HealthCare Consumerism Solutions - 2015 2nd Quarter Issue

2015 FORUM & Expo Atlanta Conference Agenda

ISSUE || Second Quarter • 2015

Innovative Health and Benefit Management

What’s Next in Wellness?

Solutions Emerge to Improve Employee Health The Case Against Big & Broad How Do Business Leaders View Wellness?

INSIDE: The Official Magazine of

www.theihcc.com

INSIGHT. INSIGHT.

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INSIDE

FEATURES 37 The Fallacy of Big & Broad Wellness Programs For wellness offerings to move the needle on medical costs, they must help the right employees — and live up to a much tougher set of standards.

While working at a large benefits consulting firm, I cringed every time I heard someone quote the famous movie line “If you build it, they will come,” in reference to employee wellness programs (and it happened often).

It wasn’t just that Field of Dreams quotes are painfully dated — this one was also painfully inaccurate. Yes, building big and broad wellness programs has been an undeniable trend in the market. But the time, money and effort it takes to encourage participation, combined with the lackluster results achieved by many of these programs, leave us facing a sobering reality: They’re just not working.

BY MATT COOK, DIRECTOR OF ACCOUNT MANAGEMENT, OMADA HEALTH

41 Get the Boss on Board for Better Employee Health Middle managers just as important as C-suite to wellness program success Leadership takes many forms and styles, depending on the organizational culture and the style of individual leaders. Those people who make up the leadership team within a given company influence the experience that employees have with everything from the work they do, to the way they socialize and the health benefits they receive. The overall culture of the workplace, including the perceptions of leadership support for employee health and well-being, is emerging as possibly the most significant area of influence for corporate leadership.

For several years now, employers and companies of all sizes have demonstrated their support for improving employee health by increasing their investment in workplace wellness programs that range from the simple to the sophisticated. And, while industry research shows that many employers initially invest in wellness as a way to reduce health care spending, their reasons for ongoing investment change over time, with 91 percent claiming to offer wellness programs for reasons beyond medical cost savings. As it turns out, business leaders are committed to investing in workforce health due to the long-term business benefits of good employee health.

BY JESSICA GROSSMEIER, VP OF RESEARCH, HERO, AND NIKKI HUDSMITH, VP, CONSULTING, PERFORMANCE pH

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: With the Q3 HealthCare Consumerism Solutions magazine, publishing in mid-August, contributors will delve into key topics of discussion leading into the Open Enrollment season.

HealthCare Consumerism Solutions™ I www.TheIHCC.com I Second Quarter 2015

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INSIDE 6 Publisher’s Letter

DEPARTMENTS 14 Stats & Data: Accountable Care Organizations

8 Bachman’s Banter

Accountable Care: Are We Near the Tipping Point?

9 Briefs & Innovations t t t t

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10 FORUM & Expo Conference Preview 48 Affiliate Member Profiles

By Niyum Gandhi, Partner, and Josh Michelson, Principal, Oliver Wyman

Are Employees Becoming Better Health Care Consumers?

By Jennifer Benz, Founder and CEO, Benz Communications

June 23-25, 2015 Cobb Galleria Centre Atlanta

Private Exchange FORUM

Sept 1-2, 2015 Renaissance Harborplace Hotel Baltimore

IHC FORUM West

Nov 16-18, 2015 Red Rock Resort Spa & Casino Las Vegas Come LEARN, CONNECT and SHARE with the top thoughtleaders in health care consumerism. Find more information at: www.theihccforum.com

Social Connectivity Key to Employee Health Management

By Boyd Lyles, MD, Chief Medical Officer, and Jeff Brizzolara, PhD, MPH, Chief Clinical Officer, Viverae, Inc.

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34 Benefits Enrollment Leveraging the Marketing Mix Can Change the Course of Health Care Consumerism

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By Allyson Kuper, Consultant, Bug Insights

35 Corporate Wellness Active Design Is The New Workplace Wellness Program

By Meena Krenek, IIDA, LEED AP BD+C, Associate Principal, Perkins+Will

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45 Pharmacy Benefits Management Specialty Rx: What’s An Employer To Do?

By Carolyn Pare, President and Chief Executive Officer, Minnesota Action Health Group

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46 Digital Health Five Transformative Innovations in Wellness

By Penny Moore, Chief Growth Officer, ShapeUp

47 Regulatory & Compliance

ONLINE EXCLUSIVES The Supreme Court’s Ruling on ACA: Should Employers Hold Off Implementing Regulations?

It has been a little over five years since the President signed the Affordable Care Act (ACA), which enacted a comprehensive health insurance reform program. The various regulations have been spread out to allow employers and government agencies time to plan for and then implement new requirements. While this has been a “slow walk� of implementing the ACA policy, employers should be in a place where they are ready for the reporting and disclosure requirements that are approaching. The fear, however, is that employers are awaiting the opinion from the Supreme Court’s ruling on Burwell v. King, a case that has the potential to end Obamacare subsidies in 34 states that use HealthCare.gov.

By Perry Braun, Executive Director, Benefit Advisors Network 4 Second Quarter 2015 * XXX 5IF*)$$ DPN * HealthCare Consumerism Solutions™

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33 Health Management

Events IHC FORUM & Expo

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15 Stats & Data: Engagement

50 Resource Guide/Ad Index

SIGN UP TO ATTEND

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King v. Burwell: Understanding the What Ifs of the Supreme Court’s Looming PPACA Decision

By Dennis G. Fiszer, Chief Compliance Officer, HUB International Employee Benefits

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Survey Reveals Consumer Dependence on ER Services for Non-Emergent Care More than 14.1 million people nationwide have signed up for health insurance since enrollment under the Affordable Care Act opened in October 2013, and, in the same period, an additional 2.3 million young people have gained insurance through their parents’ health care coverage.

Overall, the national uninsured rate is estimated to have dropped 7.1 percent in a year and a half. It is critically important that these newlyinsured individuals, as well as those already insured, understand their insurance benefits and their own payment responsibilities.

By Robin Gelburd, President, FAIR Health

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LETTER

PUBLISHER www.theihcc.com VOLUME 11 NO. 3 | SECOND QUARTER 2015

What’s Next for Corporate Wellness?

Published by FieldMedia LLC 292 South Main Street, Suite 400 Alpharetta, GA 30009 Tel: 404.671.9551 • Fax: 770.663.4409 CEO

Doug Field 404.671.9551 ext. 101 ¡ dfield@ theihcc.com

With the sixth annual IHC FORUM & Expo on the horizon, we have asked our contributors to take a look at the corporate wellness landscape of today and the future.

The corporate wellness arena, of course, is no stranger to controversy or disagreements. After all, there’s not be an easy answer to the underlying question, “What should employers be doing about their employee’s health?� How much of a role should they play? Should they monitor? Screen? Incent?

Health is at the same time a very personal and public issue. And employers, vendors, researchers, academics, physicians and others have debated endlessly how employers should tread these difficult waters. For each organization, depending on each organization’s goals, there may be a different answer to this question. Like other areas of employee benefits, industry leaders are discovering that there isn’t a one-size-fits-all solution.

In this issue, the conversation continues. In one feature, researchers from the Health Enhancement Research Organization take a deep dive into how business leaders view employee health, productivity and performance. In the second feature, an executive at tech company Omada Health looks at why “big and broad� wellness programs may not be the right fit for many employers.

Elsewhere in this issue, contributors delve into emerging topics in workplace wellness, including the importance of social connectivity, how corporate design can influence healthy behaviors and technology innovations that could potentially change the wellness game.

NATIONAL SALES DIRECTOR

Brent Macy 404.671.9551 ext. 103 ¡ bmacy@theihcc.com CHIEF MARKETING OFFICER

Andrew Dietz adietz@theihcc.com MANAGING EDITOR

Jonathan Field 404.671.9551 • jfield@theihcc.com SENIOR EDITOR

Heather Loveridge hloveridge@theihcc.com ART DIRECTOR

Kellie Frissell 404.671.9551 ext. 107 ¡ kfrissell@fieldmedia.com ASSOCIATE DIRECTOR OF EDUCATION SERVICES AND PROGRAMS

Dusty Rhodes CHAIRMAN OF IHC ADVISORY BOARD

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

Kim Adler, Allstate; Diana Andersen, Zions Bancorporation; Bill Bennett; Doug Bulleit, DCS Health; Jon Comola, Wye River Group; John Hickman, Alston+Bird LLP; Tony Holmes, Mercer Health & Benefits; Marc Kutter, Aflac; Sanders McConnell, TSYS Healthcare; Roy Ramthun, HSA Consulting Services LLC; John Young, Consumerdriven LLC WEBMASTER

Tim Hemendinger timh@fieldmedia.com

The discussion on employee health will continue at FORUM & Expo this June in Atlanta and at FORUM West this November in Las Vegas. On behalf of everyone at The Institute for HealthCare Consumerism, I hope to see you there.

DIRECTOR OF CONFERENCE SPONSORSHIP/ CORPORATE MEMBERSHIP/REPRINTS

Rogers Beasley 404.671.9551 ext 109 ¡ rbeasley@fieldmedia.com ACCOUNT MANAGERS

Michelle Gatehouse 404.405.3007 • mgatehouse@theihcc.com

Sincerely,

Ted Arvan 678.296.1906 • tarvan@theihcc.com PARTNERS/ALLIANCES

Doug Field CEO/Publisher dfield@fieldmedia.com

Joni Lipson 800.546.3750 ¡ jlipson@fieldmedia.com BUSINESS MANAGER

Karen Raudabaugh 404.671.9551 ext. 108 ¡ kraudabaugh@fieldmedia.com HealthCare Consumerism Solutions™ Volume 11 Issue 3 Copyright Š2015 by FieldMedia LLC. All rights reserved.

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

Periodical postage paid at Alpharetta, GA and additional mailing offices.

TO SUBSCRIBE: Make checks and money orders payable to HealthCare Consumerism Solutions ™ magazine 292 S. Main Street, Suite 400, Alpharetta, GA 30009 or visit www.theihcc.com. Non-qualified persons may subscribe 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 or subscriberservice@fieldmedia.com for name/address changes.

PRINTED IN THE U.S.A. HealthCare Consumerism Solutions™ is designed to provide both accurate and authoritative information with regard to the understanding that the publisher is not engaged in rendering legal, financial, or other professional service. If legal advice is required, the services of a professional adviser should be sought.

The magazine is not responsible for unsolicited manuscripts or photographs.

Send letters to the editor and editorial inquiries to the above address or to jfield@fieldmedia.com. Permission to reuse content should be sent to jfield@ fieldmedia.com.

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UNITED WE SHAPE UP ShapeUp connects your employees, programs, and rewards to maximize wellbeing.

Our Social Wellness™ methodology is a revolutionary approach to employee wellness, using trusted social networks, behavioral economics, and engaging technology to deliver a holistic wellbeing solution to employers worldwide. Visit us at shapeup.com.

Visit with Us at the 2015 IHC Private Exchange FORUM, March 31-April 1 in Dallas

BACHMAN’S BANTER

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

“Doc Fix� Bill Signed Into Law WHO: Doctors providing Medicare services and tangentially all doctors under insurance network contracts.

WHEN: The FY2015 omnibus appropriations bill was signed into law on December 16, 2014. The law (Public Law 113-235) is effective for fiscal year 2015, which is the period from October 1, 2014 to September 30, 2015.

assessed on efforts to improve their practice and participate in advance payment methods currently used by accountable care organizations. By 2022, the bonuses could reach +/- 9 percent, with the aggregate total being budget neutral.

For the first two years of MIPS, the following Medicare Part B providers are deemed eligible professionals: physicians, physician assistants, nurse practitioners, clinical nurse specialists and nurse anesthetists.

For the third and succeeding years, the following providers also become MIPS-eligible: physical or occupational therapists, speechlanguage pathologists, audiologists, nurse midwives, clinical social workers, clinical psychologists and dietitians or nutrition professionals.

The following caregivers are excluded from MIPS eligibility: 1. Providers mainly participating in an APM (They have separate incentives.)

2. Providers below a Medicare volume threshold.

3. Providers who enroll in Medicare for the first time are exempt until the next year.

Vendors supporting physician reimbursement and billing systems may need to

reprogram software. Insurers may want to revise existing negotiations and provider

WHAT: The “doc fix� bill is the layman’s term for eliminating a 1997 law — referred to as the Sustainable Growth Rate — that controlled Medicare physician reimbursements. The SGR was designed to limit medical spending to the annual growth rate of the U.S. gross domestic product.

However, medical costs have mostly been higher than GDP growth, and Congress has overridden the SGR in most years to prevent an otherwise required reduction in physician payments. Without a repeal of SGR, the cumulative overrides would have reduced physician Medicare reimbursements by 21 percent in 2015.

contracts related to Medicare costs and quality measures.

EXECUTIVE SUMMARY: Physicians are paid based on diagnosis and services identified as Current Procedural Terminology (CPT) codes. The “doc fix� bill directly changes the increases in CPT amounts paid for Medicare services.

In addition, most commercially negotiated insurance rates are typically related (directly or indirectly) to Medicare reimbursements, so indirectly the cost of nearly all physician services could be altered as provider network contracts renew.

Under the new law, Medicare will increase physician reimbursements 0.5 percent in July 2015 and each year through 2019. From 2020 through 2025, rates will remain the same but beginning in 2018 payments can vary based on individual quality incentives called the merit-based incentive payment system.

MIPS replaces three existing incentive programs that will sunset in 2017.

The new incentive program will assess quality, resource use and the use of electronic health records. In addition, physicians may be

8 Second Quarter 2015 * XXX 5IF*)$$ DPN * HealthCare Consumerism Solutions™

ACTIONS: Providers should seek guidance from their consultants, lawyers or other management support to better understand the impact of the “Doc Fix�, the opportunities to participate in the current and future incentive programs and the potential impacts on non-Medicare contracts.

Vendors supporting physician reimbursement and billing systems may need to reprogram software. Insurers may want to revise existing negotiations and provider contracts related to Medicare costs and quality measures.

The information presented and contained within this article was submitted by Ronald E. Bachman, president and CEO, Healthcare Visions, and chairman of the Editorial Advisory Board at The Institute for HealthCare Consumerism. This information is general information only, and does not, and is not intended to constitute legal advice.

You should consult legal advisors to determine the laws and regulations applicable to your company. Any opinions expressed within this document are solely the opinion of the individual author.

HEALTHCARE CONSUMERISM NEWS BRIEFS

Doctor On Demand Selected as One of UnitedHealthcare’s First Virtual Visit Providers Doctor On Demand, the next generation telemedicine provider, announced that UnitedHealthcare has selected Doctor On Demand as one of the first provider groups for virtual visits. Starting immediately, Doctor On Demand will be an in-network provider group available to eligible UnitedHealthcare commercial members. Virtual visits are available to select UnitedHealthcare self-funded customers in 2015 and will expand to most UnitedHealthcare commercial members in 2016.

Member co-pays for virtual visits will be equal to or less than office visits, depending on the benefit plan.

The Bancorp Introduces Innovative Tool for HSA Management The Bancorp announced the launch of Pivot: All the Right Moves in HSA Management™, an innovative Web-based portal that delivers a new level of ease, flexibility and efficiency to company-sponsored health savings account programs. The tool uniquely meets that need by combining HSA enrollment, funding and comprehensive reporting into a single portal accessed by a single user ID and can be used to manage a single HSA group or multiple groups of any size. Among its specialized features is an interactive dashboard that displays account status, average balances, contribution history and other pertinent data.

Alegeus Technologies Announces Exclusive Partnership with CoPatient Alegeus Technologies announced an exclusive partnership with CoPatient, a leading provider of medical bill review and consumer advocacy services. Through the partnership, Alegeus participants will gain access to an (optional) service to scrutinize health care bills for errors and other savings opportunities prior to payment. Once bills are reviewed, integration to the Alegeus platform will enable seamless bill payment via consumer-directed health care accounts.

Through proprietary technology and direct negotiation with health care providers, CoPatient is frequently able secure consumer savings — saving consumers an average of 40 percent through bill corrections and adjustments.

Mercer Launches Tools to Help Employers Navigate the Complex Value-Based Care Landscape Mercer recently announced the launch of a suite of solutions to help employers navigate the growing market for value-based care, one of the core strategies that will drive the transformation from a feefor-service to a fee-for-value health care delivery model. Millions of Americans already receive their health care through a value-based care model, while health care reimbursement via value-based care is supposed to more than double by 2020 (20 percent to 46 percent).

Using proprietary and industry data as well as innovative technology, Mercer has developed a way to help employers assess what value-based care approaches are right for them, what opportunities exist in key local markets to support these approaches and how to implement and communicate appropriately with the target employee populations.

SelectAccount’s New WalletDoc Lets People Take Control of Their Health Care Spending Like Never Before SelectAccount takes a huge leap forward beyond helping people save money to pay for health care expenses with their new WalletDoc suite of consumer tools designed to stretch dollars further. Not only can people

compare costs and find discounts, they can now evaluate treatment options through a strategic relationship with WiserTogether, Inc., a treatment transparency company offering Wiser Health. The seamless user experience gives people access to a market-leading health solutions platform that provides users with comprehensive treatment information, allowing them to assess treatment options based on clinical outcome data, personal and popular preference, cost and coverage.

The Alliance Launches Groundbreaking QualityPath Initiative to Guide Patients to Quality Care The Alliance, a cooperative of employers that self-fund their health benefits, is creating a path to high quality care at a lower cost to transform the local marketplace. The Alliance QualityPath program is one of few nationwide that measures the performance of a specific doctor at a specific hospital. Other innovative elements include focusing on high-stakes procedures and using national measures of quality to assess hospital-and-doctor pairings. The Business Health Care Group, a coalition of large and small employers in southeastern Wisconsin, is a co-developer of the project.

Healthentic Earns Intel-GE Care Innovations’ Validation Healthentic, an analytics company that easily identifies health savings for employers, announced it earned validation from Intel-GE Care Innovations™ and the Validation Institute. Healthentic is the first and only company to be validated in the health analytics category.

From identifying the cost savings of avoidable emergency room visits to quantifying the value of a simple flu vaccination, Healthentic consistently delivers health and financial value to its clients. On average, Healthentic finds $180,000 in annual savings opportunities for every 1,000 people covered on en employer’s health plan.

MDLIVE Teams Up with Microsoft to Provide Digital Health Experience through Skype for Business MDLIVE announced a new relationship with Microsoft that makes MDLIVE the first company to deliver digital health services to millions of health care consumers through the Skype for Business platform.

The collaboration follows Microsoft’s acquisition of Skype and launch of Skype for Business, which offers MDLIVE patients a new, secure and seamless digital health experience. As part of its collaboration, Microsoft will offer Surface Pro 3 clinical grade tablets to deliver MDLIVE’s digital health experience and launch the new MDLIVE app for the Windows Phone.

Health Advocate Launches Medical Visit Checklist Builder Health Advocate announced the launch of its new Medical Visit Checklist BuilderTM. This free, online tool enables members to create customized checklists with reminder questions in preparation for a wide range of doctor visits and other medical appointments. For any number of reasons, patients too often return home following a medical appointment and realize they forgot to ask their provider an important question about their care or treatment. By answering a few short, confidential questions about an upcoming visit, the Medical Visit Checklist Builder generates a print-friendly checklist to take along to the appointment. This checklist can help ensure patients are better prepared for their visit, have a clear understanding of important topics related to their care and get the possible outcome. continued on page 12

HealthCare Consumerism Solutions™ I www.TheIHCC.com I Second Quarter 2015

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The 6th Annual FORUM & Expo Will Help You June 23 to June 25, 2015 Cobb Galleria Centre Atlanta, Georgia %BWJE 'JSFTUPOF 71 PG &YDIBOHF 4BMFT "FUOB *OD 3PCFSU 4UFFMF 1SFTJEFOU 2VBESBOU )FBMUI +FGG #BLLF $IJFG 4USBUFHZ 0GmDFS &WPMVUJPO &VHFOF 4BZBO $IBJSNBO $&0 1SFTJEFOU 4PGUIFPO

DAY THREE Thursday, June 25

GENERAL SESSIONS DAY ONE Tuesday, June 23 OPENING KEYNOTE ADDRESS 2:30 to 4:30 p.m.

C-Level Executives Share Health Care Strategies, Including the Shift to Consumerism and Their Look Ahead Moderator: %PVH 'JFME $&0 5IF *OTUJUVUF GPS )FBMUI$BSF $POTVNFSJTN Panelists: 4UFWF (SJFDP $&0 $POOFDU:PVS$BSF +BOFU 4UPLFT 5SBVUXFJO &71 $&0 /BUJPOBM "TTPDJBUJPO PG )FBMUI 6OEFSXSJUFST /")6 4IBOF +BDLTPO $&0 +BDLTPO )FBMUI BOE $IFSZM %F.BST 1SFTJEFOU $&0 5IF "MMJBODF

DAY TWO Wednesday, June 24

MORNING GENERAL SESSION 8:30 to 10:00 a.m.

Health & Wellness: The Best Kept Secret for Corporate Performance!

Moderator: +BDL $VSUJT .4 'PVOEFS $&0 $PSQPSBUF )FBMUI 1BSUOFST --$ Panelists: 3BZNPOE + 'BCJVT .% $1& '"$1& 1SFTJEFOU )FBMUI/&95 +FTTJDB (SPTTNFJFS 1I% 71 PG 3FTFBSDI )&30 /JLLJ )VETNJUI 71 $POTVMUJOH 4FSWJDFT 1FSGPSNBODF Q) %S 4DPUU )BOTFO .FEJDBM %JSFDUPS -J7F8FMM $FOUFS *OUFSNPVOUBJO )FBMUI CLOSING GENERAL SESSION 1:45 to 2:45 p.m.

Health Care Consumerism: What Leading Employers Are Doing in 2015 and Beyond

OPENING GENERAL SESSION 8:45 to 10:30 a.m.

Innovative Physicians, Telehealth and Health Care Executives Discuss Latest Health Care Access Strategies

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WORKSHOPS

AFTERNOON GENERAL SESSION 1:30 to 2:45 p.m.

Health Care Reform and Compliance Issues Moderator: +PEZ - %JFUFM "'$'$* $"4 $IJFG $PNQMJBODF 0GmDFS 8BHF8PSLT *OD Panelists: +PIO )JDLNBO 1BSUOFS "MTUPO #JSE --1 + ,FWJO " .D,FDIOJF &YFDVUJWF %JSFDUPS 5IF "#" )4" $PVODJM BOE 471 %JSFDUPS 5IF "#" 0GmDF PG *OTVSBODF "EWPDBDZ CLOSING GENERAL SESSION 4:15 to 5:45 p.m.

Defined Contribution and Health Exchanges: A Panel Discussion with Leading Experts Moderator: +PIO :PVOH $)$$ $&0 $POTVNFSESJWFO --$ Panelists: /BODZ 7BTUB #VTJOFTT -FBE 1SPQSJFUBSZ 3FUBJM &YDIBOHF $JHOB

10 Second Quarter 2015 * XXX 5IF*)$$ DPN * HealthCare Consumerism Solutionsâ„¢

TRACK ONE Tuesday, June 23 from 4:45 to 5:45 p.m.

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Navigate the Changes in Health and Benefits Change is the new constant in health care and employee benefits. The Institute for HealthCare Consumerism constantly tracks the transformation and translates the chaos into clarity and into strategies and tactics that work. IHC FORUM & Expo is the main event where you can access the most current insights, innovations and industry leaders in one place.

TRACK TWO Wednesday, June 24 from 11:00 a.m. to Noon SESSION 201 – 4FWFO 5SFOET *NQBDUJOH 8FMMOFTT /PX SESSION 202 – $BO 1SJDF 5SBOTQBSFODZ 1SPNPUF )JHI 7BMVF $BSF SESSION 203 – 1IZTJDJBOT %JTDVTT )FBMUI $BSF $POTVNFSJTN BT UIF 4PMVUJPO GPS )FBMUI 3FGPSN 4ESSION 204 – .PWJOH UP )FBMUI $BSF $POTVNFSJTN o 4FMMJOH UIF $ 4VJUF SESSION 205 – 8FMMOFTT *ODFOUJWFT BOE &NQMPZFF &OHBHFNFOU SESSION 206 – .PWJOH JOUP UIF /FYU (FOFSBUJPO PG %FDJTJPO 4VQQPSU 5PPMT SESSION 207 – 5FMFIFBMUI *NQSPWJOH )FBMUI "DDFTT UISPVHI 5FDIOPMPHZ SESSION 208 – *OOPWBUJWF #FOFmU 1MBO %FTJHO 4USBUFHJFT GPS UP

Thank you PLATINUM and GOLD sponsors for your support!

TRACK THREE Wednesday, June 24 from 3:00 to 4:00 p.m.

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HealthCare Consumerism Solutionsâ„¢ I www.TheIHCC.com I Second Quarter 2015

11

HEALTHCARE CONSUMERISM RESEARCH, SURVEYS & REPORTS

continued from page 9

Research from Alegeus Reveals Consumers Enrolled in CDHPs Are More Likely to Shop for Health Care

Study: Companies Spending More on Corporate Wellness But Employees Leaving Millions on the Table

Alegeus Technologies recently released new consumer research that highlights the impact of account-based, consumer-directed health care programs in increasing consumer engagement with their health care.

The study, commissioned by Alegeus and administered by a third party research firm, surveyed 5,000 U.S. consumers and analyzed numerous dimensions of consumers’ health care characteristics, attitudes and behaviors. The survey revealed an overall lack of engagement by health care consumers. However, one particular segment of consumers was found to be much more engaged. Consumer-directed health care participants — those enrolled in HDHPs and account-based programs — scored universally higher than those enrolled in traditional health care plans in virtually all aspects of engagement.

The latest survey on wellness programs from Fidelity Investments and the National Business Group on Health reveals employers will spend an average of $693 per employee on wellness-based incentives in 2015, up from $594 in 2014 and $430 five years ago. Of the 79 percent of employers who offer health improvement programs, larger companies (those with more than 20,000 employees) are spending the most on these programs, where the per-employee average climbed to $878, up from $717 in 2014. The average for companies with between 5,000 and 20,000 workers rose to $661, up from $493 in 2014.

HEALTHCARE CONSUMERISM PEOPLE ON THE MOVE

Castlight Health Hires Mark Sarbiewski as Chief Marketing Officer Castlight Health announced that it has hired veteran technology marketing leader Mark Sarbiewski as chief marketing officer. Sarbiewski comes to Castlight Health from San Francisco-based Anaplan, a cloudbased planning platform for finance, sales and operations. There he was the company’s first chief marketing officer, where he scaled out global marketing and helped the company create a new enterprise planning category to disrupt the corporate and sales performance management markets.

Vitals Announces Appointment of Kyle Raffaniello as Chief Revenue Officer Vitals announced that Kyle Raffaniello, former chief strategy officer and executive vice president of ValueOptions, will join the company as its first chief revenue officer. Over the past three years, Vitals has

seen its revenue nearly quadruple as consumers and payers demand cost and quality transparency solutions that result in choosing better value care. The company develops online provider search tools, along with cost calculators and incentive programs that it delivers to market through its consumer website and health system partners. Raffaniello will accelerate growth at the already fast-moving company.

Cambia Welcomes Ben Albert as Operating Partner Cambia Health Solutions is pleased to announce Ben Albert has joined its team as operating partner within its Direct Health Solutions division, an area focused on investing in and building companies that change the way people experience the health care system. In his new role, Albert will be responsible for accelerating Cambia’s investments, which are focused on transforming health care so that it is both economically sustainable and person-focused, while looking for new strategic business opportunities supportive of the mission.

HEALTHCARE CONSUMERISM FUNDING ANNOUNCEMENTS

Cox Enterprises Invests In Digital Health Company Rimidi Cox Enterprises announced an investment in Atlanta-based Rimidi, a digital health company focused on diabetes and other chronic conditions. This marks a major milestone for the company, paving the way for Rimidi’s expansion into additional markets and collaborative opportunities. Rimidi’s flagship product, Diabetes+Me™, provides a cloud-based platform for diabetes management. Through its software platform, patients can track their health and lifestyle data, as well as obtain medical and nutritional information about their condition. The care team can leverage the data through proprietary analytics for better decision making for treatment options, population management and improved care.

Livongo Health™ Raises $20 Million in Series B Funding Livongo Health, a consumer digital health company that is empowering people with chronic diseases to live better, announced that it has secured $20 million in Series B funding from investors including Kleiner Perkins Caufield & Byers, DFJ and previous investor General Catalyst. The funding will enable the company to further develop its

12 Second Quarter 2015 * XXX 5IF*)$$ DPN * HealthCare Consumerism Solutions™

chronic disease management ecosystem and accelerate the adoption of the company’s digital diabetes management program, Livongo for Diabetes™, among self-insured employers, health care providers and payers.

Kaiser Permanente Ventures Leads $12.5 Million Round For Validic Digital Health Platform Validic, the health care industry’s leading digital health platform, announced recently that it has secured a $12.5 million Series B round led by Kaiser Permanente Ventures, the corporate venture capital arm of Kaiser Permanente. The funding will continue to fuel Validic’s rapid growth. Since launching Validic in 2010, the company has grown its client population reach to over 160 million lives in 47 countries and now integrates with over 175 fitness and clinical devices and applications. Validic continues to add clients within a variety of health care segments powering their patient data integration, including pharma, providers, insurance companies, wellness and health care technology companies.

Building a

Happier, Healthier, More Productive Workforce

As a leading administrator of Consumer-Directed Benefits, WageWorks provides employee programs that deliver corporate tax savings while helping employees manage everyday expenses.

For Flexible Spending Accounts, Health Savings Accounts, Health Reimbursement Arrangements, COBRA, Commuter Benefits, Wellness Programs and other types of employee programs, we make Consumer-Directed Benefits easy to understand and use—empowering employers, employees and their families to lead happier, healthier and more productive lives.

Booth 105 Visit us online at www.wageworks.com

BY NIYUM GANDHI, PARTNER AND JOSH MICHELSON, PRINCIPAL OLIVER WYMAN

STATS & DATA: ACOS

O

Accountable Care: Are We Near the Tipping Point?

ver the past year, we’ve been seeing mixed signals from the nation’s accountable care organizations.

On the one hand, as dissatisfaction with Medicare policies grows, a number of ACOs have pulled out of the key Pioneer ACO Program. On the other, the number of ACOs has continued to grow, though at a much slower pace.

Number of ACOs Non-CMS ACOs Medicare ACOs

135

What’s going on?

Number of ACOs

124

Waiting for the percent served by atFlip least one ACO, in February 2013. Roughly 40 p

currently ACOsACOs. in the United States, in aWe PCSA served count by two585 or more up a healthy 12 percent from 2014, and more than twice “We regard thiscounted last number as extremely as many as we in in February 2013. important,�

Together theyexplains Niy 154 partner in Oliver Health & Life or Sciences serve between 49Wyman’s and 56 million patients roughlypractice 15 to group a firm’s ACO experts. “ACOs need to be treated as a triggering mech 17 percent of the population. revolution American healthcare.

Their reach ispercent at least as import Here’sin the more important fact: Sixty-nine watch as their current enrollments.� of the U.S. population currently live in a primary percent served by at least one ACO, in February 2013. Roughly 40 percent livecare

368 served byservice areaACOs. served by at least one ACO. This compares We’d suggest that ACOs have hit a very crucial point: in a PCSA two or more Non-CMS ACOs Current enrollments are problematic, Gandhi explains, because m to 67 percent in 2014 and 52 percent in 2013. When They’ve achieved critical mass, and when they prove their 235 currently an early stage of development, offering care that diffe “We regard this last number asat extremely 134 154 Medicare ACOs consumers see value,important,� and whenexplains the bestNiyum modelsGandhi, are ablea value in terms of cost, quality and patient experience, they from traditional healthcare providers.

Butand theone factofthat partner in Oliver Wyman’s Health & Life Sciences practice group the they are rei to commercialize their value through targeted products can potentially get a large percentage of the population to firm’s Jan ACO experts. “ACOs needthan to betraditional treated as afee-for-service triggering mechanism for ameans that th differently providers 2014 Jan 2013 July 2013 and more compelling patient experience, the conditions switch over from conventional fee-for-service providers. 135 revolution in American healthcare. reach isunnecessary at least as important a factor to to profit from Their eliminating services and replacing trea are right for the market to flip rapidly from fee-for-service And a small but significant number of ACOs are deeply watch as their current enrollments.� prevention—something fee-for-service providers cannot do. to value-based engaged in making that happen — implementing124 new models Percent for patient care total population coveredhealth care.

368 Current enrollments are problematic, Gandhi because most are Right now, the“ACOs signs are that the Centers for aMedicare Medicaid and focusing on generating cash flow, including shared savings payments from were designed toexplains, create new kindand of ACOs competition in healt 235LOWER BOUND currentlywill at an early stagethis of development, offering care that differs very little 134 services take a step year to bring that day closer.

Medicare, of course, Medicare, so they can expand the way they commercialize their value. providers taking responsibility for the patient’s total health and co from traditional healthcare providers. But the fact that they are reimbursed engine is supposed to quality,� drive the Gandhi growth ofexplains.

ACOs, but critics Superficially, it may look like the ACOs are losing momentum, but from our is the financial thethat basis of cost and “The idea is that co 15%than traditional fee-for-service providers means that they can begin Jan 2013 July 2013 8% Jan 2014 12% differently pointing out that Medicare’s reimbursement rules make to deliver h perspective, as advisers to ACOs, something else is happening: The basic build- have increasingly been drive them to adopt more effective, cost-efficient ways to profit from eliminating unnecessary services and replacing treatment with too hard for high-performing toproviders actually make money in Medicare.

The though t out of the “O� part of the ACO movement is largely complete. Now we’re waiting itprevention—something Those newACOs delivery models already and they work, fee-for-service cannot do.exist, population covered agency has been paying attention, and has proposed rules — including theWhen will w for serious competition to kick in on the “AC�Percent side andtotal drive the next wave of widespread and they have proven difficult to scale up.

UPPER BOUND “ACOs were designed to create a new kindwould of competition inon healthcare, with That’s the re kind ofModel competition that leads to meaningful new Next Generation ACO — that put things a fairerchange? footing. innovation, creating a serious alternative to theLOWER failingBOUND fee-for-service model. taking responsibility forbest the patient’s total health and competing on But nowThe that two-thirds Americans have access to an ACO and m 14% providers That is exciting news.

ACOs areof extraordinary organizations that 10% 17% the basis of cost and quality,�

Gandhi explains. “The idea is that competition will 15% 8% have access to two or more, here’s a prediction: Once the fire is lit, 12% slash costs and produce outcomes head and shoulders above what conventional Growth Continues drive them to adopt spread more effective, cost-efficient ways to deliver healthcare.

Jul 2013 Jan 2013 Jan 2014 quickly.� providers accomplish.

We’ve all grown rather leery of how much money flows into Each year, Oliver Wyman conducts a census of ACOs. (For purposes Those new delivery models already exist, and they work, though they are not pockets of health care companies. But these inspired, ambitious companies of our analysis, we use the term to refer to any health care provider that has the widespread and they have proven difficult to scale up. When will we see the UPPER BOUND In more than halfcare of states, of people have access to an for what health ought atomajority be, and they can fulfill their entered into a publicly announced shared savings or shared risk contract with are setting an example

at least one government or private payer.) Here are our latest14% figures, from 10% 17%data collected in January 2015: Jul 2013 Jan ACOs 2013 in Medicare Jan 2014 ACOs in CMS programs: There are now 426 programs; about 5.6 million Medicare beneficiaries, or about 11 percent of total Medicare beneficiaries, will now receive their health care from ACOs. The corresponding figures in January 2014 were 5.3 million beneficiaries and 10 percent of total beneficiaries. The number of ACOs rose by about 16 percent, while the number of patients served rose by only six percent, indicating that smaller ACOs are joining the program — something that many observers had predicted.

Non-Medicare patients in ACOs in CMS programs: ACOs in CMS programs currently serve an estimated 35 million non-Medicare patients, up from 33 million in 2014 and 15 million in January 2013.

ACOs not participating in CMS programs: These ACOs are difficult to count, because there is neither an official list nor an official definition. Our count draws on press releases, news accounts and other forms of direct research and must be regarded as imperfect. We currently count 159, virtually unchanged from 154 in 2014 and up from 124 in January 2013. These ACOs serve between nine million and 15 million patients, roughly the same as last year and up from eight million to 14 million in February 2013.

kind of competition that leads to meaningful change? That’s the real question.

promise in an environment wherehave financial incentives areand correctly aligned.

But now only that two-thirds ofWA Americans access to an ND ACO more than half MT MNit’s going to Here’s hopingtoCMS willmore, do itshere’s part. a prediction: Once the fire is lit, have access two or spread quickly.�

14 Second Quarter 2015 * XXX 5IF*)$$ DPN * HealthCare Consumerism Solutions

WI

SD

ID

MI

WY

IA

NE

In more than half of states, a majority of people have access to an ACO IL NV

WA

MT

OR

CA

UT

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ID

NV

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CA NM

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KS OK

AZ

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AZ

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IN

MO

KY

MI

AR VT

NY

GA

OH WV

TN

ME NH MS AL MA CT PA TX LA RI IN OH MD NJ WV DE VA KY DC TN NC

MS AL

SC

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% of acce L FL

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% of residents with TX access to ACOs Updated as of January 2014 LA Low Claritas, <50%Oliver Wyman analy Sources: News releases, company websites, Dartmouth Atlas PCSAs, 1. ACOs defined as providers participating in Pioneer Shared Savings, a Medicaid A FL ACO, Medicare Medium 50â&#x20AC;&#x201C;75% or in a shared savings/risk arrangement with a commercial payer; Prep activity defined as particip High >75% collaborative or providers preparing to become an ACO Updated as of January 2014 Sources: News releases, company websites, Dartmouth Atlas PCSAs, Claritas, Oliver Wyman analysis 1. ACOs defined as providers participating in Pioneer ACO, Medicare Shared Savings, a Medicaid ACO, PGP Transition, or in a shared savings/risk arrangement with a commercial payer; Prep activity defined as participation in a learning collaborative or providers preparing to become an ACO

Copyright Š 2014 Oliver Wyman

â&#x201E;˘

OR

BY JENNIFER BENZ FOUNDER AND CEO BENZ COMMUNICATIONS

C

STATS & DATA: ENGAGEMENT

Americans need to connect the dots Are Employees Becoming Better between money and medical care Health Care Consumers?

onsumer-driven plans are pushing employees toward a new role in must be part of the motivation. For instance, when introducing health care health care — from “My doctor knows best, and insurance will pay estimators to employees, use cost savings as the lead message. Once in the for it” to “Am I making the best choice for my health and my wallet?” tool, individuals must clearly see the price differences among health care with information about medicalworkers outcomes.say Research indicates that high-deductible plans are working for demographics a subset of services Across diverse andpaired income levels, American Consumers personally experiencing better value personally — quality employees and that strong patient engagement leads to lower costs. they have enough information to get the right health care for their families. care at a fair price – is our best hope to shift health care purchasing patterns.

But, have we created “good health care consumers” yet?

However, they don’t ask health care providers, “How much will it cost?”

We heard from more than 2,000 U.S. employees in a study done in nearly often enough. Those five words can be the difference in hundreds of partnership with Quantum Workplace. All respondents have participated Employers have the leverage to push for change medical bills—which can to financial crisis.

Bankruptcy caused in an employee engagement survey, anddollars nearly allinhave employer-based Whenlead the Affordable Care Act first was signed into law in 2010, many bysurprise medical debt million Americans eachbreak year. health insurance. The results probably won’t you — but Iaffects hope they1.7 experts predicted the law would the familiar and long-standing coupling motivate you to invest more in educating employees and providing tools that of employment and health insurance. Yet, 89 percent of workers say health These are among the top-line findings from survey of more 2,000 U.S.half (48 support them through the health care system. benefits play a part in a staying at their current than employer — nearly employees, conducted by Benz Communications andpart.

Quantum Workplace. percent) say benefits play a major Further, workers don’t yet see alternatives on the state or federal health Employees are confident but don’t ask about costs exchanges.

Just five percent say definitively they can find a better deal American workers are confident that they’re health care savvy. Across diverse demographics and income levels, 69 percent believe they have through the exchanges than with their employer plan options.

Many companies shy enough information to get away from proven stratethe right health care for Blindsided by the bill Not myof money, gies for fear disrupting not m themselves and their family. their workers. In the near However, cost isn’t a Among all respondents, High earners are able—but term, it seems, employees strong part of the equation.

69% believe they have leadparticipants in making arethe willing in cost con Employees aren’t asking enough information to get all the changes they’ve enough questions to get the the right health care for experienced in their health right outcomes. Specifically, and wellness programs. our study found that less themselves and their family.

Employers shouldn’t hesithan half (48 percent) tate to evolve their health always ask their doctor how plan design, especially much their care will cost. those that couple quality For all the effort employers But only 48% always ask and cost. put into driving consumer their doctor how much Whatever strategies behaviors, workers still their care will cost. are appropriate, a commudon’t believe cost is critical <$25K nication plan tightly coninformation in getting the nected to business goals is right care. critical. Our study correlates leadership trust to frequent Moving from cost Companies can Mother knows best health and wellness messages from leaders.

Organizations that continue to spark savings to better, higher-quality care provide health insurance must see and support their employees’ new role as From the survey data, it is clear that young, single, less-educated Parents—whether single or married—are more likely workers with lower household incomes are generally less confident that they patient-consumers — not just in plan design, but also through high-touch non-parents to feel in their health care education and resources. know enough to get the right care. They than are also more likely to ask their confident Respondents navigation skills. doctor about cost. Employers can and should focus on those most likely to more likely to adopt new behaviors.

Jennifer Benz is the founder and CEO of Benz Communications, a San Franciscoabout medica Yet, while economics are a major driver in these existing behaviors, based marketing firm specializing in employee benefits. Find detailed data from the Benz-Quantum health and engagement survey at benzcommunications.com/ we’ll only see lasting change if these new solutions build on an individual’s quantumsurvey. proclivity toward cost savings rather than rely on it. Value and quality care

69%

58%

48%

72% parents

66% non-parents

HealthCare Consumerism Solutions™ I www.TheIHCC.com I

3

their emplo resources a to2015navigate Second Quarter 15 care system

Second Quarter 2015

Exchange

About Innovative Health and Benefit Mar etplaces

Back to the Future

Itâ&#x20AC;&#x2122;s not fantasy. Health management strategies crucial to exchangesâ&#x20AC;&#x2122; long-term survival.

Cadillac Tax Driving Growth Private Exchange Questions?

Liazon Has Answers

The Official Magazine of

www.theihcc.com

WHAT’S YOUR EXCHANGE STRATEGY? WHAT’S YOUR Let Softheon help plan your next move.

EXCHANGE STRATEGY? Let Softheon help plan your next move.

INSIDE FEATURE 13 Taking Private Exchanges Back to the Future Health management strategies key to future sustainability

PERSPECTIVES 9

So Many Private Exchange Questions.

Finally, Some Answers.

How do employees shop for benefits in an environment of choice? Are they making smart decisions for themselves? With the latest statistics pointing to the number of people enrolled on a private exchange for benefits selection having doubled for the past year’s enrollment, the answers to these and other questions are becoming increasingly necessary for the industry to understand.

It’s been billed as the solution to rising costs. But many in the private exchange world — solution providers and employers alike — have been so focused on the here and now that they’ve neglected to look a few years down the road.

By Ashok Subramanian, Chief Executive Officer and Co-Founder, Liazon

10 “Cadillac Tax” Driving Rampant Growth in Private Exchange Enrollment The health care conversation among employer groups has changed from “What is a private exchange?” to “How do we enroll?” The reasons are simple: better cost management, improved population health and the looming implementation of the “Cadillac Tax.” Analysts predict that the shift to private exchanges will be dramatic.

By Joseph Berardo Jr., Chief Executive Officer, MagnaCare

A private exchange in and of itself will only succeed for a while. But, take a private exchange, combine it with a health management strategy and, according to many, the result is a recipe for success.

“A health management strategy in conjunction with a private exchange is critical to the employer,” said Scott Brown, private exchange offering lead at Accenture. “In terms of the evolution of private exchanges, I think much has focused on the shopping experience and purchasing benefits. In the long run it’s crucial that private exchanges, wellness strategies and incentive tools come together.”

Less than a year out of the first open enrollment for many private exchanges, it’s still uncharted territory to some extent. Employers are still understanding what private exchanges are and how — or if — they will benefit them and their employees. But one thing is becoming clear to those in the industry; health management — though crucial — is often overlooked.

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

11 Member Perceptions of the Exchange Experience, Their Plans and Where We Go From Here The J.D. Power Healthcare Practice released the findings from its 2015 Health Insurance Marketplace Exchange Shopper and Re-enrollment Study (HIX) on April 23 and found that satisfaction with the health exchange marketplace enrollment and health plans obtained through the marketplace have performed well in terms of overall plan satisfaction.

By Rick A. Johnson, Director, Healthcare Practice, J.D. Power

4

Publisher’s Letter CEO and Publisher Doug Field covers the latest trends in private exchanges and shares what’s happening at The Institute for HealthCare Consumerism around exchanges.

6-7 Briefs & Innovations Keeping you up-to-date with the latest news, research and innovation in health insurance exchanges (both public and private) and defined contribution.

HealthCare Exchange Solutions™ I www.TheIHCC.com I Second Quarter 2015

3

PUBLISHER

Exchange www.theihcc.com VOLUME 2 NO. 2 | SECOND QUARTER 2015

Forward Thinking

Published by FieldMedia LLC 292 South Main Street, Suite 400 Alpharetta, GA 30009 Tel: 404.671.9551 • Fax: 770.663.4409 CEO

While much talk has focused on the basics of implementing private exchanges — educating consumers, providing basic decision support tools, gathering data and so on — few have strayed from the here and now to focus on the future.

Doug Field 404.671.9551 ext. 101 · dfield@ theihcc.com NATIONAL SALES DIRECTOR

Brent Macy 404.671.9551 ext. 103 · bmacy@theihcc.com CHIEF MARKETING OFFICER

That’s slowly changing, though. As we move further into the experience, it’s becoming apparent that long-term sustainability of private exchanges rests on a few key factors — a big one being health management.

Our cover story in this issue discusses that very topic. We need to go “back to the future” to ensure success now and in the long run. Our Senior Editor Heather Loveridge interviewed key players in the private exchange space to get their perspective on combining health management with private exchanges. You’ll want to read what Scott Brown, private exchange offering lead at Accenture; Cathy Kenworthy, CEO of Interactive Health; John Young, CEO of Consumerdriven; and Rob Harkins, practice leader, private exchanges for Willis all have to say.

We hope you’ll find their comments thought provoking and helpful as you consider long-term strategies for private exchanges.

Andrew Dietz adietz@theihcc.com MANAGING EDITOR

Jonathan Field 404.671.9551 • jfield@theihcc.com SENIOR EDITOR

Heather Loveridge hloveridge@theihcc.com ART DIRECTOR

Kellie Frissell 404.671.9551 ext. 107 · kfrissell@fieldmedia.com ASSOCIATE DIRECTOR OF EDUCATION SERVICES AND PROGRAMS

Dusty Rhodes CHAIRMAN OF IHC ADVISORY BOARD

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

Also in this issue is a look at how members are perceiving the exchange experience, presented

by Rick Johnson, director of healthcare practice at J.D. Power. You’ll also want to read about Liazon’s newest venture, the Private Exchange Research Council — a think tank formed to analyze and share findings concerning the private exchange space; and MagnaCare’s CEO Joseph Berardo, Jr.’s comments on the Cadillac Tax driving rapid exchange enrollment.

There’s much talk surrounding private exchanges, and I am excited to further those discussions even more with the advent of our newest forum, the Private Exchange FORUM Baltimore. Held September 1-2, 2015, the Private Exchange FORUM Baltimore features industry leaders such as John Young, CEO of Consumerdriven; Ernie Harris, NPDP, Conference Co-Chair, EVP of Exchange Solutions, Maestro Healthcare Technology; Barbara Gniewek, Principal, GHRS, PricewaterhouseCoopers and many more! For more details, visit www.theihccforum.com/ private-exchange-forum-baltimore.

I hope you will join us this September. It’s an exciting time in the private exchange world!

Sincerely,

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, Mercer Health & Benefits; Marc Kutter, Aflac; Sanders McConnell, TSYS Healthcare; Roy Ramthun, HSA Consulting Services LLC; John Young, Consumerdriven LLC WEBMASTER

Tim Hemendinger timh@fieldmedia.com DIRECTOR OF CONFERENCE SPONSORSHIP/ CORPORATE MEMBERSHIP/REPRINTS

Rogers Beasley 404.671.9551 ext 109 · rbeasley@fieldmedia.com ACCOUNT MANAGERS

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Joni Lipson 800.546.3750 · jlipson@fieldmedia.com BUSINESS MANAGER

Karen Raudabaugh 404.671.9551 ext. 108 · kraudabaugh@fieldmedia.com

Doug Field CEO/Publisher dfield@fieldmedia.com

HealthCare Exchange Solutions™ Volume 2 Issue 2 Copyright ©2014 by FieldMedia LLC. All rights reserved.

HealthCare Exchange Solutions™ is a trademark of FieldMedia LLC. HealthCare Consumerism Solutions™ is published eight times yearly by FieldMedia LLC., 292 South Main Street, Suite 400, Alpharetta, GA 30009. Periodical postage paid at Alpharetta, GA and additional mailing offices.

TO SUBSCRIBE: Make checks and money orders payable to HealthCare Exchange Solutions ™ magazine 292 S. Main Street, Suite 400, Alpharetta, GA 30009 or visit www.theihcc.com. Non-qualified persons may subscribe 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 or subscriberservice@fieldmedia.com for name/address changes.

PRINTED IN THE U.S.A. HealthCare Exchange Solutions™ is designed to provide both accurate and authoritative information with regard to the understanding that the publisher is not engaged in rendering legal, financial or other professional service. If legal advice is required, the services of a professional adviser should be sought.

The magazine is not responsible for unsolicited manuscripts or photographs.

Send letters to the editor and editorial inquiries to the above address or to jfield@fieldmedia.com. Permission to reuse content should be sent to, jfield@ fieldmedia.com.

4

Second Quarter 2015 I www.TheIHCC.com I HealthCare Exchange Solutions™

15.2%

Offer a wider array of options

Continue to offer benefits that

14.8%

for benefit plans

would otherwise be in jeopardy

NEWS BRIEFS & INNOVATIONS

Where are you in the process of exploring or adopting a DCP to offer on a private exchange?

NEWS BRIEFS 24.5%

12.8%

41.9%

Have not begun to explore DCPs

Already using DCPs (not on a

Still learning

Towers Watson Acquiresprivate Acclaris to Administer Consumerexchange) Driven Benefits for Exchange Solutions Segment

Infogr

Defined Contribution & Private Exchange Trends

How familiar are you with defined contribution Towers6.8% Watson announced that it has acquired 6.8% Acclaris, a provider health benefit plans (DCPs) & private exchanges?

Using DCPs on a private exchange Are considering exploring/adopting of software-as-a-service-based technology and services for consumDCPs to offer on a private exchange er-driven health care and reimbursement accounts, including health in the future Familiar Not Familiar savings accounts, health reimbursement arrangements and other consumer-directed accounts. The acquisition enhances Towers What partners would you depend on to help you learn Infographic Benefits a DCP wouldexperts bringand to your company: Watson’s position as a leading benefits administration and exchange comprised of private benefits exchange top national about new health benefit designs and distribution models? provider. Acclaris’ CEO, Dean Mason, will join the leadership team brokers and consultants. As private exchanges are poised to of Towers segment. strengthen employee engagement, empowerment and education, InsuranceSolutions Brokers Benefit Consultants Employees will have a better 50% Watson’s Exchange Help employees make mo 30.2% 31.9% 17.9% understanding costs this think tank will provideof benefit the market with insights into how benefit de cost-conscious Research Independently Insurance Carrier 26% people are making decisions when shopping for their benefits.

Benaissance Announces Partnership 16%GoHealth How familiar are you with definedwith contribution PERC plans to explore frequently asked questions with respect Benaissance® announces plans to bring the GoHealth Marketplace health benefit plans (DCPs) & private exchanges?

Third Party Administrator Industry/Trade Association 11.8% 11.1% to private exchanges, such as delving into how demographic and to its COBRApoint® platform, which provides access to benefits for Offer a wider array of options Continue to offer benefits behavioral factorsfor influence buying decisions, the 14.8% impact of decision millions of COBRA-eligible and retiree consumers.

The partnership 15.2% benefit plans would otherwise be in jeo 4.6% Familiar Payroll Companies Not Familiar support on buying patterns and the benefit to employers of greater provides consumers with enrollment support, giving them the option consumerism, among others. of continuing their health insurance through COBRA or enrolling in Benefits a DCP would your in company: Employer utilities youbring wouldtovalue offering health Where are you in the process of exploring or adopti a new individual Marketplace health plan — putting the consumer plans in an exchange environment: offer on a Companies private exchange? in the driver’s seat. The GoHealth Marketplace provides education Blue CrossDCP andtoBlue Shield to Launch Employees will have a better Help employees makeRetiree more and 31.9% accessibility to a wide range of individual insurance options Health Insurance Exchange 17.9% understanding of benefit costs 41.9% 24.5% 12.8% cost-conscious benefit decisions and allows consumers to compare benefits from the nation’s top Blue Cross and Blue Shield companies will launch a health 82.6% 78.3% 82% Already using DCPs (not on a Still learning Have 65.3% 65%not begun to explore DCPs insurance carriers, apply for subsidies (to reduce health insurance insurance exchange this summer that will support employers’ private exchange) premiums and out-of-pocket expenses) and enroll in an individual Health efforts to help retirees transition from group health benefits to Spending Carrier Integration COBRA Compliance Premium Payment Payroll Processing Offer a wider array of options Continue to offer benefits that health insurance plan. individual Medicare coverage that starts 6.8% Jan. 1, 2016. BCBS Accounts Automation 6.8% 15.2% 14.8% for benefit plans would otherwise be in jeopardy Marketplace will offer Blue Cross and Blue Shield Using DCPs on a private exchange Are considering exploring/adopting DCPs to (Medigap), offer on a private exchange If considering defined contribution plans for future, when?

Medicare Supplement Insurance in the future Medicare Advantage Plans and Medicare Part D 61.1% of exploring or Where are you in the process adopting a 11.1% 22.2% prescription drug coverage in more than 45 states DCP to offer on a private exchange? 2017 What partners would you depend on to help you le 2015 2016 and Washington, D.C. The personalized exchange about benefit designs andfor distribution m will new help health Medicare-eligible retirees shop the 41.9% 24.5% 12.8% coverage that best meets their health care needs.

Already using DCPs (not on a Still learning Have not begun to explore DCPs Insurance Brokers Benefit Consul 50% 30.2% private exchange) BCBS Marketplace can help employers reduce the costs of benefit Maestro Health Adds Two Key Industry Leaders What employee features would you to include if you could administration and support contributions to Insurance Ca Executivedesign Team as Rapid Growth Continues Researchemployers Independently who provide a benefit offering using an insurance 26% 16% 6.8% 6.8% retiree coverage, all while providing a near-paperless process for As an innovator of health environment? insurance exchange and employee benefits exchange Using DCPs on a private exchange Are considering exploring/adopting Third Party Administrator Assoc 11.8% 11.1%co-brandIndustry/Trade Medicare-eligible members.

Employers can optionally the management, Maestro Health is continuing DCPs expansion with the to offer on a private exchange Plan and Cost Comparison Tools 67.9% BCBS Marketplace with their logo to demonstrate their partnership addition of two new members to its key executive team.

Maestro in the future Payroll Companies 4.6% in ensuring a smooth coverage transition.

Health appointed Nancy Reardon as chief product Online Access 50.4%officer and Jeff Yaniga asWhat executive vice president exchange in the partners wouldofyou depend onfirst to quarter help you learn Progressive Cost Tracking Tools 46.9% Employer youHealth would value in offering he of this year.

Three Results in theutilities Aon Active Exchange about new health benefit designs and distributionYear models?

77.5%

22.5%

Defined Contribution & Private Exchange Trends 77.5%

22.5%

plans in an exchange of environment: Underscore Long-Term Sustainability Private Exchanges

38.5%

Help Line

50% Research

Council Forms to Provide Insights 30.2% on Combined Benefit Enrollment 37% Consumer Behavior in Private Exchanges

Aon Hewitt has announced that the third-year enrollment results from the Aon Active Health Exchange further demonstrate that Consolidated Employer BillingIndependently Research Insurance Carrier 82.6% 26% 16% 78.3% 82%exchanges can 29.4% 65.3% 6 Services well-designed private health deliver on their promise Liazon announced an initiative to analyze data from hundreds of to control cost, engage consumers and offer broad choice.

All of thousands of employees who have purchased benefits through Mobile 29.4% Third Party Administrator Industry/Trade Association 11.8% 11.1% Health Carrier Integration COBRA Compliance Premium Payment Payroll Processing the companies and insurance carriers that participated in the Aon Liazon’s Bright Financial Account Choices® Exchange and other Liazon-powered Acc Automation 22.1% Options Companies 4.6% Active Health Exchange in 2014 returned in 2015. Companies private exchanges. ThePayroll Private Exchange Research Council is If considering contribution forhad future, wh that wentdefined through their second-yearplans renewal Private exchange features most important: average annual health cost increases of 2.6 percent Employer utilities you would value in offering health 61.1% 11.1% over the two years they were in the exchange,22.2% plans in an exchange environment: The exchange actively screens and 2015 including costs associated A large choice of plans with the Affordable Care 2017 2016 restricts the number of plans that available at your company’s Act and administration.

This compares favorably to 43.1% 40% may participate on the exchange targeted benefit level industry data reflecting the average health care cost 82.6% according 78.3% 82% 65.3% to price and quality 65% increase for large U.S. companies for you comparable What employee features would include if you plan designs will be approximately 6.5 to Health Spending Carrier Integration COBRA Compliance Premium Payment Payroll Processing design a benefit offering using anpercent insurance The exchange allows any plan to Accounts Automation eight percent in 2015.

The exchange is government-run exchange environment?

39.2%

6

Insurance Brokers

Benefit Consultants

21.4%

meet the exchange’s minimum

standards to participate If considering defined contribution plans for future, when?Plan and Cost Comparison Tools Second Quarter 2015 I www.TheIHCC.com I HealthCare Exchange Solutions ™

11.1%

61.1%

22.2%

Online Access

67.9%

77.5% Familiar

22.5% Not Familiar

6.8%

6.8%

Using DCPs on a private exchange

Are considering exploring/adopting

Benefits a DCP would bringDCPs to toyour company: offer on a private exchange in the future Employees will have a better

Help employees make more

31.9% Whatunderstanding partnersof benefit would costsyou

depend to help you 17.9% oncost-conscious benefitlearn decisions about new health benefit designs and distribution models?

50% 15.2% 26%

Insurance Brokers

Offer a wider array of options for benefit plansIndependently Research

11.8%

Third Party Administrator

30.2% 14.8% 16% 11.1%

Benefit Consultants

Continue to offer benefits that would otherwise be in jeopardy Insurance Carrier Industry/Trade Association

Where are you in the process of exploring or adopting a DCP to offerPayroll on Companies a private exchange?

that will complement SAP’s market-leading core human resources and talent management solutions and help its customers with U.S. employee benefits enrollment and management.

Gravie Receives An Additional $12.5M in Funding to Meet Growing Demand

Gravie recently announced that it has raised a $12.5M Series B round of funding, led by new investor Split Rock Partners, with existing investors 41.9% 24.5% 12.8% Employer utilities you would value in offering health also participating.

The company had previously raised $10.5M in Connecture Names Steve Cohen VP of Sales Overseeing Already using DCPs (not on a Still learning Have not begun to explore DCPs plans in an exchange environment: Series A funding, and the new infusion of capital will help Gravie Private Exchange Product for Brokers privateLine exchange) keep pace with the high demand for its platform and services that Connecture, Inc. announced that Steve Cohen will serve as the vice help employers transition their employees to the individual health president of sales for Connecture’s On Ramp product.

Cohen brings 6.8% 6.8% 78.3% 82% 65.3% 65% Using DCPs of on asales privatemanagement exchange Are considering exploring/adopting insurance market. Gravie helps organizations make the shift from more82.6% than 25 years experience working in the DCPs to offer on a private exchange group to individual coverage by making available a state’s entire fields of health insurance, human resources and employee benefits in the future Health Spending Carrier Integration COBRA Compliance Premium Payment Payroll Processing insurance marketplace, including offerings in the private market to the company.

As vice president of sales, he will oversee sales Accounts Automation as well as public exchanges. Gravie then helps employees pick teams serving customers for On Ramp — a robust, secure and timeWhat partners would you depend on to help you learn a plan that works best for them, identifies and pursues tax credit tested online benefits marketplace.

If considering contribution plans future, when? about newdefined health benefit designs and for distribution models? eligibility on behalf of employees, manages employer contributions 61.1% 11.1% 22.2% and provides an integrated online and mobile platform for people to GetInsured Unveils New Shared HIX Platform to Insurance Brokers Benefit Consultants 50% 30.2% manage their health care in one spot.

Address2015 State-Based Exchange 2016 Sustainability Concerns 2017 Research Independently Insurance Carrier 26% 16% GetInsured recently unveiled the GetInsured Shared HIX Platform as an alternative to existing state-based marketplaces that have selfSoftheon Confirms Web Broker Entity Status with the Third Party Administrator Industry/Trade Association 11.8% 11.1% sustainability concerns.

With thefeatures Shared HIX Platform, will if you Centers of Medicare & Medicaid Services What employee would you states include could have 4.6% accessdesign to a full-featured, ACA-compliant Individual and Small Softheon, Inc. has confirmed its status as a Web Broker Entity Payroll Companies a benefit offering using an insurance Business Health Options Marketplace. The GetInsured Shared with the Centers of Medicare & Medicaid Services. Under this exchange environment?

HIX Platform offers states a pathway for continuing marketplace agreement, Softheon will establish an enrollment channel with EmployerTools utilities you would value in offering health Plan and while Cost Comparison innovation advancing self-sustainability through a solution67.9% that access to the Federal Data Hub to assist and facilitate the plans in an exchange environment: carries no upfront cost and offers a predictable per-member-perenrollment of eligible consumers into qualified health insurance Online Access 50.4% month cost structure. plans. Through this agreement, Softheon will exchange real-time Progressive Cost Tracking Tools 46.9% eligibility information with the Federally-Facilitated Marketplace that 82.6% 78.3% 82% 65.3% 65% will provide information regarding eligibility as well as the amount Benefitfocus Announces Reseller38.5% Agreement with SAP Help Line of subsidy for which consumers qualify. Softheon has completed all Benefitfocus recently announced the signing of a reseller agreement Health Spending Carrier COBRA Compliance Premium Payment Payroll Processing Combined Benefit Enrollment 37%Integration necessary training and requirements needed to meet the FederallywithAutomation SAP. SAP will resell BENEFITFOCUS® Marketplace as the SAP® Accounts Employer Billing 29.4% Facilitated Marketplace standards. This integration resembles the U.S.Consolidated Benefits Management application by Benefitfocus.

Through this Services If considering defined contribution plans for future, when?

Direct Enrollment solution utilized by all of Softheon’s Health Plan agreement, SAP will offer customers in the U.S. a powerful, endMobile 29.4% Partners offering Qualified Health Plans in FFM States. to-end human capital management solution that improves benefits 61.1% Financial Account 11.1% 22.1% 22.2% Options administration efficiency and platform user experience throughout the 2015 2016 Management by Benefitfocus 2017 employee lifecycle. SAP U.S. Benefits Array Health and HealthEquity Partner to Address Private exchange features — scheduled to be available soon from SAP — ismost a cloudimportant: application Growing Demand for Health Accounts Array Health and HealthEquity, Inc. announced a partnership to provide personal health accounts on What employee include if you could The exchange actively screens and A large choice of plans features would you restricts the number of plans that available at your company’s the Array Spectrum e-commerce platform. Through a benefit offering using 43.1% design 40% an insurance may participate on the exchange targeted benefit level this partnership, the Array Health private exchange exchange environment? according to price and quality solution will provide seamless access to HealthEquity’s Plan and Cost Comparison Tools 67.9% personal health account offerings, including HSAs Online Access The exchange allows any plan to and FSAs. The Array Health private exchange solution 50.4% The exchange is government-run meet the exchange’s minimum 39.2% 21.4% enables health insurers to deliver their own branded standards toTools participate Progressive Cost Tracking 46.9% online exchange — a strategic channel that helps Help Line 38.5% them differentiate their offerings, better serve their © Copyright 2015. Healthcare Trends Institute. existing customers and attract new members.

Source: 2014 Healthcare Benefits Trends Combined Benefit Enrollment 37% 4.6%

www.HealthcareTrendsInstitute.org Consolidated Employer Billing 29.4% Services

Benchmark Study Sponsored by Evolution1®

29.4%

Mobile Financial Account Options

22.1%

Private exchange features most important:

The infographic on defined contribution and private exchanges included here has been reprinted with permission from Healthcare Trends Institute. The data is sourced from the 2014 Healthcare Benefits Trends Benchmark Study. For more information, visit www.

HealthcareTrendsInstitute.org.

HealthCare Exchange Solutions™ I www.TheIHCC.com I Second Quarter 2015

7

PRIVATE EXCHANGE Q&A

BY ASHOK SUBRAMANIAN CHIEF EXECUTIVE OFFICER AND CO-FOUNDER LIAZON

So Many Private Exchange Questions.

Finally, Some Answers.

H

ow do employees shop for benefits in an environment of choice? Are they making smart decisions for themselves?

With the latest statistics pointing to the number of people enrolled on a private exchange for benefits selection having doubled for the past year’s enrollment, the answers to these and other questions are becoming increasingly necessary for the industry to understand.1 That’s why Liazon, as one of the longest-standing private exchange providers in the space, has joined forces with several of our broker partners and other researchers and experts to form a think tank to analyze and share findings that will truly move the industry forward.

Launched last month, the Private Exchange Research Council was formed to gather insights from the rich data that we have acquired working with nearly 1,000 employer clients and will develop unique insights about consumer behavior on a private exchange to address such questions as: t What are people buying when presented with choice in an exchange environment? t Are people buying enough coverage, and the right types of coverage, to provide themselves with adequate financial protection? t What factors (demographic, behavioral, geographic) affect these buying patterns? t How does the amount of employer contribution influence buying behavior? t How do recommendations and access to educational materials affect buying decisions? t How do people’s choices in an exchange environment change over time?

The data garnered through PERC promises to have value not just for the benefits industry, but for behavioral scientists, economists and thought leaders in consumer behavior and decision making.

Rick Strater, division vice president & national exchange practice leader of Arthur J. Gallagher & Co., and a member of PERC, is a strong proponent of the initiative: “We made the decision to partner with Liazon for three reasons: They have very smart people; their decision support is best-in-class; and they have implemented far more exchanges than any other firm. The opportunity to mine the data from those implementations is exciting.

The data can be a huge differentiator as we continue to look for ways to help our clients and their employees make better benefit decisions and control costs.”

Here’s an example of the type of research Liazon is able to generate based on our eight-plus years of market experience: When given a choice in benefits selection, not all employees will opt for the lowest-priced plans. Instead, they are buying based on their needs, which has led to a much higher uptake in HSA-qualified plans

versus the national average, as well as a strong appetite for ancillary products to ensure they have the financial protection they need.

Other past insights based on Liazon’s own data include the following: t Eighty percent of employees are choosing to put additional money toward their benefits on top of what their employers are providing through the defined contribution, in order to buy the benefits they feel would provide the best coverage for their families. Conversely, 20 percent of employees buy their benefits without spending any money out of their own pockets.2 t When shopping with their own money and given a choice, nearly 90 percent of employees would consider a less expensive plan that allowed access to only in-network doctors and facilities or required referrals from a gatekeeper — or both. Given the two options, employees gravitate more towards the in-network provider plans, with 83 percent of employees open to this option. 3 t Factors that influence decision making on an exchange include: t Age: Younger employees are more likely to take the systemgenerated recommendation than choose products on their own. t Gender: Men are more likely to take the system-generated recommendation than women. t Salary: Lower-paid employees are more likely to take the system-generated recommendation.

Our vision for PERC is to work together with our broker and other partners, to identify new research frontiers through discussion, sharing experiences in the market and helping us to see the results from their perspective.

“The private exchange industry needs its own ‘think tank’ to analyze the millions of health care decisions that have been made by consumers who have shopped for a health plan through a private exchange platform,” says PERC member Chris Condeluci, an expert in tax law, ERISA and the Affordable Care Act. “Understanding consumer behavior, understanding the tools that can aid a consumer in making a decision that is right for them and understanding how to simplify the shopping experience and the administrative complexities associated with employee enrollment is critical to the long-term future of the private exchange industry.”

With more than eight years’ experience in the private exchange marketplace, during which time we’ve collected hundreds of thousands of data points on enrollments, we believe we’re best suited to address everyone’s burning questions for the long-term and bring the first of its kind think tank for private exchanges to the industry.

Results of the first of a series of PERC analyses will be available later this year. 4 To see the footnotes, see the online version at www.theihcc.com.

HealthCare Exchange Solutions™ I www.TheIHCC.com I Second Quarter 2015

9

PRIVATE EXCHANGE ENROLLMENT

“Cadillac Tax” Driving Rampant Growth in Private Exchange Enrollment

BY JOSEPH BERARDO JR. » CHIEF EXECUTIVE OFFICER » MAGNACARE

The health care conversation among employer groups has changed from “What is a private exchange?” to “How do we enroll?” The reasons are simple: better cost management, improved population health and the looming implementation of the “Cadillac Tax.” Analysts predict that the shift to private exchanges will be dramatic.

Private Health Exchange Annual Enrollment 40 Projected

40

Estimated Actual

30 Enrollment (Millions)

In fact, an estimated six million individuals enrolled on private exchanges for the 2015 plan year and, according to Accenture, that number will spike to 12 million in 2016, 22 million in 2017 and 40 million by 2018 – the year when “Cadillac Tax” penalties kick in. This 40-percent excise tax on high-cost plans could affect 38 percent of large employers and 17 percent of all American businesses.

22

20

High-performance networks A number of insurers selling plans on the exchanges are looking at highperformance networks in order to leverage more favorable pricing from providers, drive down unit cost and lower premiums.

Also known as narrow networks, high-performance networks consist of 6 3 carefully selected health care providers 0 and health professional organizations Source: Accenture 2015; Calculation includes pre-65 employees and dependents recruited to serve a defined patient Private Exchange Advantages An estimated 6 million members enrolled in private health exchanges for 2015 employer benefits, says Accenture. population. These networks are and Options designed to raise the level of care while Typically, private exchanges use a defined also helping to make health care more affordable. contribution approach to health care. In this model, employers give a set amount of money to employees, who then choose a health Health plans say they can lower costs with high-performance plan from participating payers on the exchange. network plans because they are able to choose more cost-effective providers and, in some cases, pay them lower reimbursement rates Private exchanges offer key advantages: in exchange for sending them more patients. t Positively impact total cost of care t Lower spending t Simplify employer administration Bottom Line t Offer more choice for employees While private exchanges do not provide access to premium t Improve cost-consciousness among employees subsidies like the public exchanges, they do have the potential to reshape the employer-sponsored health insurance landscape.

To realize these advantages, employers should consider every That said, employers should keep in mind potential pitfalls and factor. For instance, employers striving to maximize the health and learn how best to provide guidance and support for employees. productivity of their employees should not neglect prevention and wellness initiatives, despite offering coverage through a private A health services company can help to ensure a successful rollout, exchange. making it possible to achieve that rare feat: Group employee health benefits that work for both the employer and employee.

They should also weigh the differences between the two private exchange models that are emerging: Private exchanges give employers an effective way to cap costs t Single-carrier exchanges target employers that want to retain and make it possible for them to continue offering benefits, rather some role in choosing both the insurance carrier and plan than setting employees adrift on the public insurance exchanges. design. Depending upon the employers involvement, benefit Ultimately, private exchanges can help companies to stabilize design can be customized to provide a unique plan tailored to a rates, shape the health and wellness of their employees and take given employee population. greater control over their financial future. t Multi-carrier exchanges provide a broad range of payer and plan design options, but appeal more to employers that prefer Joseph Berardo Jr. is chief executive officer of MagnaCare, an administrator of self-insured health plans for employers and Taft-Hartley Funds in New York and to be hands-off.

10

12

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New Jersey.

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Second Quarter 2015 I www.TheIHCC.com I HealthCare Exchange Solutions™

PERCEPTIONS

Member Perceptions of the Exchange Experience, Their Plans and Where We Go From Here

BY RICK A. JOHNSON » DIRECTOR, HEALTHCARE PRACTICE » J.D. POWER

T

he J.D. Power Healthcare Practice released the findings from its 2015 Health Insurance Marketplace Exchange Shopper and Re-enrollment StudySM (HIX) on April 23 and found that satisfaction with the health exchange marketplace enrollment and health plans obtained through the marketplace have performed well in terms of overall plan satisfaction.

a possible 1000 for new enrollees and 731 for re-enrollees compared to 615 in 2014). Satisfaction among those who automatically re-enrolled is higher than those re-enrollees who did not auto reenroll. More than one in three re-enrollees were not sure if they could auto re-enroll (18 percent) or stated that their exchange/ plan did not allow auto-reenrollment (19 percent).

Now in its second year, the HIX study measures satisfaction with the health insurance shopping experience of new marketplace enrollees and re-enrollees from 2014, including oversamples in 11 key states. In addition, the study measures satisfaction with the health plans obtained last year by examining six attributes (in order of importance): cost; provider selection; coverage and benefits; communications; customer service; and claims processing.

Those shopping on or enrolled through an exchange tend to be more pricesensitive than those who get their health insurance off-exchange, as cost is the most impactful of the six factors in our model on overall satisfaction with onexchange health plans. Unfortunately, only 35 percent of re-enrollees noted they received information about subsidy qualification, and 13 percent of new enrollees stated they did not know if they qualified for a tax credit or subsidy.

One challenge we saw last year was that many shoppers were not very familiar with how insurance worked, and those Overall Marketplace Health Plan Satisfaction that registered did not

by Marketplace Type fully understand their (Based on a 1,000-point scale) benefits. Consequently, providing easy-tounderstand information Partnership Marketplaces 716 about how insurance works and around the benefits of the products they purchased or Federally Facilitated Marketplace 699 are trying to purchase would have a significant impact on Marketplace Type Average 696 user satisfaction.

Enrollment satisfaction in 2015 increased significantly from last year (670 out of

State-Based Marketplaces 600

683 650

700

750

800

Source: J.D. Power 2015 Health Insurance Marketplace Exchange Shopper and Re-Enrollment (HIX) Study ™

Unfortunately, only 54 percent of those new to a heath plan and 42 percent of re-enrollees received welcome kits from their plans.

In addition, only 50

percent of re-enrollees who stayed with their health plan and 63 percent of those who were new enrollees or switched plans stated they received any kind of follow-up from their health plans. The lack of followup information has a dramatic impact on satisfaction, as those that received follow-up information or a welcome kit had satisfaction scores that are roughly 100 points higher than those that did not receive that information.

In conclusion, here are six things that can be done to increase satisfaction with obtaining insurance through public exchanges and with the on-exchange plans themselves: t Improve the hand-off. Many members are not clear that they have insurance after they have finished the exchange transaction and are not clear on how to use their benefits. t Help make sure members know what their benefits are and how to use them, including improving onboarding. t Improve notice of what tax credits or subsidies are available to potential members to help minimize the cost of insurance. t Make sure those renewing know they have the option of auto-renewing their policy. t Increase information available on plans and how insurance works. Some plans cut back on plan information in an attempt not to overwhelm potential members. More plain language, jargonfree information is needed — not less.

Just make sure its easy to find and laid out well. t Keep in mind that overall satisfaction with health plans — both obtained on or off exchange — is below that of most other industries. We have a ways to go to match consumer expectations and should look to other industries when it comes to ways to enhance the consumer experience.

HealthCare Exchange Solutions™ I www.TheIHCC.com I Second Quarter 2015

11

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TAKING

PRIVATE EXCHANGES BACK TO THE FUTURE Health management strategies key to future sustainability

I

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

t’s been billed as the solution to rising costs. But many in the private exchange world — solution providers and employers alike — have been so focused on the here and now that they’ve neglected to look a few years down the road.

A private exchange in and of itself will only succeed for a while. But, take a private exchange,

combine it with a health management strategy and, according to many, the result is a recipe for

success.

“A health management strategy in conjunction with a private exchange is critical to the employer,” said Scott Brown, private exchange offering lead at Accenture. “In terms of the evolution of private exchanges, I think much has focused on the shopping experience and purchasing benefits. In the long run it’s crucial that private exchanges, wellness strategies and incentive tools come together.”

HealthCare Exchange Solutions™ I www.TheIHCC.com I Second Quarter 2015

13

that,” said Rob Harkins, practice leader, private exchanges for Willis.

“It’s not a bad thing, but it means there needs to be a long-term strategic directive by an employer to control costs in the long run. If they can’t do that — maybe they’re not in a position based on their population or the size of their group — then they need to go in with eyes wide open. They can’t go in thinking it’s one thing and it’s going to fix their problems; otherwise they’re going to be really unhappy in two years when they have a whole new set of problems to deal with.

“The beauty of an exchange is that it engages consumers in ways the industry hasn’t seen before; it involves them in the process and the decisions. It provides a natural segue into health management.”

But what if you don’t currently have a wellness plan in place? Do you look for a private exchange that offers one within the exchange? Or do you find a vendor to partner with an exchange to provide the health management?

“I think it’s difficult in multi-plan exchanges to leave health management solely in the hands of the carrier or health plan,” said Young.

“I believe it’s because of this: most people in multi-plan environments are going to be given the opportunity to change year over year. Because of that, some are going to stay and some are not going to stay. If people are able to make changes to the insurer they might not be with the insurer long enough to effectively impact health and productivity. Or even wellness.

“In single carrier exchanges, I think it’s easier for the carrier to step up and be that resource. Good carriers, of course, have strong health management programs within. Much is going to depend on the exchange and the strategy.

“My opinion is employers are not off the hook on this; that what they do around health management does matter to the productivity within their workforce, direct impact on earnings per share, etc. If they want to do this, it’s a good business decision to be involved and trying to improve the John Young, CEO, Consumerdriven, LLC: health of their employees.”

How strong is your own culture of health initiatives?

For those employers who haven’t fully bought into health How does the exchange try to manage those health management, implementing a private exchange may be the initiatives to your total population? push they need to focus on the future health and wellness of How do the health plan options within the exchange further manage their employees. those initiatives?

On the flip side, employers with a robust wellness/health management system in place are prime for a private exchange.

Rob Harkins, Practice Leader, Private Exchanges, Willis: “Wellness can be a fabulous enabler of a transition to a What is it about this private exchange model that will private exchange,” Kenworthy said. “The whole idea of more control or impact long-term cost (and how do you complexity in the choices that employees are able to enjoy can prove that)? be significantly empowered by a great wellness program, where How is that different from what has been done in the people have an understanding of what their actual health looks past to control long-term cost? like. Therefore they become a far more effective consumer of Employers need to look at their short-term strategy and their long-term strategy those choices. and then approach those actuarial companies and have them model long term “There’s a lot of interesting and innovative capabilities what happens if their trend continues to go up at the rate of double digits while that are emerging and obviously the secret is to pick through their contribution level is only going up in single digits. In that case, what what the culture and priorities of the organization are.” happens in two-to-three years to their employees?

As the data rolls in and more discussion swirls around this What is your decision-support technology able to do? topic, the general consensus is the same: the marriage of private The exchange needs to have a decision-support tool that can help the employee exchanges and health management is always a good union. make intelligent, appropriate decisions as opposed to just pushing them toward “We believe that as consumers start to shop for their the lower-cost product, which is what we see many of the decision supports do. benefits they will continue to be more engaged in their health and welfare and part of that engagement includes wellness Employers need to look at things much deeper, with much more intelligence programs/health management and managing their risks, not and sophistication around capabilities and functionality. Some things can be just shopping their health,” Brown said. “We think exchanges spreadsheeted, but realistically that’s not where we’re at right now. It’s still an will provide another mechanism for future improvement upon emerging market with many nuances, and employers need someone who really a lot of what exists today in the market of health management works the private exchange concept to understand how these things can and strategies.” should differ and be able to help them make the right choice.

Less than a year out of the first open enrollment for many private exchanges, it’s still uncharted territory to some extent. Employers are still understanding what private exchanges are and how — or if — they will benefit them and their employees. But one thing is becoming clear to those in the industry; health management — though crucial — is often overlooked.

“One of the myths that employers sometimes have about private exchanges is this idea that if employees go to a private exchange it’s kind of off their plate — they don’t have the burden anymore,” said Cathy Kenworthy, CEO of Interactive Health. “But the reality is that the group of employees sent into an exchange continues to be risk rated as an individual group. They are not actually pooled with any other participants so the health status and burden of health costs associated with that population is distinct and attributable back to that employer group.”

As John Young, CEO of Consumerdriven relates, the Buck Consultants exchange known as RightOpt uses three words to help outline their value proposition: choose, use and improve.

“Exchanges, I think, are doing a phenomenal job helping employees choose/self-select their medical plans, and some are taking steps to really help individuals understand how to use the plan they select,” Young said.

“But not all exchanges are equal in their attention to helping improve the health of its population.”

Reportedly one of the first exchanges to offer an integrated health management program, Willis North America sees a need to change employers’ perception of exchanges.

“A private exchange does nothing to control cost in the long run.

It’s an elegant cost-shifting mechanism. And we need to be upfront about

Six questions you need to ask when considering a private exchange:

14

Second Quarter 2015 I www.TheIHCC.com I HealthCare Exchange Solutions™

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HEALTH MANAGEMENT

Social Connectivity Key to Employee Health Management

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umerous studies over the years demonstrate that strong social life goals. Being socially connected with others whether through use of relationships play a vital role in health and have been linked to an online health community, financial planning class, participation in both emotional and physical well-being and life expectancy.1 People fitness challenges, or working out at an onsite fitness center, helps ensure with poor social connections have an increased risk for depression, stress, personal accountability, minimizes negative behavior and is associated cancer, heart attack and even death compared to those with the ongoing with healthier lifestyle choices. support of friends, family or community.2 Social connections can also affect our health by influencing routine Benefits of Emotional Support behaviors such as what we eat, drink and how much we exercise. Efforts to Some leading health management programs today offer access to lead a healthier lifestyle can be impacted in both good and bad ways by the tools and programs that provide a safe and even anonymous way for people we are closest to, including employees to exchange information co-workers at the office.

Interacting with like-minded people can make on specific health issues to help In recent years, we have reach their health goals. These a big difference in achieving a health goal. witnessed an explosion of programs provide a sense of social networking sites, such as community that encourages selfFacebook, Twitter, LinkedIn and management, offers emotional Instagram, that allow us to use a variety of technology platforms to support and provides fresh perspectives. incorporate social interaction into our daily lives. A significant percentage While we know that having social connections has been shown to of consumers now use social media sites for health-related matters such play a key role in supporting our overall health and well-being, research as researching medical conditions, accessing videos about health topics or has shown that even the perception of being socially connected is participating in online communities or blogs. associated with lower blood pressure rates, better immune responses and Interacting with like-minded people can make a big difference in lower levels of stress hormones, all of which contribute to better health.3 achieving a health goal. With the health care industry transitioning to One useful feature of peer-supported social health communities value-based models of care focused on self-management, prevention and is evaluating the emotional perspective of the individual while they positive behavior change, social networking activities and programs that are participating in the program. Using tools to identify the emotional provide support from colleagues are also playing a key role in workplace state of participants on an ongoing basis also allows for the application wellness programs. of game mechanics, such as points, levels and badges to help motivate Health management and wellness programs that incorporate social participation, reward achievement over time and add relevance to the elements such as condition-specific health communities, health and fitness program. challenges, coaching, mobile fitness apps, group yoga and even support of Health management programs that integrate social health local community events help engage and motivate employees for better communities into the care planning process are also showing promising health outcomes. results for reducing hospital re-admissions and lowering health care costs compared to traditional care management approaches. Such programs can significantly extend the reach of the care team, and keep people connected Better Engagement and Accountability Social-based programs and employee group activities help create following treatment.

In many aspects of workforce wellness and health care management a sense of belonging and provide a continual process for outreach to employees when and where they need it. The ability to connect with today, social programs that support all areas of well-being are playing someone managing the same health condition or participate in a similar a key role in inspiring employees and increasing their ability to lead health challenge is an engaging and powerful aspect of workplace wellness healthier lives. programs.

When integrated into a comprehensive corporate health management 1 House JS, Landis KR, Umberson D. Social relationships and health. Science. program, social-based programs help support numerous areas of well- 1988;241(4865):540–545 being — including physical, behavioral and emotional — to address 2 Umberson D, Montez J. Social Relationships and Health: A Flashpoint for Health Policy. the needs of the “whole person,” making it easier for employees to J Health Soc Behav. 2010; 51(Suppl): S54–S66. address overlapping issues important to achieving their health and 3 Cacioppo John T., Hawkley Louise C. Social Isolation and Health, with an Emphasis on Underlying Mechanisms. Perspectives in Biology and Medicine. 2003;46:S39–S52.

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BENEFITS ENROLLMENT

BY ALLYSON KUPER CONSULTANT BUG INSIGHTS

Leveraging the Marketing Mix Can Change the Course of Health Care Consumerism

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when half have asked for hot and e, as HR professionals, Initial research on the customer is half have asked for iced. encourage employees to be Statistically youâ&#x20AC;&#x2122;re meetthoughtful consumers of conducted in order to understand what they ing everyoneâ&#x20AC;&#x2122;s needs, but practihealth care, yet we are not treating are looking for, how sensitive they are to cally youâ&#x20AC;&#x2122;re failing to satisfy anyemployees like the consumers of Differences exist within your benefits that they are. We typically price, how they respond to messaging, etc. one. employee population. arenâ&#x20AC;&#x2122;t providing a product that lives For example, our study up to expectations because we are revealed that Baby Boomers need not thinking in terms of marketing. more help with annual enrollment and those 55 years and older are more If this continues, health care consumerism is destined to fail.

A fundamental marketing skill set is the ability to understand and than two times as likely to need additional assistance when compared to leverage the marketing mix â&#x20AC;&#x201D; or the four Ps: price, promotion, product the overall population. To compound that, this demographic is least likely and place. This mix is an essential tool that marketers across industries to know where to turn for additional help.

Before annual enrollment next year, ask: rely on to develop and roll out products. It spells potential disaster for any â&#x20AC;˘ Who are the target audiences? product success if any of these categories are overlooked. â&#x20AC;˘ How do I message specifically to each? â&#x20AC;˘ What is the best way to reach each audience?

PRODUCT: Often we overlook the importance of offering a product that meets employeesâ&#x20AC;&#x2122; needs. We donâ&#x20AC;&#x2122;t take the time to fully understand employee preferences, and we make a best guess at the rewards that PRICE: It is imperative that as our costs increase and we ask employees employees want based on â&#x20AC;&#x153;gut feel.â&#x20AC;? Even after years in the industry, to take on more of a cost burden, we help them to understand value. however, we cannot read minds. The only way to truly understand Our study revealed that one-in-two employees believe that they could preferences is to directly ask through focus groups and surveys. Once we get a better rewards program if they were to go work elsewhere. Often understand these, we can then design a program that actually meets the employees feel this way because they donâ&#x20AC;&#x2122;t fully understand the value of needs of employees. their current program.

Before annual enrollment next year, ask: Price is something that is harder to control in the world of HR, so â&#x20AC;˘ What do employees need from the product? we must be sure that employees understand the value of what is offered. â&#x20AC;˘ Do the benefits that we offer meet those needs?

Often with health care, the perceived value of the benefit is lower than â&#x20AC;˘ Are there features that are missing? Are there current features that the dollar amount spent by employers. This disconnect is detrimental employees do not use? to organizations and could mean that employees are looking elsewhere, thinking that their benefit doesnâ&#x20AC;&#x2122;t measure up when in reality it does.

Before annual enrollment next year, ask: PLACE: Place is less of a concern in HR, as benefits and rewards Do employees understand the value of their benefits and rewards? are expected as part of employment. It is important to remember that â&#x20AC;˘ How are we communicating this value to them? fundamentally, many people seek employment as a way to provide for their â&#x20AC;˘ Are there areas where perceived value is less than dollar value? If so, families, so employees place significant value in the coverage provided â&#x20AC;˘ how can we help employees to better understand the value? to them and to their dependents. In a study by Bug Insights of random Americans, we found that one-in-three survey respondents said they Much of the challenge for HR is providing data to answer these would leave their current job if their employer were to cut dependent questions and support decisions made. Marketing decisions are not made benefits and coverage. in isolation. Initial research on the customer is conducted in order to Before annual enrollment next year, ask: understand what they are looking for, how sensitive they are to price, â&#x20AC;˘ What rewards are expected as a part of employment? how they respond to messaging, etc. Taking a page out of a marketing â&#x20AC;˘ Are we meeting employee expectations with the benefits available? book means that first we have to start listening to our employees and PROMOTION: Too often, we overlook the importance of promotion as understanding what makes them different, then we can begin to address well. We take a â&#x20AC;&#x153;one-size-fits-allâ&#x20AC;? approach, communicating to employees the issues with our four Ps. as a whole. This, however, is like serving everyone in a room lukewarm tea 34 Second Quarter 2015 * XXX 5IF*)$$ DPN * HealthCare Consumerism Solutionsâ&#x201E;˘

BY MEENA KRENEK, IIDA LEED AP BD+C, ASSOCIATE PRINCIPAL PERKINS+WILL

CORPORATE WELLNESS

Active Design Is The New Workplace Wellness Program

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ow your office environment is outfitted has a dramatic impact on the adoption of healthy, active choices by your workforce. Active Design is defined as the promotion of workforce wellness, physical activity and healthy food access through thoughtful office design.

Active Design is about getting your workforce in motion. Healthconscious business leaders are now asking their corporate interiors experts and architects to build opportunities into everyday workspaces that get employees out of their seats, into circulation and back in shape.

Here are five key areas addressed through Active Design: 1. Standing. If sitting is the new smoking, stand-up desks are the new iPhone. So, too, are stand-up meeting spaces with barheight conference tables. Perkins+Will â&#x20AC;&#x201D; in partnership with the Center for Active Design, Steelcase and Mt. Sinai Hospital â&#x20AC;&#x201D; was recently awarded the Association of Interior Designers Foundation Grant to study the effectiveness of standing desks.

2. Walking. Active Design encourages movement, so while standing is a step forward, taking actual steps is the ideal. First there were workplace pedometer step-tracking challenges.

Then Fitbit, Jawbone, Withings and other â&#x20AC;&#x153;smart devicesâ&#x20AC;? turned the walking challenge digital. The ultimate in workplace walking, though, is the treadmill desk. Sales of treadmill desks continue to rise, according to Forbes Magazine. Some organizations have created treadmill conference rooms where multiple treadmills with height-adjustable working surfaces face each other so executives can walk and talk business at the same time.

3. Climbing. Stair climbing is great exercise and more employers are intentionally placing staircases in highly visible areas â&#x20AC;&#x201D; or increasing the attractiveness of less obvious staircases â&#x20AC;&#x201D; to encourage their use. One of our major pharmaceutical company clients has converted fire stairs into more welcoming places by extending landings

4.

5.

and adding glass. In another instance, for a commercial lab/office building currently under construction, we designed the fire stair to be particularly welcoming and open to the lobby to encourage use. Where appropriate, we add way-finding features like artwork and signage, which inspire stairwell usage.

Connecting. The nature 4UBOEJOH XPSLTUBUJPO JO "UMBOUB PGmDF of connecting in the PG UPQ UJFS TUSBUFHJD DPOTVMUBODZ workplace is shifting â&#x20AC;&#x201C; on the move, so to speak. Company-provided exercise spaces, including on-site fitness centers, running tracks, bike paths, and yoga studios, are becoming impromptu meeting spaces.

Going beyond the designated fitness facilities, corporate designers are configuring open, naturally lighted spaces that encourage workers to leave their desks, untether from their digital devices, move through the office and interact in-person with others. We are intentionally crafting office spaces so that colleagues more frequently and happily collide and engage in direct conversations.

Balancing. Employers are increasingly interested in a Google-esque culture, work style and workspace that blurs the lines between work and home. This includes time and space to refresh, recharge and re-balance. In response, meditation/ focus rooms, privacy/enclosure chairs, quiet rooms and even nap rooms are behavioral health features springing up in corporate office designs. And, to further reduce stress and encourage movement, amenities such as on-site showers, lockers and bike storage facilities make it easier than ever to mix work and workouts without having to go back-and-forth between office and home.

In short: If sitting is the new smoking, Active Design is the new reality of wellness in the workplace. #SFBL BSFB XJUI mUOFTT USBDL BU 6 4 IFBERVBSUFST PG HMPCBM TQPSUJOH HPPET DPNQBOZ

Meena Krenek, IIDA, LEED AP BD+C, is associate principal with Perkins+Will, one of the worldâ&#x20AC;&#x2122;s leading architecture and design firms.

HealthCare Consumerism Solutionsâ&#x201E;˘ I www.TheIHCC.com I Second Quarter 2015

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The Fallacy of Big & Broad Wellness Programs For wellness offerings to move the needle on medical costs, they must help the right employees — and live up to a much tougher set of standards.

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BY MATT COOK » DIRECTOR OF ACCOUNT MANAGEMENT » OMADA HEALTH

hile working at a large benefits consulting firm, I cringed every time I heard someone quote the famous movie line “If you build it, they will come,” in reference to employee wellness programs (and it happened often).

It wasn’t just that Field of Dreams quotes are painfully dated — this one was also painfully inaccurate. Yes, building big and broad wellness programs has been an undeniable trend in the market. But the time, money and effort it takes to encourage participation, combined with the lackluster results achieved by many of these programs, leave us facing a sobering reality: They’re just not working.

Perhaps a better line to describe the current state of wellness programs would be “If you build it, and spend a lot of money to incentivize people to use it, they will come — but they probably won’t stay or change their behavior long-term.” Not as catchy, but certainly more accurate.

Fortunately, a gradual shift is beginning to take place, in which we’re

learning from the failures of big and broad and zeroing in on a more focused and effective approach to wellness.

Big & Broad: A Good Idea at the Time There are a number of reasons why the big and broad model made initial sense to so many of us in the employee benefits industry. Building a “culture of health” requires maximum visibility and access, and creating a wellness program that is available to 100 percent of employees broadcasts this message loud and clear. It seems logical to offer the same program to everyone in order to educate employees about their health risks as quickly as possible As organizations, we also want and need to be equitable. Offering a wellness program to both the healthiest and the sickest employee is the right thing to do, and the prospect of addressing employees based on their health

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a one-time health assessment risk status is tricky. We never Precursors to Chronic Disease Among (an educational task that may want individuals with poor Overweight, Obese Individuals not lead to change), we can see health to feel stigmatized or how often they step on their threatened rather than aided scale (a daily actionable task and supported.

PREDIABETES that indicates change in habit).

And frankly, we often For Omadaâ&#x20AC;&#x2122;s flagship diabetes just donâ&#x20AC;&#x2122;t know where to start. prevention program Prevent, So we begin by assessing the focused on reducing the risks current state of our entire DYSLIPIDEMIA associated with type 2 diabeemployee population. We offer tes, we see 74 percent daily a health assessment and/or active use over the course of biometric screening to create our 16-week program, which a baseline and hope the data HYPERTENSION demonstrates our participantsâ&#x20AC;&#x2122; will indicate where we should long-term commitment. go next.

But with big and broad Obese Severely Obese Overweight Individuals Individuals Individuals programs come trade-offs.

Raising the Bar 25.0 - 29.9 BMI 30.0 - 34.9 BMI 35.0+ BMI Health is such a personal topic Even Higher Source: National Health and Nutrition Examination Survey, Centers for Disease Control and Prevention. http://www.cdc.gov/nchs/nhanes.htm. Accessed January 13, 2015 to every individual, and specific Focus and engagement needs vary so drastically by are critical, but there are two person that treating everyone clinically relevant outcomes. And weâ&#x20AC;&#x2122;re also more steps that will raise the bar the same limits an organizationâ&#x20AC;&#x2122;s ability to finally able to get better answers to the questions even higher. Itâ&#x20AC;&#x2122;s imperative that the programs positively impact the employees who need weâ&#x20AC;&#x2122;ve asked ourselves so often before: you implement to address specific problems are intervention the most. Offering something for â&#x20AC;˘ How can we help the right people? both evidenced-based and demonstrate return everyone ends up doing very little for anyone. â&#x20AC;˘ How do we define real engagement? on investment for employers.

Another key trade-off: broad wellness Take type 2 diabetes: The Diabetes programs force us to lower standards for success Finding an answer to the first question Prevention Program clinical trial demonstrated â&#x20AC;&#x201D; standards we know we need to reach in order demands a deeper understanding of the health that individuals who lose seven percent of their to truly move the needle. A prime example is of your employees. Most organizations offer body weight through an intensive lifestyle interhow our definition of â&#x20AC;&#x153;engagementâ&#x20AC;? gets easily disease management and complex care/case vention program had a 58 percent reduction watered down. management programs to their sickest employ- in incidence of diabetes. Thatâ&#x20AC;&#x2122;s a goal that can For employees to prevent serious illness ees. Everyone else is lumped together as â&#x20AC;&#x153;wellâ&#x20AC;? be met and a metric than can be measured. Itâ&#x20AC;&#x2122;s and the onset of chronic disease, they need to and offered wellness programs. But based on also exactly the kind of intervention that can engage with their health on a daily basis; it truly data collected from the National Health and move the needle by helping at-risk employees is a lifestyle change. Because big and broad Nutrition Examination Survey, nearly two- tackle the serious, chronic diseases that drive health and wellness programs follow the â&#x20AC;&#x153;one- thirds of overweight/obese individuals already up health costs. size-fits-allâ&#x20AC;? philosophy, they lack the personal- have a precursor (prediabetes, dyslipidemia, And we must demand more from our ization necessary to effectively engage employ- hypertension) that can lead to certain chronic vendor partners. Employers should challenge ees on a daily, weekly or even monthly basis. vendors that charge on a â&#x20AC;&#x153;per employee, per diseases like type 2 diabetes and heart disease.

As a result, we settle for one-time particiBy using available data (biometrics, health monthâ&#x20AC;? basis. More and more doctors are movpation in an activity like a health assessment or assessment results, etc.) to deliver solutions to ing from fee-for-service to performance-based biometric screening as the engagement baseline. these individuals, we give employees an oppor- payment. Shouldnâ&#x20AC;&#x2122;t our wellness vendors be Sure, this allows us to say that â&#x20AC;&#x153;75 percent of tunity to engage with their health at a time when doing the same? employees engaged in the annual health assess- engagement can make the biggest difference.

This is an exciting time in health care. ment.â&#x20AC;? But it makes it impossible to meet more This brings us to our second question: We finally have the opportunity and tools to meaningful standards, like â&#x20AC;&#x153;50 percent of my at- How do we define real engagement? Itâ&#x20AC;&#x2122;s time provide effective solutions to problems that risk population successfully reduced their risk that we in health care measure engagement the cause needless suffering, shorten lives and add for developing a chronic condition.â&#x20AC;? same way most other industries do: via daily billions of dollars in cost to our health care active involvement. Technology can help; a flood system. Employers must insist that vendors of new wearable and wireless health devices â&#x20AC;&#x201D; and their solutions â&#x20AC;&#x201D; hold themselves to To Move Beyond Big & now makes it easier than ever to measure daily the highest standards. If we do, we have an Broad, Ask the Right opportunity lead a health care revolution involvement.

Questions focused on prevention and wellness and driven Here at Omada Health, we sync a wireless This lack of meaningful results â&#x20AC;&#x201D; and measurable outcomes â&#x20AC;&#x201D; is driving much- scale directly to our group-based health coach- by programs that deliver real engagement needed change. Using data we already have, ing platform, so we know how often participants and measurable results. And, combined with data that we can now obtain are weighing-in and whether or not theyâ&#x20AC;&#x2122;re personally, Iâ&#x20AC;&#x2122;m looking forward (via consumer-focused health trackers), we losing weight. Rather than equating engage- to never hearing that Field of can better measure engagement and determine ment with how many participants completed Dreams quote ever again.

38 Second Quarter 2015 * XXX 5IF*)$$ DPN * HealthCare Consumerism Solutionsâ&#x201E;˘

39%

45%

45%

42%

52%

63%

34%

44%

52%

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HSA Council HealthCare Consumerism Solutions™ I www.TheIHCC.com I Second Quarter 2015

39

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BY JESSICA GROSSMEIER « VP OF RESEARCH « HEALTH ENHANCEMENT RESEARCH ORGANIZATION, AND NIKKI HUDSMITH « VP CONSULTING SERVICES « PERFORMANCE PH

eadership takes many forms and styles, depending on the organizational culture and the style of individual leaders.

Those people who make up the leadership team within a given company influence the experience that employees have with everything from the work they do, to the way they socialize and the health benefits they receive. The overall culture of the workplace, including the perceptions of leadership support for employee health and well-being, is emerging as possibly the most significant area of influence for corporate leadership.

For several years now, employers and companies of all sizes have demonstrated their support for improving employee health by increasing their investment in workplace wellness programs that range from the simple to the sophisticated. And, while industry research shows that many employers initially invest in wellness as a way to reduce health care spending, their reasons for ongoing investment change over time, with 91 percent claiming to offer wellness programs for reasons beyond medical cost savings. As it turns out, business leaders are committed to investing in workforce health

due to the long-term business benefits of good employee health.

The Health Enhancement Research Organization, which is dedicated to research and education that advances employee health management best practices, recently conducted a national survey of business leaders to determine the degree to which corporate leadership makes the connection between good employee health and corporate performance and productivity. The survey also aimed to gather insight into the factors they believe influence how their company performs.

More than 500 business leaders from across the country, representing a variety of industries (health care services, manufacturing, education, wholesale/retail, transportation, financial services, government and others) and company sizes (from less than 100 employees to more than 50,000 employees) completed the online survey between May and July 2014.

The HERO business leader survey evaluated not only how business leaders differentiate between commonly used terms, such as productivity and performance, but to what degree they feel employee

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health influences factors like morale, engagement contributor to broader business results.

What does that mean for well-meaning and overall corporate performance.

The survey revealed the following about how business owners who strive to create a culture of health for their employees? For starters, leadership business leaders perceive employee health: According to 91 percent of business leaders at all levels of a company must understand the in this survey, productivity and performance are business case for their company to create and related, but different concepts. This has implica- sustain a culture of health. This looks different for tions for program evaluation and how we use every business, depending on company size and such terms when making the business case for an the nature of the business. The HERO business leader survey showed that executive leaders were investment in workforce health.

For those employers who were surveyed, more likely than middle managers to see the the top drivers of productivity and performance connection between health and performance, include employee engagement with their work which could influence how supportive a companyâ&#x20AC;&#x2122;s and having the right tools to do oneâ&#x20AC;&#x2122;s job. Health employees perceive the organization to be in its was listed as one of the top three drivers by efforts to promote a culture of health.

A companyâ&#x20AC;&#x2122;s executive leaders can believe more than 20 percent of business leaders. Future research should examine how workplace wellness in the importance of good health as it relates to programs influence productivity and performance performance on and off the job, but if the frontdirectly through improved worker health and indi- line managers donâ&#x20AC;&#x2122;t share this belief or if the work rectly through improvements to employee engage- environment isnâ&#x20AC;&#x2122;t supportive of healthy behaviors, then companies will fail to see the results and ment with their work.

Most business leaders (57 percent) said their long-term benefits on their bottom line. In fact, organizationâ&#x20AC;&#x2122;s leaders viewed health as an invest- a disconnect between what executive leaders say ment in human capital or as part of the organiza- is important and the attitudes and behaviors of middle management can contribute to confusion tionâ&#x20AC;&#x2122;s core business strategy. LessHERO than a third Byof the Numbers or even foster cynicism among business leaders What viewed the investments in health boss really thinks about employee healthemployees. And primarily as a health care cost containment strat- according to this survey, there is a difference in egy. This is important for how wellness programs how senior executives versus middle management are highlights fromorganization, a recent HERO survey of more business leadershealth: from across the country who were asked view employee areFollowing positioned within an and we maythan 500 about their views on health as it relates to productivity and performance in the workplace. Access this study at http://bit.ly/1vvjMGA. Executive leaders are more likely (97 perbegin to see these programs being aligned with broader functional oversight, rather than with the cent) than directors (85 percent) to say that health influences performance. corporate benefits function. â&#x20AC;˘ Executive leaders (87 percent) felt their Although many business leaders did not organizationâ&#x20AC;&#x2122;s leaders were committed list worker health as one of the top drivers of to improving the health of their workproductivity and performance, itâ&#x20AC;&#x2122;s still an force, but only 71leaders percent of managers important business investment to most business of executive say that health influences performance believed senior leaders in their organileaders. When asked directly about the role zations were as committed. of workforce health, more than 90 percent of surveyed business leaders said they believe health To give an employee wellness program the has a very significant or significant influence on workplace productivity and performance. support it needs to thrive and yield results that of business leaders surveyed said their Additionally, businessinleaders said business leaders care about over time, all levels of leaders 41 viewpercent health as of an investment human capital or as part of the company's core business strategy health has a significant influence on employee leaders throughout an organization should underof business leaders felt their organization's incommitted the companyâ&#x20AC;&#x2122;s wellness engagement with their work, which is a key stand and participate leaders are to improving

97%

57%

77%

the health of their workforce

Benefits cost reduction

Performance

60%

Business Priorities Influenced by Employee Health

Sales

Global competitiveness

30%

3%

4%

Benefits plan 10% design

Employee Health

41% 6%

Recruitment/ Retention

62%

10%

Sustainability Productivity

Š HERO (Health Enhancement Research Organization) 2015

42 Second Quarter 2015 * XXX 5IF*)$$ DPN * HealthCare Consumerism Solutionsâ&#x201E;˘

22%

29%

Quality Safety

Employee engagement or morale

program. If a direct supervisor doesnâ&#x20AC;&#x2122;t participate in wellness offerings and doesnâ&#x20AC;&#x2122;t understand the link between wellness and business results, chances are employees wonâ&#x20AC;&#x2122;t participate either. One way to get all management levels on board is to make sure the companyâ&#x20AC;&#x2122;s wellness program aligns with the organizationâ&#x20AC;&#x2122;s core business strategy. Most business leaders (57 percent) in the HERO survey said their organizationâ&#x20AC;&#x2122;s leaders viewed health as an investment in human capital or as part of the organizationâ&#x20AC;&#x2122;s core business strategy.

Business leaders can support employee health and improve program participation by striving to offer a comprehensive workplace wellness program that supports employees at all levels of the company and that is anchored by a supportive culture. It is important for employers to understand that a comprehensive program is much more than an incentive and biometric screening program; itâ&#x20AC;&#x2122;s about policies, day-to-day practices, workplace norms and offering behavior change activities that appeal to and are accessible to all employees.

To foster a healthy culture, management at all levels need to encourage and enable employees to make healthy choices by supporting the companyâ&#x20AC;&#x2122;s healthy vending policies to include healthy options in catered meetings, encouraging walking meetings, or encouraging employees to take advantage of the health promoting programs and services that the organization provides.

A companyâ&#x20AC;&#x2122;s executive leaders can believe in the importance of good health as it relates to performance on and off the job, but if the frontline managers donâ&#x20AC;&#x2122;t share this belief or if the work environment isnâ&#x20AC;&#x2122;t supportive of healthy behaviors, then companies will fail to see the results and longterm benefits they seek.

Getting middle managers on board may need to start with helping them understand how taking care of their own health and well-being influences their effectiveness as leaders. An emerging trend in wellness is the integration of key messages about the link between workforce health and business results into leadership development programs. Some highly innovative organizations incorporate metrics about employee perceptions of organizational support for health into managerial performance scorecards.

Related initiatives at HERO include the HERO Employee Health Management Best Practice Scorecard in collaboration with Mercer, which identifies specific practices that demonstrate leadership support for workforce health as well as a program measurement and evaluation guide that recommends metrics and measurement tools related to organizational support for health.

The full survey report can be found on the HERO website at http://hero-health.org.

WOW!

Westgate Resorts does wellness right.

Healthy food options in vending machines and break rooms, plus posted nutrition information Programs on life issues, including alcohol and drug abuse On-site exercise facility and group fitness classes Dedicated company wellness committee

UMR is proud to recognize Westgate Resorts, a Central Florida Investments company, as a recipient of our Wellness Opportunities at Work (WOW) awards program. The WOW award honors organizations who, in partnership with UMR, demonstrate a commitment to improving their employeesâ&#x20AC;&#x2122; quality of life through a comprehensive, worksite health promotion program.

Find out what enhancing wellness opportunities @ work can do for your company.

Visit UMR at the IHC Forum and Expo in Atlanta (booth #316), or contact Mike Benson at 715-841-6112.

BY CAROLYN PARE PRESIDENT AND CHIEF EXECUTIVE OFFICER MINNESOTA ACTION HEALTH GROUP

PHARMACY BENEFITS MANAGEMENT

Specialty Rx: What’s An Employer To Do?

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osts for specialty medications are projected to quadruple by 2020, in part because the current pipeline includes hundreds of new drugs, some of which will come with a price tag of over $100,000 per patient, per year. At prices like this, it’s no wonder specialty pharmacy has been called “the new gold rush”, especially given the lack of checks and balances that could hold drug makers and sellers accountable for rational pricing practices.

In the coming years, drug manufacturers will unleash an unprecedented raft of new specialty drugs into the marketplace; some will improve the treatment of common medical problems like high cholesterol and diabetes, while others will be used to treat complex conditions like multiple sclerosis, Hepatitis C and cancer.

The good news: these therapies provide new and, in some cases, better treatment options.

The bad news: the cost of such prescription drugs in the United States is breathtaking. For example, it’s estimated that by 2018, the cost for hundreds of specialty drugs that are flooding the pipeline will account for more than half of total U.S. drug spend, up from 25 percent in 2006.

Spending on this category is currently growing almost 20 times as fast as non-specialty drug spending.

Drug companies argue that new products are harder to develop and manufacture, which justifies the additional cost. But U.S. pricing is often three to 10 times that in other developed nations. Is that really acceptable?

Employers, take note!

The likelihood is very real that specialty drug pricing could financially overwhelm employers who purchase health care for their employees.

In fact, it’s quite possible excessive specialty drug costs could make it untenable for employers to maintain good health coverage without severely compromising other important benefits. Just as worrisome, these costs could exacerbate the health care cost burden and cannibalize profits.

Mobilizing employers to take action This issue is clearly too big and too complex for any single employer to take on alone. That’s why the Minnesota Health Action Group formed an initiative called a Specialty Pharmacy Care Delivery Learning Network that gives employers who are members of The Action Group the opportunity to collaborate and develop strategies to ensure health care consumers — and the employers who purchase health and pharmacy benefits on their behalf — are protected from exorbitant drug pricing. The Action Group Learning Network gives employers access to national pharmacy experts (not drug manufacturers or pharmacy benefits managers) who have educated them on the factors that influence pricing and how employers can use their collective power to influence the situation.

Learning Network participating employers give their time to help drive change, quite simply because they understand that if they don’t, they will end up paying the price. Consider the following:

Drug companies argue that new products are harder to develop and manufacture, which justifies the additional cost. But U.S. pricing is often three to 10 times that in other developed nations. Is that really acceptable?

•

•

The Hepatitis C drug, Sovaldi® made headlines last year when a course of treatment was pegged at $84,000 in the United States, crushing previous cost and use records. The same drug is priced at $900 in Egypt and $51,000 in France.

U.S. costs for a powerful new cholesterol management drug, PCSK9, are expected to be $7,000-$12,000 per patient per year, compared with about $1,000 on average for conventional drug therapies. Given the number of patients who might benefit, the market for this one drug could easily reach $100 billion per year — or about 1/33 of what we currently spend on all U.S. health care. All this for a maintenance drug, that comes with annual, lifelong, recurring costs.

So, what’s an employer to do? In addition to looking for opportunities to join forces and collaborate for change with other employers, here are five key drug management goals for payers as identified by The Minnesota Health Action Group Learning Network: 1. Understand your current specialty pharmacy drug spend, including all drugs administered as part of your medical benefit.

2. Ask vendors to project specific future costs given your company history and drugs in the pipeline.

3. Make sure your benefit plans don’t drive patients to higher-cost sights of care, such as outpatient hospital settings.

4. Require health plans to contract with providers to eliminate any incentive for them to administer more expensive drugs, in more expensive settings.

5. Require PBMs and health plans to administer prior authorization and step therapy programs based on clinical, objective, evidence.

The bottom line is that all employers should be informed about this issue and work together to hold drug manufacturers and sellers accountable for rational pricing practices. It appears that it’s time, yet again, for business to lead the way in health care innovation.

Carolyn Pare is president and CEO of the Minnesota Health Action Group. She can be reached at cpare@mnhealthactiongroup.org.

HealthCare Consumerism Solutions™ I www.TheIHCC.com I Second Quarter 2015

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BY PENNY MOORE CHIEF GROWTH OFFICER SHAPEUP

DIGITAL HEALTH

Five Transformative Innovations in Wellness

A

s todayâ&#x20AC;&#x2122;s employers move to create a culture of wellness within their organizations, many struggle to evolve from their disease management pasts. The habit of identifying and stratifying employee risk is so ensconced in employer health and benefits programming, it presents a challenge when employers look to create more inclusive and holistic approaches that offer real behavior change. The relevance of regular benchmarks driven by tedious HRAs is often lost on employees and fails to achieve the primary goal â&#x20AC;&#x201D; making employees healthier.

Let me walk you through the five innovations ShapeUp has used to transform the wellness space, taking it far beyond the traditional confines of disease management:

The habit of identifying and stratifying employee risk is so ensconced in employer health and benefits programming, it presents a challenge when employers look to create more inclusive and holistic approaches that offer real behavior change.

Innovation #1: Taking a Social Approach to Health Improvement Health interventions traditionally take an individualistic approach. A person takes an HRA, receives an assessment and gets a treatment plan on his or her own. ShapeUp is turning this paradigm on its head by implementing a social approach to health. Through our ShapeUp Social Wellnessâ&#x201E;˘ platform, we leverage group support, peer coaching, friendly competition and social accountability to empower people to achieve their goals, improve their health and enhance their overall well-being together. Five studies published in peer-reviewed journals have proven the effectiveness of our powerful new approach to health care.

Innovation #2: Catalyzing Action within Corporate Workforces Weâ&#x20AC;&#x2122;ve enabled wellbeing outcomes across almost 1,000 companies and three million employees worldwide by identifying, recruiting and empowering highly influential people within corporate social networks. We call these individuals Wellness Champions and our Champion Tools harness their passion and connectivity in the service of a healthier, more engaged workforce.

Innovation #3: Turning Hard Work into a Fun and Rewarding Game The same mechanics that make games appealing â&#x20AC;&#x201D; competition, teamwork, achievement, rewards, status, feedback loops â&#x20AC;&#x201D; can be applied to 46 Second Quarter 2015 * XXX 5IF*)$$ DPN * HealthCare Consumerism Solutionsâ&#x201E;˘

a more significant purpose, like helping people increase their exercise, improve their diet or lose weight.

ShapeUpâ&#x20AC;&#x2122;s team challenges bring people together in virtual and real-life settings to undertake activities like scaling mountains, visiting historic cities across Europe, daring to try new fruits and vegetables and competing to earn donations for their favorite charity â&#x20AC;&#x201D; all while steadily achieving a higher level of fitness.

Innovation #4: Leveraging Behavioral Economics to Sustain Engagement

Financial incentives have been instituted by corporations to combat lack of participation and attrition. However, most financial incentive plans are poorly designed. For example, many companies bundle a $100 wellness reward into a weekly paycheck or annual insurance premium, masking the reward and diminishing its impact.

At ShapeUp, we have developed a rewards solution that enables employers to deploy unbundled incentive programs that measure and reward outcomes as well as progress and fulfill rewards in real-time, the moment that a participant achieves a goal or takes a step in the right direction. ShapeUp has tracked, managed and fulfilled tens of millions of dollars of incentives in corporate wellness programs that have led to clinically significant health improvements.

Innovation #5: Taking Fitness On-The-Go with Mobile Apps & Wearable Devices Employees are using smartphones, mobile apps and wearable, wireless devices in droves. ShapeUp allows our participants to connect a variety of different apps and devices to our platform so that no matter what they choose to use, their data automatically flows into a centralized location where they can view their progress, participate in challenges, receive personalized feedback, and earn rewards. We call this approach BYOA (Bring Your Own App) and BYOD (Bring Your Own Device) because it allows ultimate flexibility, serving our participantsâ&#x20AC;&#x2122; preferences.

BY DENNIS G. FISZER CHIEF COMPLIANCE OFFICER HUB INTERNATIONAL EMPLOYEE BENEFITS, EASTERN REGION

REGULATORY & COMPLIANCE

King v. Burwell: Understanding the What Ifs of the Supreme Court’s Looming PPACA Decision

T

Roberts. Although a close vote is again expected and the Court may simply say that a broader contextual interpretation of the spirit of the law allows the IRS rule; however, the more interesting speculation centers on “what ifs” related to the Court invalidating payments.

If the Court says this was a Congressional Instead, it’s more likely they drafting error, and therefore, Congress should Background enact a legislative fix, Republicans would sudBack in 2012, the Supreme Court first exam[Republicans] would seize the denly gain leverage they have not previously ined the constitutionality of the Patient Protection opportunity to negotiate for enjoyed. This is because despite winning control and Affordable Care Act. In a close vote, the court upheld the law and implementation went moderating parts of the law. of both houses of Congress in the most recent midterm elections, they do not have a large forward. Fascinating stories abound concerning enough majority to overcome any White House what took place in the days before the final decision was published. Speculation centers on unusually worded phrasing in the veto for legislative changes they might wish to enact.

So where does this take us? dissent. Some conspiracy buffs suggest that at one time the dissenting opinion was actually written as the prevailing opinion. They say Justice John Roberts changed his mind at the very last moment, voted to uphold the law and that Possible Scenarios required an opinion that had originally been prepared as the winning discusBecause so much work has already been done for implementation, sion to quickly be rewritten as the dissent. it seems unlikely that the Republicans would simply allow the law to With that backdrop, fast-forward to 2015. To the surprise of many, function with subsidy payments operating schizophrenically in only PPACA is again before the Supreme Court, and this time the case is King certain parts of the country. Instead, it’s more likely they would seize the v. Burwell. opportunity to negotiate for moderating parts of the law.

For example, the GOP might push towards raising the full-time definition from 30 hours per week to 40 hours per week. Or, it might seek Subsidy Payments and the Employer Mandate to raise the employer size threshold from 50 workers to a higher number, PPACA includes language that would appear to limit the authority for federal subsidy payments only inside states that have affirmatively perhaps 100. It’s also possible that Republican leaders might wish to established their own exchange (also sometimes called “marketplaces”). moderate the effects of the Cadillac Tax. As PPACA is often regarded as The plaintiffs argue that the IRS exceeded its authority when it issued a the Administration’s singular achievement, the Republicans might wish rule that would “deem” any state defaulting into a federal exchange as the to cooperate with enacting a correction to the law and reserve their newfound “leverage” to spend on an entirely unrelated issue such as immigraequivalent of a state established exchange.

The stakes are high because if the subsidy payments are invalidated, tion. These all become highly political options. not only will individuals in certain states lose funding for their health coverage, but to a great extent, the employer mandate attached to PPACA Looking ahead becomes eroded. This is because the law’s penalty trigger mechanism is The bottom line is that a decision will be announced soon. Although intrinsically tied to whether an employee who would otherwise be entitled the impact of the ruling could have far reaching effects, it’s unlikely to coverage instead opts to use the exchange and receives federal money to we will see health care reform collapse. Employers should therefore help fund that coverage. plan accordingly and anticipate continued implementation with possibly If the government’s power to issue subsidies in certain states is favorable mitigation the best case scenario. invalidated, employers operating in those states should be shielded from penalty exposure. This would mean that employers operating in places Dennis G. Fiszer is the chief compliance officer for HUB International Employee like Texas and Missouri would have a key financial advantage compared to Benefits, Eastern Region, and is a nationally recognized speaker on health care reform and the Affordable Care Act. He provides compliance and consulting services employers operating in places like California and New York. regarding health plans and other employee benefits. His areas of expertise include

he Supreme Court will soon rule on the validity of “subsidy” payments in states that have not created their own state exchange platform.

Billions of dollars of federal subsidies are at stake for residents of the approximately 80 percent of states that have not established exchanges.

What Will Happen?

Experts who carefully watched oral arguments appear split. Key focus seems to center on Justice Anthony Kennedy and Chief Justice John

COBRA, Health Insurance Portability and Accountability Act of 1996 (HIPAA), wellness programs, federal and state health care reform, employment and labor issues, ERISA and the Family and Medical Leave Act.

HealthCare Consumerism Solutions™ I www.TheIHCC.com I Second Quarter 2015

47

AFFILIATE MEMBER PROFILES

WWW.THEIHCC.COM

The Institute for HealthCare Consumerism Affiliate Member Profiles The Institute for HealthCare Consumerism would like to thank all of its Affiliate Members for their support.

For information on becoming an Affiliate Member, please contact Brent Macy at bmacy@theihcc.com.

Alegeus Technologies: Alegeus Technologies is the market leader in healthcare and benefit payments – offering the industry’s most comprehensive platform for the administration of tax-advantaged benefit accounts.

ARAG: ARAG® is a leading provider of voluntary legal insurance products and services for employers, membership groups and associations.

Arthur J. Gallagher: Arthur J. Gallagher & Co. is a world-wide leader in Commercial Insurance & Risk Management, as well as Benefits & HR Consulting. They now offer Gallagher Marketplace, a leading Private Exchange.

Benaissance: Benaissance® is the trusted financial management partner for health benefits administration.

Castlight Health: Castlight Health provides cost and quality transparency through a health care management suite that helps lower health care spending while improving the quality of care.

CodeBaby: Founded in 2001 by two Canadian physicians turned gaming entrepreneurs (of Bioware), CodeBaby uses emotional engagement and gaming expertise to help millions of consumers make personalized and informed employee benefits and healthcare decisions.

Colibrium: Colibrium provides health plan sales, marketing, service and wellness solutions.

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Second Quarter 2015 I www.TheIHCC.com I HealthCare Consumerism Solutions™

ConnectYourCare: ConnectYourCare provides an independent Consumer-Directed Healthcare (CDH) platform for consumers and employers.

ConsumerMedical: ConsumerMedical helps your employees answer the five most important questions in healthcare: What do I have?

What do I need? Where do I go? What will it cost? How do I connect?

DataPath, Inc.: DataPath creates solutions for the administration of consumer-directed healthcare benefit plans and insurance payments.

DentaQuest: Over the past 40 years, DentaQuest has grown to manage the dental and vision benefits of approximately 20 million members across all market segments, from commercial to Medicaid and Medicare. We’re trusted because of our experience.

Doctor on Demand, Inc.: Next-generation telemedicine for employers. Best technology, no PEPM, seamless implementation.

mission is to bring transparency to healthcare costs and health insurance information through consumer resources, comprehensive data products and research tools.

Flexible Benefit Service Corporation (FLEX): For 25 years, Flex has helped thousands of clients make their healthcare dollars go further with our consumer driven plans and benefits administration services, including FSAs, HRAs, HSAs, Transit, COBRA and more.

GoHealth: GoHealth is a Chicago-based company that powers GoHealthInsurance. com, a private health insurance marketplace that has helped more than 30 million consumers shop for coverage.

Hartville Pet Insurance Group: As one of the oldest and largest pet insurance providers in the US, Hartville Pet Insurance Group has committed itself to helping more pet parents have access to reliable and affordable pet insurance plans.

HealthCare.com: HealthCare.com is an unbiased search engine for health insurance.

Own Your Healthcare

HealthExpense EBenefits Solutions: Supporting employers with one powerful online solution that brings it all together.

TM

HealthExpense: HealthExpense helps health plans, administrators and employers increase engagement in healthcare marketplaces through simplified medical bill management, shopping tools and tailored incentives resulting in reduced healthcare costs.

Evolution1: Evolution1 and our Partners serve more than 9 million consumers, making us the nation’s largest electronic payment, on-premise and cloud computing healthcare solution that administers reimbursement accounts.

Healthstat, Inc.: Healthstat, Inc. is a leading provider of on-site primary care, high health risk intervention and disease management services.

FAIR Health: FAIR Health is a national independent, not-for-profit corporation whose

Hodges-Mace Benefits Group, Inc.: Hodges-Mace is an employee benefits technology and

WWW.THEIHCC.COM

AFFILIATE MEMBER PROFILES

Access these solution providers online at www.theihcc.com. communications firm that helps employers improve their overall delivery of benefits by implementing cutting-edge solutions coupled with proven employee engagement and decision-support services.

HSA Bank: At HSA Bank, we’ve been helping businesses optimize their healthcare spending for over 15 years. We offer unmatched service and expertise when it comes to health-based savings accounts.

Intrepid: 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.

Jiff: Jiff reduces enterprise health care costs by using smart analytics, beautiful design, and the best digital health technology and services to deliver customized benefit programs for each employee.

Level1 Diagnostics: Level1 Diagnostics is an innovative program that, unlike conventional cardiology tests, provides new advanced technology testing and methods to detect and prevent the earliest signs of cardiovascular disease and encourage optimal health.

Pantone 102c

Maestro Health: Maestro Health is the only technology-meets-service platform delivering the most complete, all-in employee benefits management solution for brokers and employers.

75% BK

MasterCard Worldwide: MasterCard is a global payments and technology company. It operates the world’s fastest payments processing network, connecting consumers, financial institutions, merchants, governments and businesses in more than 210 countries and territories.

Maxwell Health: Maxwell Health, a fast-growing industry leader in health IT, is the first Health as a Service platform.

Omada Health: Omada Health’s personalized chronic disease prevention programs feature dedicated health coaches, small social networks, and smart devices delivered right to participants’ doors.

PayFlex: Considered and described by clients as an innovative technology company, PayFlex, a subsidiary of Aetna, provides consumerdirected account-based solutions that educate, engage and empower employees to improve their health and financial wellbeing.

PilotHSA: PilotHSA provides HSA technology and administration services to financial institutions and third party benefit administrators. If you are a bank, credit union, or a benefit TPA looking for a turnkey HSA solution, please contact us at www.pilothsa.com.

Quantum Health: Quantum Health is a care coordination and consumer navigation company.

SelectAccount: SelectAccount has been driving innovation in medical savings accounts for over 25 years.

Solstice Marketplace: The Solstice Marketplace is a private exchange developed by health insurance carrier Solstice Benefits.

Transitions: Transitions Healthy Sight Working for You is an educational program that helps HR professionals communicate the value of the vision benefit to employees. More information and a free Vision Education Kit is available at HealthySightWorkingForYou.org.

Truven Health Analytics: Truven Health Analytics, formerly Healthcare at Thomson Reuters, delivers unbiased information, analytic tools, benchmarks, and services to the healthcare industry.

TSYS Healthcare: TSYS Healthcare partners with third party administrators, financial institutions and health plans to provide benefit payment solutions for customers with HSAs, HRAs, FSAs, cash accounts and lines of credit.

UnitedHealthcare: UnitedHealthcare is dedicated to helping people nationwide live healthier lives by simplifying the health care experience, meeting consumer health and wellness needs, and sustaining trusted relationships with care providers.

WageWorks: WageWorks is a leader in administering Consumer-Directed Benefits (CDBs), which empower employees to save money on taxes while also providing corporate tax advantages for employers.

Wells Fargo Health Savings Accounts (HSA): Wells Fargo is a leading provider of comprehensive Health Savings Account (HSA) programs.

HealthCare Consumerism Solutions™ I www.TheIHCC.com I Second Quarter 2015

49

RESOURCE GUIDE

WWW.THEIHCC.COM

Solutions to help your innovative health and benefit programs.

Listen Live Every Friday at 11 a.m. (ET) Now on Blog Talk Radio www.blogtalkradio.com/theihcradio 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

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ADVERTISING CONTACTS 404.671.9551

Aetna ....................................... Back Cover

IHC Radio Show ....................................50

ABA/HSA Council ................................... 39

ShapeUp .................................................. 7

Cigna ...............................................HCX 5

Softheon ..........................................HCX 2

CodeBaby............................................... 44

Transamerica Employee Benefits .........................Inside Front Cover

ConnectYourCare ...........Inside Back Cover TSYS Healthcare ...................................... 5 HSA Bank..............................................16

CEO

Quadrant 4 Health ............................HCX 8

Doug Field 404.671.9551 ext. 101 · dfield@ theihcc.com NATIONAL SALES DIRECTOR

Health Expense .....................................40 Quantum Health...................................... 36

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IHC Affiliate Member Profiles...........48 - 49 UMR ....................................................143

Andrew Dietz adietz@theihcc.com DIRECTOR OF CONFERENCE SPONSORSHIP/ CORPORATE MEMBERSHIP/REPRINTS

IHC FORUM & Expo Atlanta ...............10-11 WiserTogether ....................................... 16

Rogers Beasley 404.671.9551 ext 109 · rbeasley@theihcc.com ACCOUNT MANAGERS

IHC FORUM West Las Vegas ..........HCX 12 WageWorks ........................................... 13

Michelle Gatehouse 404.405.3007 • mgatehouse@theihcc.com Ted Arvan 678.296.1906 • tarvan@theihcc.com

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IHC Private Exchange FORUM Baltimore ..........................HCX 15

How do you effectively roll out an HSA program to your employees?

Education and communication are the keys to your success.

We know how to simplify things, and drive account enrollment through uniquely tailored strategic communication solutions. Our clients have enjoyed a 23-29% increase in account enrollment.

www.connectyourcare.com

Financial Healthierwell-being living Intelligent solutions Financial well-being Quality health plans & benefits Intelligent solutions Healthier living Financial well-being Intelligent solutions

Building a healthier worldSM SM Building a healthier world Aetna is proud to sponsor The Institute for SM for Aetna is proud to sponsor The Institute HealthCare Consumerism.

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Aetna is the brand name used for products and services provided by one or more of the Aetna Aetna is brand name used for products and group of the subsidiary companies, including Aetna services provided by one of the Aetna Life Insurance Company andor itsmore affiliates (Aetna). group of subsidiary companies, including Aetna Š2015 Aetna Inc. Life Insurance Company andused its affiliates (Aetna).

2014015 Aetna is the brand name for products and Š2015 Aetna Inc. services provided by one or more of the Aetna