HealthCare Consumerism Solutions

2014 IHC FORUM & EXPO Show Wrap-Up

ISSUE || May/June 2014

The Tech Revolution in Wellness

The Future Will Be Mobile, Social and Wearable Consumers Turning to Retail Clinics Population Health 2.0: The Age of the Consumer

INSIDE: www.theihcc.com

Healthcare is

Predictable

Implemented Healthstat for his company last year.

Reduced his health claims. Saved the company $700.

Found out he had diabetes. Learned to manage it at work.

FEATURES

INSIDE

35 The Tech-Driven Revolution in Employee Health Management Across the board, if you’re interested in something, there’s probably an app for it. And if there isn’t, there soon will be. Technology is exploding throughout every industry, including health care.

The last few years have debuted an incredible amount of new health carerelated technology, especially when it comes to wellness. Yet, at times, health care is still struggling to keep up with the demands of tech-savvy consumers, who want the latest and greatest. Here’s a look from five field experts at the present and future of employee health management technology.

Contributors include Dr. Rajiv Kumar, ShapeUp; Dr. Jonathan Dugas, The Vitality Group; Fran Melmed, context communications consulting; Sue Lewis, StayWell; and Eric Zimmerman, RedBrick Health.

40 The Doctor Will See You Now Why more consumers are turning to retail clinics for health care needs It’s 7 p.m. You have a raging headache, a fever that’s slowing creeping upwards and a very sore throat. You’re working on some big projects at work and can’t afford to be gone several days in a row. Your general practitioner’s office closed a while ago, so what do you do? You head to the nearest retail health clinic.

It’s a scene that’s played out time and again every day. For myriads of reasons, Americans are choosing to visit their nearest CVS, Walgreens, RiteAid, Target or other retail clinic for health care. Retail clinic locations are exploding and encouraging other trends — including a shift into workplace health and wellness.

By Heather Loveridge, Senior Editor, The Institute for HealthCare Consumerism

INSIDE The Industry’s Only Magazine Dedicated Exclusively to Health Exchanges 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: Open enrollment is just around the corner, and for the July/August issues of HealthCare Consumerism Solutions

and HealthCare Exchange Solutions, we’ll be looking at trends, innovation and best practices for this year’s enrollment season.

HealthCare Consumerism Solutions™ I www.TheIHCC.com I May/June 2014

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INSIDE 6

Publisher’s Letter

9-10

t t t t

Briefs & Innovations

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12-13

2014 FORUM & Expo Re-Cap

43-50

Solution Provider Member Profiles

50

Resource Guide/Ad Index

DEPARTMENTS 8 Bachman’s Banter New Child Oral Care Benefit Required as Preventive Care

By Ronald E. Bachman, Chairman, Editorial Advisory Board, The Institute for HealthCare Consumerism

15-16 Stats & Data Employers Finding Their Way in Specialty Pharmacy

By Cheryl Larson, Vice President, Midwest Business Group on Health

The Dangers of Underinsuring Hearing Loss

SAVE THE DATE Events IHC FORUM West

/PW t Red Rock Resort & Casino – Las Vegas /PW t Pre-conference Come LEARN, CONNECT and SHARE with the top thoughtleaders in the rapidly growing health care consumerism megatrend: www.theihccforum.com The Institute for HealthCare Consumerism’s IHC FORUM Conferences are the only national events 100% dedicated to health care consumerism. HR professionals, wellness program directors, brokers, consultants, TPA’s and regional health plan administrators attend IHC FORUM events for cutting-edge workshops, general sessions, preconference events and networking opportunities. FORUMgoers learn from peers who have successfully adopted health care consumerism programs, and gain insights from industry thought leaders and policymakers on how to navigate the marketplace, cut costs, engage employees and comply with current health care laws share leading practices. In addition, attendees are eligible for IHC University’s Certified HealthCare Consumerism Specialist (CHCS) designation as well as HR CEU credits.

Membership Become a Member, Reap the Rewards Have you become a member of The Institute for HealthCare Consumerism (IHC) at www.theihcc.com? Why wait? Visit the 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 IHC. Share a case study, white paper, article or post a blog at www.theihcc. com. Members also receive special discounts to attend IHC events, such as the IHC FORUM conference series.

4 May/June 2014 * XXX 5IF*)$$ DPN * HealthCare Consumerism Solutions™

By Mike Reha, CEBS, Director of Sales and Marketing, EPIC Hearing Health Care

33 Voluntary Benefits Four Vision Coverage Trends That Merit a Second Look

By Kimberly Landry, Analyst, Group Insurance Research, LIMRA

34 Population Health Management Population Health 2.0: Engaging Patients in the Age of the Consumer

By Yale Miller, Executive Vice President of Operations, Aegis Health Group

ONLINE EXCLUSIVES What Are the Ingredients in Your Health Care Cost Estimation Tool?

Employers are increasingly hearing about the importance of offering employees tools to help them factor cost into their health care decisions.

Such tools are especially relevant as many more employers shift their employees to high deductible health plans or plans with more extensive cost-sharing provisions.

By Robin Gelburd, President, FAIR Health, Inc.

Points in Wellness: What’s the Point?

Points are all the rage. Wellness is all about giving out points these days for pretty much everything, because the goal is to “gamify� health. Sign up for a service. Get points. Share with a friend. Get points. Submit this questionnaire. Get points. Like a friend’s activity. Get points. Points are very powerful, but I think I can officially say that programs that give points for everything have hit the “point� of diminishing returns.

By Russell Benaroya, Co-Founder and CEO, EveryMove

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LETTER

PUBLISHER www.theihcc.com VOLUME 10 NO. 4 | MAY/JUNE 2014

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

Looking back at the recently completed 2014 FORUM & Expo, one clear message emerged from the event: health care consumerism is rapidly expanding across the market as a credible solution to health care reform.

While health exchanges, defined contribution and the growth of account-based health plans are rightfully big discussion items today, it is important that we all look at health care

MANAGING EDITOR

Jonathan Field SENIOR EDITOR

Heather Loveridge hloveridge@theihcc.com ACCOUNT MANAGER

Joni Lipson

reform and health care consumerism as not just “health benefits reform,� but a larger umbrella that prominently includes preventive care and health management.

In this issue and the accompanying HealthCare Exchange Solutions supplement, we’ve taken an in-depth look at some of the moving pieces around employee health management

ART DIRECTOR

Kellie Frissell GRAPHIC DESIGN

Patrick Washington MARKETING COMMUNICATIONS MANAGER

today, including apps, wearable devices, social media platforms and health exchanges.

Lana Perry

Special thanks to our feature contributors: Dr. Rajiv Kumar, ShapeUp; Jonathan Dugas, The

ASSOCIATE DIRECTOR OF EDUCATION SERVICES AND PROGRAMS

Vitality Group; Fran Melmed, context communications consulting; Sue Lewis, StayWell; and Eric Zimmerman, RedBrick Health.

And finally, remember that nominations are currently open for the 2014 HealthCare Consumerism Superstars awards. You can nominate a colleague, partner, client or vendor today by visiting our Web site. Nominations close on August 15, and winners will be announced at the 2014 FORUM West in Las Vegas this November.

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 Group; John Hickman, Alston+Bird LLP; Tony Holmes, Sanders McConnell, TSYS Healthcare; Roy Ramthun, HSA Consulting Services LLC; John Young, Consumerdriven LLC WEBMASTERS

Sincerely,

Kevin Carnegie Tom Becher ASSOCIATE WEB ADMINISTRATOR

Tim Hemendinger

Doug Field CEO/Publisher dfield@fieldmedia.com

DIRECTOR OF CONFERENCE SPONSORSHIP/ CORPORATE MEMBERSHIP/REPRINTS

Rogers Beasley BUSINESS MANAGER

Karen Raudabaugh

™ Volume 10 Issue 4 Copyright Š2014 by FieldMedia LLC. All rights reserved.

™ is a trademark of FieldMedia LLC. ™ is published eight times yearly by FieldMedia LLC., 292 South Main Street, Suite 400, Alpharetta, GA 30009.

TO SUBSCRIBE: Make checks and money orders payable to ™ magazine 292 S. Main Street, Suite 400, Alpharetta, at the following rates: single copy $7.50; $75.00/yr in the U.S., $105/yr in Canada and $170/yr international. Please contact FieldMedia at 404.671.9551 PRINTED IN THE U.S.A. ™ is designed to provide both accurate and authoritative information with regard to the understanding that the publisher

legal advice is required, the services of a professional adviser should be sought.

The magazine is not responsible for unsolicited manuscripts or photographs.

Send letters to the editor and editorial inquiries to the above address or to

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BACHMAN’S BANTER

BY RONALD E. BACHMAN FSA, MAAA CHAIRMAN, EDITORIAL ADVISORY BOARD THE INSTITUTE FOR HEALTHCARE CONSUMERISM

as Preventive Care: The United States Preventative Services Task Force’s Final Recommendation on Children’s Fluoride Varnish Treatments WHO: Children covered for insurance under Medicare, Medicaid or private insurance (individual and group plans whether insured or self-insured) that are subject to the preventive care requirements of the Patient Protection and Affordable Care Act. WHEN: Starting January 1, 2015 or the beginning of their next plan year.

WHAT: The PPACA requirement for preventive care coverage at 100 percent (i.e. no patient out-of-pocket costs) has been expanded by the United States Preventive Services Task Force’s recommendation to include fluoride varnish to the primary teeth of all infants and children, starting with primary tooth eruption.

EXECUTIVE SUMMARY: Fluoride varnish is a temporarily adhesive form of fluoride applied to the tooth surface that helps prevent childhood caries (i.e. tooth decays). The new USPSTF recommendation for preventing childhood caries adds child fluoride varnish treatment.

This updates the previous childhood dental recommendation issued in 2004 (included in the original list of PPACA preventive care services) when only the oral fluoride supplementation was recommended for children in areas with fluoride levels below 0.6 ppm in the local drinking water. That recommendation remains, with the fluoride varnish added based on new research.

Both interventions are now recognized as “USPSTF B recommendations�, and therefore are required by the Affordable Care Act to be covered by insurers without out-of-pocket costs to the patient, as with all preventive care services that receive an A or B recommendation.

The target audience for USPSTF recommendations is primary care clinicians, who provide a wide range of health care services to children and adults. Although dentists can be considered primary care providers of oral health needs, for the purposes of this recommendation statement, a primary care clinician or primary care provider is defined as a non-dental health care professional (e.g. physician or nurse practitioner).

ACTIONS: Employer plan sponsors should consult with their agent, broker, plan consultant, legal counsel or human resources department to determine if and when any contract changes are required to satisfy the new preventive services requirement for fluoride varnish treatments. They should also ensure that their employee notifications properly inform plan participants of any changes. Insurers will need to review their plan offerings to ensure compliance.

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HEALTHCARE CONSUMERISM NEWS BRIEFS

HealthEquity Surpasses One Million Health Savings Accounts Now more than ever, Americans realize the power of health savings accounts to thrive in the changing health care scene and save for the future while reducing tax liability today. HealthEquity, one of the largest HSA non-bank custodians, has announced it now manages over one million health savings accounts. HealthEquity was founded in 2002, approximately one year before HSAs became law. The company was founded with the vision to help consumers to make more informed health care saving and spending decisions.

consulting on best-in-class worksite wellness, provides employers a unique and powerful tool to achieve their desired outcomes.

AmWINS Group Benefits Creates Self-Funding Practice and administrative services, has formed a comprehensive SelfFunding Practice that brings together expertise from all operating companies under the divisional brand and will be dedicated solely to providing consultative products and administrative services Self-Funding Practice to provide the most comprehensive suite

HealthEquity has empowered millions to build health savings for the short and long term.

market. In addition to providing support services for companies that

ShapeUp and Hewlett-Packard Extend Strategic Corporate Wellness Partnership

can provide strategic counseling services to companies that are contemplating switching from a fully insured plan.

ShapeUp, the leading global provider of social networking and incentives-based employee wellness solutions, has announced Hewlett-Packard has renewed its contract for another three years.

The extension of HP’s current contract includes tools and updates to encourage more global participation in ShapeUp’s ongoing wellness offerings. Through the duration of the contract, ShapeUp will partner with HP to promote wellness across HP’s global workforce using a combination of engagement methods, including annual global wellness challenges, crowd-sourced content that enables HP employees to provide healthy insights to one another, mobile apps to engage employees on the go and lifestyle programs.

ConnectYourCare and Castlight Health Partner to Help Employers and Employees Better Manage Health ConnectYourCare has announced a partnership with Castlight Health, a leading provider of cloud-based software for health care.

With this partnership, ConnectYourCare’s health savings account data will be integrated into Castlight’s Enterprise Healthcare Cloud technology platform, providing ConnectYourCare mutual customers employers can better manage enterprise health care spending and employees and their families can better manage their health

New “Pay or Play” Tools from Unum Help Businesses Evaluate Next Steps in Health Care Reform

services; and make decisions that enable them to get maximum

A new collection of tools will help employers navigate through the next crucial decision regarding health care reform — whether to offer health coverage to employees or pay a penalty instead. The tools from Unum are additions to a suite of materials that offer

ConnectYourCare with Castlight gives employers another means

Employers with 100 or more employees must make the health care pay or play decision in time for employees to begin receiving coverage in 2015. Employers with 50-99 employees are exempt from the mandate until 2016.

Grady Health System has chosen Healthstat, Inc. to administer and manage an onsite health and wellness program for more than

Group Health to Provide RedBrick Health’s Health Engagement and Behavior Change Platform to Clients RedBrick Health, a fast-growing leader in consumer health engagement and behavior change technology, and Group Health, advanced wellness solution suite, powered by RedBrick, is available to the employers of Group Health for their entire population, including Group Health members and non-members. Through this the RedBrick platform to drive healthier behaviors, better health outcomes, higher productivity and lower overall costs in their populations. The RedBrick platform, combined with Group Health’s

promote sound health care management practices.

Healthstat Selected by Grady Health System to Manage Employee Health and Wellness Program

to operate a comprehensive program that will continue to improve employee health and further reduce costs associated with Grady’s health plan. Grady is one of the largest public safety net academic medical health systems in the United States and the premier level I trauma center for Metro Atlanta. Operating more than 300 workplace health and wellness centers nationwide, Healthstat is one of the country’s leading providers of onsite primary care, health-risk intervention, chronic care management and occupational medicine in employer facilities. Grady’s onsite health center will provide employees access to disease management, health risk counseling, and acute and urgent care.

continued on page 10

HealthCare Consumerism Solutions™ I www.TheIHCC.com I May/June 2014

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HEALTHCARE CONSUMERISM PEOPLE ON THE MOVE

Briefs, continued from page 9

Alegeus Technologies Names Steve Auerbach Chief Executive Officer

Castlight Health Appoints athenahealth COO Ed Park to Board of Directors

Alegeus Technologies recently announced that Steven Auerbach has

Castlight Health has appointed Ed Park to its board of directors.

board of directors. Auerbach brings over 25 years of experience in senior leadership positions with UnitedHealth Group, ChannelPoint and Cigna. With a singular focus on making customers successful, Auerbach has a proven track record of driving organizational growth by offering differentiated value, providing excellent customer service, and creating an outstanding consumer experience. Auerbach will report to Bob Natt, executive chairman of Alegeus.

Hooper Holmes Introduces New Management Team Hooper Holmes has announced two new senior executive appointments, completing the consolidation of operations at the company’s new headquarters in Olathe, Kansas. Tracy D. Mackey has been appointed general counsel and corporate secretary and David N. Rexroat has been appointed senior vice president, health and wellness products and operations. Mackey has been a trusted legal advisor on a wide range of corporate legal issues for more than federal securities laws, mergers and acquisitions, and business where, as managing partner, he created a secure, tablet-based application to automate employer-based health screenings and vaccinations.

athenahealth. Park has served as an advisor to Castlight’s board of directors. In his expanded role serving on Castlight’s board of directors, Park will contribute his expertise scaling a company that works at the intersection of technology and health care. Park is widely recognized as a thought leader in health information technology, having served as the lead architect for athenahealth’s respected cloud-based services platform.

Employee Benefits Expert Julie Devine to Head Client Services at Maxwell Health and professional services, starting in human resources and moving

compliance. At Maxwell, Devine will manage and scale the service and support teams as the company continues its rapid growth, ensuring a consistently positive experience for our broker partners at HighRoads, serving early on as a manager/director and ultimately she managed the delivery and operational team for the employer business.

HEALTHCARE CONSUMERISM RESEARCH, SURVEYS & REPORTS

Greater Health Care Price Transparency Could Save $100 Billion Over 10 Years Providing patients, physicians, employers and policymakers more information on health care prices could reduce U.S. health care spending by an estimated $100 billion over the next decade, according to a new analysis from the Gary and Mary West Health Policy Center. Most health care transparency initiatives focus solely on providing patients with information on out-of-pocket costs. As a result of the analysis, the West Health Policy Center announced that it is in the process of contracting with the University of New Hampshire to create a Manual for APCD Development. The University of New Hampshire and the National Association of Health Data Organizations supports and staffs the APCD Council, which, since its inception in 2007, has worked with many states to facilitate the planning and implementation of state-based APCDs.

Colonial Life White Paper Says Small Businesses Can Offer Big Benefits Although employees of small businesses share the same interests and

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the message of a white paper released recently by Colonial Life & Accident Insurance Company. The new research document, called small business employers and employees regarding their workplace and employee recruitment and retention. Using proprietary and industry research, the white paper focuses on companies with fewer than 100 employees.

Change Healthcare Q4 Healthcare Transparency Index Shows Widely Varying Prices for Health Care Services Change Healthcare’s latest quarterly Healthcare Transparency Index shows nine medical procedures with high costs and price variances as high as 796 percent. Even within a given network, charges for pharmacy, medical and dental services often vary by more than 300 percent. Imaging services were the leading area for cost reduction opportunities for plan sponsors and consumers. From an analysis of a database including more than 180 million insurance claims from Q4 of 2013, Change Healthcare found CT scans varied 796 percent from $307 to $2,747 per scan, with an average cost of more than $1,200. Ultrasound costs varied by 411 percent.

already moved their employee population into a private exchange, or are planning to in the highest adoption rates, according to recent research published by Alegeus Technologies.

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IHC FORUM & Expo Hits Largest Number of Attendees

as Industry Validates Health Care Consumerism Photos by Sharewik

T

he Institute for HealthCare Consumerism “This year’s FORUM & Expo brought is excited to announce that its 2014 together a wider range of stakeholders FORUM & Expo reached a record number of attendees with approximately 800 employers, in the health care system than ever brokers, consultants, vendors, physicians and other before in this event’s five-year history. stakeholders present at the Atlanta conference.

The event began on the afternoon of May ‌In addition, a general theme of the 7 when two leading health economists — John conference was that we are moving away Goodman, National Center for Policy Analysis, and from strictly health insurance reform into Kenneth Thorpe, Emory University — debated the future of health care reform, representing opposing the era of true health care reform. sides of the aisle respectively. The keynote event attracted considerable attention from both attendees and outside policy groups.

For the first time in its five year history, The Institute for HealthCare Consumerism’s anchor event included the theme, leading consultant John Young, chief executive officer, Consumerdriven perspectives of leading physicians on how to improve LLC, moderated a general session panel on private exchanges that included Reese the U.S. health care system. Through a partnership with Feuerman, CFO, ConnectYourCare; Christopher Goff, CEO, Employers Health; Don advocacy group Docs 4 Patient Care, the conference Garlitz, executive director, Exchange Solutions, bswift; and Barbara Gniewek, principal, featured both a pre-conference workshop and general PwC. session on what physicians see as the major barriers With over 60 sponsors — including platinum sponsor ConnectYourCare and to reducing cost and empowering patients to be true gold sponsors WageWorks and HealthSparq — the premier health care consumerism consumers of health care. conference also reached a new milestone for number of sponsors. “This year’s FORUM & Expo brought together a With the completion of the fifth annual FORUM & Expo in Atlanta, The Institute wider range of stakeholders in the health care system for HealthCare Consumerism now turns its focus to the West Coast version of the event than ever before in this event’s five-year history,â€? said to be held once again at the Red Rock Resort & Spa in Las Vegas. The 2014 FORUM Doug Field, chief executive officer and founder, The West event will be held from November 11-12 — with pre-conference on November Institute for HealthCare Consumerism. “Health care 10 — placed strategically after the crucial mid-term congressional elections. consumerism has clearly established itself as having a major role in the future of the U.S. health care system. In addition, a general theme of the conference was that we “I found the Health & Wellness Lounge to are moving away from strictly health insurance reform into the era of true health care reform.â€? be educational and very interesting. I got Among other hot topics discussed at the conference good information from the panels held was the emergence of private health insurance exchanges as a major disruptive force in how employer-sponsored throughout the conference.â€? health care is administered and delivered. In addition to multiple pre-conference sessions that addressed this — Sandie Cooper, COO at TRIFLEX Corporation 12 May/June 2014 * XXX 5IF*)$$ DPN * HealthCare Consumerism Solutions™

“This was one of the most engaging conferences I’ve been to in a long time.”

— Cindi Gatton, Principal, Cynthia R. Gatton & Associates, LLC

“All of the sessions were great that I attended. The most useful were on the private exchanges and the legal updates.”

— Robyn Wegner, Benefits Director at Cardinal Glass Industries

“I enjoyed the general sessions the most. The topics were interesting and speakers were engaging.”

—Jaime Magarity, Marketing Manager, United Healthcare

HealthCare Consumerism Solutions™ I www.TheIHCC.com I May/June 2014

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BY CHERYL LARSON

STATS & DATA

VICE PRESIDENT MIDWEST BUSINESS GROUP ON HEALTH

I

t’s predicted that specialty drug costs are estimated to make up about 67 percent of an employer’s total pharmacy spend by 2015, making it crucial for businesses to understand how to manage this challenging benefit. To support employers in this area, we’ve been conducting research and educational programs, developing online tools and testing strategies via employer demonstration pilots, with the intent of educating purchasers on how to address challenges and identify new approaches to benefit plan design and vendor contracting.

The Midwest Business Group on Health’s third annual survey was conducted late last year and found that employer understanding of biologic drugs and specialty pharmacy is growing by small increments.

The survey also showed that while employer involvement in managing specialty drugs continues to be low, their understanding of what costs are paid through the medical benefit is increasing. At the same time, employers indicate they are still only minimally aware of the cost increases their company has incurred over the past three years.

Employers also noted that top business goals include: 1. reducing drug acquisition costs, 2. reducing inappropriate utilization, 3. improving adherence/ compliance, 4. reducing variability between pharmacy and medical plan designs, and 5. improving productivity.

For the third consecutive year, case management leads the list of employer tactics used to address the above goals, followed by benefit coverage coordination for pharmacy and medical and drug utilization.

Level of involvement in managing specialty pharmacy benefits Moderate: Work collaboratively with consultant/PBM/healthplan

35%

Minimal: Rely primarily on consultant/PBM/health plan

27%

Significant: Work collaboratively and are very involved but do not lead Very significant: Internal staff is wholly involved in all aspects, including leadership of the activity 9

26%

Respondent level of understanding of specialty pharmacy benefits 3 Years 2011

Medium

2012

53%

Above Average

48%

Average Low

25%

High

10% 6%

0%

50%

100%

50%

22%

Average

17%

Below Average

5%

Low

0%

0%

0%

56%

High

22% Low

7

Above Average

36%

Below Average High

2013

100%

0%

50%

100%

Copyright © 2014 MBGH/IIR

Step therapy, prior authorization and preferred products/formulary for some drugs also continue to rank high. However, respondents indicate seldom utilization of a limited fill supply strategy despite indicating it as effective (39 percent) or somewhat effective (29 percent).

This year’s survey also revealed employers are heavily focused on cost-shifting strategies to manage rising costs (e.g. use of multiple drug tiers, coinsurance and traditional plan design strategies). With 25 percent of respondents indicating employee maximum out-of-pocket costs of more than $2,000 per Rx fill, this is yet another indicator of shifting costs to their covered population. This is a significant increase from last year’s survey which indicated only six percent who had OOP costs of over $2,000.

Seventy-five percent of employers are also requiring employees use a specialty pharmacy, and 73 percent are incentivizing them for using one. However, there are minimal or no incentives offered for lower cost site-of-care options such as home-based infusions.

With no industry changes in sight to reduce drug acquisition costs, the MBGH project is focused on supporting employers in managing what they can control such as benefit plan design, working more effectively with their PBM and encouraging implementation of “low-hanging fruit” strategies designed to impact adherence, quality of care and other key outcomes. To support employer efforts, MBGH has developed a no-cost toolkit for employers at www.specialtyrxtoolkit.com.

7% Copyright © 2014 MBGH/IIR

HealthCare Consumerism Solutions™ I www.TheIHCC.com I May/June 2014

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BY MIKE REHA, CEBS

STATS & DATA

DIRECTOR OF SALES AND MARKETING EPIC HEARING HEALTH CARE

T

he impact of hearing loss on today’s workforce is far larger than most employers realize and is likely having a significant impact on organizations’ bottom line.

According to a recent research survey by EPIC Hearing Health Care, more than one in ten employees have a diagnosed hearing problem for which they are already seeking treatment and almost one-third (30 percent) of employees suspect they have a hearing problem, but have not sought treatment.1 (See chart.)

Of those with untreated hearing loss, nearly all (95 percent) report that this hearing loss impacts them on the job. The most common complaint is having to ask people to repeat what they said (61 percent), followed by straining to understand a conversation when there is background noise or other people are talking at the same time (57 percent). Additionally, 42 percent say they often misunderstand what is being said; 40 percent admit they sometimes pretend to hear when they cannot; and 37 percent of employees report trouble hearing over the phone.

Strain from untreated hearing loss can not only negatively influence an employee’s work product due to issues with communication, it can also take a further toll on the employee’s health and well-being by causing excessive anxiety and stress, even contributing to depression.2 This is unfortunate, given that today’s hearing aids have advanced significantly so that people with mild to moderate, and even severe, hearing loss can function as well as the general population.

Hearing Health Among Full-time Employees Healthy Hearing 30%

Diagnosed Hearing Problem 58% Suspected, Untreated Hearing Problem

12%

2013 Listen Hear! Employee Survey

16 May/June 2014 * XXX 5IF*)$$ DPN * HealthCare Consumerism Solutions™

But EPIC’s research shows that classic barriers for employees seeking care remain, including stigma and financial concerns. Consider that nearly half of employees say they would be concerned about their employer suspecting or knowing he or she has hearing loss. Add onto this the shock of the high cost of hearing aids, especially when most employees realize their medical plans do not cover these costs. According to the National Institutes of Health, the average price of a digital hearing aid is about $1,500, but can be as high as $3,000-$5,000.

Employers have a unique opportunity to both show their support of hearing health care (reducing stigma) and help employees overcome financial obstacles by offering supplemental hearing health insurance. These plans can provide access to a robust network of hearing professionals for yearly checkups, as well as substantial savings on hearing aids from major manufacturers for a very reasonable monthly cost of $.35 to $1.75 per member.

If employees are offered health savings accounts or flexible savings accounts,employers can also educate employees that hearing aids are eligible expenses. By using hearing aids as an example of an eligible expense during open enrollment presentations, employers can help bring further attention to this type of financial assistance.

The bottom line is that as employers serve to guide employees through their health care options, hearing health care should be a priority. By showing support for hearing loss treatment, employers can help employees achieve a better quality of life, while preventing the health- and productivity-related consequences of untreated hearing loss.

May/June 2014

Exchange Connecting the Dots Between Private Exchanges and Wellness Are you asking the right compliance questions?

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INSIDE

FEATURE 11 Connecting the Dots Between Wellness and Private Exchanges As private health insurance exchanges continue to capture the attention of forward-thinking employers, advisors, health plans and other stake holders across the country, many have rightfully posed the question: will these exchanges actually deliver on the promise of a sustained reduction in employer health care spend?

While early customer data from Mercer and Aon Hewitt indicates that private exchanges have been effective in reducing costs in the short term, the jury is still out on private exchanges as a viable, long-term solution. However, among many of the emerging exchange experts, there has been a consensus forming that population health management will be an essential component of any effective private exchange solution.

In a continuation of our panel series on private exchanges, we asked five private exchange thought leaders to discuss the role of wellness in the realm of health exchanges.

7 Private Exchange Profile Customizing the Health Insurance Shopping Experience With private health insurance exchange enrollment projected to reach 40 million people by 2018, health plans are not thinking if they should offer employers private exchanges so much as how they will implement them and what 4 Publisher’s Letter CEO/Publisher Doug Field covers the latest trends in private exchanges and shares what’s happening at The Institute for HealthCare Consumerism around exchanges.

they’ll look like. The driving factor? Cost — to employers, their employees and the entire health care industry.

By Jeff Yaniga, VP of Exchanges, Connecture

9 Legal & Compliance Are You Asking the Right Questions?

Many of the private exchange strategies that employers are currently examining 5

Briefs & Innovations Keeping you up-to-date with the latest news, research and innovation in de ned contribution and health insurance exchanges.

DEPARTMENTS contemplate a private exchange offering “fully-insured” group health plans. Here, the employer contracts with an insurance company, effectively shifting all of the health risks of its employees to the insurer.

However, a private exchange may be utilized to offer “selfinsured” group health plans to employees, which allows the employer to continue to control and manage the employees’ utilization of health care.

By Chris Condeluci, Counsel, Venable LLP

HealthCare Exchange Solutions™ I www.TheIHCC.com I May/June 2014

3

PUBLISHER

Exchange www.theihcc.com VOLUME 10 NO. 3 | MAY/JUNE 2014

Looking at the Complete Picture of Private Exchanges

Published by FieldMedia LLC 292 South Main Street, Suite 400 Alpharetta, GA 30009 Fax: 770.663.4409 CEO

Doug Field @ theihcc.com MANAGING DIRECTOR

At the recently completed 2014 FORUM & Expo, health exchanges were predictably a hot ticket item. Although private exchange adoption still remains relatively low, employers and brokers are seriously examining whether an exchange is right for them or their clients.

At a general session panel featuring experts from bswift, Employers Health, ConnectYourCare and PricewaterhouseCoopers, a common theme developed: employer-sponsored wellness initiatives will continue to have an important role in the era of health exchanges. And all exchange solutions should be seriously looking at how they will incorporate the health management aspect into their model.

Brent Macy

MANAGING EDITOR

Jonathan Field

SENIOR EDITOR

Heather Loveridge hloveridge@theihcc.com ACCOUNT MANAGER

Joni Lipson

MARKETING COMMUNICATIONS MANAGER

Lana Perry

In this pages of this issue, we’ve brought together a number of private exchange thought leaders to discuss how private exchanges and workplace wellness will continue to evolve symbiotically over the coming decade. Many thanks to John Kaegi, Healthstat; Brad Wolfsen, bswift; Sherri Bockhorst, Buck Consultants; Nancy Scola Lombaer, Laurus Strategies; and Stephanie Pronk and Mike Christie, Aon Hewitt, for their contributions.

During the week of FORUM & Expo, The Institute for HealthCare Consumerism also made a signi cant announcement regarding updates to its industry-leading private exchange resource, PrivateHealthCareEXCHANGES.com. Following a brief hiatus, the Web site is now updated with over 145 private exchange solutions and a new blog. Access to the database is now available to the public for a one-time $99 fee.

And nally, remember that nominations are currently open for the 2014 HealthCare Consumerism Superstars awards. In 2013, we launched “The Most Effective Private Exchange Implementation” award for employers, brokers or solution providers that have had considerable success with a private exchange.

ART DIRECTOR

Kellie Frissell

GRAPHIC DESIGN

Patrick Washington 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 Group; John Hickman, Alston+Bird LLP; Tony Holmes, Sanders McConnell, TSYS Healthcare; Roy Ramthun, HSA Consulting Services LLC; John Young, Consumerdriven LLC WEBMASTERS

Kevin Carnegie

After awarding Darden Restaraunts, PrimePay and Analysts International Corporation the initial exchange awards last year, we’re looking for another three recipients for 2014. You can nominate a colleague, partner, client or vendor by visiting our homepage. Nominations close on August 15, and winners will be announced at the 2014 FORUM West in Las Vegas this November.

Tom Becher ASSOCIATE WEB ADMINISTRATOR

Tim Hemendinger

DIRECTOR OF CONFERENCE SPONSORSHIP/ CORPORATE MEMBERSHIP/REPRINTS

Rogers Beasley

Sincerely, BUSINESS MANAGER

Karen Raudabaugh

Doug Field CEO/Publisher dfield@fieldmedia.com

™ Volume 10 Issue 3 Copyright ©2014 by FieldMedia LLC. All rights reserved.

™ is a trademark of FieldMedia LLC. ™ is published eight times yearly by FieldMedia LLC., 292 South Main Street, Suite 400, Alpharetta, GA 30009. Periodical postage

TO SUBSCRIBE: Make checks and money orders payable to ™ magazine 292 S. Main Street, Suite 400, Alpharetta, GA following rates: single copy $7.50; $75.00/yr in the U.S., $105/yr in Canada and $170/yr international. Please contact FieldMedia at 404.671.9551 or PRINTED IN THE U.S.A. ™ is designed to provide both accurate and authoritative information with regard to the understanding that the publisher

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Send letters to the editor and editorial inquiries to the above address or to

4

May/June 2014 I www.TheIHCC.com I HealthCare Exchange Solutions™

NEWS BRIEFS & INNOVATIONS

NEWS BRIEFS WageWorks Tapped as Provider of Consumer-Directed Benefits for Liazon Private Exchanges

employees. Employees can shop the AultCare Choices Marketplace using those funds, choosing their insurance from a range of medical, dental and visions plans.

WageWorks, Inc. has announced an agreement to be a national administration partner for flexible spending accounts, health reimbursement arrangements and health savings accounts for the Bright Choices Exchange® and other private exchanges powered

by Liazon Corporation. Liazon helps employers save money on their health care costs by setting predictable budgets while allowing employees to personalize their bene ts package with a selection of health, dental, vision, life, disability and other bene ts. As a national partner, WageWorks’ consumer-directed bene ts will be offered to employees via Liazon’s private exchanges throughout the United States.

HDH Group Launches Your SelectBenefits

Utah’s Avenue H Pioneers Small Business Health Care Exchange with PlanSource Technology

Principal Financial Group® announces an agreement with Liazon’s Bright Choices® as the rst private exchange access point for employer-sponsored group bene t plans. The Bright Choices Exchange is a private bene ts exchange where an employer can choose how much to spend each year on bene ts, then each employee determines how to spend their share of the money.

Through this exchange, The Principal will offer all ancillary group bene ts, including, dental, life insurance, disability insurance and critical illness.

PlanSource has announced that it successfully powered the rollout of the online health insurance marketplace and bene ts shopping platform for Utah’s small business health care exchange, Avenue H. Since 2010, Avenue H has helped Utah’s small businesses control costs and simplify their bene ts management, while offering expanded health coverage options to their employees. After three years, however, state of cials knew they needed to improve the ef ciency of their enrollment process, especially the manual intervention dictated by participating insurance carriers and the nature of the state’s program. When open enrollment for the Health Insurance Marketplace started on October 1, 2013, Utah of cials saw it as an opportunity to update their processes on a single endto-end solution.

Bloom Health Names Anudeep Parhar as Chief Technology Officer Bloom Health has announced the hiring of Anudeep Parhar as its chief technology of cer. Parhar will lead Bloom Health’s technology strategy including deployment and management of current technologies and evaluation, optimization and deployment of future platform tools. He will also oversee project de nition, engineering and platform development on Bloom’s technology stack. As a member of the executive leadership team, Parhar will help drive overall company strategy and future direction. Parhar has held leadership positions at companies in the Twin Cities including Digital River, Blue Cross and Blue Shield of Minnesota and Thomson Reuters.

AultCare Offers AultCare Choices Marketplace To Employer Groups Through ConnectedHealth AultCare, one of the largest hospital-based preferred provider organizations in the Midwest, has partnered with ConnectedHealth to launch AultCare Choices Marketplace, a consumer-focused e-commerce bene ts platform. With AultCare Choices Marketplace, the company’s employer clients will be able to set the contribution amount they want to allocate for each category of bene ts-eligible

The HDH Group has announced the availability of its new private exchange, Your SelectBene ts™. This online marketplace provides mid-size employers a comprehensive solution for better managing the costs and compliance requirements of their health bene t programs in the complex, post-health reform environment. It is the rst independent private health insurance exchange available that includes plans from Highmark and UPMC, along with other leading carriers.

The Principal Signs Private Benefits Exchange Agreement

Krauter & Company Advances its Private Exchange Platform with Advisory Services Employers are looking for the most effective way to control health care spend while continuing to meet the needs of a diverse workforce; many are turning to private exchanges. However, the popularity and rapid growth of private sector exchanges has also resulted in confusion and hesitation for companies faced with tackling increasing health care costs. Krauter & Company’s Private Health Exchange Solution Platform provides an innovative and timely approach to identify which exchange meets the client’s best interests while also evaluating more traditional strategies. With multiple established private exchange partnerships in place, Krauter & Company’s Exchange Services provides clients with a side by side analysis of traditional plans and multiple exchanges.

Benefit Express Releases Defined Contribution System, My Benefit Shoppe Bene t Express Services, LLC has released My Bene t Shoppe, a de ned contribution market for employee bene ts enrollment. When employers determine the money they will allocate to their employees for their annual bene ts, they can better predict and control their costs. Employees then log-in into My Bene t Shoppe, and through the de ned contribution approach, they can use credits to spend on the bene ts that they choose. With My Bene t Shoppe, employees may purchase insurance such as health, dental, life, disability and much more. Any amount in excess of the de ned contribution is taken from payroll deductions.

HealthCare Exchange Solutions™ I www.TheIHCC.com I May/June 2014

5

HE AL

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N

PRIVATE EXCHANGE PROFILE

Customizing the Health Insurance Shopping Experience

BY JEFF YANIGA » VP OF EXCHANGES » CONNECTURE

With private health insurance exchange enrollment projected to reach 40 million people by 2018, health plans are not thinking if they should offer employers private exchanges so much as how they will implement them and what they’ll look like. The driving factor? Cost — to employers, their employees and the entire health care industry.

According to the Kaiser Family Foundation, health insurance premiums increased 160 percent during the past 12 years, far surpassing inflation that climbed 33 percent during the same period. That’s a strong basis to seek a smarter approach to health insurance coverage and control cost.

While the majority of employers used to feel health insurance was necessary to stay competitive, now less than half feel this way; 30 percent welcome the opportunity to shift these costs to employees and 24 percent to the government (Source: Harris Interactive).

The once sacred health insurance bene t is being viewed in a completely different way by employers today and trending that way in the future.

So the question is how should brokers, bene t consultants and health plans adapt? The answer is to make shopping for and purchasing health insurance easy, to offer value to the employer and their employees, and to build loyalty.

Connecture’s One Marketplace: An Intuitive Health Insurance Shopping Experience Connecture, Inc., a provider of Web-based information systems used to create health insurance marketplaces, has a unique view of the individual, leading to an easier and ultimately more costeffective health insurance shopping experience. Through its One Marketplace strategy – based on 15 years’ working with multiple plans, government entities and agents representing employers, and with successful experience integrating with other complex systems — Connecture tracks one record for each individual throughout their coverage history.

That means if employment status changes, coverage options shift, or someone moves from an individual to a family plan, they do not need to start from scratch. In fact, One Marketplace is built on the idea that all health insurance channels should be available to the consumer, either through their employer or directly.

How does it work? Depending on the employer, there are many private exchange options ranging from one designed to provide

health coverage through a single health plan with a de ned contribution to a much broader option that covers retirees, individuals and groups for health and ancillary services through a combination of partners with both a de ned contribution and de ned bene t option. Employers may also offer a health savings account.

Once in the exchange, consumers have a personalized shopping experience that tracks the degree to which they would like to interact, provides pre-loaded elds for convenience, and conducts cost-saving analysis that alerts consumers to things like upcoming Medicare options based in their age. Decision support questions are personalized for the user’s “season in life” and uncover recommendations for voluntary and ancillary products as well as medical products. Connecture’s marketplaces include easy-to-use decision support tools, such as click-to-chat/call, physician search, and an out-of-pocket cost calculator to determine overall cost – not just the monthly premium.

Connecture’s One Marketplace technology and analytics also recognize that some consumers are hesitant when shopping online for health insurance, especially for the rst time, and allow them to come back as often as necessary before making a purchase.

Health insurance is a signi cant nancial commitment, so it is critical the shopping experience is a good one and consumers feel empowered to do what’s right for them.

For the employer, private exchanges open up new channels for part-time workers and retirees, even as they move away from providing health care. But private exchanges should not be considered a short-term nancial cost curve strategy — they involve a major shift in behavior, transparency and a commitment to ensuring an experience for employees that is not intimidating.

Most employers want to get out of the health bene ts business to save money. This can be achieved by partnering with health plans that can provide an intuitive private exchange platform and guidance on how to make the best health coverage decisions. This will ultimately save money for employers and their employees, and impact nationwide health costs over time.

HealthCare Exchange Solutions™ I www.TheIHCC.com I May/June 2014

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LEGAL & COMPLIANCE

BY CHRISTOPHER E. CONDELUCI COUNSEL VENABLE LLP

Are You Asking the Right Questions?

M

any of the private exchange strategies that employers are currently examining contemplate a private exchange offering “fully-insured” group health plans.

Here, the employer contracts with an insurance company, effectively shifting all of the health risks of its employees to the insurer. However, a private exchange may be utilized to offer “self-insured” group health plans to employees, which allows the employer to continue to control and manage the employees’ utilization of health care. Interestingly, regardless of whether a fully-insured or self-insured employer chooses to partner with a private exchange, the legal obligations are essentially the same as they are today.

Tax Treatment of Employer Contributions Even if an employer adopts a “de ned contribution” funding strategy, the contributions used by an employee to purchase a health plan (fully-insured or self-insured) through a private exchange may be deducted by the employer as an “ordinary and necessary” business expense. These employer contributions are also not taxable to the employee for income and FICA tax purposes.

And, employee contributions for coverage under the plans may be made on a pre-tax basis through a Code section 125 cafeteria plan.

Obligations Under the Employee Retirement Income Security Act Regardless of whether an employer is offering fully-insured or selfinsured group health plans through a private exchange, the employer is subject to all of ERISA’s requirements (e.g., ERISA’s reporting and disclosure requirements, duciary responsibilities, and claims procedures).

In the case of a self-insured employer partnering with a private exchange, the employer would continue to enjoy “ERISA preemption,” which means, among other things, the self-insured employer would not

pay state premium taxes and the employer would not be required to comply with state insurance laws that mandate that certain bene ts be offered under the plans.

State Insurance Laws Speaking of state insurance laws, fully-insured group health plans offered through a private exchange would be required to comply with the bene t mandates in the state in which the health plans are issued (i.e., the “situs” state). Many states only require coverage of the bene t mandates of the “situs” state. However, some states require coverage of some or all of the “home” state’s bene t mandates, regardless of where the plans are sitused.

Note: fully-insured employers are required to pay premium taxes in all states in which their employees are working.

The Patient Protection and Affordable Care Act The ACA set forth new requirements applicable to both fully-insured and self-insured group health plans, and the plans offered through a private exchange must comply with these new rules. Regardless of whether an employer partners with a private exchange, an employer with 50 or more “full-time equivalent” employees remains subject to the “employer mandate”. In most if not all cases, the private exchange will help the employer offer an “affordable/minimum value” plan(s). Finally, the employer must comply with the “high-cost plan tax” in 2018.

What Issues Must an Employer Consider When Deciding to Partner With a Private Exchange?

As stated, employers are subject to ERISA’s duciary requirements, which means an employer deciding whether it should partner with a private exchange must determine whether the move is, among other things, in the best interest of its employees and for the exclusive HealthCare Exchange Solutions™ I www.TheIHCC.com I May/June 2014

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LEGAL & COMPLIANCE

purpose of providing plan bene ts, including defraying reasonable expenses of plan administration.

As a result, an employer must ensure that the fees charged for partnering with the private exchange are reasonable. If commissions are paid (in the case of a fully-insured private exchange), the employer should weigh whether these commissions are reasonable, and the employer should ensure that “steering” is not occurring (for example, in the case of a fully-insured multi-carrier exchange).

If an employer decides to partner with a single-carrier private exchange, the employer should ensure that the premium rates for plans inside the private exchange are competitive with plans sold outside of the exchange.

Finally, regardless of whether the employer will offer fullyinsured or self-insured plans, an employer must weigh whether a conflict of interest is present in cases where a bene t consulting rm is seeking to offer its private exchange capabilities to the employer’s employees.

Employers must also pay close attention to the terms of any contract. For example, is the contract a year-to-year contract, or does the contract require the employer to commit to a multiple year partnership? If the contract is multi-year, are there fees associated with terminating the contract before the end of its term? Are there reasons for early termination that do not trigger a nancial penalty?

For example, if the employer is partnering with a multi-carrier private exchange, can an employer terminate the agreement if one of the insurance carriers exits the exchange? If the contract runs through 2017, can an employer terminate its partnership if a state in which the employer operates elects to allow fully-insured large group plans to be sold through the ACA Exchange (because upon such an election, many of the ACA market reforms that are applicable to individual and small group coverage will apply to fully-insured large group plans sold inside and outside of the ACA Exchange (e.g., the new adjusted community premium rating rules)?

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May/June 2014 I www.TheIHCC.com I HealthCare Exchange Solutions™

Finally, in the case of contracting, the employer may consider obligating the private exchange to similar fiduciary responsibilities the employer is under (i.e., acting in the best interest of the employer’s employees).

Although this may prove dif cult from a contract negotiation perspective, the federal government itself may impose duciary obligations on private exchanges at some point in the future.

Are There Other Things to Consider?

In addition to the requirement to perform its “due diligence” before agreeing to partner with a private exchange, an employer must consider other dimensions of a private exchange. For example, does the employer simply want to offer “pre-packaged” health plans developed by the private exchange (or in the case of a fully-insured private exchange, plans developed by the insurance carrier or carriers working with the private exchange)? Or does the employer want to develop its own plan designs? What type of education tools and decision-support system does the employer want to deploy, and what is the level of customer services? For example, does the private exchange have a call-center with licensed professionals that may assist an employee who has questions during the shopping experience on the private exchange portal?

Although compliance issues associated with partnering with a private exchange are generally no different than the compliance issues today, when it comes to deciding whether to partner with a private exchange — and which private exchange company to partner with — a signi cant amount of thought must go into making any such decision. This is because the law requires it. Moreover, strategic thinking should be a part of any decision to partner with a private exchange to ensure that the features that the private exchange is offering provides the employer — and its employees — the best value.

CONNECTING THE DOTS BETWEEN PRIVATE EXCHANGES AND WELLNESS

Don’t Give up on Wellness in Lieu of an Exchange

BY SHERRI BOCKHORST, NATIONAL PRACTICE LEADER, HEALTH EXCHANGE SOLUTIONS, BUCK CONSULTANTS

As private exchanges continue to gain employer should be asking is, “How does our exchange address sustainability?” survey , 87 percent of employers believe that managing employee health is an important role of their organization. This is because only four health risk behaviors — lack of exercise or physical activity, poor nutrition, tobacco use and drinking too much alcohol — cause much of the direct and indirect health care costs (e.g. medical expenditures, lost productivity and workdays) in the United States.

In our view, private exchanges that are focused predominately

on competition among health plans to reduce premiums are missing the most sizable opportunity to reduce the cost of care: prevention. According to California Department of Managed Health Care enrollment reports, one in three members will not return to the same health plan in California the next year. Meaning even the most well-intended health plans may not have the member enrolled with them long enough to impact health and productivity.

That’s why we took a comprehensive approach to our private exchange solution — RightOpt. We address the varying health-related needs of all family members through what we’ve named “choose, use and improve”. While we offer a strong administration solution to support HealthCare Exchange Solutions™ I www.TheIHCC.com I May/June 2014

11

Connecting the Dots Between Private Exchanges and Wellness employee choice at time of enrollment, we also offer support to members during the year on how to use care appropriately and improve their health.

Our Working Well survey also showed that employers recognize value in extending wellness initiatives to family members of their employees.

Seventy-one percent of respondents — up from 65 percent in the 2010 survey — include family members in some aspect of their health and wellness programs. Through RightOpt, we personalize the experience for each family member based on that person’s health, age, gender, preferences and readiness for change. The result is that every family member is engaged in health-related decisions. The goal is to make it as simple as possible for individuals to access the information they need when they need it, using any handheld device or computer. Long gone are

60-page enrollment guides that gather dust.

Does it work? Our results show it does. Reducing health risks is a step that continues to gain momentum as wellness efforts mature — 84 percent of employers surveyed report medium to high impact for their step could mean you might be looking to unwind your exchange solution than simply shifting costs and reducing the health and productivity of your workforce, I encourage you (especially if you’re one of the 76 percent of supports continuing this momentum.

The Private Exchange Impact on Health Promotion

BY JOHN KAEGI, CHIEF STRATEGIST, HEALTHSTAT, INC.

their employees to share annual medical cost increases which tend to create wiser consumption of health care. Employees use health care more cost-consciously when they are directly exposed to the cost of insurance.

The future of health promotion may be brighter thanks to the expansion of private health insurance exchanges (or marketplaces).

Private exchanges are burgeoning as employer counterpoints to ObamaCare’s public exchanges, and Healthstat has created an interesting scenario about how private exchanges will

exchange assumes the responsibility for helping employees with plan selection and coverage issues, supplanting that role of the employer’s human resources department.

The resulting savings can fund additional

and become a windfall for health promotion.

Why Private Exchanges?

Compared to buying health insurance straight from insurers, private exchange platforms offer employers three advantages: 1. larger insurance pools that reduce the

thought unaffordable luxuries. Private exchange products will eventually include health promotion bundled with worksite health centers, alongside health insurance plan choices.

2. which their employees share more of the burden of increasing medical cost 3. Choice of more affordable health insurance plans bundled with other cost for their employees.

The opportunity to market efficient, bundled plans is enticing large benefits Walmart into the private exchange arena, and employers are quickly embracing the concept.

In 2013, an employer survey by the National Business Group on Health found that 30 percent from private exchanges by 2015. Employers are quickly realizing that private exchanges offer more protection from continuing medical

For example, employers can elect to bear the full burden of medical inflation, or they can constrain their contributions, forcing their employees to share annual medical cost increases which tend to create wiser consumption of health care.

The Role of Private Insurance Exchanges Bundled plans in private exchanges will offer employers more choice and improved productivity at lower costs. They can administer insurers resulting in expanded choice and improved risk pools, all the while increasing employee cost sensitivity.

For example, employers can elect to

create worksite cultures of health and well being. they can constrain their contributions, forcing 12

May/June 2014 I www.TheIHCC.com I HealthCare Exchange Solutions™

How Private Exchanges Help Employers services; their private exchanges will do the clinics and coaching that employers struggle to fund in addition to health insurance will become attractive uses for the money saved by private Private exchange clients will be able to afford more convenient, round-the-clock health care — plus provide incentives to engage in health promotion and behavior change and access to professional wellness coaching right on site. And the good news continues because worksite health access and promotion further reduces downstream health care costs. Perhaps more importantly, they will increase employee productivity while also creating an employer-of-choice reputation.

Net, Net Private exchanges are the product of American business ingenuity in the face of

unrelenting medical cost inflation. Most employers already believe that health promotion can provide relief from bloated insurance costs, implement them.

We believe that all health insurance will eventually be purchased through private exchanges because they offer a better economic value, including bundled health promotion services. We are excited about the prospect

of more affordable coverage and expanded health promotion promised by the emergence of private exchanges.

How the Emerging Private Exchanges Will Impact Employee Population Health

BY NANCY SCOLA LOMBAER, PARTNER, LAURUS STRATEGIES

The surge of interest in private exchange solutions is not technically related to the Affordable Care Act, though it has been a catalyst to employers reassessing the value of providing Financial through education and counseling as well as to insurance products such as life insurance, disability and wealth accumulation vehicles.

compliance and administrative complexity.

In order to navigate these changes, many employers are relying heavily on outsourced themselves from the management of the health plans. For some employers, this may be an eliminating employer-sponsored health plans at some point in the future.

The fragmentation of the employee population among multiple health plans caused by private exchanges will provide a variety of wellness, health management and coaching programs that may or may not be able to produce

A well-being program that is supported by both senior management and the culture of the company can produce positive results without the traditional linkage to the health plans.

Work-life balance – access to time savers, stress reducers as well as programs/policies that help employees about their work and community.

the private exchange offers fully insured plans, not the employer.

One strategy to ensure an ROI to the employer is to develop a broad well-being and their families that are already participating in the health plans.

being happy, healthy and prosperous. Laurus Strategies believes that these concepts can translate into an employee well-being program addressing the following categories: Health – physical and behavioral

By addressing well-being in the broad sense, employers can try to impact the root cause of poor health, low productivity and lack of engagement.

A well-being program that is supported by both senior management and the culture of the company can produce positive results without the traditional linkage to the health plans.

Defined Contribution Gives Employers a Path to Turbocharge Wellness Incentives

BY BRAD WOLFSEN, EXECUTIVE DIRECTOR, BSWIFT EXCHANGE SOLUTIONS

Private benefits exchanges currently dominate the conference and webinar circuit.

Despite the energy focused on converting the reality is that adoption remains relatively limited. exchange adoption is what to do with wellness.

Most cost-conscious managers have

invested significantly in developing and communicating their wellness initiatives.

Wellness is typically integrated with the annual enrollment cycle; in particular, premium-based wellness incentives — the most commonly used incentive for wellness — are closely tied to the corporate cost-sharing philosophy. As a result, many administrators view the separation of continued on page HCX 14 HealthCare Exchange Solutions™ I www.TheIHCC.com I May/June 2014

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Connecting the Dots Between Private Exchanges and Wellness Wellness, continued from page HCX 13

wellness management from plan design

wellness incentives can be better positioned vs.

contribution private exchanges for their active employees.

However, savvy exchange administrators are addressing this challenge in the marketplace by integrating configurable health risk assessments, biometric testing and wellness programming into their exchanges. By replicating some of these “common core” wellness solutions within the exchange format, administrators can

approach, employers communicate the employee dollar contribution, usually pegged at 20 percent

through the exchange’s aggregated purchasing, while not abandoning their legacy investments.

In addition, the recently released 2014 incentives are much more likely to drive engagement than are low-value incentives. In

value incentives, up to the 30 percent maximum, must communicate a doubling of contribution cost to employees who fail wellness goals.

that employers, in general, are moving away from wellness incentives that are embedded in plan designs and abandoning co-pay reductions and plan eligibility criteria in favor of premium credits or surcharges and cash incentives. By eliminating the plan design incentive, it is much easier to leverage the standard designs available Defined

transition to a high-value incentive program. A wellness incentive of 20 percent to 30 percent of plan value can easily be stacked on top of the employer funding commitment as an earn-up that employees receive for participating in wellness approach translates employee behavior directly

contribution

reframes

the

employers’ efforts to increase employee accountability for their healthy and unhealthy behaviors. While carefully evaluating the capabilities of private exchange operators, benefits managers should also consider exchanges as an opportunity to turbocharge their wellness incentives.

Employee Wellness in the Era of Health Insurance Exchanges

BY STEPHANIE PRONK, HEALTH TRANSFORMATION TEAM LEADER, AND MIKE CHRISTIE, SENIOR VICE PRESIDENT, NATIONAL EXCHANGE SALES, AON HEWITT

Health insurance exchanges have been a hot topic for the health care industry since the passage of the Patient Protection and Affordable Care Act. While the general public and media have been closely following the rollout of the public health exchanges, private health exchanges have also emerged, allowing employers to provide group coverage to employees through a competitive marketplace.

At the same time, managing employee health and wellness has become increasingly important as population health continues to decline. We know from experience and supported by research that employees with strong overall and 32 percent more likely to stay with the company. A highly engaged workforce provides better business results, including 21 percent higher productivity and 22 percent To manage costs and improve employee health, wellness programs, services and resources to creating a work environment and culture that makes being at one’s optimal health easy to incorporate into the daily work life.

Employers are also looking at forms of incentive designs that move from compliance-based incentives to a focus on commitment rewards that actually provide meaning and value to employees. Emerging examples include completing a preventive care exam that triggers a charitable contribution to pay for a preventive care exam of someone in need or addressing prolonged sitting with a movement break challenge that leads to being rewarded with a sit-to-stand workstation.

For a large portion of organizations, these wellness initiatives will continue to reside with the employer.

However, it will be important that private exchanges also 14

May/June 2014 I www.TheIHCC.com I HealthCare Exchange Solutions™

Employers are also looking at forms of incentive designs that move from compliancebased incentives to a focus on commitment rewards that actually provide meaning and value to employees.

have options for employers as it relates to keeping members healthy, reducing members at risk and managing the severity of disease. So how can an exchange facilitate more effective health and wellness programs?

Employers that move to private health exchanges have the opportunity to focus more on employee health versus health insurance. With standardized plan designs and multiple carrier options, private health exchanges let employers spend less time on plan design and focus more on the development and effectiveness of their population health strategies.

Additionally, in an exchange model, employees have more ownership, accountability and choice for their overall health care and greater clarity of the trade-offs they make.

Through greater transparency around the costs of care, they can better understand how their health and health expenses are connected.

We are already beginning to see these results play out. Of the 600,000 employees and their family members Aon Active Health Exchange, three-quarters of employees said they had a good understanding of how they share the cost of group medical coverage with their employer. In chose the health plan that offered the best value for them and their family, and 87 percent liked being able to choose among multiple carriers.

No matter how employers decide to fund health care insurance, whether through traditional approaches or through a private health exchange, employee health and wellbeing continues to be an important strategy for all U.S. and global businesses.

EXCHANGE SOLUTION PROVIDER MEMBER PROFILES

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 TECHNOLOGY: ADMINISTRATION & MANAGEMENT

A PRIVATE EXCHANGE THAT SIMPLIFIES HEALTH INSURANCE

INSUREXSOLUTIONS

10275 W. Higgins Road, Suite 500 Rosemont, IL 60018 855-563-6993 info@insurexsolutions.com www.insurexsolutions.com

The InsureXSolutions® private exchange offers employers a simplified role in the new health insurance marketplace. Employers with part-time workers or retirees, as well as small businesses can utilize this exchange to empower their employees to choose the health and dental insurance that best fits their personal and family needs. Employers can reduce costs and administrative tasks, while employees receive interactive support tools and personal guidance from our licensed insurance professionals. Available in select markets, InsureXSolutions is exclusively offered and operated

by Flexible Benefit Service Corporation (Flex). Contact your broker or consultant, call us directly at 855-563-6993, or visit www.insurexsolutions.com to learn more.

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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BY KIMBERLY LANDRY

VOLUNTARY BENEFITS

ANALYST, GROUP INSURANCE RESEARCH LIMRA

Four Vision Coverage Trends That Merit a Second Look

T

rends entice us because they can foreshadow the future, providing opportunities to prepare for what’s ahead and a plot a course accordingly. Annual research, like LIMRA’s, gives the industry a 3.

future opportunities and challenges.

Interpreting the results of trends research goes beyond merely tracking it and becomes a mix of art and science. This is especially true

The smaller the company, the less likely they are to conduct employee surveys. How do employers know what their employees want if they don’t survey them?

Employees understand the importance of a vision plan. In 2010, employees were asked why they chose not to enroll in vision coverage that was offered through their employer (medical, dental,

vision coverage lags behind medical and even some other voluntary end of the market.

4.

this coverage.

Younger employees are the most likely to say that they don’t need vision coverage. On the surface it seems a logical choice because eyesight worsens with age; but this shows that they aren’t as familiar with the preventive aspects of vision care. .

Employers understand the implications of a vision plan.

Employers also appear to underestimate the connection between eye health and overall health and wellness.

Consider that only 39 percent of small businesses with 10 to 19 employees offer vision coverage, compared with roughly 74 percent of these opportunity to convert non-users into users, given the right approach.

Here are four potentially limiting beliefs related to vision insurance coverage that, according to trends research, deserve a second look: 1.

Vision doesn’t have the potential for penetration that other of choice, nearly half of private employers offer vision coverage to employees, ranking it behind only dental and life insurance in terms Most employees (65 percent) say it’s important to have vision

2.

higher penetration.

Coverage is provided in response to demand. When

Employers mainly offer vision because they want to provide a wellvision coverage provides in terms of workforce health and productivity.

This could become a problem if employers decide to cut costs. Of small employers (those with fewer than 100 employees), 39 percent medical premiums increase rapidly, almost twice as many as the 22 percent that would consider eliminating medical coverage.

aren’t recognized as medically necessary it puts them in a position of vulnerability.

Recognizing the challenges in overcoming false perceptions about

regularly survey employees, while 47 percent said they do so “once in

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POPULATION HEALTH MANAGEMENT

BY YALE MILLER EXECUTIVE VICE PRESIDENT OF OPERATIONS AEGIS HEALTH GROUP

Population Health 2.0: Engaging Patients in the Age of the Consumer

T

he time has come for consumerism in health care. There has been no other period in our history when individuals were more empowered

In the most strategic use of the Web for managing population health, some highly evolved health systems are offering online portals that

responsibility for their own health.

From the rise of cost-sharing arrangements such as high-deductible health plans to the health insurance exchanges created as a result of the Affordable Care Act, consumers are increasingly being charged with making their own choices at all points along the care continuum.

are a hallmark of population health 2.0 because they go beyond collecting only clinical information, and they make a concerted effort to connect with consumers who aren’t yet patients. They do this through conscious engagement initiatives that support health monitoring, prevention and education programming, health risk reduction and other relevant initiatives.

These comprehensive population health portals are essentially “one-

This is good news for payers and employers.

Population health management — the fundamental concept behind the ACA — hinges on keeping people well and managing costly chronic conditions. If done right, health costs could hypothetically stabilize as more consumers stay out of the hospital. Under the ACA, hospitals and health systems are increasingly transforming themselves from enterprises offering services within four walls to accountable care organizations that

personalized health information tailored to their health risks, concerns and interests. They can track health improvements and biometrics such as weight, cholesterol and blood glucose as well as schedule classes, workshops and health screenings. Some health systems even offer online health coaching and syncing with health devices, such as Fitbits and Nike Fuel Bands.

outside the hospital. This reality makes hospitals and health systems ideal partners to create wellness programs that work.

screening devices, some hospitals are sending health professionals out to worksites and community events to reach consumers where they

Data Drives Population Health

and foster instant engagement with consumers by offering them almost instantaneous personal health reports and linking them on the spot to patient portals that can help them achieve their health goals. This also serves as an early-entry pathway for moving at-risk individuals to appropriate preventive or corrective care, such as health coaching or condition management.

In the age of accountable care, health systems are increasingly committed to embracing the population health 2.0 consumerism trend. In an independent study Aegis Health Group conducted last fall — our second year in a row — we found that the number of hospital leaders who rated

critical linkages with their local employers and community groups to identify health risks and manage consumers’ health through an ongoing outreach strategy. By collecting and tracking data about consumers with their informed consent, hospitals can proactively build relationships and develop tailored prevention and wellness services customized for each individual. The reach of the Internet helps facilitate this process.

According to Pew Center research: 60 percent of U.S. adults say they track their weight, diet or exercise routine; and 33 percent track health indicators or symptoms like blood pressure, blood sugar, headaches or sleep patterns using online or mobile tools.

46 percent attribute tracking to an overall change in their approach to maintaining their health or the health of someone for whom they are a caregiver.

40 percent say that tracking has led them to ask a doctor new questions or to get a second opinion from another doctor; and 34 percent say it has affected a decision about how to treat an illness or condition.

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from 18 percent in 2012 to 34 percent a year later. In addition, 21 percent said they planned to increase their outreach to employers in their area, and almost one-third said they have increased their formal population health management programs.

Despite the inevitable tweaks that legislators will make to the mechanics of the ACA, one thing will remain constant: consumerism employers, payers, patients and the health systems charged with keeping people healthy.

The Tech-Driven Revolution in Employee Health Management

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The Future of Workplace Wellness is Mobile, Social and Wearable

BY DR. RAJIV KUMAR, FOUNDER AND CHIEF EXECUTIVE OFFICER, SHAPEUP

Workplace wellness is being revolutionized by advances in technology, but it needs to happen faster. Consider this: most corporate wellness programs are still Web-based with no mobile access and rely on old-school tracking devices, such as digital pedometers.

But employees themselves are leveraging smartphones, mobile apps, wearable and wireless devices in droves. More than half of all Americans use a smartphone, almost every one of those smartphone users has downloaded a health-related mobile app, and tens of millions For employee wellness to be successful, it has to get in front of this trend.

Here’s an example. In 2013, my company, ShapeUp, designed and launched an updated corporate wellness platform that allows our participants to connect a variety of different mobile apps and devices such as RunKeeper, Fitbit, Bodymedia and Fitlinxx to our platform so that no matter what app or device they into a centralized location where they can view their progress, participate in challenges, receive personalized feedback, and earn rewards from their employer. We call this approach BYOA (Bring Your Own App) and BYOD (Bring Your Own Device) because it allows ultimate choose their favorite consumer products. We expect this platform to expand dramatically, allowing connections with hundreds and eventually thousands of different products.

But cutting-edge technology isn’t simply about gear and devices. The biggest technological trend of the past ten years has been social — using technology to create connections and unite us. And it’s what we’ve found to be the most powerful ingredient for engaging, effective and sustainable wellness programs.

Health interventions have traditionally taken an individualistic approach, focusing on one person at a time, often in targeted and stigmatizing ways. But by turning the paradigm on its head through group support, peer coaching, friendly competition and social accountability, people become more empowered to achieve their health goals. ShapeUp has proven, through published outcomes and millions of participants, that the combination of technology and social networking is the most effective way 36 May/June 2014 * XXX 5IF*)$$ DPN * HealthCare Consumerism Solutions™

to approach workplace health promotion.

to this future, and the rest would be wise to

here and it’s social, mobile and wearable. The most innovative employers are already adapting

that their employees are already 10,000 steps ahead of them.

Is the Hype Justified?

Do Wearable Fitness Devices Impact Health?

BY JONATHAN DUGAS, PHD, DIRECTOR OF CLINICAL DEVELOPMENT, THE VITALITY GROUP

One simply has to do a quick Google search a great deal of buzz lately. We wanted to see if the hype is real and examine who and how they are using wearable technologies. To that end, we conducted an analysis of three years’ worth of data to determine how prevalent the use of these devices are and if they indeed impact health.

As it turns out, people of all ages, weight and real-time data to track their physical activity.

Our member data shows that when incorporated as part of a broader structured program, there was a measurable change in behavior. However, the impact is greater when using devices paired with incentives, which was more likely to reduce key risks such as BMI and cholesterol levels. include: Over the three years of the study, smartphone and pedometer use

skyrocketed, while heart rate monitors and gym membership declined.

Pedometers and activity trackers are more popular with the older demographic (more than 30 percent are 35-44) and smartphones show an expectedly younger audience (almost 65 percent are ages 18-34).

A slightly larger percentage of women use pedometer/activity trackers (56 percent) and smartphone devices (51 percent), whereas heart rate monitors are more popular with men (52 percent).

Within the Vitality wellness program, a high proportion of those who use devices are overweight or obese — 67 percent of people who use a pedometer or activity tracker, 62 percent of those who use a heart rate monitor and 63 percent who use a smartphone are overweight. activities reduced their health risk factors

We’re Still Standing: Employers Fight Sitting Disease

BY FRAN MELMED, CONTEXT COMMUNICATIONS CONSULTING

Nine hours. That’s how many hours the average American spends Thanks to research stretching back as far as the ‘40s, we now know that time spent sitting is time doing us harm.

for more than four hours per day with an increased risk of earlier death.

If that’s not enough to stir you out of your seat, consider that sedentary behavior is linked to a two-times greater risk of diabetes, a 90 percent greater risk of cardiovascular disease, and an increased risk of obesity and a variety of cancers.

Unfortunately, for employer and employee alike, the focus on 30 minutes of moderate to vigorous daily activity doesn’t cut the risk. The gym won’t save us. With sedentary behavior, what’s needed are routine activity breaks of short duration scattered throughout one’s day.

Many employers are starting to tackle sedentary behavior within their wellness strategies. The growth in sales of treadmill desks and

Technology in Wellness Can Open Doors and Change Lives

shows the appetite. Yet at several hundred to several thousand dollars a pop, investment in these desks demands consideration. well-being of their employees, and the struggles they experience while seeking engagement and culture shift. we struck on the idea for Hotseat, a workplace wellness tool designed to defeat the chair, one person at a time. Hotseat uses a person’s smartphone to deliver a rotating, individualized schedule of two-minute activity breaks, based on each user’s activity preferences, calendar availability and desired times and hours of use. Every employee can select and initiate competitive challenges where they vie to be the last person standing, and family members and friends can play too, pulling in important and motivating health partners.

A two-month pilot with the American Heart Association showed excellent engagement and results. More than 250 employees and family members used Hotseat over a two-month trial period. At the end of the pilot, 78 percent remained engaged, 67 percent would recommend Hotseat to others, 67 percent took more activity breaks and 76 percent were more mindful of their time spent sitting.

Employing technology to beat the health hazards of technology?

Strange, but true.

BY SUE LEWIS, CHIEF PRODUCT AND STRATEGY OFFICER, STAYWELL

Technology, when applied properly and wisely, can improve the way we live and work. It can help us make better use of staff time and resources.

It can make people productive and processes more cost effective. It can also help us connect and communicate with people and is dramatically changing how we engage individuals in their personal health management and employer-sponsored wellness programs.

While technology is being used to boost participation in wellness

improvement, reducing their factors by 22 percent.

Incentive structures built around daily step counts motivated members to reach thresholds.

In 2013, activity trackers generated an estimated $290 million in U.S. retails sales, according to the NPD Group, who says the market could double in 2014. Vitality was an early adopter of integrating devices as wellness programs to integrate heart rate monitors. The program now works with more than 100 unique devices.

As these technologies evolve, Vitality will continue to monitor and track (pun intended) the impact of these devices and tweak our program designs accordingly to drive the most impact on health. Additional details can be found in our new wearable devices technical brief.

1.

2.

Social or peer-to-peer apps: Whether it’s mobile apps, a Webbased program on your participant portal or a workplace challenge, the power of social wellness leverages the support, motivation and accountability of peer relationships to achieve engagement. Harnessing the power of community and competition through social wellness platforms is yielding notable results on engagement and outcomes.

Wearables: linked to social wellness apps, allow users to monitor their progress in real time and compete with others for rewards. There is a bright HealthCare Consumerism Solutions™ I www.TheIHCC.com I May/June 2014

37

future for devices that help patients make healthy choices and monitor physiological characteristics associated with chronic disease such as blood pressure, heart rate, blood glucose and calories burned.

4.

overall health. Recent case studies, although preliminary, have shown

3.

completion, completion of lifestyle and disease management programs, and reduction in overall health risks and health care costs.

Personal digital coaching: When it comes to health, whether it’s changing a behavior or following a care plan, personalization of programs and communications is essential. High-tech with hightouch coaching is delivered through online chat, SMS and innovative

one’s readiness to change, recent successes or barriers.

Data integration: The integration of numerous data sources such as health risk assessments, medical and pharmacy claims, incentive and activity tracking, biometric results and electronic medical records are not the cornerstone of the more sophisticated population health management programs anymore. Future wellness programs will sets to help payers enhance wellness and drive targeted interventions.

Driving and sustaining engagement is quite possibly the biggest challenge and the biggest opportunity for wellness providers and employers.

Technology, while not a silver bullet, will help us zero in on that target and give us the ability to engage more people in the right programs, at the right time.

The Seven Key Principles of Health Behavior Change (and How Technology Empowers Them)

BY ERIC ZIMMERMAN, CHIEF MARKETING OFFICER, REDBRICK HEALTH

4. internship at the Mattel toy company. It was truly the dark ages. No Web. No smartphones. No social media. We scanned HRA questionnaires through optical readers and gave out printed reports. We delivered classroom educational programs and one-one-one counseling. We staged worksite challenges and tallied team data by hand into leaderboards.

Indeed, we lacked the high-tech tools that make up the modern wellness arsenal. But — more importantly — we relied heavily on the belief

5.

6. communication, education and goal setting.

Fast forward to 2104. So much has changed. Let’s start with what’s stayed the same, though: behaviors: inactivity, poor nutrition, inadequate coping skills, spotty treatment adherence, use of tobacco and other of an increasingly complex and still weakly coordinated health care system, So is technology transforming the delivery of worksite wellness? create cool stuff. It’s because we can put into practice powerful principles of behavior change in a more scalable and effective way. And make it more fun at the same time.

Here are seven key principles we use to transform the experience, and how technology powers them.

1. Know who you’re talking to, not just what you’re talking about. It’s not about educating or motivating, it’s about tapping existing motivation. We use technology to capture what moves each individual and use it in creating your experience.

2. Get small. The classic educational paradigm teaches, encourages goal setting, and relies on information to drive action. Our new paradigm uses technology to get you to commit to very small steps. Why do small

3.

creates momentum, moving you closer to your goal.

Put the person back into the personalization. We don’t focus so much on tailoring content but rather on using our technology to

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7.

Give a nudge. This is where technology really shines. As you commit to each small steps, we use data-driven, automated triggers (SMS or email nudges), tuned to your preferences and schedule, to gently trigger your desire behavior.

Measure what works and iterate. Not all small steps are created equal. We use technology-captured performance data to tune experience. To enable the things that work — for individuals or groups of like individuals — to be served up more often.

Make it social. You don’t need to create a new social network for health (though you can). The family dinner table can be a powerful network. We let you engage those who matter most — via Facebook, Twitter, or simply email with each step.

Create fast feedback loops that reinforce. Humans don’t come with dashboards. Fortunately an explosion of personal technology helps close that gap. We let you link to an array of personal devices — wearables, apps and smartphones — to essentially create a coach-inyour-pocket to reward and reinforce your progress.

Is it technology that’s making the difference? Yes, in that it’s powering smarter design based on a more informed view of how behavior works. Does it work? We’re seeing the rapid growth of a rich data set that

Everyone deserves the opportunity to live one’s best life.

At Alere, it’s more than clinical, it’s personal.

We support each person in realizing their individual version of health and wellbeing to nourish life.

Our programs combine the compassion of human touch with the power of technology to connect and inspire. We work with each individual to identify and overcome barriers — both personal and those presented by the world in which we live — to create healthy change.

As a leading expert, we transform health and wellbeing through proven coaching and care coordination.

© 2014 Alere. All rights reserved. The Alere Logo and Alere are trademarks of the Alere group of companies.

The Doctor Will See You Now Why more consumers are turning to retail clinics for health care needs

I

BY HEATHER LOVERIDGE Âť SENIOR EDITOR Âť THE INSTITUTE FOR HEALTHCARE CONSUMERISM

t’s 7 p.m. You have a raging headache, a fever that’s slowing creeping upwards and a very sore throat. You’re working afford to be gone several days in a row.

ago, so what do you do? You head to the nearest retail health clinic.

It’s a scene that’s played out time and again every day. For many reasons, Americans are choosing to visit their nearest CVS, Walgreens, RiteAid, Target or other retail clinic provider for

health care. Retail clinic locations are exploding and encouraging other trends — including a shift into workplace health and wellness.

In fact, in 2008, the Deloitte Center for Health Solutions published a report,

“Studies comparing the quality of care provided by physicians and nurse practitioners or physician assistants have found that clinical outcomes are similar.�

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and concluded in it that “retail medical clinics would become a staple of the U.S. health care delivery system: ‌retail clinics are not a fad — they are a disruptive innovation with a sustainable value proposition (price, quality, service) that is welcomed by consumers. Stated simply, retail clinics are an important and growing part of the Six years later, the numbers continue to prove their popularity. CVS recently announced they’ve exceeded 20 million patient visits since Walgreens now has more than 400 health care clinics across the nation. RiteAid also made the news with its acquisition of RediClinic.

As employers are discovering, retail clinics pricing, decreased time off from work, lower costs and more.

“We’ve heard that employees and their families like having convenient access to health

“Retail clinics create

Tine Hansen-Turton, executive director of the Convenient Care Association. “Additionally, employers may be able to keep premiums the same (no cost increases) for employees, and, on top of that, provide incentives to employees for

The Health and Wellness Trend

a better health care experience for patients all part of the effort to make the health care experience a positive one.

“We live in a world where convenience

Retail clinics have become far more solution. Their forays into health and wellness and managed care partnerships have made employers sit up and take notice.

In January of this year, Walgreens brought big data analytics to retail clinics through an expanded relationship with Inovalon, a leading health care technology company. The integration of data analytics allows health care clinic providers to gain even deeper insights to help improve patient care and outcomes nationwide.

Meanwhile, Rite Aid purchased population health management company Health Dialog, allowing the company to support and advance Rite Aid Health Alliance. The Alliance is a health management collaboration among various healthcare providers who deliver comprehensive care and support to individuals with chronic and poly-chronic health conditions. bill pay, allowing members of participating health plans the opportunity to pay their premiums in store at no additional cost. It’s

CVS Caremark/MiniuteClinic state practice manager, Georgia. “We feel that if we can make the access easy, more patients will be willing to come in and get the care they need. The bottom

While some may still have (unfounded) misconceptions — thinking the care is substandard, not as personalized, etc. — most employers encouraging their employees to utilize them.

“Most retail clinics are staffed by nurse Hansen-Turton said. “Studies comparing the quality of care provided by physicians and nurse practitioners or physician assistants have found that clinical outcomes are similar.

Further, research shows that patients seeing nurse practitioners or physicians assistants have higher levels of satisfaction with care, and shortage more quickly than could physicians.

Nurse

for many reasons.

Seventy percent of Americans can’t get a same day appointment with their primary care physician and 30 percent lack a regular source of primary care.”

Practitioners and Primary Care. Health Affairs Policy Brief.).

“Retail clinics create a better health care experience for patients for many reasons.

Seventy percent of Americans can’t get a same day appointment with their primary care physician and 30 percent lack a regular source of primary care.

“Lack of access to health care, particularly after hours and during weekends, presents a barrier to effective and timely treatment for many people in the United States. Only 29 percent of primary care physicians report having support

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“Chronic disease care hours if needed. This often leads to overuse of emergency departments and urgent care facilities Additionally, retail clinics are open at convenient times for consumers, about 12 hours a day on the week days and about 8 hours per day on the weekends, and are located in convenient places — 1/3 of population lives within 10 miles of a retail clinic. According to Hansen-Turton, they also offer transparent pricing, lower costs and accept insurance — a typical visit is $75, making retail clinics the lowest cost unsubsidized provider of health care. “We also hear time and again how the retail clinic provider spent time with someone and really explained things in a way they have served more than 30 million patients and by 2017, it’s predicted that there will be more

Going Beyond the Obvious While retail clinics typically treat common health care problems, they often uncover other, more serious issues. “We treat our patients holistically; meaning we look for ways to keep them healthy beyond the illnesses for which they present identify health concerns that could lead to implications of practicing in this manner is that we may help our patients avoid problems that could affect their ability to continue to function “Our providers have uncovered many significant health issues during sports physicals. One patient was found to have a loud, previously undiagnosed heart murmur.

With further study he was found to have a linked to sudden death with sports activity. “Another provider discovered a physical

is done in collaboration with PCPs in local physician groups or health systems for nonhospital operators and PCPs within the health system for hospital clinic operators. This helps to promote quality and continuity and coordination of care.� some are exploring the option of sharing a clinic with another, nearby company.

Along with treating minor illnesses and provide treatment for chronic conditions as well as offering wellness solutions.

Last year, Walgreens announced it was expanding the scope of services provided at its retail clinics to include assessment, treatment and management for chronic conditions such as hypertension, diabetes, high cholesterol, asthma and others, as well as additional preventive health services. “Our goal is to coordinate with physicians in order to help patients manage their chronic conditions in alignment with their physician’s Walgreens group vice president for health care clinics. “[We] also continue to develop to coordinate patient care and to help meet the triple aim of improving health outcomes and patient satisfaction while reducing health care

growing tumor behind the eye. We have sent more than one patient to the ER with with meningitis, which if left untreated, could have been deadly. “We don’t treat everything, but we see Many clinics are also in-network with many health insurance companies – driving costs even lower for employers and employees.

health clinics. For other smaller companies,

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are providing chronic disease care for conditions such as diabetes, hypertension, hyperlipidemia “Chronic disease care is done in collaboration with PCPs in local physician groups or health systems for non-hospital operators and PCPs within the health system for hospital clinic operators. This helps to promote quality and continuity and coordination of care. “Additional education and wellness services offered in the clinics include, but are not limited

to, smoking cessation, weight management, diabetes education, hypertension evaluation and From the provider side, CVS has seen an uptick in consumers utilizing those same “More patients are coming to us for weight loss, smoking cessation and diabetes monitoring. “We are very proud of the fact, that as a health care company concerned with the wellness of the communities we serve, we have made the commitment to remove all tobacco products from our shelves beginning in October of this year. We are also proud of our innovation, piloting telemedicine in California to improve In today’s marketplace, despite the Affordable Care Act, many consumers are turning to high-deductible health care plans.

Because of that, they are shopping smarter. “With health care putting more and transforming patients into savvy health care consumers and they want to get a good value for As Duane Putnam, director, consultant/ broker relationship with Walgreens recently said, “There’s a ‘retailization’ of health care that’s happening. We have a generation of people that want it on demand — they may not want it now but when they want it they want it then. There’s a focus on population health with a realization that retail clinics can contribute but not by ourselves, by working in tandem with Aside from ease of access and lower costs, other factors are contributing to the popularity of retail clinics.

McDonald said. “Within the next 10 years we’ll reach a shortage of 50,000 physicians. We see retail clinic providers as a compliment to the primary care practices out there. “When you think of the fact that 50 percent of the patients that come to see us when their open, in the evening, on the weekends, holidays — there’s obviously a need. “I believe we will see a continued focus on wellness and how to keep patients healthy and As a relatively new model of health care, retail clinics are making huge inroads — giving consumers what they want and helping employers provide cost-effective health care access across the board.

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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.

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

SOLUTION PROVIDER MEMBER PROFILES

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 HSA/HRA/FSA TECHNOLOGY: ADMINISTRATION & MANAGEMENT

A PRIVATE EXCHANGE THAT SIMPLIFIES HEALTH INSURANCE

INSUREXSOLUTIONS

10275 W. Higgins Road, Suite 500 Rosemont, IL 60018 855-563-6993 info@insurexsolutions.com www.insurexsolutions.com

The InsureXSolutions® private exchange offers employers a simplified role in the new health insurance marketplace. Employers with part-time workers or retirees, as well as small businesses can utilize this exchange to empower their employees to choose the health and dental insurance that best fits their personal and family needs. Employers can reduce costs and administrative tasks, while employees receive interactive support tools and personal guidance from our licensed insurance professionals. Available in select markets, InsureXSolutions is exclusively offered and operated

by Flexible Benefit Service Corporation (Flex). Contact your broker or consultant, call us directly at 855-563-6993, or visit www.insurexsolutions.com to learn more.

HealthCare Consumerism Solutions™ I www.TheIHCC.com I May/June 2014

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SOLUTION PROVIDER MEMBER PROFILES

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.

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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, CEO, Orrian

44

FSA/HRA/HSA/TRANSIT/COBRA: ADMINISTRATION & MANAGEMENT

May/June 2014 I www.TheIHCC.com I HealthCare Consumerism Solutions™

eflexgroup (eflex) is a nationwide eflexgroup administrator of pre-tax benefits 2740 Ski Lane and COBRA. Committed to providing Madison, WI 53713 fast answers, fast claims, and web 877.933.3539 ext 300 self-service, we set the industry www.eflexgroup.com standards for service. With a efgsales@eflexgroup.com customer focus and Lean Six Sigma methodology, we don’t talk about service, we prove it. See our metrics at eflexgroup.com.

“eflexgroup’s customer service department should be a model for ALL customer service departments. The courtesy, professionalism and knowledge surpass ANY customer service department I’ve encountered! I feel the outstanding, exemplary customer service of eflexgroup is simply the best!”

— Kimberly Adams, Southeast Energy Assistance [testimonial]

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

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

SOLUTION PROVIDER 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 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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SOLUTION PROVIDER MEMBER PROFILES

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, CodeBaby 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, WiserTogether 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

HSA/HRA/FSA TECHNOLOGY: ADMINISTRATION & MANAGEMENT

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.

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.

— Jeff 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.

SOLUTION PROVIDER 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

LOOKING FORWARD TO A CONSUMER DRIVEN FUTURE

FLEXIBLE BENEFIT SERVICE CORPORATION (FLEX)

10275 W. Higgins Road, Suite 500 Rosemont, IL 60018 888-353-9178 fpsales@flexiblebenefit.com www.flexiblebenefit.com

It has been an exciting year at Flexible Benefit Service Corporation (Flex). We celebrated our 25th anniversary along with a decade of increasingly popular HSAs. We have been a trusted benefits administrator of these consumer-driven plans since day one and also offer FSAs, HRAs, Transit and COBRA Administration. In fact, we now offer the InsureXSolutions® private exchange to employers with part-time workers or retirees, as well as small businesses. At Flex, we look towards the future and leverage our consumer-driven experience as a way to help our clients move forward in the changing marketplace.

Contact your broker or consultant, call us directly at 888-353-9178 or visit www.flexiblebenefit.com to learn more.

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SOLUTION PROVIDER MEMBER PROFILES

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BENEFIT ADMINISTRATION/PRIVATE EXCHANGES

Avoid the the Cadillac CadillacTax! Tax! Consumer’sMedical Consumer Medicalhelps Resource® your(CMR) employees helps answer your the five most important in healthcare: employees answer the fivequestions most important questions What do I have?

What I need? do I go? in healthcare: What do I do have?

WhatWhere do I need?

What will cost?

How I connect?

Where do Iitgo?

What willdo it cost?

How do I connect?

CMR CMR helps helps leading leading Fortune Fortune 1,000 1,000 companies companies improve improve engagement, quality, and satisfaction engagement, quality, and satisfaction through through informed informed clinical decision-making guaranteed savings. clinical decision-making with with guaranteed savings. drive 70%70% of your “10% 10%ofofemployees employees drive of your cost. only help cost.Our Ourservices servicesnot not only help companies in in areas such companiessave savemoney money areas such as elective as reducing reducingunnecessary unnecessary elective surgeries, empower employees surgeries,but butalso also empower employees to make thethe most important makesome someofof most important decisions decisionsofoftheir theirlives.” lives.”

David J. Hines President and Founder

CMR delivers value by helping organizations take control of their healthcare costs. Find out what we can do for you. i ÞÊ7> >Vi]Ê ÀiVÌ ÀÊ vÊ >À iÌ }ÊUÊ Ü> >ViJV ÃÕ iÀà i` V> °V Ê Kelly Wallace, DiriVÌ ÀÊ vÊ >À iÌ }ÊUÊ >À iÌ }JV ÃÕ iÀ i` V> °V Ê Çn£ Çä £ÇÓÇÊUÊÜÜÜ°V ÃÕ iÀà i` V> °V Çn£ Çä £ÇÓÇÊUÊÜÜÜ°V ÃÕ iÀ i` V> °V

TOTAL POPULATION HEALTH MANAGEMENT

Steven LEVEL1DIAGNOSTICS Level1DiagnosticsDr. uses new M. Helschien Founder and CC&BW 11722 Lightfall Court tools to evaluate employees’ Columbia, MD 21044 www.level1diagnostics.com cardiovascular health

410-707-5667 ◆ doc@level1diagnostics.com Dr. Steven Helschien, Founder Heart disease is the number one killer Sales: Penny Aleo, Executive VP in the U.S. and costs millions of dollars 443.878.3087 in medical care and time lost from work. pbaleo@gmail.com Detection and prevention is the key to heart health. Level1Diagnostics is an innovative program that, unlike conventional cardiology tests, provides advanced testing and methods to detect and prevent the earliest signs of cardiovascular disease and encourage optimal health.

There is testing for the early detection of cancer and other diseases, and now we have testing for the early detection of cardiovascular disease.

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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 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.

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.

SOLUTION PROVIDER 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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RESOURCE GUIDE

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Listen Live Every Friday from 11a.m.-12 p.m. EST Listen on your mobile device.

Download on iTunes or Google Play Join the conversation by tweeting or emailing your questions to us in advance, during or after each show: Twitter: @The_IHC Email: dfield@theihcc.com

ADVERTISING INDEX If you use the services of our solutions providers, please tell them you saw their ad in Solutions™.

AHIP ...................................................... 43

IHC Radio.......................................HCX 16

Alegeus Technologies ......................HCX 2

IHC Super Saver FORUM West 2014 ......14

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

insurexsolutions .......................HCX 15, 43

Best Buy ........................Inside Back Cover

Intrepid .................................................. 43

Carena ................................................... 44

Level1Diagnostics .................................. 48

Castlight Health ..................................... 43

MasterCard ............................................ 44

CDHCentric ............................................ 49

MedEncentive ........................................ 49

ADVERTISING CONTACTS

CieloStar..................................HCX 15, 48

Orriant ................................................... 44

CodeBaby............................................... 46

Phoenix Benefits Management................ 47

404.671.9551

Consumer Medical ................................. 48

PrivateHealthCareExchanges.com ............... 11

DataPath ................................................ 47

Totem Solutions ..................................... 46

Delta Dental ........................................... 46

Transitions ............................................. 49

eFlex Group............................................ 44

Truven Health Analytics ......................... 48

Evolution1................................HCX 15, 45

TSYS Healthcare ..................7, HCX 15, 45

Flexible Benefit Service Corporation........ 47

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

HealthPERX ............................................ 47

WageWorks ........................................... 45

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

WeCare TLC ........................................... 49

HSA Bank ..................................HCX 8, 45

Wiser Together ...................................... 46

CEO/PUBLISHER

Doug Field

@

MANAGING DIRECTOR

Brent Macy ACCOUNT MANAGER

Joni Lipson DIRECTOR OF CONFERENCE SPONSORSHIP/ CORPORATE MEMBERSHIP/REPRINTS

Rogers Beasley rbeasley@theihcc.com

IHC Certification ...............................HCX 6 50

May/June 2014 I www.TheIHCC.com I HealthCare Consumerism Solutions™

REWARD THEM WITH A HEALTHY DOSE OF FUN Staying healthy feels better with Best Buy® gift cards.

GIFT CARD INCENTIVES As powerful incentives, Best Buy gift cards energize your health and wellness program by motivating people with the things they want most, from TVs to tablets to smart phones. They’re hard to resist and easy to redeem online or in store. For instant e-mail delivery and easy personalization, choose our popular e-gift cards. Make your wellness program even more rewarding.

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3TEPPING UP

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At UnitedHealthcare, we offer innovative tools that put members in touch with their information.

We’ve made it easier for your employees to find the right information at the right time (even on the go). s MY(EALTHCARE #OST %STIMATOR provides relevant information on care and estimated costs. s MY#LAIMS -ANAGER helps members understand, track and pay their medical bills online. s 5NITED(EALTHCARE (EALTH -E4- is an award-winning* mobile app that provides instant access to a family’s important health information. s MYUHC COMŽ is a resource for members, providing easy access to personal health care benefit information – whenever they need it.

Empower your employees. It’s good for their health – and the health of your business. &OR MORE INFORMATION VISIT WELCOMETOMYUHC COM OR CALL

*Produced by MediaPost Communications, a media, advertising and marketing news and events publishing company based in New York, the annual Appy Awards’ aim is to acknowledge extraordinary Applications, whether they be mobile, social, or Web-based. The Appys don’t discriminate by format, platform or device; instead, they focus on simply honoring the best Apps in all imaginable categories: http://appyawards.net/.

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. Š2014 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. UHCEW686242-000