, health plans, and software providers to navigate all aspects of HSAs, HRAs, FSAs, transportation accounts, cash reimbursements, and lines of credit. TSYS Healthcare cards offer participants the security they expect along with the ability to conveniently access funds from multiple accounts and manage their benefits payments with simplified single-card access. Clients and partners benefit from simplified processes, reduced paperwork and cost savings that can contribute to improved return on investment.
“We built the TSYS Healthcare platform to meet the market demand for reliable, configurable and intelligent solutions. Understanding the dynamic U.S. healthcare market, our customers rely on our option-driven system to prepare them for the future.” — Trey Jinks, Group Executive, TSYS Healthcare HSA / HRA / FSA ADMINISTRATION AND FINANCE
WageWorks helps employers
WAGEWORKS
support consumer directed
1100 Park Place, 4th Floor San Mateo, California 94403 United States of America
pre-tax benefit programs, including health care (FSA, HSA, HRA), wellness programs, commuting and
888-9905099 www.wageworks.com
child and elder care. Wage Works also offers retiree health care and COBRA Services. More than 100 of America’s Fortune 500 employers and millions of their employees use WageWorks.
CORPORATE MEMBER PROFILES
HSA ADMINISTRATION & FINANCE
At HSA Bank, we’ve been helping businesses HSA BANK optimize their health care spending for over 605 N. 8th Street Suite 320 15 years. We offer unmatched service and Sheboygan, Wisconsin 53081 expertise when it comes to health-based United States of America savings accounts. You can count on our 800.357.6246 dedicated business relations team for turnkey www.hsabank.com solutions and ongoing support that help your business and workforce save for a healthy future. To connect with your regional representative, call 866.357.5232 or visit hsabank.com.
“When implementing one of the first Medical Savings Account programs in the country, I had a belief that health care could be fixed with free-market principles. I still do. By adopting flexible and transparent practices that manifest core attributes of consumerism such as private exchanges, defined contributions, and self-funding; we will reform health care in our nation.” — Kirk Hoewisch, Co-Founder and President, HSA Bank, a division of Webster Bank, N.A. HSA / HRA / FSA ADMINISTRATION AND FINANCE
Evolution1 and our Partners serve more EVOLUTION1, INC. than 9 million consumers, making us 952.908.9056 the nation’s largest electronic payment, www.evolution1.com on-premise and cloud computing sales@evolution1.com healthcare solution that administers reimbursement accounts, including HSAs, HRAs, FSAs, VEBAs, Wellness and Transit Plans. It is the only solution that offers a single end-to-end user experience, provides innovative auto-substantiation technologies, and automates work ow for Partners, employers, and consumers. It does all this on one technology platform comprised of 1Cloud™, 1Direct™, 1Pay™, 1View™, 1Plan™, and 1Mobile™. Evolution1 and our Partners are dedicated to delivering value, reducing costs and simplifying the business of healthcare.
“The combination of our innovative products will further our leadership position in a rapidly changing healthcare market. Together with our Partners we are committed to reducing costs and simplifying the business of healthcare.” — Jeff Young Chairman and CEO, Evolution1
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43
CORPORATE MEMBER PROFILES
WWW.THEIHCC.COM
EMPLOYEE BENEFITS CONSULTING
Intrepid goes beyond the typical expectations of the benefits consultant. We take the time to understand each client’s unique culture in order to implement the most progressive, creative solution to their benefits needs.
INTREPID
Liz Frayer, RHU 400 Interstate North Parkway, Suite 600, Atlanta, GA 30339 888-612-4644
“Our mission is to empower clients www.intrepid7.com to achieve a more sustainable health care policy; it’s about more than just giving the client a plan — it’s a process of educating the client and their employees to better understand the plan and ensure its success. When we see the shift that occurs when employees have their ‘aha’ moment is when we feel we have done our job. —Liz Frayer, RHU, Intrepid
PROFESSIONAL DEVELOPMENT
Health Insurance 101: An Orientation is a new, flexible online course offered by AHIP. It is designed to teach health insurance basics to those new to health care or individuals who wish to review the fundamentals. The course is formatted in short modules; you learn at your own pace and on your own time, moving through the materials as you choose. Plus, AHIP will customize the course to fit your organization’s specific learning requirements.
44
AMERICA’S HEALTH INSURANCE PLANS 601 Pennsylvania Ave., NW South Building, Suite 500 Washington, D.C. 20004 Lindsey Miranda Canaley Tel: 800.509.4422 Fax: 202.861.6354 lmirandacanaley@ahip.org www.ahip.org/courses
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HEALTH DECISION SUPPORT TOOLS
Castlight Health enables employers, their CASTLIGHT HEALTH 85 Market Street, Suite 300 employees, and health plans to take San Francisco, CA 94105 control of health care costs and improve care. Named #1 on The Wall Street 415.829.1400 Journal’s list of “The Top 50 Venturewww.castlighthealth.com Backed Companies” for 2011 and one of Dow Jones’ 50 Most Investment-Worthy Technology Start-Ups, Castlight Health helps the country’s self-insured employers and health plans empower consumers to shop for health care. Castlight Health is headquartered in San Francisco and backed by prominent investors including Allen & Company, Cleveland Clinic, Maverick Capital, Morgan Stanley Investment Management, Oak Investment Partners, Redmile Group, T. Rowe Price, U.S. Venture Partners, Venrock, Wellcome Trust and two unnamed mutual funds. Giovanni Colella, M.D. CEO and Co-Founder, Castlight Health HEALTHCARE DATA ANALYTICS
Med-Vision delivers health-plan risk MED-VISION LLC management and wellness strategies to Connie Gee, Vice President help employer groups achieve optimal connie.gee@med-vision.com employee health. Med-Vision’s healthcare data analysis tool, Med-View, guides 813-205-1577 www.med-vision.com employers in mitigating health risks. With www.med-view.net Med-Vision’s help, self-funded employers, healthcare facilities, municipalities, and school districts have reversed trends and decreased healthcare costs while enhancing care.
“You can’t change what you can’t measure. That’s why Med-Vision leverages Med-View’s analytics tool to investigate employee-health data and determine actionable solutions for employers. Med-Vision uses the data to implement innovative and customized plans for strategic wellness and disease management. Results include healthier employees, greater productivity, and drastically lower healthcare costs.” — Connie Gee, Vice President, Wellness Strategist & Health Data Analyst
WWW.THEIHCC.COM
HEALTHCARE ACCESS
HealthPerx is a health and wellness marketing company specializing in creative non-insurance benefit solutions that reduce absenteeism, increase productivity and decrease healthcare costs. Consultants: These benefits differentiate you from competitors.
HSA/HRA/FSA TECHNOLOGY: ADMINISTRATION & MANAGEMENT
HEALTHPERX Jeff Marks, CEO Jmarks@hperx.com Direct: 205 222-4062 Toll Free: 888 417-6187 www.hperx.com
Corporations: These will give you a far greater ROI than your wellness program while saving your employees thousands of dollars a year. Differentiator: Telemedicine Services: offering the entire family unlimited calls with no consult fees 24/7/365—anytime from anywhere Additional Health Benefits: offering significant savings for pharmacy, dental, vision, medical advocacy, travel assistance, telephonic counseling (EAP) and more Turnkey Program: billing, administration, fulfillment, call center, marketing HealthPerx benefits complement any and all existing benefit plans. — Je Marks, CEO PRESCRIPTION BENEFITS MANAGEMENT
Provider of Prescription Benefits Management services to self-funded employee groups, TPA’s, Brokers, and Consultants. Phoenix also offers a prescription savings card, RxAdvantage, for individuals and groups alike.
CORPORATE MEMBER PROFILES
PHOENIX BENEFITS MANAGEMENT
410 Peachtree Parkway, Suite 4225 Cumming, Georgia 30041 888.532.3299 main office 678.208.6257 marketing & pr 678.208.6252 sales 678.208.6255 fax
Phoenix Benefits Management is a prescription benefit manager sales@phoenixpbm.com providing traditional PBM services marketing@phoenixpbm.com to Self-Funded companies, TPA’s, www.phoenixpbm.com Brokers, and Consultants. We also provide comprehensive 340B services as well as our very own prescription savings card known as the Phoenix RxAdvantage Prescription Savings Card. Though our approach is scalable, our solutions are individualized. It’s been our experience and it is our firm belief that prescription benefit plans are not a one-size-fits-all proposition so we create a plan that is customized to fit the unique needs of each and every one of our clients.
DataPath, Inc., is one of nation’s largest providers of CDH solutions specializing in account-based administration systems.
DATAPATH, INC.
1601 WestPark Drive, Suite 9 Little Rock, AR 72204 501.296.9990 www.dpath.com
Since 1984, service providers using DataPath systems have provided administrative solutions for over 1 million participants of FSA, HRA, HSA, and COBRA. DataPath is the only solutions provider to design and deliver a full Suite of systems for handling 125, 105, 132, COBRA, HSAs, Credit and Debit Cards all delivered to account holders through a single Internet portal, myRSC.com.
“With the significant changes in healthcare today, our software solutions allow users to create custom plans for clients that benefit both the employer and employee. Not only have we created a single platform for all systems with myRSC.com, with the integration of our mySourceCard Debit Card at Wal-Mart and other retailers, our clients are able to offer a hassle-free solution with 100% compliance.” ®
HSA/HRA/FSA TECHNOLOGY: ADMINISTRATION & MANAGEMENT
At Flex, we believe in making health FLEXIBLE BENEFIT SERVICE benefits more affordable for everyone. CORPORATION (FLEX) For 25 years, we have enabled thousands of clients to make their health care 10275 W. Higgins Road, Suite 500 dollars go further with our consumer Rosemont, IL 60018 driven plans and benefits administration +1-888-353-9178 services, including: fpsales@flexiblebenefit.com Flexible Spending Accounts (FSAs) www.flexiblebenefit.com Health Reimbursement Arrangements (HRAs) Health Savings Accounts (HSAs) Transit/Parking Reimbursement Accounts (TRAs) COBRA Administration And more! Flex continues to evolve and enhance our product portfolio with the addition of our scalable private insurance exchange, InsureXSolutions™. This latest innovation promotes a defined contribution funding model that allows employers to provide health and retiree benefits at a fixed cost, while offering employees with access to coverage options through our online insurance marketplace All Flex clients receive our personalized customer service and a wealth of resources that make our plans easy to use. Each plan we administer comes with online account access, simple transaction tools like debit cards, custom educational resources and unrivaled plan design expertise to keep you in compliance every step of the way. www.TheIHCC.com I HealthCare Consumerism Solutions™ I May/June 2013
45
CORPORATE MEMBER PROFILES
WWW.THEIHCC.COM
HSA/HRA/FSA TECHNOLOGY: ADMINISTRATION & MANAGEMENT
MasterCard (NYSE: MA), is a global payments and technology company.
MASTERCARD WORLDWIDE 2000 Purchase St. Purchase, NY 10577-2509
It operates the world’s fastest payments processing network, connecting consumers, financial institutions, merchants, governments and businesses in more than 210 countries and territories. MasterCard’s products and solutions make everyday commerce activities—such as shopping, traveling, running a business and managing finances—easier, more secure and more efficient for everyone.
HEALTH ACCESS ALTERNATIVES
Carena provides 24/7, on-demand access to CARENA, INC. health care by phone, webcam, and house 1525 4th Avenue, Suite 300 call. Seattle-based Carena is committed to Seattle, WA 98101 delivering the best health care experience 800.572.2103 possible. Its technology-enabled care delivery www.CarenaMD.com model provides on-demand access to health James.Taylor@CarenaMD.com care 24/7, via phone, secure video, and house call. Carena provides health care solutions to patients through employers, health systems and through its consumer service, CareSimple.
“People are paying more out of pocket for care than ever—through higher co-pays and deductibles, reduced benefits, and in the rising costs of goods and services. Taken together, health care has become more expensive and less accessible. Our goal is to make health care more affordable by providing the right care at the right time for the right cost; to help people live healthier lives by removing the barriers to people taking control of their health care.” — Ralph C. Derrickson, President & CEO, Carena
TOTAL POPULATION HEALTH MANAGEMENT
Orriant helps businesses produce a better, more profitable product by creating a workforce that is healthier, more productive, and less expensive to insure.
ORRIANT
9980 South 300 West Ste. 100 Sandy, Utah 84070 801.574.2306 www.orriant.com suzanne.viehweg@orriant.com
Orriant’s proven strategy is to hold people accountable for improving their health as an integral part of your benefit strategy in a way that is fair and compassionate to all.
“Employers can fight back to control rising health care costs. Orriant’s strategies have helped major employers from almost every industry cut the cost of health care, improve the health and productivity of their workforce, and push hundreds of thousands of dollars to their bottom lines.” — Darrell Moon, Orriant CEO
HSA/HRA/FSA TECHNOLOGY: ADMINISTRATION & MANAGEMENT/PRIVATE EXCHANGE
Workable Solutions is based in WORKABLE SOLUTIONS, LLC Orlando, FL and provides a full array of 7120 Lake Ellenor Dr. employee benefit solutions including Orlando, FL 32809 HSA, HRA, FSA and commuter accounts, COBRA administration, and benefits 800.946.6342 administration outsourcing. They offer Fax: 407.540.1749 a comprehensive benefit exchange www.workablesolutions.com application, Workable Choice, which provides plan selection assistance, comparison-shopping technology, eligibility management, enrollment, consolidated billing, and more. Workable also offers a myriad of defined contribution options, which allow employers to control their employee health care costs while giving their employees greater choice and exibility.
“As a small business, we understand first-hand what challenges a small business faces. At Workable Solutions, we can help you control the cost of employee benefits. Workable Choice is a private exchange solution that makes offering defined contribution and a multitude of consumer-driven products easy and affordable.” — Terry McCorvie, President/CEO, Workabe Solutions, Inc.
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May/June 2013 I HealthCare Consumerism Solutions™ I www.TheIHCC.com
WWW.THEIHCC.COM
HEALTH INCENTIVES
MedEncentive offers a patented, web-based incentive system that’s been independently validated
MEDENCENTIVE
Cecily Hall Executive Vice President medencentive.com chall@medencentive.com
to control healthcare costs. Doctors and patients earn financial rewards for declaring adherence to best practices and healthy behaviors, provided they agree to be accountable to the other party for doing so. Easy to implement and
EMPLOYEE COMMUNICATION AND EDUCATION
ExperienceLab has created a breakthrough, CDHCENTRIC patented communication program that saves 507 S. 8th Ave. Bozeman, employers money by increasing adoption and Montana 59715 usage of consumer directed health (CDH) 617.224.6223 insurance plans among their employees. www.experiencelab.com CDHCentric, sold on a subscription basis, rtravis@experiencelab.com delivers regular, multi-media communications that are tailored based on seven unique attitudinal segments developed from proprietary research.
Traditional health plans protect employees from having to learn the basic skills for making cost-effective healthcare decisions. Our segmentation research, which is based on 20 years of behavioral marketing, found 7 unique personality types, and each makes healthcare decisions differently. The result is that, when employee messages are correctly tailored to their personalities, employees become health care consumers! — Roger Travis, President
embraced by users. SUPPLEMENTAL HEALTH
Transitions Optical, Inc. is the maker of Transitions® lenses, the #1-eyecare professional recommended photochromic lenses worldwide.
CORPORATE MEMBER PROFILES
TRANSITIONS OPTICAL 9251 Belcher Road Pinellas Park, FL 33782
800.533.2081 ext. 2262 www.healthysightworkingforyou.org
Transitions Healthy Sight Working for You® is an education initiative that helps HR professionals and benefits professionals communicate the value of the vision benefit to employees. More information and complimentary education tools are available at HealthySightWorkingForYou.org.
“Don’t overlook your employees’ healthy sight when thinking about your business goals. A vision benefit that includes an eye exam and sight-optimizing eyewear helps ensure that employees see their best, so they can do their best work, directly affecting your business.”
HEALTH ACCESS ALTERNATIVES
WeCare TLC is a medical risk management company that leverages onsite primary care clinics to provide solutions to rising healthcare costs while improving patient health and wellness.
WE CARE TLC
120 Crown Oak Centre Dr Longwood, FL 32750 800.941.0644 www.wecaretlc.com raegan.garber@wecaretlc.com
Our holistic approach to care empowers the clinic staff to act as patient advocates, which increases compliance and decreases unnecessary expensive services.
“Healthcare is now a right and employers are faced with the challenge of truly managing their healthcare costs. We have created a unique medical home clinic model that properly addresses quality of care and cost. This requires constant, aggressive, creative, and directed attention to accomplish but it can be done.” — Lynn Jennings, CEO, WeCare TLC
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CORPORATE MEMBER PROFILES
WWW.THEIHCC.COM
EMPLOYEE ENGAGEMENT TOOLS
Under the CIVA (CodeBaby Intelligent Virtual CODEBABY CIVA Assistant) brands of benefits and health 111 S. Tejon St. Suite 107 advisor, CodeBaby improves the healthcare Colorado Springs, CO 80903 consumer experience and optimizes online 877.334.3465 self-service on any web-based platform codebaby.com/online-solutions or device with absolutely no IT disruption. solutions@codebaby.com Benefits advisor offers guidance and selfservice options that help consumers and organizations alike to make better decisions about benefits selection. Health advisor engages new patient visitors on hospital or office websites or existing patients on wellness, prevention & disease management platforms.
“With the rapid changes in health care, our solutions provide organizations innovative ways to optimize their current platform while meeting the demand for an enhanced online experience. CIVA benefits and health advisor solutions are industryleading models that help consumers and organizations more efficiently navigate complex health benefit exchanges and patient portals. “ -Dennis McGuire, CEO BENEFIT ENROLLMENT AND ELIGIBILITY
Totem Solutions is a boutique benefits TOTEM SOLUTIONS consulting and administration firm offering highly 11330 Lakefield Drive specialized services and products. We serve Bldg 1, Ste 150 benefit management and HR professionals as an Duluth, GA 30097 extension of their team, allowing them to focus on key initiatives and core strengths. Our services 770-295-1600 include Employee Benefits Consulting, Benefits Toll-free 866-481-4917 Administration, Enrollment, & Communication, www.totemsolutions.com Health Care Reform Education, Enrollment, Reporting & Compliance, Leave and Disability Management Administration.
“We are hands-on benefits advisors for public and private sector companies throughout the country. Totem delivers employer-centric service that simplifies benefits administration and enrollment in order to facilitate employee understanding and ensure the best possible employee experience. Our goal is also our great passion and commitment: to offer organizations clear and accurate counsel accompanied by services and solutions that are easy to access, seamlessly implemented and custom fit, while providing a worry-free outsourcing solution.” — Debbie Schultz, President, CEO, Totem Solutions
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HEALTH DECISION SUPPORT AND COST-SAVING TOOLS
WiserTogether Inc., helps patients choose the right care at the time. It
WISER TOGETHER Praveen Mooganur
offers an innovative online treatment
202.276.3074
selection & shared decision support
www.wisertogether.com praveen.mooganur@wisertogether.com
platform that helps patients make evidence-based, cost effective
treatment decisions across musculoskeletal, cardiovascular, mental health, diabetes, pregnancy and respiratory illnesses saving payers money. Currently 1.5 million members have access to the platform through employers and health plans in the country. WiserTogether was founded in 2008 and is based in Washington, DC. — Praveen Mooganur, COO SUPPLEMENTAL HEALTH
Delta Dental leads the DELTA DENTAL industry in designing 1130 Sanctuary Pkwy, Suite 600 Alpharetta, GA 30009 innovative dental coverage programs that keep costs 770-641-5196 down and deliver quality care. Our diverse client list includes everyone from Fortune 100 companies to public agencies to individuals and families. Our customer’s satisfaction is based on our expansive dentist network, cost-saving mechanisms and superior customer service. We are part of the Delta Dental Plans Association that provides dental coverage to more than 56 million people in the US.
WWW.THEIHCC.COM
HEALTH DECISION SUPPORT TOOLS
FSAstore.com is the only one-stop-shop FSASTORE.COM exclusively stocked with FSA eligible 244 5th Avenue, Suite J-257 products and services. At FSAstore.com, New York, NY 10001 consumers have access to more than 4,000 888.FSA.1450 (372-1450) FSA eligible products, a national database of FSA eligible services, and much-needed information through the FSA Learning Center. FSAstore accepts all FSA and major credit cards, offers 24/7 customer service, one-to-two-day turnaround for all orders, and free shipping on orders over $50.
“Each year consumers lose hundreds of millions of dollars simply because they do not deplete all of the pre-tax funds available to them in their FSA. But this year, more consumers than ever are realizing that they can use that money to buy many of the daily health products they need, and without a prescription. FSAstore.com strives to make it easy for participants to use and understand their FSAs.” — Jeremy Miller, Founder and President, FSAstore.com
CORPORATE MEMBER PROFILES
BENEFIT ADMINISTRATION/PRIVATE EXCHANGES
Since 1988, CieloStar (formerly OutsourceOne) CIELOSTAR has helped brokers, employers and employees 530 U.S. Trust Building navigate the ever-changing world of benefits. 730 Second Avenue South Now, with the dawn of “Defined Contribution Minneapolis, MN 55402 Health Care” we are again on the leading edge. With a team of industry thought leaders, CieloStar 612.436.2706 makes navigating healthand benefits choices john.reynolds@cielostar.com easy for employers and employees by offering comprehensive benefits administration solutions with a high-touch, high technology model—most recently launching a proprietary private health insurance exchange.
“Fueled by the far-reaching impact and complexities of health care reform taking effect in 2013 and 2014, employers and employees increasingly find themselves in a ‘farmer’s market’ of benefits choices. Cielostar is uniquely positioned with enabling technology that helps purchasers and consumers make the best possible decisions and create a best-in-class benefits administration process. Our unique comprehensive approach to benefits offers everything from back room technology for enrollment, data, billing and call centers to complete solutions for COBRA, CDHP and health insurance exchanges.” — John Reynolds, CEO, Cielostar
TOTAL POPULATION HEALTH MANAGEMENT
Dr. tools Steven Level1Diagnostics uses new to M. Helschien LEVEL1DIAGNOSTICS Founderhealth and CC&BW evaluate employees’ cardiovascular 11722 Lightfall Court Heart disease is the number one killer Columbia, MD 21044 www.level1diagnostics.com in the U.S. and costs millions of dollars 410-707-5667 ◆ doc@level1diagnostics.com Dr. Steven Helschien, Founder in medical care and time lost from Sales: Penny Aleo, Executive VP work. Detection and prevention is the 443.878.3087 key to heart health. Level1Diagnostics pbaleo@gmail.com is an innovative program that, unlike conventional cardiology tests, provides new advanced technology testing and methods to detect and prevent the earliest signs of cardiovascular disease and encourage optimal health. “The biggest problem with traditional cardiology is that it is not preventive—there isn’t a testing program to evaluate people who don’t have any symptoms of heart disease, but may be at significant risk. Drugs and surgery are offered to patients instead of lifestyle change programs and supplements.”
HEALTH DECISION SUPPORT TOOLS
Truven Health Analytics, formerly Healthcare at Thomson Reuters, delivers unbiased information, analytic tools, benchmarks, and services to the health care industry.
TRUVEN HEALTH ANALYTICS 6200 S Syracuse Way, Suite 300 Greenwood Village, CO 80111 734.913.3000
Hospitals, government agencies, employers, health plans, clinicians, and life sciences companies have relied on us for more than 30 years. We combine deep clinical, financial, and health care management expertise with innovative technology platforms and information assets to make health care better by collaborating with our customers to uncover and realize opportunities for improving quality, efficiency, and outcomes.
—Dr. Steven Helschien, Founder, Level1Diagnostics
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AHIP ...................................................... 44
IHC Webinar - Aflac ............................... 16
Best Buy ........................Inside Back Cover
Intrepid .................................................. 44
Buck Consultants ............................. HXS 6
MasterCard ............................................ 46
Carena ................................................... 46
MedEncentive ........................................ 47
Castlight Health ..................................... 44
MedVision.............................................. 44
CieloStar................................................ 49
Mercer Marketplace......................... HXS 2
CDHCentric ............................................ 47
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CodeBaby............................................... 48
Phoenix Benefits Management................ 46
DataPath ................................................ 45
SelectAccount.......................................... 5
Delta Dental .....................................42, 48
Target GiftCards ..................................... 36
Evolution1.............................................. 43
Totem Solutions ..................................... 48
Flexible Benefit Service Corporation ....... 45
Transitions ............................................. 47
FORUMWest ......................................13-15
Truven Health Analytics .....................7, 49
FSA Store ............................................... 49
TSYS Healthcare ......................HXS 12, 43
HealthPERX ............................................ 45
UnitedHealthCare ..................... Back Cover
HealthStat ......................Inside Front Cover
WageWorks ........................................... 43
HSA Bank ........................................35, 43
WeCare TLC .....................................10, 47
IHC Corporate Member ..................... HXS 5
Wiser Together ................................40, 48
IHC Radio............................................... 50
Workable Solutions ................................ 46
IHC Superstars ....................................... 16 50
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myHealthcare Cost Estimator
TO TAKE CARE OF BUSINESS WITH INNOVATIVE TOOLS FOR THE JOB myClaims Manager UnitedHealthcare Health4MeTM
UHC.TVSM
The right health information can take you a long way. At UnitedHealthcare, we offer innovative tools that put members in touch with their information. myHealthcare Cost Estimator provides relevant information on care and estimated costs. myClaims Manager helps members understand and manage their health care claims. UnitedHealthcare Health4Me is a mobile app that provides instant access to a family’s important health information. UHC.TV presents exciting, engaging online content about good health and living well. Empower your employees. It’s good for their health – and the health of your business. For more information, visit welcometomyuhc.com or call 1-866-438-5651.
uhc.com All UnitedHealthcare members can access a cost estimator online tool at myuhc.com. Depending on your specific benefit plan and the ZIP code that is entered, either the myHealthcare Cost Estimator or the Treatment Cost Estimator will be available. A mobile version of myHealthcare Cost Estimator is available in the Health4Me mobile app, and additional ZIP codes and procedures will be added soon. This tool is not intended to be a guarantee of your costs or benefits. Your actual costs and/or benefits may vary. When accessing the tool, please refer to the Terms and Conditions of Use and Why Your Costs May Vary sections for further information regarding cost estimates. Refer to your health plan coverage document for information regarding your specific benefits. ©2013 United HealthCare Services, Inc. Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by United HealthCare Services, Inc. or their affiliates. Health plan coverage provided by or through a UnitedHealthcare company. UHCEW506202-004