HealthCare Consumerism Solutions - 2015 4th Quarter Issue

2016 Private Exchange FORUM Dallas Conference Preview

ISSUE || Fourth Quarter • 2015

Innovative Health and Benefit Management

Delivering a Simplified and Streamlined Benefits Offering What Will Happen to the Group Market in 2016 and 2017?

Three Ways for Employers to Build Healthy Communities Wearables at Work: Big Data, Big Responsibilities

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Features 37 Beacon Health System and Hub International: Delivering a Simplified and Streamlined Benefits Offering

The 2012 merger of two hospitals in South Bend, Indiana, created Beacon Health System — a robust health care provider and research organization with more than 6,000 employees. The merger exacerbated an issue the hospitals had already been grappling with for a long time: a scattered, complicated collection of benefits offerings that left both employees and their managers confused. For one, they had a number of different policies in different places, including multiple policies with two different carriers for the same product. To complicate things further, employees were asking for additional voluntary benefit options, and Beacon wanted to offer them to complement the hospital’s high deductible health plan and health savings account offerings. Beacon needed to streamline their offerings and educate employees about the value of voluntary benefits, while consolidating, simplifying and amplifying their benefits offerings.

By Tony Rice, Employee Benefits Consultant, HUB International

As another year ends and a new one starts, it’s hard not to look back over 2015 and think about what the year ahead may bring.

Last year, one of the events that shaped 2015 and our future was the Supreme Court’s favorable ruling on the Affordable Care Act’s subsidies. Despite the government’s assurances that the ACA would help contain the cost of insurance, the reality is that medical insurance under a group program has continued to increase. Even worse, employees, not just employers, have felt the impact. Insurance has continued to increase at a rate higher than inflation. For employees, cost can be defined as their contribution to participate in the plan (a deduction from their pay) or in the cost-sharing elements, such as deductibles and copayments or coinsurance provision. In fact, the Kaiser Family Foundation/Health Research & Educational Trust 2015 Employer Health Benefits Survey found that since 2010, deductibles for all workers have risen almost three times as fast as premiums and about seven times as fast as wages and inflation.

By Perry Braun, Executive Director, Benefit Advisors Network

© Can Stock Photo Inc. / ShutterM

40 What Will Happen to the Group Market in 2016 and 2017?

I nside 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: For the first issue of 2016, HealthCare Consumerism Solutions will be stacked full of expert opinions and outlooks to get you off to a successful start in the new year. Experts and thought leaders from Towers Watson, Optum, The Alliance, Benefit Advisors Network, Fidelity, Tango Health and more will share their insights on a broad range of topics in innovative health and benefits management.

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

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6 Publisher’s Letter

8 Bachman’s Banter

9, 12 Briefs & Innovations • • • •

Jiff and Quantum Health Launch Joint Product Omada Health Raises $48 Million MedWand Digital Health and Doctor On Demand Team Up Kashable Names Bob Gaydos as Corporate Strategy Advisor

10-11 Private Exchange FORUM Preview 14 Infographic: Choosing Doctors and Health Plans 48-50 Affiliate Member Profiles

50 Resource Guide/Ad Index

Sign Up To Attend Events Private Exchange FORUM Dallas: February 23-24, 2016 Embassy Suites Frisco

IHC FORUM East

Atlanta: May 24-26, 2016 Cobb Galleria Centre

Private Exchange FORUM

Baltimore: September 8-9, 2016 Renaissance Harborplace Hotel

IHC FORUM West

Las Vegas: November 9-11, 2016 Red Rock Resort Spa & Casino Come LEARN, CONNECT and SHARE with the top thoughtleaders in health care consumerism. Find more information at: www.theihccforum.com

Online exclusive Mobile is the Future in Health Care AccessHealthCT, Connecticut’s health insurance marketplace, recently announced a new addition to their mobile application that allows brokers to enroll consumers on the state’s public exchange directly from their smartphone. The app also touts many new enhancements, including an “Uber-like” feature for consumers to find and connect with brokers to help them enroll in benefits! At KTP, we think that AccessHealthCT is ahead of the curve and is making strides in helping people access and enroll in benefits. We see mobile devices and apps as the way of the future, especially in the health insurance exchange space (both private and public).

Mobile compatibility and mobile solutions will allow exchanges to meet individuals where they have access and where they are most comfortable, which is vital, especially when considering that a large majority of Americans are smartphone dependent.

By Jennifer E. Jones, Director of Private Exchange Advisory Services, and Barry Eyre, VP of Business Development, KTP Advisors 4 Fourth Quarter 2015 I www.TheIHCC.com I HealthCare Consumerism Solutions™

Departments 15 Voluntary Benefits Employee Benefits: Where “New” Really Means New

By Matthew Owenby, SVP and Chief Human Resources Officer, Aflac

Owenby

33 Health Engagement Get in the Game: Seven Game Design Principles That Improve Your Health Benefits Program

By Johnathan Hodge, Executive Vice President of Product, Jiff

Hodge

34 ACA Compliance Top Three ACA Reporting Challenges — and How to Tackle Them

Haynes

By Kami Haynes, Director of Marketing, Tango Health

35 Legal & Compliance Wearable Technology in the Workplace: Big Data, Big Responsibilities

Hill

By Stan Hill, Associate, Polsinelli PC Atlanta

43 Dental Care & Benefits Consumer Attitudes about Oral Health

By Robin Gelburd, President, FAIR Health

Gelburd

44 Workplace Wellness Three Ways for Employers to Build Healthy Communities — and Healthy Employees

By Nico Pronk, Ph.D., VP and Chief Science Officer, HealthPartners

Pronk

46 Flexible Spending Accounts Improve Employee Satisfaction with FSA Education: Tips and Reminders for Year-end FSA Spending

By Jeremy Miller, Founder and President, FSAstore.com/HSAstore.com

47 Employee Education & Communication

Miller

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L etter

Publisher www.theihcc.com VOLUME 11 NO. 6 | Fourth Quarter 2015

A Banner Year for Health Care Consumerism

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

As we turn the page to 2016, it’s been another strong year of growth for health care consumerism.

While health savings accounts, wellness programs and other long-standing components of consumerism have continued their steady growth, we’ve also witnessed the proliferation of emerging technology solutions — telehealth, private exchanges, digital health tools, etc.

In this final issue of 2015, our expert contributors tackle many key areas in employer-sponsored health and benefits today — from ACA reporting measures to consumer attitudes on dental benefits and oral care.

In the main feature, Tony Rice, an employee benefits consultant with Hub International, gives a thorough rundown of the consumer-driven benefits program implemented after the merger of two hospital systems. Rice’s case study gives real examples of how consumerism-based benefits programs can create reduced health care costs and an overall more engaged workforce. In the second feature, Perry Braun, the executive director at Benefit Advisors Network, gives readers his outlook on the group market over the next 24 months — you won’t want to miss his insights there.

These articles — along with those in the HealthCare Exchange Solutions supplement — are a sliver of what readers can expect at our upcoming 2016 conference series. This May, we’ll return to the Cobb Galleria Centre in Atlanta for our flagship conference: the IHC FORUM & Expo. Now in its seventh year, FORUM & Expo has become the epicenter of all things health care consumerism. As consumerism continues to take a more important role in the health care system, I hope you’ll join us at this event as we look at best practices, top solutions and future innovation.

If you’re particularly interested in following the emerging private exchange market, we invite you to join us at private exchange-specific events in Dallas and Baltimore next year.

From all of us here at The Institute for HealthCare Consumerism, happy holidays, and we hope to see you in-person at any or all of our four 2016 conferences. Here’s to a happy, healthy and productive

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

2016!

Ted Arvan 678.296.1906 • tarvan@theihcc.com

Sincerely,

Partners/Alliances

Joni Lipson 800.546.3750 · jlipson@fieldmedia.com

Doug Field CEO/Publisher dfield@fieldmedia.com

HealthCare Consumerism Solutions™ Volume 11 Issue 6 Copyright ©2015 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 Fourth Quarter 2015 I www.TheIHCC.com I HealthCare Consumerism Solutions™

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

Bachman’s Banter

By Ronald E. Bachman FSA, MAAA Chairman, Editorial Advisory Board The Institute For Healthcare Consumerism

HHS Proposed Rule on Non-Discrimination and Health Equity Who: Health insurance issuers, health care providers, third party administrators and group health plans (including some self-funded plans).

When: On September 8, 2015, the HHS Office of Civil Rights proposed a rule and requested comments no later than November 9. The rule will be effective 60 days after being finalized.

What: Section 1557 of the Patient Protection and Affordable Care Act provides that an individual shall not be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any health program or activity.

Language Services: The rule requires language assistance for those with “Limited English Proficiency”, such as oral interpreters and written translations. Affected entities could be required to post a notice of consumer rights regarding communication assistance and provide some information in up to 15 languages.

Legal Exposure: The rule provides for a private right of action and damages for violations to the same extent that such enforcement mechanisms are provided for under the current federal civil rights laws, making it clear that individuals have the ability to file a lawsuit. The rule may bypass existing administrative processes for settling complaints and open the door to direct legal exposure for affected entities.

The rule may bypass existing

Executive Summary: HHS proposed a rule to advance health equity and reduce disparities in health care. The proposed rule prohibits discrimination based on an individual’s race, color, national origin, sex, age or disability under a health program or activity.

Previously, The Office for Civil Rights did not include “sex” as a potential discriminatory concern in health plans.

administrative processes for

settling complaints and open the door to direct legal exposure for affected entities.

Sexual Anti-Discrimination: Under the rule (1) individuals cannot be denied health care or health coverage based on their sex, including their gender identity; (2) individuals must be treated consistent with their gender identity, including in access to facilities; (3) sex-specific health care cannot be denied or limited only because the person seeking such services identifies as belonging to another gender; and (4) explicit categorical exclusions in coverage for all health services related to gender transition are discriminatory.

Disability Services: The rule includes requirements for auxiliary aides and services for those with disabilities, including alternative formats for written materials and sign language interpreters.

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Certification of Compliance: Under the rule, each entity participating on a federal or state-based marketplace would need to certify compliance for all policies and services provided (including any TPA or ASO), whether in or outside of the marketplace offerings.

Actions: The broad inclusive nature of the proposed rule means that insurers, employers, TPAs and health care providers need to seek legal and compliance advice to determine if any changes are needed to their products, services, and their own employee benefits. Those entities wanting to impact the final ruling must have submitted comments to HHS by November 9, 2015.

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

Jiff and Quantum Health Launch Joint Product to Improve Health Care Experience for Employees Jiff, the leading enterprise health benefits platform, and Quantum Health, the leader in care coordination and consumer navigation, recently announced a joint-service offering for self-funded employers that will address the growing need for a comprehensive personal and digital solution to improve the health and health care experience of employees. Both Quantum Health and Jiff are proven experts at understanding the consumer, and together with the launch of IQHealth, they integrate Jiff’s smart technology with Quantum Health’s live experts for guided support to create the ultimate personalized experience for employees. IQHealth allows the consumer to quickly and easily connect to expert advice and information about individual health plan and health care options through their preferred channel.

SelectAccount’s WalletDoc Expands Cost-Saving Opportunities Through ZendyHealth Partnership SelectAccount has announced a new partnership with ZendyHealth to expand the already diverse suite of consumerism tools available through WalletDoc. The ZendyHealth platform will allow SelectAccount account holders to find, book and bid on medical, dental and cosmetic procedures seamless through their Online Member Service Center to further SelectAccount’s mission to empower people to be smarter health care consumers. Described as the “Priceline of health care,” ZendyHealth’s platform presents people with potential savings of up to 80 percent off procedures offered.

MedWand Digital Health and Doctor On Demand Team Up to Improve Patient Care Anywhere MedWand recently announced its partnership with Doctor On Demand as MedWand’s preferred telemedicine provider. The collaboration allows MedWand to add the leading, next generation video telemedicine company to its national distribution and allows Doctor On Demand patients to receive MedWand-enabled, real-time remote physical exams. The two companies plan to market their respective telemedicine services together. In addition, MedWand plans to bundle its telemedicine technology with Doctor On Demand services for national distribution.

Teladoc Conducts One Millionth Telehealth Visit Teladoc, the nation’s first and largest telehealth platform, crossed an industry milestone recently with the completion of its one millionth telehealth visit. Each telehealth visit reflects an interaction between a board-certified, state-licensed physician and a patient in need of health care via video, phone or online. In addition to being the first telehealth provider to conduct one million physician visits, Teladoc also counts among its industry “firsts” as being the first and largest telehealth platform and the first and only telehealth company to be certified by the National Committee for Quality Assurance for its physician credentialing process.

Fitbit Wellness Adds Over 20 New Enterprise Customers Fitbit Wellness has introduced more than 20 new enterprise customers in the last four months, including Aon Service Corporation, Barclays, BMC Software, Boston College, Emory University and

Emory Healthcare, GoDaddy.com and Gonzaga University. In addition, the company will launch Fitbit Corporate Challenges as part of its Fitbit Wellness offering, a premium software feature to help drive employee engagement. Barclays PLC recently announced that the company will roll out its global wellness program. As part of this, more than 75,000 employees in the US and UK will be able to purchase a subsidized device. Overall, the company plans to roll the program out to all 140,000 Barclays employees worldwide, as Fitbit Wellness’ international capabilities continue to expand.

New HealthSparq Clean Helps Health Plans Avoid Costly Fines for Inaccurate Provider Directories HealthSparq recently announced its new data-as-a-service offering HealthSparq Clean, a program that helps health plans correct the inaccuracies in their provider databases and establish ongoing updates. Unlike any solution on the market, HealthSparq Clean is designed to help health plans avoid significant fines from CMS, while giving members a directory they can trust. Recent studies indicated that provider directory data is inaccurate and outdated by as much as 50 percent. Patients rely on provider directories to find doctors who are in their network and accepting new patients, and inaccurate directories can lead to patients ultimately shouldering a much higher portion of the cost of their care. As a result, CMS is requiring health plans to continuously update provider directory information in real-time beginning January 1, with many states enacting their own mandates and fines.

ShapeUp Select™ Unites Best-In-Class Wellness Vendors in Employee Wellbeing Platform ShapeUp has expanded its holistic offering to include products and programs from innovative, specialized partners that are fully integrated into its wellbeing platform. The ShapeUp Select™ partner ecosystem consists of products from third-party vendors that are seamlessly integrated into ShapeUp’s Wellbeing Hub, a central space for employees to receive personalized recommendations, enroll in programs, earn rewards and connect with colleagues working towards similar health goals. ShapeUp is proud to announce four new ecosystem partners: Wellness Corporate Solutions, meQuilibrium, Zipongo and Claritas Mindsciences.

Anthem and Castlight Collaborate to Accelerate and Enable Broader Health Care Consumerism Anthem and Castlight Health announced their expanded collaboration that will help employers and consumers make smarter health care spending decisions. Through this strategic relationship, the companies will focus on providing innovative cost and quality decision-support tools, as well as developing new products that will offer consumers easy to understand health care cost and quality information. In addition, the arrangement will foster the accelerated market adoption of Castlight’s solutions. The collaboration strives to build trust and an open dialogue with employers and consumers when it comes to supporting health and health care spending decisions.

continued on page 12

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Get An Insider’s View Of The Private Exchange

FORUM

February 23 – 24, 2016 Embassy Suites Frisco Dallas, TX

GENERAL SESSIONS

DAY TWO Wednesday, February 24

DAY ONE Tuesday, February 23

OPENING GENERAL SESSION 8:30 to 9:45 a.m.

The Dual Role of Health Plans: Selecting Partners and Building Proprietary Exchanges

OPENING GENERAL SESSION 2:00 to 3:00 p.m.

Is It Worth It? Consultants Analyze the Move to a Private Exchange Private exchanges promise to be a hub of consumerism that finally leads to the elusive outcomes of improved employee engagement and reduced corporate health costs. However, there are many factors to consider whether a private exchange (and which private exchange) is right for your organization. This expert panel of consultants will help navigate through today’s private exchange maze, providing answers on the tough questions from implementation to communications obstacles to potential pitfalls. They will analyze the numbers from early adopters and investigate whether exchanges are currently delivering on their promise. By the end, you should know if a private exchange is worth it for your organization.

Given the rapid growth of private exchange enrollment on (primarily) consultant-run platforms, health plans are devising their strategies for how they remain a focal point for health care consumers. According to a report from Deloitte, health plans need a “dual-pronged strategy to play defense against third party-sponsored private exchanges disaggregating and commoditizing their value proposition while also playing offense with a proprietary offering.”

This session will analyze the current and upcoming private exchange offerings from some of the nation’s leading health plans and why employers/brokers may prefer this option to a consultant-run or “pure play” exchange. The panelists will also look at strategies for selecting valuable exchange partners where they can include their major medical and voluntary benefits products.

DAY ONE AFTERNOON GENERAL SESSION 3:15 to 4:15 p.m.

Friendly Feud: Exchange Leaders “Battle” Emerging Players

Mid-Morning GENERAL SESSION 10:00 to 11:00 a.m.

Friendly Feud: What the #$@&%*! Should Brokers Be Doing?

In this friendly debate on private exchanges, leaders representing the early leaders in private exchanges (per enrollment numbers) will engage with leaders from up-and-coming private exchange innovators. The discussion will follow the format of presidential debates, with questions sometimes being posed from our moderator and in other cases from the audience. Come hear the different approaches that these players are taking with their private exchanges and learn what models or products might be the best fit for your (or your client’s) organization. Engage the players by asking your own questions.

Pick a side or just come to learn.

This panel discussion will cover all angles of how benefits brokers fit into the private exchange puzzle. In the post-ACA era, there has been considerable debate on the future role of brokers in the employer-sponsored benefits landscape. With a growing number of self-service technologies available, some prognosticators called for the end of the broker. However, it’s now clear the opposite is true: brokers will continue play a major role in this market in the years ahead. Panelists in this general session will delve into the changing role of benefits broker, whether or not they should partner with a private exchange, what qualities they should look for in an exchange partner if they decide to do so and much, much more.

DAY ONE CLOSING GENERAL SESSION 4:30 to 5:45 p.m.

Rapid Fire Innovation Demos: What’s on the Horizon?

Looking for the latest ideas and products in the employer-sponsored health and benefits world? You have come to the right place. This session showcases the newest innovations on the landscape and how they integrate with the world of private exchanges. Watch participants feature their newest breakthroughs, demonstrating the most innovative, cutting-edge products affecting health and benefits management today.

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AFTERNOON GENERAL SESSION 1:45 to 2:45 a.m.

Providing the Right Consumer Experience: Empowering Consumers Beyond Major Medical Millennials have now taken over as the largest growing component of the U.S. workforce, and they’ve brought their digital age preferences with them.

If private exchanges are to be the promised consumer-centric hub for benefits, the technology will have to meet the demands of its users. Beyond enrollment in major medical, employees are looking for other tools like cost/ quality transparency, HSA account info, telehealth, wellness incentives, health advocacy and more. They want to navigate benefits in a consumer-friendly, Amazon-like experience. In this informative session, panelists will share how exchanges can expand consumer choices beyond insurance options and

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. how embedding other solutions can create a more robust, more effective consumerism platform.

CLOSING GENERAL SESSION 4:30 to 5:30 p.m.

To Adopt or Not to Adopt: Employers Evaluate Exchanges and Share Experiences

Thank you GOLD and Silver sponsors for your support!

According to a recent survey of employers by the Deloitte Center for Health Solutions, 30 percent of non-adopters say they are interested in moving to private exchanges, and 62 percent say will likely move in the next one to two years. More employers than ever are either jumping on the private exchange bandwagon or are considering it. Before any employer makes the move, though, they must consider all aspects of the transition — what is involved with benefits administration, the cost and effort to switch to a private exchange, the transition and use for their employees — even fee levels for not adopting. Employers in this general session will share their experiences with and thoughts about private exchanges. They will discuss the positives and potential shortcomings with exchanges, providing attendees with first-hand knowledge they can bring back for use in their organizations.

WORKSHOPS TRACK ONE Wednesday, February 24, 11:15 a.m. to 12:15 p.m.

• • • • • •

SESSION 101 – Health Management: Crucial to Private Exchange Success?

SESSION 102 – What to Put on the Shelf? Voluntary Benefit Considerations SESSION 103 – Defined Contribution Health Care: A Hands-on Workshop SESSION 104 – Retiree Health Care and Private Exchanges: Key Considerations SESSION 105 – Employer Case Studies: What’s Working? What’s Not? SESSION 106 – Managing Member Retention as Members Migrate to Private Health Exchanges

TRACK TWO Wednesday, February 24, 3:00 p.m. to 4:00 p.m.

• • • • • •

SESSION 201 – Decision Support and Engagement: Helping Employees “Right-size” Benefits Selection SESSION 202 – Going Beyond Enrollment: Embedding Telehealth, Transparency and Other Solutions SESSION 203 – Benefits Brokers and Private Exchanges: Death Knell or Huge Opportunity?

SESSION 204 – Compliance Concerns for Private Exchanges SESSION 205 – Private Exchanges for the Middle Market: A Rapidly Emerging Area SESSION 206 – Game-Changing Combination of HSAs and Private Exchanges HealthCare Consumerism Solutions™ I www.TheIHCC.com I Fourth Quarter 2015

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HealthCare Consumerism Research, Surveys & Reports

continued from page 9

ACA Influencing How Employers Fund, Deliver Workplace Benefits Programs

Accenture: Use of Virtual Health Solutions in Primary Care Could Save $10 Billion Annually

The Guardian Life Insurance Company of America® recently announced new findings from the third annual Guardian Workplace Benefits StudySM that highlight how the Affordable Care Act is causing employers to consider new approaches to benefits funding and delivery.

Employers need guidance on how to manage the challenges they expect under the ACA, including new administrative and compliance requirements, in addition to the demands of offering employees benefits choices and enhancing the enrollment experience while controlling costs and funding. Sixty-one percent of employers cite “preparing for a post-health care reform era” as a highly important benefits objective, but only four in ten feel prepared to meet this objective.

The use of virtual health solutions in primary care could save $10 billion annually, according to a report released by Accenture. Virtual health solutions are digital-enabled models that provide clinical care and at-a-distance support for self-management, engagement and patient monitoring. The Accenture study highlights the economic value of applying virtual health solutions to three care scenarios: annual patient visit; ongoing patient management; and self-care. An Accenture analysis shows that applying virtual health tools to annual patient visits can save each primary care physician in the United States an average of five minutes per encounter. This is a time-saving equivalent to as many as 37,000 PCPs — or 18 percent of the existing PCP workforce — with an economic value of more than $7 billion annually across the U.S. health system.

HealthCare Consumerism People On the Move

ECFC Announces the Appointment of Robert L. Natt to Board of Directors ECFC, the leading nonprofit organization promoting choice in benefit solutions by working together through education and advocacy to put a consumer-driven account into the hands of everyone, announced the appointment of Robert L. Natt, executive chairman of Alegeus Technologies, to its Board of Directors. Natt has an extensive career in health care and brings more than 30 years of experience in the employee benefits industry to his ECFC Board of Directors position. Prior to his current role at Alegeus Technologies, he served as CEO of PayFlex Holdings, Inc., until presiding over its successful sale to Aetna in 2011.

Kashable Names Bob Gaydos as Corporate Strategy Advisor Kashable, an alternative consumer lending program for employees, announced the appointment of Bob Gaydos, a nationally-recognized

expert in the field of employee benefits management, as corporate strategy advisor. In his advisory role at Kashable, Gaydos will utilize his extensive expertise and passion for continuously improving the health insurance industry, to grow and further Gaydos’s strategic alliances, distribution channel partnerships and relationships with fast growing exchange and benefit administration platforms. Bob also serves as VP of strategic partnerships at Maxwell Health, where he focuses on carrier and vendor relationships.

WiserTogether Welcomes New Chief Growth Officer to Senior Leadership Team WiserTogether announced that Halle has been named as chief growth officer. Halle will join Wiser’s operating committee and will lead the company’s commercial operations and strategy. Matt Halle comes to WiserTogether from Welltok where he served as SVP of sales.

HealthCare Consumerism Funding announcements

Omada Health Raises $48 Million to Fight ObesityRelated Chronic Disease Building on the largest year of growth in the company’s history, digital health pioneer Omada Health announced that it has raised $48 million in Series C funding in a round led by Norwest Venture Partners. Its strategic investors include two Omada customers and health care leaders — Humana Inc. and Providence Health & Services, as well as prior investors US Venture Partners, Rock Health and Andreessen Horowitz and new investors GE Ventures and dRx Capital. Omada will use this funding to meet market demand, expand the company’s rigorous clinical research and publishing schedule and drive continuous improvement and enhancement of Prevent, the company’s flagship program.

HealthiestYou Secures $30M Investment from Frontier Capital HealthiestYou, a leader in telehealth user engagement, announced a $30 million growth investment from Frontier Capital. The company will use the investment for more aggressive sales and marketing efforts, technology enhancements and leadership to increase its share of the large and rapidly growing telehealth market. Over 4,000 employer

12 Fourth Quarter 2015 I www.TheIHCC.com I HealthCare Consumerism Solutions™

groups throughout the nation provide the HealthiestYou service to their employees. HealthiestYou’s Web-based and mobile technology application enables users to conveniently manage their health care needs 24/7, within the framework of their employer-provided benefits and with the most cost-effective options.

Collective Health Closes $81 Million Series C From Google Ventures, Founders Fund and NEA Enterprise health insurance software and services leader Collective Health has secured $81 million in Series C funding. The round includes financing by new investor Google Ventures and returning investors NEA and Founders Fund along with Maverick Capital, Redpoint Ventures and RRE Ventures. Collective Health will use the new funding to offer its employer health insurance solution to companies nationwide in 2016, expanding beyond California for the first time.

Collective Health also announced that it is teaming up with leaders in health care, including Anthem and Blue Shield of California, to bring companies its complete health benefits solution. In 2016, the Collective Health platform will serve 30,000 members and is expected to process over $200 million in health insurance claims.

©2015 WiserTogether, Inc. All Rights Reserved.

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Stats & Data Infographic

Choosing Doctors Health Plans Wearables andand Employers: Consumers' Healthcare Decision-making Varies Across Age, Gender and Socio-economic Status

A Match Made in Heaven?

Does cost always or usually affect your decisions when choosing a doctor?

56% Consumers with children in their household

53% Female consumers

42%

45% Consumers without children in their household

Male consumers

Which is most important to you when enrolling in a health plan?

MONTHLY PREMIUM 28% 28% 17% 20% 18% 23%

Millennials Young Gen-X Old Gen-X Boomers Seniors Total population

OUT-OF-POCKET COST 25% 24% 22% 24% 18% 23%

DEDUCTIBLE

FAMILY DOCTOR ACCEPTS PLAN

NUMBER OF DOCTORS IN-NETWORK

12% Millennials 23% Millennials Millennials 14% Young Gen-X 16% Young Gen-X Young Gen-X 9% Old Gen-X 32% Old Gen-X Old Gen-X 7% Boomers 32% Boomers Boomers 4% Seniors 30% Seniors Seniors Total population 10% Total population 26% Total population

6% 9% 5% 4% 7% 6%

Millennials Young Gen-X Old Gen-X Boomers Seniors Total population

*Millennials (age 18-34), Young Gen-X (age 35-44), Old Gen-X (age 45-54), Boomers (age 55-64), Seniors (age 65+)

Choosing a Health Plan Cost of the monthly insurance premium is the top concern for younger healthcare shoppers, under age 45 (Millennials and Young Gen-Xers).

In-network access to the family doctor is the top concern for older consumers, over age 45 (Older Gen-Xers, Boomers and Seniors).

Number of doctors in-network was not a primary consideration across all age groups.

Source: FAIR Health survey conducted on March 5-8, 2015 by ORC International Telephone CARAVANÂŽ. Study conducted using two probability samples: randomly selected landline telephone numbers and randomly selected mobile telephone numbers.

The combined sample consists of 1,011 adults (18 years old and older) living in the continental United States. The margin of error for the sample of 1,011 is +/- 3.08 at the 95% confidence level.

14 Fourth Quarter 2015 I www.TheIHCC.com I HealthCare Consumerism Solutions™

By Matthew Owenby Senior Vice President and Chief Human Resources Officer Aflac

Voluntary Benefits

Employee Benefits: Where “New” Really Means New

I

n most industries, new trends are really old fitness centers, 59 percent are implementing trends — just recycled. For example, “The health or fitness challenges, and 50 percent are King and I” just reopened on Broadway, and providing wellness coaching services. 4 Fiat plans to introduce a new version of the • Using voluntary insurance as a strategy classic Spider sports car in 2016.

– A recent Aflac survey showed that 64 percent One place where “new” actually means of employees see a growing need for voluntary new is in the area of workplace benefits. That’s insurance today when compared to years past.

5 because workers, weary of the high cost of However, more often than not, only dental health care, are becoming savvier consumers. and vision policies serve as the foundation of They expect and demand more, both of their most companies’ voluntary offerings. It’s more insurance carriers and of their employers. difficult for someone to absorb bills stemming As the calendar year rolls into 2016, from a serious accidents or illness when workers can be excused for their harder-tocompared to the cost of a root canal. In fact, it’s impress personas. After all, many are bringing for this very reason that critical illness policies home less today than they were a decade ago — are becoming more popular because they in large part due to the cost of health insurance. provide financial protection in a way that dental Employees’ share of premiums increased by 81 and vision policies simply don’t. percent between 2004 and 2014,1 and health insurance deductibles have risen six times faster Prepare for the New Year than workers’ earnings since 2010.2 Weary of the high cost of health care, Benefits professionals are keeping those workers are becoming savvier consumers and numbers in mind as they work with companies expect employers and insurance providers to Weary of the high cost of to improve their benefits offerings, and some offer benefits that fit their unique circumstances. are coming up with meaningful new ways to Whether it’s rethinking paid vacation, wellness health care, workers are help accounts give workers more bang for their efforts or offering products that provide benefits bucks. Among the new trends: becoming savvier consumers financial safety nets, smart companies will be • All work and no play isn’t good for thinking about creative and cost-effective ways anyone – According to a recent Glassdoor to ensure workers are happy in 2016. and expect employers and survey, 75 percent of employees are not insurance providers to offer 1 Kaiser/HRET survey of employer-sponsored health taking all of their time off, and three out of benefits, 2004-2014, accessed Oct. 27, 2015 - http://kff. five employees admit to doing work while benefits that fit their unique org/report-section/ehbs-2014-summary-of-findings/ on vacation.3 Employers are realizing that 2 Henry J. Kaiser Foundation 2015 Employer Health in order to keep their employees happy, Benefits Survey, accessed Oct. 27, 2015 - http://kff.org/ circumstances. they need to support employees’ efforts to health-costs/report/2015-employer-health-benefits-survey/ balance their work and family lives. With 3 Glassdoor, “Average U.S. Employee Only Takes Half of the rise in popularity of companies like Earned Vacation Time; Glassdoor Employment Confidence Survey (Q1 2014)” April 3, 2014, accessed Nov. 12, 2015 - http://www.glassdoor.

Netflix offering “unlimited” vacation and telecommuting, employers com/blog/average-employee-takes-earned-vacation-time-glassdoor-employment-confidencewill need to rethink what it means to have work-life flexibility and survey-q1-2014/ find new ways to help promote this in 2016.

4 Optum, “6th Annual Wellness in the Workplace study,” April 1, 2015, accessed Nov. 12, 2015 • Rise in cost-effective health and wellness efforts – From - https://www.optum.com/content/dam/optum/resources/whitePapers/15986.O.WIW. reimbursing employees for gym memberships to offering an WhitePaper_6.pdf on-site workplace clinic, companies are finding new ways to lower 5 2015 Aflac WorkForces Report, conducted in Jan. and Feb. 2015 by Research Now on health care costs by emphasizing preventative care and disease Aflac’s behalf, accessed Oct. 27, 2015 - https://www.aflac.com/business/resources/aflacworkforces-report/default.aspx. management. In fact, 35 percent of employers are offering on-site

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

15

# hellowork There’s nothing like the smell of compliance in the morning.

Even before that first pot of caffeinated goodness, we’ve got tax and ACA regulation on the brain.

Because at ADP, we’re always looking for new ways to pair innovative technology and human expertise to help you navigate risks associated with compliance. That way you can start your day by focusing on what’s important — whole milk or skim.

Visit adp.com/hellowork and see how we can provide a more human resource for your business.

ADP and the ADP logo are registered trademarks of ADP, LLC. ADP A more human resource(SM) is a service mark of ADP, LLC. Copyright © 2015 ADP, LLC.

HR Solutions | Benefits Administration | Good Job

Fourth Quarter 2015

Exchange

About Innovative Health and Benefit Marketplaces

Why Exchanges are Evolutionary, Not Revolutionary Health Care Exchanges are Changing the World of Benefits Private Exchange Tailwind 2016: The “Cadillac� Tax

The Official Magazine of

Exchange www.theihcc.com

Inside FEATURE 14 The Evolution of Private Exchanges

Departments

“We hold these truths to be self-evident” … “Liberté!” … “Egalité”… “Fraternité ou La Mort” … “Iskra!”

Revolutions — and words of revolution like those above from American, French and Russian history, respectively — are often defined or marked by a sudden and pervasive change to society. When I joined Lockton a few years back as director of our Exchange Solutions practice, the headlines in employee benefit publications screamed “Private Exchanges Could Trigger Health Benefits Revolution” or “Meet America’s Private Health Care Revolution” or “A Health Care Revolution on Private Exchanges.”

Technology firms, carriers, brokers and consultants were all rapidly building out exchange products and services, as well as creating alliances to serve this market. At the same time, enrollment projections from many reputable analysts claimed that between 12 and 20 million Americans would receive benefits through an exchange by 2016. When I visited with our associates, there was a large demand to learn about this emerging market. Clients also were bombarded with sales and marketing efforts trying to stoke the flames of private exchanges.

9 Private Exchange Tailwind 2016: The “Cadillac” Tax By using a private exchange in 2016 for 2017 effective dates, employers can wade their employers into these new waters. The private exchange model can educate users on the importance of choosing the right plan. It can give them tools to evaluate options and pick the one that suits their needs.

It can introduce the idea of defined contribution. Defined contribution is one keyPERSPECTIVES strategy to avoid the “Cadillac” tax!

By Jeff Yaniga, Chief Revenue Officer, Maestro Health

Perspectives 10 What Small Employers Need to Know about the Affordable Care Act 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 George Tzinas, Chief Experience Officer, Benefitalign

Revolution was in the air.

By Mike Smith, AVP and Director of Exchange Solutions, Lockton Benefit

11 Health Care Exchanges are Changing the World of Benefits Even More than Parachute Pants Changed the World of Fashion In the 1980s, a huge shift occurred in the way retirement plans were funded. Traditional, company-funded pension plans began to be replaced by self-funded 401(k) plans, which were cost effective for employers and gave employees unprecedented freedom to invest for their retirement. The benefits world is now in the midst of a similar change, stemming from the rising popularity of private health care exchanges using defined contribution benefit models.

By Scott Carver, President, PlanSource

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.

• • • •

MassMutual Launches Integrated Private Exchange WEX Acquires Benaissance Mercer Marketplace™ Continues Strong Growth Blue Cross Blue Shield of Arizona Selects Maestro Health

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

3

Publisher

Exchange www.theihcc.com VOLUME 2 NO. 6 | Fourth Quarter 2015

Benefits Evolving Toward 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

In both of this supplement’s features, our contributors — Mike Smith at Lockton and Scott Carver at PlanSource, respectively — look at the market trends that have led to the advent of private exchanges. Revolution or evolution, Mike Smith asks? The two contributors — both veterans of the health care space and now recognized experts in the private exchange market — come to the conclusion that private exchanges are much more so an evolution.

As Smith writes, exchanges have developed as employers continue to “look for ways to control costs, provide additional benefit choice, engage with their workforce more effectively, find better and cheaper ways to administer benefits and achieve compliance.” In a nutshell, the aims of health care consumerism.

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

Eric Bruce ebruce@theihcc.com Art Director

In our coverage of private exchanges over the last several years, our point-of-view has aligned very closely with those of Smith and Carver. As John Young has often said, private exchanges are a catalyst for consumerism; at the same time, it’s clear that path carved out by health care consumerism over the past decade has been a catalyst to the development of private exchanges.

As we enter a new year, everyone in employer-sponsored health care and benefits will be paying close attention to the adoption rate of private exchanges. While some would perhaps argue that the adoption curve has been less steep than expected, employers will continue to move to exchanges as a natural progression of the consumerism track they have been on for years. It will be interesting to see how fast this shift happens, and this will depend on several factors.

Coming up in February, we’ll attempt to address some of what’s working and what’s not with private exchanges at our first event of 2016 — the second annual Private Exchange FORUM in Dallas.

Following up on the sold-out event last March in Dallas, over 500 attendees will gather to take a hard look at the truths and myths of the current private exchange landscape.

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

From all of us at The Institute for HealthCare Consumerism, happy holidays, and we hope to see you in Dallas — or our other three 2016 conferences. Here’s to a happy, healthy and productive 2016!

Ted Arvan 678.296.1906 • tarvan@theihcc.com Partners/Alliances

Joni Lipson 800.546.3750 · jlipson@fieldmedia.com

Sincerely,

HealthCare Exchange Solutions™ Volume 2 Issue 6 Copyright ©2015 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.

4

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

At BenefitAlign, we understand your challenges, from Quote to Care.

New regulations, compliance issues and changing markets make it hard to stay ahead of the competition. With solutions supporting health plans, brokers and employers, Benefitalign can keep your organization compliant and competitive.

Our Private Exchange solution provides customized broker and employer Exchanges supporting health and ancillary products for active and early retiree populations.

Our modular Direct Enrollment solution is designed to support the entire Quote to Card process across all markets, including your subsidy eligible members.

BenefitAlign offers a suite of solutions to meet your challenges: 

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News Briefs & Innovations

News Briefs Blue Cross Blue Shield of Arizona Selects Maestro Health as Private Exchange Solution Provider Maestro Health, a leading all-in employee health and benefits company, announced that its shopping and enrollment platform, maestroEDGE, has been selected by Blue Cross Blue Shield of Arizona to serve as its exclusive private exchange solution for employers. Providing health insurance products, services or networks to more than 1.4 million customers, BCBSAZ gives consumers the option of selecting from hundreds of plan designs with 40 different attributes per design. Given the sheer volume of options and number of variables to track, monitor and administer, BCBSAZ saw an opportunity to modernize its benefits management technology to provide employer groups with greater clarity and visibility into the status of their benefits applications, billing, collection, reimbursement and operational processes — beyond annual open enrollment.

MassMutual Launches Integrated Private Exchange with Retirement Savings, Health Care and More Massachusetts Mutual Life Insurance Company is launching BeneClick!, a unique, integrated exchange featuring a guidance tool that helps employees prioritize their retirement savings, health care and insurance protection benefits based on their individual life stages and then take action. The new exchange, an online marketplace for people to select their employer-sponsored benefits, is powered by Maxwell Health’s benefits technology platform. Maxwell Health built the first “Health as a Service” platform, an operating system for benefits that engages employees, incentivizes a holistic view of health and provides a centralized place to access health and benefits services.

Softheon Launches Welltheos, A Private Exchange with 32,158 Plans from 249 Carriers Softheon™, a proven leader in health insurance marketplace integration and certified Web Broker Entity, announced its private exchange platform, Welltheos. Designed to provide relevant health plan information, while reducing the complexity of purchasing coverage through the Marketplace, Welltheos is set to enroll tax subsidy-eligible residents in the 37 states where HealthCare.gov is utilized. Welltheos serves as an Enrollment channel for subsidy eligible consumers into Qualified Health Plans (QHPs), offering access to 32,158 brand name health insurance products, from 249 health insurance issuers participating on and off the Federally Facilitated Marketplace. The platform hosts a variety of consumer decision support tools, including real-time eligibility determinations and subsidy estimations. This is achieved through accessing the federal data hub, CMS, IRS and other federal agencies to verify applicants’ identity and income.

6

and payment acceptance practices through two industry-leading SaaS solutions. This includes ExchangePoint℠, which addresses the complex financial management demands of public and private health insurance exchanges for employers and individuals as well as COBRApoint®, which addresses complex financial management, benefits administration and payment processing for individual subscribers.

Mercer Marketplace™ Continues Strong Growth with 96 Percent Participant Satisfaction Mercer recently announced that its Mercer Marketplace private benefits exchange continues to grow in both individual participants and numbers of clients. The exchange now serves more than 300 companies with 703,000 eligible employees and retirees, with an anticipated 1.5 million lives. More than 200 companies offer Mercer Marketplace to their active employees for health care and additional benefits. The Mercer Marketplace medical plan cost savings have proven to be sustainable.

Medical plan savings in the first year can be as much as 15 percent.

Second year savings for the initial group of Mercer Marketplace clients demonstrate significant reductions in medical plan cost trend, with just a 1.5 percent medical cost average increase in year two. This is well below the 4.6 percent cost increase experienced by companies according to the annual Mercer National Survey of Employer-Sponsored Health Plans.

Quadrant 4 Announced as Newest Member of The Private Exchange Coalition Quadrant 4 announced it has joined the The Private Exchange Coalition as a new member. PEC is the premier industry association for organizations affiliated with private exchanges and includes the following firms: Connecture, Array Health, Bloom Health, ConnectedHealth, Softheon and Leavitt Partners. The Private Exchange Coalition was originally formed by five industry-leading private exchange technology vendors as a means to promote shared industry standards, best practices and increase awareness of the powerful ways private exchanges improve the selection, administration and use of employee benefits.

New Aite Group Report Finds Private Exchanges Ready for Liftoff The stage is set for a sharp increase in the number of U.S. employees who enroll in health insurance on third-party private exchanges. Brokers sit at the forefront of the charge as a result of competitive pressures and the “Cadillac” tax, but there is another reason — the technology works.

As brokers use the tax and the technology to increase their standing as an employer’s trusted advisor, what segments and approaches are they eyeing to fuel this ascent? This report projects total private exchange enrollment, examines the market factors fostering or inhibiting enrollment growth and outlines key competitive trends.

WEX Inc. Announces Definitive Agreement to Acquire Benaissance

hCentive Implements Arkansas Health Insurance Marketplace for Small Businesses

WEX Inc., a leading provider of corporate payment solutions, announced it has entered into a definitive agreement to acquire Benaissance, a leading provider of integrated software-as-a-service technologies and services for health care premium billing, payment and workflow management, for total consideration of $80 million. WEX expects the acquisition to be slightly accretive in 2016, excluding one-time integration costs. Since its founding in 2006, Benaissance has revolutionized premium billing

hCentive, the leader in public health insurance exchange solutions, has implemented Arkansas Small Business Health Options, a state-based marketplace through which brokers and small businesses provide employees access to health insurance. Arkansas SHOP launched successfully under the My Arkansas Insurance brand on November 1.

With the launch, Arkansas offers brokers across the state an end-to-end SHOP solution that includes online health insurance plan shopping

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

and enrollment with integrated billing and payments to better serve their clients — for example, by creating online proposals for employers. hCentive is also proud to open their SHOP Contact Center in Little Rock, which is staffed by trained local Arkansas SHOP representatives to provide the support brokers and small businesses need to successfully enroll employees.

Sun Life Suite of Employee Benefits Now Available on Bloom Health Private Exchange Platform® The U.S. business group of Sun Life Financial has added a comprehensive suite of employee benefits to Bloom Health’s Private Exchange Platform® solution. Bloom Health employer customers can now select Sun Life’s short-term disability, long-term disability, life and accidental death & dismemberment, critical illness and cancer, accident and dental insurance products when tailoring their benefits package.

This partnership allows Sun Life to further its growth strategy in the employee benefits market and its commitment to meeting the diverse needs of employers and their employees. Through a customized suite of options, Bloom Health helps brokers, health plans and employers create a more compelling benefits program that provides consumers with the education and technology tools to understand the wide array of offerings, while improving the business results of benefits partners.

Maestro Health and ARAG® Announce Partnership Maestro Health also recently announced that ARAG®, a leader in legal insurance, will be a featured voluntary benefit partner on its complete private exchange marketplace, maestroEDGE™. ARAG offers legal plans — including identity theft protection and caregiving services — to consumers, while maestroEDGE delivers the choice and decision support needed for the optimal employee benefits experience. Maestro Health owns, operates and integrates the key components of employee health and benefits, including a private exchange marketplace, benefits administration, ACA compliance and self-funded solutions.

Paychex Expands Its Private Exchange Offerings for Employers Nationwide In time for open enrollment, Paychex, Inc., a leading provider of payroll, human resource, insurance and benefits outsourcing solutions for small- to medium-sized businesses, has announced the addition of new tools and resources available through the Paychex Insurance Agency (PIA) Personal Marketplace, a private insurance exchange where employees who are not eligible for group coverage can shop, compare and purchase individual health insurance from a variety of insurance carriers. In its second full year, the Personal Marketplace offers a convenient way for employers who are not required to offer a group plan under the Affordable Care Act to help their employees gain access to coverage, and avoid increasing penalties for non-coverage under the ACA’s individual mandate to purchase health insurance.

EIIA, ConnectedHealth Deliver Award-Winning Benefits Offering to Institutions of Higher Education ConnectedHealth, a leading private insurance exchange company, and Educational & Institutional Insurance Administrators, a not-forprofit organization that provides insurance and risk management services to member colleges and universities, recently announced the implementation of the My Benefit Basket™ platform for medical and ancillary benefits for two EIIA member institutions. In addition, the

benefits platform will be offered to all EIIA member institutions by the end of 2016. With regulatory changes afoot and demand for an easier and paperless benefits enrollment process, EIIA realized it needed to re-imagine how to deliver benefits to its member institutions. Together with ConnectedHealth, EIIA customized an online offering that meets the needs of its members’ entire workforce, whether part-time, tenured or pre-retiree.

Employees Embrace Choice According to Liazon Private Exchange User Survey A new survey by Liazon found that employees using a private exchange are embracing choice when it comes to their benefits enrollment process and making good choices when given the right tools. The survey reveals that employees genuinely enjoy being in the driver’s seat when it comes to choosing their benefits. When asked if they preferred to choose for themselves or have an employer do so, an overwhelming 96 percent said they would rather make their own selections. From the employer perspective, the study found that eight out of 10 employers are satisfied with the exchange overall, seven out of 10 have experienced streamlined administration, and seven out of 10 were able to stabilize or even reduce benefits costs in the first year after moving to an exchange. The survey clearly indicates that employees are making informed decisions based on what’s right for their unique needs — not just what’s light on their wallets. In fact, price is not the largest driver of benefits selection. The majority chose the benefits they did because they provided the right level of coverage.

AmeriHealth New Jersey Enhances Private Exchange for Small Businesses with New Software Technology AmeriHealth New Jersey announced that its private exchange, MyAHNJ, now provides enhanced technology that offers employer groups a comprehensive selection of products for their employees through a guided online shopping site. In 2013, AmeriHealth New Jersey began offering a defined contribution model for small businesses, which eliminates the “one-size-fits-all” approach employers often use when selecting a health insurance plan for their employees. With this new option, employers give employees a set amount of money to shop for a health benefits plan on a private exchange. Employees are given a username and password to log on to MyAHNJ and shop for plans preselected by the employer. The model not only helps employers manage costs more effectively, it allows employees more options to select a plan that is right for them. With the new software technology provided by Array Health, MyAHNJ is more comprehensive than ever.

Purchasing Alliance Solutions’ Private Benefits Exchange, GeorgiaPIE®, is Open for Business CieloStar recently announced that the Purchasing Alliance Solutions’ private benefits exchange, GeorgiaPIE®, is now offering a broad array of employee benefits for employers in Georgia. GeorgiaPIE includes medical insurance plans, some with unique funding arrangements, and supplemental insurance products, as well as administrative and compliance products to assist and protect business owners. As more employers and their benefits advisors work to comply with the ACA and manage costs associated with benefits, they are turning to firms like Purchasing Alliance Solutions, a Roswell, Georgia-based aggregator of innovative benefits solutions designed to create packaged cost savings and administrative ease for employers.

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

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Visit usVisit at Booth us Visit at Booth #124, at Booth and #124, let’s #124, and talk let’s and about talk let’sabout talk about Visit us at us Booth #124, and let’s talk about how tohow create how to your to create highly your highly effective highly effective effective how to create create your your highly effective onlineonline marketplace! online marketplace! marketplace! online marketplace!

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Private Exchanges

By Jeff Yaniga Chief Revenue Officer Maestro Health

Private Exchange Tailwind 2016: The “Cadillac” Tax

E

ver been to a wedding with an open bar? At an open-bar wedding, consumption increases. People order off the top shelf. More drinks are wasted. More people are too. Have a sip, set it down. Let’s do shots.

A study was done about the number of shots done at an openbar wedding versus a cash-bar wedding. Six times as many shots are done at an open-bar wedding! I just made that up, but my guess is that it probably is true! What the heck, it’s “free”. Generally, the average open-bar wedding attendee is “inefficient”.

The legislative hypothesis is that rich health plans promote this same irresponsibility. The “Cadillac” tax theorizes that employers and employees will act more responsibly if they have to pay 40 percent more for that extra couple of drinks.

Here’s a Problem Most of the early press on the “Cadillac” tax suggested that only the fat cats would be affected.

Not the case.

Brian Marcotte, CEO of the Washington-based National Business Group on Health, stated “nearly half of large employers say that, if they don’t take additional measures to control their costs, at least one of their health plans will trigger the 40 percent excise tax... when it goes into effect in 2018.” This is basically saying that “the ‘Cadillac’ tax is really not a tax on generous plans, it’s a tax on all plans — eventually all plans will trigger the ‘Cadillac’ tax.”

Worth repeating: “Eventually all plans will trigger the ‘Cadillac’ tax”.

Health Care Inflation A recent Forbes article all but predicted a health care bubble.

The logic makes sense: over the last five years, employers have deployed high deductible health plans to decelerate health care spend inflation. Faced with painful deductibles, many stopped going to the doctor. Fewer people go to the doctor, less spend. Yeah!

But wait. If sick people don’t go to the doctor because of a high

deductible, they don’t get better. The bubble expands. They may get worse. Much worse. Eventually, an unattended early visit results in a massive, expensive incident. The bubble expands. Hospitalization?

Surgery? Very expensive medicine? Pop! Huge expenses for the employer and the employee.

The Cash Bar is Coming: Private Exchanges Are One Answer The time to act for employers to start talking about the cash bar is now. By 2018, it is too late. By the way, 2018 — in the benefits world — is really 2017. 2017 is when the planning for January 1, 2018 effective dates must be complete.

By using a private exchange in 2016 for 2017 effective dates, employers can wade their employers into these new waters. The private exchange model can educate users on the importance of choosing the right plan. It can give them tools to evaluate options and pick the one that suits their needs. It can introduce the idea of defined contribution.

Defined contribution is one key strategy to avoid the “Cadillac” tax!

And last, but not least, the private exchange model can provide post enrollment tools and services to help people use the cash bar most effectively. It can tell them about other bars that have the same drinks, but they cost less!

All this said, the “Cadillac” tax law may change. Republicans want to repeal it. Labor unions want to repeal it arguing that in encourages employers to cut benefits. Leading Senator Harry Reid wants to fix it. The White House is defending it as is. Surprisingly to some, Hillary Clinton has broken ranks saying it should be repealed, and she has proposed that she can make up the $87 billion with other health care reform plans. Many predict change, but the legislative intent is likely to remain.

Regardless of how the political winds blow, is the time now for employers to deploy the cash bar. Everything else consumers buy is a “cash bar”, why not health care?

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Perspectives

What Small Employers Need to Know about the Affordable Care Act

By George Tzinas » Chief Experience Officer » Benefitalign

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he Affordable Care Act is very specific in outlining employer responsibilities for small and large employers. The size and structure of your workforce determines what taxes, subsidies and penalties apply to you. Because there are different provisions of the ACA for small and large employers, we will tackle each segment separately, beginning with a summary for small employers first.

Seasonal Employees Seasonal workers are taken into account in determining the number of full-time employees only if they worked for more than 120 days during a calendar year.

First, the good news: small employers are exempt from many of the ACA provisions and requirements, including the employer shared responsibility provisions and the employer information reporting provisions.

Now, the less good news: the definition of a small employer is not as simple as it sounds, and, as you can expect, there are lots of rules and regulations to consider when determining your status.

One additional item to consider: if you are part of a larger organization with common ownership, the ACA aggregates all the employees across all the related groups and considers that as a single employer.

Under the ACA, a small employer is defined by the IRS as: An employer with fewer than 50 full-time employees, including full-time equivalent (FTE) employees, on average during the prior year. What is an FTE? A full-time equivalent employee is an individual employed on average at least 30 hours of per week. One hundred thirty hours of service in a calendar month is treated as the monthly equivalent of at least 30 hours of service per week.

Chances are you probably have a mixed group employees with some full time, some part time and maybe even seasonal workers. Well, there are regulations for non-full time employees: Part-time Employees Part-time employees are counted as partial FTEs. Basically, two half-time employees count as one FTE. That means 20 half-time employees are equivalent to 10 FTEs.

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If your regular workforce changes throughout the year, you’ll need to use average workforce size to determine small or large group status.

And one final note on group status: the ACA had a provision that all groups from 51 to 100 employee size would be defined as part of the small group market beginning in 2016. The president recently signed into law an amendment to the ACA that allows states the option of keeping the existing 50 employee definition or moving to the 100 employee definition.

Without this change, many firms that are considered large group today would have been forced to purchase coverage in the more regulated — and more expensive — small group market.

Now that you’ve determined your company is considered a small employer under the ACA, what do you need to know as an employer?

The IRS and Small Business Association have compiled a list of items that apply to small employers. Not all of these provisions may apply to all small groups employers. As a small group employer: • You must withhold and report an additional 0.9 percent on employee wages or compensation that exceed $200,000 (the employer portion of

•

•

the tax remains unchanged at 1.45 percent).

You may be required to report the value of the health insurance coverage you provided to each employee on his or her Form W-2.

Effective for calendar year 2015, if you provide self-insured health coverage to your employees, you must file an annual return reporting certain information for each employee you cover. The first of these reports must be filed in early 2016. Refer to the IRS website for more information.

Also, if you self-insure, you may also be required to pay a fee to help fund the Patient-Centered Outcomes Research Trust Fund.

Some small employers choose not to offer employer sponsored health plans to your employees, but instead offer to reimburse employees for premiums they pay for health insurance. This is called an Employer Health Care Arrangement or Employer Payment Plans. There have been changing regulations around this type of arrangement, but generally these do not satisfy the employer requirements under the ACA and may be subject to $100/day excise tax per applicable employee. You can find out more about Employer Payment Plans on the IRS website.

Of course, there are also many other requirements that have been in force for several years for employers of all sizes who offer group coverage — Exchange Notification, Minimum Plan Requirements, Eligibility and Enrollment Requirements.

To read the rest of Tzinas’s insights on ACA requirements for small businesses, please visit www. theihcc.com.

Perspectives

Health Care Exchanges are Changing the World of Benefits Even More than Parachute Pants Changed the World of Fashion

By Scott Carver » President » PlanSource

I

The benefits world is now in the midst of a similar change, stemming from the rising popularity of private health care exchanges using defined contribution benefit models. The private exchange market, or a hybrid model in which employers adopt characteristics of an exchange such as defined contribution, ACA compliance and multiple health plans offered by diverse carriers, is projected to grow by the millions in the next few years. Six million U.S. employees and their dependents enrolled in a private exchange for their 2015 benefits, up from three million in 2014, according to an Accenture report from April 2015. We are just beginning to understand the implications of this movement, but it is safe to say that, like the retirement world, the benefits world will never be the same again.

The advent of the health care marketplace The definition of a private exchange is still evolving. And like all new concepts, what it started as is not necessarily what

© Can Stock Photo Inc. / racorn

n the 1980s, a huge shift occurred in the way retirement plans were funded. Traditional, company-funded pension plans began to be replaced by self-funded 401(k) plans, which were cost effective for employers and gave employees unprecedented freedom to invest for their retirement. Many thought it would never catch on, but 401(k) plans were quickly adopted by companies of all sizes, and the retirement world has never been the same. Nearly 80 percent of full-time workers now have access to retirement plans like 401(k)s, and more than 80 percent of these workers participate in a plan.

Exchanges have given consumers more power to control their benefits coverage, and in doing so, have also made consumers responsible for choosing appropriate coverage. The number of plans offered in a private exchange is typically three times higher than in a traditional defined benefit model. Choice is good, but it does require that consumers have enough information to make intelligent decisions.

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Perspectives it will end up being. But in its simplest form, a health care exchange is an online marketplace where consumers can shop for and enroll in health care plans. This model has far-reaching consequences, due primarily to the inherent retail nature of a marketplace. Traditionally, employersponsored benefits coverage used a wholesale model. Companies bought plans in bulk from a single carrier and parceled them out to employees, who had very little say in how and by whom they were covered. The consumer was removed from the purchasing process.

Exchanges, on the other hand, use a retail model. In essence, a marketplace is set up with a variety of plans offered by multiple carriers and employees can pick the plans that are best for them.

Now, at first glance, this change from a wholesale to retail marketplace model may not seem too significant. But when you think about all that it implies, you realize that it is enormous. Retail is a lot different than wholesale. To be successful, a retail set-up requires a much higher level of service, transparent pricing, a broad selection of products, and an intuitive and attractive shopping experience. A retail experience puts consumers front and center in the purchasing process. They have the wallet and make the final buying decision. So by moving health plans from a wholesale to a retail model, the exchange marketplace concept has given consumers an unprecedented amount of control over how they get health care coverage.

With great power comes great responsibility Exchanges have given consumers more power to control their benefits coverage, and in doing so, have also made consumers responsible for choosing appropriate coverage. The number of plans offered in a private exchange is typically three times higher than in a traditional defined benefit model.

Choice is good, but it does require that consumers have enough information to make intelligent decisions. Let’s face it:

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benefits can be confusing, and many employees go into open enrollment armed with precious little knowledge about benefits plans and the terms used to describe them. This is remarkable, considering that insurance and benefits are typically one of the largest expenses in a family’s budget.

Back to the 1980s, when 401(k) plans hit the scene, the majority of consumers were ill-equipped to make investment decisions for their retirement funds.

Eventually, however, an entire industry sprang up offering to educate and guide fledgling investors on the options that were right for them. We are seeing a similar movement today to fill the need for better education and guidance around health care plans and benefits.

Employers are currently taking the lead in this effort, and many now conduct full-scale communication campaigns to educate their employees on what plans will be offered and explain some of the more commonly misunderstood benefits terms. A multi-pronged approach tends to work best with in-person meetings combined with videos, printed and online materials.

As control of health care plans shifts to the consumer and new regulations from the ACA are making benefits increasingly complex, it would be fair to ask: why are employers still in the benefits business? Wouldn’t it be easier to just leave it completely to the consumers? Easier, maybe, but probably not in the employer’s best interest.

Benefits are a big part of an employee’s overall compensation and can play a significant role in attracting, retaining and engaging employees. According to the Metlife Employee Benefits Trends Study, 71 percent of employees who are satisfied with their benefits remain with their company, and employees who are satisfied with their benefits are four times more likely to be satisfied with their jobs. Many employers are finding private exchanges (or characteristics of exchanges) to be the most effective way to offer the best compensation package

to their employees. But they do need help. And that is where technology comes in.

Technology is no longer optional The world of benefits has become increasingly complex, especially with new reporting and compliance requirements set forth by the ACA. Health care exchanges have made it possible to offer more plan choices in a simplified way, but there are many more moving parts than in a traditional defined benefits model. To run an exchange effectively it is just not feasible to use paper plans to sign up employees for benefits. That is why more and more employers are adopting technology for benefits shopping and enrollment. Good benefits software saves employers time in administration and gives employees a much better benefits experience, educating them and engaging them along the way. Software with good decision support can be coupled with live support by licensed agents to make benefits shopping and enrollment quicker, easier and (dare I say it?) even enjoyable.

The 1980s taught us many things. Some things, like parachute pants and shoulder pads, are probably best forgotten, but the lessons learned from the shift to 401(k) retirement plans should be remembered well. Consumers ended up with more control of their retirement funds due to the shift, and now consumers are gaining much more control of their benefits coverage due to the shift to health care exchange models. So I say embrace the spirit of the 80s. Go put on your Members Only jacket, pop a Van Halen cassette in your boombox and rock on to the new wave of change health care exchanges are bringing.

Scott Carver is president of PlanSource and is an entrepreneur and industry innovator with more than 28 years of executive level management experience at some of the nation’s top health care and insurance organizations. Prior to PlanSource, Carver was the founder and president of SYLINQ Corporation where his strategic guidance resulted in significant growth and recognition as an industry leader in large employer benefits administration.

A customizable way to simplify benefits administration, lower costs, and encourage employees to take an active role in their health.

We offer: • Health Savings Accounts • Health Reimbursement Arrangements • Flexible Spending Accounts • Health Incentive Accounts • Other specialized solutions

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www.mybenefitwallet.com ©2015 Xerox HR Solutions, LLC. All rights reserved. BenefitWallet® is a trademark of Xerox Corporation in the United States.

The Evolution of Private Exchanges

By Mike Smith » AVP and Director of Exchange Solutions » Lockton Benefit Group

“We hold these truths to be self-evident” … “Liberté!” … “Egalité”…

“Fraternité ou La Mort” … “Iskra!”

Revolutions — and words of revolution like those above from American, French and Russian history, respectively — are often defined or marked by a sudden and pervasive change to society.

W

hen I joined Lockton a few years back as director of our Exchange Solutions practice, the headlines in employee benefit publications screamed “Private Exchanges Could Trigger Health Benefits Revolution” or “Meet America’s Private Health Care Revolution” or “A Health Care Revolution on Private Exchanges.”

Technology firms, carriers, brokers and consultants were all rapidly building out exchange products and services, as well as creating alliances to serve this market. At the same time, enrollment projections from many reputable analysts claimed that between 12 and 20 million Americans would receive benefits through an exchange by 2016.

When I visited with our associates, there was a large demand to learn about this emerging market. Clients also were bombarded with sales and marketing efforts trying to stoke the flames of private exchanges.

Revolution was in the air.

So let’s fast-forward to present day: • The aggressive enrollment projections have not lived up to reality, as the market is growing much slower than expected.

• Several exchange providers have been acquired (e.g. Bloom Health, Extend Health, Liazon and bswift).

• New models for the provision of benefits are entering the market (e.g. Zenefits, Oscar and ADP).

• Some clients that were early adopters of private exchanges are moving out of the strict product models while maintaining several of the advantages of private exchanges.

• Providers are becoming more flexible. In earnings calls this quarter, firms talked about the variety of their exchanges and offerings.

A leading exchange provider stated: “We’ve got exchanges, large, medium, small. We’ve got exchanges that are fully insured and selfinsured.” This was a marked change in direction from a few years ago when this agency introduced its exchange as multi-carrier and fully insured for the larger market.

In my opinion, these signs point to the fact that exchanges are less revolutionary rather than evolutionary, as employers look for ways to control costs, provide additional benefit choice, engage with their workforce more effectively, find better and cheaper ways to administer benefits and achieve compliance.

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Since the consistent top driver for an exchange is better cost control management, and only 14 percent believe that technology will help them achieve this goal, exchanges must be implemented solutions aimed at a different set of targets (i.e. employee engagement, communication, etc.).

The forces driving some of the exchange market continue to exist and in fact may be amplified.

Employers have invested heavily in their benefit programs and many are hesitant to implement a wholesale shift in the way these valued plans are structured which is what many of the private exchanges represent.

A recent industry survey found that employers are planning to spend heavily on benefits technology in 2016, especially in the areas of benefits administration, benefits enrollment and employee benefits portals.

One of the central components of a private exchange should include services for communication, enrollment and administration. But these services can be (as they historically have been) purchased outside of an exchange in a traditional benefits administration manner.

With new demands from the Affordable Care Act hitting this year for reporting, many employers are looking to enhance their existing benefits administration services as opposed to the wholesale new approach represented by many private exchanges.

The survey also shows that 14 percent of the employers feel that these technology investments will help reduce costs as opposed to gain better insight and control over benefits and the associated administrative processes. Since the consistent top driver for an exchange is better cost control management, and only 14 percent believe that technology will help them achieve this goal, exchanges must be implemented solutions aimed at a different set of targets (i.e. employee engagement, communication, etc.).

While not as prevalent as many predicted, private exchanges are slowly gaining steam and evolving to meet the needs of employers.

Employers Considering a Private Exchange

industry experts expect...

71 %

66 %

To me, it is very reminiscent of the change from health maintenance organization restrictive network plans to more open preferred provider organization models in the late 1980s and 1990s.

The market liked the cost control elements of the HMO but needed a more open architecture to satisfy the broader needs of their employees.

Likewise, clients that implemented private exchanges want more flexibility than the early market providers were willing to give. In some cases, that circumstance resulted in lost clients, and in other cases, the vendors have loosened their approaches to retain existing clients and attract new ones.

For instance, in the same earnings call regarding exchanges, that leading exchange provider referenced above also said: “Our range of solutions provide clients with a unique ability to seamlessly transition between funding choices depending on their level of risk tolerance.” This is a great example of market evolution since this firm’s original exchange was implemented solely under fully-insured funding mechanisms.

This fall, I had the privilege to visit with a handful of benefits administration vendors to review their strategy, successes and road maps.

It is clear that these firms have been putting good use to the capital that has flowed into their space either through acquisition or capital injection.

Employers will soon see these enhancements as well in the areas of decision support, selfservice tools, physical expansion for expanded teams and services. Employers will be able to take advantage of these developments either through a private exchange that these firms support or directly in a traditional benefits administration approach.

Sounds much more like evolution than revolution.

Wouldn’t you agree?

The Evolution of Private Exchanges

2016

of all employers to adopt a private exchange approach by 2018

20-30

%

21 %

Another sign that we are in a much more evolutionary than revolutionary market is the fact that a number of early adopters to private exchanges are moving away from the strict contracts, service models and carrier/plan design relationships sold primarily by consulting firms and technology providers. We have worked with employers that have been disappointed in exchange results due to: • Unrealized cost projections; • Broken service delivery models; • Lack of deep consulting expertise; • Lack of access to data; • Lack of compensation transparency; and • Low/no utilization of plans and services.

that could mean...

2017

Americans on private exchanges by 2019

2018

Source: Midwest Business Group on Health

15-20

million

Forces Driving the Exchange Market

Healthcare Cost Inflation

Government Regulation The Affordable Care Act (ACA)

MultiGenerational Workforce

Technology Evolution

Capital Influx

Components of a Private Exchange

EmployerSponsored Plan

multiple options and plans to create a vibrant marketplace

Marketplace/ Shopping Experience for the Consumer

enrollment decision support tools

Online Technology integrated with or potential replacement Platform for benefits administration system EmployerFunded Defined Contribution Enrollment Advocacy Resources

shifting the paradigm from payroll deduction to providing funds and choice

online and call center

follow us @LocktonHIXSolutions HealthCare Exchange Solutions™ I www.TheIHCC.com I Fourth Quarter 2015

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By Johnathan Hodge Executive Vice President of Product Jiff

Health Engagement

Get in the Game: Seven Game Design Principles That Improve Your Health Benefits Program

H

increased by 2.56 times year over year. ealth benefits administrators Game designers who have cracked Programs that employ game have been on a quest to cultivate mechanics, such as Akamai’s, are healthier employees for years. A the code on engagement use progress fun and addictive — because they healthier workforce allows a company to reduce its healthcare spending, one monitors, updates and milestones to show are designed to be. Behind the most successful games are seven proven of its largest costs. With new digital health companies entering the market players what they have accomplished and design principles that draw people in and keep them interested in coming every day — from nutrition tracking how much they have left to complete to back for more. apps to wearables to telemedicine 1. Religiously simple: A simple user services — employers have no shortage reach the next level. They provide timely interface can help facilitate a smooth, of options to target the big-ticket items enjoyable employee experience that that drive up their health care costs, reminders, countdowns and notices of doesn’t confuse or frustrate users. like chronic disease and unnecessary 2. Make it beautiful: Delightful ER visits. The challenge now is getting how to move to the next step. And they design draws in employees and employees to use them. improves engagement, making your Too many employees don’t use incorporate a social aspect to inspire benefits something employees love — or worse, don’t know about — the looking at. benefits available to them. Benefits competition among players.

3. Clear next steps: Make benefits administrators are finding that simply dummy-proof. No one wants to spend providing employees lots of options a lot of time figuring out what to do. is no guarantee they will be used.

Break it down into bite-sized pieces, and offer a single, clear Communicating about these options is difficult, and even if they know next step. about them, most employees aren’t interested or motivated to use 4. Incentives: Offer clear incentives that are easily visible them. As a result, employees miss out on the value of their benefits, and throughout the benefit program. Use points, progress bars and employers don’t get the most out of their budget. rewards to motivate users to take the actions you want them to To remedy this, some employers are turning to an unlikely source: take. game designers. Though it may seem like an improbable partnership, 5. Social proof: When users can see that their friends or employee benefits managers and game designers face a similar challenge colleagues are interacting with the game, it creates a sense of — converting one-time users into long-term players who keep coming back community, encouragement and positive reinforcement. for more. Games like Candy Crush and Words with Friends dominate the 6. Call it like it is: Carefully choose straightforward and direct app store year after year. People download them quickly, spend hours language throughout the benefit program. playing them, and come back day after day.

7. Use your words: Denote actions and instructions through Game designers who have cracked the code on engagement use simple words in the benefit program. Don’t rely on users to progress monitors, updates and milestones to show players what they interpret symbols or cryptic icons. have accomplished and how much they have left to complete to reach the next level. They provide timely reminders, countdowns and notices of how Gamification won’t motivate every employee. Incentives might work to move to the next step. And they incorporate a social aspect to inspire better for some, while social reinforcement might be the key for others. competition among players.

Health benefits administrators can leverage some of these same But for the many people who respond well to challenges and contests, tactics. For example, when Akamai wanted to boost the number of gamification of health benefits can inspire them to adopt healthier employees completing an annual biometrics test, they kicked off a behaviors.

While no one will be asking a benefits administrator to design the company-wide program through their Jiff app. Employees could earn points for scheduling their appointment, completing their screening, and next Minecraft anytime soon, more companies will do well to turn to game scoring within the healthy ranges. As a result, screening completion rates designers to get employees more engaged in their health benefits.

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ACA Compliance

By Kami Haynes Director of Marketing Tango Health

Top Three ACA Reporting Challenges — and How to Tackle Them

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omplying with Affordable Care Act rules for reporting employee health benefits data to the IRS poses some formidable challenges.

After all, the law is new, and its requirements complex. But with a good basic understanding of these requirements and your options for meeting them, you can ensure that your company will be in a strong position to avoid the risk of non-compliance.

Basically, the law requires you to report (both to your company’s employees and to the IRS) information about the health care coverage your company offered. To do this, you need to collect the appropriate data and use it to fill out IRS Form 1095-C — then send the completed form to employees by January 31, 2016 for the 2015 tax year and file it with the IRS by March 31.

Here are the main challenges you’re likely to face along the way:

#1: Coordinating Data Sources If only there were one data system in your organization with all the data you need to meet ACA reporting requirements — but for now, there’s not. Instead, you have to pull data from sources such as your payroll platform, human resources information system and benefits administration platform.

The payroll platform is typically the source for employee pay information and Employer Identification Number. What it doesn’t usually have is the employee leave information ACA requires; that’s more likely to come from your HRIS, since they’re often used to automate HR management tasks that include time-off requests.

Finally, you’ll need to head to the benefits administration platform for data on areas like employee and employer benefit costs, benefits offered and information about tax-advantaged accounts such as health savings accounts and flexible spending accounts.

The key is combining the information from the various platforms to get the complete picture that you’ll need for ACA reporting.

#2: Resolving Data Issues Coordinating data is a challenge that can be made even more challenging by various data issues that are likely to come up in the process.

Gathering employment history data from payroll systems can be difficult, and even if you’re able to get it — possibly by paying a hefty fee to your payroll-services provider — you may find it doesn’t provide the detail about employment history that ACA reporting demands. Also, if you

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haven’t been tracking employee leave (and why would you since there was no reason to before ACA?), you’ll have to sift through the data manually to calculate leave earned and leave taken as ACA requires.

Other data issues include correlating employee identifying information and establishing employment status. The correlation issue comes when an employee’s name, date of birth, demographic information and other data are contained in multiple systems and are inconsistent from one system to another — as when, for example, someone is “Curt Haynes” in one system but “Curtis Haynes” in another. It can take a lot of cross-referencing to resolve these issues.

As for establishing employment status, the issue is determining whether an employee should be categorized as full-time, part-time or another category established for ACA. This requires calculating hours worked over time and then comparing them against the ACA threshold of 30 hours per week for full-time employment.

#3: Populating Forms Once you’ve gotten data out of the various systems, resolved any issues and organized it all to meet ACA requirements, it’s time to complete IRS Form 1095-C, Employer-Provided Health Insurance Offer and Coverage. You’ll need to fill out a separate form for each employee, file it with the IRS and provide a copy to the employee — a process that’s similar to what your company does with W2s. Form 1095-C, however, is more complex. For example, to determine the correct codes to use in Part II of the form, you’ll need an extensive look-back period to assess employee eligibility.

Here’s the rundown on each line of Part II. • Line 14: Offer of Coverage – Fill this out to meet the requirement that you certify by month whether you offered full-time employees and their dependents the opportunity to enroll in a health plan offering minimum essential coverage.

• Line 15: Employee Share of Premium – Here, you’ll report the employee’s share of the lowest-cost monthly premium for self-only coverage providing the minimum value that your company offered.

• Line 16: Applicable Safe Harbor – This section is optional, but if you’re seeking a penalty exception under ACA Pay or Play requirements, it can be a way to demonstrate that your company qualifies.

To find out the three ways you can tackle these ACA reporting challenges, please visit the full article at theihcc.com.

By Stan Hill Associate Polsinelli PC Atlanta

Legal & Compliance

Wearable Technology in the Workplace: Big Data, Big Responsibilities

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earable technology in the workplace has evolved far beyond 20th may face requests to work from home or other off-site location as a century relics like wireless headsets. Employers now can track disability accommodation. Employers should carefully consider whether and analyze proprietary measures of worker productivity and the freedom of movement offered by technology is a suitable substitute for face-to-face interaction in the workplace or physical presence results-driven metrics through wearable devices.

Leveraging robust streams of real-time data can implicate various during certain business hours. If not, employers should document employment laws and associated legal responsibilities to employees. In office attendance requirements in a written job description. Without addition, collected data may be subject to a preservation duty, discoverable documenting, an employer may be compelled to accommodate a disability by a remote or after-hours working in litigation and, in some cases, relevant to legal claims by employees. With big Employers should carefully consider arrangement that adversely affect productivity or business operations, but data comes big responsibilities and, for does not rise to the high level of an undue the unwary employer, a minefield of whether the freedom of movement burden. employment laws.

The Double-Edged Sword of Performance Metrics

offered by technology is a suitable

substitute for face-to-face interaction

Limitations on Tracking Employee Movements

Data streamed and aggregated Technology tracking employee in the workplace or physical presence movements is potentially problematic through wearable technology may be boon to employers seeking realin the context of protected concerted during certain business hours. time, objective metrics of employee activities guaranteed to virtually all nonperformance. But if the numbers do management employees (whether or not lie, such data could also be used not in a union) by the National Labor by employees to dispute negative performance reviews and adverse Relations Act and analogous state public-sector union laws. Employees employment actions. In addition, an employee may rely on productivity have the right to gather to discuss unionization, or other terms and data to argue that a termination decision for poor performance was conditions of work, on breaks and outside working hours, without pretext for unlawful discrimination or retaliation. employer interference or coercion. To reduce the risk of a claim of Employers that rely on objective productivity data to make day- interference or chilling of protected activities, employers should disable to-day personnel decisions should do so consistently and document any or require employees to surrender wearable technology outside of deviations by identifying other legitimate business reasons. Moreover, working time. Because employees have a right to engage in protected should an employer rely on an employee’s objective data for a personnel concerted activities on work premises during non-working time, an decision, the employer may be obligated to preserve and produce the data employer cannot categorically ban protected activities on its premises. of other employees for comparison purposes.

Data Affecting Disability Accommodations Wearable technology can both foster and challenge employment law compliance. The Americans with Disabilities Act requires employers to engage in an interactive process with qualified employees to identify appropriate disability accommodations. Employers who aggregate data on employee productivity through wearable technology may use such metrics to assess whether an employee’s desired accommodation, or any accommodation, is reasonable. Data could also be used to document that a desired accommodation poses an undue burden on business operations, in which case, the accommodation need not be provided.

To the extent wearable technology enables employees to work remotely, or without constraints to a particular location, employers

Genetic Information Is Off Limits

Finally, employers should exercise extreme caution before using wearable technology to assess employee productivity by gathering biometric data. Such data most likely must be gathered and stored in accordance with HIPAA regulations governing protected health information, and its use in employment decisions may trigger the requirements of the ADA and the Genetic Information Nondiscrimination Act. While there are endless possibilities for leveraging wearable technology in the workplace, care must be taken to implement advancements without discriminating against or disparately impacting protected individuals. The legal limits of wearable technology will most likely continue to evolve, as the courts begin to confront these issues.

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Through the IHC University program, The Institute for HealthCare Consumerism has established the industry’s first and only certification program for health care consumerism expertise. Either through online courses or a four-hour pre-conference class at each of our quarterly conferences, establish yourself as a leader in this fast-growing space.

For more information, visit theihcc.com/university.

Beacon Health System and Hub International:

Delivering a Simplified and Streamlined Benefits Offering

By Tony Rice » Employee Benefits Consultant » HUB International

The 2012 merger of two hospitals in South Bend, Indiana, created Beacon Health System — a robust health care provider and research organization with more than 6,000 employees.

The merger exacerbated an issue the hospitals had already been grappling with for a long time: a scattered, complicated collection of benefits offerings that left both employees and their managers confused. For one, they had a number of different policies in different places, including multiple policies with two different carriers for the same product.

T

o complicate things further, employees were asking for additional voluntary benefit options and Beacon wanted to offer them to complement the hospital’s high deductible health plan and health savings account offerings.

Beacon needed to streamline their offerings and educate employees about the value of voluntary benefits, while consolidating, simplifying and amplifying their benefits offerings. At the heart of Beacon’s efforts was a three-year strategic plan that includes various employee education efforts as well as periodic review of compensation statements and benefits.

Consolidation was Beacon’s first concern, as the HR team knew that adoption is less likely when there are too many options.

Beacon was able to consolidate all of its offerings under two carriers.

Simplification resulted in numerous improvements: • A reduction in overall costs, even for products that were unchanged or similar to those previously offered. For example, Beacon now offers a critical illness policy with the option of a hospital rider, where they had previously offered the two as

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•

•

separate policies. Consolidation simplified enrollment and reduced prices.

Faster response times. Beacon can respond faster and more accurately to employee questions because information on all offerings is housed in one system. Benefits managers have all the data at their fingertips.

With a single point of contact, human resources spends less time running down contacts with concerns or questions.

Employee Education Helps Maximize Enrollment Beacon crafted an employee education program with numerous components, including a series of enrollment meetings offering employees optional one-on-one sessions with HUB consultants as well as a call center and email blasts to inform and engage employees in the process.

Beacon held group meetings with managers to help them understand why they needed to give their employees time to meet individually with enrollers. These meetings helped increase manager buy-in, which led to smooth adoption and additional improvements to the company’s internal marketing strategy — all completed mid-campaign.

Beacon also added a new wellness plan, allowing employees to earn points that translated into premium discounts. Some of the plan initiatives give employees a reason and an incentive to enroll in voluntary benefits.

In the first year, about 80 percent of Beacon employees are enrolled in medical, dental and vision offerings. Of the voluntary benefits offered, whole life insurance is most popular, with almost 700 employees enrolled to date, while hundreds of employees have purchased accident, critical illness (with or without a hospital rider) and short-term disability policies as well.

Voluntary Benefits: Offering More for Less

Employers: seize this opportunity to engage your employees. Meet with them one-on-one. Find out what types of voluntary benefits they’d like to see. Build a transparency around offerings and ultimately engage your total workforce in a dialogue about health and wellness.

Historically, ancillary benefits have provided companies with a cost-effective and personalized suite of products, but in today’s environment where employees and their families are likely to incur more out-of-pocket expenses due to high deductible plans and health savings accounts, voluntary benefits can also serve as a means to empower the employee with choice — driving the consumerization of benefits.

Additionally, offering voluntary benefits can be an ideal way to open the lines of communication during this time of fewer financial resources. At little to no extra costs to the employer, voluntary benefits — like life insurance, critical and disability insurance, accident insurance, a health and wellness program and auto/homeowners insurance — are offered to employees by outside vendors at a discounted rate because of the volume of potential customers provided by the employer, resulting in a win-win situation for all.

will ease the employer and employee transition.

Critical to the plan is an annual evaluation of what worked, what didn’t and what industry or inter-office changes have occurred that will cause the employee benefits strategy to evolve.

Conducting an annual “state of the union” will determine the necessary tweaks going forward and will ultimately keep the benefits roll out on track with the predetermined goals from day one.

Voluntary Benefits Can:

The Take-Away

• • • •

Provide more choices to meet the needs of your workforce Support the health and wellness of your employees and their families Help employees reduce out-of-pocket health care expenses Add value to a benefits program at little-to-no cost

Most employers realize the importance of securing the loyalty of and retaining existing employees, improving productivity and remaining competitive. Employees agree that they’re more productive during work hours and think more highly of their employer if they’re offered a range of benefits that include voluntary policies.2 A recent study by Transamerica found that 65 percent of employees say it is important that their employer offer voluntary products.3

Rethinking Benefits Strategies

The Three-to-Five Year Road Map: A Necessary Timetable

Beacon’s story is not unique. As health care costs and compliance requirements continue to escalate, as many as 68 percent of employers said they plan to re-evaluate their benefits strategy.1 Many companies will do this by consolidating their offerings and introducing voluntary benefits to serve as a means of managing costs while still engaging employees through additional product offerings. But, they key to it all will be creating a realistic three-tofive-year strategic plan that features employee communication as its chief ingredient.

When making changes to any benefits plan — whether switching to a high deductible plan or HSA or adding voluntary benefits — it’s important to do so gradually through a process that stresses flexibility, with changes implemented over three-to-five years.

In the same way that each organization’s key performance indicators, goals and objectives are different, so too their three-to-five-year benefits plan will be unique. Regardless of what the organization’s ultimate benefits redesign looks like, though, being purposeful and flexible

38 Fourth Quarter 2015 I www.TheIHCC.com I HealthCare Consumerism Solutions™

Although there’s much talk these days about the intended and unintended consequences of health care reform, like everything else in life, there’s a silver lining here, too. Changing benefits plans and creating a three-to-five-year plan to do so presents employers with a unique opportunity to open the doors of employee communication around benefits enrollment.

Employers: seize this opportunity to engage your employees. Meet with them one-on-one. Find out what types of voluntary benefits they’d like to see. Build a transparency around offerings and ultimately engage your total workforce in a dialogue about health and wellness. It just may just revolutionize your employee benefits program — like it did for Beacon.

Tony Rice is an employee benefits consultant for Hub International, the ninth largest global insurance brokerage in the U.S. and Canada.

The Hub Employee Benefits team develops comprehensive multi-year strategies for Fortune 500 companies — scoped, scaled and tailored for middle market businesses.

1 Deloitte (2012). 2012 Deloitte Survey of US Employers: Opinions About the US Health Care System and Plans for Employee Health Benefits 2 LifeHealthPro “Employees Favor Companies That Offer Voluntary Benefits,” Warren Hersch (July 2013), quoting a WellPoint Survey.

3 Transamerica Employee Benefits. https://www. transamerica.com/images/transamerica-employees-valuevip-2014_tcm73-35063.pdf

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

Education and communication are the keys to your success.

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

www.connectyourcare.com

What Will Happen to the Group Market in 2016-2017?

A

By Perry Braun « Executive Director « Benefit Advisors Network

s another year ends and a new one starts, it’s hard not to look back over 2015 and think about what the year ahead may bring. Last year, one of the events that shaped 2015 and our future was the Supreme Court’s favorable ruling on the Affordable Despite the government’s assurances that the ACA would help contain the cost of insurance, the Care Act’s subsidies. reality is that medical insurance under a group

• •

40 Fourth Quarter 2015 I www.TheIHCC.com I HealthCare Consumerism Solutions™

program has continued to increase.

Even worse, employees, not just employers, have felt the impact. Insurance has continued to increase at a rate higher than inflation.

For employees, cost can be defined as their contribution to participate in the plan (a deduction from their pay) or in the costsharing elements, such as deductibles and copayments or coinsurance provision.

In fact, the Kaiser Family Foundation/ Health Research & Educational Trust 2015 Employer Health Benefits Survey found that since 2010, deductibles for all workers have risen almost three times as fast as premiums and about seven times as fast as wages and inflation.

Before predicting what insurance premiums may look like in the next few years, it’s worth mentioning the following points are present in all years for the foreseeable future. Specifically; • The group insurance market will continue to develop premiums based on a workforce — and an overall population — that is aging up; • An aging population demands higher utilization of services and is a key factor that affects the development of the insurance premium; Consolidation of carriers and provider systems will continue as the arms race for market share will remain a front-page story; History teaches us that during a change over into a new presidential administration (as we will have in 2017), there will not be new significant domestic policy change in 2016, unless it is related to national security.

2016: Slight Increases

and/or 2017 to place the plan in position to meet the threshold and avoid the tax in 2018. The measures taken — either modest or severe — to bring the plan in compliance with the threshold is proportionate to: • the amount of tax; • the ability of the business or governmental entity to absorb the tax within their existing revenues; • the ability of the business to drawn down the benefits and transfer contributions to the employees according to their labor agreements (if this is the case), and; • the ability to offset the reductions in benefits which the employees will see a negative with adjustments in pay or compensation which will be viewed as a positive.

© Can Stock Photo Inc. / ShutterM

For 2016, insurance premiums in the group market will most likely continue to move up in the high single digit to low double digits increase (eight to 12 percent) before adjustments are made to the plan — for example, raising deductibles and co-pays.

Also, most likely there will be little movement in deductibles and co-pays in 2016 since cost sharing/transferring to the employee tactics are at levels today that are creating issues for employees when compared to their gross or net income. In other words, the deductible is very high today for the majority of the workforce.

When contribution to the plan (payroll deduction) is factored in as well, a clear picture presents itself. Transferring more incremental cost to the employee is a losing strategy from an employee satisfaction and retention strategy.

For the employer, the need to retain employees is strong and absorbing additional cost in the benefit plan will have strong short-term consideration.

The bottom line: America can expect status quo for 2016, with the exception of a small adjustment here or there.

2017: Year of Digestion — or Indigestion The administration and leaders of Congress that put through the ACA should be commended for the staggered implementation of the components of ACA. Specifically, the heavier items are clearly set to take effect during the next administration, making it someone else’s problem. One issue that the next administration will have to address is the concerns of large business and labor as the implementation of the provisions in the Affordable Care Act (specifically the Cadillac Tax) affects these stakeholder groups.

Earlier this year, Humana and Cigna were absorbed by Aetna and Anthem/WellPoint, respectively. These two mergers may have an impact on the insurance premiums for 2017.

As it relates to the consolidation, it will be interesting to watch how federal and state regulators react to the consolidation with the latter having some authority over how premiums are developed in the individual and small group markets.

Additionally, there are certain industries that will have to prepare in 2017 for the Cadillac Tax, set to take effect in 2018. This excise tax assessed against plans that cost more than the threshold will have several consequences to a business: • To avoid the excise tax the benefit plan will need to be modified starting in 2016

Significant issues are on the horizon that will impact insurance premiums in the future.

•

•

•

Finally, there are additional trends to watch that could potentially impact insurance premiums in 2017: • Provider consolidation. Specifically hospitals and the trend for physicians to become employees of these larger systems rather than remaining independent has caused capacity issues of hospital services as well as shortages in certain specialties (specifically as it relates to treating diseases associated with a population that is aging up); • Provider systems entering the insurance marketplace. This is likely a business strategy larger systems will implement as they have completed the digestion of their integration with other hospitals/health systems and will want to work around the “traditional” insurance carrier market and sell directly to the consumer/employer; • Prescription drug costs. The specialty drug products will continue to rise at a much faster rate versus other cost items that comprise a premium since the demographics of the country are aging up and demand will increase as a result of this coupled with the protections afforded to drugs that are new to the market. Generic drugs will not be developed and introduced while protections exist; • Individual marketplace renewals. Those that participate in exchanges will be a “canary in the coal mine” which may signal what will happen in the group marketplace, specifically the small employer marketplace as it pertains to insurance premium adjustments in the group market.

What Does This All Mean for the Next Three Years?

Can the business or governmental entity raise the revenues to offset the tax if they choose to do nothing; What are the competitive forces that the business operates in and will this — in part — dictate what the business will do?

In the case of a governmental entity, which is publicly financed through tax revenues, can the costs of the tax be absorbed within the tax revenues it receives or will it need to raise taxes to cover the costs associated with the excise tax?

For the business and government entities, this additional tax will also force businesses to make decisions regarding where to invest.

Unlike the practices of the current administration, business cannot “kick this can down the road.” Significant issues are on the horizon that will impact insurance premiums in the future.

In the next six to 12 months, additional trends will emerge that will alter the industry’s views on what insurance premiums will look like in 2017 — not to mention the new administration that will assume control of the federal government.

Hopefully, we can work together to find a cure for the problems we collectively face — how to keep our clients thriving in this new normal.

Perry Braun is the executive director of Benefit Advisors Network and its sister organization, National Benefits Center — together comprising an exclusive, national network of independent employee benefit brokerage and consulting companies. For more information, please visit www.benefitadvisorsnetwork.com or contact the author at pbraun@benefitadvisorsnetwork.com.

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

41

SAVE THE DATE FOR OUR

2016 EVENTS!

EMBASSY SUITES FRISCO

COBB GALLERIA CENTRE

RENAISSANCE HARBORPLACE HOTEL

RED ROCK CASINO RESORT

Registration and more info available at theihccforum.com

By Robin Gelburd President FAIR Health

Dental Benefits

Consumer Attitudes about Oral Health

A

recent consumer survey conducted by ORC International for FAIR Children’s Oral Health Health, an independent, non-profit organization focused on health The survey uncovered apparent confusion about just how early care cost transparency and health literacy, showcases consumer children should start seeing the dentist. Only 15 percent of respondents attitudes about dental care and insurance. The survey found that many were aware that dental professionals recommend that young children Americans do not visit the dentist regularly and are confused about should see a dentist as soon as the first tooth appears. when young children should visit the dentist for their first oral exam.

The American Academy of Pediatric Dentistry notes that preventable Furthermore, the survey reveals that tooth decay is the most common a significant number of people are chronic childhood disease and, if Health experts believe that routine dental turning to the hospital emergency left untreated, can have a long-term, departments for dental treatment. negative impact on a child’s health examinations and preventive care in a The results of this opinion and education, job opportunities poll underscore the need for more dental office setting generally lead to better and general socialization. The consumer education about oral importance of pediatric dental care health and further exploration is reflected in the inclusion of such outcomes, prevent serious health issues of other factors, such as cost and care as an essential benefit under the from developing and provide opportunities Affordable Care Act. access to oral health care services that may possibly serve as a barrier for cost savings for both individual to dental care.

Selection of Dental Benefits According to survey consumers and dental plans. respondents, when it comes to Dental Care in the selecting dental benefits, consumers Emergency Department tend to focus first on the total out-ofRespondents to the summer pocket cost (33 percent), followed 2015 survey, a random sample by the monthly premium (16 of more than 1,000 adults in percent) and whether their dentist America, indicated that while accepted a plan (16 percent) as most Americans (67 percent) their key concerns. visit the dentist at least once each Interestingly, because of the year, 14 percent said they visit connection between oral health the dentist only when they are in and overall health, a dentist may pain or face an urgent oral health often be the first to diagnose a issue. Another 10 percent visit health issue in its early stages. the dentist only once every two to To reap that benefit, however, three years, and six percent say patients must have regular dental they never go to the dentist. examinations so that oral health While some oral health changes can be quickly identified emergencies may require and diagnosed. Based on the FAIR treatment in the ED, the hospital emergency room setting generally is not the appropriate location to Health survey results, consumer education must be promoted and access receive most dental care, whether emergency or routine. The failure to issues must be addressed to help Americans from all socio-economic obtain regular dental care supervised by a practitioner or practice group backgrounds take full advantage of the benefits of consistent dental care.

Highlights of this survey and others can be found on the FAIR Health who can provide consistent, effective care over the long-term may lead to poorer dental health and greater out-of-pocket expenses for consumers website. FAIR Health also offers consumer engagement tools to help than would be incurred if they had continuing relationships with primary individual consumers estimate their dental and medical expenses and dentists. Health experts believe that routine dental examinations and learn about insurance reimbursement. preventive care in a dental office setting generally lead to better outcomes, prevent serious health issues from developing and provide opportunities 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. for cost savings for both individual consumers and dental plans.

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Workplace Wellness

By Nico Pronk, Ph.D. Vice President and Chief Science Officer HealthPartners

Three Ways for Employers to Build Healthy Communities — and Healthy Employees

H

istorically, the private sector has shouldered the burden of direct • Worksite efforts impact only one-third of family members. To address the other two-thirds (spouses and dependents), we need to and indirect health costs, including health plan premiums, workers’ partner with the community. compensation, disability, absenteeism, presenteeism, employee retention and turnover, and low morale. According to the Public Health As you move forward, identify the metrics you will use to measure Institute, as much as 50 percent of company profits may go towards those progress, and be sure to relate it to the business language of profit and costs.

To date, worksite wellness programs have been widely adopted as a investment. way to control health care spending, and to get employees involved. But as a recent report from the Vitality 2. Be aware of what’s Institute confirms, the health of the working — and use it to Employers may have the capability workforce is linked to the overall your advantage health of the community. Employers What do Target, The Dow and capacity to bring leadership and who are committed to reducing Chemical Company, Nike and organization to community health efforts, health care costs and improving Disney have in common? These workforce productivity will need companies are among 25 case but that doesn’t mean they always need to studies of successful community to broaden their approach to good health to reach the community. health initiatives available on Getbe in the driver’s seat.

HWHC.org.

Employers may have the Meet “Healthy Workplaces, capability and capacity to bring Healthy Communities” leadership and organization to community health efforts, but that doesn’t A national initiative to improve the health of all people through employer-community collaboration, “Healthy Workplaces, Healthy mean they always need to be in the driver’s seat. Nonprofits, foundations, and public health and civic leaders are important partners to initiate Communities” is designed to help achieve this important goal.

With support from a variety of organizations, such as the Robert community health collaboration.

Wood Johnson Foundation and the Health Enhancement Research Organization, HWHC has brought together a diverse group of business 3. Engage key community connections leaders and organizations to connect employers and community leaders When you think of leaders in your community, who and what and to provide them with resources for investing in community health. organizations come to mind? Consider other businesses, government, The website, Get-HWHC.org, launched a few months ago and offers nonprofits, social agencies and schools. And consider their stake in the a wide range of case studies and information on emerging practices and health and well-being of your community. practical strategies to drive community health.

In an example described in The Atlantic, Oklahoma City’s mayor For example, here are three ways employers can begin to get involved challenged residents to collectively lose one million pounds. Soon, in community health: churches, schools and employers joined the effort to collectively tackle obesity and address the root cause of a myriad of diseases that contribute to significant health care spending.

1. Understand how to make the business case Employers ultimately need to recognize that health and well-being Including workplace wellness program goals and metrics in an organization’s strategic plan has been recognized as critical for success and is more than a nine-to-five proposition and that they can play a key role in change by providing leadership, directing corporate philanthropy, sustainability. It’s also critical for launching a community health effort.

When talking to corporate leadership, be clear about how the health advocating for effective policy, boosting volunteerism, and promoting of your community impacts your business. Consider these potential health throughout their community. messages: • The health of the community is linked to company sustainability Nico Pronk, Ph.D., is vice president and chief science officer at HealthPartners. He co-chairs the HERO Employer-Community Collaboration Study Committee, which serves because the workforce comes from our community. as the governing body for the HWHC initiative.

• Partnering with the community can result in business opportunities and increased purchasing power.

44 Fourth Quarter 2015 I www.TheIHCC.com I HealthCare Consumerism Solutions™

Flexible Spending Accounts

By Jeremy Miller Founder and President FSAstore.com/HSAstore.com

Improve Employee Satisfaction with FSA Education: Tips and Reminders for Year-end FSA Spending

O

pen enrollment is a done deal for many companies, but employees — especially those who are facing a year-end flexible spending account deadline — still need support and direction from human resources and benefits professionals.

Recent surveys have shown that consumers still don’t fully understand how their spending accounts work and, more importantly, that they look to their employers as a source of education and information about how to use their accounts. You can improve employee education, engagement and satisfaction with your company’s FSA by reminding employees of these key spending account tips and reminders.

The most common questions people have about FSAs at this time of year are:

1. When is the deadline to submit expenses?

For many employers, December 31 is the deadline for employees to spend down FSA funds — or risk forfeiting unused dollars. This is commonly known as the “Use-it-or-lose-it” rule.

2. Is there an extension for spending FSA dollars?

Be sure to communicate clearly (and often) if your company offers one of the following plan features that give employees extra time to spend down their FSA or submit expenses for reimbursement: • Carryover or Rollover Option: This allows employees to carry over up to $500 of unused FSA dollars to the next plan year. This amount is added to their balance for the next year.

• Grace Period: A grace period gives employees two-and-a-half months beyond December 31 (until March 15) to incur expenses and spend unused FSA dollars.

• Run-Out Period: A run-out period gives employees additional time (usually 90 days) beyond the end of the plan year to submit reimbursement requests for eligible expenses, but only if those expenses were incurred during the plan year.

Employers can offer the carryover option or a grace period, but not both. Your company is not required to offer either of these options, but if your plan includes an extended deadline, that means employees have more time and flexibility to use their accounts, so be sure they understand this benefit.

3. How can FSA dollars be used?

Spending FSA dollars doesn’t have to be a chore, once employees know what’s eligible and where to shop. For one-stop FSA shopping and a complete list of eligible expenses, visit FSAstore.com.

In the meantime, here are the 10 most common FSA expenses: 1. Thermometers 2. First-aid kits/Band-aids 3. Electrotherapy pain relief kits 4. Handheld steam inhalers 5. Breast pumps 6. Blood pressure monitors 7. Eye care products (contact lenses, contact lens care and prescription eyeglasses) 8. Shoe inserts 9. Orthopedic neck supports 10. Warm steam vaporizers In addition to the following lesser-known, but still eligible FSA expenses, don’t miss the opportunity to inform employees about the fact that they can use FSA dollars to pay for copays, deductibles and coinsurance costs. If employees are looking for something off the beaten path, try these products: 1. Defibrillators 2. Smartphone-compatible items from Hi-Tech Health 3. Hot or cold therapy stuffed animals, like those by Thermal-Aid 4. Sunscreen (broad spectrum, SPF 15+) 5. KT tape 6. Acne treatment through laser therapy (non-medicated treatment) 7. Prenatal vitamins 8. Stethoscopes Once employees understand FSA deadlines and eligibility, you can help them maximize their time and get reimbursed faster by offering an FSA debit card, which eliminates waiting for reimbursement. Providing access to an online FSA calculator to help estimate annual account contributions and stay on top of spending throughout the year can also be of great value to employees. Your FSA administrator may offer an online calculator, or you can find one at FSAstore.com.

Jeremy Miller is president and founder of FSAstore.com and HSAstore.com, companion websites dedicated exclusively to products that are eligible for reimbursement with a flexible spending account or health savings account.

46 Fourth Quarter 2015 I www.TheIHCC.com I HealthCare Consumerism Solutions™

By Erin McCarthy Business Development Manager StayWell

Cheretta Clerkley, MBA, CASE, CME Director, Hormone Health Network Endocrine Society

Employee Communication

Taking Employee Health Education to The Next Level

M

enopause isn’t exactly water cooler chatter, but it’s a fact of life that impacts millions of working Americans, influencing their work performance and how they interact with others on the job.

Employers can benefit from understanding how a little education can go a long way to helping female employees effectively manage their menopause symptoms.

It’s estimated that by 2020 the menopausal population in the United States will double, with more than 75 percent of working women experiencing symptoms, such as changes in memory and concentration, fatigue due to sleep disorders and mood swings — all of which can affect work performance.

A national survey by the Working Mother Research Institute and Pfizer on the impact of menopausal symptoms on women in the workplace found that managing menopausal symptoms at work is extremely or somewhat difficult for nearly half (48 percent) of working women between the ages of 45 and 65 who have experienced symptoms in the past year.

That’s why StayWell and the Endocrine Society’s Hormone Health Network teamed up to produce an online resource and campaign to educate women about menopause, so they can better manage their symptoms.

Finding a Place for Health Education at Work The fact that the majority of people still get their health benefits through their employer, coupled with the fact that the average American spends more than 2,000 hours a year on the job, means that employers can play a crucial role in helping employees manage everyday health.

Whether that support comes in the form of collaborating with health care organizations to provide educational resources or connecting employees to the right health care providers who can deliver the best treatment options for them.

The campaign from StayWell and the Endocrine Society provided education and support through the following tools: • A multi-channel communication approach, that included an online experience, digital and print, video and in-person consumer and health care provider events; • Peer-to-peer support in the form of a partnership with the Red Hot Mamas, the nation’s leader in menopause education, outreach and patient support; • Calculators that allowed women to asses their risk for heart disease and osteoporosis, as well as evaluate calcium intake and caloric burn rate; • Access to shared decision-making tools that helped women manage their day-to-day and long-term symptoms, such as a medication tracker, symptom tracker, questions for health care providers and links to resources;

•

•

A social media campaign to break through the stigma of menopause and encourage people to talk about their symptoms and share information; and A companion microsite and toolkit to engage health care providers.

Improving Results for Women Everywhere The campaign and partnership delivered numerous positive results.

In addition to receiving a National Information Award and a Web Health Award, the interactive campaign recorded nearly 76,000 page views, a social media reach of more than 142,000 and an open rate of 35 percent for the e-newsletter. But more importantly: • More than 62 percent of women surveyed said they have a better understanding of menopause and the factors that affect it, and • More than 83 percent of women surveyed say they understand the health risks of menopause and how to reduce those risks.

When it comes to managing changes in health status, there are three simple steps employers can take to educate employees and to create a more supportive environment: • Talk about it. Only one percent of women say their employers offer support specifically for women in menopause.

• Encourage peer support. Encourage employees to come together in the workplace to share information and to learn about ways to manage their health status.

• Provide credible resources. Provide employees with the turnkey resources (like the Menopause Map) that can help them actively take charge of their health.

As our population and workforce continues to age, employers need to more cognizant of how health topics like menopause are affecting their employees and what they can do to create an environment that is educational and supportive.

Erin McCarthy, Business Development Manager, StayWell: As a senior new business developer and strategist for StayWell, McCarthy consults with medical associations and nonprofit patient advocacy groups to identify goals and long-term communications and engagement solutions that advance organizational brands. McCarthy serves on the executive board for the YWCA Greensboro where she chairs the advocacy and racial justice committee. Erin holds a B.A. in communications studies and English literature from Trinity College in Vermont.

Cheretta Clerkley, MBA, CASE, CME, Director of the Hormone Health Network, Endocrine Society: In her position as director of the Hormone Health Network for the Endocrine Society, Clerkley is responsible for leading the revitalization of the Network’s public education programs and was instrumental in the redesign and launch of the new Menopause Map. Clerkley serves on the board of Temple University’s Young Alumni Donor Association and volunteers as a mentor for the Bill and Melinda Gates College Success Foundation. She received her Bachelor’s degree in journalism from Temple University and her Master’s in Business Administration from the University of Maryland College.

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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.

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.

Avidia Health, a division of Avidia Bank, is an HSA marketplace leader, offering a No Fee product combined with personal attention. Headquartered in Massachusetts, Avidia Bank is an FDIC insured bank with accounts in all 50 states.

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

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.

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

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.

Claritas MindSciences brings the practice of mindfulness, emerging digital technology and behavioral psychology to develop and scale mobile solutions that will enable people to control their cravings & addictions.

Consumer Medical

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

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

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

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

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

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, onpremise and cloud computing healthcare solution that administers reimbursement accounts.

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.

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Affiliate Member Profiles

Access these solution providers online at www.theihcc.com. hC entiv e hCentive is a provider of cloud-based technology that helps consumers connect, communicate and engage in acquiring health insurance benefit products.

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.

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.

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.

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

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.

Paylogix: Paylogix® solutions facilitate benefit communication, enrollment and administration for payment processing and secure data management spanning from promotion-topayment.

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

HealthExpense Own Your Healthcare

TM

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

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.

Pantone 102c

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.

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

75% BK

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.

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.

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.

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

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

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.

RedBrick Health, a consumer health engagement company, helps create behavior change and clinically-meaningful improvements in objective measures like BMI, blood pressure and cholesterol.

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

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Affiliate Member Profiles

www.theihcc.com

The Institute for HealthCare Consumerism Affiliate Member Profiles 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.

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

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

TailorWell is changing how brokers help small employers buy and manage health insurance and other employee 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®.

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

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.

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.

Advertising index If you use the services of our solutions providers, please tell them you saw their ad in HealthCare Consumerism Solutions™.

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

ADP........................................................ 16 Aetna........................................ Back Cover BenefitAlign......................................HCX-5

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BenefitWallet..................................HCX-13

Advertising contacts

Connecture.......................................HCX-8

404.671.9551 sales@theihcc.com

HCCS Mobile App.................................... 45

ceo

Doug Field 404.671.9551 ext. 101 • dfield@ theihcc.com Chief Marketing Officer

Andrew Dietz adietz@theihcc.com

Rogers Beasley 404.671.9551 ext 109 • rbeasley@theihcc.com

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Withings: Withings leads the connected health revolution. Our beautifully designed award-winning products bring long-term engagement and measurable health impacts to your workforce.

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

Director of Conference Sponsorship/ Corporate Membership/Reprints

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.

WellRight: WellRight is a provider of corporate wellness software and its solutions help increase the physical and mental well being of employees.

Cigna................................................HCX-2

ConnectYourCare.................................... 39

IHC Events.............................................. 42 IHC Private Exchange Preview...........10-11 IHC Certification (CHCC).........................36 Quadrant4.......................................HCX-16 RedBrick Health..............Inside Back Cover

Account Managers

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

Michelle Gatehouse 404.405.3007 • mgatehouse@theihcc.com

TSYS........................................................5

Ted Arvan 678.296.1906 • tarvan@theihcc.com

WiserTogether........................................ 13

Todd Cusumano 561.320.9841 • tcusumano@theihcc.com

WageWorks.............................................. 7

People empowered We provide technology-enabled enterprise solutions that empower people to improve their health behaviors and make smarter healthcare decisions.

Want meaningful engagement and real results?

Visit us at RedBrickHealth.com/ShowMe or email us at ShowMe@RedBrickHealth.com.

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

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

Building a healthier world HealthCare Consumerism.

Aetna is proud to sponsor The Institute for HealthCare Consumerism.

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

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