2015 Private Exchange FORUM Baltimore Conference Agenda
ISSUE || Third Quarter • 2015
Innovative Health and Benefit Management
Consumerism, Telemedicine and the Internet of Things Millennials and Health Care Shopping Will Wearables Disrupt Workplace Wellness? Intrinsic vs. Extrinsic Incentives Seven Lessons for Delivering Cost/Quality Information
INSIDE: The Official Magazine of
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FEATURES 37 Consumerism, Telemedicine and the Internet of Things
By 2020, the Internet of Things is expected to support 212 billion connected devices representing an $8.9 trillion market. Goldman Sachs reported this digital health revolution and the Internet of Things (IoT) could result in nearly $305 billion in industry savings by increasing the use of telemedicine, remote patient monitoring and consequent behavioral modification. Over $200 billion of these savings may come from remote chronic care management of diseases such as heart disease, COPD, asthma and diabetes by leveraging telemedicine technology into the home, assisted living, elder care and long-term care facilities. About half of all American adults (roughly 117 million people) have some form of chronic disease for which this new technology could be used. At the recent, successful IHC FORUM & Expo conference in Atlanta, Teladoc reported generating an estimated savings of $1,157 per patient per year or $21 per member per month for payers from their telehealth services — noting that they had just achieved one million annual virtual visits with an expectation of doubling that number in the next year. Teladoc then went public a few days later raising $157 million in their IPO. By Steven R. Gerst, MD, MBA, MPH, CHE
40 Cost Transparency and Consumer Health Insurance Preferences As the U.S. health care system undergoes significant change, consumers must adapt by taking greater responsibility for their health care decisions, including choosing health insurance plans and managing medical expenses. A 2015 survey sponsored by FAIR Health, a national nonprofit organization dedicated to advancing transparency in health care costs and providing educational material on health insurance coverage, sheds light on the need for individuals to gain a better understanding of their health insurance benefits and their out-ofpocket expenses for health care services. The survey of U.S. consumers spans five main areas: individuals’ use of emergency department (ED) services for non-emergent care; their use of online tools for selecting a health plan; their selection of physicians; comparison shopping for health care; and their experience with medical bills. The survey’s results provide insights that can help to inform consumer education and engagement strategies. A detailed report analyzing the survey’s findings, Understanding Consumer Health Insurance Preferences, is available for download on FAIR Health’s website. By Robin Gelburd, President, FAIR Health
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: In October, The Institute for HealthCare Consumerism will publish its 10th annual HealthCare Consumerism Superstars edition, featuring leaders in innovative health and benefits management. For the first time, award winners will be invited to a special banquet in Las Vegas to receive their awards. Stay tuned to find out this year’s winners... HealthCare Consumerism Solutions™ I www.TheIHCC.com I Third Quarter 2015
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INSIDE 6
Publisher’s Letter
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Bachman’s Banter
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Briefs & Innovations t t t t
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DEPARTMENTS 14 Stats & Data: Wearable Devices Wearables and Employers: A Match Made in Heaven? By Rod Reasen, Chief Executive Officer, Healthiest Employers
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15 Health Care Transparency Seven Lessons for Delivering Cost and Quality Information at the Point of Decision By Cheryl DeMars, President and CEO, The Alliance
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10 Private Exchange FORUM Preview 48 Affiliate Member Profiles 50 Resource Guide/Ad Index
SIGN UP TO ATTEND Events
33 Account-Based Plans The Three A’s Force a Shift in Consumer Engagement By Seth Ravine, Chief Revenue Officer, Acclaris
34 Voluntary Benefits Open Enrollment and Millennial Workers: The Focus is on Financial Independence By Tye Elliott, Vice President of Broker Strategy, Aflac
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 Private Exchange FORUM March 2016 Dallas Exact dates and location to be announced. Come LEARN, CONNECT and SHARE with the top thoughtleaders in health care consumerism. Find more information at: www.theihccforum.com
ONLINE EXCLUSIVE Six Tips for Creating a Successful Global Wellness Program According to a Buck Consultants survey in 2014, 56 percent of multi-national employers are utilizing a global health promotion strategy to improve worker productivity, reduce employee absences and lower health care costs. This number is up from 34 percent in 2008. With such high-value benefits on the table, multi-national employers are confronting their concerns surrounding culture and language barriers and looking for proven best practices to ensure a successful global wellness program. For those looking to create a global wellness program that ignites and sustains employee engagement across their population, here are six tips to keep in mind. By Jane Peacock, Vice President of Innovation, ShapeUp 4 Third Quarter 2015 * XXX 5IF*)$$ DPN * HealthCare Consumerism Solutions™
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35 Health Incentives Taking a Strategic Approach to Incentives By Lucas Coffeen, Senior Product Manager, ShapeUp
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43 Wellness How to Make Workplace Wellness Another Form of Entertainment — and Gain Employee Engagement
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By Carrie Greene, General Manager, Interactive Health
44 Digital Health Disrupting Workplace Wellness with Wearables By Alexis Normand, Director of Healthcare Development, Withings
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46 Telehealth What Is Next-Generation Telemedicine? By Lena Cheng, MD, Vice President of Medical Affairs, Doctor on Demand
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47 Health Data Analytics Focusing on High-Risk Members Reaps Greatest Reward By Rich Williams, Executive Vice President, Advanced Plan for Health
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LETTER
PUBLISHER www.theihcc.com VOLUME 11 NO. 4 | THIRD QUARTER 2015
Technology, Millennials and The Future of Health & Benefits
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 CHIEF MARKETING OFFICER
With only a few weeks now until our second Private Exchange FORUM of 2015, it’s clear that technology solutions are coming to the health and benefit management industry in a big way. But while private exchanges are certainly attracting industry buzz, the overall technology revolution in health and benefits is much more expansive. Health care access, employee communication/engagement and workplace wellness — to name a few — are all experiencing their own technology-driven revolutions. And much of this innovation is arguably being driven by the forthcoming millennial generation — now the largest segment of the U.S. workforce, according to a Pew Research Center analysis from earlier this year. As this generation of digital natives becomes increasingly important in the workforce, HR and benefits tools are set to rapidly modernize across the board. Technology is highlighted in this issue of HealthCare Consumerism Solutions with multiple articles addressing telehealth and wearable devices in wellness. These trends have moved to the forefront of the industry in just a short period of time, and growth projections show no sign of slowing down. The millennial generation is highlighted in this issue in articles from FAIR Health’s Robin Gelburd, who addresses millennials’ use of cost/quality transparency tools, and Aflac’s Tye Elliott, who looks at open enrollment considerations for millennials. From both of these articles, it’s clear that employers need to change their communication and engagement strategies to reflect the reality of their new largest workforce segment — one that was raised on video games, YouTube, smartphones and e-commerce websites. Following Private Exchange FORUM next month in Baltimore, we will head back to Las Vegas for our fifth-annual FORUM West conference. With our West Coast event, we will be paying particular attention to the high-tech solutions that promise to change the face of HR and benefits. And until the end of September, we’re offering registration rates of only $99 for employers, brokers, consultants and health plans. I hope to see you there.
Andrew Dietz adietz@theihcc.com MANAGING EDITOR
Jonathan Field 404.671.9551 • jfield@theihcc.com SENIOR EDITOR
Heather Loveridge hloveridge@theihcc.com RELATIONSHIP MARKETING MANAGER
JJ Atherton jjatherton@theihcc.com DIGITAL MARKETING MANAGER
Eric Bruce ebruce@theihcc.com ART DIRECTOR
Kellie Frissell 404.671.9551 ext. 107 ¡ kfrissell@fieldmedia.com 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 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 Ted Arvan 678.296.1906 • tarvan@theihcc.com PARTNERS/ALLIANCES
Joni Lipson 800.546.3750 ¡ jlipson@fieldmedia.com
Sincerely,
BUSINESS MANAGER
Karen Raudabaugh 404.671.9551 ext. 108 ¡ kraudabaugh@fieldmedia.com
Doug Field CEO/Publisher dfield@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.
6 Third Quarter 2015 * XXX 5IF*)$$ DPN * HealthCare Consumerism Solutions™
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BACHMAN’S BANTER
BY RONALD E. BACHMAN FSA, MAAA CHAIRMAN, EDITORIAL ADVISORY BOARD THE INSTITUTE FOR HEALTHCARE CONSUMERISM
Final Rule on Summary of Benefits and Coverage Requirements WHO: Affects anyone issuing or covered under group and individual health policies whether fully insured or self-insured, including grandfathered plans. WHEN: On June 16, 2015, the Department of Health and Human Services (HHS), Department of Labor (DOL) and Department of the Treasury jointly published the final regulations governing summary of benefits and coverage (SBC). The effective dates are September 1, 2015 for group health plans and January 1, 2016 for individual health plans. WHAT: The Patient Protection and Affordable Care Act (PPACA) requires health plans to provide a document called a summary of benefits and coverage (SBC). It is intended to help consumers compare and select health coverages that best meet their needs using easy-to-understand language of health plan benefits.
The final rule gives additional clarifications and requires: 1. A website address where coverage details can be reviewed. 2. Plans to monitor the compliance of any third party contracted to provide the SBC. 3. Insurers to disclose what type abortion services are covered or excluded. 4. A separate SBC for each product, with an option to provide a combined SBC if the plan uses two or more products from separate insurers within a single health plan.
Until a final form is detailed,
no enforcement action is likely for those making good faith efforts to communicate the
EXECUTIVE SUMMARY: The SBC is an additional mandated document to educate consumers it does not replace the more detailed traditional summary plan description (SPD). The SBC must include 12 basic elements, as detailed in previous government rulings: 1. Uniform definitions of insurance and medical terms. 2. A description of the coverage. 3. Exceptions, reductions or limitations. 4. Disclosure of the cost-sharing provisions. 5. Renewability and continuation of coverage. 6. Coverage examples. 7. Statement that plan meets the minimum essential coverage. 8. A statement that the SBC is only a summary. 9. Information to obtain other plan documents. 10. Information to obtain a list of network providers. 11. Information on prescription drug coverage. 12. Paper copies are available for all information required by the SBC.
requirements of the SBC in
The final rule did not finalize an official SBC form. Such form is proposed to be finalized by January 1, 2016 and will be required for use during the open enrollment for the first policy anniversary on or after January 1, 2017. Until a final form is detailed, no enforcement action is likely for those making good faith efforts to communicate the requirements of the SBC in written and electronic forms.
written and electronic forms.
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ACTIONS: Group health plans and insurers should carefully review the new requirements and make changes to assure compliance by the effective dates. They may need to consult with their HR specialists, IT staff, lawyers and other consultants to meet a short time frame for implementation. Additional changes may be required when the final SBC form is released for use in 2017. 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
Aetna to Acquire Humana for $37 Billion to Drive Consumer-Focused, High-Value Health Care Aetna and Humana announced that they have entered into a definitive agreement under which Aetna will acquire all outstanding shares of Humana for a combination of cash and stock valued at $37 billion or approximately $230 per Humana share based on the closing price of Aetna common shares on July 2, 2015. The acquisition brings together Humana’s growing Medicare Advantage business with Aetna’s diversified portfolio and commercial capabilities to create a company serving the most seniors in the Medicare Advantage program and the second-largest managed care company in the United States. The combined entity will help drive better value and higher-quality health care by reducing administrative costs, leveraging best-in-breed practices from the two companies and enabling the company to better compete with more cost-effective products.
New Transparency Tool Helps Consumers Make Informed Health Care Decisions Health Care Service Corporation (HCSC), the nation’s largest noninvestor-owned health insurer, announced that retail members will have access to a price transparency tool, the Provider Finder with Cost Estimator, to help them easily find appropriate providers in their network and compare and estimate treatment costs. The Provider Finder tool offers members an easy-to-navigate website to help them select the best network provider for their needs, based on location, industryrespected third-party quality indicators and cost. Consumers can access information on more than 400,000 health professionals and 21,000 medical facilities nationwide, as well as compare costs for more than 1,500 common medical procedures.
State of Mississippi Selects Castlight Health Enterprise Healthcare Management Solution Castlight Health announced that the State of Mississippi Department of Finance and Administration has selected the Castlight Enterprise Healthcare Cloud (EHC) to help the state manage its significant health care investment while driving improved health outcomes for Mississippi’s
public employees and their families. The State of Mississippi had been searching for a more effective way to manage the State and School Employees Health Insurance Plan, which covers over 116,000 employees across Mississippi. The State selected the Castlight platform to support employees in making high-value care decisions as they begin to implement new health benefit program designs.
Willis, Towers Watson Announce Merger to Create Leading Global Advisory, Broking and Solutions Firm Willis Group Holdings and Towers Watson have announced the signing of a definitive merger agreement under which the companies will combine in an all-stock merger of equals transaction. Based on the closing prices of Willis and Towers Watson common stock on June 29, 2015, the implied equity value of the transaction is approximately $18 billion. The transaction has been unanimously approved by the Board of Directors of each company. The combined company will be named Willis Towers Watson. The merger brings together two highly complementary businesses to create an integrated global advisory, broking and solutions provider to serve a broad range of clients in existing and new business lines. The combined company will have approximately 39,000 employees in over 120 countries.
Humana Closes the Gap Between Dental Insurance and Wellness Often viewed as an afterthought to health plans, dental plans have largely sat on the sidelines as medical plans have shifted their focus to long term health and wellness. Humana is changing that dynamic with sweeping changes to its dental plan benefit structure and integration with medical and wellness plans. Effective August 1, new employer-based Humana dental plans will include no-cost coverage for preventive care including cleanings, exams, x-rays, space maintainers and oral cancer screenings; first-of-its-kind coverage beyond the dental plan’s annual maximum; sophisticated reporting for members and employers to help maximize plan benefits; and rewards and incentives for members enrolled in the HumanaVitality® wellness program through their medical plan.
HEALTHCARE CONSUMERISM RESEARCH, SURVEYS & REPORTS
HSA Consulting Services and Avidia Bank Release Study Projecting Coming Wave of HSA Investment Growth Avidia Bank recently released a study highlighting the coming wave of investment growth in health savings accounts. The study is available at AvidiaHealth.com or AskMrHSA.com. The analysis found that while the ability to invest funds inside an HSA for long-term tax-free growth has long been available, many HSA owners do not even know it exists.
Survey: Peers Most Likely to Influence Employers’ Health Strategies Most employers plan to change their long-term health strategies to evolve with the changing health landscape, yet a new Aon Hewitt survey shows there has been little effort over the past year to move in that direction. So what is most likely to drive the impetus for change? According to the survey of more than 1,000 companies, one of the biggest drivers is what other employers do. More than three-quarters of companies (77 percent) said the actions of their peers have a significant or moderate influence on
their own health care strategies, and 59 percent said so do the actions of major employers in their key geographies.
CPR and HCI3 Release State Report Card on Access to Health Care Prices for Consumers While most state grades remained unchanged, in some states there has been a flurry of activity in legislatures aimed at making price information for health services available to consumers. These are among the findings of the third annual Report Card on State Price Transparency Laws developed by Catalyst for Payment Reform (CPR) and Health Care Incentives Improvement Institute (HCI3). The state-by-state resource offers policymakers, consumer advocates and other health care stakeholders a comprehensive look at the progress being made — or the lack thereof — for price transparency. This year’s report includes new analyses of the legal arguments made by price transparency opponents and the benefits of creating public price information from all payer claims databases. continued on page 12
HealthCare Consumerism Solutions™ I www.TheIHCC.com I Third Quarter 2015
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Get An Insider’s View Of The Private Exchange
FORUM GENERAL SESSIONS DAY ONE Tuesday, Sept. 1 OPENING GENERAL SESSION 2:00 to 3:00 p.m. Private Exchanges: What’s Working, What’s Not and What Lies Ahead Moderator: Doug Field, CEO, The Institute for HealthCare Consumerism Panelists: Barbara Gniewek, Principal, GHRS, PricewaterhouseCoopers; Mike Smith, Director of Exchange Solutions, Lockton Benefit Group; Paul Rogers, President & COO, Pacific Resources; Faisal Saleh, Principal, Hager Strategic DAY ONE AFTERNOON GENERAL SESSION 3:15 to 4:15 p.m. Understanding Private Exchange Models and Implementation Options Moderator: Barbara Gniewek, Principal, GHRS, PwC Panelists: Eugene Sayan, Chairman, CEO, & President, Softheon; Dana Leopold, Director of Emerging Markets, Connecture; Scott Carver, President, PlanSource; Robert Steele, President, Quadrant4 Health; and William Giaconia, Vice President, Healthcare Strategy, ADP, LLC DAY ONE CLOSING GENERAL SESSION 4:30 to 5:45 p.m. What Defined Contribution & Exchange Solutions Are Leading Brokers/ Consultants Offering Their Clients? Moderator: John Young, CHCC, CEO, Consumerdriven, LLC (Conference Co-Chair) Panelists: Eric Grossman, Senior Partner, Marketplace Active Exchange, Mercer; Karen Frost, Senior Vice President, Health Strategy & Solutions, Aon Hewitt; Dan Graovac, Principal, Health Exchange Solutions, Buck Consultants LLC, A Xerox Company; Travis H. Brashear, J.D., West Division Client Development Leader, Towers Watson
DAY TWO Wednesday, September 2 OPENING GENERAL SESSION 8:30 to 9:45 a.m. Leading Health Plans Reveal Product Strategies for Their Own Exchange Solutions and Inside Other Exchanges Moderator: Paul Lambdin, Exchange and Retail Practice Operating Model Practices Leader, Health Plans, Deloitte Consulting LLP Panelists: Lisa Feddema, Executive Director, Exchange Management, Health Care Service Corporation (HCSC); John Mills, Senior Director of Commercial Products, UPMC Health Plan; Joseph Berardo, Chief Executive Officer, MagnaCare 10 Third Quarter 2015 * XXX 5IF*)$$ DPN * HealthCare Consumerism Solutions™
September 1-2, 2015 Renaissance Harboplace Hotel Baltimore
MID-MORNING GENERAL SESSION 10:00 to 11:00 a.m. Defined Contribution Health Care: Why Do It, How to Do It and What to Do in Renewal Years Moderator: John Young, CHCC, CEO, Consumerdriven, LLC (Conference Co-Chair) Panelists: David A. Osterndorf, FSA, Partner and Chief Actuary, Health Exchange Resources (HER); Barb Vasko, Vice President, Aon Hewitt; Nick Nyhus, VP of Human Resources, University of Minnesota Physicians; Dean Mason, CEO and President, Acclaris AFTERNOON GENERAL SESSION 1:45 to 2:45 a.m. Providing the Right Consumer Experience: The Value and Importance of Building the Complete Exchange Solution Moderator/Lead Speaker: Shandon Fowler, Director of Product Management for Marketplaces, Benefitfocus Panelists: Robin Gelburd, President, FAIR Health; Vinay Gidwaney, Chief Product Officer & Co-Founder, Maxwell Health; Dr. Bruce Sherman, MD, FCCP, FACOEM, Medical Director, Population Health Management Health Exchange Solutions, Xerox; Lois Chianese, Principal, Client Services, BenefitWalletÂŽ, A Xerox Solution CLOSING GENERAL SESSION 4:30 to 5:30 p.m. Employer Perspectives on Private Exchanges and Defined Contribution Moderator: Barry Eyre, Vice President, Business Development, KTP Advisors Panelists: Nick Nyhus, VP of Human Resources, University of Minnesota Physicians; Randy Spicer, VP, Health & Insurance Services, National Restaurant Association
WORKSHOPS TRACK ONE Wednesday, Sept. 2 from 11:15 a.m. to 12:15 p.m. SESSION 101 Providing the Right Benefits Mix in Your Exchange Moderator: Craig Hasday, Chief Operating Officer, Frenkel Benefits Panelists: Ryan Thomson, Director of Private Exchanges, Group Voluntary Auto & Home, Liberty Mutual Insurance; JoAnne K. Novak, AVP Business Development, Hartville Pet Insurance Group/ASPCA Pet Health Insurance; Mark Parabicoli, Managing Director for Exchanges, ARAG Group; Eric Runci, Senior Enrollment Firm Development Manager, Aflac Broker Channel SESSION 102 Private Exchange Trends and Strategies for Retirees Moderator: Christopher E. Condeluci, Principal, CC Law & Policy PLLC Panelists: Thomas J. Dimmer, Vice President–Business Development,
Private Exchange Future... Now The best decisions begin with a complete view of the private exchange landscape. Because the private exchange market is a confusing tangle of models, choices and offerings, there’s only one way that you can truly be prepared. Private Exchange FORUM is your guide to gaining a 360-degree perspective on private exchanges and defined contribution. Whether you’re an employer, broker/advisor or insurer, this is where you’ll find the education, collaboration and access to solutions that you need to help make the right decisions going forward for your business. Individual Markets & Exchanges, Renaissance Dental, Renaissance Life & Health Insurance Company of America; Girish Panicker, CEO, BenefitAlign; Michael Cho, Chief Innovation Officer, Connecture; Rob Harkins, Practice Leader, Private Exchanges, Willis
Thank you PLATINUM and GOLD sponsors for your support!
SESSION 103 Engagement and Decision Support Considerations for Private Exchanges Moderator: Paul Smith, Chief Strategy Officer, CodeBaby Panelists: Shandon Fowler, Director of Product Management for Marketplaces, Benefitfocus; Robert P. Poli, CBC, President and Chief Operating Officer, Insurance Marketing Center SESSION 104 The Importance of Integrating Health Management and Private Exchange Models Moderator: Ernie Harris, NPDP, Conference Co-Chair, EVP of Business Development, Maestro Health Speakers: Jim O’Connor, President, CBIZ Employee Benefits Services; Dr. Bruce Sherman, MD, FCCP, FACOEM, Medical Director, Population Health Management Health Exchange Solutions, Xerox; Tricia Johnson, Director of Marketing, Interactive Health
TRACK TWO Wednesday, Sept. 2 from 3:00 p.m. to 4:00 p.m. SESSION 201 Private Exchanges Compliance 101 Moderator: Ronald E. Bachman FSA, MAAA, CHCC, Chairman, Editorial Advisory Board, The Institute for HealthCare Consumerism Speaker: John Hickman, Partner, Alston + Bird LLP SESSION 202 Best Fit Exchange Solutions for Mid-Market Employers Moderator: Zack Pace, CBIZ Panelists: Frank B. Mengert, Partner & Director of Exchange Technology, ebenefit Marketplace; Jeff Yaniga, Chief Revenue Officer, Maestro Health; Megan Urbaniak, Director of Business Development, WebInsure Benefits, hCentive SESSION 203 The Game-Winning Combination of HSAs and Private Exchanges Moderator: Todd Berkley, President, HSA Consulting Services, LLC Panelists: Nitra LaGrander, Vice President of Strategic Markets, Evolution1; Gregg Larson, Senior Vice President and Managing Director, Healthcare Consumerism, Xerox HR Solutions, LLC; Dean Mason, CEO and President, Acclaris
One Source. Many Benefits.
SESSION 204 Optimizing Employee and Employer Needs in a Private Exchange Moderator: Doug Field, CEO, The Institute for HealthCare Consumerism Panelists: Kismet Toksu, President, EBenefits Solutions; Brian Ridder, Vice President, Business Development, Benaissance; Greg Licata, VP for Product Development, DataPath; Jay Belschner, CEO & Founder, Certifi HealthCare Consumerism Solutions™ I www.TheIHCC.com I Third Quarter 2015
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HEALTHCARE CONSUMERISM RESEARCH, SURVEYS & REPORTS
continued from page 9
Survey: Employers Split on Impact that Carrier Consolidation Will Have on Their Health Strategies
Flex Releases FSA, HSA, HRA Report; Identifies ACA Impacts for Employers
In the wake of the Aetna and Humana merger, a new pulse survey from Aon reveals that companies have varying opinions on the impact that existing and future health insurer consolidation will have on their organization’s health and benefits strategy. On July 8, Aon conducted a brief pulse survey of approximately 100 companies to gauge their initial reactions to current and future carrier consolidation. Twenty-one percent said carrier consolidation will provide greater cost efficiencies that will be reflected in better cost management. Forty-six percent, however, believe it will result in fewer health plan options for them and their employees. One-third said it will not greatly impact their organization or employees. Despite these differences of opinion, 44 percent of companies do not expect to make any meaningful changes to their overall health strategies.
Flexible Benefit Service Corporation (Flex), a leading benefits administrator, released its first FSA, HSA & HRA Report: Trends & Predictions. The report provides trends data on consumer-driven accounts that is specific to employer size to help benefits decision-makers (among other business and insurance professionals) understand the effects of the ACA on their own employee benefit offerings. Key findings from the Flex survey of more than 500 employer respondents indicate FSAs will continue to be offered by a majority of employers; the offer rate of HSAs will increase significantly; and HRAs may be offered more due to its lesser impact on Cadillac Tax thresholds.
HEALTHCARE CONSUMERISM PEOPLE ON THE MOVE
Limeade Appoints Former McKesson SVP Suzanne Obst to Vice President of Partnerships
Jean Moore Joins Mercer from Towers Watson as North America Health & Benefits Specialty Practice Leader
Limeade welcomes Suzanne Obst as vice president of partnerships. Bringing more than two decades of strategic business development experience, Obst now leads partnership strategy to expand the capabilities and programs Limeade offers through its platform. Obst will launch new partner relationships and maximize the success of existing Limeade partners. Limeade seamlessly integrates with partners to deliver apps, devices, interventions, content and programs for weight management, smoking cessation, financial fitness, safety, training and much more. With partner programs connected through the Limeade platform, HR leaders create an engaging employee experience in a way that’s easy to manage through a central dashboard.
Mercer has announced that Jean Moore has been named North America Health & Benefits Specialty Practice Leader, effective July 6. In this role, Moore will be responsible for leading growth and driving differentiated intellectual capital across a broad set of Mercer’s specialty practices as well as supporting intellectual capital development for Mercer’s North American Health and Benefits Business overall. She will also become a member of the Health & Benefits North America Leadership Team. Based in Phoenix, Moore will report to Jim McNary, North America Health & Benefits Region Leader.
HEALTHCARE CONSUMERISM FUNDING ANNOUNCEMENTS
Doctor On Demand Announces $50 Million Series B Financing, Signs 200th Employer Customer Doctor On Demand announced it has closed a $50 million round of Series B financing. The company will use the funds to continue the rapid expansion of its top-rated video telemedicine service, which addresses two massive problems in health care: skyrocketing costs and increasingly limited access to high-quality physicians and psychologists. Doctor On Demand’s top-rated service and unique business model is changing the telemedicine space, an industry projected to grow to $4.5 billion by 2018.
Picwell Secures $4 Million in Series A Funding Picwell announced that it has closed its Series A round of funding totaling more than $4 million. MassMutual Ventures led the investment, with additional participation from a group of prominent health care industry executives.
Limelight Health Raises $3 Million in Series A Funding Limelight Health announced it has received $3 million in Series A funding from MassMutual Ventures, the corporate venture capital arm of Massachusetts Mutual Life Insurance Company (MassMutual), and AXA Strategic Ventures. The company will use the funds to
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help grow its sales and engineering teams, to deliver innovative product enhancements to its cloud-based SaaS technology platform and aggressively expand distribution nationally.
MDLIVE Announces $50 Million of New Funding MDLIVE Inc., a telehealth provider, recently closed on a $50 million investment from Bedford Funding. This funding will enable MDLIVE to continue its organic growth and expand its acquisition strategy and consumer reach to further its vision of building a fully integrated, end-to-end virtual health system. Bedford Funding joins previous investors, Sentara Healthcare, Sutter Health, Heritage Group and Kayne Anderson Capital Advisors.
MYidealDOCTOR Receives Strategic Investment from ValorBridge Partners MYidealDOCTOR, a leading provider of cloud-based telemedicine and mHealth services, announced that it has received an investment from ValorBridge Partners, an Atlanta- and New York-based holding company that invests in leading-edge health care companies and adjacent markets. MYidealDOCTOR will use the investment to grow its technology team, expand the functionality of its mobile application and boost sales and product marketing.
©2015 WiserTogether, Inc. All Rights Reserved.
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BY ROD REASEN CHIEF EXECUTIVE OFFICER HEALTHIEST EMPLOYERS
STATS & DATA: WEARABLE DEVICES
T
Wearables and Employers: A Match Made in Heaven?
he wearable movement is in full swing. In fact, 54 percent of surveyed right one for your members. Your purchasing decision is easier if you have an employers1 are actively purchasing wearable devices in the next intentional strategy in hand, before evaluating devices. The wearables should twelve months. So, what do these new tools mean for employers? be a catalyst to grow your health and wellness program. This revolution is a direct response to the financial pressure facing Data: What data is important to you? Steps, sleep, GPS, miles, burned employers, who are using wellness initiatives as a strategic lever. To effectively calories and activity levels present different opportunities for advanced drive change and track outcomes, it’s becoming necessary to quantify the analytics. It’s paramount that you move beyond a participatory approach value of the data “behind the in your device purchase. Tracking device.� usage and steps only scratch the In the early days, countsurface of driving change. There ing steps was the easiest metare tools available to correlate ric for wellness participation. activity to health outcomes. in wearables Unfortunately, the pedometers Community: There is were inaccurate and lacked the tremendous value in the social Where devices fit into employer programs quality to endure the length of the competition component. Friends wellness program. Today’s new and co-workers with similar devices breed of devices is in tune with will find each other and engage WHAT DEVICES WEARABLES HAVE an incresing role in strategic planning of wellness programs. ARE BEING USED TO the “big data� movement, and in challenges. This interaction MANAGE HEALTH? 25% .........................................................use wearables includes unprecedented informastrengthens the experience and 69% ..........................................use biometric screenings tion on activity, sleep, calories, ensures a longer-term adoption. 67% ....................................use health risk assessments 27% bluetooth, heart rate and more. In working with over 6,000 58% non-bluetooth, yet Employers have upped employers nationally, I hear similar 62% use participation YET, THERE’S A GAP the ante, by changing how questions from employers. In which in using devices to assess the health of an employer population. they approach wellness. Once device should we invest? Which only 22% .........................................................use wearables use considered an inexpensive gift to one will outlast the dreaded six64% ........................................................use claims data device employees, fitness trackers have month drop-off rate? Which tracker 62% ..................................................use participation data. become consumer-minded with integrates with my wellness vendor broad appeal. applications? These questions are So how can these devices key considerations on the path to big data is a big THE FUTURE: be deployed more effectively? better data and outcomes. problem for employers. ANALYTIC TOOLS Like any wellness initiative, there Fortunately, there are free Only connect the dots between are many success factors. Below resources available. I encourage 11.7% 13.7% activity & outcomes. are five areas to consider when you to check out the Employer evaluating the right device for your Guide to Wearables for a organization. comprehensive review of over Price point: Don’t overlook twenty devices. This study also the inexpensive devices that still deliver strong functionality. Conversely, don’t outlines an employer checklist for device purchases. shy away from expensive options. Depending on the size of your order, some Employers represent over half of the U.S. population. This gives them manufacturers offer a volume discount from the full retail price. a powerful voice to improve individual health. Together, we can move the Usability: The interface and app of the device are critical in employee needle and make wellbeing a reality in our workplaces and communities. adoption. It’s important to identify what features are critical to your population. Rod Reasen is the founder of the nationally recognized Healthiest Employer Awards Try the application first-hand to see if the system supports your overall Program that serves over 6,000 employers in forty-five U.S. cities. With a front-row seat to the trends in corporate health, Reasen is a speaker, researcher and author in health initiatives. Shiny packaging and a long feature list are less important if the analytics and wellness programming. Reasen serves as CEO of SpringbukŽ Health app itself is a hurdle. Analytics. Application: Do you just want to track steps or do you want more information? Knowing what you want from a device will help you pick the 1 2015 Workplace HealthScan Survey, Healthiest Employer LLC. track absenteeism of participants versus non-participants
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track changes in health spending from wellness programs
BY CHERYL DEMARS PRESIDENT AND CEO THE ALLIANCE
HEALTH CARE TRANSPARENCY
Seven Lessons for Delivering Cost and Quality Information at the Point of Decision
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hat’s the best time to learn about the cost and quality of care? Is it when you get the bill or when you choose the doctor or hospital? If you’ve answered “when you choose,” then you’re aiming to offer information at the point of decision. That’s when cost and quality transparency data is most likely to impact patients’ choices. The Alliance has been engaged in groundbreaking experiments aimed at making cost and quality transparent to patients since the late 1990s. Here are some of the vital lessons we’ve learned along the journey to the point of decision.
Lesson 1: Build On Data The Alliance is a cooperative of employers who self-fund their health benefits in Wisconsin, Illinois and Iowa. The Alliance has its own network of health care providers, which means it has the data required to provide accurate cost estimates. The Alliance also collaborates with other data-driven organizations, including the Wisconsin Health Information Organization. Before this data can be shared, it must be analyzed based on cost and quality measures, which should be nationally endorsed when possible. The Alliance believes it is essential to use credible, transparent measures and then offer hospitals and doctors an opportunity to review and comment on the results before they are shared with the public.
Lesson 2: Experiment The Alliance’s first transparency effort was the QualityCounts® report published in 1999. QualityCounts attracted regional and national attention as an early attempt to help consumers make decisions based on cost and quality. The introductory report was a paper document that used symbols to rate cost and quality at area hospitals. It was distributed by employers and as an insert in the area’s major daily newspaper and was available online. Over time, QualityCounts shifted to an online e-book that provided inpatient and outpatient cost estimates and offered quality ratings for some inpatient procedures.
Lesson 3: Reach Out The Alliance worked with employers to use QualityCounts information in new ways. Several employers developed steerage programs that rewarded employees for choosing high-value, low-cost providers for procedures and imaging. For example, one employer offered a $500 gift card to employees who chose the high-value provider for laparoscopic gallbladder surgery. The employee also gained savings of almost $1,000 on out-of-pocket costs, based on a roughly $5,000 difference between high- and low-cost providers and a $1,000 deductible.
Lesson 4: Lean In To broaden its reach, The Alliance worked with Doctor.com to create its Find a Doctor provider directory in 2014. Find a Doctor offers cost and quality information at the time when consumers seek information about in-network doctors and hospitals. The online directory is mobile-responsive and user-friendly. Consumers can access the directory from a link on their employer’s benefits page or by visiting The Alliance website at www.the-alliance.org and clicking the Find a Doctor logo. Find a Doctor is designed to encourage users to search for health care providers based on the type of care they need, which can range from an office visit to hip replacement. Once consumers log in, they can view the cost of more than 70 procedures. Consumers can also search by provider name, location and other factors.
Lesson 5: Be Visual Early experiments proved consumer response increases when symbols and charts are used. Find a Doctor uses a green “check” to mark providers that are in the “best price tier,” while a red “alert” warns consumers that a facility fee is charged. Stars rate providers on quality. Nationwide, health plans average about two percent adoption of cost and quality tools. Thanks to support from employers, registered users for Find a Doctor passed the two percent mark less than a year after it was introduced. Users must log in to see cost estimates but can search for providers and check on quality without registering. After 10 months, Find a Doctor was nearing 30,000 search sessions by all users.
Lesson 6: Get Bolder In January 2015, The Alliance introduced QualityPath® to guide employees and family members to lower-cost, high-quality providers for total hip replacement, knee replacement and heart bypass surgery. Employers must sign up to use QualityPath, which requires 100 percent coverage of medical procedure costs, bundled payments and 90-day warranties. Because QualityPath impacts the cost and quality of care, Find a Doctor search results now list QualityPath providers first.
Lesson 7: Keep Experimenting The Alliance’s experiences show that information alone is not enough to engage consumers. Instead, we must measure what matters to consumers and then share the information in a way that is relevant to their needs. That means reaching them at the point of decision so cost and quality information is always as close as their smartphone, tablet or computer.
HealthCare Consumerism Solutions™ I www.TheIHCC.com I Third Quarter 2015
15
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 Visit us online at www.wageworks.com
Third Quarter 2015
Exchange
About Innovative Health and Benefit Marketplaces
Blue Directions Building a High-Performing Consumer Environment Who Needs a Private Exchange Anyway? Private Exchanges Leading to “Buy-down” and “Buy-up” Effect The Business Case for Private Exchanges
The Official Magazine of
Exchange www.theihcc.com
INSIDE FEATURE 14 Blue Directions: Moving to a High-Performing Consumer Environment
STATS & DATA 9
Private Health Insurance Exchanges Demonstrate Their Business Value According to a recent study from Array Health, insurers are seeing a notable reduction in their administrative burden as well as an increase in their market share as a result of operating a private exchange.
Not so long ago, in the early days of private exchanges, there was hardly a consensus on what they would mean for employer-sponsored health insurance. There were plenty of opinions on best practices, what makes a good platform and how much interest employers would have in moving their employees to a private exchange.
By Lance Hood, Senior Director of Marketing, Array Health
PERSPECTIVES 10 Private Exchanges Leading to Both a “Buy-down” and a “Buy-up” Effect In a private exchange environment, employees typically purchase less medical coverage (sometimes called the “buy-down” effect), leaving money available to purchase other benefit options (the “buy-up” of voluntary benefits). By Rob Harkins, Vice President of Private Exchanges, and Jon Trevisan, Senior Vice President and Director of Placement, Willis Human Capital Practice
11 Who Needs a Private Exchange Anyway? Chances are by now, the average broker, consultant or employer has evaluated four or five different flavors of “private exchanges” in the past 12 months. As we enter into the fourth quarter of 2015 one thing is for certain: there is still confusion about what a private exchange is and how employers can benefit from one. By Frank B. Mengert, Director of Exchange Technology, ebenefit Marketplace
12 Midsummer Reflections on a Favorite Subject… Exchanges It’s been about a year and a half since I joined We now know there is plenty of interest, with 47 percent of employers considering a private exchange by 2018 and enrollment projections of 40 million for that same year. This has led to a vast array of platforms from consultants, technology companies and even carriers themselves jockeying for position within the emerging market. And with many platforms come many value stories: from single-carrier to multi-carrier exchanges; carrier-administered versus consultant-administered; consumer-driven enrollment and streamlined administration for HR administrators just to name a few. One focus that has not deviated, however, has been the emphasis on the front-end abilities of private exchanges. By Lisa Feddema, Executive Director, Private Exchange Management, and Bob Quigley, Consultant, Private Exchange Management, Health Care Service Corporation
Lockton as director of the Exchange Solutions Practice. In that time, some of the assumptions we (and by “we”, I mean all of us in this industry) had about the private exchange space have missed the mark, some are on point and others are emerging as developing trends. By Mike Smith, Assistant Vice President, Director, Exchange Solutions, Lockton Benefit Group
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 Third Quarter 2015
3
PUBLISHER
Exchange www.theihcc.com VOLUME 2 NO. 3 | THIRD QUARTER 2015
Building a Consumerism World with Private Exchanges
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 CHIEF MARKETING OFFICER
If you picked up a copy of this magazine, chances are you’re at our Private Exchange FORUM in Baltimore. We’ve been preparing for this for months and are glad to finally kick off our second Private Exchange FORUM of 2015 — this time in Baltimore. It’s evident from turnout at our private exchange events that exchanges are a hot topic, and we hope the knowledge you gain from this helps you now and in the years to come. Like our event, each issue of HealthCare Exchange Solutions that we publish is full of relevant information about this new world we’re all navigating.
Andrew Dietz adietz@theihcc.com MANAGING EDITOR
Jonathan Field jfield@theihcc.com SENIOR EDITOR
Heather Loveridge hloveridge@theihcc.com RELATIONSHIP MARKETING MANAGER
JJ Atherton jjatherton@theihcc.com DIGITAL MARKETING MANAGER
In this issue, our editorial team has compiled a number of timely articles, including our feature “Moving to a High-performing Consumer Environment”. Written by Lisa Feddema and Bob Quigley at Health Care Service Corporation, one of the nation’s largest health insurers, the article discusses their private exchange for large employers — Blue Directions — and how it’s focusing on health and wellness and providing an array of offerings designed to improve consumer experience. While many of us in the industry are very familiar with private exchanges, the fact remains that many are still confused about what it is and how it can help employees. Frank Mengert, director of exchange technology for ebenefit Marketplace, tackles this topic, giving his perspective by answering the question “Do I need a private exchange?” I also appreciate the insights from Rob Harkins and Jon Trevisan at Willis into how private exchanges are prompting consumers to “buy-down” and “buy-up” in regard to major medical and voluntary benefits. This year’s open enrollment season will be an important time for private exchanges — giving everyone a better look at their growth as well as consumer opinions and experiences. To help us plan our 2016 conferences and content, I’d love to hear your thoughts on this year’s open enrollment. You can reach me on Twitter @dougfield52 or at the email address below.
Eric Bruce ebruce@theihcc.com ART DIRECTOR
Kellie Frissell 404.671.9551 ext. 107 · kfrissell@fieldmedia.com 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 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 Ted Arvan 678.296.1906 • tarvan@theihcc.com PARTNERS/ALLIANCES
Joni Lipson 800.546.3750 · jlipson@fieldmedia.com
Sincerely,
BUSINESS MANAGER
Karen Raudabaugh 404.671.9551 ext. 108 · kraudabaugh@fieldmedia.com HealthCare Exchange Solutions™ Volume 2 Issue 3 Copyright ©2014 by FieldMedia LLC. All rights reserved.
Doug Field CEO/Publisher dfield@fieldmedia.com
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.
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Third Quarter 2015 I www.TheIHCC.com I HealthCare Exchange Solutions™
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NEWS BRIEFS & INNOVATIONS
NEWS BRIEFS EPIC Launches Private Exchange in Partnership with Hodges-Mace EPIC Insurance Brokers and Consultants, a retail property and casualty insurance brokerage and employee benefits consultant, recently unveiled its next generation private exchange, coined EXP (The EPIC Exchange Platform) in partnership with Atlanta-based Hodges-Mace. The integrated offering includes robust benefits administration and enrollment, advocacy through a licensed call center and actuarially-based decision support tools that empower employees to select benefit plans specifically suited to their personal needs while managing ongoing benefit program costs. EXP delivers multi-option enrollment and online decision support tools, benefit communication and education for employees supported by state of the art professional, licensed call center. The flexible technology platform also allows for multi-year strategy — beginning with core benefits administration and the option to migrate to full private exchange and defined contribution approach without disruption.
hCentive Expands Partnerships with Insurers, Administrators to Participate in Private Exchange hCentive has announced that the company has added health and ancillary insurance carriers and benefits administrators to its WebInsure™ Benefits marketplace. WebInsure™ Benefits is a cloud-based marketplace platform that simplifies administration for brokers, offers an intuitive online experience for individuals and control for employers to shop, enroll and manage health insurance, ancillary benefits and consumer-directed accounts. New insurance carriers and benefits administrators providing medical and ancillary benefits include: Discovery Benefits, Kaiser Foundation Health Plan of the Mid-Atlantic States, Reliance Standard and WageWorks.
Private Exchange GoHealth Plays Significant Role During Tax Special Enrollment Period GoHealth, the nation’s leading private online exchange for individuals and families to shop and compare health insurance plans, announced its enrollment results from the tax Special Enrollment Period (SEP), which occurred from March 15 to April 30. This SEP gave people who were unaware of the tax penalty for going without health coverage the opportunity to sign up for major medical health insurance outside of the national Open Enrollment Period. During this time, Chicagobased GoHealth proved to be a primary enrollment channel for eligible shoppers. CMS announced that approximately 147,000 consumers signed up for health insurance through HealthCare. gov during the tax SEP. Of those consumers, roughly one-in-seven sign-ups were processed through GoHealth’s exchange platform and network of licensed insurance agents. As a government-approved enrollment partner of CMS, GoHealth serves as an additional free resource that connects consumers with insurance subsidies and health plans offered on HealthCare.gov.
Maestro Health Acquires Group Associates Maestro Health, a leading benefits administration and exchange provider, announced that they have acquired Group Associates, Inc., a Michigan-based benefit administration company. Group Associates, which recently unveiled its unique, automated Affordable 6
Third Quarter 2015 I www.TheIHCC.com I HealthCare Exchange Solutions™
Care Act reporting technology, will maintain its current Detroit location and leadership team. Their automated ACA compliance technology will immediately become an integral part of the “AllIn” Maestro Health offering. January 1, 2016 marks the first year employers are required to provide reports to the IRS and statements to employees as part of the Affordable Care Act legislation. The law, which carries a financial penalty for employers that do not comply, has extensive tracking and reporting requirements that many brokers and employers are struggling to successfully satisfy.
Community Health Choice Goes Live with Softheon Marketplace Connector Cloud in Under 90 Days Softheon, a proven leader in health insurance marketplace integration and business operation, announced that Community Health Choice, Texas’ ninth largest health plan, serving over 300,000 lives, has fully implemented its Marketplace Connector Cloud (MC2) as its software platform to integrate its comprehensive plan offerings to the Federally-Facilitated Marketplace. Community Health Choice is a not-for-profit managed care plan and a member of the Association of Community Affiliated Plans (ACAP). Following this implementation, Softheon MC2 Plan Catalog Management, Eligibility & Enrollment, Electronic Direct Enrollment Consumer Portal and Premium Billing solutions have been utilized by Community Health Choice — leveraging its core administrative system. The focus of this partnership will enhance Community Health Choice’s multi-channel distribution and outreach channels, while cultivating the user experience of its members and brokers.
Towers Watson Names Sherri Bockhorst Managing Director, Group Exchange Towers Watson announced that it has hired Sherri Bockhorst as a managing director in its group exchange business. In this role, Sherri will help continue to drive innovation and outcomes in the private exchange market. Before rejoining Towers Watson, Bockhorst led the launch of the RightOpt® private exchange solution offered by Buck Consultants at Xerox. At Buck, Bockhorst oversaw product strategy, operations, vendor/partner relations and sales and marketing for the solution, serving both active and retiree populations.
Benefitfocus Partners with HealthTap to Add Virtual Care to Its New Voluntary Benefits Store Benefitfocus has partnered with HealthTap to make it easier for employers, carriers, brokers and consumers to add virtual health care services to their benefits packages. BENEFITFOCUS® Platform users will be able to select HealthTap on the same platform that they use to enroll in their traditional benefits via a Benefitfocus voluntary benefit exchange and consultation solution — Benefitstore. Benefitfocus platform users will be able to select HealthTap at a preferred rate along with a selection of curated voluntary insurance and benefits services such as critical illness, hospital indemnity, accident, legal, permanent life, pet, auto, home and more.
PlanSource Adds MetLife to its Distribution Platform for Employee Benefits PlanSource, a leading provider of cloud-based health exchange and benefits engagement technology, announced that it has added MetLife®, a global provider of life insurance, annuities, employee
benefits and asset management, to its distribution platform for employee benefits. PlanSource now distributes MetLife’s portfolio of products through its highly-configurable benefits engagement system, which can be administered by employers or configured as a public or private exchange using PlanSource OneMarket. Launched in 2014, PlanSource OneMarket provides standard benefit products and services from leading insurance companies in a marketplace where employees can shop for benefits in the same consumerfriendly way they shop for other products online. Through the PlanSource platform, consumers have access to 11 MetLife product lines, including traditional benefits such as basic and supplemental life, dental and vision, as well as ancillary benefits such as accident, hospital indemnity, and critical illness.
Industry Leaders Form Coalition to Drive a Productive Path Forward in Private Exchanges The Private Exchange Coalition (PEC) has announced its formation to help guide the rapidly growing private exchange industry. The PEC will serve as a forum for those in the industry to share ideas and best practices and increase awareness of the powerful ways in which private exchanges improve the selection, administration and use of employee benefits — while empowering consumers at every point in the decision-making process. Against the backdrop of health reform — and with shared goals to eliminate waste, provide greater transparency and increase accessibility to health insurance and other benefits — the PEC aims to help establish private exchanges as a long-term solution for enabling consumers to easily evaluate and select employee benefits that best meet their health care, economic and lifestyle needs.
Quadrant 4 System Corporation Announces Its Breakthrough Online Exchange Solution, QHIX Hybrid Exchange Quadrant 4 System Corporation recently announced its breakthrough online exchange solution, QHIX Hybrid Exchange™. The QHIX Hybrid Exchange brings together employers, benefits products, associates/team members, service providers, payroll and banking solutions into a single place. It is a robust administrative ecosystem providing sophisticated benefits administration where employers, employees, brokers and insurance companies come together in an online environment to buy, sell and manage insurance and other benefits-related products. The QHIX Hybrid Exchange™ is unique because it combines the functionality to service the largest group exchanges in addition to serving the exchange needs of a single individual.
HPOne Launches Next-Generation Multi-Carrier Exchange Solution for Retirees HPOne, one of the nation’s leading private exchanges for retirees and individuals, has launched the ClearChoice Exchange, a new health care exchange solution created for employers seeking to manage retiree health care costs while enhancing the flexibility, choice and value provided to their retirees. The ClearChoice Exchange provides a full-service solution for employers looking to transition from a traditional group insurance plan for retirees to a defined contribution approach. The ClearChoice Exchange offers plans from multiple carriers for pre-65 retirees; individual Medicare Advantage plans
from multiple carriers; and the UnitedHealthcare Group Medicare Advantage Preferred Provider Organization (PPO) plan.
Hager Strategic Partners with The Terry Group to Offer a Robust Solution for Private Exchange Evaluation Hager Strategic, a Washington D.C.-based benefits, HR & payroll administration consulting firm, recently announced its partnership with the Terry Group, a Chicago-based actuarial firm. With this new partnership, Hager significantly bolsters its services in the private health care exchange evaluation market. Employers seeking advice in assessing exchange provider solutions can now expect independent actuarially-based analysis and vetting of competing vendor proposals. Until now, the firms in the best position to perform actuarial analysis of exchange proposals were the same firms that also offered exchange solutions of their own. Hager Strategic and the Terry Group have focused on developing the necessary actuarial tools and models to facilitate relevant exchange proposal evaluations. The combined Hager Strategic-Terry Group exchange team has already been engaged by a number of clients. In addition, the Hager-Terry team has been interacting with key health care exchange providers so that RFPs can be shaped to accurately reflect the critical elements of each provider’s exchange approach, while also facilitating relevant comparisons from one approach to another.
bswift, First Niagara Benefits Consulting and LVBCH Partner to Provide Private Exchange Services The Lehigh Valley Business Coalition on Healthcare (LVBCH) recently announced its selection of bswift’s technology to power a private exchange for its member employers. Concurrently, bswift announced that First Niagara Benefits Consulting (FNBC), a division of First Niagara Risk Management and subsidiary of First Niagara Bank, N.A., will manage the LVBCH private exchange. The LVBCH private exchange is designed to assist employers with managing costs more effectively. It also offers competitive benefit options for employees by leveraging existing LVBCH products and the robust technology that bswift has developed over the past 15 years.
Deloitte Report: Health Insurance Exchanges May Spark Consumerism People who obtain health insurance through the public exchanges (HIX) show signs of acting more like savvy shoppers versus passive patients when engaging the health system, according to the Deloitte report, “Public Health Exchanges — Opening the Door for a New Generation of Engaged Health Care Consumers.” The study compared people who obtained insurance through an exchange with those who have it through their employer or Medicare or Medicaid. It found that HIX enrollees better understand their benefits and costs and are more likely to compare providers and services on price and, to some extent, quality. They also are willing to switch plans, thrusting carriers into a new arena of having to continually win over this segment based on price, product and service. The report found that 51 percent of the HIX individuals surveyed used an online tool to compare and negotiate prices among doctors and hospitals, versus 45 percent for those with employer-based coverage and 36 percent for those on Medicare.
HealthCare Exchange Solutions™ I www.TheIHCC.com I Third Quarter 2015
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Visit us at Booth #124, and let’s talk about how to create your highly effective online marketplace! And be sure to join us for a panel discussion on the topic of “Understanding Private Exchange Models and Platform Options.”
connectu.re/go-on-ramp
STATS & DATA BY LANCE HOOD SENIOR DIRECTOR OF MARKETING ARRAY HEALTH
Private Health Insurance Exchanges Demonstrate Their Business Value
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umerous studies over the past couple of years have documented the growth in employer and insurer adoption of private exchanges. Accenture and Deloitte have both predicted that private exchange enrollment could reach 40 million by 2018. What these studies haven’t demonstrated, however, are the tangible business benefits realized by insurers through the implementation of private exchanges. What pain points are being solved through exchanges? What competitive advantages do exchanges create for insurers? What barriers do they need to overcome in order to realize these advantages? Health Check: Examining the Business Impact of Private Health Insurance Exchanges, a May 2015 study of 100 health insurance industry stakeholders, sought to explore these questions and others facing a more mature private exchange market. According to the study, insurers are seeing a notable reduction in their administrative burden as well as an increase in their market share as a result of operating a private exchange. While insurer-led private exchanges have been touted as solutions that offer flexible options for employees and cost control for employers, the business case for these exchanges is less often discussed. But the business case is evident in the data – more than half (52 percent) of survey respondents reported seeing a reduction in administrative costs, and 48 percent have increased their market share. Reduced administrative costs can be significant, as they can offer extensive cost savings to employers, brokers and insurers by eliminating paper-based waste, errors and process inefficiencies. The recognition of these substantial business benefits is not limited to those currently operating private exchanges. Of those that plan to offer single-insurer private exchanges, 55 percent expect that a reduction in administrative costs will be among the benefits, followed closely by increased revenue (45 percent) and increased market share (43 percent). If you currently use a single-insurer private exchange to sell to groups and individuals, what areas of your business have been most impacted by the implementation of the exchange? If you are planning to use a single-insurer private exchange to sell to groups and individuals, what value do you expect to realize through the implementation of the exchange?
% of respondents 60
52%
55%
50
45%
48% 43%
40
32% 30
20
19% 12%
10
0
Increased revenue
Improved margins
Reduced administrative costs
Increased market share
By January 2016, what percentage of private exchanges (single and multi-insurer) will offer a robust and comprehensive set of ancillary products such as life, critical illness, accident, pet insurance, etc.?
% of private exchanges
76-100 51-75
7% 14%
31%
26-50 0-25 0
10
20
30
40
47% 50
As private exchange adoption increases, ancillary products represent one of the biggest growth opportunities for insurers. The data unveiled an interesting paradox — most notably, that ancillary products are seen as key to a compelling consumer experience, but exchanges are slow to adopt beyond only the most common products. Anecdotal evidence suggests that this is because the partnering and set-up burden for ancillary products is a delaying some insurers. Yet, 59 percent of respondents believe that the availability of ancillary products will lead to an improved consumer shopping and enrollment experience on private exchanges. Given that ancillary offerings are increasingly considered an important component of an employee’s overall compensation package, insurers are missing an opportunity to create a compelling consumer experience by not extending their offering beyond traditional product sets fast enough to offerings like life, critical illness, accident and pet insurance. Increasingly, insurers are looking to their private exchange vendors to bring a library of ancillary partners with their technology solution. Looking ahead to the market changes, and with the “Cadillac” tax set to begin in 2018, private exchanges hold the promise to relieve a significant administrative burden for insurers and employers — particularly if they can capitalize on the ancillary opportunity — and further empower consumers to be the ultimate stewards of their care. In fact, the data shows that private exchanges are well on their way to becoming the de facto model for employer-sponsored health insurance, with nearly three-quarters of respondents indicating that the majority of health insurers will offer a private insurer-led exchange by the end of 2017, if not sooner, and almost half of respondents (44 percent) indicating that the majority of employers will offer employer-sponsored health benefits via a private exchange within that same time frame. Clearly, today’s health insurance landscape is more complex than ever. Changes triggered by the Affordable Care Act and increasing health care costs, coupled with the emergence of an increasingly empowered and engaged health care consumer, have created a “perfect storm” of factors leading to the widespread growth of private exchanges. For the first time, the industry now has a data set that clearly shows the extent to which private exchanges enable insurers to win and retain business by controlling costs for employers and providing greater choice, control and convenience for consumers.
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PERSPECTIVES
Private Exchanges Leading to Both a “Buy-down” and a “Buy-up” Effect BY ROB HARKINS » VICE PRESIDENT OF PRIVATE EXCHANGES AND JON TREVISAN » SENIOR VICE PRESIDENT AND DIRECTOR OF PLACEMENT » WILLIS HUMAN CAPITAL PRACTICE
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ne interesting result of the advent of private exchange technology combined with a defined contribution is that when individuals are given a) money to spend on benefit purchases and b) a shopping experience that they can navigate, they behave like consumers. In this environment, they typically purchase less medical coverage (sometimes called the “buy-down” effect), leaving money available to purchase other benefit options (the “buy-up” of voluntary benefits). In effect, their benefit choices change, reflecting a true consumerminded benefit model. What’s prompting this surprising turn? Currently, many employers choose medical plans that they believe will accommodate the needs of the greatest number of members. In so doing, they often select a benefit plan that meets the needs of those members who utilize the plan more than most. Additionally, the traditional benefits culture has fostered an environment where more insurance is better, even if a cost benefit analysis indicates otherwise. The end result is that many individuals are over-insured. However, this concept is becoming increasingly challenged, supplanted by the idea that one can be adequately insured at a lower (in fact, correct) level of benefits. A private exchange is the ideal solution to help people navigate choices, evaluate options and “right-size” their benefits. When people are provided money to spend on benefits and multiple plan options exist — in conjunction with a robust decision-support tool that helps them evaluate choices — they behave differently. By becoming more educated benefits consumers, people behave more efficiently and buy only those plans that they need.
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Private exchange decision support tools provide individuals with a recommendation that is customized to their personal needs. Armed with a recommendation that presents personalized financial and benefit options, many people have the confidence to make decisions that best suit their needs. In most cases, they purchase a lower cost medical plan than what their employer previously offered in the traditional one-size-fits-all approach. As a result of this change in buying habits and the “buy-down” effect realized for the reasons previously identified, the Willis Private Exchange experience has demonstrated savings of almost $700 per employee per year. Coupled with the “buy-down” of medical insurance, we are finding an increase in the number and volume of voluntary benefits purchased by employees in a private exchange. Employees are buying a greater number of voluntary benefits to supplement the traditional lines of insurance that have historically been offered; they’re also buying more voluntary benefits when given additional options. Based on an analysis of the Willis book of business available, we found that voluntary benefit purchasing more than doubled when employees purchased in a private exchange. This behavior could be attributed to employees taking a more consumer-minded approach when presented with an increased number of medical benefit plans and decision support technology that shows them in real dollars and cents how much each benefit selection costs. When employees act as rational consumers, they buy what is most important to them. And as purchasing habits reveal, employees have determined
that voluntary benefits are an important component of their comprehensive employee benefits package. Private exchanges offer more choice, with an increased number of plan options to choose from and a greater suite of voluntary products to buy. Expanded choice is important because we now have four generations in the workforce. In addition, many baby boomers are working past age 65. Therefore, buyer’s needs are becoming more varied and voluntary benefits are increasingly used to meet the varied needs of a more diverse and sophisticated workforce. Most significantly, as medical plan deductibles and out-of-pocket levels continue to increase, the use of voluntary benefits — which can help offset the employee’s deductibles and coinsurance responsibility — can be a cost-effective way to protect against the financial impact of a costly medical incident. Private exchanges, by their very design, help consumers realize the importance that voluntary plans can play in getting a comprehensive benefits program that is best suited to their needs. And that’s a good thing. With rising medical costs trends remaining unchecked, the inherent structure of a private exchange can actually assist in optimizing consumer behavior in such a way that appropriate medical coverages are purchased (the “buy-down” effect), accompanied by complementary, lower cost, voluntary benefits (the “buy-up” effect). This model can actually assist in mitigating the financial risk for the individual, while lowering the overall cost to the employer. We believe this is a winwin scenario that truly ushers in the next stage of consumerism.
PERSPECTIVES
Who Needs a Private Exchange Anyway? BY FRANK B. MENGERT » DIRECTOR OF EXCHANGE TECHNOLOGY » EBENEFIT MARKETPLACE
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hances are by now, the average broker, consultant or employer has evaluated four or five different flavors of “private exchanges” in the past 12 months. As we enter into the fourth quarter of 2015 one thing is for certain: there is still confusion about what a private exchange is and how employers can benefit from one.
Five years ago, a “pure play” private exchange came onto the scene and was sweeping the nation. Seemed like everyone wanted to join in. Fast forward to today, that organization was gobbled up by a national firm, and quite frankly we haven’t heard their name in quite some time. Not only is this because of the competition within the market, but it
Employers are shifting from paper-based enrollment into some form of benefits administration. Maybe they want multiple plan choice or maybe they want defined contribution. Most likely they just want to automate some of the manual processes and when the time comes to adopt defined contribution, they can flip a switch and turn it on.
Chances are by now, the average broker, consultant or employer has evaluated four or five different flavors of private exchanges in the past 12 months. As we enter into the fourth quarter of 2015 one thing is for certain: there is still confusion about what a private exchange is and how employers can benefit from one. As a national technology partner with bswift, I have the luxury of speaking with brokers of all types — national players as well as the regional and local firms. The influx of RFPs has risen dramatically; this means that not only brokers — but employers as well — are starting to take a serious look at the solutions on the market, how they differ and what the plus side is to adopting this technology. There are many times I know our technology is not a proper fit for a group. The good thing is that with all of the available technologies on the market, brokers and consultants have a variety of options to offer up. The question still is... do I need a private exchange?
is also due to the nature that not every employer needs a true private exchange. Take bswift for example. It’s basically a storefront. Employers can “stock the shelves” with any product they wish. The technology isn’t tied to any carrier, and there is flexibility for employers to move from carrier to carrier without fearing they will lose their platform. At the same time, they still get the benefits of defined contribution, decision support, multiple plan options, employee self-service and ACA compliance. Competition is good for the market. Options are good for employers. Private exchanges will continue to grow… however you are defining it.
Bottom line is that whatever you are calling your private exchange, let’s hope it is solving a problem — whether that is better plan choice, multiple funding options, electronic enrollment or ACA compliance. The next few years will see continued growth with these platforms: that is certain. A seasoned information technology executive with over two dozen industry-recognized certifications and a B.S. in Computer Science, Frank is the director of exchange technology for ebenefit Marketplace. He is focused on partnerships with national, regional and local distribution channels. Under his leadership, ebenefit has grown nationally, providing organizations across the United States with the tools and resources they need to succeed in this new world of employee benefits.
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PERSPECTIVES
Midsummer Reflections on a Favorite Subject… Exchanges BY MIKE SMITH » ASSISTANT VICE PRESIDENT, DIRECTOR, EXCHANGE SOLUTIONS » LOCKTON BENEFIT GROUP
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e just returned from our annual family trip to the beach. Lots of sun, surf, sand, seafood... and reflection.
It’s been about a year and a half since I joined Lockton as director of the Exchange Solutions Practice. In that time, some of the assumptions we (and by “we”, I mean all of us in this industry) had about the private exchange space have missed the mark, some are on point and others are emerging as developing trends. Predictions miss the mark Industry-wide, the biggest “miss” would be our collective predictions on exchange adoption rates for 2014, 2015 and 2016. There were some very aggressive bets out there — one analyst stated there would be 22 million employees enrolled by 2017, while another predicted somewhere between eight and 18 million. Others were off by even more than that. Much has been written about why these figures have not lived up to the hype. We could point to the newness of the market, employers searching for financial, administrative or engagement value, corporate economic strength and the focus on talent retention over cost management, easing of medical inflation, increasing attention to employee wellbeing and, lastly, implementation focus on Affordable Care Act (ACA) reporting requirements and tools. Still, growth is coming But the underlying drivers as to why employers want to consider exchanges — managing costs, leveraging technologies, expanding choice, driving employee engagement, administering HR/benefits efficiently and in compliance – remain in place and will grow in importance over the coming years.
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Why do I think so? First, we are undergoing a massive shift of workforce demographics. Baby boomers are retiring, and millennials are starting and advancing in their careers. Employers are focusing on strategies that meet and exceed the demands of these new entrants. Technology expansion We all know millennials have grown up during the largest technological expansion (i.e. the Internet) and have come to expect services and products served up to them through technology. We estimate that 50 percent of employers still enroll, track and report their benefit programs on paper or through spreadsheets. Can you imagine the impression a 20-something new hire has of his or her employer when they are handed paperwork for payroll or benefits enrollment? “Paper, what the heck is this?” So there is — and will continue to be — a huge emphasis on technology expansion to serve the workforce over the next 10 years, and guess what is fueling this expansion? You guessed it, capital. Capital counts too USA Today Tech recently quoted Ahmed Albati, founder and CEO of Medullan, a digital health innovation lab in Boston, saying that more than $2 billion was invested in digital health startups in 2014. In the same piece, McKinsey said it has found “more than 2,000 startups with the key words ‘digital health’ and ‘new health care technologies.’” These amounts are on top of the current $3.8 trillion in U.S. health care spending. In the exchange space, let’s consider the $400 million that Aetna spent on bswift, and Towers Watson spending in excess of $775 million for its acquisitions of ExtendHealth, Liazon and Acclaris — in addition to its new $8.7 billion merger deal with
former rival Willis Group Holdings. There are more examples, but you get the point. Government regulation spurs market developments Another element pointing toward exchange expansion is government regulation, namely the ACA. Now that the Supreme Court has ruled in favor of the federal exchanges in King v. Burwell, it’s safe to say the ACA is here to stay. Government regulation (or deregulation) always spurs market developments to meet these requirements. Think about the expansion of the health care system, including hospitals, technologies, providers, etc., in the 47 years since the passage of Medicare. What Medicare and then Medicaid did to the post-65 and lower income/limited resource populations will increase with the expansion of health care to the pre-65/ working populations. Employers are now focused on making at least good faith efforts to comply with ACA reporting requirements, as well as embracing strategies to avoid payment of excise taxes. The excise tax conversation will be robust and morph into the 2016 election cycle, challenging everything from the current tax code to repealing the excise tax. But given our federal budget deficits and that the recent trade bill that doubled the penalties for ACA reporting noncompliance, I don’t think excise tax repeal is in the cards. This will fuel the exchange conversation, since a marketplace filled with choice is an efficient method of costshifting. To read the rest of Mike’s reflections on the private exchange market, visit The Private Exchange Blog at PrivateHealthCareEXCHANGES.com.
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While the “one-size-fits-all” mantra of benefits continues to dissipate, carrier-owned exchange solutions will be in the advantageous position of offering plan designs, products and networks to best accommodate the changing demands of the market.
The New Enrollment Experience Traditional enrollment scenarios often leave consumers on their own — or with help of HR administrators — to select benefits which can be both difficult and time-consuming. Blue Directions engages members before enrollment begins and throughout the enrollment process to help members make the right decisions for them and their family. Engagement includes: Pre-Enrollment Education – The Blue Directions Member Site is available prior to enrollment, so consumers can see the plans available, how they compare, the enrollment experience and how to take the next steps. Online Decision Support – Once enrollment begins, members can access an online survey that matches them with plans based on coverage needs, risk adversity and their budget. The simple survey creates a personalized profile to find “great match” plans. Advisor Call Center – The Blue Directions Advisor Line is staffed by licensed agents who are available for enrollment questions, benefit inquiries or to consumers who prefer to enroll over the phone. Price Transparency – Members will understand exactly how much their employer is contributing toward coverage and exactly how much they will pay out of pocket. Contributions vary on a plan-by-plan basis.
Moving to a High-Performing Environment As members have enrolled through Blue Directions, we have seen a large segment of members migrate into consumer-driven health plans — plans with typically higher deductibles. Nearly 50 percent of members have elected CDHPs, with 74 percent of those members also opening a tax-advantaged savings account during enrollment4. While an increase in CDHP enrollment is encouraging, we also recognize the importance of providing members with support to ensure that they make good benefit decisions throughout the year and not just during enrollment. HCSC leverages our market-leading experience to help move members into a high-performing environment where they can both maximize their benefits and reduce their total costs. Blue Edge, our portfolio of CDHPs, have demonstrated true behavioral change in consumer spend after switching from a traditional plan. The most recent analysis of BCBS claims experience show reduction in total spending and an increase in preventive services for members switching to these plans. In the first year following a switch from a more traditional plan, Blue Edge plans reduced per member per year (PMPY) spend by 9.7 percent. And in the subsequent three year period, they reduced PMPY by 11.8 percent overall, accounting for an average of $443 in cost reduction5. While lowering spend elsewhere, members showed a tendency to maintain or improve their use of preventive care services and routine visits. Over three years, Blue Edge members showed a 14 percent reduction in professional services, 5.1 percent reduction in outpatient services and a 23.5 percent reduction of inpatient services in terms of PMPY. This cost reduction has been accomplished by providing Blue Edge members with tools and services to empower them to make better health care decisions. Blue Directions incorporates these programs to ensure the members have the resources they need to be good health care consumers and healthy employees. These programs are traditionally buy-up options that have been incorporated into the Blue Directions program because of
their demonstrated return on investment. For 2016, members will have access to: Blue Care Connection with Primary Nurse – Enhanced medical management program that leverages a multi-disciplinary team to create a member-centered advocacy program. Primary Nurse realized $200 average cost avoidance PMPY6. Integrated Provider Finder – An interactive network tool that compares providers by location, cost, quality, member reviews and wait time through data based on 20,000+ health care facilities and 400,000+ professional providers in the BCBS network7. Benefits Value Advisor – Cost transparency service that provides comprehensive per incident pricing (from admission to discharge) and includes over 300 procedures. Costs are based on claims data from 30 million members and 958,400 providers8. Awareness campaigns based around the availability and advantages of these programs will be communicated to Blue Directions throughout the benefit year. These programs and communications are not limited to Blue Edge plans either as they are available to all members enrolled through Blue Directions. Outside of the tools and programs we have highlighted, Blue Directions maintains the distinct advantage of being Blue – with the ability to leverage our strong local networks and our partnerships with the provider community. The next generation of Blue Directions will be based around valuebased care, transparency tools and high-performing networks that will continue to address the rising costs of health care. Network strength and network experience will be pivotal in controlling costs while advancing our member-centric approach.
Embracing the New Experience Private exchange technology has increased transparency during enrollment and increased choices for members, but it is the integration of transparency tools, carrier-driven medical management programs and strategic product offerings that will ultimately mitigate the true costs of health care. Blue Directions offers an exciting opportunity to create a comprehensive experience for health care consumerism by combining the value of BCBS with 21st century technology — delivering quality care through an individual, consumer and member-centric lens. Blue Directions for Large Business is available for employers with 101+ employees in Illinois, Montana, New Mexico, Oklahoma and Texas. Learn more at bcbsil.com/blue-directions. Private Exchange Evaluation Collaborative (PPEC): Private Exchange Employer Survey Findings. December 2014. 2 Accenture: “Private Health Insurance Exchange Enrollment Doubled from 2014 to 2015 According to Accenture Analysis” April 2015. 3 HCSC Internal Analysis: 2015 Blue Directions book-of-business enrollment statistics 4 HCSC Internal Analysis: 2015 Blue Directions book-of-business enrollment statistics 5 HCSC Internal Analysis: 2013 Internal Study for consumer-driven health plans 6 HCSC Internal Analysis: 2014 BCBS National Account Case Study of 8,200 members over two year period (2012-2013). 7 BlueCard Program data for all Blue Cross and Blue Shield plans 8 HCSC Internal Analysis: Based on HCSC 2013 book-of-business 1
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Over Over Over 17 1717 million million million Americans Americans Americans fund fund fund their their their health health health care care care needs needs needs through through through HSAs. HSAs. HSAs. Let’s keep that number growing. Let’s Let’s keep keep that that number number growing. growing. The The ABA ABA HSA HSA Council Council brings brings together together banks, banks, insurers insurers and and technology technology The ABA HSA Council brings together banks, insurers and technology leaders leaders to to drive to drive policies policies that that protect, protect, preserve preserve and and expand expand banks’ banks’ ability ability leaders drive policies that protect, preserve and expand banks’ ability to to offer to offer HSAs. HSAs. NoNo other No other advocacy advocacy group group in in the in country the country is is dedicated is dedicated offer HSAs. other advocacy group the country dedicated solely solely to to supporting to supporting thethe use the of use HSAs of HSAs through through banks. banks. solely supporting use of HSAs through banks.
Find Find outout more out more Find more aba.com/HSACouncil aba.com/HSACouncil aba.com/HSACouncil
HSA HSA HSA Council Council Council
BY SETH RAVINE CHIEF REVENUE OFFICER ACCLARIS
ACCOUNT-BASED PLANS
The Three A’s Force a Shift in Consumer Engagement
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he consumer-directed health care — thinking about how they Today’s consumers need more from care movement demands that spend their money and from consumers take on the three health plans and employers than ever before which accounts. However, health A’s — awareness, accountability plans and employers should be and active involvement — when helping consumers understand — more access, education, transparency, it comes to health care decisions the ins and outs — whether it support, urgency … more everything. and spending. However, to help comes in the form of quarterly consumers tackle this immense lunch-and-learns, mobile/text We are entering the era of engagement. transition, health plans and alerts, reminder emails or a wellemployers need to properly timed mix of all channels. engage consumers so they can Effective engagement better understand the financial happens at the moment when impact of their health care choices. consumers are ready to take action and need advice most — picking a Consumers now get rewarded (or penalized) for the lifestyle doctor, buying a prescription or selecting a payment option. Getting and health choices they make, and the new health care dynamic has consumers to participate in a two-way conversation and embrace their shifted more responsibility to the consumer. Therefore, consumers role in the next era of health care will lead to smarter health care are demanding changes in how health plans and employers provide decisions, lifestyle choices and spending/payment habits. consumer education as well. 3. Active Involvement: While instilling confidence is a critical Today’s consumers need more from health plans and employers component of the new consumer engagement imperative, than ever before — more access, education, transparency, support, employers and health plans must also meet higher expectations urgency … more everything. We are entering the era of engagement. for exemplary service and continuous support. Consumers want to make sure that they have what they need to make informed 1. Awareness: Health care is full of the unexpected, which makes decisions, but to do so they need easy-to-use financial tools, consumers even more apprehensive about their new responsibility. educational resources and full visibility into spending and Even the most informed decision could quickly become the reimbursement. Education cannot be a once-and-done activity or wrong one due to an accident or startling test result. Adding to a quick item to check off the list every year during the enrollment the uncertainty, consumers are also trying to make sense of more period; consumers need ongoing guidance as they try to shoulder plan options, rising deductibles and a seemingly endless list of this new responsibility and make continuous smart decisions. spending account and reimbursement account options. While consumers of decades past primarily entrusted Thanks to the market shifts, employers are taking on a new role employers to make sound health care coverage/spending — stepping beyond simply being the provider of the benefit. The way decisions, today’s consumers are realizing that they need more people want to learn and how and who they expect to provide educational educational tools to make sure they understand their benefits. resources continues to evolve. Health plans and employers should proactively alert consumers Based on a recent Acclaris report, more than half of the 300+ health when major events serve as a change catalyst, provide competitive care industry professionals surveyed think that employers are responsible report cards based on their peers and, most importantly, provide for educating consumers about consumer-driven health plans. Even educational resources at every step in their health care journey. more telling, the report found that employers that want to educate 2. Accountability: As consumers become more financially consumers should forego social media and focus on communication accountable, health plans and employers must help them optimize channels like email, online help and benefits portals. The health care health care spend. The new consumer-directed health care industry needs to collectively embrace engagement. This means giving dynamic makes consumers accountable for changing their own consumers the tools they need to quickly make smart health care (and behavior. They need to internalize the banking basics for health financial) decisions on an ongoing basis.
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VOLUNTARY BENEFITS
BY TYE ELLIOTT VICE PRESIDENT OF BROKER STRATEGY AFLAC
Open Enrollment and Millennial Workers: The Focus is on Financial Independence
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illennial workers take it to reach an investment goal When communicating with millennials about need on the chin when it comes of $250,000 or $500,000 in assets to the public’s perception voluntary benefits options, employers should before they can start withdrawing of their job habits. The buzz is three to four percent, because along that they’re job hoppers who want keep their fragile financial circumstances — with other income streams this is immediate rewards and rapid enough to cover their expenses each and eagerness to save — in mind. promotions for little effort. year for life.�3 The truth? Most of today’s younger workers aren’t lacking in The Right Communication motivation or work ethics. They simply joined the workforce in a period Given that millennials are both financially strapped and eager to of economic strife and adjusted their nine-to-five habits to fit the times. achieve financial independence, where do health insurance benefits fit For example, millennials know from experience that it’s hard to find a job in? — and even harder to find a job that’s right for the long term. They’re also Millennials’ often-crushing debt loads, combined with their less loyal and trusting of employers than previous generations, perhaps commitment to enjoy life, make many young workers hesitant to enroll because they’ve seen their long-tenured parents laid off by companies in in benefits that shrink their paychecks. That’s evidenced by the fact that the name of cost cutting and downsizing. millennials comprise our nation’s most underinsured generation: 24 Here’s one thing employers should keep in mind when communicating percent of Americans ages 18 to 29 don’t have health insurance. It’s not with millennials: Unlike their more nose-to-the-grindstone parents, just health insurance they’re rejecting, because millennials are the least they’ve decided life is meant to be enjoyed. According to a report from likely of any age group to have any type of insurance, including life, auto, Mindshare, 72 percent believe life is too short to be uptight, and 71 renters, homeowners and disability coverage.4 percent consider having fun a core part of their lives.1 When communicating with millennials about voluntary benefits Still, despite their dedication to good times, millennials’ lives are options, employers should keep their fragile financial circumstances — often clouded by financial responsibilities. According to a Wells Fargo and eagerness to save — in mind. That’s because millennials might be survey, 40 percent describe their debt as overwhelming, compared to 23 the generation least equipped to cope with the out-of-pocket expenses percent of baby boomers. When asked to quantify debt as a percentage that accompany an unexpected accident or illness. In fact, the 2015 of their monthly pay, millennials broke down their financial burdens this Aflac WorkForces Report found that despite their intentions to save, 66 way: credit card debt, 16 percent; mortgage debt, 15 percent; student percent of millennials have $1,000 or less on hand to pay out-of-pocket loan debt, 12 percent; auto debt, nine percent; and medical debt, five medical expenses, and 72 percent would not be able to adjust to the percent. What’s more, 47 percent of millennials devote 50 percent — or financial costs associated with a serious injury or illness.5 more — of their paychecks to ongoing payments.2 For this reason, voluntary insurance is something most millennials may not want to go without. Employers should stress that a serious Financial Independence, Not Retirement accident or illness might not only endanger their present financial Today’s companies often miss the mark when advising millennials security; it might also endanger their long-term goals for financial about open enrollment strategies. Much of their communication focuses independence. They should also emphasize the value of life insurance. on setting aside funds for retirement, which is a key issue for baby This is especially important for those with families who depend on their boomers. However, millennials are less interested in planning for income or who share the responsibility of debts, including college loans, retirement than in planning for financial independence. with a co-signer. Unlike their parents and grandparents who intend to retire in The bottom line? By emphasizing financial independence their 60s, many millennials would like to say goodbye to conventional over retirement and stressing the role of health insurance benefits employment as quickly as possible. In fact, some are willing to work side in achieving that independence, employers will strike a chord with jobs or even to invest 50 percent or more of their income to do so. millennials, increasing their interest in open enrollment and their As Alan Moore, co-founder of the XY Planning Network, wrote in benefits engagement. a recent issue of Money magazine, millennials “don’t need $1 million to $3 million in the bank when they’re 63 years old. Instead, they may To see the footnotes, read the online version at theihcc.com.
34 Third Quarter 2015 * XXX 5IF*)$$ DPN * HealthCare Consumerism Solutions™
BY LUCAS COFFEEN SENIOR PRODUCT MANAGER SHAPEUP
HEALTH INCENTIVES
Taking a Strategic Approach to Incentives
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n the past few years, employers have learned a lot about the best (and focus on activities and behaviors rather than outcomes; habits lead longworst) ways to deliver wellness programs that improve employee term behavior change, while outcomes are temporary. health, productivity, satisfaction and retention. Using wellness Next, it’s important to understand the role of social rewards. incentives to drive program adoption and ongoing engagement has been Things like public recognition, badges, awards for top-performers and a very popular technique, but it can be tricky. There is a fine line between social feedback loops tap into intrinsic motivation, leading to longenabling a sustained, new habit and throwing payments at employees term wellness engagement. Increasingly, the value of social incentives with little lasting impact. is also being recognized and leveraged. Peer-reviewed research studies To drive positive employee behavior change, organizations must have validated the impact of social incentives, proving their ability use two kinds of motivators: intrinsic and extrinsic. Intrinsic motivators drive clinically-significant results both when coupled with modest are those that come from within, like the desire to feel healthier or to financial rewards and on their own. At ShapeUp, we see the power lose weight. Extrinsic motivators are of social incentives at work every day external, like monetary rewards for through team accountability, peer-toAs you design your incentive meeting certain goals or participating peer motivation and social recognition in particular programs. program, consider how complex your while employees strive for and meet their While extrinsic incentives act like health and wellness goals. a spark that create a powerful burst of The third thing to consider is rewards criteria are. If it’s confusing activity, intrinsic motivators are like behavioral economics. This field of to figure out how to earn a reward or study combines tenets of psychology slow-burning coal, fueling a sustained fire. Meanwhile, financial penalties are and economics to understand how and avoid a penalty, the success of your often deployed to encourage certain why people make choices. Behavioral behaviors, but they come with their economics research has highlighted the overall design will suffer. own risk to employee participation necessity of simplicity when rewarding and trust. The key is to use targeted behaviors, a concept called “cognitive extrinsic rewards sparingly, like a load.” The higher the complexity — or starter flame to ignite the ongoing cognitive load — of a behavior, the less intrinsic incentives, and to use penalties judiciously. This approach likely an incentive will work. For example, losing weight is a high may sound complicated, but there are four questions that will inform cognitive load outcome; it’s hard to know how to start losing weight! incentives design: Thus it’s unlikely that a reward for weight loss will be very effective. • What is the value of the carrot versus the stick? Instead, choose an action that can lead to weight loss, like exercising • What is the impact of social rewards? 90 minutes a week. This action is very straight forward; it has a low • How can I apply behavioral economics? cognitive load — and is ripe for a wellness reward. As you design your • What are my employees’ mindsets? incentive program, consider how complex your rewards criteria are. If it’s confusing to figure out how to earn a reward or avoid a penalty, the First, consider the value of the carrot (reward) versus the stick success of your overall design will suffer. (penalty). ShapeUp has studied incentives, and our research has shown Finally, it’s important to inhabit your employees’ mindset. By that bigger rewards do not necessarily deliver bigger results. Instead, understanding the motivations of separate segments of your population, there is a diminishing return on engagement as an incentive value grows. you’ll be better prepared to design rewards that are meaningful and That’s good news: you don’t need to break the bank on rewards. In fact, therefore motivating. Though there are many nuances to creating a a reward value of $50-$99 is the most effective amount per employee successful incentive program, having a strong understanding of your per year. employee base will help mitigate some of the guess work and testing. As reward amounts normalize in the $50-$99 range, there is a Some cultures are more inherently philanthropic and others highly growing trend of mixing rewards with penalties. Towers Watson’s 2014 competitive or financially driven. What’s your employee culture like? Staying@Work Survey found that the use of penalties in wellness What gets them going? Understanding these answers will go a long way programs will nearly double in 2015-2016, from 36 to 61 percent. At the in informing your strategy. Take a holistic view and allocate resources same time, the use of financial rewards will continue to climb from 80 to drive desired actions with financial incentives, coupled with social to 89 percent. When using rewards and penalties alike, it’s important to incentives that foster sustainable improvements over time.
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Consumerism, Telemedicine and the Internet of Things BY STEVEN R. GERST, MD, MBA, MPH, CHE
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y 2020, the Internet of Things is expected to support 212 billion connected devices representing an $8.9 trillion market1. Goldman Sachs reported this digital health revolution and the Internet of Things (IoT) could result in nearly $305 billion in industry savings by increasing the use of telemedicine, remote patient monitoring and consequent behavioral modification2. Over $200 billion of these savings may come from remote chronic care management of diseases such as heart disease, COPD, asthma and diabetes by leveraging telemedicine technology into the home, assisted living, elder care and long-term care facilities. About half of all American adults (roughly 117 million people) have some form of chronic disease3 for which this new technology could be used. At the recent, successful IHC FORUM & Expo conference in Atlanta, Teladoc reported generating an estimated savings of $1,157 per patient per year or $21 per member per month for payers from their telehealth services — noting that they had just achieved one million annual virtual visits with an expectation of doubling that number in the next year. Teladoc then went public a few days later, raising $157 million in their IPO4. As video consultation services to grow from 19.7 million in 2014 to an expected 158.4 million by 2020, Goldman estimates this connected device digital health market for telemedicine/telehealth may generate revenues close to $32.4 billion in the next few years.5 Current and developing home and hospital sensor technology, telemedicine and patient/provider portals all networking together will allow physicians, patients and hospitals to swap HIPAA-secured information daily, monitoring patients at home and in assisted-living facilities much more cost effectively than today.
The new Fast Healthcare Interoperability Resource (FHIR) protocols being developed by Epic — the multi-billion dollar electronic medical record (EMR) company — for Cerner, Orion and their new Epic App Store6 will allow patients and caretakers to download applications directly to smartphones and tablets to create direct patient portals, populating their medical records and creating comprehensive, transportable, interoperable medical record systems. This will allow consumer devices from the Internet of Things to populate electronic medical records directly and create comprehensive, portable records under consumers control to reach unprecedented levels. This increased access to consumer friendly, convenient, cost-effective health services can ultimately reduce overall health system expenditures, preventing medically unnecessary costly emergency room visits for primary care issues and hospitalizations by early diagnosis and triage. By dramatically improving access to care for both rural and urban settings, the Internet of Things, combined with consumer-based telemedicine, will reduce work and school absences and increase economic productivity for our society. In addition, consumer-based companies like Validic, which provides cloud-based connected device services for over 160 million people in 47 countries, will allow consumer-oriented medical devices to connect through their systems to providers throughout the world. These are permission-based systems for the consumer, which are often paid for — or sponsored by — payers to allow providers to access critical data that can be used for telemedicine/ telehealth visits. Driven to bridge the digital health divide, these systems are designed to connect the entire digital health ecosystem, including hospital systems, providers, payers, wellness companies, health information technology (HIT) platforms and pharmaceutical companies.7 HealthCare Consumerism Solutions™ I www.TheIHCC.com I Third Quarter 2015
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This will form “a new construct in the information and communications technology world.� The International Data Corporation has estimated IoT technology and services spending at $4.8 trillion in 2012, projected to grow to $7.3 trillion with a compound annual growth rate of 8.8 percent8.
M2M Consumer-Driven Technologies Create the Internet of Things Known as machine-to-machine technology (or M2M), the Internet of Things will consist primarily of machines talking to one another with computer-connected humans observing, analyzing and acting upon the resulting Big Data explosion. This next disruptive development, in which the majority of Internet traffic will be generated by devices communicating rather than by human-operated computers, has the potential to change it even more. Microprocessors are currently embedded in many of our current consumer devices from cars and HSA credit cards to all kinds of medical device technologies able to sense and transport data throughout an evolving health care system. For telemedicine, this means providing physicians with vital sign and diagnostic data from the home directly via secure, HIPPA compliant portals to telemedicine companies for virtual physician visits. The data that can and will be collected by existing devices includes heart rate (pulse), blood pressure, pulse oximetry (blood oxygen saturation), EKG or rhythm strips, temperature, respiratory rate, blood glucose and weight. Much of this will be wireless. When one adds camera technology in high definition, then the patient can take pictures of their own skin for post-surgical wound care, nevi (for melanoma) and other skin diseases, perhaps their throat and tympanic membrane (ear drum) for virtual telemedicine pediatric and adult visits, 38 Third Quarter 2015 * XXX 5IF*)$$ DPN * HealthCare Consumerism Solutions™
as well of a host of other conditions. Some technologies allow for fundascopic exam of the eye as well. Once the picture is taken and transmitted to the physician prior to a virtual telemedicine visit, the physician may be able to refocus the image in different ways to look for infection in the throat, otitis media in the ear, cancers on the skin and a variety of other ailments which can be diagnosed via telemedicine. IntelŽ’s new RealSense 3D camera may have health retro-focus applications in this arena that haven’t yet been explored9. Ultimately, intelligent systems and clinical decision support such as IBM’s Watson may be built into the telehealth workflow to aide in computer-assisted diagnosis at the consumer level, triaging patients from the home, providing much needed primary care extenders through technology for routine conditions without requiring consumers to take time off from work, travel or require expensive home nursing visits. As the population ages, leveraging this technology for home care and assisted-living situations may become a ubiquitous and cost-effective approach to helping solve the ever increasing physician shortage throughout the nation and in rural areas in particular. These M2M communications fundamentally differ from the classic human-to-human (H2H) Internet communications. Device-todevice communications will feature more nodes by orders of magnitude than H2H. Most of these are and will be low-bandwidth, upload-biased traffic with extremely low-power or self-powered (e.g. solar powered) devices. These applications will deliver and process information in real time or near-real-time. For short-range or local area, wireless technologies — RFID, NFC, Wi-Fi, Bluetooth (including Bluetooth Low Energy), XBee, Zigbee, Z-Wave and Wireless M-Bus — and wired links — such as Ethernet, HomePlug, HomePNA, HomeGrid/G.hn and LonWorks — are currently
available. For longer range, wide-area links there existing mobile networks currently use GSM, GPRS, 3G, LTE or WiMAX and satellite connections. New wireless networks, such as the ultra-narrowband SIGFOX and the TV whitespace NeulNET 10 and the new IntelŽ Atom™ x3 Processor Series with a low-cost SoC with 64-bit processor cores and integrated cellular baseband modem for smart or feature phones, phablets and tablets available in 4G LTE and 3G version11, along with their Quark and Curie™ modules for wearable technology solutions, are emerging to cater specifically for M2M connectivity. In addition to the terms telehealth and telemedicine, these systems fall under the general category of e- and assisted living. Hospitalized patients with non-life-threatening conditions can be issued these devices by the hospital or payer and be monitored remotely by medical staff. In many cases, patients can be shown how to interpret the data themselves or send it to their telemedicine provider to free up hospital beds and physicians’ time for more urgent cases. Consumer-oriented sensors, many of which are already in the market, can encourage people to adopt healthier lifestyles, reducing health care costs and reducing the number of physical doctor visits and hospitalizations necessary. For accountable care organizations, this could offer tremendous savings and a new, more efficient consumer-facing health care ecosystem. Dr. Steven Gerst is a graduate of the Columbia University College of Physicians and Surgeons (MD), Columbia College (BA), Columbia School of Public Health – Health Administration (MPH) and the Goizuetta School of Business at Emory University (MBA). He is a diplomat in the American College of Healthcare Executives and also dean emeritus of the Masters of Science Program in Applied Health Informatics at Bryan University where he serves on the Board of Advisors and has taught on the faculty. Dr. Gerst is currently at the University of Miami’s Miller School of Medicine in the Office of the Chief Innovation Officer and Vice Provost as an entrepreneur–in-residence.
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Cost Transparency and Consumer Health Insurance Preferences
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BY ROBIN GELBURD ÂŤ PRESIDENT ÂŤ FAIR HEALTH
s the U.S. health care system undergoes significant change, consumers must adapt by taking greater responsibility for their health care decisions, including choosing health insurance plans and managing medical expenses. A 2015 survey sponsored by FAIR Health, a national nonprofit organization dedicated to advancing transparency in health care costs and providing educational material on health insurance coverage, sheds light on the need for individuals to gain a better understanding of their health insurance benefits and their out-of-pocket expenses for health care services. The survey of U.S. consumers spans five main areas: individuals’ use of emergency department (ED) services for non-emergent care; their use of online tools for selecting a health plan; their selection of physicians; comparison shopping for health care; and their experience with medical bills. The survey’s results provide insights that can help to inform consumer education and engagement strategies. A detailed report analyzing the survey’s findings, “Understanding Consumer Health Insurance Preferences,â€? is available for download on FAIR Health’s website 40 Third Quarter 2015 * XXX 5IF*)$$ DPN * HealthCare Consumerism Solutions™
Emergency Department Utilization Because EDs are especially equipped to treat complex, acute and potentially life-threatening conditions and injuries, care received in that setting is typically far more costly than care administered in a physician’s office or an urgent care center. For this reason, some insurance plans require patients to pay the entire bill if they seek ED treatment for routine illnesses. Nonetheless, the FAIR Health national survey and report found that approximately 21 percent of the survey respondents said they would go to the ED for a non-emergent situation. And, some groups were far more likely than the population as a whole to visit the ED for a non-emergency illness: • 39 percent of Latinos; • 33 percent of African-Americans (nonLatino); • 32 percent of individuals with household income of less than $35,000 a year; and • 31 percent of consumers with a high school graduate education or less. The routine use of EDs decreased as consumers’ levels of education and household income increased. The groups that indicated they were least likely to use the ED for nonemergency care were college graduates and those with household incomes of $75,000 or higher.
Selecting a Health Plan The FAIR Health survey showed that when enrolling in a health plan, individuals under age 45 ranked premium costs as their most important consideration. However, consumers ages 45 and older identified their relationship with their primary care physician as a higher priority. While the primary care relationship was not the top concern for all age groups, it ranked high across all generations. Few people, regardless of ethnicity, household income or age, ranked the size of their plan’s network as a top concern. Nonetheless, it is noteworthy that people with household incomes of $100,000 or higher were twice as likely as those with incomes under $35,000 to say that the number of doctors in their network was their top concern when signing up for health insurance. Notably, consumers in all groups did rate as important the ability to continue to see their present primary care physician on an in-network basis.
Choosing a Doctor FAIR Health asked consumers how they factor costs into their decision when selecting a doctor. There were significant differences along demographic lines, including:
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A majority of Latinos (63 percent) said they usually or always consider cost, versus 48 percent of the general population. More than half (56 percent) of consumers with children in their household said they usually or always consider cost, versus 45 percent of respondents without children at home. Most respondents (60 percent) with annual household incomes under $35,000 said they always or usually consider cost, versus 48 percent of the general population.
Experience with Medical Bills Half of those surveyed report that they have experienced higher-than-expected out-of-pocket medical costs. A third of the respondents felt that costs were much higher than anticipated. To help consumers understand health care costs, New York State recently enacted a law providing some of the nation’s most comprehensive health care cost transparency protections. This new law is intended, in part, to help consumers avoid surprise medical bills — defined as bills received from an out-ofnetwork provider who the patient reasonably believed was in-network and consequently would be charging the lower, in-network fees. Other states — including Texas, California, New Jersey, Connecticut, Oregon and Colorado — are considering legislative proposals to address similar consumer concerns. It will be interesting to see if the percentage of people reporting medical bills that are much higher than expected begins to decrease over the next few years as these consumer protections become more widespread.
Comparison Shopping for Health Care Based on the survey, nearly 75 percent of millennials (ages 18-34) said they comparison shop online for financial services, groceries, automobiles, consumer electronics or medical or dental services. By contrast, 57 percent of respondents ages 35 to 44, 54 percent of consumers ages 55 to 64, and 35 percent of those ages 65 and over said that they use a mobile device or computer to check prices or comparison shop in one of the specified categories. Despite millennials’ reputation for online use and technological expertise, the survey shows that there is no statistically significant difference between millennials (19 percent) and the overall adult population (15 percent) when it comes to comparison shopping online for medical and dental services.
Millennials — avid Internet shoppers — are relatively healthy due to their youth. As they age and require more complex health care, however, it is likely that they will make greater use of their technical expertise to comparison shop and save money on health care.
Working toward Solutions The survey underscores the need to provide consumers with better and more understandable information about their health care options. Informed selection and careful use of health care services will not only help individual consumers control their health care expenses, it also will support the effectiveness and efficiency of the national health care sector to the benefit of all. Efforts to help individuals better understand and manage their increasing responsibilities for cost-sharing under their health benefit plans are already underway. Government agencies, legislators and nonprofit and community organizations are promoting consumer cost awareness. In addition, some unions and employers, who frequently bear the financial ramifications of their members’ and employees’ health care decisions, offer instruction and resources to improve consumer understanding and decision-making. But, there is still more to do. Consumers need comprehensible educational resources and reliable cost-estimation tools to help them evaluate the cost-sharing implications of plans available to them and the out-of-pocket cost consequences of their choices. FAIR Health, a nonprofit company founded to serve as an independent source of transparent, reliable and objective health care cost information, offers free, award-winning consumer resources. FAIR Health’s treatment cost estimation tools, fueled by the nation’s largest collection of privately billed medical and dental claims, as well as its health care literacy resources in English and Spanish, are available at fairhealthconsumer.org and consumidor. fairhealth.org, respectively. The sites feature videos and articles that help consumers to understand the out-ofpocket obligations for premiums, deductibles and copays or other cost-sharing rules of different health insurance choices and assist them in selecting the plan options that best meet their needs About the Survey: Commissioned by FAIR Health, the survey was conducted March 5-8, 2015 by ORC International’s Telephone CARAVAN®. The study used two probability samples: randomly selected landline and randomly selected mobile phone numbers. The combined sample consisted of 1, 011 U.S.-based adults. The margin of error was +/- 3.08% at the 95% confidence level. Robin Gelburd is the founding president of FAIR Health, an independent nonprofit with the mission of bringing transparency to medical and dental costs and insurance information.
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BY CARRIE GREENE GENERAL MANAGER INTERACTIVE HEALTH
WELLNESS
How to Make Workplace Wellness Another Form of Entertainment — and Gain Employee Engagement
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here is much good news to report in the world of employee wellbeing. To begin, more and more workplaces incorporate wellness programs. According to the recent PricewaterhouseCoopers’ 2015 Health and Well-being Touchstone Survey, just under three-fourths of companies offer some kind of wellness program. Further, SHRM reports in its 2015 Employee Benefits Survey that another eight percent of companies plan to offer wellness programs in the next 12 months. Employers clearly recognize that healthy employees help reduce costs, grow output, improve culture, increase retention and more. As Allen Buechel, the county executive for Fond du Lac County in Wisconsin, has said about the effects of their wellness program: “Better health positively affects absenteeism and productivity.” It’s now time to increase focus on the next stages of workplace wellness: participation and engagement. These are related but different goals. Participation means employees sign up for the wellness benefits their employers provide. Engagement means employees actively take advantage of the programs and offerings – to take active control of their health. Engagement is where the “wellness rubber” meets the “healthier outcomes road.” Engagement is tough, because it means changing behavior – eating healthier, walking instead of driving, standing instead of sitting and more. It also can mean exercising, which is hard to start and hard to maintain. But an important trend is emerging (or should we say, reemerging) in workplace wellness engagement — entertainment. Here’s what I mean: We all do what we enjoy. We need to find and implement creative ways to connect personal enjoyment with workplace wellness activities. We need to make wellness a type of entertainment — something fun to do that fits with people’s interests. I know this approach can work, because I’ve seen it in action. The key is to think like any other kind of retail business: By paying attention to your “customers” (in this case, your employees). I first saw this work several years ago in a program we ran for a hospital in an urban area. The employer was dedicated not only to improving patients’ health (of course), but also their employees’ health. They were, and remain, ahead of their time. One of their key offerings was a kickboxing aerobics class. It was a big effort — music, instructors and equipment in a gym that could hold their anticipated 100 participants.
And yet when it launched, only 15 employees showed up. And given the ethnic mix of the employee base, it was clear that the class was a miss. None of the participants represented the ethnic minorities that comprised a majority of the employee population. So we did what any good consumer product would do. We rebuilt and re-branded. We asked ourselves: Where do our “customers” — the employees — find entertainment? And how can we integrate that into the exercise? Within weeks, our kickboxing aerobics class had transformed into “gospel aerobics”. The instructors changed the music, introduced dancing and movement and re-marketed the class. Soon, we had nearly 60 employees participating regularly. Importantly, they represented a full cross-section of the employee base. The approach has worked in other situations: • With one defense industry employer who offered a terrific day care program, we added a wellness class for parents to attend inside the day care facility. We held it just before pick-up time and integrated parenting tips with the wellness information. We even included tips for how to get your kids to eat healthier. The class was a hit. • Golf is another big draw. We’ve used the game to engage executives into supporting their own wellness programs. At one business strategy consulting firm, we introduced a “golf for beginners” program that mixed wellness and golf instruction. The key in any of these efforts is to identify the wellness elements that need to be employed (health information, eating tips, exercises, etc.) and the entertainment that will attract the masses. Then integrate. Host the activity and mix in some of the wellness. Or lead with the wellness and integrate some of the entertainment. Time after time, we’ve found that starting small — finding the enjoyable way to launch employee engagement — invariably leads to increased and consistent engagement over the long run. Above all, remember the old line from show business: Keep ‘em entertained, and they’ll keep coming back. Carrie Greene is general manager of Interactive Health, the leading provider of flexible health management solutions designed to increase overall company health and actively engage employees to make lasting behavior changes.
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DIGITAL HEALTH
BY ALEXIS NORMAND DIRECTOR OF HEALTHCARE DEVELOPMENT WITHINGS
Disrupting Workplace Wellness with Wearables
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romoting healthy lifestyles for employees has been an important priority for human resource managers in the past ten years. As the prevalence of obesity and hypertension have risen to epidemic levels in the U.S., companies have begun to feel the financial burden of the sedentary lifestyle. Did you know that nearly $153 billion are lost each year due to a lack of productivity caused by chronic health conditions?1. Similarly, stress is believed to account for half of the 550 million sick days taken by American workers every year, according to the American Institute of Stress. The Withings Health Institute estimates that these sick days represent a deficit of nearly 80 billion dollars. Luckily, there are many opportunities within the workplace to prevent unhealthy lifestyles and associated health risk factors. Empowering employees with resources to stay healthy in the workplace is mutually beneficial for both the employee and the company, as a reduction of health hazards ultimately leads to a reduction in spending. The Center for Disease Control and Prevention has shown that over a two- to five-year period, companies with workplace wellness programs and appropriate health plans in place can yield $3 to $6 for each dollar invested, while also reducing the likelihood of employee heart attacks and strokes2. The newest players in the wellness game — smart devices — have begun to transform the health and wellness revolution entirely. The growth of sensors that allow users to access comprehensive and seamless self-tracking metrics are disrupting the health care space in a positive way. These devices allow users to track the evolution of your activity, sleep and weight at an affordable cost to wellness programs. The ease of access to extensive data and seamless share-ability with doctors, not only improves the doctor-patient relationship, but also facilitates self-management of chronic conditions. One of the most remarkable things about mHealth is that it is taking root first in corporations — not in hospitals. To this end, companies are seeing the importance of preventative medical methods and have taken strides toward becoming progressively responsible for employee health. The smart device workplace wellness revolution not only adds an exciting new gamification experience, but also allows for extensive data and insights regarding the success of the programs. For instance, a sixweek Corporate Wellness 360∞ program organized by Withings at MIT in 2014 resulted in a 14 percent increase in daily steps on average. Even less active participants — i.e., those who walked less than 5000 steps a day before the challenge — increased their step count by an average of 58 percent. The program proved to be effective for the employees that most needed the extra motivation to get active. Trackers and data driven approaches can help customize programs to target employees who need the most help. In its 2015 Corporate Wellness 360∞ study, Withings Health Institute researchers asked more than 10,000 users to participate in an unprecedented collaborative research experiment, relating survey answers about occupations and job satisfaction
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to health metrics (i.e. number of steps, weight, body mass index, and sleep time). The study showed that people who spent most of their time behind a desk — e.g. cashiers, accountants, HR managers, IT professionals — are among the least active occupations. Nearly two-thirds of employees with desk jobs walk less than 4,000 steps per day (the average recommended number of steps is 10,000). Employees with customer-facing jobs on the other hand (real estate, retail, etc) are among the slimmest and most active employees in America. The data also linked increased physical activity levels to reduced stress levels and lower reported BMIs, findings confirmed by medical research3. Smart devices provide real-time feedback to users about their activity levels helping to set and achieve health goals. This is valuable not only for employees, but also for wellness managers who can track and positively influence large scale behavioral changes without breaking the company bank. Gone are the days when introducing mildly healthier food options or flexible hours to accommodate exercise throughout the day were sufficient enough measures as wellness programs. As smart devices wedge their way into the workplace, the case for a data-driven technological approach to health becomes much stronger. Though health appraisals and behavioral coaching can be helpful for short-term change, connected health devices and incentive based wellness programs are more successful in creating lasting behavior change. While corporate risk assessments may be successful in raising awareness about certain health topics, they lack the interactivity and playfulness of device-based programs. More importantly, the old era of wellness programs lacked the ability to track and measure program outcomes. The connected health revolution is changing the game for wellness programs. Smart devices empower users to make small changes to achieve healthier lifestyles while simultaneously incentivizing employees to walk the extra mile through algorithm-based coaching and gamifying activity and weight levels with colleagues. Through engaging apps and programs, users can spark healthy competition, share steps and weight data and inspire their peers to succeed. Connected devices and associated apps allow for effortless health assessment from doctors, early detection of health risk and more efficient risk management systems. Wearables are already disrupting the workplace. Will you join the revolution? For more information on advances in workplace wellness, check out corporate.withings. com to download studies, discover devices and see the solutions that are leading the future of corporate wellness. 1 Gallup-Healthways Well-Being 2 Reducing the Risk of Heart Disease and Stroke, Centers for Disease Control. 3 Simon C. Does the practice of a physical activity have a preventive effect on the emergence of pathologies? Conference Physical activity for preventive purposes, 2005.
TELEHEALTH
BY LENA CHENG, MD VICE PRESIDENT OF MEDICAL AFFAIRS DOCTOR ON DEMAND
What Is Next-Generation Telemedicine?
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lockbuster vs. Netflix. Flip phones vs. smartphones. Paper maps vs. GPS. Traditional banking vs. online banking. We are surrounded by products and services that helps us get the things we need and want — faster, easier and, in many cases, more cost-effective than just a few years ago. With telemedicine, we should expect no less. Telemedicine for employers has been available for over 10 years and is becoming more popular than ever. In a survey of U.S. employers with at least 1,000 employees, the strategic consulting firm Towers Watson found that 22 percent of employers offered telemedicine as a benefit to their employees in 2014; 37 percent expect to offer it in 2015; and another 34 percent are considering offering telemedicine in 2016 or 2017.1 Regardless of employee count, sector or demographics, employers understand that a telemedicine benefit can help them reduce health care costs, improve health care access and increase employee productivity and satisfaction. However, as the telemedicine industry continues to evolve, what may not be clear is what features employers should expect from a telemedicine solution. The challenges that employers have with legacy telemedicine services include laborious patient experiences, low utilization, 15-minute or longer call-back times, telephone-only visits, low levels of customer service, limited or no smartphone/tablet accessibility and security/privacy issues. Next-generation telemedicine provides employers with a vastly different experience than earlier models of telemedicine: No-risk financial model • Employers pay for services their employees utilize and find valuable — and not for per-member-per-month (PEPM), integration fees or other non-service costs. • PEPM fees force employers to assume much of the engagement risk associated with a vendor contract. • Regardless of the number of employees who use the service, the vendor collects the same PEPM fee — month after month. With low utilization, this is cost-ineffective. • However, a pay-as-you-go model places the financial risk upon the vendor and incentivizes the vendor to deliver a service that employees like — even love — to use and at high enough utilization rates to sustain the vendor’s business. • A no-PEPM model allows employers to offer the service to nonbenefit-eligible and non-benefit-enrolled employees. • Full marketing and reporting programs are included with all implementations. Excellent patient experience • Next-generation telemedicine is more intuitive, more responsive and easier to use than older models. In fact, it is as easy to use and interact with as popular consumer websites and mobile apps like Facebook, Instagram, YouTube and Pandora. • On-demand care is available with an option to schedule visits with 46 Third Quarter 2015 * XXX 5IF*)$$ DPN * HealthCare Consumerism Solutions™
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preferred providers. Call-backs are a thing of the past. A seamless patient experience will naturally lead to higher utilization of next-generation telemedicine versus legacy telemedicine services.
Advanced technology • It is developed by some of the best engineers and designers, many of whom came from leading technology companies in Silicon Valley, such as Google, Facebook, Apple and Twitter. • Telemedicine visits are conducted in high-definition video, enabling the most rich and effective provider-patient interaction. • You can access the service with nearly any smartphone, tablet or computer. • Patient privacy and security are backed by enterprise-grade encryption while not interfering with a great patient experience. Health insurance integration • The telemedicine company can work with any health insurance provider to access eligibility files, coordinate the administration of claims and track utilization for deductible and out-of-pocket maximum levels — all in real time. • Implementation takes four to six weeks. Regulatory compliance • Video is becoming an essential component for telemedicine regulatory compliance. • Increasingly, video is being recognized by organizations such as the Federation of State Medical Boards and the American Medical Association as the standard of care for telemedicine and necessary for establishing a doctor-patient relationship. • By contrast, health care and regulatory experts regard telephone, email and text as inadequate for establishing a doctor-patient relationship. High clinical standards • All providers are U.S.-trained, U.S.-licensed and, in the case of physicians, Board-certified. They also all have clean background checks and no medical malpractice issues. • Providers are screened, interviewed and hired individually to assess clinical acumen, bedside manner and fit for the telemedicine platform. • Providers are trained specifically for telemedicine, with evidencebased protocols. • Clinical quality is monitored on a regular basis through peer review of cases and random auditing by clinical staff members. To discover the remaining criteria for next-generation telemedicine, read the online version at theihcc.com. 1 Current Telemedicine Technology Could Mean Big Savings http://www.towerswatson. com/en-US/Press/2014/08/current-telemedicine-technology-could-mean-big-savings
BY RICH WILLIAMS EXECUTIVE VICE PRESIDENT ADVANCED PLAN FOR HEALTH
HEALTH DATA ANALYTICS
Focusing on High-Risk Members Reaps Greatest Reward
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mplementing a wellness plan to help your employees improve their properly addressed and even decreased on a member-by-member basis. health seems like an easy solution to help reduce a company’s rising Using this approach to analyze an employee population has an added health care costs. However, relying on members to participate in a bonus ability of predicting future risks. voluntary wellness program and hoping that health costs will decrease is An effective plan of action begins by first gathering accurate member unlikely to garner real results. A one-size-fits-all plan will work for some data using an analytics “risk engine” that allows a company to customize a of your members, but creating a tailored plan that is both strategic and plan according to highly-individualized analysis. A data analytics program results-oriented will produce a measurable reduction in health care costs. that can evaluate behavior and other non-clinical attributes produces a Getting to the root cause of a company’s rising health costs and creating predicted risk calculation with greater accuracy and certainty, regardless a plan that targets high-risk members is easier than some might think. of company size. Once properly analyzed, a customized care plan can be Often, the analysis of health insurance costs and utilization does developed and implemented which should result in fewer preventable not drill down to the individual level nor does it monitor behavioral risk. admissions, better managed chronic conditions and cost savings. Traditionally, identifying The best care plan If an organization can remove the element of uncertainty, is one that focuses on the risk is done by evaluating the most readily available most high-risk health then health care costs can be properly addressed and information: existing plan members, while still conditions, age, historiimproving the health of even decreased on a member-by-member basis. Using cal trends and how much the entire population this approach to analyze an employee population has an and the company’s certain chronic conditions have historically bottom line. By engaging added bonus ability of predicting future risks. cost the company. There the high-risk population, is nothing “wrong” about including behaviors this approach. In fact, it previously mentioned, is well-known in the industry that typical population health management and actively working with them to improve their health and reduce care solutions aim to reach the standard, most costly five to seven percent of gaps, health care costs are better managed. Every company’s care plan health plan members in a population in order to be more inclusive. should address the following questions: What this approach does not consider, however, is each member’s • Which high-risk groups should be prioritized, and why? behavior in utilizing health services. We have found that the behavior of • How can the company work with patients who have multiple the individual member is often a missing link that, once revealed, results conditions and/or barriers to proper care? in savings. The trick is to know which behaviors are actually causing the • Which members’ health goals are most critical? rise in costs in order to predict future risk and potential spikes in health • How can members be better educated about their health and care spend. their behavior choices? Behavioral analytics in health services is the risk element not factored • Perhaps most importantly, how will you measure the success into most analyses of member populations. This can include identifying of the plan? how many different providers a person is seeing, how many different providers are writing prescriptions, how many different pharmacies Without the proper tools to ask these questions, let alone answer are used by an individual and more. Combined with multiple other them, getting an efficient and effective care plan in place is much more factors, behavioral analytics identifies members who may not be properly challenging. If the risk engine software cannot monitor and integrate managed and who are visiting several providers seeking a solution. It is non-clinical or behavioral elements that allow for a customized analysis, apparent that these individuals need help managing the process through vital information will be missing from the equation and a prime savings continuity of care. opportunity will be lost. As soon as the high-risk members are identified, a dynamic care plan can be developed to support not only members with chronic conditions Rich Williams is the marketing leader for Poindexter, a risk management predictive and and those who ineffectively use the medical system, but also those who analytical software that is helping self-insured companies save millions. Poindexter can be found online at www.mypoindexter.com. Williams can be reached at richwilliams@ have a greater chance of becoming high-risk members. If an organization mypoindexter.com. can remove the element of uncertainty, then health care costs can be HealthCare Consumerism Solutions™ I www.TheIHCC.com I Third Quarter 2015
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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 the sales team at sales@theihcc.com.
Acclaris: Acclaris offers an integrated package of SaaS technology and services to support all account-based healthcare plans on a robust, private-labeled platform.
Aflac: Over 50 Million people worldwide have chosen Aflac because of our commitment to providing customers with the confidence that comes from knowing they have assistance in being prepared for whatever life may bring.
ARAG: ARAG® is a leading provider of voluntary legal insurance products and services for employers, membership groups and associations.
ConnectYourCare: ConnectYourCare provides an independent Consumer-Directed Healthcare (CDH) platform for consumers and employers.
DataPath, Inc.: DataPath creates solutions for the administration of consumer-directed healthcare benefit plans and insurance payments.
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.
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.
Benaissance: Benaissance® is the trusted financial management partner for health benefits administration.
Doctor on Demand, Inc.: Next-generation telemedicine for employers. Best technology, no PEPM, seamless implementation.
BenefitAlign: Benefitalign® is a comprehensive, cloud-based platform that enables your organization to rapidly launch shopping and enrollment solutions, including Private Exchanges, across all lines of business.
ebenefit Marketplace: Based in Connecticut, ebenefit Marketplace offers brokers nationwide the software and services to streamline benefits, HR and payroll administration through a private exchange platform.
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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.
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FAIR Health: FAIR Health is a national independent, not-for-profit corporation whose 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. EBenefits Solutions: Supporting employers with one powerful online solution that brings it all together.
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.
Own Your Healthcare
HealthExpense
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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.
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AFFILIATE MEMBER PROFILES
Access these solution providers online at www.theihcc.com. Hodges-Mace Benefits Group, Inc.: Hodges-Mace is an employee benefits technology and 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.
Interactive Health: Interactive Health provides comprehensive worksite wellness solutions that are personalized for each individual.
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.
KTP Advisors: KTP Advisors™ is a specialty advisory firm consulting in the areas of private exchange strategy and evaluations, retiree health benefits, and pharmacy benefit risk management.
Liberty Mutual: What started out as an experiment offering discounted auto & home coverage to employees over 40 years ago has become a way of business.
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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.
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.
Pricing Healthcare: Pricing Healthcare is a completely open, independent, online marketplace for direct-pay healthcare. Our data is current, searchable, and free to access from anywhere in the world.
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.
Quantum Health: Quantum Health is a care coordination and consumer navigation company.
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Maxwell Health: Maxwell Health, a fast-growing industry leader in health IT, is the first Health as a Service platform.
Renaissance Dental: It is our goal to bring quality to all we do by providing flexible, innovative plans and exceptional customer service to individuals, groups, and dentists.
Modern Emergent Care: We are Atlanta’s only ER alternative. Less wait time. Less cost. Less hassle, than hospital ER. Upscale facility with state of the art diagnostic center. CT scan, Ultrasound, X-Rays and full Lab testing.
SelectAccount: SelectAccount has been driving innovation in medical savings accounts for over 25 years.
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.
Paylogix: Paylogix® solutions facilitate benefit communication, enrollment and administration for payment processing and secure data management spanning from promotion-to-payment.
Solstice Marketplace: The Solstice Marketplace is a private exchange developed by health insurance carrier Solstice Benefits.
Transamerica: Transamerica is one of the world’s leading financial services companies, providing insurance, investments and more to 27 million customers. Yet we see ourselves as far more than just number crunchers or investment managers. We are the Tomorrow Makers®.
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AFFILIATE MEMBER PROFILES
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The Institute for HealthCare Consumerism Affiliate Member Profiles Truven Health Analytics: Truven Health Analytics, formerly Healthcare at Thomson Reuters, delivers unbiased information, analytic tools, benchmarks, and services to the healthcare industry.
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.
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.
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.
UMR: UMR is a third-party administrator (TPA), hired by your employer, to help ensure that your claims are paid correctly so that your health care costs can be kept to a minimum and you can focus on well-being.
Wells Fargo Health Savings Accounts (HSA): Wells Fargo is a leading provider of comprehensive Health Savings Account (HSA) programs.
WellRight: WellRight is a provider of corporate wellness software and its solutions help increase the physical and mental well being of employees.
Withings: Withings leads the connected health revolution. Our beautifully designed award-winning products bring long-term engagement and measurable health impacts to your workforce.
ADVERTISING INDEX If you use the services of our solutions providers, please tell them you saw their ad in HealthCare Consumerism Solutions™.
Aetna ....................................... Back Cover
IHC Private Exchange FORUM Baltimore .............................10-11
ABA/HSA Council ...........................HCX 16 IHC University (CHCC) ...........................39
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benefitalign ......................................HCX 5
ADVERTISING CONTACTS
Intrepid .................................................. 45 BenefitWallet .................................HCX 13
404.671.9551 sales@theihcc.com
Cigna ...............................................HCX 2
CEO
Doug Field 404.671.9551 ext. 101 · dfield@ theihcc.com
Connecture ......................................HCX 8
Transamerica Employee Benefits .........................Inside Front Cover TSYS Healthcare ...................................... 5
CHIEF MARKETING OFFICER
Andrew Dietz adietz@theihcc.com
ConnectYourCare ...........Inside Back Cover
DIRECTOR OF CONFERENCE SPONSORSHIP/ CORPORATE MEMBERSHIP/REPRINTS
Rogers Beasley 404.671.9551 ext 109 · rbeasley@theihcc.com
IHC Affiliate Member Profiles.............48-50
Quadrant 4 Health .................................. 42 UMR ........................................................ 7
ACCOUNT MANAGERS
Michelle Gatehouse 404.405.3007 • mgatehouse@theihcc.com Ted Arvan 678.296.1906 • tarvan@theihcc.com
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IHC FORUM West Las Vegas ..................36
WiserTogether ....................................... 13 WageWorks ........................................... 16
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.
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