2016 HealthCare Consumerism Outlook

ISSUE || Annual 2016

2016

The Institute for HealthCare Consumerism

Our Experts Share Insights

Best Practices. Innovation.

Expert Insights.

The Official Magazine of

www.theihcc.com

2016

The Institute for HealthCare Consumerism www.theihcc.com

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HEALTH CARE CONSUMERISM How does health care consumerism fit into the history of reforms?

Many employers are stepping up and addressing employee concerns by realizing they have options for creating a balanced benefits program.

LEGAL & COMPLIANCE

By Nick Rockwell, Senior Consultant, Eastbridge Consulting Group, Inc.

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By John Hickman, Esq. and Steven Mindy, Esq. Alston & Bird, LLP

It’s vital for business leaders to also understand that health doesn’t just consist of physical well-being.

By Cathy Kenworthy, President & CEO, Interactive Health

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Now, the latest emerging body of research shows there may be yet another reason to invest in a healthy workforce: improved stock performance.

Bending the Health Care Cost Curve to Avoid the Cadillac Tax The so-called Cadillac Tax provision of the Affordable Care Act has created much anxiety among employers, benefit advisers and patient advocacy groups.

By Jessica Grossmeier, Vice President of Research, HERO

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HEALTH CARE TRANSPARENCY The Movement for Transparency in Health Care

HEALTH PLANS

Consumer demand will eventually force a total shift towards transparency, but in the meantime individual consumers are vulnerable.

The Opportunity of Telehealth for Health Plans Now it’s health care’s turn to empower individuals with integrated, personalized tools.

By Ceci Connolly, President and CEO, Alliance of Community Health Plans

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HEALTH MANAGEMENT Expanding the Value Proposition for Employee Health and Well-Being

HEALTH SAVINGS ACCOUNTS

By Roy Ramthun, President, HSA Consulting Services

PROVIDER FORECAST: WORKPLACE WELLNESS The Future of Wellness: Holistic Program Links Physical and Emotional Health

In many cases, common benefit design practices for employer credits and opt-outs must be revisited prior to the next annual enrollment.

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VOLUNTARY BENEFITS Have You Found the Right Balance in Your Benefits Program?

IRS Guidance Creates New Burdens for Exchanges and Other Defined Contribution Health Care Arrangements

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(From the publishers of HealthCare Consumerism Solutions, the official magazine of The Institute for HealthCare Consumerism)

The Development of Health Care Consumerism in the United States

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

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INSIDE

By Leah Binder, President & CEO, The Leapfrog Group

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HEALTH ENGAGEMENT An Uneven Playing Field

PRIVATE EXCHANGES

Low-wage workers face difficult choices in today’s highout-of-pocket health care system.

Are You Ready for an Exchange?

Many plan sponsors are entertaining a transition to a defined contribution approach, away from the employerdriven model to a consumer-driven one.

By Bruce W. Sherman, MD, and Wendy D. Lynch, PhD

By Paul Rooney, Managing Partner, EBS Capstone

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PHARMACY BENEFITS The Specialty Pharmacy Elephant If you want to talk about growing health care costs in the United States, specialty pharmaceuticals is one topic which gets people excited for multiple reasons.

By George Van Antwerp, Senior Manager, Deloitte Consulting LLP

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MEDICAL TRAVEL Employers of Every Size Embrace Medical Travel U.S. domestic medical travel represents an effective way for employers to lower costs while giving plan members access to quality care.

By Laura Carabello, Editor and Publisher, Medical Travel Today

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INSIDE 38

LEARN.CONNECT.SHARE.

DIRECT PRIMARY CARE

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More Employers Exploring Direct Primary Care, Concierge Medicine

TELEHEALTH

The way companies and their employees get access to and pay for health care is evolving quickly.

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verbaska/shutterstock.com

By Michael Tetreault, Editor-in-Chief, and Catherine Sykes, Managing Editor, The Direct Primary Care Journal

TELEHEALTH Consumerism is Driving Telehealth Growth, and It’s Here to Stay

The system is designed to help nurses quickly identify signs of a patient’s worsening condition and work with the individual and his or her physician to create custom interventions to provide needed care rapidly.

There is plenty of evidence of consumers’ desire for convenience and how it is driving health care options.

By Krista Drobac, Executive Director, Alliance for Connected Care, and Partner, Sirona Strategies

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ONSITE CLINICS The Evolving Role of Employer Clinics: from Occupational Health to Population Health Management Today, the services provided by employers at the worksite run the entire spectrum of health care.

By Larry S. Boress, Executive Director, National Association of Worksite Health Centers

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PHARMACY BENEFITS

BROKERS & ADVISORS

pogonici/shutterstock.com

Three Strategies to Solve Your Customers’ Fundamental Problems – and Propel Your Long-term Growth Our industry is in the midst of unprecedented change and disruption.

By Les McPhearson, CEO, United Benefit Advisors

Departments 6

Publisher’s Letter

48-50 Affiliate Member Profiles 50

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Resource Guide/Ad Index

Annual Outlook 2016 I www.TheIHCC.com I HealthCare Consumerism Solutions™

While a lot of our focus is on cost management through formulary, copays and utilization management, we spend a lot less time thinking about the patient journey and how that varies by age, gender, condition, geography and other attributes.

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2016 EVENTS!

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LETTER

PUBLISHER

2016 www.theihcc.com VOLUME 12 NO. 2 | ANNUAL OUTLOOK 2016

The Next Steps 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

Looking back at past issues of HealthCare Consumerism Outlook, one quickly notices a key difference this year: a lack of regulatory anxiety. With the delay of the Cadillac Tax until 2020, there’s currently a relative calm before the potential storm of the upcoming presidential election in November.

Since the passage of the Affordable Care Act, there has been a steady current of regulatory issues affecting (and, in some cases, hindering) employers’ benefits strategies; however, in 2016 so far, we’re seeing many employers that are ready to embrace innovation and change. And much of the innovation that has sprung up in the last five years is now more or less familiar throughout the HR/ benefits community and, in many cases, is beginning to be widely implemented.

Telehealth, for example, is now nearly a staple for employers, health plans and physicians alike.

According to a recent survey from Willis Towers Watson, 67 percent of employers offer a telehealth program to their employees, and this number could potentially rise to 90 percent within two years. In this year’s issue, the growing importance of telehealth is reflected in articles from both Ceci Connolly, now the president and CEO of the Alliance of Community Health Plans, and regular contributor Krista Drobac of the Alliance for Connected Care.

The embrace of telehealth is also part of a greater acceptance by employers of exploring alternative means of health care access. While medical travel and direct primary care, for example, are by no means recent innovations, their growth among the employer sector has been strong over the past few years. Laura Carabello of Medical Travel Today and Catherine Sykes and Michael Tetreault, both with The Direct Primary Care Journal, provide insights on domestic medical tourism and direct primary care/concierge medicine respectively in this issue.

Equally as important as the employer innovation, benefits brokers/advisors seem to largely be coming into their own in this new consumer-driven, digital era of employer-sponsored health care and benefits. Les McPhearson, the chief executive officer at United Benefit Advisors, offers readers strategies to meet their clients’ needs in “the midst of unprecedented change and disruption” that we’re seeing today.

Ultimately, no single strategy is likely to be the “silver bullet” of fixing all of an employer’s health care and benefits goals. However, as is reflected in this issue, employers already seem increasingly committed to these goals in 2016 and are exploring and utilizing a wide range of strategies both old and new. Despite what regulatory or legislative changes may come ahead in 2017, the outlook from here looks good.

On behalf of everyone at The Institute for HealthCare Consumerism, I would like to thank all of this year’s contributors for their time and dedication to providing in-depth, lasting insights in their areas of expertise. And to all of our readers, I hope you find this to be a valuable issue throughout the upcoming year and beyond.

Doug Field 404.671.9551 ext. 101 · dfield@ 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 BUSINESS DEVELOPMENT

Tonya Warner twarner@theihcc.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 PARTNERS/ALLIANCES

Joni Lipson 800.546.3750 · jlipson@fieldmedia.com

Sincerely,

HealthCare Consumerism Solutions™ Volume 12 Issue 2 Copyright ©2016 by FieldMedia LLC. All rights reserved.

Doug Field CEO/Publisher dfield@fieldmedia.com

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.

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

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BECOME CERTIFIED IN HEALTHCARE CONSUMERISM (CHCC)

Be the go-to person for health care consumerism expertise in your organization and become recognized as a leader in the health and benefit management industry.

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.

2016 Health Care Consumerism

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

The Development of Health Care Consumerism in the United States Winston Churchill once said, “You can always count on Americans to do the right thing — after they’ve tried everything else.”

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ell, the United States has tried many different ways to lower the cost, expand access and improve the quality of health care. We have tried payment reforms, insurance reforms, cost shifting, self-insured funding, HMOs, PPOs and a myriad of other initiatives. How does health care consumerism fit into the history of reforms?

Below is a time line of where we came from and how we got to the “market-oriented, consumer-centric, patient-centered, personalized health” that we now call “health care consumerism”. So, sit back, relax and enjoy the history lesson because as the old saying goes, “Those who do not learn history are doomed to repeat it.”

Up until the early 20th century the federal government left health insurance matters to the states. The states, in turn, left health insurance up to private and voluntary programs. Here are key moments that formed the legal and market forces leading to health care consumerism.

1920s-30s

Blue Cross Blue Shield: In 1929, Baylor University’s health care facilities started the first insurance program in America for teachers in the Dallas area. During the Depression years when most could not afford a hospital stay, a new financing system was adopted with a fixed cost (premium) that was paid for a guarantee of a limited number of hospital days. This became Blue Cross. Following the lead of hospitals, Blue Shield was developed by employers in lumber and mining camps of the Pacific Northwest to provide medical care by paying monthly fees to groups of physicians.

In 1939, the first official Blue Shield plan was founded in California. Ultimately, BC and BS joined to become dominant players in the U.S. health insurance industry.

1944

Public Service Act: The Public Health Service Act was enacted in 1944. It gave the United States Public Health Service responsibility for preventing the introduction, transmission and spread of communicable diseases from foreign countries into the United States.

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1940s

Employer-based Health Insurance: During World War II, wage and price controls were placed on American employers.

To compete for workers, companies began to offer health benefits, giving rise to the employer-based system.

1965

Medicare and Medicaid: In 1965, President Johnson signed the Medicare and Medicaid programs into law, providing comprehensive, low-cost health insurance coverage to elderly and low income individuals.

1974

ERISA: The Employee Retirement Income Security Act of 1974 was enacted September 2, 1974. While originally thought to cover only retirement plans, subsequent court cases established selfinsured health plans under ERISA to be exempt from state insurance laws. Self-insured plans shift the risk of plan solvency from insurance companies to employers. These rulings started the movement towards widely used self-insured plans that use insurers and TPAs as administrators.

Subsequent amendments to ERISA include: a. The Consolidated Omnibus Budget Reconciliation Act of 1985 which provides some employees and beneficiaries with the right to continue their coverage under an employer-sponsored group health benefit plan for a limited time after the occurrence of certain events that would otherwise cause termination of such coverage. b. The Health Insurance Portability and Accountability Act of 1996 prohibits a health benefit plan from refusing to cover an employee’s pre-existing medical conditions in some circumstances. It also bars health benefit plans from certain types of discrimination on the basis of health status, genetic information or disability. c. Other relevant amendments to ERISA include the Newborns’ and Mothers’ Health Protection Act, the Mental Health Parity Act, and the Women’s Health and Cancer Rights Act.

1978

Flexible Spending Accounts: This is the first account-based option for employee contributions. However, it included a use-itor-lose-it provision for unspent funds at the end of a calendar year. Allowed by Treasury in 1978, flexible spending accounts provide for employees to have their compensation reduced by

an amount necessary to cover certain fixed benefit costs and non-fixed benefit costs with pre-tax dollars rather than aftertax dollars. Eligible benefit costs include health insurance premiums, dependent care, dental care, vision care, other services not reimburse by the regular health plan, etc.

1973

HMO Act: It was the first step in creating a managed care system. Enacted December 29, 1973, the federal HMO Act provided for a trial program to promote and encourage the development of HMOs. The HMO Act amended the 1944 Public Health Service Act.

1970s-80s

PPOs/EPOs: This was the first step in creating proprietary insurance owned provider discounted networks. In the 1970s, employers began using preferred-provider organizations. PPOs steer employees to cooperating doctors and hospitals that have agreed to a predetermined discount reimbursement for services provided.

Various forms of PPOs were created, including exclusive provider organizations that were very limited generally localized networks of hospitals.

1983

DRGs: This was the first phase of establishing a bundled payment for hospital services. On October 1, 1983, Medicare’s new Prospective Payment System became effective for payment of services to hospitals. According to this payment scheme, hospitals are paid a fixed amount per patient discharge. The rate of reimbursement will be based on diagnosis related groups, a classification of 467 illness categories. For Medicare, the prospective payment system replaces the fee-for-service plan in which the payment is cost-based and retrospectively determined following treatment.

New opportunities were opening to serve employers, state Medicaid programs and seniors on Medicare.

Hospitals concluded that the best way to regain some of the economic power they had lost to HMOs was to try and play the same game.

We have tried payment reforms, insurance reforms, cost shifting, selfinsured funding, HMOs, PPOs and a myriad of other initiatives. How does health care consumerism fit into the history of reforms?

1990s

Hospital-owned HMOs: This was the first movement towards provider risk-bearing through owned insurance companies. During the mid-1990s, starting hospital owned HMOs was a managed case growth industry. New opportunities were opening to serve employers, state Medicaid programs and seniors on Medicare. Hospitals concluded that the best way to regain some of the economic power they had lost to HMOs was to try and play the same game. From 1995 to 1997, literally dozens of HMOs were formed (or acquired in a few cases) by hospital organizations.

1996

Medical Savings Accounts : The MSA must be coupled with a high-deductible health plan.

This is first form of consumer-driven health care. Pat Rooney, founder and president of Golden Rule Insurance Company, was instrumental in the 1996 passage of medical savings account pilot program that allows for tax-free contributions to a medical savings account. It was passed as a part of the Health Insurance Portability and Accountability Act in 1996.

1996

Health Reimbursement Arrangements: HRAs were the first non-pilot savings accounts option that spurred the initial consumer-driven health care movement. While only employer allotments were allowed, this is first time a continuous carry forward of an account was allowed. An HRA is an arrangement that: (1) is funded solely by the employer; (2) reimburses the employee for medical care expenses incurred by the employee and the employee’s spouse and dependents and; (3) provides reimbursements up to a maximum dollar amount for a coverage period and any unused portion of the maximum dollar amount at the end of a coverage period is carried forward to increase the maximum reimbursement amount in subsequent coverage periods.

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2016 Health Care Consumerism

2003

Health Savings Accounts: HSAs are the first to financially empower employees with medical dollars to spend in addition to coverage under high deductible health plans. HSAs continued a trend of employee empowerment and the movement to consumer-driven health care. In December of 2003, the Medicare Modernization Act prescription drug bill was passed that also included health savings accounts. HSA are real dollar put into savings account and owned by employees. Employers, employers, and even other third parties can contribute triple tax advantaged dollars into an HSA (tax deductible, tax-free accumulation and non-taxed qualified withdrawals).

2005

Health Care Consumerism: Health care consumerism is the natural market extension of account-based plans. As account-based plans, including HRAs and HSAs, gained favor in reducing costs, additional support services surfaced to expand on the pure account-based plan designs. Wellness initiatives, disease management, incentives and rewards, and health education allowed for effective engage of plan members in making better informed health and health care decisions.

2010

The ACA & Health Care Marketplaces: The development of health care consumerism has been spurred on by the Patient Protection and Affordable Care Act that was signed into law on March 20, 2010.

The ACA established comprehensive health insurance reforms, including the creation of health insurance marketplaces (also called health exchanges). The ACA-mandated coverages have highlighted the relative affordability of HSAs paired with high deductible health plans. The health marketplaces, sometimes

Government laws and regulations will continue to form the basis for change and opportunities, but the concept of empowering individuals is an unstoppable megatrend now encompassing health care.

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under employer fixed defined contribution financing, offer individuals more choice of coverages. Health care consumerism has continued to grow and flourish under the ACA.

2016

AND BEYOND

The Future of Health Care Consumerism: Health care consumerism continues to evolve. New care models are developing from telehealth, direct payment, concierge services to Accountable Care Organizations. Private health exchanges or marketplaces are developing to offer more options, choices and alternatives to consumers. We are shifting emphasis from health insurance reform to health care reform. We also see a shift from a focus on health to a desire for productive longevity. Science, genomics, technology and social media will likely influence the course of future health care products and care. Government laws and regulations will continue to form the basis for change and opportunities, but the concept of empowering individuals is an unstoppable megatrend now encompassing health care.

The Institute for HealthCare Consumerism believes that there are least five generations of consumerism that are currently developing and are at differing stages of maturity. The first generation is mainly about high-deductible health plan designs.

The second generation has a focus on shared savings (incentives and rewards) that support behavior changes. The third generation design relates to population health and the interactions of workplace health and productivity. The fourth generation is about personalized health care. And, the fifth generation connects health care needs to community involvement and group health and health care support activities.

It’s an exciting future that will unfold as market forces build products to serve consumers and enhance the patient-provider relationship.

Ronald E. Bachman has been at the center of U.S. health care transformation, advancing free market, consumer-based solutions to lower the number of uninsureds, improve mental health coverage and advance employer introductions of health care consumerism. Currently he is the president and CEO of Healthcare Visions, a thought leadership firm dedicated to advancing ideas and policy initiatives that are impacting the U.S. health care market. He is also currently the chairman of the Editorial Advisory Board at The Institute for HealthCare Consumerism. Formerly, Bachman was a principal with PricewaterhouseCoopers, where he consulted to a broad range of clients including: employers, HMOs, hospitals, physicians, indemnity carriers and Blue Cross Blue Shield plans, as well as state and federal agency clients.

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

For Health Savings Accounts, Flexible Spending 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.

Š2016 WageWorks, Inc. All rights reserved.

2016 Legal & Compliance

BY JOHN HICKMAN, ESQ. AND STEVEN MINDY, ESQ. ALSTON & BIRD, LLP

IRS Guidance Creates New Burdens for Exchanges and Other Defined Contribution Health Care Arrangements In IRS Notice 2015-87, the IRS provided much-needed guidance on how exchange arrangements may be impacted by the so-called “pay or play” (IRC Section 4980H) employer shared responsibility requirements. In many cases, common benefit design practices for employer credits and opt-outs must be revisited prior to the next annual enrollment.

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he IRS first issued helpful FAQs that addressed some current practices related to individual medical policies and employer sponsored arrangements. In FAQ 5, the IRS clarified that an HRA or other defined contribution arrangement can reimburse individual coverage that is restricted to excepted benefits only. Typically, such excepted benefits include standalone dental and vision coverage. When funded through an HRA (as opposed to salary reduction through a cafeteria plan or cashable credits through an exchange arrangement), such coverage should not include specified disease or other fixed indemnity coverage. In FAQ 6, the IRS confirmed that a cafeteria plan that allows employees to purchase individual market major medical coverage with pre-tax dollars would be considered an employer payment plan and thus

In FAQ 5, the IRS clarified that an HRA or other defined contribution arrangement can reimburse individual coverage that is restricted to excepted benefits only. Typically, such excepted benefits include standalone dental and vision coverage.

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would be prohibited from funding individual market major medical coverage. This ruling precludes cafeteria plan arrangements (as well as employer sponsored exchange arrangements) from funding individual market major medical coverage.

The IRS next addressed how employer credits would be treated under the so-called pay or play provisions of IRC 4980H. Depending on how an exchange (or other defined contribution plan) is structured, FAQ 8 concludes that employers may not get credit for employer contributions that can be cashed out or used for non-medical coverage. Moreover, under FAQ 9, amounts that can be cashed out as “opt-out” credits may actually increase the cost of coverage under the IRC 4980H analysis.

Employers should review this guidance carefully to ensure that their exchange/defined contribution arrangement does not give rise to unintended compliance problems.

Health Flex Contributions Under FAQ 8, certain employer credits reduce the employee’s required contribution for 4980H affordability purposes when they are “health flex contributions”. Health flex contributions are employer contributions that the employee: 1. Cannot opt to receive as a taxable benefit; 2. May use to pay for minimum essential coverage; and 3. May use exclusively for Section 213 medical care.

For purposes of the IRC 4980H(b) excise tax (the “tackhammer penalty”), as well as Section 6056 reporting (IRS Form 1095-C), a health flex contribution is treated as made ratable for each month of the period it relates to.

Employer contributions that are not health flex contributions do not reduce the employee’s required contribution for affordability purposes. Thus, if an employee can use a flex credit to pay for non-health care benefits (for example, dependent care, an HSA or life insurance), then the flex credit will not reduce the amount the employee pays toward the employer’s group health plan for affordability purposes even if the employee ultimately uses the credit for health coverage.

Example: An employee who elects self-only health plan coverage must pay $200 per month toward the cost of coverage. The employer offers flex contributions of $600 per year that can only be applied toward the employee share of health plan coverage or contributed to a health FSA. In this case, the flex contribution is a health flex contribution regardless of whether the employee applies it to the employee share of health plan coverage or contributes it to the health FSA. For Section 4980H(b) and its reporting under Section 6056, the employee’s monthly required contribution for group health coverage is $150 ($200 – $50).

Note that the amounts above are based on the example in Notice 2015-87. However, if more than $500 of the health flex credit can be contributed to a health FSA, then the health FSA would not be an excepted benefit, which means that the health FSA would be subject to the ACA’s market reforms. Plan sponsors should use caution when applying this example.

Example: An employee who elects self-only heath plan coverage must pay $200 per month toward the cost of coverage. The employer offers flex contributions of $600 for the plan year that can be used for any cafeteria plan benefit, including non-health benefits like dependent care. The flex credit is not available as cash. In this case, the flex contribution is not a health flex contribution and does not reduce the employee’s required contribution because it can be used for purposes other than medical care.

Again, note that a flex credit of more than $500 that cannot be cashed out would prevent a health FSA from being considered an excepted benefit, which would violate the ACA’s market reforms.

Employers offering benefits through an exchange-based (or defined contribution) arrangement should carefully review this guidance. If they intend for credits to reduce the cost of coverage for affordability purposes they must ensure that the credits can only be used for health coverage purposes. Solely for purposes of the Section 4980H(b) tackhammer penalty and for plan years beginning before January 1, 2017, employer flex contributions that are not health flex contributions, but that can be applied toward health coverage, will be treated as reducing the employee’s required contribution for health plan coverage. However, these flex contributions must be made under an arrangement adopted before December 17, 2015.

Opt-out Credits Many employers provide “opt-out credits” for employees who decline health coverage. Under FAQ 9, the IRS clarified its position regarding unconditional opt-out payments, which are payments when an employer offers an amount that cannot be used for coverage under its health plan and is only available if the employee declines

An opt-out payment is “unconditional” if it is conditioned solely on the employee declining coverage and not on the employee satisfying other meaningful requirements, such as providing proof of coverage through a spouse’s employer. or waives coverage. An opt-out payment is “unconditional” if it is conditioned solely on the employee declining coverage and not on the employee satisfying other meaningful requirements, such as providing proof of coverage through a spouse’s employer.

The IRS stated that the choice between cash and coverage for an unconditional opt-out payment is the same as the cash or coverage choice employees make with salary reductions. In both cases, the employee can purchase health coverage only by giving up a specified amount of cash that he or she would otherwise receive (in other words, salary for salary reductions, or other compensation for the opt-out payment). For example, an employee who must reduce his or her compensation by $1,000 to pay for employer-provided health coverage is making a choice similar to the employee who is not required to pay anything for coverage, but who receives an additional $1,000 in compensation for declining coverage. In both cases, the employee must give up $1,000 in compensation that otherwise would be available.

Example: An employer requires employees who elect self-only coverage to contribute $200 per month through its cafeteria plan. However, the employer offers an additional $100 per month in taxable wages if the employee declines coverage. The offer of $100 in additional compensation has the effect of increasing the employee’s contribution to $300 per month because he or she must forgo $100 per month in compensation in addition to the $200 per month salary reduction for coverage.

The IRS intends to issue proposed regulations regarding this rule. However, the IRS anticipates amounts offered or provided under an unconditional opt-out arrangement that is adopted after December 16, 2015, will increase the employee’s contribution for affordability purposes.

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2016

BY ROY RAMTHUN PRESIDENT HSA CONSULTING SERVICES

Health Savings Accounts

Bending the Health Care Cost Curve to Avoid the Cadillac Tax The so-called Cadillac Tax provision of the Affordable Care Act, a 40 percent excise tax on “overly generous” employee health benefits, has created much anxiety among employers, benefit advisers and patient advocacy groups.

Sadly, the rise in utilization has origins in the declining health status of our population, evidenced by smoking and obesity and their side effects. For example, almost 17 percent of adult Americans still smoke despite a decades-long anti-smoking campaign, and health care costs related to Most of these stakeholders, including scores of politicians smoking amount to more than $170 billion annually. and presidential candidates, simply want the excise Although anti-smoking efforts have had tax repealed. Only some economists and Obama a fairly dramatic impact on smoking rates administration officials continue to support keeping the in America over the past 40 years, much of these health-related gains have been offset provision in place. by rising obesity rates.

For example, the percentage of ongress recently provided some temporary relief in the Americans who are obese has more than doubled since 1980. From form of a two-year delay on its implementation, but did 1995 to 2010, the incidence of diabetes increased by 50 percent or not repeal the tax, so the anxiety continues. The threat more in 42 states and by 100 percent or more in 18 states. of the tax may have already served at least some of its Widespread obesity has a significant impact on health care purpose, however, in forcing employers to think seriously about how spending and is expected to continue its dramatic increase in the to avoid being taxed. future. In 2012, diabetes accounted for an estimated $245 billion in No company wants to pay any tax, but is it more important to medical spending. repeal the tax or address the challenges of rising health care spending Recent efforts by employers have kept employee-benefit cost head-on? growth to single digits, but these costs are still rising by more than It is no secret that health insurance premiums and workers’ two times the rate of general inflation. At that pace, it’s no wonder contributions to them have both risen by more than 200 percent over employers worry about hitting the Cadillac Tax at some point in their the past 16 years (1999-2015), far outpacing both growth in workers’ future. earnings and general inflation.

Changes in benefit plan design have had the most impact, as the While some of the increase has been caused by the rising costs ACA has limited employers’ ability to reduce covered benefits. in health care goods and services, health care utilization changes have also contributed significantly to the rise in premiums.

What have been the most effective strategies to

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control health spending?

It is no secret that health insurance premiums and workers’ contributions to them have both risen by more than 200 percent over the past 16 years (1999-2015), far outpacing both growth in workers’ earnings and general inflation.

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According to the latest survey by the National Business Group on Health, they are offering consumer-driven health plans, most frequently paired with health savings accounts and wellness initiatives to improve employee health.

According to Mercer, 59 percent of employers offered CDHPs in 2015. Among large employers, 83 percent planned to offered CDHPs in 2016, including 33 percent as the only option(s) available to employees.

Figures vary on the percentage of workers enrolled in CDHPs in 2015, from 24 percent (Kaiser/HRET) to 28 percent (Mercer).

Most if not all surveys suggest that the number of employers offering CDHPs will continue to rise, as will the percentage of employees enrolled in these plans.

In 2012, the Rand Corp. published a study that concluded that health spending would decline by $57 billion per year if half of all employers switched to CDHPs. If those same employers switched to CDHPs combined with HSAs, the annual savings would be even larger — $74 billion each year.

Switching to CDHPs from traditional plans produces premium savings (15 percent on average, per Kaiser/HRET), and most employers that have switched are redirecting at least some of those savings into contributions to their employees’ HSAs. According to Kaiser/HRET, employers that reinvest premium savings contributed an average of $1,400 to their employees’ HSAs in 2015. Unfortunately, a sizable number (44 percent) of employers are not making any contributions. This is shortsighted, in my opinion.

“Best-in-class” large employers are tying contributions to participation in wellness or education programs or making progress toward or achieving certain health goals, according to the NBGH. Many of these employers are also beefing up consumerism tools, such as self-service decision support, medical decision support and price-transparency tools, the NBGH says. All of these elements in combination are part of employer efforts to engage employees as health care consumers, increase physical activity and manage weight, improve resiliency and reduce stress.

According to the 2015 Consumer Engagement survey conducted by the Employee Benefits Research Institute, evidence suggests that adults enrolled in a CDHP are more likely to be engaged in maintaining their health and improving their health care decisionmaking.

For example, EBRI found that CDHP enrollees were more likely to participate in wellness programs, such as health-risk assessments, health promotion programs and biometric screenings.

The survey also found that CDHP enrollees were more likely to: • Check whether their plan would cover care; • Ask for a generic drug instead of a brand name; • Talk to their doctors about prescription options and costs; • Ask a doctor to recommend a less-costly drug; • Talk to their doctors about other treatment options and costs; • Develop a budget to manage health care expenses; and • Use an online cost-tracking tool provided by the health plan.

Despite this evidence, many employers are sitting on the sidelines fretting about the Cadillac Tax and struggling to plan ahead for healthy growth. However, leading companies are showing the way. The top three strategies can be summarized as: • Adding or expanding CDHPs • Adding or expanding wellness programs and incentives • Adding or expanding consumerism tools Towers Watson’s research for NBGH (2015) identified more than 40 companies that qualified as “best performers,” based on their ability to manage both benefit-cost trends and efficiency. They projected that these companies would pay more than $2,000 less per employee per year for health care in 2015 compared with the

All-inclusive prevention programs and financial incentives are just two examples of strategies that refocus attention on maintaining and improving health in ways that will pay dividends for the country. national average. The following characteristics of best performers were identified: • Offer a CDHP as the only coverage choice • Offer a CDHP with an HSA • Have a year-round communication strategy that emphasizes the value of CDHPs to employees while they are working and in retirement • Evaluate CDHP member behavior change against objectives (e.g., cost and utilization metrics and program participation) • Offer price/quality transparency tools • Offer lower co-payments or charges for telemedicine to reduce out-of-pocket costs One final note concerning preventive care: CDHPs (specifically, HSA-qualified plans) pioneered the concept of exempting preventive care from the policy deductible.

The ACA incorporated the idea into the coverage required of all health plans. The concept is a good one. Consumers can access recommended age, gender and risk-specific screening and diagnostic services that have been shown highly effective without any out-ofpocket expense.

Unfortunately, two things have happened since the preventive care mandate went into effect: (1) many people have not taken advantage of these high-value services, even though they bear little cost; and (2) many CDHP enrollees have reduced their use of these services under the mistaken impression that their policy’s deductible applies.

More attention to these issues is warranted, and some promising approaches already exist. All-inclusive prevention programs and financial incentives are just two examples of strategies that refocus attention on maintaining and improving health in ways that will pay dividends for the country.

Combined with CDHPs and HSAs, these elements offer the best chance of avoiding any Cadillac Tax and, more importantly, of putting employee health and their health benefits on a more sustainable trajectory for the future.

Roy Ramthun, an advocate for consumerism in health care, serves as chief of policy & regulatory affairs at EHE International. He is also the founder and president of HSA Consulting Services..

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2016 Health Plans

BY CECI CONNOLLY PRESIDENT AND CEO ALLIANCE OF COMMUNITY HEALTH PLANS

The Opportunity of Telehealth for Health Plans A wide variety of industries offer the ability to bank, shop, book tickets and rent a car 24/7 from the comfort of home.

Now it’s health care’s turn to empower individuals with integrated, personalized tools. And it’s not just tech-savvy millennials who expect the freedom and control to manage their health care how and when they want. Seniors facing additional care needs as they age and middle-aged consumers — caring for their kids, themselves and perhaps their parents — are also open to new, affordable, convenient, digital, homeoriented options. Hands down, the freshest opportunity in health care for 2016 and the coming years is telehealth.

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elehealth, also known as telemedicine or virtual care, involves tapping technology to provide care and seamlessly exchange information with the goal of improving health and lowering costs. Greater patient access, less wait time for appointments and ongoing monitoring are just some of the benefits already seen by leading telehealth innovators.

The Alliance of Community Health Plans and our 22 member organizations across the country do not consider telehealth a separate service, but rather a tool that enables doctors, nurses and the entire clinical team to deliver care in a way that improves health and lowers the cost without increasing utilization. Without replacing the intuition, experience and judgment of the health care team, it is a way of meeting customers where they are, whenever they need us.

Geisinger Health Plan in Danville, Pennsylvania, created an expansive telemonitoring program that remotely performs routine checks of patient conditions to identify and solve potential health issues before they become serious problems that can lead to emergency department visits and even hospitalizations.

The system is designed to help nurses quickly identify signs of a patient’s worsening condition and work with the individual and his or her physician to create custom interventions to provide needed care rapidly.

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One of the plan’s longest-standing telemonitoring programs uses Bluetoothenabled scales for patients with heart failure.

The scale records the person’s daily weight, sending it automatically to Geisinger’s electronic health record, and has a built-in interactive voice response system that asks a series of questions — such as whether the patient is short of breath or has more swelling or a change in appetite — to detect changes in physical condition. The system is designed to help nurses quickly identify signs of a patient’s worsening condition and work with the individual and his or her physician to create custom interventions to provide needed care rapidly. From 2012 to 2013, Geisinger Health Plan Medicare Advantage members in the program had a hospital readmission rate of 11.5 percent, about half the national average for similar patients.

In 2010, HealthPartners in Minneapolis, Minnesota, launched virtuwell, a 24/7 online clinic that treats more than 50 common conditions for $45. It can be accessed on any computer or mobile device, and is available to consumers in 12 states. The convenient online care uses sophisticated algorithms to pose the right questions about symptoms and medical history, and it evaluates replies against hundreds of safety protocols. If the standard of care calls for being seen in-person, that is recommended and the member is not charged for the virtual visit. After the interview is completed, a certified nurse practitioner reviews the case and writes a treatment plan. The member receives a text or email when the plan is ready. The plan includes a diagnosis, remedies for improvement, prevention tips to guard against recurrence, and, if necessary, a copy of the prescription already sent to the pharmacy.

The virtual clinic lowers the cost of care for both the plan and the patient, while producing identical clinical outcomes to care delivered in-person and saving patients an average of 2.5 hours. Ninety-eight percent of those surveyed would recommend the program to others.

Kaiser Permanente makes extensive

But challenges remain. Telehealth is available only in a very limited set of circumstances to Medicare beneficiaries, in large part because the Centers for Medicare and Medicare Services interpret telehealth as a separate set of services, rather than a tool to facilitate existing and already covered services. depressive disorder, schizophrenia or bipolar disorder, and require ongoing psychiatric treatment. Psychiatrists are paid at the same rate as a face-to-face appointment and the technology allows them to use their time more efficiently. Almost all members surveyed about the program said it is as good as face-to-face service.

But challenges remain. Telehealth is available only in a very limited set of circumstances to Medicare beneficiaries, in large part because the Centers for Medicare and Medicare Services interpret telehealth as a separate set of services, rather than a tool to facilitate existing and already covered services. ACHP strongly supports the CONNECT for Health Act (S. 2484) that would allow Medicare Advantage plans to cover Medicare services that are provided through, or enabled by, telehealth and related technologies, expanding access to services for more than 17 million Americans covered

by MA. As Baby Boomers enroll in Medicare Advantage, consumer demand for the most convenient, most affordable care options will continue to grow. The proliferation of mobile technology is only going to increase in the years to come, and telehealth is part of that reality. ACHP plans will continue to embrace this technology as one of many vital tools in the physician’s black bag. verbaska/shutterstock.com

use of video visits and email correspondence, with 20 million patient emails annually and 40 percent of physician time spent caring for patients outside of face-to-face visits.

Presbyterian Health Plan in Albuquerque, New Mexico, recognized the potential to offer clinically equivalent care at a much lower cost, and offers video visits at no cost for members, preventing any barrier to participation. Outcomes data show that Presbyterian members received safe and effective care through the video visit program, and were highly satisfied with the experience.

Our nation has only one-half the mental health professionals we require to serve our needs, and telehealth can help. It can reduce the wait time for an appointment; increase patient access to psychiatrists, particularly for those who live in underserved rural areas; and allow doctors to use their time more efficiently by reducing long travel times. Most importantly, telepsychiatry can lead to improved quality of care through more timely diagnosis, treatment and monitoring of patient progress.

In 2015, individuals from 23 rural counties in western Pennsylvania participated in the telepsychiatry program of the Community Care Behavioral Health Organization, part of the UPMC Insurance Division. In several counties, almost half of all individuals who receive psychiatric service participate in a program supported by telepsychiatry. UPMC developed its telepsychiatry program for Medicaid members, both adults and children, who live in rural areas and do not have access to the mental health care they need. Most of the individuals seen have a serious mental illness, such as major

Ceci Connolly, a nationally-recognized health care leader, took over as president and CEO of the Alliance of Community Health Plans in January 2016. In her role, she works with some of the most innovative executives in the health sector to provide high-quality, evidence-based, affordable care. She is passionate about transforming America’s system to deliver greater value to all. Connolly has spent more than a decade in health care, first as a national correspondent for the Washington Post and then in thought leadership roles at two international consulting firms. She is a leading thinker in the disruptive forces shaping the health industry and has been a trusted adviser to C-suite executives who share her commitment to equitable, patient-centered care.

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To learn more about our suite of WalletDoc consumer tools, visit SelectAccount.com/WalletDoc

2016

BY PAUL ROONEY MANAGING PARTNER EBS CAPSTONE

Private Exchanges

Are You Ready for an Exchange?

Employer-provided health care, a popular component of employees’ overall compensation program, has been a constant since the early 1940s, a result of a tax break provided to labor groups during the postWorld War II economic recovery. What once was considered a “benefit” used to attract and retain employees has developed into a basic expectation, a very expensive and somewhat uncontrollable expectation.

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ver the past few decades, this health insurance delivery model has come under increasing pressure as costs have soared, and employers have questioned their ability to design and implement the types of plans that their increasingly diverse workforce needs and wants. In addition, the complexities presented by health reform legislation, both here in Massachusetts and at the federal level, have added to the burden of plan sponsors.

As a result, many plan sponsors are entertaining a transition to a defined contribution approach, away from the employer-driven model to a consumer-driven one. As an analogy, think about the creation of the 401(k) defined contribution plans of the 1980s and

Instead of designing and offering defined health plans, employers can cap health care costs at a desired threshold by making predetermined contributions to savings accounts from which employees make personal buying decisions. the tremendous migration away from defined benefit pension plans.

Instead of designing and offering defined health plans, employers can cap health care costs at a desired threshold by making predetermined contributions to savings accounts from which employees make personal buying decisions. The promise of this strategy includes control over current benefit expenses, the introduction of the concept of consumerism for employees and the mitigation of future liabilities.

Fueling this transition is the proliferation of private exchange platforms that create online marketplaces, set prices, provide plan specifics and help employees (consumers) make personal buying decisions with the help of decision support tools. Many also include telephonic support using call centers. And platform offerings include other employee benefit programs like life, disability and dental plans, as well as pre-tax spending accounts… even pet insurance can be offered!

What’s the difference between public exchanges like HealthCare.gov and private exchanges?

The public platforms are run by states and/or the federal government and, for the most part, designed to enroll individuals who are either not eligible for employer-sponsored programs, cannot afford the cost of their company’s plan(s) and/or are eligible for free or subsidized health care coverage. The public exchanges provide premium tax credits and subsidies for those applicants who qualify. Whereas public exchanges are

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2016 Private Exchanges

“open” to anybody who qualifies, private exchanges are “closed” and only available to organizations who implement them.

Proponents of the defined contribution/private exchange approach, including the many technology companies that have invested in platform construction, promise employers a chance to fix and predict health care costs, to offer more choice to employees and to reduce administrative expenses.

There are many in the health insurance industry, however, who believe that many of the advantages of private exchanges are overstated, that investors who have spent millions building the technology are trying to earn a return by re-packaging existing solutions. For instance, many large plan sponsors have been offering online enrollment and employee education for years. Existing benefit administration and HRIS products from payroll vendors like ADP, Paychex and Ceridian, already installed and connected to insurers electronically, have been providing the same type of plan choices and employee education through many renewal cycles.

In addition, some health care economists believe that the value proposition of a private exchange is ambiguous and question whether or not there are any real savings. Of all of the potential benefits of a defined contribution approach using a private exchange, the number one is cost savings. But a technology platform alone does not address the underlying drivers of escalating health care costs: increased utilization caused by an aging workforce and medical inflation.

Furthermore, in most cases, initial cost savings are achieved by designing a menu that includes core plans that cost more for participants, effectively shifting costs to employees and their families.

Steerage, the strategy used by plan sponsors to entice consumers to choose lower cost options, can backfire if employees are uninformed, choose the wrong plan solely based upon cost and end up in financial trouble due to higher out-of-pocket expenses.

As far as implementation, employee education is very, very important.

Because the exchange marketplace is such a new concept to most employees, a robust communications effort is necessary to assure that they fully understand how to use the platform during open enrollment.

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Is a private exchange the right fit for you?

Well, that depends upon the results of a readiness assessment.

Plan sponsors who want to move towards a defined contribution model and use a private exchange platform have a wide variety of vendors to choose from. And as much as technology companies want you to believe that private exchanges are pre-assembled, very easy to implement and inexpensive, the real story is a bit more complex.

For instance, experience-rated, larger plan sponsors (generally greater than 100 employees) must go through medical underwriting to obtain plan pricing. Underwriting includes an analysis of a population’s demographics, family content, claims history, industry and geographic location. Only after pricing is established and enrollment assumptions are made can a plan sponsor develop the proper contribution strategy in a private exchange.

As far as implementation, employee education is very, very important. Because the exchange marketplace is such a new concept to most employees, a robust communications effort is necessary to assure that they fully understand how to use the platform during open enrollment. Adding in the electronic feeds that must be established to the various insurers/payors, and the monthly fees to run the platform, fees can be substantial. Project timelines of six to eight months for installation are not unusual.

If you are an innovative employer with a diverse population looking to allow employees to design their own benefit program to meet their own personal and financial needs, and/or a CFO looking to manage health care costs now and in the future by fixing the organization’s contribution to medical insurance, then a private exchange should be an option you consider before your next renewal.

Any employer or plan sponsor considering a move to a private health care exchange should strongly consider retaining an independent, neutral third-party expert to evaluate the market and conduct a highly competitive RFP process. Any independent advisor’s fees should be transparent and not tied to which insurer wins the business.

As managing partner of EBS Capstone, Paul Rooney specializes in advising employers on group health, life and disability benefit funding methods, plan design, cost containment, flexible benefits and state and federal compliance issues. Over the past 25 years, Rooney has had extensive experience in the area of managed care, specifically developing plans for multi-state employers and negotiating pricing with various managed care companies. He began his career in the group insurance sales division of Metropolitan Life Insurance Company in Boston. Prior to forming EBS Capstone in 1997, he was senior vice president of employee benefit services for Minet Insurance Brokers. As a registered representative with LPL Financial, Rooney also helps plan sponsors design and implement 401(k) plans and other qualified retirement programs. He holds a Certified Employee Benefit Specialist designation and is an active member of the New England Employee Benefits Council.

2016

BY GEORGE VAN ANTWERP SENIOR MANAGER DELOITTE CONSULTING LLP

Pharmacy Benefits

The Specialty Pharmacy Elephant If you want to talk about growing health care costs in the United States, specialty pharmaceuticals1 (i.e., high cost drugs used to treat conditions like cancer, rheumatoid arthritis or Hepatitis C) is one topic which gets people excited for multiple reasons: 1. Pharmacy spending in employer insurance benefits has ballooned up to 19 percent of total health care costs (excluding drug spending under the medical benefit); 2. U.S. spending on pharmaceuticals is projected to grow 34 percent between 2015 and 2020, driven by2 specialty drug costs; and 3. Forty-two percent of the late-stage drug pipeline is for specialty drugs3.

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ight now, specialty pharmacy issues remind me of the story of the Six Blind Men and the Elephant — each man can only get a sense of the part of the animal in front of him, and, therefore, each comes away with a completely different take. Like the elephant, everyone has a different view of the high costs of specialty drugs depending on his or her vantage point.

• Pharmaceutical manufacturers are worried about innovation (and return on R&D investment) and being limited by payers’ actions on pricing and utilization management.

• Employers and health plans are worried about their ability to provide coverage at a reasonable cost (which is important for attracting and retaining talent) with increases in drug prices4 and new, high-cost drugs coming to market.

• Consumers are worried about health care costs. Forty-five percent of surveyed adults under the age of 65, reported not filling a medication due to cost.

• Distributors and specialty pharmacies are concerned about growth opportunities.

While a lot of our focus is on cost management through formulary, copays and utilization management, we spend a lot less time thinking about the patient journey and how that varies by age, gender, condition, geography and other attributes.

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•

Physicians are worried about the increased use of prior authorization requirements to control the limit the use of specialty medications since PAs are already estimated to take 20 hours per week.

If we can’t all agree on what this elephant is and how to manage it, the risk is that the industry will face increasing government regulation or intervention. We already know that 76 percent of consumers say the top health care issue5 for the President and Congress is to address high cost medications. Additionally, several of

pogonici/shutterstock.com

the presidential candidates have already come out and discussed this issue in their campaigns.

Of course, the actual elephant in the room is the patient and his or her experience with our complex health care system. If a patient is struggling with a complex disease that may change his or her life, we don’t want to leave him or her struggling to pay for the medication or the treatments while confused and unclear about whom they should listen to and where to find the best information.

As health care becomes more consumer centric, our research continues to show that one size doesn’t fit everyone as you look to engage consumers and drive behavior change. It does point to three things that continue to grow in importance: 1. Partnering with providers; 2. Tapping online resources; and 3. Increasingly relying on technology.

These trends are important especially for patients with complex conditions, but there are other areas where the industry can improve.

For example, while a lot of our focus is on cost management through formulary, copays and utilization management, we spend a lot less time thinking about the patient journey and how that varies by age, gender, condition, geography and other attributes.

On the surface, some of the topics you’ll hear to address these opportunities are consumer experience management, value-based care, digital solutions and technology transformation. While these are

On the surface, some of the topics you’ll hear to address these opportunities are consumer experience management, value-based care, digital solutions and technology transformation. all important strategic approaches, we find several common elements when doing a deeper dive. As pharmacy embraces these tactics, it will create opportunities to build sustainable differentiation: 1. Analytics: Using data from multiple sources (pharmacy, medical, lab, patient reported) to develop insights and predictive models to create personalized interventions to improve the customer experience, identify risks, and support population health management; 2. Care Management: Expansion of services “beyond the pill” to help improve clinical outcomes and consumer experience through care coordination between providers and pharmacies and embracing the role of the caregiver6; and 3. Integration: Approaching the patient experience in a holistic way that integrates the physician and other stakeholders using health information technology and digital technology to make health care less complex and help patients to achieve their goals.

Allowing our current financial paradigms to create a stalemate in the industry, hurting consumers and pushing the role to the government is not the answer. Collectively, we have to figure out how to create and share value that both inspires and rewards innovation while clearly linking value to reimbursement.

George Van Antwerp is a senior manager within the Strategy & Operations practice of Deloitte Consulting LLP. He focuses on pharmacy strategy and the convergence of specialty pharmacy across payers, providers, and life sciences.

1 http://healthaffairs.org/blog/2015/08/31/rising-cost-of-drugs-where-do-we-gofrom-here/ 2 http://www.drugstorenews.com/article/ims-institute-projects-us-drugspending--00 3 http://www.pharmacytimes.com/product-news/specialty-drugs-dominate-latestage-pipeline 4 http://www.wsj.com/articles/for-prescription-drug-makers-price-increasesdrive-revenue-1444096750 5 http://kff.org/health-costs/poll-finding/kaiser-health-tracking-poll-april-2015/ 6 http://www.pewinternet.org/2013/06/20/family-caregivers-are-wired-forhealth/ This post originally appeared on the Deloitte Center for Health Solutions blog, A view from the Center. Copyright © 2016 Deloitte Development LLC.

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2016

BY NICK ROCKWELL SENIOR CONSULTANT EASTBRIDGE CONSULTING GROUP, INC.

Voluntary Benefits

Have You Found the Right Balance in Your Benefits Program?

Employers have long sought to offer a benefits plan that protects employees from three universal risks — dying too soon, loss of earnings and living too long. Historically, most of the products provided under these plans have been employer-paid or “cost-free” to employees and included basic life and disability insurance as well as a match on the retirement plan.

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oday, however, the “employer-pay-less” approach is more often the standard as employers continue to face escalating premium costs and profitability pressures amidst an unstable economy. Employees, now more than ever, must bear some of the burden.

Shifting the Burden Coupled with New Threats Alongside the trend of more benefits being paid for by employees is the advent of new approaches to health care management. Whether it is in the form of higher deductibles and coinsurance, unexpected medical expenses, or expensive hospital stays, employees today face greater financial threats from what their health insurance policy alone may not cover.

But out-of-pocket medical expenses are not the only risks or concerns for employees. A few other threats include: • Identity theft • Paying for legal services like a will • Paying for the cost of medical care for four-legged family members • Saving for college • Home modifications to accommodate a disabled family member As more employees find themselves paying for a greater portion of their insurance and health care costs and are distracted by other risks and concerns, they have come to question where the “benefit” is in their benefits packages. This is especially true for those who have not been educated on, or do not understand the value of, what their employer is still able to provide. If perception is reality, this is a real threat to the value of an evolving (or devolving,

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Balancing the Scales for All Involved

The good news is that many employers are stepping up and addressing employee concerns by realizing they have options for creating a balanced benefits program — ones that consider their financial outlay versus the shifting burdens and increased threats felt by employees. Enter voluntary products.

Employers can continue to focus on programs from a perspective of “this is what we do for you” (i.e., communicating the value of what the employer is able to provide), while also bolstering the solutions available in each risk category with the addition of traditional payroll-deducted voluntary options. These options may serve as a compliment to the existing employer-paid benefits or, in many cases, a replacement. For instance, an employee’s exposure to new or unexpected medical costs can be supported with a variety of choices like voluntary accident, critical illness or hospital indemnity coverage. Additionally, there are a number of programs that can help fill the gaps around the growing list of unanticipated and unplanned financial burdens employees face (e.g.: contributing to a health savings account to offset higher out-of-pocket costs associated with a high deductible health plan).

According to a 2015 Eastbridge study, 93 percent of the employees surveyed purchased voluntary products to fill the gaps in their primary medical coverage and, among those not already owning voluntary, 25 percent are open to buying an employee-pay-all

Additional Products 8%

Legal plans

14% 3%

ID protection

Pet insurance

2013

12% 13%

EE purchase program

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depending on your perspective) benefits program.

2015

11% 1%

0%

5%

10%

20%

30%

product. These high percentages suggest that any “employee-paymore” medical plan needs to have additional options for employees to use as offsets to the mounting out-of-pocket burdens they may or may not be prepared for financially.

Many companies are also adding non-traditional-type voluntary products to address the needs of employees. Non-traditional benefits are among the fastest growing segment of the industry based on Eastbridge research, with solutions to meet problems like identity theft and pet expenses ranking highest in terms of employee interest.

Given the advances in veterinarian medicine, for example, pet owners are now able to choose from a variety of treatment options that can prolong the life of their beloved animals. All too often, however, these options are expensive and typically not part of a family’s budget. Voluntary pet insurance allows employees to choose treatments for their sick or injured pet based on the best medical option available rather than the choice being restricted by family finances. Identity theft protection is also trending as individuals are

Non-traditional benefits are among the fastest growing segment of the industry based on Eastbridge research, with solutions to meet problems like identity theft and pet expenses ranking highest in terms of employee interest.

According to the Eastbridge employee study, employees are responding favorably to this cost/benefits-balancing approach, with the majority of employees who own voluntary products today owning more than one.

This means that Employer Paid Solution: Life Insurance Dying employers can rest Voluntary Compliment or Offset: Voluntary Life Insurance Too Soon with Buy Up Options assured that offering Employer Paid Solution: Disability Insurance a range of products Voluntary Compliment or Offset: Voluntary Disabilty, Accident or Loss of Earnings (employer-paid, Critical Illness employer/employee Employer Paid Solution: Match on the Retirement Plan Living Too Long shared and employeeVoluntary Compliment: adding a financial planning program may expose them to other areas of preparation, critical to their lifetime goal attainment. pay-all) to address each risk area is not only what Identity Theft Protection Pet Insurance employees need but what they want.

Additional Voluntary Offerings The reality is that Purchasing Programs Legal Plans the employees’ risks are not getting any less nor becoming more vulnerable to large-scale security breaches and as are the financial and competitive demands on employers to keep they embrace modern technology and the world-wide web to pay a business running — it truly is a constant balancing act. But with for…well, everything! the addition of voluntary benefits to the equation and the advent So what might a balanced benefits package look like? Consider of technology and a more stream-lined process, the introduction of surrounding the original threats with more options, built around voluntary programs is far more manageable today than ever before the areas employees want to protect and where you know they are and more valuable for employers and their employees alike. vulnerable.

Number of Voluntary Products Owned Response One Two Three Four Five More than five

2010 21% 23% 17% 12% 9% 18%

2013 15% 32% 20% 14% 13% 5%

2015 35% 26% 15% 12% 5% 7%

Rockwell has over 14 years’ experience in sales, distribution and marketing strategy development, management, training and business leadership. Most recently, Rockwell brought LifeLock into the voluntary benefits market in 2007, built and ran that business and achieved 388 percent sales growth over a two-year period.

Rockwell has had direct leadership experience in the development of distribution, marketing, product and administrative strategies for the voluntary benefits marketplace. With Eastbridge, Rockwell serves as the company’s senior consultant, helping clients enter the business and develop voluntary/worksite strategies as well as improve their business results. Leveraging his experience with companies, from start-up through maturity, Rockwell brings new perspectives to the voluntary benefits marketplace.

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2016

Provider Forecast: Wellness

The Future of Wellness: Holistic Program Links Physical and Emotional Health

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ost business leaders understand that the health of their employees can dramatically affect the viability of their business, especially with health care costs rising six times faster than general inflation. It’s vital for those leaders to also understand that health doesn’t just consist of physical well-being. Emotional health is a major driver of day-to-day well-being for employees, and promoting good emotional health in the workplace could be one of the most important steps a business leader can take to improve an organization.

We know for example, that: t According to the U.S. Department of Health and Human Services, behavioral health issues account for 7.3 percent or $135 billion of the $1.85 trillion spent on health care every year, almost as much as heart disease and cancer treatment combined. t Employee depression accounts for $12 billion in lost workdays and more than $11 billion in costs accrued from decreased productivity. t Depression costs nearly $19,000 per person per year while diabetes averages nearly $8,000 per year for life; over $20,000 per year with complications according to the American Diabetes Association.

These various health issues don’t happen in a vacuum. Physical health issues can often lead to stress and emotional health consequences and vice versa. Someone experiencing stress can be more vulnerable to physical illness. This is not happenstance. Although many wellness programs have traditionally focused on the physical health risk, it is important for wellness program offerings to integrate and support emotional health with a similar methodology that utilizes strong engagement strategies, rather than simply providing connections to outside services. The most effective employers take emotional health one step further by creating an integrated holistic health strategy — bringing all their providers and programs together — including wellness, employee assistance programs, health plans, safety programs, etc.

Data Informs Insights As company executives think about their employee populations and review their wellness programs in light of business goals, recognizing and addressing this link is critical. At Interactive Health, data drives insights and decision-making, confirming some striking trends: t The percentage of individuals who participated in our wellness program from August 2014 – August 2015 who fell in the moderate-to-severe range for depression, stress, and anxiety was 2.9, 1.9, and 3.9 percent respectively.

Individuals with significant emotional distress often have higher than average physical health risk as quantified by their personal health score. t People with conditions such as diabetes or high blood pressure are more likely to suffer from emotional distress.

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BY CATHY KENWORTHY PRESIDENT & CEO INTERACTIVE HEALTH

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People suffering from elevated stress levels, anxiety or depression are also more likely to suffer from physical health challenges like metabolic syndrome.

It’s an unhealthy cycle that can be interrupted with the help of a proactive and holistic wellness program that addresses both physical and emotional health risks and outcomes.

Having the Conversation When incorporating emotional health into wellness programs, normalizing the conversation about emotional challenges in the workplace is important. Emotional health risk has a social stigma which often prevents individuals from seeking care. Emotional health is as important to a person’s overall wellbeing as physical health, although the symptoms may not be as obvious or as comfortable to discuss. Educating employees about emotional health risks is the first step. This helps to reduce the stigma surrounding emotional health so that individuals feel comfortable discussing and seeking assistance when needed. Employers can also provide internal and external emotional health resources for employees, family members, and caregivers and set goals to increase utilization of Employee Assistance Programs offered to employees and spouses.

Interactive Health wellness offerings address emotional health throughout the program and include resources that allow participants to begin acting upon emotional health risks identified in the health evaluation. This is followed up with robust tools surrounding emotional health that are integrated with online, onsite and telephonic coaching programs. This holistic program approach allows companies to further impact physical and emotional health outcomes in a positive and meaningful way.

The Importance of Personalization Another key factor in the success of any wellness program is the ability to tailor it to an individual’s needs within the participant population. Technology continues to enable more personalized action plans and customized engagement strategies that encourage and empower participants to achieve their health goals. For example, some individuals may be more successful addressing their emotional risks first, while others are more comfortable starting with their physical risks. Our entire team of health coaches, which include licensed behavioral health coaches, are trained to identify behavioral health concerns and assist each member in a meaningful and personal way that can best affect their emotional and physical health outcomes.

Lasting Impact Cleary the implications of emotional health in the workplace are staggering. There are many factors that contribute to a person’s overall health, and the workplace can make a positive or negative impact. Leading companies understand the significant business value of investing in the well-being of employees as whole people— mind and body.

2016

BY JESSICA GROSSMEIER VICE PRESIDENT OF RESEARCH HERO

Health Management

Expanding the Value Proposition for Employee Health and Well-Being The concept that good health is good business has been validated over the years by research linking health risk factors to higher employee health care costs, reduced on-the-job productivity and higher absenteeism. More recently, research has expanded its focus to overall wellbeing, with some studies showing a correlation between low employee well-being, higher turnover, lower employee engagement and lower employee performance. Now, the latest emerging body of research shows there may be yet another reason to invest in a healthy workforce: improved stock performance.

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arlier this year, three separate but related studies were published that demonstrate a correlation between a company’s approach to employee health and well-being and their corporate stock performance. One of those studies was conducted by the Health Enhancement Research Organization.

The HERO study revealed a distinct correlation between comprehensive, best practice wellness programs and corporate stock performance. More specifically, the study showed companies that scored highly on the HERO Health and Well-Being Best Practices Scorecard in Collaboration with Mercer® (HERO Scorecard) — which signals an investment in wellness best practices — outperformed the Standard & Poor’s 500 Index over the course of six years.

In the best-performing scenario, the study group achieved a 333 percent return, compared to an S&P 500 return of 105 percent during the same period. In the lowest-performing scenario of 11 companies, the study group achieved a 204 percent return, compared to an S&P 500 return of 105 percent during the same period.

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The study, “Linking Workplace Health Promotion Best Practices and Organizational Financial Performance,” was published in the January issue of the Journal of Occupational and Environmental Medicine and tracked the stock performance of a portfolio of 45 publicly traded companies from 2009 through 2014 that earned top scores on the HERO Scorecard. The performance of these companies was compared to that of the Standard and Poor’s 500 Index (S&P 500) over the six-year study period.

Findings at a glance

Findings indicate that companies who share the common practice of investing in workplace health and well-being represent superior investments in the marketplace. More specifically, researchers found that this simulated portfolio of companies outperformed the S&P 500 in the following areas: • Appreciated 235 percent compared to 159 percent for the S&P 500, • Outperformed the S&P 500 in 16 out of 24 (67 percent) quarters during the study period, and • Produced a comparable dividend yield of 1.97 percent by the end of the study period, compared to a 1.95 percent yield for the S&P 500.

Companies in the study ranged in size from 762 to 272,890 employees and came from a diversified collection of industry categories including: consumer discretionary, consumer staples, energy, financial services, health care, industrial, information technology and utilities. The average age of employees within these companies was 42.8 years and 56 percent were male.

A growing body of work The two related studies were also published in the January issue of JOEM. These studies were drawn from different populations of employers and used differing methodologies and timeframes, but the outcomes were similar: companies recognized for their significant investment in workplace health and well-being realized higher performing investments.

These studies were conducted by the American College of Occupational and Environmental Medicine — with sponsorship from the Underwriters Laboratories Integrated Health and Safety Institute

— and by The Health Project. The research methodologies for the three studies were developed by Ray Fabius, M.D., co-founder of HealthNEXT. Fabius is also a co-author on all three papers.

The ACOEM study followed the stock performance of as many as 16 companies that had applied for the Corporate Health Achievement Award over a 13-year period and achieved high scores in the areas of health and/or safety. The simulated investment returns for these companies were significantly higher than average S&P 500 returns — as much as triple in some of the scenarios. In the best-performing scenario, the study group achieved a 333 percent return, compared to an S&P 500 return of 105 percent during the same period. In the lowest-performing scenario of 11 companies, the study group achieved a 204 percent return, compared to an S&P 500 return of 105 percent during the same period.

The Health Project studied 26 companies that had won the C. Everett Koop Award from 1999 through 2014. These companies distinguished themselves by excelling in workplace wellness programming and promoting population health among their employees and covered lives. The study found these companies doubled the return of the S&P index yielding a 325 percent return compared against the 105 percent return from the S&P 500, while returning higher dividends: 2.31 percent compared to 1.95 percent for S&P 500 companies. The price-to-earnings ratio for the award winning companies was lower (17.13) than the overall S&P 500 (18.27), which means the performance of the study group was not based on an overvaluing of the companies.

What does this research mean for employers?

The combination of these studies reinforces a broader value proposition that links workplace health and well-being to favorable business performance. Better employee health is clearly linked to higher levels of employee productivity and performance, and emerging evidence shows healthier employees are also more engaged in their work and have lower turnover. For health and benefits professionals who want to make the business case for wellness to corporate leaders, this research is one more indication that effectively run companies do, indeed, invest in workplace health and well-being.

This body of work suggests the need for additional research to better determine the connection between workforce well-being and organizational performance. At this point in time and based on the existing knowledge, we can say there is a strong correlation between a company’s investment in workplace health and well-being and its stock performance. There are many factors that were not analyzed in these studies that could influence stock performance, and it may be the case that investment in health and well-being is a proxy for companies that engage in other best practices to achieve their competitive advantage.

What these outcomes do tell us, is that If you are looking to run an effective health and well-being program for your employees and want to see positive financial results, you can emulate the

The HERO Scorecard is a free, online inventory of evidence-based health and well-being practices. It allows companies of all sizes and from any industry to complete a self assessment of their health and well-being initiatives including programs, policies, and other organizational support. desired results by offering best-practice wellness programs, like the companies in these studies. Each of the studies points to tools that can help organizations identify the elements of best practice programs. The HERO Scorecard provides the most detailed inventory of specific practices while the C. Everett Koop Award publishes information about award-winning programs on The Health Project website. And ACOEM provides information on its CHAA criteria on its website.

Employer guidance on a best practice approach The HERO Scorecard is a free, online inventory of evidencebased health and well-being practices. It allows companies of all sizes and from any industry to complete a self assessment of their health and well-being initiatives including programs, policies, and other organizational support. Upon completion, companies receive an individual score and a comparison of their program based on industry, company size and geography, which is useful for benchmarking and strategic planning.

Companies that score high on the HERO Scorecard report adhering to common best practices, including: strong strategic planning, senior leadership engagement and cultural support for health, a rich and comprehensive set of programs that meet a diverse spectrum of health needs, a comprehensive array of communication and participant engagement strategies, and robust program evaluation and performance reporting. Since its inception, more than 1,700 companies have completed the HERO Scorecard.

Jessica Grossmeier, Ph.D., is vice president of research for the Health Enhancement Research Organization and lead author on the HERO Scorecard stock performance study. She can be reached at jessica.grossmeier@hero-health.org. Raymond Fabius MD, is co-founder of HealthNEXT and can be reached at ray.fabius@healthnext. com for questions specific to the ACOEM study or data analysis associated with the three studies. Ron Goetzel, PhD, is lead author of the Health Project study and can be reached at ron.goetzel@truvenhealth.com.

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2016

BY LEAH BINDER PRESIDENT & CEO THE LEAPFROG GROUP

Health Care Transparency

The Movement for Transparency in Health Care Early one September morning in 1982, 12-year-old Mary Kellerman of Elk Grove Village, Illinois, awoke with cold symptoms. Her parents gave her Tylenol and tucked her back in bed. They awoke at 7 a.m. to a horror no parent should ever have to endure: their daughter dying on her bedroom floor.

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ithin two days, Mary and six other young people would be dead, all after taking Tylenol. A perpetrator (still at large today) had opened the capsules on random retail store shelves and added cyanide. The tampering was undetectable because bottles were not sold in sealed containers.

What followed was a national frenzy known as the Tylenol Scare, with day after day of front page headlines of tragedy and fear.

How does a company react to such a catastrophe? Johnson & Johnson, the makers of Tylenol, took responsibility for not preventing the tampering, enacted a national recall, shut down manufacturing and maintained candid communications with the press and the public. This transparent approach still stands as the textbook example of what to do in a public relations crisis.

Johnson & Johnson, the makers of Tylenol, took responsibility for not preventing the tampering, enacted a national recall, shut down manufacturing and maintained candid communications with the press and the public. This transparent approach still stands as the textbook example of what to do in a public relations crisis.

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Johnson & Johnson ultimately emerged from the scare not only preserving its reputation — but actually improving it. Tylenol market share rebounded to 35 percent and within several years become the most popular over-the-counter analgesic in the United States. Most importantly, radical changes were made. The company quickly developed tamper-resistant packaging, and within months, every single competitor followed suit.

Think about what might have happened if Johnson & Johnson followed the standard 1982 protocol for handling the media, the reaction their attorneys likely advised: refuse to apologize or speak publicly about the situation — except to say the company complied with the law. Admit no fault and lay low. After all, the company adhered to government standards for packaging and couldn’t be responsible for a homicidal villain.

But if they had taken that approach, the Tylenol brand would be long gone today, assigned to the dust bin of failed business enterprises like Enron. Fair or not, the public would have forever associated the brand with terrible tragedy. And while meeting basic standards for safety is enough for government regulators, it’s not enough for scared consumers. By leaning into transparency — admitting they didn’t do enough to meet standards of excellence their customers deserved — Johnson & Johnson reassured the public they weren’t hiding anything, and they were going to the ends of the earth to put their customers’ safety first.

Fast forward two decades or so, to the dawn of a new age of transparency, catapulted by the 24-hour news cycle, web-based communications and social media. Transparency is not only the typical strategy for crisis communications, but a mandatory element of all communications and marketing, crisis or not. Consider online shopping sites like Amazon.com, where visitors expect customer reviews of each product — the good and the bad. Social media like Facebook and Twitter give instant feedback and create buzz around new products and services, often enough to assure the success or failure of the product within a few hours.

There has been a transformative turnaround in virtually every American business, with one glaring exception. The culture of the health care industry is still living in 1982, when transparency was optional and uncommon. But finally, slowly, with some prodding, change is happening there too.

The vast majority of data hospitals and physicians collect and monitor is not made public. Government has long protected health care providers from public scrutiny by refusing to make claims data public (until recently) and failing to reveal sensitive statistics like infection rates at different hospitals.

But today we see a shift toward transparency. It is driven in part by policymakers, with the Affordable Care Act mandating release of more data from hospitals on patient safety and quality. Even if Obamacare is repealed, transparency is a priority for Republicans in Congress who support consumerism. Free market competition won’t work without information to aid consumer decision-making.

The shift toward transparency also comes from market forces.

The Baby Boomers are hitting retirement age, and Generation X and Y are beginning to recognize their own mortality. Most of these new patients expect the same level of transparency and convenience from health services that they get from every other service. They want an appointment now (preferably through an online portal), access to quality ratings and patient reviews, and communication through social media. These new generations increasingly finance their health care with high-deductible health plans, thus increasing the demand for a much higher level of customer service.

This is revolutionary change for an industry long calcified in a culture of keeping quiet. Many health leaders are like Johnson & Johnson’s attorneys: accustomed to suppressing publicity and keeping mum on critical information. Today the expectation is that you lean into transparency, and if you don’t raise any eyebrows you aren’t doing it right.

In 2000, my national nonprofit, The Leapfrog Group, started what is now a craze: public reports comparing hospitals across the country on quality. Still, despite the plethora of public reporting sites today — from Consumer Reports to Healthgrades to Consumers’ CHECKBOOK to U.S. News & World Report — the publiclyavailable data these outlets have at their disposal is mostly from government sources and is surprisingly constrained. Leapfrog, in contrast, collects and publicly reports hospital data ranging from computerized prescription ordering and safety protocols to maternity care and mortality rates of high-risk surgeries. By applying pressure from employers and other purchasers, we persuade hospitals to be extremely transparent about their quality of care.

But the information consumers crave the most is almost entirely unavailable: how good is my doctor? There are virtually no public reports comparing physicians’ effectiveness, and only a scintilla of data publicly available on outcomes by surgeon. The data exists, and health systems spend an enormous amount collecting and analyzing it. But they aren’t sharing it publicly.

Leapfrog, in contrast, collects and publicly reports hospital data ranging from computerized prescription ordering and safety protocols to maternity care and mortality rates of high-risk surgeries. By applying pressure from employers and other purchasers, we persuade hospitals to be extremely transparent about their quality of care.

Purchasers and payers have an important role to play at this critical juncture in history. Consumer demand will eventually force a total shift towards transparency, but in the meantime individual consumers are vulnerable. They do not have enough information to select the best providers, and as individuals they have no clout to demand the data. But purchasers do, and it is in their interest to act.

Here is what purchasers can do: • Insist that your plans and third-party administrators make transparency a top consideration in contracting.

• When identifying narrow networks, insist that each provider offer outcome data and make it available publicly.

• Don’t accept excuses for lack of transparency from providers and plans.

• Insist that hospitals in your network report to Leapfrog, which is free to them and free to consumers. Hospitals that don’t report are not transparent; those that do are leaning into transparency.

That’s good for the public, good for them, and good for purchasers and payers, who created the Leapfrog movement.

Transparency in health care is not a subject of conjecture or speculation. It’s a sure bet. Market pressure and rare Washington consensus are coming at us with hurricane force. It’s time health care advance beyond the 1980s, and catch up with the rest of the world.

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2016

BY BRUCE W. SHERMAN, MD AND WENDY D. LYNCH, PHD

Health Engagement

An Uneven Playing Field

health care inflation has outpaced all other employment costs, employers have utilized cost-shifting as a primary means to manage benefit expenses. Widespread health care Low-wage workers face difficult choices in today’s consumerism engagement, anticipated as a high-out-of-pocket health care system. market-generated response to greater out-ofpocket cost, has simply not materialized. aced with escalating health insurance costs, employers As a result, the portion of health care average premium paid by have been making tough choices in recent years. Given a employees has increased by 83 percent in 10 years, while the average finite human resources budget, should companies sacrifice deductible has increased 255 percent from $303 in 2006 to $1,077 in wages, benefits-eligible workers or health benefits? Evidence 2015.1 Today, a worker with family coverage in a HDHP can expect suggests some of each; employee-paid deductibles have risen 67 to pay about $4,000 for premiums1 and the maximum out-of-pocket percent in five years, and wages remain essentially flat. limit for a family is about $13,000, yet on average, employers deposit What gets less attention is the trickle-down effect of greater only $527 in a HSA2. For low-wage workers, many of whom live cost-sharing for health care on low-wage workers. They, too, face from pay-check to pay-check, those dollars simply aren’t available. budgetary choices: housing, groceries and transportation, or medical Unfortunately, HSAs have become yet another vehicle for income visits and medications? For high-paid workers, higher out-of-pocket tax sheltering for the wealthy, while providing little benefit for the costs for health care may require irritating tradeoffs. But for lowmajority of working poor. wage workers, the burden is potentially harmful. The median salary for employed workers is under $30,000, while the average premium Waiting for a serious problem and deductible paid by a worker is now over $6,000.

In our preliminary analysis, the effects of significant costThis significant expense burden results in distinct and sharing are noticeable. Low-wage workers enrolled in health benefits worrisome patterns of health care (non)utilization among the lowest use less care overall than higher-paid cohorts. Among the lowest paid paid workers. However, these patterns are not widely recognized workers ($25K and under), 35 percent used no health care services because health plans do not have access to wage information and at all during the year. Almost 45 percent of low-wage workers in a thus do not report utilization by salary. This paper presents some CDHP used no care at all (closer to 25 percent in the PPO plans). preliminary findings from a wage-specific analysis conducted using Compare that to the highest paid cohort (above $100K), where 19 claims and wage data from the Xerox Right Opt private exchange.1 percent and 10 percent used no care in the CDHP and PPO plans, respectively.

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Background

While consumer-oriented plans have led to advances in many areas (transparency, reference-based pricing, shared decision making, etc.), the original goal of mitigating increased costs with employer-funded health savings accounts has fallen short. As

Ratio of ER versus Preventive Visits Per 100 Members 70 60

62

50

45

40 30

25

20

12

10 0

Besides the overall lower health care utilization rate, our data show some notable differences in utilization patterns that differ between high-wage and low-wage workers, as shown below:

1. Reaction versus prevention.

One of the most dramatic differences is in the orientation about when and how to use care. We created a ratio of the number of preventive visits compared to the number of ER visits. In the higher-wage groups, there were four preventive visits (a rate of just over 45/100 people) for each ER visit (a rate of about 12/100).

In the lowest-wage group, there were six times as many ER visits (62/100) for a ratio of almost three ER visits for every preventive visit (25/100). High-wage workers are 3.8:1 while low-wage workers are 1:2.5.

Part of the reason for this may be because many of these workers may be unable to leave the workplace to receive medical care during working hours due to risk of wage loss.

2. Rescue versus manage Lowest Wage (<80K) ER Visits/100

Highest Wage (>80K) Preventive Visits/100

When ER visits are categorized as ambulatory-care sensitive visits, it indicates that the condition could have been handled with appropriate primary care. Low-wage workers had four times the HealthCare Consumerism Solutionsâ&#x201E;˘ I www.TheIHCC.com I Annual Outlook 2016

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2016 Health Engagement

rate of ER visits categorized as such compared high-wage workers.

Similarly, low-wage workers had roughly six times the rate of avoidable hospital admissions. These patterns indicate that health issues are not managed in ways that preempt serious events and complications, either because of a lack of awareness or concerns about cost.

Earning status and health care use In support, in a national survey,3 people above and below federal poverty level thresholds were asked how cost influenced their use of health care. In all cases, economic status influenced the person’s likelihood of forgoing care due to cost, as shown below.

Furthermore, low-wage workers prefer to seek care from sources that do not involve an appointment or an ongoing relationship.

Based on national survey data, more than half of those making $35K or less prefer seeking non-emergency care from the ER (32 percent), urgent care centers (16 percent) or retail clinics (five percent).4 Conversely, among those making $75K or more, over 70 percent prefer primary care, with fewer than 10 percent indicating that they preferred the ER. The result leads to a likely lack of coordination and the absence of a true medical home for low-wage workers with chronic conditions.

Percent responding that they did this due to cost.

Percent of those above 200% federal poverty level

Percent of those below 200% federal poverty level

Had a medical problem but did not see a doctor

10%

30%

Did not fill a prescription

10%

28%

Skipped a test, treatment or follow-up

12%

28%

Did not see a specialist after being referred

10%

24%

Understanding wage-based discrepancies Public health policy-makers have studied health disparities extensively; however, their focus has mostly been a comparison of public versus private insurance or community-based assessments.

Far less attention has been paid to health and health benefits inequalities within the employed workforce. To better understand this phenomenon and the extent to which low wage-earners may be forgoing necessary care, employers should consider the following steps: 1. Integrate work and health data to make salary-specific comparisons. Simply documenting differences in access, prevention and sources of care can help identify areas of education or support that may be needed by different groups.

These comparisons may highlight other patterns, such as highwage, two-worker families that resort to urgent care because primary care is limited to work hours.

2. Reevaluate current incentive designs to minimize disparities to access to care, whether they are financial, cultural or organizational (no time off allowed during work hours to access health care).

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Promoting individual responsibility for health and appropriate care-seeking is a commendable goal. However, when the financial barriers preclude basic, necessary services — particularly for chronic care — one must wonder if the bar has been set too high.

In the face of rising deductibles and without sufficient funds to support necessary utilization, the lowest-paid workers may bear a disproportionate share of the burden on physical and financial health.

References 1. Kaiser Family Foundation, Health Research & Educational Trust. Employer Health Benefits: 2015 Summary of Findings. 2015. http://kff.org/report-section/ ehbs-2015-summary-of-findings/. Accessed February 23, 2016.

2. Fronstin P. Health Savings Account Balances, Contributions, Distributions, and Other Vital Statistics, 2014: Estimates from the EBRI HSA Database. EBRI Issue Brief. July 2015(416):1-26.

3. Collins SR, Rasmussen PW, Doty MM, Beutel S. Too high a price: out-of-pocket health care costs in the United States. Findings from the Commonwealth Fund Health Care Affordability Tracking Survey. September-October 2014. Issue brief.

Nov 2014;29:1-11.

4. FAIR Health. Understanding Consumer Health Insurance Preferences: Consumer Survey. 2015: http://www2.fairhealth.org/FHSurveySpring2015. Accessed July 27, 2015.

Additional Sources Fronstin P, Elmlinger A. Health Savings Accounts and Health Reimbursement Arrangements: Assets, Account Balances, and Rollovers, 2006-2014. EBRI Issue Brief. Jan 2015(409):1-17. http://www.ncbi.nlm.nih.gov/pubmed/26422932.

Accessed February 18, 2016.

Fronstin P, Elmlinger A. Findings from the 2015 EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey. EBRI Issue Brief. Dec 2015(421):125. http://www.ncbi.nlm.nih.gov/pubmed/26827459. Accessed February 18, 2016.

Kaiser Family Foundation, Health Research & Educational Trust. 2015 Employer Health Benefits Survey. 2015: http://kff.org/report-section/ehbs-2015-summary-offindings/. Accessed February 23, 2016.

Kodjak A. Rising Health Deductibles Take Bigger Bite Out Of Family Budgets.

Shots: Health News from NPR. 2015. http://www.npr.org/sections/healthshots/2015/09/22/442546652/rising-health-deductibles-take-bigger-bite-out-offamily-budgets. Accessed February 23, 2016.

Mercer. Modest Health Benefit Cost Growth Continues as Consumerism Kicks Into High Gear. 2014; http://www.mercer.com/newsroom/modest-health-benefit-costgrowth-continues-as-consumerism-kicks-into-high-gear.html. Accessed February 24, 2016.

Mercer. The winning streak continues as employers predict another year of low health benefit cost growth. 2015; http://www.mercer.com/newsroom/The-winningstreak-continues-as-employers-predict-another-year-of-low-health-benefit-costgrowth-in-2016-mercer-survey.html. Accessed February 24, 2016.

(Endnotes) 1 To ensure we were testing the effect of wage, we tested and found no differences in rate of having a high deductible, or level illness. Low-wage workers were slightly younger, meaning that they may have been less healthy for their age, but not less healthy than higher-paid workers.

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2016

BY LAURA CARABELLO EDITOR AND PUBLISHER MEDICAL TRAVEL TODAY

Medical Travel

Employers of Every Size Embrace Medical Travel When faced with substantial monetary penalties for noncompliance, and the need to curb staggering health care costs, U.S. domestic medical travel represents an effective way for employers to lower costs while giving plan members access to quality care.

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edical travel — leaving one’s home state or region to travel to a designated health care “center of excellence” for high-quality, more-affordable surgical procedures or episodes of treatment — has been an important new strategy for large retailers. In fact, 15 percent of the nation’s 50 largest employers offer a medical travel program.

Wal-Mart, Lowe’s, Jet Blue and others have begun offering U.S. domestic medical travel programs to their employees, covering the medical treatment and costs, as well as expenses for a required caregiver to accompany the patient. This year expect to see a growing number of smaller, mid-sized companies following suit.

Consider the facts: The number of outpatient procedures done in the United States tripled between 1999 and 2005. Outpatient surgeries represent about 75 percent of medical travel procedures, according to experts, in part because the out-of-pocket payments are relatively high in the United States, but vary widely based on location and among providers.

Given this huge demand, the benefits of domestic medical travel program are highly appealing. What’s more, many employers that recognize the advantages of a domestic surgery travel program

Outpatient surgeries represent about 75 percent of medical travel procedures, according to experts, in part because the out-of-pocket payments are relatively high in the United States, but vary widely based on location and among providers.

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soon migrate to international medical travel where the savings are even more significant.

About one million Americans sought medical treatment abroad in 2014, compared to about 750,000 in 2013, according to AARP Magazine. Experts expect this trend to increase 25 to 35 percent per year, with particular emphasis on procedures not traditionally covered by employer insurance, such as dental or cosmetic work.

Domestic medical travel has also sparked a new type of health management company that gives employers access to the country’s top hospitals and doctors — at a predictable cost.

These select hospitals must adhere to strict benchmarks for: • Positive outcomes • Low hospital-acquired infection rates • High patient satisfaction • Advanced staff training and skills • Thorough patient data capture and other factors • Doctor’s costs, hospital expenses and fees are part of a single, transparent price.

Combined Purchasing Power More mid-size employers are drawn to domestic medical travel because they recognize the opportunity to provide access to highvalue care for their employees. In fact, many mid-size and smaller employers aggregate their purchasing power through coalitions and other multiple employer welfare arrangements.

They also build in incentive programs to prompt workforce uptake of the benefit, including waiving co-pays and deductibles, and covering both patient and companion/caregiver travel expenses. One of the drivers is the documented track-record of a COE to achieve better results for specific procedures, mitigating complications, repeat procedures, and readmissions — which can be very expensive in terms of hard costs, time lost from work and the health of employees.

Several organizations and purchasing coalitions are helping to guide employers in their selection process. For example, The Pacific Business Group on Health unites employers to improve the quality of health care while moderating health care costs. PBGH’s member companies provide health care coverage to 10 million Americans and their dependents, offering employers a wide array of services that range from advising on relationships with carriers,

supporting projects that accelerate price and quality transparency, and advocating for policy initiatives.

A key PBGH member, Wal-Mart, launched a COE travel surgery program for cardiac and spine procedures, and suggested that this type of program could have a stronger impact in the market if multiple employers joined together. Since then, PBGH has learned that employers want a travel surgery program that offers high-quality surgical care at affordable rates, not simply the “best deal.”

Employers that sign on with PBGH’s Employers Centers of Excellence Network can expect to receive a complete return on investment within two years — and significant savings thereafter. In addition to the competitive bundled rates, higher quality care leads to greater savings.

This prompts providers to collaborate to ensure the best outcomes because any additional cost incurred beyond the fixed price comes out of the provider’s pockets. As a result, Geisinger Health System, for example, has seen a 21 percent reduction in complications, a 25 percent reduction in surgical infections and a 44 percent drop in readmissions.1

Getting Started In today’s tumultuous health care landscape, cost of care has become as important as quality of care when it comes to choosing a hospital or physician for a specific treatment or procedure. As patients assume greater proportion of costs through higher co-pays, deductibles and other plan cost-sharing features, they are becoming more comfortable with the idea of leaving home to access better care that costs less out-of-pocket — rather than seeking care locally.

Having access to geographically specific health care cost information is essential for empowering patients to make moreinformed decisions about whether to travel for care and how to plan for it financially. In fact, every stakeholder benefits from price transparency and bundled pricing.

Overcoming Price Variation Enormous variation in health care prices persists across the country. One hospital might bill $40,000 to remove a gallbladder using minimally invasive surgery, while another hospital might charge $91,000, according to the New York Times.2 Prices can also vary within each state. The median cost for a common inpatient heart procedure in southeastern Wisconsin, for example, ranges from $178,647 at Waukesha Memorial Hospital to $105,119 at Wheaton Franciscan Healthcare — All Saints Hospital in Racine, as the Milwaukee Business Journal reported.3 By only signing contracts with providers priced in the low range,

By only signing contracts with providers priced in the low range, but that also demonstrate good outcomes, employers can lower the cost of providing health care without compromising quality. but that also demonstrate good outcomes, employers can lower the cost of providing health care without compromising quality.

COEs also offer bundled pricing. This is the reimbursement of health care providers based on expected costs for clinically defined episodes of care. Providers are paid a single fee for a set of evidenced-based services related to a diagnosis, with payments typically linked to outcomes, as well as other quality measures.

As plan members take on a greater share of their own health care costs, they are beginning to distinguish between low prices and high quality. Likewise, employers are playing a more proactive role by contracting directly with health care providers and COEs in order to find the best value for their employees, and opting for bundled, fixed-price procedures. This has created a new dynamic that benefits companies of every size, plan members and the entire U.S. health care system.

Laura Carabello has been an entrepreneur and a strategy consultant in both domestic and international businesses related to health care and technology since 1985. She is the publisher/managing editor of Medical Travel Today, the authoritative, online business-to-business international newsletter of the medical tourism industry, as well as US Domestic Medical Travel. In 2011, Carabello published Medical Travel Today: Opinions and Perspectives on an Industry in the Making.

1 Champion, Wes; How Bundled Pricing Just Might Save Healthcare From Itself; Healthcare Blog; Oct. 26, 2012; http://thehealthcareblog.com/blog/2012/10/26/ how-bundled-payments-just-might-save-health-care-from-itself/; accessed January 9, 2015.

2 Meier, Barry et al; Hospital Billing Varies Wildly, Government Data Shows; New York Times; May 8, 2013; http://www.nytimes.com/2013/05/08/business/ hospital-billing-varies-wildly-us-data-shows.html?_r=0; accessed August 31, 2015.

3 Kirchen, Rich; Latest hospital pricing data show wide variance in costs of procedures; Business Journal; Aug. 21, 2014; http://www.bizjournals.com/ milwaukee/news/2014/08/21/latest-hospital-pricing-data-show-wide-variance-in. html?page=all;

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2016 Direct Primary Care

BY MICHAEL TETREAULT EDITOR-IN-CHIEF AND CATHERINE SYKES MANAGING EDITOR THE DIRECT PRIMARY CARE JOURNAL

More Employers Exploring Direct Primary Care, Concierge Medicine The way companies and their employees get access to and pay for health care is evolving quickly. Surveys show that many of the estimated 30 million people who gained insurance coverage last year under health care reform do not have a primary health care physician or do not use one.

According to The New York Times, many opted for highdeductible health plans. This group is expected to become picky with the dollars they spend and to be less tolerant of the opaque pricing that is still the industry’s norm.

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mployers, employees and their families are starting to demand more convenient, on-demand access to health care. It is clear that this trend will continue, especially as today’s higher deductibles are causing increased consumer sensitivity to health care costs.

Wise employers and benefit managers will take heed. With rising consumerism and transparency in health care, innovative solutions are rising to the surface.

“I heard an interesting story from a colleague recently that some patients in a hospital telemedicine program rated videoconferencing more personal than an actual bedside visit by a physician,” said Terry Bauer of Stroudwater in Atlanta. “Why? Because the physicians being beamed into the room were focused, undistracted by phone calls or pagers and not in a hurry to complete their rounds.”

In this fast-changing world, retail health care is a one-stop shop for health care. For employers and insurers, retail health care clinics offer a way to reduce costs for noncritical conditions. A study by researchers at the RAND Corporation estimated that more than a quarter of emergency room visits could be handled at retail clinics

Wise employers and benefit managers will take heed. With rising consumerism and transparency in health care, innovative solutions are rising to the surface.

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and urgent care centers, creating savings of $4.4 billion a year.

Concierge Medicine Today, the trade publication for the membership medicine industry said to CNNMoney.com that there are a number of physicians around the country who have set up membership-based programs that offer employees primary care health care anywhere from $1,200 a year to $2,500 annually — depending on patient load and the level of personal attention desired. It’s a trend also known as concierge medicine, membership medicine and direct primary care. The strength of membership medicine lies in its focus on the doctor-patient relationship.

In an effort to circumvent health insurance headaches, some employers like Expedia, Comcast and others companies in small beta-site pockets around the country are looking to membership medicine and cash-only primary care physicians (typically with more than one office location) as an innovative, cost-saving solution. Just last year, an article in Forbes noted that WeCare Clinics, Iora Health, Qliance Medical Management, MDVIP and OneMedical have all reported reductions in total health care costs for their patients of 15 percent or more versus population norms.

There are third-party administrators that are beginning to see the benefits of a corporate physician working alongside self-funded employers.

“We have a third party administrator who immediately saw the benefits a corporate physician can bring to a self-funded employer,” said Bill Cossart, CEO and founder of MedFirst Partners, a consulting firm that assists direct primary care physicians with their entry into DPC. “Even smaller companies can easily adopt DPC. The employer sees the rebates. The employees love the level of service with a 24/7 DPC physician and the doctor gets to practice medicine the way they always have wanted. Everyone wins. There are no losers in this arrangement.”

We are beginning to see three tiers of fees emerging.

For a couple of thousand dollars each year, an employee can receive same-day appointments, office and home visits from their doctor, the physician’s cell phone number and the contractual promise that a physician may spend an hour with them instead of four minutes. There is also a technology component to this tier that enables the employer to work with the physician to assess the health care needs of his workers and adjust accordingly.

“Employers, both large and small, are struggling with the staggering costs of health care in this country,” said Mason Reiner, CEO at R-Health, in an interview with The Direct Primary Care Journal last year. “They are desperately seeking innovative solutions that involve something other than shifting even more costs to employees and their families. Independent primary care physicians can be an employer’s most valuable ally as they seek ways to improve the care their plan members receive while controlling costs. When given the rare opportunity to sit in the same room with independent primary care physicians to discuss health care, employers find the DPC physician perspective both eye-opening and refreshing.”

For $1,200 to $1,700, you may get same-day service, phone consults with an annual physical included.

The lowest tier is priced between $250 to $500 per-person and gives you a less exclusive package of services.

“We can help small and mid-sized businesses become selfinsured despite not having large reserves, cut health care expenses and circumvent many of the stringent requirements of the Affordable Care Act,” says Dr. Samir Qamar of MedLion.

“MedLion can include workman comp injuries within its direct primary care plans, drastically reducing costs to the employer, as well as the insurance carrier, and we are able to structure agreements with employers in such a way that monthly MedLion fees can become tax deductible. We can also offer a minimum of affordable primary care benefits to part-time employees, dependents, opted-out full-time employees, early retirees and independent contractors, all of which keep the entire workforce healthy.

“Because MedLion practices have protocols for safe and effective telemedicine, in many cases employees can be treated without them having to visit the doctor’s office — increasing productivity for the host company. We also offer wellness programs, occupational health programs and screenings to employers of all sizes.”

Interestingly, this is all happening at a time when health care costs for employers is rising and becoming more complex each quarter. And, here is another benefit. By charging a flat, per-member, per-month membership fee, the doctors can then sell their various services to each employee at a deep discount.

By cutting out the middleman, [one doctor] said he can get a cholesterol test done for $3, versus the $90 the lab company he works with once billed to insurance carriers, Concierge Medicine Today reported to CNNMoney. An MRI can be had for $400, compared to a typical billed rate of $2,000 or more.

Employers are switching to high-deductible health plans where individuals are now responsible for so many thousands of dollars upfront before the company picks up the tab. When that happens, individuals and families start to treat health care spending like it is their own money and become more cost conscious.

“When you look at the numbers, if a membership medicine contract can save an employer 20 to 30 percent in a year, that could equal a few hundred thousand dollars per year for a mid-

“They are desperately seeking innovative solutions that involve something other than shifting even more costs to employees and their families. Independent primary care physicians can be an employer’s most valuable ally as they seek ways to improve the care their plan members receive while controlling costs.” sized employer,” said Blaine Lindsey, JD, MPH, executive director, Aledade in Louisiana. “This leaves a lot of room for aggressive pricing because self-insured employers are often desperate just to bend the cost curve. When a practice such as that delivers the kind of savings that they are capable of, there will be champagne and crying and hugs in the company HR department.”

Seattle-based health clinic chain Qliance is feeling the impact of the Affordable Care Act, and tweaking its business model in response and pivoting from individual and families to employers. Qliance has long been a provider of primary care to employers, unions, Medicaid and uninsured individuals. CEO Erika Bliss noted that since the 2010 passage of the ACA, more employers have been coming to Qliance with questions about how to tie together new health care innovations that are cropping up in hospitals and primary care settings.

Services include telemedicine, employee wellness programs, patient engagement strategies and more.

As a result, Qliance is now pivoting its business model toward employers and planning to make all of those services available in one place. The company just raised about $2.7 million from existing investors, partly to upgrade its software systems to provide these types of services.

What kind of employer groups are a good fit for membership medicine?

• Manufacturing • Small local employers <50 employees • Self-insured employers • Professional firms (CPA, attorneys, engineering, architectural, technology, etc.)

• Assisted living communities “Retailers have left it alone for decades, but now they see opportunity because traditional providers have not always been responsive to the changing needs of consumers, which creates

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2016 Direct Primary Care

opportunities for others to step in,” said Mark Grube, managing director of Kaufman Hall, an Illinois consulting firm to the Boston Globe (August 9, 2015).

Bottom-line selling points for direct primary care: • Enhanced and increased access to primary care services • Generally 80 percent of needs can be covered by a primary care doctor • Emphasis on wellness and keeping employees healthy • Cap on primary care costs • Decrease number of hospitalizations • Decrease total number of sick days • Decrease number of ER visits • Reduce number of hospital days • Decrease specialty visits • Increase productivity • Reduce absenteeism and presenteeism • If offered, reduced costs on tests and screenings

Deductibles – We have all seen the results of the ACA where individual deductibles have been raised to an astronomical level with individuals. $6,000 is no longer uncommon. Employers are going more and more to the high deductible plans causing providers to have larger ARs than in the past.

• Out-of-pocket limits have also escalated as a result of poor plan design — medical plans have not addressed the actual expense of health care — only who pays the ticket.

• Copays have escalated like all other aspects of the plan. PBMs keep moving the formularies around while the prices for generics are growing at about 10 percent per year.

Accessibility – Having health care without access is tantamount to rationing. There is already a shortage of primary care physicians and practitioners especially in particular rural areas.

• Having to travel long ways to get care robs the employer of productivity and the employee of wages.

• The average employer population has 40 percent to 50 percent of employees who have no primary care provider.

Accountability – Physicians are so busy now trying to increase appointments to stay even with the cuts in payments and paper requirements they find themselves limited in the time spent with individual patients. This is an irritant to both the provider and the patient.

• Patients want a “medical home” where the patient is cared about and they are encouraged to adhere to treatment regimens that will assure them of a longer life with better quality.

• When it comes to population health management, time and staff is limited and the patient is the ultimate victim.

“You really do have a say in the future of primary care in this country,” Bliss said. “We believe that some of the models that continue to evolve, continue to change, will make an impact that’s going to pave the way for the next generation of doctors and all of the patients that are to come.”

The Puget Sound Business Journal in August of 2015 noted that the bigger change is coming from big employers with the muscle to design custom plans: anywhere from 500 to several hundred thousand employees.

“Those employers tend to be what’s called self-insured,” Bliss explained, which means they pay the claims themselves. “So whatever savings accrue to the plan, that’s theirs, that’s money that goes to their bottom line.” For Qliance’s institutional customers, Bliss said the savings have been in the neighborhood of 20 percent.

Expedia uses Qliance for the 2,500 employees at its Seattle headquarters.

“You really do have a say in the future of primary care in this country,” Bliss said. “We believe that some of the models that continue to evolve, continue to change, will make an impact that’s going to pave the way for the next generation of doctors and all of the patients that are to come.”

What employees need and want

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Affordability – Traditional health plans continue to do the same thing over and over again. There is no cost management — only cost shifting to those least able to pay the tab.

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2016 Telehealth

BY KRISTA DROBAC, EXECUTIVE DIRECTOR, ALLIANCE FOR CONNECTED CARE AND PARTNER, SIRONA STRATEGIES

Consumerism is Driving Telehealth Growth, and It’s Here to Stay If you look up the definition of “health care consumerism”, according to Wikipedia, the term means a movement toward patients being more involved in their own health care decisions. It’s more than that. It is also about patients setting the terms by which they will seek and receive health care services. The old paradigm of making an appointment between 9 a.m. and 5 p.m. two weeks in advance doesn’t work anymore. People are busy. They want health care when they need it and they aren’t afraid of receiving it via technology.

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here is plenty of evidence of consumers’ desire for convenience and how it is driving health care options.

Retailers are offering on-site clinics in more and more locations; urgent care centers are popping up in busy neighborhoods across the country; and telehealth is surging. It’s easy to see why retail clinics and urgent care centers are successful, but what about telehealth? Will consumers really accept remote care in place of in-person visits or an ongoing relationship with their provider? The answer is yes.

In the “Telehealth Index: 2015 Survey” conducted by Harris last year, 76 percent of patients said that they prioritize access to

Of the more than 1,700 respondents who used the telehealth option, 33 percent liked telehealth better than an in-person visit, 57 percent liked it just as well, 10 percent weren’t sure, and only 1 percent found it worse.

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health care services over the need for human interactions with health care providers. The same poll found that 70 percent of patients are comfortable communicating with their health care providers via text, email or videos, in lieu of seeing them in person.

Polls are one way of measuring acceptance. What about a head-to-head, real-time choice between telehealth and an in-person visit? A study released

by CVS Health last summer measured just that. CVS Health piloted a capacity management solution using telehealth in select MinuteClinics. Patients at busy MinuteClinics were given the option to use telehealth to connect with a provider in another MinuteClinic rather than wait for an in-person visit. The study is unique because participants were already standing at a location with a practitioner and were given a choice to use telehealth. Of the more than 1,700 respondents who used the telehealth option, 33 percent liked telehealth better than an in-person visit, 57 percent liked it just as well, 10 percent weren’t sure, and only 1 percent found it worse. More than 95 percent of respondents were highly satisfied with the quality of care they received, the ease with which technology was integrated into the visit, and the timeliness and convenience of their care.

Consumer preferences aren’t the only development driving telehealth’s growth. Employers’ desire to save money and decrease

The biggest remaining challenges to fully meeting consumer needs with telehealth are 1) the absence of telehealth in the traditional provider office; 2) payments in public programs; and 3) inconsistent standards of care across states. absenteeism plays a big role. The National Business Group on Health “Large Employers’ 2016 Health Plan Design Survey”, a survey conducted of 140 employers with 10,000 or more employees, found rapid growth in telehealth — from 28 percent of employers offering telehealth as an option in 2014 to 74 percent (projected) in 2016. According to the “United States Telehealth Market Opportunities, 2011-2021” published by Pharmaion in February 2016, the telehealth market is set to grow to $13 billion by 2021.

Initially telehealth was offered as a benefit largely separate from medical benefits. Now, more and more insurers are offering telehealth as an integrated part of their traditional benefit package.

Anthem leads the way, but other large insurers like United Healthcare and most Blue Cross Blue Shield plans are including telehealth in their offerings. This will make telehealth even more mainstream as patients are given the choice to visit remotely with a provider through their insurer.

The biggest remaining challenges to fully meeting consumer needs with telehealth are 1) the absence of telehealth in the traditional provider office; 2) payments in public programs; and 3) inconsistent standards of care across states. A recent survey by Anthem and the American Academy of Family Physicians of 1,500 family doctors found that about nine in 10 family physicians said they would use telehealth to treat patients if they were paid for it, but only 15 percent said they had used the technology in the last year. The Anthem/AAFP survey found users are more likely to be younger, rural and use an electronic health record.

Much of the reason physicians don’t use telehealth is because they don’t get paid for it. Imagine if your boss told you that you are allowed to work remotely but you couldn’t get paid on those days. You wouldn’t work remotely. Given the high number of physicians that would use telehealth if they were paid, it’s time we have consistent reimbursement policies across public and commercial insurers.

There is a major effort underway in Congress to reimburse for telehealth in Medicare. Giving access to telehealth to seniors is a priority for a bi-partisan group of senators and representatives who introduced the CONNECT for Health Act last month. Led by Senators Brian Schatz (D-HI) and Roger Wicker (R-MS), the bill will help physicians serving Medicare patients who are transitioning to value-based care, provide a permanent telehealth benefit to seniors in Medicare Advantage plans, and establish a remote patient monitoring benefit in Medicare. It is good public policy that will provide Medicare beneficiaries access to convenient care that will replace in-person services in more expensive settings. Enactment of the CONNECT for Health Act will go a long way toward improving access to telehealth for all Americans.

Finally, a consistent regulatory framework at the state level would enable telehealth providers, employers and health plans to offer telehealth with greater ease. The boards of medicine and pharmacy are two good examples. Some states allow prescribing over telehealth modalities while others don’t. Some states allow direct-to-consumer telemedicine while others don’t. For multi-state employers or entrepreneurial physicians, these varying regulations are a barrier.

Krista Drobac is the executive director of the Alliance for Connected Care and a partner at Sirona Strategies. She was previously the director of the Health Division at the National Governors Association’s Center for Best Practices where she directed technical assistance for governors’ health advisors in the areas of health insurance exchanges, Medicaid, health IT, delivery system reform and public health programs. Prior to NGA, she was a senior advisor at the Center for Medicare and Medicaid Services, where she worked in Medicaid and was one of the original members of the team that launched the Center for Consumer Information and Insurance Oversight. She also spent five years on Capitol Hill, where she was a health advisor to the Majority Whip Senator Dick Durbin and a John Heinz Senate Fellow for Senator Debbie Stabenow.

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2016

BY LARRY S. BORESS EXECUTIVE DIRECTOR NATIONAL ASSOCIATION OF WORKSITE HEALTH CENTERS

Onsite Clinics

The Evolving Role of Employer Clinics: from Occupational Health to Population Health Management Early worksite health programs were developed to provide first aid and emergency care to employees working in remote or dangerous locations. Over time, many employers, particularly manufacturers, offered a company nurse or doctor to provide occupational health services to comply with federal and state workplace requirements, manage absences and prepare employees for foreign travel – with a few offering onsite physical therapy and acute (non-emergent) medical triage.

as “health and wellness centers” and medical homes. They can effectively become the hub and integrator of all worksite activities. And rather than adding another fragmentation of health care to an uncoordinated medical marketplace, the onsite health center offers the ability to be an extension of a patient’s physician’s office into the worksite. It also offers a source of primary and acute care for those 40-60 percent of employees who don’t have a personal physician.

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Today’s Worksite Health Programs

oday, the services provided by employers at the worksite run the entire spectrum of health care. Leading employers are beginning realize that to manage the cost and health of their covered populations, they need to develop a strategy that integrates and analyzes ALL the data from their vendor and employer-sponsored health related programs and activities. At the same time, they need to increase the engagement of their workers in the multiple preventive and condition management programs they offer. This type of population health approach effectively identifies unnecessary services, gaps in care, opportunities for savings and quality variations to be addressed.

Employer-sponsored onsite and near-site clinics are evolving to support this type of population health management efforts by serving

And rather than adding another fragmentation of health care to an uncoordinated medical marketplace, the onsite health center offers the ability to be an extension of a patient’s physician’s office into the worksite. It also offers a source of primary and acute care for those 40-60 percent of employees who don’t have a personal physician.

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Purchasers have found they can reduce costs and improve productivity by providing services that historically cause employees to leave the worksite for non-emergency care. Subsequently, businesses of all sizes are providing worksite programs to address injuries, occupational health requirements, risk identification, prevention of disease, health education and coaching, chronic disease management, wellness programs, primary care and ancillary services — such as lab tests, imaging, dental, vision, chiropractic, acupuncture and massage services.

Typically, these services are provided by multiple partners, both internal and external to the worksite. This has resulted in a fragmented approach to addressing the health needs of a covered population. Different providers use different communications, promotions and medical record-keeping systems. For the employer, gauging the health status of its workforce becomes a difficult task, as each activity or service operates in a siloed fashion. Employees are faced with multiple entry points and no common messages or providers, which often leads to minimal engagement in worksite wellness efforts, and wasting millions of dollars from limited employer resources.

Additionally, employers find an external health care marketplace — not a system — that offers limited access, uncoordinated care and no incentives to encourage people to manage their health. Patients see their physician one to two times each year, for seven to 12 minutes per visit — hardly enough time to enable the provider or the patient to communicate or drill down on physical and mental health issues.

However, people are at their workplace 1,000-2,000 hours a year, which gives the employer a tremendous opportunity to engage,

educate, monitor and motivate employees to learn about and address key health issues and conditions.

In response to this situation, today around 30 percent of companies offer some form of onsite, near-site or mobile health services to employees, dependents, retirees and others, with 54 percent of those having three or more onsite clinics according to the nonprofit National Association of Worksite Health Centers. A 2015 survey by Willis Towers Watson found that close to 40 percent of employers with onsite clinics intend to add new ones to serve their populations.

The Landscape of Worksite Clinics Often employers are reluctant to consider sponsoring an onsite clinic, concerned about high costs, malpractice liability and reactions from local physicians. To address these concerns, about 60 percent of employers contract with third-party vendors and about 18 percent work with local providers. However, close to a third of employers have decided to manage these clinics and hire provider staff on their own.

Worksite health centers are not limited to manufacturers, though many started with an occupational health clinic. We find onsite and near-site centers sponsored by all industries, in both urban and rural communities.

Willis Towers Watson has found that employers who can benefit from having an onsite or near-site clinic include those with locations having 500 or more employees; geographic areas facing primary care shortages; locations with barriers to reaching external care settings (e.g., remote locations, long commutes, heavy traffic); low utilization by employees/dependents of existing primary care, preventive, screening and condition management programs and services; employers with populations with high emergency room utilization for non-emergency conditions or high absence and lost time for unscheduled medical issues; industries with low-turnover, long-term employees; and older populations with high utilization of services and even younger populations without primary physicians and with limited time.

The Value of Onsite Health Centers An onsite health center can serve as a vehicle to achieve many health benefit objectives, including efforts to reduce medical cost trend by avoiding utilization of unnecessary care; improve health of covered population; integrate all worksite health care, preventive and wellness programs; and reduce absenteeism, while improving productivity.

The onsite health center offers an employer the ability to bring together the various vendors contracted to provide worksite wellness, screening and condition management services. This can enable the employer to consolidate data from internal and external sources with the health center’s EMR.

Telemedicine devices, kiosks and carts, as well as retail clinics, mobile units, self-care apps on cell-phone and website access on laptops are ingredients in the solution to total population health. With these resources available, NAWHC expects less than 50 percent of employee primary and acute care will be provided outside a physician’s office within the next five to seven years.

The presence of the clinic can also increase the visibility and access to other benefit programs and services, now available via a warm handoff between providers and vendors. The consolidated data now can track patient use of service and referrals and allow vendors to collaborate on a patient’s care management. Onsite fitness centers, often underutilized, can also be integrated into the health center’s physical therapy and cardio programs. Finally, the integration enables easy collection and measurement of the center’s performance and impact on the population’s health and employer’s benefit costs.

Beyond the Physical Center Today’s onsite health centers are taking advantage of new technology to go beyond their immediate service area and expand their services to patents when the clinic is closed, to remote locations and where sites are too small to support a clinic operation.

Telemedicine devices, kiosks and carts, as well as retail clinics, mobile units, self-care apps on cell-phone and website access on laptops are ingredients in the solution to total population health.

With these resources available, NAWHC expects less than 50 percent of employee primary and acute care will be provided outside a physician’s office within the next five to seven years.

Tomorrow’s onsite center will serve as the integrator and hub of an employer’s health data and activities. In doing so, employers, with the cooperation and support of their vendor partners, will finally be able achieve population health management and reduced cost, while improving health, productivity and their firm’s bottom line.

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2016

BY LES MCPHEARSON CEO UNITED BENEFIT ADVISORS

Brokers & Advisors

Three Strategies to Solve Your Customers’ Fundamental Problems — and Propel Your Long-Term Growth Our industry is in the midst of unprecedented change and disruption. Benefit advising is quickly evolving from a “products and spreadsheet” business to a sophisticated advising and consulting services model. Advisors who recognize this season of change and embrace a future that is dramatically different than it was three to four years ago will naturally come out on top. But if we miss this opportunity, it will cost us our very livelihood.

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bout 40 years ago, economist and Harvard Business School professor Theodore Levitt said, “People don’t want a quarter-inch drill, they want a quarter-inch hole.” As we look toward the future, we must continuously ask ourselves whether we’re trying to sell a drill or developing solutions to get the quarter-inch hole our customers need.

At UBA,we believe there are three strategies that will help solve fundamental employer problems — and, in the process, propel your own long-term growth and success.

Strategy 1: Manage health care costs with improved analysis.

Employers may say they want health care at the lowest price, but they need more than just a spreadsheet of bids. They need careful analysis of how their costs compare to other employers of their same size, industry and region. They need help navigating the myriad of plan design options to choose the ones that best accomplish savings goals and still attract and retain employees. What employers are really saying is, “Help me do better and make it easy.”

In the 20 percent to 30 percent increase category, fewer than 17 percent of larger employers saw that level of rate hikes versus 23 percent among smaller employers.

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Serious savings only comes with serious analysis that informs customized strategies.

At UBA, our partners collectively invested in the UBA Health Plan Survey — the nation’s most comprehensive health plan cost benchmarking survey, encompassing more than 18,000 plans. The survey revealed that premium rate increases edged up from 5.6 percent in 2014 to 6.2 percent, on average, in 2015. Nearly a third of small employers with 50 or fewer employees saw rate increases of more than 10 percent, while only a quarter of businesses with more than 50 employees also experienced doubledigit increases. With no negotiating power, small groups were hit hardest. In the 20 percent to 30 percent increase category, fewer than 17 percent of larger employers saw that level of rate hikes versus 23 percent among smaller employers. Just over five percent of larger employers saw a rate increase of more than 30 percent, whereas 9.5 percent of small employers experienced such astronomical increases.

UBA bargaining power did play a big cost-containment role for nearly 11,000 employers. Comparing proposed rates from carriers to final rates, UBA Partners offered approximately 20 percent savings, aiding employers of all sizes at the bargaining table, not just the largest ones where savings are more likely. Such successful negotiating is only possible with meticulous benchmarking and a comprehensive understanding of community rating impacts, “grandmothering” protections, carrier nuances, legislation like the PACE Act, minimum value rules, affordability and many other variables that help inform plan design.

Though offering savings to employers is critical, planning for the future is equally important. Employers recently got a reprieve from the immediate ramifications of the Cadillac tax, but the longterms risks are still looming. Many employers falsely assume that the Cadillac tax will apply only to the richest plans. However, newly released data from the 2015 UBA Health Plan Survey shows that even the lowest quality “bronze-level” health insurance plans on the ACA exchanges are at risk of triggering the tax, potentially affecting 74 percent of employers by 2022.

When the Affordable Care Act was created, it was assumed that only three percent of plans would trigger the Cadillac tax, and it was marketed as a tax on “the rich benefits of executives”. The reality is that this tax will weigh heavily on a majority of American businesses and many of these employers, even after reducing benefits and

premiums, will still not be able to lower their annual costs under the Cadillac tax thresholds.

Advisers need to be strategizing with clients now — particularly those with an aging workforce, those with high claims, and those in areas with high medical care costs — in order to mitigate liabilities in the future.

Strategy 2: Build a compliance competency.

The ACA is a behemoth of rules, notices, fees, penalties, exceptions, safe harbors, proposed regulations, final regulations and reporting obligations. Employers lack the legal resources (and, let’s face it, the sheer stamina) to navigate the evolving laws and translate them into sound practices. Whether they need a letter template explaining IRS Forms 1095-B and 1095-C to employees or help counting their seasonal employees under the ACA, the question for you is: Have you invested in the compliance resources your customers need?

Although the ACA implementation is well underway, continued regulatory guidance will shape plan design and costs going forward.

The industry is still awaiting federal guidance on non-discrimination for fully insured group health plans, as well as finalization of proposed non-discrimination regulations in relation to Section 1557 of the ACA, which prohibits discrimination on the basis of race, color, national origin, sex, age or disability. It is certain that these rules, once finalized, will greatly affect plan design.

In addition, federal agencies have confirmed that, beginning in 2016, self-only, cost-sharing limitations will apply to each individual on a health plan, regardless of whether the individual is enrolled in a self-only plan. The annual self-only out-of-pocket limit for 2016 will be $6,850. This requirement will apply to both high-deductible health plans and non-high-deductible plans and is in response to consumer complaints about high deductibles and out-of-pocket limits.

In 2016, the HDHP maximum out-of-pocket amounts are $6,550 for an individual and $13,100 for a family. Going forward, the family’s cost sharing to the deductible limit can continue to be offered under the HDHP policy, as long as the self-only annual outof-pocket limitation is applied to each individual on the plan. This change will have a significant impact on how employers select their cost-sharing limits. Your agency’s access to knowledge resources and its ability to help navigate these changes may very well make or break your future.

Strategy 3: Transform the market with innovative solutions.

If you think through some of the most transformational innovations in recent history (the iPhone, Amazon, Netflix, critical illness insurance), they didn’t come from huge

Many employers falsely assume that the Cadillac tax will apply only to the richest plans. However, newly released data from the 2015 UBA Health Plan Survey shows that even the lowest quality “bronze-level” health insurance plans on the ACA exchanges are at risk of triggering the tax, potentially affecting 74 percent of employers by 2022. companies like Samsung, Borders, Blockbuster or Blue Cross Blue Shield. They came from smaller firms, creative individuals and bold innovators. All advisors can find an area where they are particularly expert and identify innovation opportunities.

After all, when clients ask for help managing risk, they’re saying to us, “Bring me new options that I can understand and that are easy to use.”

As an industry we need to move from being product oriented to solution oriented. Many advisors are doing just that by offering great solutions such as private insurance exchanges and downmarket self-funding. UBA Partners are continually bringing their entrepreneurial local solutions to our national table, showing that good, old-fashioned grassroots problem solving can be highly successful. More recently, UBA Partners launched a stop-loss captive that addresses the unique needs of companies with fewer than 300 lives and historically good experience in order to control volatility and cost by sharing risk with like-minded employers. We set out to help clients escape the deteriorating risk pools, ACA taxes and fees and community rating cost drivers associated with traditional health insurance. We also wanted to avoid the pitfalls of many stop-loss captives by keeping it simple — a cost management program with an underlying financial vehicle. As a result, instead of staying with a familiar yet high-cost health plan, an innovative group of employers is taking a divergent path to higher-quality, lower-cost health care.

Bottom line, we need to know our customers as well as — or even better than — they know themselves. That’s no small feat. But it’s the surest path to our future success.

Les McPhearson is the CEO of United Benefit Advisors. A 15-year veteran in the insurance industry, McPhearson leads the 140-firm, partnership-driven organization that serves 36,000 employers and five million members.

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AFFILIATE MEMBER PROFILES

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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 offers an integrated package of SaaS technology and services to support all account-based healthcare plans on a robust, private-labeled platform.

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

Ameriflex, established in 1998, is an independent administrator providing technology-based, consumer-driven benefits, compliance, and workforce management solutions to clients throughout the United States.

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.

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.

Bloom Health is transforming the way employers use the range of workplace benefits to help attract, retain and motivate talent.

Certifi provides private-labeled premium and commission billing, payment processing, accounting, and remittance software and services to carriers, benefit exchanges, and administrators. Our proprietary technology uses accounting principles to provide true end-to-end membership accounting, from group and consumer invoicing to carrier & broker payment, and all associated financial reporting.

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.

Founded in 2005, Colibrium delivers integrated software solutions designed specifically for the health insurance industry.

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.

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

Based in Connecticut, ebenefit Marketplace offers brokers nationwide the software and services to streamline benefits, HR and payroll administration through a private exchange platform.

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

FAIR Health is a national independent, not-forprofit corporation whose mission is to bring transparency to healthcare costs and health insurance information through consumer resources, comprehensive data products and research tools.

At Fidelity, our goal is to make financial expertise broadly accessible and effective by focusing on a diverse set of customers. Good health is a smart investment. That’s why Fidelity Health Marketplace is pleased to offer small and mid-sized employers an extensive network of medical, dental, vision, disability and other providers, giving them the options they deserve.

GetInsured works with employers and benefits consultants to develop individual health insurance solutions for part-time, retiree, COBRA and other non-sponsored

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Access these solution providers online at www.theihcc.com. employee populations. Our suite of Employee Transitions solutions connect employees with the health insurance coverage they deserve while helping employers reduce their healthcare costs.

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.

hCentive is a provider of cloud-based technology that helps consumers connect, communicate and engage in acquiring health insurance benefit products.

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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.

Interactive Health provides comprehensive worksite wellness solutions that are personalized for each individual.

Intrepid goes beyond the typical expectations of the benefits consultant. We take the time to understand each client’s unique culture in order to implement the most progressive, creative solution to their benefits needs.

Jiff 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.

PokitDok is an API platform to streamline transactions and power interoperability in healthcare.

Liberty Mutual: What started out as an experiment offering discounted auto & home coverage to employees over 40 years ago has become a way of business.

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Own Your Healthcare

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

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.

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

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

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

Renaissance Dental: It is our goal to bring quality to all we do by providing flexible, innovative plans and exceptional customer service to individuals, groups, and dentists.

Modern Emergent Care: We are Atlanta’s only ER alternative. Less wait time. Less cost. Less hassle, than hospital ER. Upscale facility with state of the art diagnostic center. CT scan, Ultrasound, X-Rays and full Lab testing.

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

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

Money Starts Here™ provides financial wellness programs that help large group employers and their employees cut healthcare costs and avoid costly financial mistakes.

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.

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

Tango Health Benefits Optimization saves organizations money, makes employees happy, and ensures Affordable Care Act compliance.

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Totem Solutions provides full service benefits consulting, administrative outsourcing, and communication services to public and private employers.

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.

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.

WiserTogether delivers better outcomes and lower cost by bringing clinical evidence and patient-reported ratings together in a personalized consumer experience.

Whil is the leader in digital mindfulness, yoga, and leadership training.

Withings leads the connected health revolution.

Our beautifully designed award-winning products bring long-term engagement and measurable health impacts to your workforce.

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ADVERTISING INDEX Vericred Inc. is a healthcare technology company enabling the transformation of the health insurance shopping experience.

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

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HSA Bank ......................Inside Front Cover Dallas-based Viverae®, is a total population health management provider with a proprietary, intuitive, and configurable webbased application, MyViverae, that meets members where they are in their health, from wellness to health management.

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

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Rogers Beasley 404.671.9551 ext 109 • rbeasley@theihcc.com BUSINESS DEVELOPMENT

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WageWorks ........................................... 11

Reimagine how technology can be used to drive member engagement and loyalty.

With decades of experience in the health plan industry, we’re able to bring our insights to life within the products we provide.

Our highly configurable, single platform—Tuo® Marketplace—works for all market segments, so you can easily add products and plans or choose from a host of features that are available out of the box.

Tuo® 360 is an innovative overlay that instantly transforms SalesForce or Dynamics into a health plan-specific solution, removing the barriers to your CRM success. Whether they’re implemented independently or together, both of these software solutions are built to help you succeed in this consumer-centric, reform-driven world.

www.colibrium.com | info@colibrium.com General Inquiries: 404-793-1300 | Sales: 678-800-1886 (1TUO)

Give your health coverage wings.

70 percent of employees say they’d likely purchase voluntary insurance if it were offered by their employers.1 The question is, who will you choose?

You could opt for a voluntary option from another carrier, or you could offer coverage from Aflac — the provider whose promise is to process and pay, not deny and delay.

There’s no direct cost to employers for offering it, and our portfolio of coverage options are sure to complement any major medical plan.

Just add a payroll deduction, notify your workforce and let it fly.

Contact your Broker, local Aflac Agent, or go to aflac.com

Critical Illness

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2015 Aflac WorkForces Report, a study conducted by Research Now on behalf of Aflac, January 20 - February 10, 2015. Includes somewhat, very and extremely likely; of those employees who are not currently offered voluntary insurance benefits by their employers. 1One Day PaySM available for most properly-documented, individual claims submitted online through Aflac SmartClaim® by 3 p.m. ET. Aflac SmartClaim® not available on the following: Disability, Life, Vision, Dental, Medicare Supplement, Long-Term Care/Home Health Care, Aflac Plus Rider, Specified Disease Rider and Group policies. Aflac processes most other claims in about four days.. Processing time is based on business days after all required documentation needed to render a decision is received and no further validation and/or research is required. Individual Company Statistic, 2015. Individual coverage is underwritten by American Family Life Assurance Company of Columbus. In New York, coverage is underwritten by American Family Life Assurance Company of New York. Worldwide Headquarters | 1932 Wynnton Road | Columbus, GA 31999

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