solutions ISSUE || November - december 2011
Innovative Health and Benefit Management
rJ Young Makes it right with hDhp/hsa plan
integration: redefining employee-centric health Care Consumer-oriented Communications: the Key to advancing health Care Consumerism newer riders Boost Critical illness Plans to meet 21st Century needs
www.theihcc.com
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23 RJ Young Makes it Right Having seen its bottom line affected by skyrocketing health care costs, RJ Young cut ties with its long-time health benefits broker, who said the office equipment manufactuer’s bluecollar workforce would never accept a consumer-directed health plan, and hired a new broker who implemented a health savings account with a highdeductible health plan. By Sam Shallenberger, CFO, RJ Young
5 editor and Publisher’s letter
16 health Plans – Self-funding
Wow, Where has the Year Gone?
Stop-loss Protection: The Key to Self-funding for Mid- to Large-size Companies
7 health Care Consumerism
26 ask the expert
Integration: Redefining Employee-centric Health Care
By Joseph Bernardo, Jr.
The Future for Private and State-based Health Exchanges By Ronald E. Bachman
9-11 ihC FOrum east
• Featured Speakers in Atlanta • Benefits of Attending FORUM • Professional Credits Available for CRCs and HR Professionals • Sponors/Exhibitors • Registration Rates
17 hSa/FSa/hra administration & Finance Notes from the Trenches: The Coming Storm in Health Care
By Kevin McKechnie
18 health Plan Communication
Consumer-oriented Communications: The Key to Advancing Health Care Consumerism By Charles Epstein
19 rewards & incentives
12 People on the move 12 Briefs/innovations
Where’s the Boost to Getting Healthy?
• Cigna Agrees to Buy HealthSpring • Aetna, Carilion Partner on Care-coordination Plans • MetLife’s Multi-product, Multi-channel Enrollment Platform Provides Enhanced Employee Experience, Reduces Employer Administration
By Don Doster
21 Supplemental health & Voluntary Benefits
By Evan Falchuk
27 Who’s Who Profiles 30 resource Guide/ad index
event the 2012 ihC Forums
Our Conference series returns to the Cobb Galleria Centre for FORUM East on April 12-13, and will go out West again in late summer for our second annual Forum WEST at the Red Rock Resort in Las Vegas on Sept. 6-7.
For more information please visit www.theihccforum.com Have something to share? Post a blog or forum on our new website www.theihcc.com. Come be apart of The Institute for HealthCare Consumerism.
New Riders Boost Critical Illness Plans to Meet 21st Century Needs By Alex Moral
Print anD Online Key Connect with CDHC experts and community members online at www.TheIHCC.com by looking for the following symbols at the end of each article: blog
MEMBER
BLOG
WHO’S WHO PROFILE
BROKER/ADVISOR/ CONSULTANT
EMPLOYEE COMMUNICATION & EDUCATION
HEALTH PLANS
HSA/HRA/FSA ADMIN & FINANCE
S TOTAL POPULATION HEALTH/WELLNESS
PHARMACY BENEFITS MGMT
POLICY & LEGIS PERSPECTIVE
SUPPLEMENTAL BENEFITS MGMT
TOOLS AND TECHNOLOGY
MEDICAL TOURISM
www.TheIHCC.com I CDHC Solutions™ I November/December 2011
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Learn.Connect.Share.
Online
What’s Happening at The Institute
Web Features | Visit www.theihcc.com for instant access to constantly evolving communities. Here are just a few of the latest lessons and perspectives by industry insiders:
The IHC brings you the Collective Voice on Health Care Consumerism via a social networking site that uses a 24/7 virtual, portable format.
Health Plan Communication Improve Your Organization’s Participation Rates in 2012 By Missy Popp-Lloyd, Director of Participation Strategy, Wellness & Prevention Inc., a Johnson & Johnson company
Health Decision Support Tools Indiana’s Innovative System Clings to Life By Benjamin Domenech, The Heartland Institute
HSA/HRA/FSA Admin & Finance Shifting to Health Care Consumerism: For Employers, it’s not a Matter of When, but How By CeridianVoice
Medical Travel Making Sense of Health Care Prices By John Goodman, president, National Center for Policy Analysis
Pharmacy Benefit Management How a ‘Clean Room’ Helped Two PBMs Get Together By Jill Brown, AISHealth
Regulatory & Compliance Query Results: Private Health Exchanges By Interpro Publications Inc
Blogs | Sharing thought leadership with 70,000+ members. It’s our mission to feature blogs with helpful advice, best practices and solutions that really work. Connect with experts who take pride in learning and staying motivated:
What Health Care Benefits Issues Are You Most Concerned About?
One Minute Left in the Game.
LinkedIn: Make sure to join our CDHC Solutions by the Institute for HealthCare Consumerism where you can participate in the latest discussion on CDHPs.
Score: Patient Education 100, Patient Accountability 0. By Dr. Wendy Lynch
4
November/December 2011 I CDHC Solutions™ I www.TheIHCC.com
Sign up as a free member to join the only networking community for innovative health benefits management. Learn the latest trends. Connect with like-minded professionals in your field. Share your blog, forum or vision on health care consumerism. Visit www.ihcc.com, today. Social Networking | Facebook: Become a Fan of CDHC Solutions Magazine and connect with other CDHC followers, plus receive recent site postings from our wall feeds, which include FORUM incentives and more.
TweetTweet: Follow us on Twitter@the_IHC and stay in the constant loop with health care reform news, industry updates and more.
Letter
Editor & Publisher
www.ihcc.com VOLUME 7 NO. 7 November/december 2011
Published by FieldMedia LLC 292 South Main Street, Suite 400 Alpharetta, GA 30009 Tel: 404.671.9551 • Fax: 770.663.4409
Wow, Where has the Year Gone?
ceo/ Publisher/Editor-In-Chief
Doug Field 404.671.9551 ext. 101 · dfield@ fieldmedia.com Associate Publisher
Brent Macy 404.671.9551 ext. 103 · bmacy@fieldmedia.com Managing Editor
Todd Callahan 404.671.9551 ext. 105 · tcallahan@fieldmedia.com Senior Editor
Mavian Arocha-Rowe 404.671.9551 ext. 104 · marocha@fieldmedia.com Associate Editor/Social Media Manager
Jonathan Field jfield@fieldmedia.com Marketing & Sales Coordinator
Kelly Hall • khall@fieldmedia.com Sales Associates National Account Manager
Brent Macy 404.671.9551 ext. 103 · bmacy@fieldmedia.com Vice Presidents of Business Development
Susan Yakots 404.671.9551 ext. 102 · subscriberservice@fieldmedia.com Murray Kasmenn 770.356.2342 · mkasmenn@fieldmedia.com Business development Associates
David Cerri 404.671.9551 ext. 106 · dcerri@fieldmedia.com Art Director
Kellie Frissell 404.671.9551 ext. 107 · kfrissell@fieldmedia.com Chairman of CDHC Solutions Editorial 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, PilotHSA; Sanders McConnell, My HSA Rewards; Roy Ramthun, HSA Consulting Services LLC; John Young, CIGNA Webmaster
Kevin Carnegie kcarnegie@fieldmedia.com Tom Becher webmaster@fieldmedia.com Reprints
Susan Yakots 404.671.9551 ext. 102 · subscriberservice@fieldmedia.com Business Manager
Karen Raudabaugh 404.671.9551 ext. 108 · kraudabaugh@fieldmedia.com CDHC Solutions ™ Volume 7 Issue 7 Copyright ©2011 by FieldMedia LLC. All rights reserved. CDHC Solutions ™ is a trademark of FieldMedia LLC. CDHC Solutions ™ is published eight times yearly by FieldMedia LLC., 292 South Main Street, Suite 400, Alpharetta, GA 30009. Periodical postage paid at Alpharetta, GA and additional mailing offices.
It seems just a few weeks ago we debuted the expanded program for our day-and-a-half CDHC Solutions FORUM. Since the successful CDHC Solutions FORUM East at the Cobb Galleria in Atlanta in May and the inaugural CDHC Solutions FORUM West in September in Denver, 2011 has been an unforgettable year. In addition to our expansion of the only conference series focused 100 percent on health care consumerism and providing employers with the proper tools to create better consumers of health care, arguable the highlight of a successful calendar year was the creation of The Institute for HealthCare Consumerism. Credited by industry leaders as “the voice of health care consumerism,” we elected to go a step further and enhance that with the creation of the IHC. Formerly known as CDHC Solutions, the Institute website, www.theihcc.com has continued to provide cutting edge information and breaking news from the leading industry thought leaders, focusing on best practices in health and benefit management. However, the new Institute website is not only the premier stop on the Internet to learn the latest innovations in consumer-directed health plans and employee wellness programs, this is truly an interactive website. Next year is going to be a pivotal year for the health care industry, and the IHC will continue to be the No. 1 source for the latest information on the health care law, the Supreme Court ruling, and the latest trends and innovations in employee health and benefit management. Additionally our conference series returns in 2012, with FORUM East returning to the Cobb Galleria Centre in Atlanta on April 12-13 and FORUM West being held at the Red Rock Resort in Las Vegas on Sept. 6-7. For more information and to register visit www.theihccforum.com. Have a question or an idea in regard to your company’s health care spend or the latest trends in benefit management? Chances are there are firms and HR managers out there in the same boat as you, looking for the most efficient way to provide the best employee benefit package. The Institute can provide those answers and connect you with key solution providers and thought leaders on the front line of health care consumerism. We do this through our interactive website and in our conference series. Visit our website www.theihcc.com, become a member of The Institute and start learning, connecting and sharing experiences with fellow Institute members. As we close out 2011 and look forward to a new year and a new beginning, we at The Institute for HealthCare Consumerism want to wish everyone a Merry Christmas and the happiest of New Year’s.
Sincerely,
TO SUBSCRIBE: Make checks and money orders payable to CDHC Solutions ™ magazine 292 S. Main Street, Suite 400, Alpharetta, GA 30009 or visit www.cdhcsolutionsmag.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. CDHC 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.
Todd Callahan Editorial Director tcallahan@fieldmedia.com
Doug Field CEO/Publisher dfield@fieldmedia.com
The magazine is not responsible for unsolicited manuscripts or photographs. Send letters to the editor and editorial inquiries to the above address or to tcallahan@fieldmedia.com. Permission to reuse content should be sent to, tcallahan@fieldmedia.com.
www.TheIHCC.com I CDHC Solutions™ I November/December 2011
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1
By Ronald E. Bachman FSA, MAAA President and CEO » Healthcare Visions
Bachman’s Banter
The Future for Private and State-based Health Exchanges
T
T:10.5”
B:11.125”
S:9.5”
he Patient Protection and Affordable Care Act (PPACA) mandates implementation of health exchanges by Jan. 1, 2014. The health reform law requires states to show significant progress in developing health exchanges by Jan. 1, 2013 or risk the federal government establishing a health exchange for the state. Since health insurance has historically been controlled by states and, to the extent PPACA allows, each state wants to develop flexible health exchanges with state-specific unique features. The main questions being studied by most states are: 1. If PPACA is upheld in the United States Supreme Court as constitutional, are state-based exchanges under PPACA likely to be financially sound self-sustaining entities independent of on-going state appropriations? How might future shifts in political control impact the future of exchanges? 2. If PPACA is found in part or in whole as unconstitutional, are statebased or private exchanges needed and can they be financially viable entities to improve access to affordable health insurance? How might future shifts in political control impact the future of exchanges?
Massachusetts, Utah). Each state must then decide if state-based exchanges are given a monopoly or will compete against private exchanges. Under either approach, the ability for state exchanges to be self-sustaining financially sound business models are likely to fail. As a monopoly, state/federal funds will likely be needed to operate a state-based monopoly exchange (e.g. Massachusetts). As a state-based exchange competing against private exchanges, special competition limiting rules state funds supporting state-based exchanges may be needed (e.g. Utah). A state-based exchange is unlikely to survive direct competition with private exchanges offering more health information and support for health insurance purchases. Private exchanges will have the advantage of existing broker, hospital, physician, and other health stake-holders customers. Private companies developing exchange services are providing the exchanges as additional products and services within their existing business portfolios. They are investing heavily in technology, business infrastructure, research and development, marketing, and administrative capabilities.
Changing Pre-PPACA State Insurance Laws Like any business, health exchanges must perform at least two major functions: Intake of customers and output of value-added products and services. On the intake, the concept of health exchanges is to act as a central point of entry for individuals and small groups to purchase health insurance. The idea of exchanges is developing as a potential answer to a problem highlighted by national health reform—a need to increase health literacy and improve the traditional sales/marketing distribution system.
The Effect of Constitutional Ruling If PPACA is ruled constitutional and the individual mandate stands, individuals will be mandated by law to purchase whatever is allowed by the federal government. The “Intake” of customers will be guaranteed by a universal requirement supported by a penalty for non-compliance and a rewarding financial subsidy for compliance. In addition, a state-based exchange will have the advantage of being the only place of purchase where federal subsidies are granted. If PPACA is ruled unconstitutional many believe there is little reason for states to invest in developing a state-based health exchange. First, there are many who believe it is unconstitutional for states to mandate insurance. Second, many believe that even if an individual mandate is constitutional at the state level, it is philosophically not the role of state government to implement such a mandate. Third, without a state mandate, a state-based exchange would be at a competitive disadvantage to more information rich private companies with existing clients and the capital to invest in health literacy and consumer sales.
State-based Versus Private Exchanges If the PPACA individual mandate is ruled unconstitutional or PPACA is otherwise inoperable, the states could still establish a health exchange (e.g.
If individuals are no longer federally or state mandated to purchase exchange products and services, states will need to review and revise the products and services allowed under pre-PPACA insurance laws. In most states, significant portions of the citizenry rejected purchasing health insurance as unaffordable or lacking sufficient value. Without the PPACA purchasing mandate, there is no reason to project that there will be an increase in individuals or groups purchasing insurance. However, if the state insurance laws are changed to allow more affordable insurance, increase access to coverage, improve a porous free market safety net, and focus on lowering the uninsured—then more individuals could maintain and seek coverage without a government mandate.
Conclusion The Supreme Court’s decision on the constitutionality of PPACA and the elections of 2012 and beyond will ultimately determine the future and purpose for developing a state-based health exchange. Until it is clear, most states are likely to defer development of state-based health exchanges. The business uncertainties and the lack of evidence that states can develop a unique valueadded state-based exchange further support the need for delay. State advisory committees can play an important role by advance planning. If by June 2012 PPACA is ruled constitutional and states can outline: (1) a self-sustaining business model, (2) show that that under PPACA states can develop a flexible exchange rules that benefit its citizens, and (3) prove that a state-based exchange is needed, then a special session of the state legislatures could be called during the summer of 2012 to further consider the advisory committee recommendations. To read an extended version of the article please visit http://bit.ly/uIBYa6 www.cdhcsolutionsmag.com I CDHC Solutions™ I November/December 2011
7
Seeking Direction About
Health Care Reform? Health Reform Navigator—Your complete Health Reform Information Center. It provides an aggregation and “point & click” navigation to information regarding the Patient Protection and Affordable Care Act (PPACA).
The Health Reform Navigator helps insurance brokers and consultants answer client questions and benefit managers to quickly respond to issues about the Patient Protection and Affordable Care Act (ObamaCare).
The Health Reform Navigator organizes massive information into a simple searchable format. It provides easy access to actual legislative language, regulations from DOL, HHS, and the Treasury, multiple industry and think tank time lines, and industry surveys on what employers think of reform. You can stay alert to HOT TOPICs, read independent legal and consulting observations, and much more. There are even more than 50 government produced videos and multiple private conference video links. “The Health Reform Navigator is a great new tool for our readers to get answers to questions that make their jobs easier.”
— Doug Field, CEO FieldMedia
BONUS – Four for the price of one – Subscribers purchase Health Reform Navigator and also receive four separate Navigators: the Insurance Navigator, Tax & Penalty Navigator, Preventive Care Navigator and Medicare Navigator. Each Navigator is structured with a timeline for when individual sections of the law become effective and each uses the same easy, “point & click” technology to get answers to specific questions about the health care law. Each Navigator also includes direct links to PPACA, regulations, independent legal opinions, and consulting observations. The unique Preventive Care Navigator includes explanations of the USPSTF recommendations, mandated coverages and allowed exclusions, sample SDP language, and CPT codes applicable to each benefit.
A combined $400 value, subscribers can get instant access and a one-year subscription for $99 or $9.99 for a monthly subscription. CDHC Solutions also is offering a one-year subscription for free by signing up for pre-conference event sponsored by Center for Health Transformation. For details please see www.theihccforum.com.
Start navigating today.
Access your Health Reform Navigator
https://sites.google.com/site/hrnihc/
Formerly CDHC Solutions FORUM
The Place to Help You on Your Journey to HealthCare Consumerism
REGISTER TODAY AND SAVE foruM EAST 2012
April 12-13
ATLANTA
Cobb Galleria Centre
January 20, 2012
SUPER SAVER DEADLINE WWW.THEIHCCFORUM.COM
LEARN. CONNECT. SHARE. FieldMedia LLC is the parent company to CDHC Solutions magazine, EmployersWeb.com, IHC FORUM and The Institute for HealthCare Consumerism. 292 South Main St., Ste 400, Alpharetta, GA 30009
2012
www.theihccforum.com
Benefits of Attending Learn how to get your employees to become better health care consumers and lower your health care benefit costs. Attend the day-and-a-half conference to: • Learn new strategies to enhance your current health and benefit offering • Hear the latest updates and changes to the health care law
This year’s theme is “The Journey to HealthCare Consumerism” The Institute for HealthCare Consumerism Advisory Board Chairman Ron Bachman and Dr. Wendy Lynch, a senior scientist with the Health and Human Capital Foundation discuss the five generations of health care consumerism from plan design and implementation to communities-wide sharing and information exchange to aid the overall health of the general population. This general session will be informative and set the tone for the rest of the FORUM. The two will share their insights and guidance for employers on the road to HealthCare Consumerism.
• Connect with key industry leaders, see the latest solutions and be able to implement them right away • Build your health benefit skills in our educational workshops, earn CEU Credits • Network with your peers — Hear what has worked for them and share your successes
Wendy Lynch Founder Lynch Consulting Senior Scientist Health as Human Capital Foundation
Ron Bachman, FSA, MAAA Chairman CDHC Solutions Editorial Advisory Board
What You’ll Learn The FORUM EAST conference will be a day and a half event with 40 speakers participating in five general sessions and your choice of 24 workshops. In addition to networking with top industry leaders, you will learn how to successfully be on the cutting edge of new health care benefits through topics and discussions, such as: • The Journey to HealthCare Consumerism • HealthCare Reform: A Potential Pothole on the Journey to HealthCare Consumerism • Population Health Management: Implementing a successful wellness program • Health Provider Panel: Panel discussion focusing on best practices for plan design • Employer Panel: What HealthCare Consumerism Means to You Plan to attend the pre-conference workshop on April 11 (additional fees apply) for certification courses on HealthCare Consumerism, Consumerism 101 and Population Health Management.
FORUM EAST 2012
Atlanta
NEW AT THE FORUM – “Innovation Showcase” Workshops – Round Table Sharing Sessions – Exhibitor Prize Drawings – Interactive Employer Panel – Broker Workshops
Visit www.theihccforum.com to preview the agenda and register for the conference.
THE JOURNEY TO HEALTHCARE CONSUMERISM Plan Ahead and Save Register now to receive our Super Saver rates and save your company money. At the FORUM you’ll learn strategies to lower health care costs and save even more.
FORUM East 2012 • April 12 - 13 • Cobb Galleria Centre • Atlanta, GA Registration Dates:
Your registration package includes:
Super Saver Deadline — January 20, 2012
· · · · · ·
Group rates available for two or more attendees. 50% off your registration rate. Register at www.theihccforum.com
Five General Sessions Three Hands-On Workshops Breakfast, Lunch, Breaks and our Opening Night Reception Conference Workbook Online access to all workshop presentations Chance to win multiple sponsor prizes
SAVE THE DATE: 2012 FORUM WEST Sep 6-7, 2012 Las Vegas Red Rock Resort Super Saver Rates Available!
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Briefs
People on the move
People on the Move The point man for carrying out President Barack Obama’s health care law resigned after Republicans succeeded in blocking his confirmation by the Senate. Medicare chief Don Berwick, a Harvard professor widely respected for his ideas on how to improve the healthcare system, became the most prominent casualty of the political wars over a healthcare overhaul law whose constitutionality will be now decided by the Supreme Court. Berwick’s Dec. 2 resignation was confirmed by a senior congressional official, speaking on condition of anonymity ahead of an announcement by the administration. He will be replaced by his principal deputy, Marilyn Tavenner, formerly Virginia’s top health care official. Forty-two GOP senators—more than enough to derail Berwick’s confirmation—had announced their opposition to his nomination months ago. That started a countdown on his temporary appointment, scheduled to run out at the end of the year. Dr. Jeffrey Kang, most recently the chief medical officer at Cigna, joined Walgreens on Oct. 31 as senior vice president of health and wellness services and solutions. Kang, 55, will report to Walgreens President and CEO Greg Wasson and to Kermit Crawford, the company’s president of
CDHC Innovations
CIGNA
Cigna Agrees to Buy HealthSpring Cigna Corporation and HealthSpring Inc. announced they have signed a definitive agreement under which Cigna will acquire all the outstanding shares of HealthSpring for $55 per share in cash, a 37 percent premium over the closing stock price on the day of purchase (Oct.21), representing a total transaction value of approximately $3.8 billion. HealthSpring’s proven leadership team, headed by its Chairman and Chief Executive Officer Herb Fritch, will lead Cigna’s expansion in our rapidly growing seniors and Medicare segments. The business combination is expected to be accretive to Cigna earnings per share in the first full year of operations. The agreement has been approved by the boards of directors of both companies and is subject to required regulatory approvals and customary closing conditions. The transaction is expected to close during the first half of 2012 and is not subject to a financing condition. “HealthSpring is a great fit with Cigna’s growth plans to expand into the seniors and Medicare segment through a premier business and trusted brand name,” said David M. Cordani, president and chief executive officer. “Our two companies share a common strategic vision and philosophy that we create customer value by partnering with health care professionals, and use information and incentives to deliver highquality, differentiated programs.” Cigna’s acquisition is the latest in a series of deals made by health insurers to expand their Medicare Advantage businesses, which are growing at a faster rate than commercial insurance as baby boomers become eligible for them. In addition, big insurers like Cigna have reported strong results in recent quarters, and analysts have speculated that companies would start exploring acquisitions. HealthSprings also saw the benefits of the acquisition. “We are thrilled to announce this transaction with Cigna,” Herb Fritch said. “Following a review undertaken by our board of directors of the company’s strategic options, we concluded that the combination is in the best interests of our shareholders. The combination will also expand our ability to serve our physician partners and customers. Cigna recognizes the 12
November/December 2011 I CDHC Solutions™ I www.TheIHCC.com
pharmacy, health and wellness. Kang is board-certified in internal medicine and currently serves on the board of directors for the National Committee for Quality Assurance and the Healthcare Information and Management Systems Society. As Philadelphia-based Cigna’s CMO, Kang oversaw payfor-performance programs and directed health strategy and policy for the insurer’s medical, pharmacy and behavioral products. From 1998 to 2002, he served as chief clinical officer at the Health Care Financing Administration, now the CMS. Integrated Healthcare Strategies, a national consulting firm dedicated exclusively to improving the operations of health care organizations, announced senior consultants, James A. Rice, Ph.D., executive vice president will join Management Sciences for Health (MSH) as the Project Director for an MSH-USAID Program, whose mission is to enhance leadership, management and governance of health systems in developing nations. Dr. Rice has focused his consulting work on strategic governance for tax-exempt health sector organizations and integrated care systems, and leadership development for physicians and medical groups. Dr. Rice has engaged in governance and strategy projects in more than 32 countries for the past 40 years.
» H E althspring
» A etna
» C arilion C linic
value in HealthSpring’s differentiated model of physician engagement, and shares our commitment to providing high quality, cost-effective care to the members and communities we serve. We truly look forward to continuing and expanding upon this mission.”
Aetna, Carilion Partner on Care-coordination Plans Aetna and Carilion Clinic have launched a suite of new health benefit plans—called Aetna Whole Health™—now available to Virginia employers with two to 100 eligible employees. Aetna Whole Health plans create a unique opportunity for Roanoke-area businesses to help their employees optimize their health and get healthier faster. The plans feature a new model of health care delivery designed to offer: (1) a more coordinated, personalized experience for patients; (2) lower copays for seeing designated providers; and (3) better health care outcomes. Aetna Whole Health plans unite Aetna’s network of contracted providers and small-group plans with doctors, hospitals and outpatient specialty centers from Carilion Clinic and LewisGale Regional Health System. The plans are priced to reflect the cost and quality benefits of the Aetna-Carilion collaboration. Members can benefit from a low copay differential by using “designated network providers” who have been recognized or are in the process of being recognized by the National Committee for Quality Assurance (NCQA) for meeting stringent efficiency and quality measures. Providers will help to create healthier communities by sharing information as patients pass through different health care settings and using personalized care and patient engagement to improve quality. These new products are based on Carilion’s and Aetna’s accountable care organization (ACO) relationship, announced in March.
New Provider/Payer Relationship Incentivizes Better, More Comprehensive Care for Southern California Anthem Blue Cross and Wilshire Oncology Medical Group announced the launch of a new pilot program that helps serve California
Blue Shield of California has named Dr. Marcus Thygeson the company’s vice president of medical services. Thygeson previously served as president of the Center for Healthcare Innovation for Allina Hospitals and Clinics in Minneapolis. Before that, he worked as corporate medical director and vice president for consumer health solutions at HealthPartners, the not-for-profit HMO headquartered in Bloomington, Minn. Thygeson’s responsibilities at Blue Shield of California will include providing strategic leadership and assisting in the integration of the company’s clinical functions. Regence BlueCross BlueShield of Oregon is pleased to announce the appointment of Don Antonucci to the position of president. In his new role, Antonucci will continue to direct efforts in expanding Regence’s existing position of leadership within a dynamic Oregon market. With a sharp focus on understanding and responding to the evolving needs of members, he will guide Regence’s growth and service in Oregon and southwest Washington. Antonucci has been serving in this new role on an interim basis for the past month, while continuing to direct the Oregon sales team as vice president of sales. As he assumes this permanent position, he will begin an immediate search for a new sales vice president. Originally from New York, Antonucci
A nthem B lue C ross B lue S hield
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has an undergraduate degree from the State University of New York College at Cortland, and he earned a master’s degree in Public Policy Analysis and Administration from Binghamton University. Health Net Inc. has announced that Scott Law joined the company as its chief Medicare officer Nov. 14. In this position, Law is responsible for the sales and marketing of Health Net’s Medicare Advantage plans. He also works closely with Health Net’s compliance and operational departments to ensure the company is providing high quality services to its beneficiaries. Law joins Health Net with 25 years of health care experience. Previously, Law was senior vice president of Healthcare Delivery for WellCare Health Plans Inc. Prior to joining WellCare, he was with Health Net for five years, where he served first as its national chief network officer and later as its national health care delivery officer. His experience also includes roles with CIGNA Healthcare Corporation and Humana Inc. Lockton, the world’s largest privately held insurance broker, has named Valerie Houghton, RD, LD, as Health Risk Manager for its southeast People on the Move, continued on page 15
M etlife
»
E mpire B lue C ross B lue S hield
cancer patients better through a patient-centered approach. Improving on the current, sometimes fragmented system of care, this new model provides patients with a single point of contact and provides payments to clinicians for spending time with patients and their families, helping them make fully informed choices for every aspect of their care from prevention to advanced disease, thus improving personalized care. This innovative approach also strives to keep patients out of the hospital and emergency room by promoting more coordinated clinic and after hours care, a major request of patients. Finally, it strives to lower costs and improve outcomes by rewarding physicians for compliance with evidencebased medicine guidelines. Dubbed the Medical Oncology Home Pilot, the program is aligned with the goals of the Affordable Care Act signed by President Obama in March 2010 and incentivizes physicians to provide high-quality, costeffective cancer therapy to achieve better outcomes for patients. “This new program encourages maximum support of patients throughout their treatments including attention to patients between physician visits to minimize side effects and symptoms while they receive highquality, comprehensive cancer therapies,” said Linda Bosserman, M.D., F.A.C.P., president of Wilshire Oncology Medical Group and a pioneer in reducing costs and improving care through evidence-based medicine.
experience. Employees can have the flexibility to enroll online in their medical benefits as well as their non-medical MetLife benefits such as life, dental, and disability insurance. (Enrollment for medical benefits is coordinated with MetLife benefits enrollment; however, it is provided by separate arrangement between the employer and an enrollment vendor.) Enrollment for MetLife benefits also can be done over the phone, in person with a benefits specialist, or with paper forms by fax or through the mail. Employees using the new online process will see an easier way to review and choose their benefits, with extensive guidance built in to help employees along each step of the process. Decision-support tools such as calculators, simple benefits explanations and rules of thumb are included to help employees determine the right amount of coverage for their needs. “According to MetLife’s ninth annual Employee Benefits Trends Study, employees who report that they are very satisfied with their workplace benefits are about three times as likely to indicate that they are highly satisfied with their current job and feel more loyal toward their employer,” said Shari Gottheim, vice president, enrollment and participant services at MetLife. “The new M-Powered Enrollment program is designed to make enrollment easier for all stakeholders, and the enhanced employee experience increases the likelihood that they will understand—and maximize—the value of their benefits options.”
MetLife’s Multi-product, Multi-channel Enrollment Platform Provides Enhanced Employee Experience, Reduces Employer Administration
Empire BlueCross BlueShield Announces Innovative Contract Agreement with NYU Langone Medical Center
Trying to solving many of the challenges employers and employees face during the benefits enrollment process, MetLife announced the launch of M-Powered Enrollment, a new multi-product, multi-channel enrollment program, featuring capabilities for employers with 50 to 1,000 employees. The program offers a simplified end-to-end enrollment experience that maximizes the value of an employer’s benefits program. With M-Powered Enrollment, MetLife makes it easy for employers to implement their employee benefits program with a coordinated enrollment
Empire BlueCross BlueShield, New York’s largest health insurer, announced a new three-year agreement with NYU Langone Medical Center, a world-class, patient-centered, integrated, academic medical center that will serve as a national model for pay-for-performance. Since 2007, NYU Langone has been in the forefront in entering pay for performance arrangements with the different payors. Part of the arrangement with Empire, NYU Langone agreed to link significant portions of its payments for in-network contracted services to health Innovations, continued on page 15 www.TheIHCC.com I CDHC Solutions™ I November/December 2011
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When DataPath began, our mission was to provide a place where people of different backgrounds and beliefs could come together and work sideby-side to become their true selves through grace as they endeavor to know, love and serve God. Our goal was to create the best solutions for the administration of employee benefit plans by understanding the needs of every client, and by entering into mutually-beneficial, long-term relationships.
The mission stands. Twenty-seven years later, those core principles are as true today as when we were a startup in a basement. Call today and let’s work together.
John J. Robbins, Jr. President and CEO
Consumer Driven, Transit, COBRA, Retiree Billing, and more. Online and fully integrated with the mySourceCard® Debit Card. 800.633.3841 • www.dpath.com • sales@dpath.com
People on the move
Briefs
People on the Move, continued from page 13
operation, based in Atlanta. As health risk manager, Houghton supports clients in evaluating, recommending, implementing, and measuring wellness programs that improve employee health and reduce employer costs. Houghton’s career in health and nutrition has taken her around the world, including her most recent stint working as a nutrition consultant with the SOS International Clinic in Baku, Azerbaijan. She has also worked in health and nutrition in the United Arab Emirates and as ARAMARK Healthcare’s Director of Patient Services in London. In addition, she has several years of experience in leadership roles with ARAMARK in Atlanta, Philadelphia, and Houston healthcare and school nutrition divisions. Cigna has announced that it has made changes to its Enterprise Leadership team to be better positioned as a customer centric organization and deliver on its “Go Deep, Go Global, Go Individual” strategy. Matthew G. Manders, currently the company’s president of U.S. services, clinical and specialty businesses, has taken on expanded leadership responsibilities, including the company’s regional segments, effective immediately. His new title is President Regional and Operations. Manders has been in his current role over two years. In more than 24 years with Cigna he has proven leadership skills demonstrated through his assumption of increasingly responsible roles. David D. Guilmette, currently the senior vice president, national accounts segment, has become president of national, pharmacy and product, effective immediately. Guilmette joined Cigna in February 2010 to lead the national accounts segment. Prior to joining Cigna, Guilmette was managing director of Towers Perrin’s Health and Welfare line of business. HighRoads, the industry leader in employer health care compliance and benefits management, announced it has added Maureen Cotter, ASA, to its health and welfare consulting team. A 25-year veteran in building benefits management strategies for notable Fortune 1000 clients and health care organizations, Cotter joins HighRoads’ growing team of health and welfare consulting experts. Prior to joining HighRoads, Cotter was the founder of Maureen Cotter & Associates Inc. Previous to that, she served as the Global Director of Group and Healthcare Consulting for Watson Wyatt Worldwide and sat on the Board of Directors of Watson Wyatt & Company. She also has held leadership positions with Mercer Human Resource Consulting and Blue Cross Blue Shield of Michigan. She holds a Bachelors of Science degree in mathematics from the University of Michigan and is an Associate of the Society of Actuaries. Retired Navy Rear Admiral William L. Putnam, and former Blue Cross Blue Shield of Wyoming President and CEO Tim J. Crilly will continue serving the men, women and families of our nation’s military community as members
of TriWest Healthcare Alliance’s Executive Advisory Board. Putnam and Crilly join TriWest’s Executive Advisory Board, which was established 15 years ago at the founding of the company and features senior retired military officers, retired non-commissioned officers and military family members. The board provides guidance to TriWest’s leadership as the company delivers on the promise of the military health care program, TRICARE, to provide access to the highest quality of care and customer service to 2.9 million beneficiaries in 21 western states. Zurich announces the appointment of Gary Hirschkron as head of product development for Zurich Global Life in North America, effective immediately. In this newly created role, Hirschkron will lead the product development effort for Global Life in the North American market, as well as drive the development and maintenance of the product portfolio. He will be integrally involved in the profitable growth of each of Zurich Global Life’s distribution pillars across North America: Farmers New World Life, Corporate Life & Pensions, Independent Financial Advisors and Private Banking. He also will work closely with the Global Life team to develop and implement strategic business plans and optimize customer relationships. Hirschkron will be based in New York and report to David Dietz, CEO for Zurich Global Life in North America. Lockton Benefit Group of Lockton Companies, the world’s largest privately held independent insurance brokerage firm, has expanded its International Benefits Services practice through the addition of Nicholas Dobelbower, PhD., as senior consultant. Dobelbower’s primary role is to provide strategic international employee benefits guidance to Lockton’s clients around the globe. Dobelbower is responsible for strategic international benefits consulting and development of key relationships with Lockton’s clients and affiliates. Supporting Lockton’s sales professionals and managing client engagements also are part of Dobelbower’s new role. Cigna, a global leader in serving expatriates and other globally mobile individuals, has appointed Phil Austin to lead Cigna’s international individual PMI business—Cigna Global Health Options (www.cignaglobal. com). Reporting to Michael J. Ross, Senior Vice President of Individual Private Medical Insurance (IPMI) and Business Development for Cigna International, Austin will be responsible for developing and implementing the company’s individual consumer strategy on an international scale and creating a world-class international individual business. Austin will be responsible for building the business segment and driving profitable growth, targeting high net worth and globally mobile individuals through various channels such as the internet, banc assurance and intermediaries in key global markets.
NYU Langone Medical Center » Empire BlueCross BlueShield Innovations, continued from page 13
outcomes, patient-safety measures and patient satisfaction benchmarks. Under the new agreement, Empire will reimburse NYU Langone for its performance based upon meeting nationally recognized measures of patient safety and quality of care, as well as additional mutually agreed upon measures for efficient delivery of medical services. NYU Langone’s participation in Empire’s award winning Quality-Insights Hospital Incentive Program (QHIP) demonstrates its unique commitment and investment to improve quality and patient outcomes. “This contract represents a new standard of collaboration between
CDHC Innovations
payors and hospitals better aligning payment with value by placing greater emphasis on health outcomes,” said Mark Wagar, president and CEO of Empire BlueCross BlueShield. Another key feature of the contract is the significant expansion of the number of participating physicians in the various Empire networks to include the Chairs of key departments and other senior faculty, bringing access of world class doctors to Empire Members in specialties such as orthopedics, neurosurgery, cardiothoracic surgery and emergency medicine.
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Health Plans Self-Funding
By Joseph Berardo, Jr. President, CEO » MagnaCare
Stop-loss Protection: The Key to Self-funding for Mid- to Larger-size Companies
W
ith legislative reform and other market forces driving up health care costs, more employers are choosing to self-insure their health benefits to achieve several clear advantages over the traditional approach: cost savings, exemption from state regulations and premium taxes, plan consistency, customizable benefits and costs based on claim’s history. For employers still reluctant to go this route, the big sticking point has been a fear of unknown costs in the form of unpredictable or catastrophic claims. Stop-loss insurance protects against these claims by going into effect after a certain amount has been paid. According to the Kaiser Family Foundation’s 2011 Employer Health Benefits Report, 58 percent of workers in self-funded health plans are covered by stop-loss insurance, with 81 percent of these plans implementing protection on each employee (specific stop-loss). The report found the average per employee claims cost at which stop-loss coverage begins to reimburse is $208,280 for workers in larger self-funded firms. Who benefits from stop loss insurance? In general, large employers have sufficient funds on hand to cover big-ticket health care costs. In contrast, mid- to smaller-size self-funded companies run a tighter ship; so purchasing stop-loss coverage to reimburse for claims above a specified amount makes sense.
Finding the Right Coverage In order to protect the bottom line from catastrophic costs, companies usually implement two types of stop-loss coverage at the same time: specific or aggregate. A health plan management company brings the additional benefit of coordinating and implementing the stop-loss program.
“Specific” Stop-loss Insurance Specific stop-loss insurance protects against a catastrophic loss incurred by any individual covered by the plan, with the deductible set at a level appropriate for the size and financial strength of the company. The employer pays a fixed premium each month and is liable for the claim payments of an individual up to the chosen deductible, with amounts in excess of that covered by the stop-loss carrier. Some specific stop-loss contracts don’t require the employer to fund the claim and wait for reimbursement. Rather, the administrator pays the claim directly from the carrier’s account. Take this real-life example: a 32-year-old female delivered a baby boy, born pre-term in the seventh month. The infant was experiencing health issues and had to be treated in the Neonatal Intensive Care Unit for 60 days. The claims total was $285,000. The mother’s self-funded employer’s specific stop-loss insurance had an $80,000 deductible. The amount reimbursed by the stop-loss carrier was $205,000. 16
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“Aggregate” Stop-loss Coverage While specific stop-loss protects the employer against a single catastrophic claim, aggregate stop-loss protects against an excessive amount of claim expenditures for the entire plan. Through actuarial studies, stop-loss underwriters can estimate smaller, predictable claims, although these projections are based on large, industry-wide samples. To protect against such fluctuations, employers can purchase protection in which the stop-loss carrier pays the claims exceeding the underwriter’s estimate by a particular amount. This coverage can be structured to include a monthly accommodation provision, which caps the employer’s maximum monthly claim payments and adds a buffer of protection. Eligible claims paid fall under the specific deductible and are accumulated. If the total exceeds the employer’s maximum exposure, the stop-loss carrier pays all further claims.
Self-funding with Stop-loss Insurance vs. Fully-insured To get a better understanding of the advantages of self-funded—with stop-loss insurance protection—over fully-insured health plans, let’s compare real-world examples of each. A mid-size textile company, Company A, is insured with a fullyinsured carrier and pays $1.5 million annually for its health insurance plan. At the end of the year, the company shows only $1 million in claims and administration costs. Their carrier keeps $500,000 in profits. Company B, is self-funded with a health plan management company managing its stop-loss insurance. This firm’s potential worst-case scenario for the year is $1.6 million annually. The company pays $20,000 a month in fixed premium costs and reserves $1.36 million for potential claims, which the company can invest, segregate or use for day-to-day business until a claim occurs. At the end of the year, Company B’s claims are $1 million. It keeps the $360,000 it reserved and sees a savings of $260,000.
Other Advantages The self-funded health plan, with risk-mitigating stop-loss insurance administered by a health plan management company, offers another enormous advantage for employers—employee satisfaction. Health plan management companies specialize in customer service, providing high levels of personalized service. They offer access to high quality doctors, facilities, specialty providers and, in some cases, comprehensive 24/7 online access to information, such as claim status, provider locations, eligibility information, member updates and health care information. More mid- and larger-size employers recognize what self insurance with stop-loss coverage can do for their employees—and for their bottom line. For employers looking to gain control of one of their largest expenditures, it’s an attractive alternative to the fully insured market.
By Kevin McKechnie » Executive Director the aba hsa council
HSA/FSA/HRA Administration & Finance
Notes from the Trenches: The Coming Storm in Health Care
I
ts been almost two years to the day since the Affordable Care Act (ACA) was signed into law by President Obama, and I’ve almost finished reading all 2,409 pages of the statute and the thousands of pages of enabling regulations HHS has published—so far—implementing the statute. What a beating. The original concept, during the campaign of 2008, was that all Americans should have access to more affordable health insurance products more quickly. NOW, in fact. I recall there being almost universal agreement that this was the problem in need of a solution. So, let’s measure success. Is health insurance more widely available? No; Gallup reports at the end of 2008, 14.9 percent of Americans were without health insurance. Today, that figure has risen to 16.8 percent. Well, perhaps the recession/depression had something to do with that. Besides, some would say it’s probably all Bush’s fault. How about affordability? Is health insurance more or less expensive than it was in 2009? Wait for it. It turns out the Kaiser Family Foundation has reported a more than 21 percent increase in the cost of a family plan between 2009 and now. Just this year, family plans have increased 9 percent, with 2 percent being directly attributable to provisions in the ACA. So the law designed to “punish the greed of big health insurance companies” by making insurance cost less has actually netted out in a premium increase that’s rising around three times faster than inflation. And to think that once upon a time President Obama promised we would save as much as $2,500 on our premium costs. The five largest insurers posted a 25 percent return over the last decade and reported 2010 earnings 22 percent larger than in 2009. The sector’s third quarter profits from this year are reported cumulatively as 20.9 percent earnings before interest, taxes, depreciation, and amortization (EBITDA). And, for those of you with Kevorkian style 401(k)s, large health insurers are still a must have portfolio item. Why? By 2014, when it will be a crime not to purchase insurance or, if you run a business, provide it to your employees, there will be a new, shiny $240 billion annual marketplace called the state exchanges from which insurers will be booking profits. So, the “villains” in this debate seem to be doing just fine. How about the people? In 2009, Massachusetts fined 49,000 people for having no health insurance. Recall that Massachusetts, ever the trend setter, established an exchange under Governor Romney’s leadership in 2006. The main complaint of most of those 49,000 people: “it was too expensive, and I couldn’t afford it.”
It’s good for Massachusetts though—the MA Department of Revenue has reported that since 2006, the state treasury has collected more than $65 million in fines. Let’s try to imagine what happens to the country when the Massachusetts model becomes the national model in 2014. How many Americans will be able to afford health insurance after another three years of premium increases? How many Americans will face fines by the IRS for being unable to afford mandated coverage? All these bad tidings have a common regulatory ancestor in the Medical Loss Ratio (MLR) regulation and in the ACA’s general regulations. The MLR rules will require insurers who return less than 80 or 85 percent of every premium dollar to consumers in claims to pay rebates to those consumers. A perverse consequence of the MLR mechanism is the upward pressure it exerts on premiums. MLR pressures feature in small business’s inability to purchase affordable group coverage. How odd that the Obama administration, in its quest to legislate more jobs in our country, has failed to notice that large employers, being self-funded, are largely immune from the ACA’s regulatory excesses, while small employers must deal with the market effects such rigorous regulation imposes. The regulatory list goes on: soon we should be seeing regulations describing essential benefits plans, preventive care and the actuarial value regulation which will be the deciding factor in whether or not health savings accounts (HSA)s are deemed sufficient for sale in the exchanges. And there is no reason to expect relief any time soon. With an election looming, republicans are keen to make sure America remains aware this is President Obama’s law, brought to you when the democrats controlled both houses of Congress. They are in no mood to fix it for him. Democrats, by contrast, have to find a way to hold the White House and the Senate and so would otherwise be disposed to quietly repeal some of the more onerous requirements but none of them want to be caught doing it lest their political opponents ask them why they voted for such a flawed unpopular law in the first place. The result is stalemate. The earliest I predict any material changes to the ACA is six to nine months after the new congress the 2012 election produces has an opportunity to debate amendments. And, that timeline is based upon the republicans controlling Congress and the White House, not just the House of Representatives. Irrespective of all the other opinions I read, the political timeline and the outcome it predicts has become more important than the law, especially if you want to see the ACA either repealed or amended.
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Health Plan Communication
By Charles Epstein » President Backbone, Inc.
Consumer-oriented Communications: The Key to Advancing Health Care Consumerism
H
ealth care consumerism is premised on personal responsibility, individual ownership, self-reliance, convenience, choice, and transparency. In other words, the application of all the elements we bring to an informed purchase of a consumer good or service. However, some view the concept as fundamentally flawed. According to Washington Post blogger Ezra Klein, “The whole argument over whether patients are really consumers or not is a bit misguided, because ‘consumer’ isn’t really a good term for what we’re trying to get at. The real question we’re asking is, ‘Who can make the decisions that would reduce costs?’ And both evidence and intuition suggests doctors as the answer. As the old saying goes, “the most expensive piece of equipment in the hospital is a doctor’s pen.” People are not accustomed to looking at health care as they do a household appliance or electronic device. They typically don’t know enough, nor are they qualified or in the ideal position to make the best decisions. While consumers are generally able to resist even the most persuasive salesperson, they seldom reject a doctor’s prescribed course of action. Ultimately, these barriers will be lowered, as technology tailors information to each patient’s history and needs, as we know more about the correlation between procedures and outcomes and there’s more transparency regarding the selection of health care providers and specialists. Eventually, more patients will take ownership of their health, as they are more confident in their ability to make smart decisions. As of now, we can make the most headway toward broad-based health care consumerism by improving the way health care providers, brokers and Human Resources (HR) communicate.
Today’s Communications Toolbox According to a recent WorldatWork survey, 39 percent of employers say the biggest challenge to increasing use of electronic communication is lack of participant interest. However, research by the Pew Research Center’s Internet and American Life Project and the California HealthCare Foundation (CHCF) found that 80 percent of Internet users look online for health information, making it the third most popular online pursuit. So if consumers are seeking information online, why do providers, brokers and HR find it so hard to reach, engage and motivate employees? Traditional health and wellness communication are ineffective at reaching and engaging employee populations primarily because the information is static (one-way) and uninvolving. While some organizations are experimenting with social media to introduce interactivity, build community and drive utilization, these tools are rarely integrated into an overarching communications framework. The challenge is to improve user engagement and increase awareness of the personal health and financial benefits of “self-directed” prevention and wellness—without which users will continue to seek care at the time of need, 18
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driving up costs.
A True Consumer Approach to Benefits Communication The solution is to find what types of information people are drawn to and why, how to foster community and what drives users to take proactive measures—before a diagnosis—and change unhealthy to healthy behaviors. You do not need to look further than consumer media to find key cues. To illustrate, what’s more interesting, a piece on breast cancer awareness or a brief feature on Christina Applegate discussing her winning approach to beat breast cancer? Editors of consumer publications—from People to The New Yorker—understand the attraction of personalities. Similarly, benefit communicators taking a more consumer-oriented editorial approach, and addressing issues through the prism of popular culture, would find a vastly more receptive audience. What works at the newsstand will certainly work on the employee’s desktop. Moreover, embedding links with each article can route readers to relevant resources, driving education, proactive behavior and utilization of programs and services. The addition of social media, i.e., a company Twitter page, would also add community-based engagement, where administrators, co-workers and colleagues share experiences, news and resources. Imagine an engaging, attractive, easy-to-read e-mail (one that embeds “actionable” links), and a dynamic, integrated Twitter page that sustains communications through the week, exposing employees to companysponsored tools, programs and resources. This approach provides consistent, year-round benefits-related communications, deepening engagement and creating a more proactive health-conscious user community ... laying the foundation for true health care consumerism.
Communication: The Missing Component Health care consumerism is often viewed as synonymous with consumer-directed health plans. However, it will take more than the potential for cost-savings to bring about true health care consumerism. It will take more refined decision tools and greater transparency, and the realization that it’s now possible to make smart, self-directed choices about one’s long-term health and well-being. Consumer engagement is the first step on the long and winding path toward this vision of health care consumerism. Indeed, health care consumerism is first and fundamentally a function of applying consumerbased editorial models to benefits communications, which boils down to combining popular content with social media. This approach will improve engagement, prompt proactive utilization and ultimately, influence behaviors. While the technologies and processes we touched on at the outset are refined and gradually implemented, we can begin changing people from passive patients to proactive—and informed— health care consumers.
By Don Doster » CEO gBehavior
Rewards & Incentives
Where’s the Boost to Getting Healthy?
I
f overweight Americans could magically drop their weight back to recognizable to peers. Used in this way, incentives will have a powerful 1991 levels, it would save our country and our employers $1 trillion a behavioral effect. And speaking of choosing—employers have a choice, too. They can year. But do employees really want to make those challenging lifestyle changes? Is there a secret ingredient that gets individuals off the sofa and pay now for a wellness solution and potentially prevent catastrophic diseases among their employees in the future, or they also can choose to into their walking shoes? avoid the “wellness” and pay big During a recent wellness claims now and later. Wellness program launch, a skeptical Motivation depends on the individual. We are incentive programs bring hope employee stated, “I’m not all motivated differently and what energizes one and turn hope into reality; interested in losing weight. My for the employer; and husband loves me just like I am.” person may not provide change for another. The savings quality of life, better health However, the employee and tangible rewards for the enrolled in our wellness incentive most effective wellness programs are the ones employee. program. Reason—she realized where employees/members can earn incentives A final example: Polly saw that by exercising three times her 2010 health assessment a week and losing at least a that they choose—incentives that are tangible profile and knew changes pound a week, she would earn needed to be made. Polly enough reward points to ‘pay’ and recognizable to peers. started immediately making for her kids’ Christmas gifts. The personal lifestyle changes by clincher—she could select the gifts she wanted from among thousands and thousands of choices. By the eating healthier and exercising. Recently Polly had her checkup with her time the holidays rolled around, she had lost 70 pounds, was completely physician and the news was outstanding. off her diabetes medication, and was thrilled. n Weight reduced by 71 pounds—IMPRESSIVE “I already knew I needed to lose weight, but education was not n Blood pressure decreased from 144/84 to 122/68—SPECTACULAR enough to make me actually do it. Choosing was the key. Getting to select n Blood sugar lowered from 120 to 89—GREAT gift for my kids motivated me. At first, losing weight was a secondary goal. n Good cholesterol up 11 points—WOW But now, I look and feel so much better, that I just want to keep on going.” n Bad cholesterol down 9 points—STUPENDOUS People generally do not change their behavior without good reasons. n HgbA1c blood test results went from 7.5 percent to 5.1 percent— Most of the time good health is not a sufficient reason. In a perfect world, AWESOME the prospect of a healthier, longer life should be enough to prompt us to change. Not so. Research shows that among heart attack patients—change These results are wonderful; there is more good news. Polly was is a life and death matter—90 percent do not change their unhealthy bothered with extreme arthritis prior to her success. She was taking habits, not even when the doctor makes it a requirement. prescription medication twice a day. Now she is not on any arthritis The Power of Choice One company previously tested a wellness medication. Her physician says if she loses 30 more pounds, she can program that paid employees $50 cash to complete a health risk further reduce her other medications. assessment, a biometric screening and a disease management program. “I feel so much better and much healthier.” Polly stated. “I want to The engagement was low—around 15 percent. After implementing our be here a lot longer. I feel like I am taking the necessary steps to make wellness incentive program with $50 in reward points, the employee that happen.” participation soared to 70 percent. Reason: Cash does not provide a On the road to wellness, getting started is the key and incentives tangible reward with trophy value. provide that boost. But the actual reward of getting healthier and feeling One company added that its incentive program did not work. better is the sustaining motivation. This program provided running shoes to employees who responded to a wellness challenge. Very few people participated because only a few Don Doster is CEO of gBehavior, which is located in Atlanta. He specializes in the employees were actually interested in having a new pair of running shoes. design and implementation of wellness incentive programs. The company’s complete wellness platform, based on years of experience and proven results, combines all Motivation depends on the individual. We are all motivated differently necessary aspects of behavior change to meet employer business objectives and to and what energizes one person may not provide change for another. The drive improved employee health through tangible rewards that capitalize on the most effective wellness programs are the ones where employees/members power of choice. can earn incentives that they choose—incentives that are tangible and For more information, visit www.gBehavior.com or call 888-949-0541.
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Every day your people give you their very best. And with Aflac, you can give them a better benefits package. If someone is sick or injured, Aflac is like a safety net: it pays your employee cash
Your benefits should work
as hard as your team does.
directly — faster than our top competitors — which helps with costs that major medical doesn’t cover. And helps let your employees know just how much they matter. Visit aflac.com/employeebenefits
Individual coverage underwritten and offered by American Family Life Assurance Company of Columbus. In New York, coverage underwritten and offered by American Family Life Assurance Company of New York. Some policies may be available as group policies. Group coverage underwritten and offered by Continental American Insurance Company. Policies may not be available in all states. Aflac pays cash benefits direct to the insured, unless assigned. Aflac processes most claims in an average of four days. For Continental American Insurance Company, the average is five days. NAD1115
By Alex Moral » Senior Vice President Trustmark Voluntary Benefit Solutions
Supplemental Health & Voluntary Benefits
Newer Riders Boost Critical Illness Plans to Meet 21st Century Needs
C
One recent rider takes out the limit on critical illness occurrences. With ritical illness insurance plans, which debuted in the United States in the late 1990s, have undergone a number of enhancements in its such a rider in place, the insured could experience a series of successive short history. Such enhancements have been spurred by our quickly critical illnesses, for example, and receive full lump-sum payments for each changing society, with new developments in health and greater survival one, as long as each critical illness was different from the previous one. Lastly, many critical illness plans now offer a rider that not only takes rates in the face of critical illnesses. As critical illness plans gained in popularity, market research has out the limit on the occurrences of a critical illness that insured may be shown a need and demand for expanded coverages. New riders allowing diagnosed with, but also will pay again if the insured experiences the exact multiple types and occurrences of payments are a major part of the critical same critical illness. For example, suppose someone with this critical illness rider has illness plan evolution. Such riders make critical illness plans available to policy holders for more reasons and for longer periods over the course of a heart attack. Upon diagnosis, he or she would receive a full lump-sum payment from the critical illness plan. Then a few years down the road, their lives. this person undergoes a second For those unfamiliar with heart attack. Another full lump-sum critical illness insurance, such plans Lastly, many critical illness plans now payment would be issued, and so help fund everyday household offer a rider that not only takes out the limit on. Do such “unlimited” riders cover expenses while employees recover from life-changing illnesses such on the occurrences of a critical illness that cancer? Some may and other may not, depending on the plan carrier. as cancer, heart attack or stroke. insured may be diagnosed with, but also The benefit is a lump-sum amount awarded above and beyond the How Employees Can Choose will pay again if the insured experiences medical treatment coverage a core the Critical Illness Plan Rider the exact same critical illness. plan provides. There is a saying in That’s Right For Them the business that “medical insurance In face of the many riders now fixes health, but critical illness available as part of a critical illness insurance fixes finances.” plan, a question remains. How do employees decide which plan and rider is Originally, a critical illness plan could only be used once. If a policy best for their needs and the needs of their families? holder was diagnosed with a critical illness, he or she would receive a Basing decisions on family health history is a good start. Has a parent, four-figure to six-figure lump-sum benefit. But after that, the policy would sibling or other close relative experienced a critical illness, or more than come to an end. one? Are one or more members of the family currently under a doctor’s care for health risks such as high blood pressure, diabetes or obesity? Another important aspect in choosing critical illness insurance is The Evolution of Critical Illness Riders with Enhanced Benefits financial. With more employers offering high-deductible medical plans to The next generation of critical illness plans introduced a rider that allows a second full benefit if the policy holder experiences a second critical their employees, many face greater financial responsibility in the event of illness. This second payment would be made as long as the second critical a critical illness to pay for costs not covered under the medical plan. These are exactly the kind of out-of-pocket costs that a critical illness plan can illness was different than the first. For example, suppose a policy holder is diagnosed with cancer. help pay for. By taking a close look at family health history and financial need, those Covered under the critical illness plan, that policy holder would be awarded the policy’s full lump-sum amount. Then imagine that a couple of years purchasing a critical illness plan can work with their company’s insurance later, the same person suffers a heart attack. That insured would receive a broker or voluntary benefits enrollment firm to make an educated choice second full lump-sum amount if such a second-benefit coverage rider had in the amount and extent of coverage to best cover themselves and their been purchased when the plan was initiated. However, after that second family members. payment takes place, the critical illness policy comes to an end. Fifteen or 20 years ago, more critical illnesses proved fatal than they do Alex Moral is senior vice president of Trustmark Voluntary Benefit Solutions, a today, with greater survival rates now occurring due to modern medicine. As carrier of voluntary and work-site benefit insurance plans for nearly 100 years, with headquarters in Lake Forest, Ill. Trustmark provides payroll-deducted voluntary a result of such changes in the health of our society, a couple of other critical universal life, disability, critical illness, and accident plans to employer groups illness riders have become popular, which expand benefits even further. through brokers. Reach Alex at alex.moral@trustmarksolutions.com. www.TheIHCC.com I CDHC Solutions™ I November/December 2011
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LEARN CONNECT SHARE CDHC Solutions, the premier magazine for innovative health and benefits management and the official publication of The Institute for HealthCare Consumerism (www.theIHCC), is inviting you to LEARN, CONNECT and SHARE. We are constantly on the lookout for enterprising contributors to showcase in our magazine, eNewsletters and for our online community. If you have an intriguing and thought-provoking feature, case study, blogs, white paper, podcast series or video, we encourage you to SHARE it with our audience of 70,000-plus. We are actively looking for topics on but not limited to: health care reform and how it pertains to employers; pharmacy and drug benefit management, population health and wellness; health care consumerism decision support tools; trends in supplemental and voluntary health; trends in health care access; broker and consultant trends; trends in health incentives; and trends in employee communication and education; trends in account-based and other plan designs. We also encourage you to become a member of www.theIHCC.com. The online community allows you to CONNECT with the top thought leaders in the health care industry, SHARE your thoughts and concerns with them and LEARN about innovative health and benefit management trends that could make your company’s health plan more efficient. CDHC Solutions is published eight times a year, including an annual Outlook edition, where top-named industry thought leaders share their prospective on the upcoming year, and a HealthCare Consumerism Superstars edition. The Superstars issue highlights innovators and industry leaders in employee benefits and honors those CEOs, and benefits managers who go above and beyond the call of duty. These issues also are housed on the website in a digital format. Although the name has changed, our commitment to being the collective voice for health care consumerism through our print, online and events, has remained the same. The Institute’s top objective is promoting health care consumerism and improving and securing the future of employee health care benefits as well as developing a healthier workforce population. So come to the Institute to LEARN, CONNECT and SHARE.
We welcome your contributions to the Institute. For more information please contact Institute CEO Doug Field dfield@fieldmedia.com or managing editor Todd Callahan tcallahan@fieldmedia.com
RJ Young Makes it Right
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hen it comes to office equipment and innovative document solutions, RJ Young is an expert, but when it comes to employee health benefits, the Nashville-based company knew it was out of its element and needed some help. Using its famed “We make it right,” guarantee for its customers, RJ Young was determined to use the same approach in making it right when choosing an employee health and benefit program. Founded in 1955, RJ Young has provided an employer-sponsored health care benefits program since the 1970s to its diverse workforce. Today the company employs more than 350 people. The employee population features: commissioned sales people, hourly administrative and logistics professionals, which include highly specialized service technicians.
By Sam Shallenberger, CFO, RJ Young
Using its famed “We make it right,” guarantee for its customers, RJ Young was determined to use the same approach of making it right when choosing an employee health and benefit program. www.TheIHCC.com I CDHC Solutions™ I November/December 2011
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However, as the company continued to grow, with its corporate office in Nashville and 16 sales and service satellite locations, RJ Young was outgrowing its health care benefits program. The company offered the traditional health maintenance organization (HMO) package and later began providing a preferred provider organization (PPO) benefit package. Employees chose from several tiers of coverage, selecting a payroll contribution level, annual deductible, co-insurance and copay from a matrix. RJ Young was self-insured with stop-loss coverage for large specific and overall claims. Yet what was working before in regard to employee health benefits 20 years ago was not presently working for the company, which was determined to “make it right” on its guarantee. As health care costs began skyrocketing, the company began feeling the numbers crunch. The rising cost of health care was making RJ Young’s c-suite executives see red and it wasn’t the color toner in the Canon and Ricoh copy machines being sold. Something had to be done. Would the company have to stop providing employees with health care coverage? Should RJ Young end its long-time partnership with the brokerage firm? These were just some of the questions the company was facing. The situation became more dire as the economic recession swept across the nation. In 2007, new CFO Sam Shallenberger became involved in negotiating the annual renewal of health care benefits with RJ Young’s brokerage firm, which had written the business for many years and also provided property and casualty lines. “The discussion each year was what I came to call the ‘Good News/Bad News’ meeting,” said Shallenberger, who joined the company in 2006. “Every year, the broker would tell me 24
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‘The bad news is, the industry is experiencing double-digit increases this year. The good news is, we expect your increase to be only X with X variously 8 percent, 11 percent or 9 percent each year.’” This was no longer acceptable. The company was seeing its expenses growing faster than the revenue. The rising cost of health care was directly affecting RJ Young’s bottom line. “The ‘good news’ was going to kill us if we did not act,” said Shallenberger, who began searching for an alternative and began investigating the concept of high-deductible health plans with a health savings account (HSA). When it came time to renew, Shallenberger asked his long-time broker about starting a consumer-directed health plan. The idea was quickly shot down. The broker advised Shallenberger that RJ Young’s employee population would not accept an HSA. The broker claimed the workforce was “too blue collar” and the engagement rate for an HDHP/ HSA plan would be too low to make a difference in controlling the expense. In 2008 and 2009 RJ Young continued experiencing higher and higher health care costs. Shallenberger once again brought up the idea of consumer-directed health care, but the broker again advised against implementing the plan. “Instead, we would nibble at the margins,” Shallenberger said. “We would introduce a third prescription drug copay tier, fiddle with the deductibles and employee contributions, but nothing that impacted our annual spending significantly.” After two years of seeing its health care spend steadily increase, the status quo was no longer acceptable. A solution had to be found and that came in the form of Alex Tolbert, a broker with Nashville-based Bernard Health,
who made a cold call to Shallenberger in the spring of 2010, believing he could solve RJ Young’s problems. Unlike the other broker, Tolbert believed the company’s workforce, blue collar or not, would readily accept an accountbased health plan. “What stood out from that discussion was Bernard’s confidence that RJ Young could introduce a consumer-directed plan and capture significant savings, while continuing to provide a quality benefit to our team,” Shallenberger said. Over the next few months, Bernard began educating RJ Young’s executives about the benefits of implementing a CDHP and what kind of communication plan Bernard would implement that would result in a high engagement percentage with the employee population. What seemed to be a daunting task of changing health plans became relatively easy. “We did not make the decision until all members of our leadership team could articulate the value we expected to receive from the change,” Shallenberger said. “We were introducing a simple plan that seemed complicated only in comparison to the prior plan. We were able to explain our plan in one paragraph.” The one paragraph referred to the employee-only plan RJ Young introduced. It read: ‘Preventative care is 100 percent covered. Care in excess of $2,500 per year is covered. You are responsible for care between $0 and $2,500. We give you $900 each year toward that care, and the money remains in your personal HSA if you don’t use all of it.’ The annual contribution was determined after examining the projected savings, and determining a split between company expense reduction and contribution toward the employees’ new higher deductible. “We initially set the amounts when we were
HEALTH PLANS concerned about take rate for the new plan as opposed to the traditional plan,” Shallenberger confessed. “We expected to offer the traditional plan as an option, but hoped with education, the majority of employees would select the HDHP/ HSA plan.” Nevertheless, that planned changed when CEO Chip Crunk become impressed with how much money the company would save by scrapping the traditional health plan, elected to go with a full CDHP replacement. The decision made choosing a health plan more simple and simultaneously it benefited the employees and the company. “The HDHP/HSA plan is better for the employees and better for the company,” Crunk said. “The only risk is they will select the wrong plan or fail to understand the new plan. Therefore the new plan will be our only option, and we’ll provide the education the employees need to understand it.” With the HDHP/HSA plan, the only plan RJ Young would offer in the coming year, open enrollment began. The company produced numerous newsletters and updates informing employees of the changes. Bernard Health participated in more than a dozen in-person training sessions at the RJ Young locations; this way, every employee would learn about the plan and ask questions. Additional sessions were scheduled every three months and six weeks after adoption to further assist employees with the changes. It was a seamless transition, thanks to Bernard’s BerniePortal, an online benefits enrollment software that helps employers save time and money and gives the organization peace of mind and makes benefits sign up for
employees easy and simpler without having to use paper. Bernard Health also produced a 20-minute BerniePortal webinar to aid employers in educating their employee population on how to use the online portal during open enrollment. The portal proved to be beneficial as Bernard Health saw 81 percent of their clients use the benefits administration process online when going through a full HSA replacement. Bernard’s clients, including RJ Young, cited four main advantages of using BerniePortal: 1. Save money: Moves complex paper business processes online 2. Save time: Cuts down on mistakes and time-intensive effort of filling out paperwork 3. Peace of mind: Eliminates liability associated with paperwork errors 4 Happier employees: No one likes filling out insurance paperwork “We didn’t have to struggle with Blue Cross Blue Shield of Tennessee paperwork, supplemental insurance paperwork, HSA Bank account setup paperwork or any of the other forms we’d used in the past,” Shallenberger said. “We pointed our employees to BerniePortal and they simply signed up.” After the first year, it was time to take a score and evaluate how efficient the move to full-replacement HDHP/HSA had been for RJ Young. During the inaugural year, the company’s expenditures were $900,000 less than the traditional health plan proposals. Of the company’s total expenditures, $400,000 were contributions to employee’s HSAs.
Good News, Bad News annual eXPenSe
3
In mIllIonS, neT
2.5
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RJ Young Company is the fourth largest independent office equipment dealer in the United States. RJ Young has more than 350 employees and provides award-winning service and support throughout the Southeastern United States, backed by their exclusive: We Make It Right Guarantee. Sam Shallenberger joined RJ Young as chief financial officer in 2006. Shallenberger is a CDIA+ Document Imaging Architect, a Certified Mergers & Acquisitions Advisor, earned an MBA from Vanderbilt University, and a Masters of Accounting from University of Phoenix. Prior to joining RJ Young he was CFO for two technical systems integrators, and he serves on the boards of several local companies. Beginning in 2011, Shallenberger advises Bernard Health as an employer advocate. Note: Todd Callahan, the editorial director for The Institute for HealthCare Consumerism contributed to this article.
1 0.5 0
Employee’s total expenditures for medical care were $200,000 below the prior period, but some of the prior period costs were difficult to capture. “They probably saved even more, but we went with the number we could document,” said Shallenberger, who added that the full conversion to an account-based plan helped avoid substantial increases in medical cost. “The beauty of the contribution is not subject to medical inflation. Even if we begin to experience premium increases, a substantial portion of our annual expense need not increase at that rate.” The good news continued for RJ Young. After the first year, provider Blue Cross Blue Shield of Tennessee’s offered the company a renewal quote that was 1 percent below the first planned year. BCBST’s statistics also illustrated the company’s employee population paid less per prescription than the carrier average, and received more preventive care. Enjoying better health care access and a cheaper price, RJ Young’s employees were extremely satisfied with their new health care benefits, proving change is sometimes a good thing. “This was quite a leap for RJ Young,” Shallenberger said of the health care transformation. “We don’t make changes lightly. But we have met our goal of reducing this expense, continuing to provide a valuable benefit, and setting a framework that will allow us to cope with the changes we expect to face in the decade ahead.”
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Ask The Expert
By Evan Falchuk President, COO » Best Doctors
Integration: Redefining Employee-centric Health Care
H
Already, many of the largest and most progressive companies in ealth care is increasingly population-based and impersonal. But a patient is not a population. She is a human being with her own America are using clinical integration to deliver customized solutions to their personal and family medical history. But managed care programs employees. These companies know their employees are getting the best answers, resources and most appropriate options needed. too often treat her like a number. A key aspect of clinical integration is that through it, employees are The truth is it’s possible to help her—and every other patient—in a way that improves not only their health, but the health of the population as better able to limit their risk of being misdiagnosed, avoiding needless a whole. It starts with making sure each person gets the right diagnosis and suffering and wasted resources in the process. Armed with information about their own health, many of them right treatment. will play a more active role in their At Best Doctors, we’re rolling out a For their part, employees health care, and will insist on getting the program called Clinical Integration that turns the traditional approach of managing experience a more customized right answers, right diagnosis and right treatment. health care on it head. It produces interaction with their benefits Clinical integration is not just the important outcomes that improve the latest buzz word or hot “trend.” It is a health care of employees, and ensures a offerings, and with the quality bona fide movement. Furthermore, as company’s existing health care programs a growing number of companies are are as effective as they can be. and responsiveness of their discovering, it is a win-win situation, for So why does this matter? Despite employer and employee alike. Employers great medical advances, 20 percent of health care overall. They make more efficient use of existing benefit people are misdiagnosed. Think about offerings, and see improved employee those odds—would you get into your car become truly empowered health and reduced absenteeism. They each morning if you knew you had a one are able to better communicate with in five chance of a car crash? The reality to be their own best health employees about all of the useful health is 20 percent of employees in health advocates—translating into a services available to them, and at the care benefit programs—even the best same time achieve significant cost programs—have been misdiagnosed. And healthier, happier, and more savings by doing so. Clinical integration if they get the wrong diagnosis, they are is simply smart business. likely getting the wrong treatment, too. productive talent pool. For their part, employees experience Think about what that means in terms of a more customized interaction with their needless suffering and wasted resources. benefits offerings, and with the quality and responsiveness of their health Now think about what that means to your company’s bottom line. Studies show close to a third of health care costs are wasted. As care overall. They become truly empowered to be their own best health such, more and more employers are realizing the time is now to address advocates—translating into a healthier, happier, and more productive talent pool. this issue head on. I predict that in the space of five years, clinical integration will be This is where clinical integration comes in. It serves employees in their time of need. It means reviewing the care of employees in all of your health mandated by companies that truly understand the value of a healthy care programs and making sure each one has the right diagnosis and workforce, one fully engaged in its own health care. Businesses will wonder treatment. It means referring those employees back into the health care why they didn’t try this approach sooner. Just wait and see. programs best matching their needs. It takes the guesswork out of which services each employee actually needs. Taking this approach is surprisingly Evan Falchuk is president and chief strategy officer of Best Doctors Inc. (www. easy to do; it just means sitting down with your health care vendors bestdoctors.com), a global health company that provides employees access to the best 5 percent of physicians for the right care and right treatment. Overseas, the service is who provide health care services and telling them they have to be provided in the form of insurance programs. accountable for making certain every one of your employees gets the correct resources they need.
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www.theihcc.com
Who’s Who Profiles
Access these profiles online at www.TheIHCC.com and www.EmployersWeb.com HSA/HRA/FSA Technology: Administration & Management
HSA/HRA/FSA Technology: Administration & Management
AmeriFlex
TSYS Healthcare®, provides end-toTSYS Healthcare end strategic payment solutions for 612.338.3871 consumer directed healthcare. We www.tsys.com/solutions/healthcare partner with benefits administrators, healthcare@tsys.com financial institutions and health plans and software providers to navigate all aspects of HSAs, HRAs, FSAs, cash reimbursements and lines of credit. TSYS Healthcare cards offer participants the security they expect along with the ability to conveniently access funds from multiple accounts and manage their benefits payments with simplified single-card access. Clients and partners benefit from simplified processes, reduced paperwork and cost savings that contribute to improved return on investment.
“We built the TSYS Healthcare platform to meet the market demand for reliable, configurable and intelligent solutions. Understanding the dynamic U.S. Healthcare market, our customers rely on our option-driven system to prepare them for the future. “ — Trey Jinks, Group Executive, TSYS Healthcare
302 Fellowship Road, Suite 100 Mount Laurel, NJ 08054 Internal Sales Support: 888.868.3539 (FLEX), option 4 Proposals and Marketing Inquiries: info@flex125.com www.flex125.com Established in 1998, AmeriFlex is an independent benefits administrator providing technology-based, consumer-driven benefits and compliance solutions. n AmeriFlex
Convenience Card® Consolidated FSA/HRA/HSA/CRA Debit Card Platform n AmeriFlex Convenience Sleeve Consolidated FSA/HRA/HSA Healthcare Payment Solution n AmeriFlex Convenience Portal WebBased System for Streamlined Administration of CDHC Plans
n Mongoose®
Enterprise Class, Web-Based Solution for COBRA Administration n ePOP Instant POP Plan Online Document Ordering n Invoice Manager Paperless, Automated System for Group Claim Activity and Funding Administration
“At AmeriFlex, we are constantly looking for new ways to bring innovative and cost-effective payment solutions to the market in order to improve efficiency and simplify the delivery of healthcare products and services to all stakeholders.” — William Short, President & CEO, AmeriFlex
HSA / HRA / FSA Administration and Finance
Evolution1, Inc. 952.908.9056 www.evolution1.com sales@evolution1.com
Evolution1 and its Partners serve more than seven million consumers, making it the nation’s largest electronic payment, on-premise and cloud computing healthcare solution that administers reimbursement accounts, including HSAs, HRAs, FSAs, VEBAs, Wellness and Transit Plans. It is the only solution that meets more than 1,200 unique plan designs, provides innovative auto-substantiation technologies, simplifies user experience, and automates workflow for Partners, employers, and consumers. It does all this on one technology platform comprised of Lighthouse1™, PayDirect®, the Benny® Prepaid Benefits Card, Lighthouse1 OneCard™ and integrated web portals. Evolution1 and its Partners are dedicated to delivering value, reducing costs and simplifying the business of healthcare.
“The combination of our innovative products will further our leadership position in a rapidly changing healthcare market. Together with our Partners we are committed to reducing costs and simplifying the business of healthcare.” — Jeff Young Chairman and CEO, Evolution1
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Who’s Who Profiles
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Solutions to help your innovative health and benefit programs. Population Health and Wellness
Population Health and Wellness
PATH
79 River St. Suite 302 Montpelier, VT 05602 802.223.5686 kelly@tomypath.com www.tomypath.com PATH is a dynamic health and productivity management program provider committed to redefining worksite wellness. PATH helps companies develop a comprehensive and cost-effective approach to reduce risks and manage healthcare costs. Our programs have earned unprecedented rates of success as demonstrated by the best sustained participation rate in the industry, and dramatic reductions in the cost of insurance claims and rates of insurance premiums for our clients.
“Based on more than 20 years of R&D, PATH is differentiated by its fun, fresh approach and easy-to-implement programs that have been lauded by both organizations and by program participants. PATH’s programs offer a suite of wellness strategies that integrate seamlessly with other wellness providers and existing employee benefits to deliver one co-branded Web-based platform for users.” – Gillian Pieper, Co-Founder and Vice President, Research and Health Promotion, PATH tools and Technology
Liazon was founded in 2007 to tackle the myriad problems inherent in employee benefits for small and mid-sized employers. Liazon’s retail employee benefits solutions give employers a cost-saving defined contribution strategy for all benefits. Liazon’s Benefits Exchange™ is the online store where employees find, learn about and purchase health care and other insurance products.
Liazon 737 Main Street, Suite 200 Buffalo, NY 716.803.6190 708 Third Avenue New York, NY 212.209.3836 www.liazon.com
“Liazon’s Bright Choices Benefits Exchange is the online store where employees shop for their benefits. It brings an exciting new retail model to employee benefits that empowers benefits consumers and saves employers money. Think of it as the ‘amazon.com’ for employee benefits.” — Ashok Subramanian, Co-founder and CEO, Liazon
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Tools and Technology
Benefit Software Inc. Benefit Software Inc. (BSI) is the leader in client satisfaction when it comes to helping 212 Cottage Grove Avenue organizations meet important benefits Santa Barbara, CA 93101 communications challenges for today’s diverse 800-533-1388 workforce. Offering web-based enrollment www.bsiweb.com solutions, web-based or printed Total Rewards sales@bsiweb.com Statements, and PC-based Statement software, BSI helps thousands of organizations achieve complex enrollment and communications goals. With over thirty years of experience supporting mid-size to Fortune 500 businesses, BSI has gained insights into solving the most challenging benefits administration and communications challenges. “If you can imagine a benefits enrollment or a benefits communication solution that will help your organization motivate and educate employees then Benefit Software can build that solution for you. We have 30 years of experience in delivering best-of-breed employee focused communications solutions. We look forward to helping you.” — William Smith III, Head of Sales, Benefits Software
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Who’s Who Profiles
Access these profiles online at www.TheIHCC.com and www.EmployersWeb.com HSA/HRA/FSA Technology: Administration & Management
DataPath, Inc., is one of nation’s largest providers of CDH solutions specializing in account-based administration systems.
DataPath, Inc.
1601 WestPark Drive, Suite 9 Little Rock, AR 72204 501.296.9990 www.dpath.com
Since 1984, service providers using DataPath systems have provided administrative solutions for over 1 million participants of FSA, HRA, HSA, and COBRA. DataPath is the only solutions provider to design and deliver a full Suite of systems for handling 125, 105, 132, COBRA, HSAs, Credit and Debit Cards all delivered to account holders through a single Internet portal, myRSC.com.
“With the significant changes in healthcare today, our software solutions allow users to create custom plans for clients that benefit both the employer and employee. Not only have we created a single platform for all systems with myRSC.com, with the integration of our mySourceCard Debit Card at Wal-Mart and other retailers, our clients are able to offer a hassle-free solution with 100% compliance.” ®
PROFESSIONAL DEVELOPMENT
The AHIP Center for Insurance Education and Professional Development has offered educational programs for more than 50 years to professionals like you.
AHIP Center for Insurance Education and professional development 601 Pennsylvania Ave., NW South Building, Suite 500 Washington, D.C. 20004 800.509.4422 www.AHIPInsuranceEducation.org
With more content online, including overall health insurance, reform implementation, LTC, DI, and more, the Center will help you learn, achieve, and succeed.
Supplemental Health Benefits
Employer Direct Healthcare (EDHC), Employer Direct Healthcare™ is the next-generation healthcare 7320 N. Mopac EXPY, Suite 203 solution designed to transform the Austin, Texas 78731 way self-funded health plans purchase kerickson@nationalsurgerynetwork.com healthcare for their members. EDHC brings together the highest quality 888.241.8537 health care providers to offer www.employerdirecthealthcare.com services directly to the employer through its leading network, National Surgery Network (NSN). Due to its extensive provider network, NSN can offer employers 30-50% savings on planned medical procedures, potentially reducing total plan cost by 6-10%. EDHC is expanding its networks to include diagnostic, imaging, oncology, and more. EDHC is a privately held company headquartered in Austin, Texas.
“The most important issue facing self-funded health plans today is rising costs. Employers can, and should be a catalyst for change in making their health plans more effective. When I bring together high quality providers and self-funded employers, everybody wins. Employers are able to take control of their healthcare expenditures, offer the highest quality care and pass savings on to their employees.” – Ken Erickson, CEO, Employer Direct Healthcare™ Pharmaceutical Benefits Management
Envision Pharmaceutical Services, Envision Pharmeceutical Inc is a full service pharmacy benefits Services, Inc. management company that delivers! John Ewell, EVP Marketing We deliver because our business 925.487.3266 model is based on transparency www.envisionrx.com and full disclosure, guaranteeing jewell@envisionrx.com 100% pass through pricing of all pharmaceutical manufacturer rebates and administrative fees at the point-of-sale. Additionally, our affiliate, Envision Insurance Company, is a national Prescription Drug Plan which enables us to offer a variety of solutions for your retirees. Envision is truly a “different” PBM!
“Envision is pleased to be recognized by its clients surveyed by the Pharmacy Benefits Management Institute for three consecutive years as the top performer in virtually every category evaluated. This solidifies our leadership position in providing transparency and full disclosure to the PBM marketplace while continuing to find innovative solutions.” — Kevin M. Nagle, President & CEO, Envision Pharmaceutical Services/Rx Options
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Solutions to help your innovative health and benefit programs. Effective print and online opportunity to put your company, its solutions, and your chief sales executive in front of 60,000 print and online prospects. How do you make your company and its solutions accessible to more than 60,000 health care benefits decision-makers, generate leads, and do so cost effectively? By participating in the industry’s only online, member-based networking community!
le Online Examp
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FieldMedia has developed a special online-only offer to ¡help you create a leadership presence on our member-based Web communities—CDHC Solutions Online and EmployersWeb.com Online—and help you generate sales leads, gain leadership presence, and connect you to our buyers and members.
Take advantage of our innovative online Who’s Who in Consumer-Directed Health Care profiles and receive the complete bonus package including lead-generating eblasts. Call your FM account rep 404.671.9551 or email at sales@fieldmedia.com. Check out the active online Who’s Who Profiles at www.TheIHCC.com.
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Liazon.........................................................28
CDHC Solutions Call for Content..................22
PATH..........................................................28
DataPath............................................. 14, 29
Target................................ Inside Back Cover
DSS Research............................................ 28
TSYS Healthcare.........................................27
Employer Direct Healthcare........................ 29
UnitedHealthCare.......................... Back Cover
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Doug Field dfield@fieldmedia.com · ext. 101 Associate Publisher
Brent Macy bmacy@fieldmedia.com · ext. 103 Vice President of Business Development
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S h o w y o u r e m p l o y e e s h o w y o u c a r e b y g i v i n g t h e m Ta rg e t G i f t C a r d s. * ®
They’re a great way to encourage participation in weight loss or smoking cessation programs, increase patient referrals, or simply reward employees for a job well done. Target, the store everyone loves, is here to help make everything better. Take two — or five — and visit Target.com/corporategiftcards or call 1-800-5GIFTS5 as directed. *Terms and conditions apply to GiftCards. ™
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Engaging consumers to make informed health care decisions
UnitedHealthcare’s industry-leading consumer-driven health (CDH) plans were designed to get employees on the path to good health with improved lifestyle habits and use of the health care system. That’s why our plans offer: • 100% preventive coverage and personalized messaging based on individual health care needs • Easy-to-use resources for employees, including treatment cost estimators, Quicken HealthSM Expense Tracker, and Health Care LaneSM to help members understand and maximize their health care benefits • Banking through our own OptumHealth Bank, Member of the FDIC, offering integrated access to account balances and a debit card that makes payments easier Tools like these help employees become active in their own health care decisions. We also offer the employer ready-to-use tools to implement and successfully maintain its consumer-driven health plans.
For more information on UnitedHealthcare’s CDH plans, visit uhctogether.com/CDH or call 1.866.438.5651.
Grow Healthy.
©2011 United HealthCare Services, Inc. Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by or through UnitedHealthcare Insurance Company, United HealthCare Services, Inc. or their affiliates. Health plan coverage provided by or through a UnitedHealthcare company. UHCEW506202-001