FORUM East April 12-13, Atlanta
solutions ISSUE || January-February 2012
Innovative Health and
Challenges of Remote Medicine Provide Solutions Many Employers Can Use to Control Health Care Costs A Dental Benefits Checkup Interactive Tool Helps Employees See Vision Plan Potential
BeneďŹ t Management
The ROI For Worksite Health Improvement Services
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InSIDE 28 The ROI for Worksite Health Improvement Services
As part of his first term in office, President Obama was able to put health care reform into law, in part, so employers would “no longer be burdened by the crushing weight of health care costs.” These costs affect every company offering health care benefits, and the costs continue to increase. To help cope with the rising costs of health care, some forward-thinking companies have taken an aggressive approach by encouraging employees to live healthier lives by implementing an on-site wellness clinic or mobile medical unit where the employee population can benefit from workplace wellness and prevention programs. By W. Tom Fogarty, M.D.
31 Challenges of Remote Medicine
34 Interactive Tool Helps
Provide Solutions Many Employers Can Use
Employees See Vision Plan Potential
Transitions Director of Managed Vision Care Pat Huot conducts a questionsand-answer session discussing the benefits of a comprehensive vision benefit plan serving as an economic way to control health care costs and boost employee productivity and satisfaction. By Pat Huot
36 A Dental Benefits Checkup Employees want dental benefits. Savvy employers know this. That is why dental benefits are and will continue to be one of the most popular benefits in an employer’s compensation package. By Evelyn F. Ireland
Small- and medium-sized companies struggle to address health care issues in the best of circumstances. Even large companies with more resources find it difficult to keep up with the constantly increasing health care challenges of cost, access, and quality. Remote worksites face even more complications as they struggle with these same challenges, plus the additional challenges of fewer medical providers to choose from, higher costs, long response times for emergencies and long travel times away from work for routine care. By Kate Woldhuis
COMInG UP nExt: The Institute for HealthCare Consumerism presents its annual HealthCare Consumerism 2012 Outlook, featuring thought leaders touching on topics such as: Health Care Consumerism, Health Plans, Pharmacy Benefit Management, Supplemental Insurance and much more. On tHE COVER: A member of Concentra welcomes an employee of a client to one of the many well-being centers being built in-house by many forward-thinking employers. www.TheIHCC.com I CDHC Solutions™ I January/February 2012
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InSIDE 8
Editor and Publisher’s Letter
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Health Care Consumerism
Departments 19 Self-funding
Visit us Online to See What’s New at The Institute; Join to Participate in Our Networking Community
Health Care Reform Fostering Growth of Self-funding
The Supreme Court Rules Against Health Reform – Now What?
By Marc Kutter
By Ronald E. Bachman
11-15 CDHC Solutions FORUM East n n n n n n
Featured Speakers in Atlanta Benefits of Attending FORUM Professional Credits Available for CRCs and HR Professionals Agenda for FORUM East Sponors/Exhibitors Registration Rates
16 People on the Move
21 Supplemental Health & Voluntary Benefits Critical Care Policies: A Necessity in 2012 and Beyond
16 Briefs/Innovations n
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n
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Transitions Optical Names Tibbs Transitions Vision Benefits Broker of the Year Medco, Castlight Health Integrate Web Tools for Drug and Medical Costs to Empower Consumers, Improve Care My HSA Rewards Announces Partnership with American Health Value Trotter Wellness, AMGA Announce Partnership in Wellness
By Tom Morey
22-23 Pharmacy Benefit Management PBM Merger Means Higher Prices, Less Access to Care for Consumers
39 Who’s Who Profiles
By Eva Clayton
42 Resource Guide/Ad Index
The Right Prescription for Public Health By Steven Miller, M.D.
Event 25 Rewards & Incentives
The 2012 IHC FORUM West
www.theihccforum.com
Incentive-driven Healthcare Yields Better Engagement, Decisions and Results
Our second annual FORUM West has expanded and will be in Las Vegas. Don’t gamble on your health and benefit management. Join us in the desert to LEARN, CONNECT and SHARE with the leading thought leaders in the health care industry at the Red Rock Resort on Sept. 6-7.
By Michael Dermer
27 Population Health Management
Have you become a member of The Institute yet? Have something to share? Become a member and post a blog or forum on www.theihcc.com, today!
Genetic Testing: Using DNA to Improve Employee Wellness By Nancy Sansom
PRInt AnD OnLInE KEy Connect with CDHC experts and community members online at www.CDHCSolutionsMag.com by looking for the following symbols at the end of each article: blog blog
MEMBER MEMBER
BLOG BLOG
WHO’S WHO’S WHO WHO PROFILE PROFILE
BROKER/ADVISOR/ BROKER/ADVISOR/ CONSULTANT CONSULTANT
EMPLOYEE EMPLOYEE COMMUNICATION COMMUNICATION & & EDUCATION EDUCATION
HEALTH HEALTH PLANS PLANS
HSA/HRA/FSA HSA/HRA/FSA ADMIN ADMIN & & FINANCE FINANCE
S TOTAL TOTAL POPULATION POPULATION HEALTH/WELLNESS HEALTH/WELLNESS
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PHARMACY PHARMACY BENEFITS BENEFITS MGMT MGMT
January/February 2012 I CDHC Solutions™ I www.cdhcsolutionsmag.com
POLICY POLICY & & LEGIS LEGIS PERSPECTIVE PERSPECTIVE
SUPPLEMENTAL SUPPLEMENTAL BENEFITS BENEFITS MGMT MGMT
TOOLS TOOLS AND AND TECHNOLOGY TECHNOLOGY
MEDICAL MEDICAL TOURISM TOURISM
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Exclusively Online | 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 Doing the Benefit Communications Time Warp By Craig Foster, president, Quantum Service Group
“From 1999 to 2009, businesses’ health insurance costs rose from 5.4 to 7.3 percent of compensation, while compensation in wages and salaries dropped from 73.0 to 70.8 percent.”
Health Decision Support Tools Health Care Predictions for 2011: How’d We Do? By David E. Williams, co-founder MedPharma Partners LLC
“Transparency will change from buzzword to reality. Information technology progress will be uneven, with the biggest breakthroughs in mobile. A culture of patient safety will begin to take root. Health reform implementation will advance despite some ugly battles.”
HSA/HRA/FSA Admin & Finance HSAs, and HRAs: Assets, Account Balances, and Rollovers, 2006-2011 By Employee Benefit Research Institute
“In 2011, there was $12.4 billion in health savings accounts (HSAs) and health reimbursement arrangements (HRAs), spread across 8.4 million accounts, according to data from the 2011 EBRI/MGA Consumer Engagement in Health Care Survey… This is up from 2006, when there were 1.3 million accounts with $873.4 million in assets, and 2010, when 5.4 million accounts held $7.3 billion in assets.”
Medical Travel Employers Encourage Workers to Travel For Care, But Leave Their Passports Behind By Steve Davis, managing editor, AISHealth
“UnitedHealth subsidiary that operates the network, said 13,519 transplants were performed at its COE network hospitals in 2011 — up 60 percent from 2004.”
Blogs | Sharing thought leadership with 65,000+ 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: Childhood Obesity Prevention – A Promising New Method for Tackling the Epidemic By Amy Sheon, Former Co-director, Altarum Institute Childhood Obesity Prevention Mission Project
“Childhood obesity is a public health epidemic with serious ramifications for health, productivity, and long-term health care system costs.” A New Twist on February Hearts: The Real Cost of Heart Disease By Audrey tillman, AFLAC Executive VP of Corporate Services
“In the U.S., all cardiovascular disease costs $273 billion each year, including heart conditions, stroke, peripheral artery disease, and high blood pressure.” 6
January/February 2012 I CDHC Solutions™ I www.TheIHCC.com
Announcing the Text4baby Toolkit for Employers: A free Addition to Your Maternity Education and Benefits Communication By Jennier Benz, Benz Communications Founder
“Thanks to the power of technology, we can target health education to broader audiences and tackle such huge issues with just the push of a few cellphone buttons.” Social networking | Follow us on Twitter: Twitter.com/the_IHC Join the discussion in LinkedIn Group: HealthCare Consumerism FORUM by the IHC Join our Facebook Group: The Institute for HealthCare Consumerism
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eDitor & publisher www.theihcc.com VOLUME 8 NO. 1 JaNUary/FEbrUary 2012
Visit us Online to See What’s New at The Institute; Join to Participate in our Networking Community
Published by FieldMedia LLC 292 South Main Street, Suite 400 alpharetta, Ga 30009 Tel: 404.671.9551 • Fax: 770.663.4409 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 EditOriaL dirECtOr
The health care industry is embracing for a volatile 2012, as the Supreme Court hears arguments and decides the future of the Patient Protection and Affordable Care Act (PPACA). The hearings begin in late March and the decision is expected early summer, and The Institute for HealthCare Consumerism (www.theihcc.com) is the only destination to get updates on what is going on in the five-story, marble Supreme Court Building in Washington D.C. In addition to getting updates on the Supreme Court case by insiders like Institute members Roy Ramthun and John Hickman, visitors to The IHC website can take advantage of new features to help them LEARN, CONNECT and SHARE on their journey to health care consumerism. In January, The Institute launched HealthCare Consumerism Radio, a weekly program heard live from 11 a.m. to noon every Friday on the website. The goal of the program is to create informational conversations to help our listeners LEARN about the latest trends and best practices in health care consumerism and CONNECT them with health care industry thought leaders, brokers, advisors, third party administrators, HR and benefit managers and regional health plans. The program is hosted by a member of The Institute; and features CEOs of innovative companies in the health care and wellness space. Listeners also are able to CONNECT and participate in the show by e-mailing or tweeting (@The_IHC) questions and comments to the HealthCare Consumerism Radio guests and hosts. The interactive show is meant to foster a weekly educational and informational conversation around trends in health care consumerism. If you’ve missed a program, you also can listen to the podcast archived on The Institute website. Here you can LEARN from past guests such as: gBehavior CEO Don Doster; Sanders McConnell, CEO of My HSA Rewards, The Institute’s Editorial Chairman Ron Bachman, and directors from companies like TSYS, Change:healthcare and Avivia Health. Another addition to The Institute is a Health & Wellness Content Library, compiled by The Institute and powered by ShareWIK (Share What I Know) Media Group. This comprehensive library is a collection of engaging, relatable, high quality, educational video and written content produced by ShareWIK, which specializes in telling factually correct, non-sponsored, personal stories of health care consumers and their caregivers. The Institute has gathered this content specifically to provide its members with an effective tool for connecting with target markets and employees. While at The Institute, don’t forget to register to attend The IHC FORUM East held April 12-13 at the Cobb Galleria Centre in Atlanta. Save $200 when you sign up before March 16. The IHC FORUM events are for those just embarking on their journey to health care consumerism as well as those who are well into their journey and looking for ways to improve their programs and participation. ‘The Institute’ is your place to participate and help advance the adoption of successful ‘HealthCare Consumerism’ initiatives.
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 SaLES aSSOCiatES NatiONaL aCCOUNt MaNaGEr
Brent Macy 404.671.9551 ext. 103 · bmacy@fieldmedia.com ViCE PrESidENt OF bUSiNESS dEVELOPMENt
Susan Yakots 404.671.9551 ext. 102 · subscriberservice@fieldmedia.com bUSiNESS dEVELOPMENt aSSOCiatES
David Cerri 404.671.9551 ext. 106 · dcerri@fieldmedia.com aCCOUNt MaNaGEr
Joni Lipson 800.546.3750 · jlipson@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 COPy WritEr + Pr
Lana Perry 770.298.1959 · lperry@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 8 issue 1 Copyright ©2012 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. 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.
todd Callahan Editorial Director tcallahan@fieldmedia.com 8
January/February 2012 I CDHC Solutions™ I www.TheIHCC.com
Doug Field CEO/Publisher dfield@fieldmedia.com
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. 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.
By ROnALD E. BACHMAn FSA, MAAA Chairman Editorial advisory Board tHE InStItUtE FOR HEALtHCARE COnSUMERISM
BACHMAn’S BAntER
The Supreme Court Rules Against Health Reform — Now What?
I
n July 2012, that just might be the headline that throws the country 4) Georgia laws should allow for a group conversion policy for those into turmoil. If the constitutional challenge to the Patient Protection and who lose their jobs and coverage. A group conversion would Affordable Care Act (PPACA) health reform by 26 states is successful— maintain consistency with other group policies and add a valuable then what? Part or all of the federal law will immediately be null and void, aspect of portability. and insurance markets will revert back to inadequate state laws that existed pre-PPACA. Second, Georgia Needs New Laws to Strengthen the We know those laws created 1.8 million uninsured Georgians, and fewer Private Market Safety Net. than one in four Georgians working in small businesses were insured. So, is Georgia prepared to make needed health reform changes for the state to Areas needing change include: equalizing pre-existing conditions improve the insurance market and lower the number of uninsureds? between self-insured and fully insured policies, expanding coverage to tax In preparation for that potential, the dependent children until age 26, allowing Georgia Public Policy Foundation (GPPF) policy rescissions only for fraud and material passing state reforms facilitated a multi-stakeholder bipartisan misrepresentation, providing lower cost options discussion group that resulted in a detailed for those selecting COBRA and continuation of now will prevent the plan for Comprehensive Health Insurance coverage. In addition, the state can provide Reform for Georgia The plan was built on basic planning, expansion grants, and HIT support chaos that will come principles of: for Georgia’s Charity Care Network. 1) Free Markets, from a court decision 2) Personal Responsibility, Third, in Addition to the Above, the Comprehensive Health Insurance 3) Competition, that Georgia Reform for Georgia Includes more 4) Choice, than 30 Specific Recommendations 5) Transparency, and is advocating and to Lower the Cost of Insurance for 6) A Level Playing Field for All hopes to win. Individuals and Small Businesses. Recommendations include three major areas of reform to be pursued simultaneously. Existing laws add unnecessary costs, limit incentives, and unfairly tax individual policies at higher levels than group plans. First, Georgia must Restructure the Insurance Market In summary, the GPPF has produced a broadly accepted Georgiato Increase Competition, Transparency, Access, and centric health insurance reform roadmap for the 2012 Georgia General Portability. Assembly. This is a chance for states to say “Yes” to a positive agenda while awaiting the Supreme Court to say “No” to unnecessary federal intrusions Four major restructuring ideas emerged: 1) Georgia should show leadership in creating a regional marketplace on states. Passing state reforms now will prevent the chaos that will come from a with consistent insurance laws and interstate reciprocity of policy approvals. A larger 24-50 million person Southeast marketplace court decision that Georgia is advocating and hopes to win. These are real will bring Georgia lower cost products, more responsive wellness solutions that will show states are prepared and positioned to help their own citizens. The Georgia solutions include ideas that could be useful to other incentive programs, and increased choices through competition. 2) Georgia should encourage the development of nascent private states. Other states will have their own ideas and may need different reforms health insurance information marketplaces. These entities will for their own situations. That is how it should work if the Constitutional provide transparency of costs, quality and consumer health literacy challenge is upheld and states truly believe in the Tenth Amendment. to both private and public insurance. 3) Georgia needs a “Personal Responsibility High Risk Pool (PRHRP).” Rnald E. Bachman FSA, MAAA, is president and CEO of Healthcare Visions Inc. He is a senior fellow at the Center for Health Transformation, the Georgia Public Policy Foundation, the Wye A PRHRP would stabilize the small group and individual markets, River Group on Health, and the National Center for Policy Analysis. Bachman is the chair of the provide affordable coverage to those otherwise locked out of editorial advisory board of The Institute for HealthCare Consumerism and can be reached at ronbachman@healthcarevisions.net. coverage, and increase access to insurance for all. www.cdhcsolutionsmag.com I CDHC Solutions™ I January/February 2012
9
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APRIL 12-13, 2012
Formerly CDHC Solutions FORUM
THE JOURNEY TO HEALTHCARE CONSUMERISM FEATURED SPEAKERS: Ron Bachman
Roy Ramthun
FSA, MAAA, Sr. Fellow, Center for Health Transformation; President, Healthcare Visions; Chairman of The Institute For HealthCare Consumerism Editorial Advisory Board
An expert on health savings accounts and consumer directed healthcare issues
Wendy Lynch
Trudy Nacin
Founder, Lynch Consulting Senior Scientist, Health as Human Capital Foundation
Division Chief, State Health Benefit Plan Georgia Department of Community Health
John Young
John Hickman
Senior Vice President, Consumerism CIGNA HealthCare
Partner Alston+Bird LLP
D.W. Edington, Ph.D.
Karen Hunt
Professor, Division of Kinesiology, Director Health Management Research Center, University of Michigan
Vice President of Sales and Marketing Paragon
Elizabeth Dixon
Kristine Hackbarth-Horn
Wellness Director Chick-fil-A
Chief Operating Officer of People Goodwill of North Central Wisconsin
WHO SHOULD ATTEND? CEOs/Presidents/CFOs HR and Benefits Executives Health Plan Administrators Corporate Wellness and Medical Directors
Benefit Brokers Third Party Administrators Benefit Consultants Bankers
WWW.THEIHCCFORUM.COM
Formerly CDHC Solutions FORUM
WWW.THEIHCCFORUM.COM
BENEFITS OF ATTENDING
WHAT YOU’LL LEARN
In today’s challenging economic and legislative climate, companies everywhere are opting to put healthcare decision making into the hands of their employee consumers. Now in our third year, the IHC FORUM East (formerly CDHC Solutions FORUM) is the only conference that offers your business proven, implementable healthcare consumerism solutions — all at a fraction of the cost of other conferences.
Through five cutting-edge general sessions, 24 workshops, intimate roundtable discussions and unlimited networking opportunities, you’ll:
No matter where you are on your journey, the FORUM will equip you with the money-saving strategies you need to successfully navigate the healthcare consumerism landscape and avoid the bumps along the road. This year’s FORUM is a must-attend event for C-level executives, HR professionals, benefit managers, corporate wellness directors, healthcare brokers and regional health plan providers interested in lowering healthcare costs, complying with the Patient Protection and Affordable Care Act (PPACA) and engaging their employees in consumerdirected health plans. In just a day and a half, you’ll get expert insights from the industry’s foremost thought leaders and policy makers, and real-life examples from peers on how to:
LEARN from forward-thinking industry experts, policymakers and peers on the cusp of the latest healthcare consumerism trends. CONNECT with health and benefits professionals from across the board, including employers, brokers and health plan providers who have successfully implemented consumerdirected plans. SHARE leading practices, valuable insights and real, actionable solutions.
This Year’s Highlights: • Industry thought leaders including, Ron Bachman, Dr. Wendy Lynch, Roy Ramthun, and John Hickman • The latest on supplemental health benefits, pharmacy benefit management and HSA/HRA/FSA administration • Expert advice on population wellness strategies and employee incentives
• Cut costs now • Comply with the PPACA to avoid hefty fines • Build the best possible plan for your company • Avoid common pitfalls of transitioning to healthcare consumerism • Turn disengaged employees into involved, well-educated healthcare consumers It is our pleasure to host this conference series. We thank you for your participation, and we continue to pledge unmatched dedication to integrity and industry knowledge through our FORUMs, publications and online communities. We look forward to seeing you there.
Doug Field CEO of The Institute for HealthCare Consumerism
Ron Bachman, FSA, MAAA Chairman of The Institute for HealthCare Consumerism Editorial Advisory Board
FORUM EAST 2012
WHAT IS HEALTHCARE CONSUMERISM? Healthcare consumerism is about transforming an employer’s health benefit plan into putting economic purchasing power — and decision making — into the hands of participants. This is best achieved by supplying employees with the decision making information and support tools they need, along with financial incentives, rewards and other benefits that encourage personal involvement in altering health and healthcare purchasing behaviors.
TAKE ADVANTAGE OF OUR EARLY BIRD RATES BY REGISTERING BEFORE MARCH 16 WWW.THEIHCCFORUM.COM
ATLANTA
APRIL12-13, 2012
JOIN US AT THE ONLY EVENT 100% DEDICATED TO INNOVATIVE HEALTH AND BENEFIT MANAGEMENT SOLUTIONS 2012 FORUM EAST AGENDA AT A GLANCE Day 1: Thursday, April 12, 2012 7:30 a.m.
Registration Open
8:00 a.m. – 9:00 a.m.
Networking Breakfast / Exhibits Open
9:00 a.m. – 9:15 a.m.
Welcome Doug Field, CEO, The Institute for HealthCare Consumerism
9:15 a.m. – 10:30 a.m. Opening General Session: “The Journey to HealthCare Consumerism” 10:30 a.m. – 11:00 a.m. Networking Break / Exhibits Open 11:00 a.m. – 12:00 p.m. Track #1 Workshops – Select One 101 – Employee Engagement Strategies: Unlocking the Potential of your CDHC Program 102 – Best Practices to Increase Employee Participation in your HDHP/HSA Plan 103 – The Changing Role of Supplemental Health Benefits and Healthcare Consumerism Initiatives 104 – Making the Health Commitment 105 – Comprehensive Healthcare Redesign: 25 Keys to Redesign U.S. Health Care 106 – Providing Decision Support Tools to Engage Your Employee Population to Become Better Consumers of Healthcare 107 – Results Based Healthcare Benefits: Managing Costs Through Personal Responsibility 108 – Simplifying and Administering Consumer-directed Health Plans
12:00 p.m. – 1:00 p.m. Table Topic Lunch 12:00 p.m. – 1:30 p.m. Lunch in Main Ballroom / Table Topic Lunch / Exhibits Open 1:30 p.m. – 2:30 p.m.
Afternoon General Session: “Health Provider Panel”
2:30 p.m. – 2:45 p.m.
Networking Break / Exhibits Open
2:45 p.m. – 3:45 p.m.
Track #2 Workshops – Select One 201 – Aligning Leadership Development and Health Improvement to Maximize Investment in Employee Total Well-being 202 – Controlling Costs and Expanding Choice within Defined Contribution Healthcare 203 – Successful Engagement Strategies Utilizing Incentives to Promote Compliance with Wellness and Care Management Programs 204 – Engaging Employees in Smart Healthcare Purchasing Decisions 205 – Taking the Fear Out of High-deductible Health Plans 206 – Show Me the Money: Improving Health Status with Consumer Directed Accounts 207 – Health Investment Strategies: The Convergence of Technology, Health Investment and Consumer Choice 208 – Value-Based Insurance Design and Chiropractic Care: An Unlikely Partnership?
3:45 p.m. – 4:15 p.m.
Networking Break / Exhibits Open
4:15 p.m. – 5:15 p.m.
Closing General Session “Population Health Management Multi Stakeholder Panel”
5:15 p.m. – 7:15 p.m.
Opening Night Reception / Exhibits Open / Prize Drawing
7:30 p.m. – 9:30 p.m.
League of Leaders Dinner and Networking Event (Invitation Only)
continued on the next page
2012 FORUM EAST AGENDA CONTINUED Day 2: Friday, April 13, 2012 7:30 a.m.
Registration Open
8:00 a.m. – 9:00 a.m.
Networking Breakfast / Exhibits Open
9:00 a.m. – 10:00 a.m. Opening General Session: “HealthCare Reform: A Potential Pothole on the Journey to HealthCare Consumerism”
10:00 a.m. – 10:30 a.m. Networking Break / Exhibits Open 10:30 a.m. – 11:30 a.m. Track #3 Workshops – Select One 301 – Health Care Reform, Medicare and What Each Means to Retirement Plans and an Employer’s Bottom Line 302 – COBRA in the Age of Health Reformal 303 – Ten Ways to Make Your Benefits Communication A LOT More Engaging. Wait – Special Bonus for IHC Participants: 11 Ways! 304 – Picking a Self-funded Claims Administrator 305 – Broker Track: Defined Contribution and Private Exchanges: The Revolution of Small Group Benefits 306 – CDHP + Price Transparency = Bigger Savings and ROI 307 – The Coming Impact of Consumer Designed Health Tech 308 – Updating your CDHP, Health Reform and Cost Strategies – A Total Replacement CDHP Case Study
11:30 a.m. – 12:30 p.m. Grand Finale Networking Break / Exhibits Open / Exhibitor Prize Drawings 12:30 p.m. – 1:30 p.m.
Closing General Session: “Employer Panel: What HealthCare Consumerism Means to You”
1:30 p.m.
End
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Professional Credits Available for CRCs and HR Professionals
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For the latest updates and to register, visit www.theihccforum.com or call 404.671.9551
Renaissance Atlanta Waverly Hotel Two Galleria Parkway Atlanta, GA 30339 (770) 989-5095 Discount room rate for attendees: $149.00. Discounted room rates are available until 5 p.m. on Wednesday, March 21, 2012. After that, the hotel’s prevailing rates apply. Register online, or call the Renaissance Waverly Hotel Reservations at (800) 228-9290, and mention you are attending the IHC FORUM East.
Register for IHC FORUM East at www.theihccforum.com. Group rates are available. Receive a 50% discount when you sign up two or more attendees.
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by certain members of the management committee. Vuolo will continue to serve as CFO of WebMD.
Wayne t. Gattinella has resigned from his position as chief executive officer and president of WebMD and as a member of its board of directors. Anthony Vuolo, currently serving as chief financial officer and chief operating officer, will serve as Interim CEO while the Board conducts a search to fill the position on a permanent basis. Vuolo will be supported, with respect to the operations and strategic priorities of WebMD’s public portals, by a newly-formed management committee consisting of Gregory Mason, executive vice president—consumer services; William Pence, executive vice president and chief technology officer; Steven Zatz, M.D., executive vice president—professional services; and Dorothy Gemmell, senior vice president—sales. The responsibilities of the COO position will be assumed
CDHC InnOvaTIOns
TRANSITIONS
Transitions Optical Names Tibbs Transitions Vision Benefits Broker of the Year recognizing his consistent efforts to communicate the value of vision benefits to HR customers and their employees, Transitions Optical Inc. has named Patrick Tibbs, financial services representative, Everence Financial advisors of Goshen, ind., as the 2011 transitions Vision Benefits Broker of the Year. The second winner of this annual award, tibbs was honored during a celebratory event—attended by an international audience of more than 1,300 optical industry professionals and 160 managed vision care industry professionals—at the 16th annual transitions academy at rosen Shingle Creek in Orlando. “I strongly believe that a quality vision benefit can serve as an efficient wellness tool for today’s employers, and as a way to provide extra value to employees and help them stretch their health care dollars,” tibbs said. “i respect what transitions Optical is doing to educate brokers and employers on vision plan potential, and I’m humbled to serve as the 2011 Vision Benefits Broker of the Year.” Prior to being named the Transitions Vision Benefits Broker of the Year, Tibbs participated in a panel discussion with the two other finalists for the award, as part of the fifth annual education track for vision plan providers and benefits brokers at Transitions Academy. During the panel discussion, tibbs spoke to his personal experience with vision issues, and his focus on educating employees about factors that could put them at risk for vision problems or eye diseases, such as age and certain ethnicities. aside from advocating for regular eye exams, tibbs said he is a strong proponent of premium eyewear options that can help employees see their best and protect long-term eye health, which is why he includes transitions® lenses and a high frame allowance in every vision plan he offers. Additional finalists included Anya Simpson, president, Benefit Plans inc.; Norfolk, Va., and Steve Farmer, executive vice president, Wallace, Welch & Willingham; St. Petersburg, Fla.
My HSA Rewards Announces Partnership with American Health Value My hSa rewards, a cash rewards program offered by healthy rebates inc., announced a marketing partnership with american health Value. My hSa rewards is a cash rewards program designed to help 16
January/February 2012 I CDHC Solutions™ I www.TheIHCC.com
Henry Albrecht, CEO of Limeade, announced that the company has filled three newly-created executive positions with talent from ShapeUp and Microsoft. Limeade has doubled its workforce since the beginning of 2011 and continues to grow rapidly. Limeade is an online corporate wellness platform that builds happy, healthy, high-performance workforces. Brett Rubin, most recently vice president of sales and business development for ShapeUp, is sales director responsible for building Limeade’s footprint in the Eastern region. Sameer Halai, most recently program manager for FUSE labs at Microsoft Research, is director of user experience. Stephanie Camp, most recently director of marketing at Doxo and prior to that digital marketing
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MY HSA REWARDS
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individuals contribute more money to their hSas via rebates from everyday purchases. the money they deposit reduces taxable income, aids in retirement savings, and builds a reserve for future medical expenses. american health Value accountholders may enroll in My hSa rewards at no cost, and when they make everyday purchases through any of the 500-plus merchants in the program, a portion of their spending will be deposited into their health savings account. “We believe our marketing alliance with My hSa rewards provides new and existing american health Value customers with a unique way to save and help pay for their health care,” said Michael berry, CEO of american health Value. “the concept of funding the hSa through the purchase of products used in everyday living is one of the most innovative and painless ways to help pay for health care costs. during these challenging times, it empowers individuals to capitalize on spending while simultaneously saving for medical expenses. It’s a win-win situation for everyone involved.” American Health Value’s partnership with My HSA Rewards provides their accountholders with an instant program enhancement that produces a significant cash benefit. Due to the fact these rebates come from common everyday purchases, the opportunity for the accountholder to put away extra money in their hSa is great.
Medco, Castlight Health Integrate Web Tools For Drug And Medical Costs To Empower Consumers, Improve Care Medco health Solutions inc. and Castlight health inc. announced they will integrate their comparison pricing features and clinical messaging services together in a pilot program with mutual employer clients. Combining these services will provide patients with the first-ever complete view of the cost and quality of medical and prescription drug services. Under this initiative, Castlight’s directory of medical quality and cost information will be married with Medco’s My Rx Choices®, a feature that allows members to compare prescription drug costs, both brand and generics, and by distribution channels – mail service or retail pharmacy. Via Castlight’s web portal, consumers will be able to examine the cost and quality of health care services and medicines together with clinically validated education and recommendations for specific conditions such as diabetes, asthma and cardiovascular disease. “Employers have long wanted to help their employees be better
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strategist at Microsoft Xbox, is director of marketing. Halai and Camp, Seattle residents, will work from Limeade’s Bellevue, Wash., headquarters. Rubin will work from New York. IncentOne, leading the charge for Incentive-driven Healthcare™ solutions to the health care industry, announced the addition of several senior executives to guide the company’s continued growth. New additions include: Hedy Foreman—chief operating officer, David Guda, chief technology officer Courtney Fawcett, chief financial officer. As demand for incentive solutions in the health care industry and IncentOne’s services continues to grow, IncentOne has tapped leaders with distinguished careers in some of the most successful and innovative health care companies to lead the company during its next phase of innovation, technological and operational performance.
TLIGHT HEALTH
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AMGA
health care consumers—to enable planning for medical and pharmacy care based on quality and cost,” said dr. Giovanni Colella, CEO and co-founder of Castlight health. “Consumers rarely know the quality they’re receiving, nor the fees for treatment until they pay the bill. information transparency is the way to empower patients to get better care at a lower cost. Medco’s My Rx Choices completes the picture by helping patients save money on medicines and stay safe with its alert features to prevent adverse drug events. by providing a continuum of care across medical and pharmacy, consumers can make smarter choices that balance quality and cost.” the integrated portal also will highlight Medco gaps-in-care alerts, which message members about late refills and/or omissions of essential therapies, along with other Medco clinical alerts and Castlight-identified medical quality and savings opportunities. The program could have a significant impact for consumers bearing an increasing share of their health care costs through higher deductibles and cost sharing. the use of CdhPs (consumer-directed health plans) has increased in recent years with 17 percent of workers getting this form of coverage in 2011, an increase from 8 percent in 2009, according to the Kaiser Family Foundation’s Employer Health Benefits 2011 Annual Survey. Costs have generally shifted increasingly to employees, since the number of workers enrolled in a plan with a general annual deductible of $1,000 or more for single coverage has increased to 31 percent in 2011 from 10 percent in 2006.
Trotter Wellness, AMGA Announce Partnership in Wellness trotter Wellness, a national provider of wellness programs, is pleased to announce a value-added partnership with the american Medical Group Association (AMGA), a nonprofit trade association that represents more than 117,000 practicing physicians in the United States. through this agreement, trotter Wellness will provide aMGa Members a unique platform to offer Wellness programs to a variety of populations presently serviced by their Members. aMGa Members may select to implement a wellness program for their own employees or provide, in partnership with trotter, an integrated product to local corporations or use to assist in managing the behaviorally related health risks of defined patient populations. “this is an excellent opportunity to create value for aMGa members through assisting them in reducing costs, improving quality and increasing
Foreman has more than 25 years of experience leading IT organizations for some of the world’s largest businesses. She held the position of senior vice president and CIO for Health Dialog. Prior to joining Health Dialog, Foreman held senior management positions with Philip Morris Companies (now Altria Group), domestically and internationally, for more than 23 years, and most recently held the position of vice president and chief technology officer (CTO). She has held worldwide leadership responsibilities. Guda is an accomplished technology executive with more than 30 years of experience, who spent nine years working closely with Foreman. He has an accomplished career of driving IT service delivery and unwavering service levels for customers in both large and small organizations, including Altria, Pepsi and Lifetime Television. Guda holds a B.S. degree in Computer Science and an MBA in People on the Move, continued on page38
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service as a part of their overall integrated delivery system” said Patrick Trotter, president of Trotter Wellness. “A scientifically based, resultsdriven system of programs with measurable outcomes is what providers are looking for and we have demonstrated we can deliver. aMGa is the perfect partnership to create these positive outcomes for members and the communities they serve.” the american Medical Group association, which represents medical groups and organized systems of care, sees the advantages to its partnership with trotter Wellness.
Kony Selected to Power Independence Blue Cross’s Long-term Mobile Strategy Kony Solutions, the leading mobile application platform provider, announced that independence blue Cross (ibC), southeastern Pennsylvania’s largest health insurer, has selected Kony Solutions as its mobile application platform. Kony’s Platform Write Once, Run Everywhere technology enables mobile deployment across more than 9,000 mobile smartphones/tablets/kiosks and operating systems, allowing ibC to develop robust mobile solutions for members, providers, and business partners regardless of what type of device they use. ibC developers will soon begin training on the Kony Studio, a proprietary integrated development Environment (idE) for the rapid development and deployment of mobile applications. the plan is to begin rollout of multiple applications as soon as possible. applications will range from simple mobile web “informational” apps for members, to more complex native applications. “ the Kony Platform lets us create mobile web applications as well as native apps and provides us with a standardized platform across all of our business units,” independence blue Cross director of ebusiness Michael yetter said. KonyOne is the only platform that enables a single application definition to deliver both native applications and mobile web (HTML5 and non-htML5) across phones, tablets, kiosks and desktops. Offering true native support for all seven operating systems (including iOS, android, blackberry, Windows Phone 7, Java ME, Symbian, webOS) along with simultaneous support for the mobile web, the KonyOne platform provides a secure, scalable and extensible mobile middleware runtime platform that can be seamlessly integrated with existing services. www.TheIHCC.com I CDHC Solutions™ I January/February 2012
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By MARK KUttER managing PartnEr & Co-foundEr PILOtHSA LLC
HEALtH PLAnS SELF-FUnDInG
Health Care Reform Fostering Growth of Self-funding
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elf-funding employee benefits has been a trend for many years for larger employee groups. With health care reform, even the smaller groups are looking at the benefits associated with self-funding. the percentage of employers with less than 1,000 members that are self-funded have increased from 29 percent in 2008 to 48 percent in 2010 according to PricewaterhouseCoopers. Why? • Lower Costs – Employers gain control over how premiums are spent; reduce plan-operating costs and tailor benefits to the employees of the company. all plans have administrative costs. a self-funded plan typically saves 30 percent on administrative costs over a fully insured plan. Premium costs are based solely on the history of your employees, not a pool of employer groups. • No Premium Taxes – Self-funded plans are not subject to state health insurance premium taxes, which are typically two to three percent of premium. • No State Regulations – Self-funded plans are governed by EriSa (Employee retirement income Security act) and not required to cover state-mandated benefits. These benefits are often unnecessary and expensive. Limits also can be set on benefits with self-funded plans, thereby reducing costs. • Claims Data – rarely an employer with less than 100 lives has access to their paid claims experience. insurers argue the disclosure of paid claims can easily be deconstructed and identify actual employees and violate hiPaa rights. With the exception of texas, small employers have little sight into claims and little motivation to view insurance as anything other than a service to be renewed annually. • Cost Savings – Changing from a fully insured plan to a selffunded plan usually results in three months of little new claims. the previous carrier is paying “run-out” claims. this lag allows your new self-funded plan to build and establish a reserve to pay future claims. reserves for claims are held by the employer and released only when claims materialize. This improves cash flow for the employer. the employer earns interest on their money instead of the insurance company. • Network Flexibility – Self-funded employers have the ability to have as many networks as needed to obtain the provider coverage needed to satisfy the employees in all areas, all with one plan of benefits. This affords significant savings on plan management expenses. through some administrators, employers now are able to access carrier networks, which afford deeper discounts for the employer.
• Stop-Loss Coverage – Stop-loss coverage allows the employer to assume the financial risk up to a preset limit. Employers choose the amount of risk they are willing to retain and then purchase reinsurance to cover claims in excess of the preset limit. Stop-loss (reinsurance) protects the liquidity of self-funded plans. • Plan Flexibility – When an employer’s benefit plan is selffunded, there are endless possibilities for plan design. All benefits can be tailored to meet your needs and customize your benefit plan. • Prescription Drugs – Prescription drug costs are rising. an average employer’s prescription drug plan can be the cause of almost 25 percent of the cost of the health plan. Fully insured carriers pass along minimal discounts and keep all rebates. On a self-funded plan, the employer will actually receive substantial rebates on a quarterly basis. Should the employer request a “transparency” contract, rebates are alleviated and the discounts are deeper. • Audits – One trend standard is to have a group of provider specialists that independently audit all claims to dollar one. hospital bills are the most expensive cost of a health plan and a good percentage of savings can range from 10-25 percent on hospital bills that are audited. Based on data from 1999 through 2009, large firms (500+ lives) which are self-funded, have increased from 66.2 percent to 82.1 percent, medium firms (100-499 lives) have slightly decreased from 29.0 percent to 25.7 percent while the small firms (<100 lives) have increased from 11.6 percent to 13.5 percent. Employers in the fields of health care, manufacturing, transportation, utilities, and communication are more likely to self-insure. retail industry is less likely to self-insure due to turnover of employees. In summary, self-funded employer groups have flexibility, control over benefits, benefit design and potential cost savings. As an investor and co-founder, Marc Kutter leads PilotHSA as a managing partner along with Scott Harward. Kutter’s primary focus is on distribution, strategic alliances, product marketing, and closing sales with Financial Institutions, Third Party Administrators, and strategic buyers. Prior to starting PilotHSA with Phil Manning, Kutter served as vice president of operations for ProNvest, Inc (acquired by Sungard), an independent money management firm specializing in active investment management of retirement plans. Previously, Kutter served as Business Team Manager of SCI Companies, an Atlanta-based HR outsourcing and services provider.
www.TheIHCC.com I CDHC Solutions™ I January/February 2012
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By tOM MOREy viCE PrEsidEnt of ProduCt dEvEloPmEnt AFLAC
SUPPLEMEntAL HEALtH & VOLUntARy BEnEFItS
Critical Care Policies: A necessity in 2012 and Beyond
n
o one likes to think about the possibility of facing a serious health condition such as a heart attack or third-degree burn, but the difficult truth is life-altering events can happen, and the last thing people want on their minds during such a time is the cost associated with recovery. thankfully, voluntary insurance policies exist today that can provide financial relief when workers are faced with a critical illness. the 2011 Aflac WorkForces Report, an online survey of more than 2,000 benefits decision-makers and more than 4,000 U.S. workers, uncovered american workers are not prepared for the real cost of accidents and illnesses, and they simply do not have a financial plan in place for the unexpected. Specifically, the Aflac WorkForces Report study revealed only 19 percent of employees think it likely they or a family member will be diagnosed with a chronic illness, such as heart disease, and just 13 percent said they thought a serious illness like cancer will occur or that there will be a need for long-term care. Only 9 percent foresee a long-term hospital stay, 8 percent think they or a family member will become disabled, and just 6 percent think they will be in a car accident. Given these statistics, American workers need to realize they aren’t invincible, and employers need to make sure their employees are covered. According to the Critical Care Roundtable, five million Americans are admitted into intensive care units each year, with the total costs of critical care services in the U.S. exceeding $80 billion annually. if hr managers are currently unfamiliar with how they can help employees facing an unexpected critical event such as bypass surgery or an organ transplant, then they should take action now and learn how they can help such workers financially by making voluntary policies available, such as critical care. as the demand for voluntary critical care insurance grows, its become an appealing insurance product for employees. Not only do such policies provide financial relief to employees, but also it’s available at no direct cost to employers. in other words, voluntary critical care insurance is 100 percent employee-paid, so it costs nothing to companies who make it available. Providers like Aflac now offer both individual and group critical illness insurance policies. Additionally, Aflac has a history of no rate increases—employers can be sure that employees are getting the best value for their premium. The purpose of these critical care policies is to help provide financial relief as the injured individual concentrates on recovery. hr managers and business decision-makers need to familiarize themselves with available critical care policies in the event a current employee undergoes intensive treatment.
Aflac offers several product options to help with critical events. For example, Aflac’s critical illness and critical care insurance plans provide cash benefits for a number of health events including stroke, paralysis, coronary artery bypass surgery, persistent vegetative state, major human organ transplant, cancer and coma. While major medical insurance helps pay hospital and medical bills, other non-medical expenses will inevitably arise, which is where critical care policies can help most. Critical care insurance is an ideal complement to major medical insurance because it can help with the other expenses that major medical insurance doesn’t. regardless how healthy one is, there is always a potential need for a product to offer benefits for critical care, especially for those with a family history of cancer, diabetes, heart disease or other critical illnesses. a critical illness diagnosis, and the resulting treatment, can put a heavy strain on monthly incomes because of medical expenses. Even if employees have health insurance, a critical illness can create a tremendous toll on their finances. the most common excuse for not applying for critical care insurance is cost. Many people have the misconception that critical care insurance is more expensive, and don’t understand that there are various levels and price ranges for plans. by allowing fear of cost to play a factor, a lot of people pass on getting critical care insurance during the times when the premium rates are least expensive, when they are young. For age-banded plans, the younger the applicant is at time of purchase, the lower the average premium. the sooner employees apply for voluntary insurance, the smaller the average premium. Critical care insurance policies also are incredibly helpful in that some plans also can be expanded to include immediate family members. Similar to other voluntary insurance policies, critical care cash benefits can be used however the insured sees fit, including helping to pay mortgage payments or help offset lost wages. there is no question about it, critical care is something people need to better understand so they can see its true value. Employers who make critical care policies available are helping employees protect their savings against the difficult financial effects of severe injuries and illnesses. HR managers should take the first step and speak with voluntary insurance providers about available policies. doing so can only lead to a happier and more financially secure workforce. Tom Morey, a 16-year insurance industry veteran, is Aflac’s vice president of product development. He oversees designs, pricing and execution to include product development, product positioning and corporate bids.
www.TheIHCC.com I CDHC Solutions™ I January/February 2012
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PHARMACy BEnEFIt MAnAGEMEnt
By EVA CLAytOn Chairman PRESERVE COMMUnIty PHARMACy ACCESS nOW!
PBM Merger Means Higher Prices, Less Access to Care For Consumers
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ith a decision expected early this year, Wall Street and health industry stakeholders are anxiously waiting to see whether the Federal Trade Commission (FTC) will allow pharmacy benefit managers (PbMs) Express Scripts inc. (ESi) and Medco health Solutions to merge. While the stakes are high for these business interests, the impact of the decision will rest most heavily on consumers.
If the FtC takes its Fundamental Mission to Protect American Consumers Seriously, it will Reject the Merger Last year, ESI and Medco—the nation’s first and third largest PbM companies—announced plans to merge in a $29 billion deal. the companies claim a combined entity would be a more powerful buyer and could use its size to push down drug prices. however, the abundance of evidence shows the merger would reduce access to cheaper generic drugs, reduce access to life-saving specialty medications and reduce access to vital community pharmacy services. in fact, a number of observers, including the american antitrust institute, the american Consumer institute, the National Urban League, the League of United Latin american Citizens, numerous members of Congress, attorneys general in dozens of states, pharmacy service providers, consumer advocates, patient groups and others, have already raised these very concerns. this is not just a mere coincidence. PbMs broker prescription drug contracts for employers, unions, health plans and others. they do so largely without regulation and with a lop-sided advantage in negotiations as they can both increase costs to insurers and reduce the reimbursements paid to pharmacies. they squeeze the delivery system at both ends, pushing profits toward the middle. these are multi-billion-dollar companies, which combined, would control an excessive share of the market—approximately 50 percent—and would be almost twice as big as the nearest competitor. an Express Scripts-Medco merger would only make a bad situation much worse.
Small and Independent Community Pharmacies Would not Stand a Chance Express Scripts has taken an aggressive stance against one of the country’s leading community chain pharmacies that is reducing patient choice. if Express Scripts is allowed to merge with Medco, it is very possible that the consolidated PbM will not only continue this bullying behavior, but will use its size and dominance to cause further harm to patients, community-based pharmacies and health care outcomes. Many smaller pharmacies would be forced to close their doors due to the increased costs and severely slashed reimbursements that would result.
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January/February 2012 I CDHC Solutions™ I www.TheIHCC.com
When the local pharmacy is shuttered or shut off to patients, the quality of their health will suffer. We must not forget that for many americans, the pharmacy is the most frequent contact they have with a medical professional. it is a place to receive vaccinations, health screenings and other services beyond simply filling prescriptions. diminishing access to the local pharmacy means a severely weakened overall quality of health, especially for the most vulnerable populations. the proposed merger also is extremely concerning for the 57 million american consumers who rely on “specialty” drugs -- treatments for complex conditions such as hemophilia, Crohn’s disease, Hepatitis C, hiV/aidS and many forms of cancer. Granting the combined company more than 50 percent market share of this specialized pharmacy area would give it the unprecedented ability to both decrease access to these critical treatments by restricting patient choice in pharmacies and increase the cost of specialty pharmaceuticals at will. these are not inexpensive drugs, having increased in price by 19.6 percent in 2010 alone (compared to a 1.4 percent increase in traditional retail drugs). the merger would lead to increased costs of traditional prescriptions as well, as the merged Express Scripts/Medco would have little incentive to include cheaper generic versions on their lists of available drugs. PbMs exercise their buying power through negotiating formularies and because of that they are more likely to have brand-name drugs on their formularies instead of generic drugs. It’s clear why the FTC and Congressional antitrust panels are examining the proposed merger, and why pharmacists, small businesses and consumers nationwide are opposed to it. PBMs, like Express Scripts, say they find cost-savings in the health care delivery system and are focused on the patient, but that’s clearly not the case. in the past three years, as most americans have struggled with a troubled economy and continually increasing health care costs, prescription drug prices have remained flat while the profits of the three largest pharmacy benefit managers have increased by a jaw-dropping 289 percent, to $3.5 billion. Express Scripts may have been focused on patients’ health once upon a time, but it’s naïve to believe they are focused there today. Unfortunately, the ones suffering most as a result of this are the most vulnerable citizens in our communities. this merger needs to be stopped. Eva M. Clayton is a former member of Congress who represented eastern North Carolina (1992-2003), Member of the Agriculture & Budget Committee, and Chair of the Congressional Black Caucus Foundation; upon retirement accepted the position of Assistant Director General of the UN Food and Agriculture Organization (20032006). She remains active with agriculture, rural development and food security issues and is chair of the Preserve Community Pharmacy Access NOW! (PCPAN) coalition.
StEVE MILLER, M.D. sEnior viCE PrEsidEnt & ChiEf mEdiCal offiCEr ExPRESS SCRIPtS
PHARMACy BEnEFIt MAnAGEMEnt
Rebuttal Piece for CDHC Solutions Magazine
the Right Prescription for Public Health
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ix years ago i left a very satisfying career helping patients as a physician and a hospital administrator to join Express Scripts. Some might consider that an abrupt turn, but i saw an irresistible opportunity to improve the health of millions of more patients while attacking the biggest problem in health care—runaway costs. that is exactly what our proposed merger with Medco health Solutions is about. We believe the combination will accelerate our abilities to make prescription medicines safer, more affordable and more accessible—all vital to improving the nation’s health. the cost and quality of health care is a concern to all americans, and that’s why this is the right merger at the right time for the right reasons. We have a responsibility to provide the leadership and resources needed to drive out waste and provide the best care in the world. Never has this role been more important, as everyone with a stake in America’s health is seeking ways to reduce the cost burden and improve outcomes. We have thousands of clients—employers, health plans, unions and government agencies—who provide prescription drug benefits for tens of millions of american families. While they represent various constituents, our clients want us to focus on one thing: eliminating waste in pharmacy benefits. Our model works for consumers, too. the actual average amount a patient pays for a prescription through Express Scripts has decreased every year for the last five years. today, there is more than $400 billion in annual pharmacy-related waste in our health care system. Express Scripts designs innovative programs to help patients make better health care choices and take waste out of the system. We are clearly part of the solution. By joining with Medco, we’ll generate greater cost savings for patients and plan sponsors, close gaps in care and achieve greater adherence through our combined behavioral and clinical approach, and optimize our ability to respond to an increasingly complex Medicare and Medicaid environment. Further, we’ll accelerate the research, development and deployment of pharmacy trend management solutions to address inefficiencies in the marketplace, advance evidence-based and safety solutions for innovative pharmaceuticals and expand our efforts against fraud, waste and abuse. We need to continue to innovate because the competition in our business remains intense. More than 40 PbMs today compete to serve 210 million americans. Strong new competitors continue to enter the field. United Health Group is significantly beefing up its PBM business by terminating its agreement with Medco. Starting this year, United will be a very significant No. 3 in the PBM business, selling PBM services directly in
competition with Express Scripts/Medco, CVS and the multitude of other significant players. there can be no doubt the PbM business will remain intensely competitive after this transaction, as PbMs continually drive for greater efficiencies to provide better service and pricing. Opponents of this merger offer speculation but no evidence. however, the history of the PbM industry is replete with mergers and acquisitions, and the evidence is clear: Competition has remained robust, and the industry has applied continual downward pressure on the cost of prescription drugs, driving out health care waste, and improving outcomes for patients. the merger of Express Scripts and Medco would only accelerate that historic trend. We welcome the review by the Federal trade Commission (FtC) and others. the government is rightly focused on health care costs, and we are aligned with its goals and objectives. We already make this case transparently every day to our clients. they understand exactly what they get from us and the value we provide. the concept of aligning and being transparent with our clients has many benefits for those who receive their medicines through a pharmacy benefit. For example, we work with clients to provide a broad-based, lowcost network of convenient pharmacies, so we ensure that the employer gets the most out of its benefit plan. You would be hard-pressed to find a health care company that makes money when its clients save money. yet that is exactly the business model of Express Scripts. by negotiating on behalf of our clients and their members, we are helping to lower the cost of prescription medicines. the resulting savings for our clients allows them to continue offering robust benefits. at a time where the economy is still on shaky ground, millions are jobless, and people are making hard decisions between basic needs and medicine, the value of what we do has never been more evident. regardless of how you think about our proposed merger, we all agree that our country needs to get a handle on its health care costs. in our view, combining Express Scripts and Medco allows the private sector to deliver on what first attracted me to the PBM industry: improving public health by driving out billions of dollars of health care waste, saving millions of dollars on prescription drugs, and helping patients across america live longer, better lives. Dr. Steve Miller joined Express Scripts in 2005 and is recognized for his research in the areas of acute renal failure, hypertension, and health care economics. He earned his medical degree from the University of Missouri-Kansas City and received additional training in the Pathology and Research fellowship at the University of Alabama at Birmingham and training in cardiology at the University of California, San Francisco. Dr. Miller also earned his MBA at the Olin School of Business at Washington University in St. Louis.
www.TheIHCC.com I CDHC Solutions™ I January/February 2012
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© 2012 BBY Solutions, Inc.
INCENTIVE POINTS
By MICHAEL DERMER CEo, PrEsidEnt and Co-foundEr InCEntOnE
REWARDS & InCEntIVES
Incentive-driven Healthcare yields Better Engagement, Decisions and Results
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ndustry studies confirm the strong connection between health care costs and the ingrained behavior of consumers and providers. ironically, consumers and providers have access to more health information, tools, programs and support than ever before. yet health care costs continue to increase at an alarming rate, and chronic diseases continue to affect a larger portion of the population. Payers, employers, providers and consumers must all be directly involved in efforts to manage the cost of care and improve health outcomes. Motivations and behaviors of all health care market participants are critical, with particular emphasis on the consumer and provider at the point of care delivery. to drive engagement in programs designed to improve health, organizations have applied both incentives and disincentives with varying degrees of success. Generally, the presence of an incentive leads to improved results, but most incentive designs have fallen short of their full potential. however, as more organizations are applying incentives, we have learned some valuable lessons. For example, the health care industry has discovered incentives can drive behavior change, and can help establish a new baseline for consumer expectations, consumption patterns and health awareness. When properly designed, incentives can serve as the cornerstone of an engagement engine that aligns earned and available incentives, and supports related protocols, such as social media, behavioral economics, shared communities and mobile interactions. this emergence of incentive-driven healthcare (idh)—a new era of heightened awareness and application of strategies to change behavior—has the potential to engage consumers and providers through intelligently designed incentive strategies based on population health issues, organizational culture, change readiness and behavioral theory. in addition to its quantitative foundation, idh also embodies what is already known at an intuitive level: incentives such as financial remuneration, group recognition and personal fulfillment can motivate people to change their behaviors. Simply put, people are driven by a ‘What’s in it for me?’ mentality, and respond accordingly. Success in idh will not be based on an exploration of whether incentives can actually change behavior. instead, the focus will be on how incentives can be designed, applied and monitored to achieve measurable results and desired outcomes. This scientific approach to health incentives is driven by actual performance data, monitored user experience and detailed cost analysis—rather than surveys, incidental reporting or actuarial projections. the important point here is idh delivers the insights that can help employers, health service organizations and health plans to accurately gauge the underlying value of incentive strategies, and ultimately reduce the cost of health care. the potential cost savings associated with increased consumer and
provider engagement is significant. Deloitte has estimated the combination of factors such as personal health records (Phr), increased transparency, incentives and technology could achieve savings as high as $440 billion over 10 years. Most organizations are well-positioned to benefit from this trend, based largely on three underlying characteristics of incentives: • Incentives possess a ‘built-in’ return on investment. Unlike many other tools in health care, no one pays for an incentive until an action is taken. this means that return can be generated as incentives are issued if the appropriate actions and behaviors are incented; • Incentives are simple and easily understood. in a health care world full of confusing jargon and complex formulas, people understand simple messages such as ‘be healthy and be rewarded.’ This fundamental concept resonates with consumers and providers alike; • Incentives are viewed positively. in an environment characterized by cost-shifting and reduced benefits, incentives positively engage consumers and providers, and put them in control. More broadly, these inherent characteristics, combined with support from both sides of the political aisle, point to broader application of incentives. According to Lockton Benefit Group, health care constituents viewed the incentive components of recent health care legislation, highlighted by an increase in the amount employers can devote to premium incentives from 20 to 30 percent, as the ‘most beneficial element’ of the health reform law. however, to realize the full potential of incentives that drive engagement, the health care community needs a standardized and effective framework for design and application that: • is based on actual performance data; • is measured in an objective and consistent manner; • delivers immediate, near-term and long-term cost savings; • Reflects the need to engage and change behaviors of consumer and providers. the good news is that in the era of idh, we are well prepared to address this challenge of standardization and measurement. We now have reliable data and the analytic tools to develop a rational, integrated approach to the design, implementation and evaluation of incentives, which can be applied to increase engagement, improve outcomes and reduce the cost of health care. From where we sit, incentive-driven healthcare has the potential to drive engagement and change behavior in a meaningful manner. the resulting health- and cost-related benefits are a significant game changer. Michael Dermer is CEO, president and co-founder of IncentOne, a leading provider of incentive solutions to the health care industry. Dermer has authored numerous articles and has been a frequent speaker at health industry conferences and events including World Congress, AHIP and Blue Cross Blue Shield Association. www.TheIHCC.com I CDHC Solutions™ I January/February 2012
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By nAnCy SAnSOM sEnior viCE PrEsidEnt of markEting and CommuniCation BEnEFItFOCUS
POPULAtIOn HEALtH MAnAGEMEnt
Genetic testing: Using DnA to Improve Employee Wellness
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echnologies and medical discoveries are providing consumers with new tools to improve their personal wellness. human genetics has moved into the spotlight in recent years as health care professionals begin to understand how a person’s DNA can impact their health. Genetic testing takes wellness to the next level by providing personalized and confidential genetic information to help employees understand how their unique genetic makeup affects well-being. as companies aim to help employees stay healthy, many are now offering genetic testing services as a supplement to their normal benefit offerings.
What is Genetic testing? Genetic analysis is a simple test delivering a wealth of personalized health information. Navigenics, a company founded in 2006, uses dNa analysis to educate and empower customers with the knowledge of their genetic predispositions and then motivate employees to use the information to prevent the onset of diseases, achieve an earlier diagnosis, appropriately manage diseases or otherwise lessen the impact. the results provide employees with a better understanding of their unique genetic predispositions for 29 preventable health conditions, including heart attack, diabetes and cancers, and 12 medication sensitivities. Navigenics then assists employees in developing strategies to reduce risks and manage their health by motivating behavior changes. Personal genetic information may help employees answer important wellness questions such as: • Which medical tests and screenings might help me most? • Will a new medication help my health or potentially cause serious side effects? • i know i need to change my diet or exercise, but what changes would benefit me most? answers to these questions are vital to improving employee wellness and ultimately driving down health care expenses.
A Simple DnA test – Really? Really. A kit is sent to the employee’s home to collect a saliva sample, which is then sent to Navigenics’ CLIA-certified lab. DNA is then extracted from the saliva and analyzed. Within two to three weeks, the employee receives an email notification that their results are ready in a comprehensive report of results via a secure, online Navigenics account. Employees are assigned a board-certified genetic expert who provides one-on-one counseling to help understand the results and encourage conversations with their regular doctor who can help make a personalized wellness plan based on their unique genetic insights. Combining the results with information about an employee’s lifestyle, environment and family history provides a more complete picture of an employee’s health risks. A doctor can then recommend changes based on this information.
For example, richard, a Navigenics customer, used his results to get earlier health screenings. “My high risk for colon cancer led me to an early colonoscopy, which let my doctor find and remove a pre-cancerous polyp years before it would have been caught otherwise,” richard said. Genetic testing cannot predict the future because dNa only indicates an employee’s predispositions. Genes interact with lifestyle decisions and the environment. Knowing their health risks puts employees in more control of their prevention strategies. “I’ve heard people say, ‘Gee, I wouldn’t want to know,” said Tony, a retired attorney and Navigenics customer. “but how could you not want to know? There’s always something that you can do with that knowledge that will enable you to have a better quality of life.”
Results are Private Some employees may be worried third parties will have access to their personal genetic information. Navigenics has taken numerous steps and uses the latest technology to keep all genetic information secure. Employees should know they control access to their genetic information and at no time is it shared with insurers, employers or medical records firms. Navigenics stands firmly by its policy to never sell or share personal genetic information with other companies. State and federal agencies also have started to develop legal policies to encourage consumers to benefit from genetic analysis without putting their personal information at risk. the main law protecting against genetic discrimination is GiNa, the Genetic Information Nondiscrimination Act of 2008. The law specifically prohibits genetic discrimination in health insurance and the workplace.
Enhancing your Benefits Package with Genetic testing Navigenics has made genetic analysis easily accessible to employees by creating a wellness application employers can offer through their benefits management platform. Employees can simply select the Navigenics test at the same time they enroll in their traditional health and voluntary benefits. Employers can choose to supplement the costs of Navigenics services to further encourage employees to participate. The benefits to the employer are equally rewarding. Navigenics makes it easy to enhance your employee benefits package without adding administrative costs. to ensure employees are educated to the value of this new application, Navigenics provides a library of content and videos. Navigenics also has worked with benefits management platform providers to offer the application on the platform so employees can access genetic analysis information from the same portal they use to enroll in their benefits, update personal information and communicate with their HR team. as health care consumerism continues to take hold, employers have an opportunity to foster a healthy workforce and lead the way by offering personalized health powered by genetics. www.TheIHCC.com I CDHC Solutions™ I January/February 2012
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The ROI for Worksite Health
Self-funding
How Poor Health Habits Among America’s Workforce are Contributing to the Nation’s Growing Rate of Obesity and the Associated Health Issues
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s part of his first term in office, President Obama was able to put health care reform into law, in part, so employers would “no longer be burdened by the crushing weight of health care costs.” These costs affect every company offering health care benefits, and the costs continue to increase. In 2008, health care spending in the United States was $2.4 trillion, up from $1.9 trillion in 2005. This sobering reality reflects the increased demand for health care services due to the worsening health status and aging population, as well as the increased cost of actual care. Employers need a health care plan that aligns costs with results, such as services that actually improve the health of employees and their dependents.
Health Care Spending In the United States, most employersponsored health plans reflect a sharing of costs 28
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with employees, and both groups have incurred enormous increases throughout this decade. Employer premiums continue to increase yearover-year; in 2009, they increased by 13 percent, nearly three times the rate of inflation. Some employers have tried shifting rising costs to employees, but this trend simply transfers the burden onto workers, forcing many to abandon their jobs or health care coverage. Since 2000, employee contributions to health care premiums have risen by 143 percent, and employee copayments have increased by 115 percent. Shifting costs may offer employers a temporary solution, but it fails to address the actual sources of rising health care costs. These rising health care costs have a broad economic impact on the lives of many Americans and their communities in the form of housing crisis and bad credit ratings. Analysts suggest that without a viable solution, annual U.S. health care spending will exceed $4 trillion by 2015.
The State Of Health The health of Americans continues to worsen and, compared to 20 years ago, Americans, as a whole, are less physically active while working longer hours and consuming poor diets. A significant side effect to employers of their employees’ poor health is presenteeism, which refers to lost productivity from workers who are on the job but not at full health. A study on health and productivity quantified presenteeism by calculating that employers absorb at least $2 of health-related productivity costs for every $1 they spend on a worker’s medical or pharmacy costs. As the health status of employees continues to worsen, employers struggle for ways to manage the increasing health and productivity costs related to poor health.
The Solution Reforming health care is a multidisciplinary approach. A health promotion program in the workplace is fundamental to
Improvement Services achieving positive results. This kind of worksite program actively engages persons in their own personal health, helps at-risk persons lower their risk of chronic disease and illness, and supports those with already established disease receive evidenced-based care. Identifying at-risk patients is crucial to helping prevent chronic disease, which accounts for 75 percent of all health care costs. As a result of this comprehensive approach, health and productivity costs are lowered over a longerterm investment period. Many qualitative studies have examined worksite health promotion services to identify the key elements required to save costs. One study analyzed several programs and identified six best practices to create measurable and effective change: 1. Organizational commitment 2. Incentives for employees to participate 3. Effective screening 4. Evidence-based interventions 5. Effective implementation 6. Ongoing program evaluation 7. Health marketing Those best practices are made even more effective when enhanced by a worksite health center, which is a medical center located in the workplace offering a customized menu of health care and wellness services designed for a specific employee population. The end result is improved health and wellness for employees from convenient and cost-effective care delivery and a high return-on-investment (ROI) for employers as health care costs continue to drop year after year.
ROI Evidence The cost effectiveness of worksite health improvement services has been examined in several recent studies and all concluded that there are significant positive results for employers and patients. One study looked at several worksitewellness efforts and calculated a $3-$6 ROI for every $1 invested over a two-to-five-year period. Additional analysis by a leading health care firm concluded worksite health promotion programs reduce average sick leave, health plan costs, workers’ compensation costs, and disability costs by 25 percent. Many researchers have remarked that this approach to health care represents an efficient way to increase access and affordability of medical care, while reducing the burden of cost on employers.
One Organization Presents a Solution Given [Concentra’s] work with some of the country’s largest employers, we inherently understood the need for an effective, efficient workplace health promotion program—one centered on a comprehensive health transformation plan. And while the needs of each employer can differ largely, requiring a certain amount of customization, we also knew the same principles would be needed for all, and are essential to the construction of the program. The first step is to establish a baseline of health through risk assessments and biometric screenings, in order to provide participants with detailed health information, including his/her potential for developing chronic disease. By identifying employees who are at-risk and using their personal information as an opportunity to educate and spur behavior change, it can create a positive motivation to begin to make better health choices. If at-risk employees are educated about their health and actively supported to change their behaviors and lower their risk levels, the long-term and future costs associated with chronic disease can be diminished or averted. Following the collection of health assessments, those employees with higher risk factors—three or more elevated levels related to blood pressure, cholesterol, glucose, height, and weight—are enrolled into a multi-step program to improve their health. Concentra’s system brings together health marketing, personal coaching, health education, and promotion to challenge employees to change behaviors and make healthier choices. With the right setup, communication, and ongoing motivation—these elements can establish and drive a health-centered organization that tangibly supports wellness among its employee population. One that also sees visible and measured change in the health of its employees. For many companies, it may be more economically sound to fully utilize health specialists in the role of coach, educator, and facilitator. These trained and experienced individuals hold a wealth of knowledge in personal health motivators, and can provide one-on-one and small group interaction with participants. Health specialists also can lead targeted lifestyle support curriculum, which often includes classes on weight management, fitness and nutrition, and lifestyle support for diabetes. Depending on the needs and size of an employer, an on-site health center delivers the
WellneSS
full health transformation offering may prove the most useful. Concentra has established several dedicated health and wellness centers, where the entire solution set is delivered on-site to employees, in addition to traditional health services including: occupational health, group health, urgent care, and primary care. The central location of such a center also helps to increase employee utilization of health and wellness programs as employers benefit from minimized employee downtime and lower fixed costs.
Conclusion Employers are the primary source of health coverage for most individuals, and smart companies are working diligently to curb the rise of poor health, unhealthy behaviors and its harmful effect on life expectancy. Countless employers have created a culture of health among their workforces, despite the substantial challenges presented by the existing system. Millions of employees continue to benefit from workplace wellness and prevention programs, even as health costs spiral upwards. From an on-site clinic, a mobile medical unit, or a personal health coach, a model to deliver medical care is needed that matches the way many Americans work and live today. Worksite wellness programs continue to increase in popularity due to their economical and efficient benefits in reducing health care costs for employers and employees, all while improving access. Both internal and external evidence have demonstrated the effectiveness of a results-oriented worksite health promotion and on-site health center. Workplace centers are an important shift in the health care industry, which present a new and proven option to traditional health needs, and has the capacity to become the new model for the new health care environment. W. Tom Fogarty, M.D., is the chief medical officer of Concentra, a national provider of injury care, physical therapy, and health and wellness services for the workers’ compensation and occupational health industry. Dr. Fogarty is responsible for the ongoing analysis of treatment patterns by physicians in Concentra’s medical center group practice, and for the refinement of clinical best practices. Dr. Fogarty is based at Concentra’s headquarters in Addison, Texas, and can be contacted at tom_fogarty@concentra.com.
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Can you see what you could be throwing away?
Use the Healthy Sight Calculator. If your workers aren’t taking advantage of a premium vision benefit, you could be paying a hefty price in avoidable healthcare costs and productivity loss. Find out for yourself. Take the “See the Savings Challenge” and calculate the cost avoidance possible for your workforce. Just for using the Healthy Sight Calculator at www.HealthySightWorkingForYou.org, you’ll be entered into a drawing to win one of two $500 prizes.
HealtH Care aCCeSS alternatiVeS
Challenges of Remote Medicine Provide Solutions Many Employers Can Use By KaTE WOldHUIS BuSiNESS DEvELoPMENt ANALYSt MEdCOr
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he landscape of health care is constantly evolving (too often it is “eroding” for many businesses). Employers are challenged with rising health care costs, everchanging and more complex regulations, health care reform uncertainty and barriers to access. Small- and medium-sized companies struggle to address health care issues in the best of circumstances. Even large companies with more resources find it difficult to keep up with the constantly increasing health care challenges of cost, access, and quality. remote worksites face even more complications as they struggle with these same challenges, plus the additional challenges of fewer medical providers to choose from, higher costs, long response times for emergencies and long travel times away from work for routine care. For businesses operating in remote locations, solving these health care problems doesn’t just affect productivity and the bottom line—it can determine whether or not they stay in business.
Most people think of health care in remote places in terms of responding to exposure from the elements, outdoor adventures gone wrong, and even encounters with wild animals. However, remote health care affects many business types, including: resort and lodge operators, restaurants, transport
companies, outfitters, construction firms, and even government agencies that work in remote locations. These businesses have to overcome health care challenges not just for their employees (especially in off-hours), but often for their customers, too. Furthermore, all the obstacles are www.TheIHCC.com I CDHC Solutions™ I January/February 2012
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magnified when the worksite is hours from the nearest clinic or hospital—everything becomes more expensive, more difficult to coordinate and takes longer. Out of necessity, some remote businesses are finding ways to treat these problems, if not curing them completely. These solutions have to be unusually efficient and self-contained, since they cannot rely on outside resources. It turns
clinics require great effort and attention to detail—from selecting the right scope of care and staff, to ensuring the services replace more costly off-site services, rather than simply adding to them. Additionally, opening an on-site clinic can require a substantial amount of start-up capital and ongoing operating expenditures. The return on investment depends heavily on utilization by employees, and how well the
L to R: Medcor’s Ashley Polucci, sitting and Karen Drescher are two employees at the Lake Clinic at Yellowstone National Park; Ashley Polucci working at Lake Clinic; Yellowstone Clinic Outside; Yellowstone_Lake Village Waiting Area out some of these solutions can work for other businesses, too, even when not operating in isolated environments. One solution for remote businesses is to host a clinic located at the worksite (“on site” or “near site”) dedicated to the businesses’ employees, dependents and customers. This provides immediate, convenient access, customized services, and, if done properly, controls costs. The concept of providing health services for employees on site is not new, and is one gaining popularity. In the past, the concept was thought to suit only large self-insured employers, but now many medium-sized firms also are finding benefits including savings on health care, lower injury rates and improved productivity from on-site models that cost less to operate by leveraging technology and other efficiencies. Employees utilizing these clinics receive the appropriate level of care at the onset of injury or illness, experience cost savings as the result of no or reduced copays, and improved access to a health care provider. As an added benefit, on-site providers dedicated to the site and community become familiar with applicable resources, plans, community, etc., and have a greater knowledge of the employees’ duties, workers’ health histories, and in some cases, they have developed relationships with local off-site providers to coordinate continuity of care. On-site providers still have limitations and challenges to overcome. Components of successful 32
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medical provider performs. Even in remote areas, employees may choose to continue seeing the provider they are used to rather than seeing a new provider at their workplace, so creating incentives to use the on-site clinic that fit the workplace culture and medical scope are key to ensuring utilization at startup and beyond. On-going coordination and cooperation with community providers also is key. In urban areas, on-site clinics can rely on nearby medical infrastructure, such as specialists, hospitals, and labs. However, on-site employerhosted clinics in remote locations don’t have those resources to lean on; consequently, they are forced to be more efficient and self-reliant. They develop specific protocols, training for staff, software (including electronic medical records), operating systems, referral guidelines and networks, incentives and QA processes. As a result, these remote clinics can operate very cost effectively, with less use of off-site resources and their associated costs. These lean operations are valuable for non-remote businesses, as well. There is no silver bullet when it comes to reducing injuries and illnesses. It is inevitable some patients will require off-site specialty care because it is impractical and costly to provide specialists and advanced technology (e.g., MRI, CT Scans, surgery) in an on-site clinic. Developing good protocols to ensure appropriate referrals are made at the right time to the right place are key to
ensuring good care and lower costs. Some on-site clinics are operated by off-site hospitals, clinics or pharmacy companies. This offers opportunity for integrated data and services, but also builds in potential conflicts of interest, since the off-site owner can generate revenue from referrals and prescriptions from the on-site clinic. Other on-site operators specialize in on-site operations and avoid financial ties to
off-site providers. The best models combine benefits of both on-site and off-site resources that are used in coordination. One remote location finding success with on-site clinics is Yellowstone National Park. Responding to the changing landscape of health care, Yellowstone National Park conducted a competitive RFP to find a more efficient operating model for its on-site clinics, focused on controlling costs and improving quality and service. Yellowstone contracted with Medcor in 2003 to operate three clinics at the park to provide primary care, urgent care, family medicine and occupational health care services for employees, their dependents and visitors to Yellowstone. Walking through the three clinics, it is evident they provide the services and amenities found in any traditional clinic—exam and treatment facilities, pharmacy, lab, x-ray and EKGs. What makes them different is how they operate in a remote environment. One difference is a flexible scope of care customized for the environment. For example, parts of Yellowstone can be a three-hour drive or more from the nearest emergency department. Consequently, access to immediate care is critical. “Our clinics are staffed and equipped to treat most emergencies—including life-threats—in addition to handling more routine cases,” stated Deborah Brown, director of operations for the Yellowstone clinics. “We have to be able to handle a wide range of ailments—from simple poison ivy and heat rash, to strokes, heart attacks and car accidents.”
Serious cases requiring surgery and other off-site specialty care still have to be stabilized and managed during transport. The clinics at Yellowstone also provide family medicine for year-round residents, and care for any of the millions of visitors to Yellowstone each year that get sick. Another difference is extended hours of operation to give patients access to clinics. “We’re open to meet the needs of our
These clinics also serve multiple constituents: patients include employees of the National Park Service and more than a dozen other area employers numbering more than 5,000 people— and their dependents, residents of the surrounding communities, and visitors to the park. To be successful, the clinics must be able to meet the different needs of these groups. Employers and employees are concerned with returning to work
What we’re doing at Yellowstone can serve as a successful template for other on-site clinics, even if they are in less remote and extreme conditions. patients, not for the convenience of our staff,” Brown explained. “That means seven-day operations, 12 hours a day when the park is busy, with staff on call even when the clinic is closed.” Urban businesses often find the only health care available during their second and third shifts is an expensive hospital emergency department or urgent care center. On-site clinics can operate early to allow families to bring kids in before school, and late to allow employees to seek care without having to take time off work. Clinic schedules also accommodate the park’s seasonality, adding staff and services each year during peak summer months. This kind of flexibility requires more recruiting and training, but controls costs in the off-season and maximizes service when it’s needed. Medcor utilizes a core staff that stays year-round, augmented by seasonal staff, many of whom return year after year. The on-site clinics operating today are quite different from what they were a decade ago. Today’s model handles just as many patients, but with roughly half the staff and cost. Working with the National Park Service, Medcor made several updates, converting from an in-patient model to an out-patient operation. Medcor updated clinic technology, converting x-rays to digital imaging and introducing telemedicine to gain immediate consultation from offsite physicians. They implemented an electronic medical record system, making the clinics near paperless. They converted from physician staffing at the seasonal clinics at Lake and Old Faithful to using physician assistants and nurse practitioners, overseen by board-certified physicians.
and regulatory compliance. Visitors want to get back to their vacations. Residents need their ongoing health care, and everyone has an increased desire for wellness and preventative medicine. Clinic providers and managers meet with employers regularly to review services and work through any issues that come up. Open communication is key to good coordination. When cases are referred to off-site facilities, it causes employees to lose hours (or in extreme cases, days) of work at a time. These costs can become larger than necessary for employers in remote locations since the ramifications of injuries may become magnified when employees are faced with long travel times to get the care they need. “It equates to them in dollars and cents that their employees do not have to lose days of work,” Brown stated. “If the clinics were not there, it would require one or two days off work to be seen. It would require hours of travel for them to receive care and then possibly more days for follow-up care.” Many area employers have large seasonal staff that are young or retired and have limited health insurance benefits. Working together with the park and employers, Medcor developed a program of discounted services for this population. Serving visitors from all over the world also has been a challenge. Good on-site clinics are used to coordinating with the multiple health plans offered by large employers, but at Yellowstone, patients can present insurance plans and expectations from literally anywhere in the country or abroad. The clinics at Yellowstone accept a huge range of plans, and provide courtesy submissions
to all other insurances and assist individuals in filing claims appeals as necessary. “We assist our patients with guidance and medical records, and we accommodate hardship cases too,” Brown said. “No one in need is turned away. Additionally, our on-site clinics provide a service that is less expensive for patients, employers and insurers alike.” Managing logistics for referrals, transfers and follow-ups requires constant attention as well. Yellowstone covers two million acres of wilderness (bigger than some states), and spans parts of three states: Wyoming, Montana and Idaho. The Medcor team must coordinate care with multiple hospitals, specialists and ambulance services in surrounding cities, most of which are hours away. This presents many opportunities for miscommunication and problems. The providers at Yellowstone meet formally twice a year, once at the end of the summer season and once in the beginning. Meetings include the stakeholders of the clinics, including Medcor and local medical directors and primary care physicians, operations directors, CEOs and legal counsel. “Working on establishing personal relationships helps them understand our constraints; they become part of our team, and as a team, we provide better care to our patients,” said Dr. Luanne Freer, Medcor’s medical director at Yellowstone National Park. Dr. Freer also explains that the on-site team is never short on obstacles when it comes to daily operations. “In general, geography, extreme and unpredictable weather, moderate altitude, bison jams (when an animal that weighs a ton—and 200 of his closest family and friends—decide to camp out in the middle of the only road out of the park) can delay traffic for hours. So we’re always on our toes.” Providing on-site care at a remote location such as Yellowstone is challenging, but in the eight years of operation, Medcor has been successful in meeting the park’s objectives and the needs of all their constituents. Out of more than 10,000 patients treated at the clinics each year, approximately 250 are sent off-site for care, on average. “What we’re doing at Yellowstone can serve as a successful template for other on-site clinics, even if they are in less remote and extreme conditions,” Medcor Chief Operating Officer, Ben Petersen said. “Employers can control costs and improve access and service levels while maintaining quality. To do that, their clinic provider must deliver the services they need when they need them, operate efficiently, accommodate their unique logistics and financial challenges, communicate openly and stay flexible.” www.TheIHCC.com I CDHC Solutions™ I January/February 2012
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Voluntary BenefitS
Interactive Tool Helps Employees See Vision Plan Potential
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etween health care reform pressures and the health care costs associated with an aging workforce, today’s employers have little choice other than to get creative in their efforts to control their bottom line. At the same time, employee loyalty is on the decline, suggesting a robust benefits package is more important than ever. A comprehensive vision benefit can serve as a low-cost way to control health care costs and boost employee productivity and satisfaction. But its potential can only be reached if employees understand the advantages of their quality vision plan enough to actually use it, something research suggests can be improved significantly. Enter the Healthy Sight Calculator, a first of its kind education tool from Transitions Optical, designed to help employers pique employees’ interest and maximize everything the inconspicuous vision benefit has to offer. Pat Huot, director of managed vision care for Transitions Optical, explains how this complimentary online tool could become a real eye-opener for today’s workforce. Q: With all the emphasis on medical benefits today, why do you feel vision benefits deserve greater attention? Today’s employers are trying everything to reduce medical costs associated with common health issues, from introducing on-site wellness programs and health incentives to cutting benefits and shepherding employees toward high-deductible health plans. But it makes sense that there’s no be-all solution that’s going to counteract the impact of chronic disease. For example, although high-deductible plans may help keep initial costs down, it could also mean that cost-conscious employees enrolled in these plans may not be seeking medical care as often, which may delay detection of looming medical issues, like diabetes or hypertension—which can develop without symptoms and lead to major medical expenses and time out of the office. Eye exams can be a hero here, as eyecare professionals are often the first doctors to see
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the signs deep in the eyes, often early enough that lifestyle factors can be changed to avoid the disease, leading to significant savings. Plus, the right eyewear can correct and enhance vision for greater productivity and vision performance— but also protect the eyes from UV, which can contribute to costly eye diseases like diabetic retinopathy. Couple this with the need to offer employees a competitive benefits package, and a quality, low-cost vision benefit becomes a no-brainer. Q. How did you identify a need for a tool like the Healthy Sight Calculator? While most HR professionals will agree that a strong benefits portfolio is important for employee attraction and retention, many don’t spend much time educating their employees about their plan options, including their vision benefit. In fact, one in four say they don’t discuss vision with their employees at all. Plus, there also is low awareness of how common eyerelated issues are among high-risk groups, such as older employees or certain ethnic minorities. The results are what you would expect: research on behalf of Transitions Optical reveals that three in 10 employees are dissatisfied with their employers’ vision education methods, and nearly half aren’t taking advantage of their plan, either by not enrolling or not using their plan to get an annual eye exam. We wanted to help HR professionals and their employees more fully understand the value behind a comprehensive vision plan, because when employees actually use it—everybody wins. Q. How exactly does the calculator work? What makes it unique? The Healthy Sight Calculator—free to the public at HealthySightCalculator.org—is the first tool of its kind that allows employees to: 1. Learn their risk for 11 vision problems eye diseases and overall health issues, based on their unique demographics. 2. Calculate the potential savings their vision benefit could offer in terms of time (minutes per day or entire
workdays lost through decreased productivity), money (lost in medical costs without early intervention) and sight (vision lost without taking the steps necessary to care for your eyes). Along the way, the tool allows employees to learn more about each of the conditions—such as trouble seeing up close, macular degeneration and prediabetes—and supplements learning with eye doctor videos, vision loss simulations and more. Ultimately, users receive a printable one-page summary of their potential cost savings, as well as recommended next steps, which always includes an annual eye exam with their eyecare professional. The Healthy Sight Calculator was developed with the help of experts in the eyecare and benefits industries, and by analyzing existing data on the prevalence of various eye diseases and conditions among specific populations, as well as published research on related medical costs and productivity loss. Q. Transitions Optical released a similar Healthy Sight Calculator in 2010. Are the two calculators designed to work together? Absolutely. The original Healthy Sight Calculator—available at www. HealthySightWorkingForYou.org/calculator is designed for HR professionals and based on the same research and methodology used in the individual Healthy Sight Calculator. The HR version allows employers to plug in their unique workforce demographics—such as size, location, and breakdown by age and ethnicity—and determine the likely prevalence of 13 eye-related conditions. It then calculates potential annual savings associated with a premium vision benefit—across an entire workforce—broken down by health care costs and productivity savings for each of the conditions. Our intention is that once HR professionals realize the bigger picture behind their vision benefit, and make sure they’re offering a quality plan, they’ll share the individual Healthy Sight Calculator with their workforce to educate them
By PaT HUOT
on the value being offered to them, and the importance of seeking regular eye care and wearing the right eyewear that helps them see their best. Q. What are some ways employers can introduce the Healthy Sight Calculator to their workforce? One nice thing about the Healthy Sight Calculator is that it’s very user friendly and only takes employees a few minutes to walk through—although we find that users get so engaged with the interactive content that they spend an average of 12 minutes on the site! The complimentary tool can be easily woven into an open enrollment presentation— and we even have a sample PowerPoint slide you can use, available on the Tools section of HealthySightWorkingForYou.org. It’s also easy to share the calculator throughout the year, such as by including a link to it in a benefit reminder email. This could also serve as a great set up to on-site vision screenings or a company health fair, or even to get employees thinking about their health needs shortly before the busy enrollment period.
»
DirECtor oF MANAGED viSioN CArE
factors, and then making an informed decision and hopefully taking advantage of their plan.
»
TranSITIOnS OPTICal InC.
to suggestions for how to improve the calculator. If you have feedback for us, please email Info@ HealthySightWorkingForYou.org.
Q. What type of feedback about the tool are you receiving from HR managers? We’re currently working with a benefits broker to test the Healthy Sight Calculator directly with HR customers, and so far their feedback has been extremely positive, including that they like the level of interactivity the tool provides, and that they would absolutely share it with their employees. We’ve also spoken with numerous other benefits brokers who report the tool is a great way to introduce the vision benefit to their HR clients, and to arm their clients with employee education on the benefit. This said, we are always open
Q. How do you see “do it yourself” tools like the Healthy Sight Calculator making a difference in vision plan enrollment and usage? Today’s employees are being encouraged to have a more active part in their benefit decisions, from selecting consumer-driven health plans to handling enrollment online. At the same time, education on the part of their employers is critical, confirmed by the recent National Business Group on Health finding that employees are looking to HR managers as sources of health information more than ever before. So it makes sense to have easily accessible online resource that employees can try on their own time, and customized for their unique demographics. The do-it-yourself approach of the Healthy Sight Calculator can be a real eye opener, one which engages them and encourages them to become a more active participant in their vision benefit by understanding their unique risk
www.TheIHCC.com I CDHC Solutions™ I January/February 2012
35
Voluntary BenefitS
A Dental Benefits Checkup
T
o create a diversion at the fairy godmother’s office, Shrek says to the receptionist, “We represent the workers in all magical industries, both evil and benign. Are you feeling at all degraded or oppressed?” “Ugh, a little … We don’t even have dental,” she replies in the popular animated film. Employees want dental benefits. Savvy employers know this. That is why dental benefits are and will continue to be one of the most popular benefits in an employer’s compensation package, according to the 2011 Group Purchaser Behavior Study, published by the National Association of Dental Plans (NADP). The study also reports the vast majority of employers plan to continue to offer dental benefits to their employees, despite the rising costs of health coverage and the unanswered questions posed by health care reform. As questions about the impact of health care reform on employer-provided coverage remain unanswered, the dental benefits industry is working hard to minimize impacts on consumers with dental coverage today and the dental market for employers. As well, the industry is working to advance dental benefits with the development of quality measures. Given the current business landscape, what can employers anticipate regarding dental benefits in the future? To understand what the future may hold, the first step is to understand the current market.
Today’s Robust Dental Benefits Market According to the 2011 NADP Study, more employers offered dental benefits to their employees in 2011 when compared to results from the 2005 or 2008 editions of this threeyear survey. In addition, the increase in the percentage of employers offering dental benefits was noted in every geographic region and employer size category. The study also indicates that as the number of employees increases, so does the likelihood of companies self-funding their dental plans. Not only did more employers offer dental benefits, the vast majority, 96 percent, 36
January/February 2012 I CDHC Solutions™ I www.TheIHCC.com
believe them to be either an “essential” or “differentiating” factor in the recruitment and retention of employees. Dental PPOs (participating provider organizations), the most common type of dental plan offered, became even more popular over the past three years while dental HMOs (health maintenance organizations), traditional indemnity and discount plans all declined. DHMO products appear to be more popular in the Western U.S. than other parts of the country, especially the Midwest. Additional key characteristics of the current dental benefit market include: • Dental coverage is purchased as a separate policy more often from a stand-alone carrier (59 percent),
By EvElyn F. IrEland CAE, ExECutivE DirECtor nadP
while dental policies purchased “in a package” from a medical carrier and its dental affiliate, subsidiary or partner declined. • In selecting a new dental carrier for dental coverage, cost is the most important factor. • The most important reasons for companies to consider offering dental benefits are: • Employee requests;
“What type(s) of dental plans does your company currently offer to its employees?” 0%
10%
20%
30%
40%
50%
Dental PPO Plan Dental HMO Plan
27% 26%
Traditional/Inemnity Dental Plan
27% 23%
Discount Dental Plan Direct Reimbursement Plan Other Type of Dental Plan
60% 53%
7% 3% 2% 1%
70%
80%
90%
100%
60% 63%
36% 35%
15% 13%
9%
2005
2008
2011
“Will you be making any changes to your employee benefit offering due to health care reform legislation? [Please check all that apply] Percent who responded “Yes” 0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
drop coverage add coverage make fewer employees eligible by reducing hours/layoffs reduce contributions eliminate employer contributions for all benefits switch to voluntary for ancillary benefits eliminate dental benefits eliminate other ancillary benefits (eg. vision, dental) add dental benefits add other ancillary benefits no changes
Currently Offers Dental Benefits
Not Currently Offering Dental Benefits
Total Sample
• Dental health impacts overall health; and, • Affordability.
The Impact of Health Care Reform on Dental Benefits What is the future of the dental benefits market under health care reform? Will dental benefits maintain their popularity among employers and employees under health care reform? Almost half of the employers responding to the study reported they expect no change in their overall employee benefit offerings because of health care reform legislation, while one-third plan to reduce employer contributions. In addition, more than half (52 percent) expect health plan costs to “increase a lot” and another 29 percent expect costs to “increase a little.” The study reveals more than 80 percent of all companies surveyed are likely to invest in—or continue—offering health benefits rather than pay a $2,000 penalty to the government when the Affordable Care Act (ACA) is implemented. With regard to the dental, the study also reports separate dental and vision benefits will continue to be purchased outside of the Exchange by 69 percent of all employers. In employer groups of 100 or less (those initially eligible to use exchanges), almost 80 percent report they are likely to continue dental coverage outside exchanges. Maintaining dental coverage will create a new challenge for employers when the ACA is implemented. While initially this challenge is greater for employers with 100 or fewer employees, there are some initial impacts on employers of all sizes. The challenge arises from how the ACA defines the benefit package to be offered in the exchanges. The ACA includes ‘pediatric oral services’ as part of the essential health benefits package to be offered in the small group and individual market—both in the exchanges and the private market. In the exchanges, as in the private market today, the pediatric oral services can be covered in a dental policy, while the other health services will be covered under a medical policy. However, one of those little know “glitches” in the language of the ACA requires that in the private market all the required services be provided under one policy from the medical carrier.
This leaves several critical questions that will impact employers. What happens when employers continue offering dental coverage outside exchanges but go to exchanges for their medical coverage? Will the dental coverage their employees have be accepted or will employees be required to purchase duplicate coverage in the exchanges? What happens when two working parents work for small employers? Or one for a large employer and the other for a small employer? What if there are no children in the family? Will both have to buy dental coverage that includes pediatric oral services? Will the coverage they select from one employer or the other be accepted as meeting the mandate? These are scenarios that create HR complaints that employers and insurers want to avoid. So NADP is working to clarify these questions. “To deliver on the promise made by President Obama and congressional leaders that Americans can keep their coverage and doctors, consumers with dental benefits need the option they have today to purchase medical that does not duplicate the dental coverage they already have,” remarked NADP Executive Director Evelyn F. Ireland, “Regulators must clarify that dental policies consumers have now will be accepted by exchanges to meet ACA requirements for children. They should also clarify that health plans can offer medical coverage without dental both inside and outside the exchanges. Without these clarifications, dental coverage could be disrupted for 1.65 million small businesses providing dental policies to 43.7 million employees, including 22.9 million children and the confusion from the change in market operation will impact many more.”
Other New Horizons for Dental Benefits As NADP’s executive director suggests, much remains uncertain on the regulatory front because of needed clarifications in the ACA. Adding to that uncertainty last year were new requirements by the Centers for Medicare and Medicaid (CMS) that the dental industry begin development of dental quality measures— which currently do not exist. Prior to the CMS
requirement, NADP had taken the lead in the industry’s development of these measures through its participation on the Steering Committee of the Dental Quality Alliance (DQA) and in the National Quality Forum. What does this mean for employers with regard to dental benefits? With the knowledge gained from the development and integration of dental quality measures, dental plans can develop innovative product designs based on oral health outcomes. This will provide more choice for employers and employees. The additional measures also could result in more detailed data for employers to use when evaluating and comparing dental plans. No one’s crystal ball reveals the detail about how dental benefits will be structured in the future. Even so, NADP is leading the charge to ensure dental plans participate in the development of viable solutions for health care reform implementation. NADP, as dental benefits industry’s representative, with participation of all its members, will ensure that the development of quality measures proceeds in a way that adds value for the purchasers and users of group and individual dental benefit programs. NADP is a Texas nonprofit corporation with headquarters in Dallas, Texas, is the “representative and recognized resource of the dental benefits industry.” NADP is the only national trade organization that includes the full spectrum of dental benefits companies operating in the United States. NADP’s members provide Dental HMO, Dental PPO, Dental Indemnity and Discount Dental products to 143 million Americans, approximately 90 percent of all Americans with dental benefits. www.TheIHCC.com I CDHC Solutions™ I January/February 2012
37
BRIEFs
PEOPLE ON THE MOVE
People on the Move, continued from page 17
Finance from New York University. A seasoned CFO with more than 20 years of experience in health care, private equity and technology, Fawcett oversees all financial, administrative and related operational functions at IncentOne. Prior to joining IncentOne, Fawcett was a private equity consultant and held positions as a senior finance manager with the IT & project management office at Health Dialog Services Corporation. He holds a B.A. degree in Business Economics from Brown University. CVS Caremark announced the appointment of Larry D. Burton to the position of senior vice president of government affairs. Burton will join the company as of Feb. 27 and will be focused on continuing to grow the company’s role as a pharmacy innovation company working to help improve health care access, reduce overall costs and improve health outcomes at state and federal levels. Burton brings more than thirty years of experience in strategy development, public policy and government affairs to CVS Caremark. He joins the company from Business Roundtable in Washington, D.C. where he was executive director. Humana Inc. announced that tim McClain, president and CEO of Humana Veterans Healthcare Services, has been named president, government and other business—which includes all Humana military lines of business. He will report to Jim Murray, executive vice president and chief operating officer. In addition, the company announced the retirement of Dave Baker, chief executive officer of Humana Military Healthcare Services. Following a distinguished 27-year active duty career in the United States Air Force Medical Service, Baker joined Humana in 1996 and launched Humana’s start-up TRICARE operations in the Southeast. For the past 12 years, he has served as president and CEO of Humana Military and doubled Humana’s TRICARE market share. To ensure a smooth transition, he will continue to serve in an advisory capacity to Humana Military through June 30. Conner Strong & Buckelew, a leading insurance, risk management and employee benefits brokerage and consulting firm, announced an expansion of its Compliance and Audit Practice. The firm has hired Dennis Hyland as claims audit manager primarily responsible for conducting claim and benefit audits for clients with self-funded health plans. With the addition of Hyland, the firm is now positioned to handle all areas of health and welfare plan consultancy and brokerage. As a member of the compliance and audit practice, Hyland will not only perform claim audits for large clients, but will assist in other key areas of compliance including plan documents, summary plan descriptions and other compliance based communications. Prior to Conner Strong & Buckelew, Hyland spent more than 15 years managing, performing and leading claim audit work at Aon and predecessor companies MDLiveCare Health Services Inc. has named Chuck Hector, MBA to lead domestic and international business development as chief sales officer. He assumed his new responsibilities Jan 1. Since March 2011 Hector has held the title of senior vice president of channel strategies for MDLiveCare during which time he successfully engineered enterprise business relationships with several recognizable national brands, further solidifying MDLiveCare’s growth trajectory as a leading telemedicine application service provider and network administrator. Prior to MDLiveCare Hector was chief business officer of Computerized Screening (CSI) where he lead the kiosk-based company into on-site deployment of integrated telemedicine kiosks which redefined access to physicians from the work place. Prior to CSI Hector was senior vice president of sales at IncentOne, the leading provider of incentive technology 38
January/February 2012 I CDHC Solutions™ I www.TheIHCC.com
solutions to the health care industry. In that role he was responsible for managing a sales team to build a foundation of core clients in the health insurance sector through collaboration with chief medical officers, product, sales, marketing and care management. Juan Reyes, M.D., was named director of clinical technologies by CareCloud, a Miami company that provides Web-based patient portals and practicemanagement systems. Reyes also is a board certified pediatrician. Dominion Dental Services appointed Bobby LeBrun sales manager for southeastern Virginia. LeBrun comes to Dominion with 10 years of experience with regional insurance carriers and brokerages. An organization promoting health care quality through accreditation, education and measurement, announced that Justine Handelman, vice president, legislative and regulatory policy for the Blue Cross and Blue Shield Association, has joined URAC’s board of directors. Handelman will serve out the remainder of Stephen Gammarino’s term, which expires in April 2013. Handelman oversees federal and regulatory policy development for BCBSA, working on a broad range of federal issues important to Blue Cross and Blue Shield plans, including health care reform, health information technology, government programs (Medicare, Medicaid, SCHIP) and delivery system reform. The URAC board of directors is established with representatives, including consumers, providers, employers, health plans, care management organizations, regulators and industry experts. These groups provide broad representation and ensure an independent, balanced organization. The Blue Cross and Blue Shield of Minnesota Foundation announced Carolyn Link as executive director of the Foundation. She previously served as senior director. “Our Foundation is a core part of Blue Cross’ work as a health company, recently developing a new strategic framework that charts the course for improving community conditions affecting low-income children and families,” said Kathy Mock, senior vice president, marketing and public and health affairs. “Carolyn has a strong track record of working on community change, including more than 10 years working with Blue Cross health improvement efforts through our Center for Prevention.” new Century Health announced that its board of directors has appointed Atul Dhir, M.D., Ph.D., chief executive officer Dr. Dhir will spearhead the national expansion of New Century Health’s specialty care management services focused on oncology and cardiology. Water Street Healthcare Partners, a strategic private equity firm focused exclusively on health care that invested in New Century Health last year, recruited Dr. Dhir to the position. Dr. Dhir joins New Century Health from his position as CEO of BiPar Sciences Inc., a Sanofi-aventis biotech subsidiary that develops new cancer drugs. He previously served as a senior executive with US Oncology, the largest provider of cancer care in the United States. During his 10 years with the company, Dr. Dhir led several businesses, including the company’s cancer research group, one of the nation’s leading cancer drug development companies. Dr. Dhir also has held senior positions in the health care division of Monsanto Company and at McKinsey & Company. Dr. Dhir possesses a rare combination of deep scientific expertise and he has advised numerous health care organizations and, currently serves on the advisory boards of several health care companies. Dr. Dhir completed his doctorate of philosophy in molecular biology from the University of Oxford, where he studied as a Rhodes Scholar. He received his medical degree from the All India Institute of Medical Sciences in New Delhi, India.
Promotions 401k matching Anniversary gifts Annual retreat Free coffee Free parking Profit sharing Company cars Expense accounts Vacations
Most employee incentives cost you money. Here’s one that doesn’t. My HSA Rewards is a free program designed to help your employees contribute more money to their HSAs simply by shopping. Your employees can earn cash back rewards from purchases at hundreds of major online retailers—like Target.com, homedepot.com, ProFlowers.com—and the rewards are even tax deductible* when deposited into their HSAs. If your company provides employees with the opportunity for an HSA, visit www.myhsarewards.com for more information. *Talk with your CPA or tax advisor regarding tax deductions in your state
Who’s Who Profiles
www.theihcc.com
Solutions to help your innovative health and benefit programs. HSA/HRA/FSA TecHnology: AdmInISTRATIon & mAnAgemenT
popUlATIon HeAlTH And WellneSS
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.” ®
HSA/HRA/FSA TecHnology: AdmInISTRATIon & mAnAgemenT
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
40
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Since 1988, Flex has provided comprehensive, benefit reimbursement services to employers throughout the U.S. that are better, faster and more seamless than any in the marketplace. We are advocates of consumer-driven health plans and have fully-dedicated ourselves to the strategic concept of taxadvantaged and account-based programs.
FlexIble beneFIT SeRvIce coRpoRATIon (Flex)
10275 W. Higgins Road, Suite 500 Rosemont, IL 60018 www.JustFlexit.com 866.472.0882 fpsales@flexiblebenefit.com
Our core portfolio includes: COBRA Administration n Flexible Spending Accounts (FSAs) n Health Reimbursement Arrangements (HRAs) n Health Savings Accounts (HSAs) – Employer & Individual Solutions! n Transit/Parking Reimbursement Accounts (TRAs) n And more! n
Our robust, integrated resources provide everything employers need to integrate Flex Plans, including scalable features, simplified transactions/ reimbursements, plan design expertise, education/ communication resources and online access.
Just Flex It™ today and discover how simple benefits administration can truly be.
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Who’s Who Profiles
Access these profiles online at www.TheIHCC.com and www.EmployersWeb.com decISIon SUppoRT & coST-SAvIngS ToolS
HSA/HRA/FSA TecHnology: AdmInISTRATIon & mAnAgemenT
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. “
my HSA Rewards allows individuals my HSA ReWARdS to earn cash rewards for purchases 12460 Crabapple Road made through merchants Suite 202-254 participating in the program. Alpharetta, GA 30009 At launch, the merchant network consists of hundreds of major online 404.551.5543 retailers representing thousands of www.myhsarewards.com brands. The program works like an sanders@myhsarewards.com airline mileage program, but, instead of earning miles, participants earn cash rewards that are directed to a health savings account (HSA). There is no cost to the employer or the employee to join.
“If you want to grow your Health Savings Account faster and with ease, my HSA Rewards is a smart and simple way to put real cash into your HSA from the purchases you make every day.”
— Trey Jinks, Group Executive, TSYS Healthcare
— Sanders McConnell, President, My HSA Rewards
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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41
www.theihcc.com
Who’s Who Profiles
Solutions to help your innovative health and benefit programs. Pharmaceutical Benefits Management
PROFESSIONAL DEVELOPMENT
Health Insurance 101: An Orientation is a new, flexible online course offered by AHIP. It is designed to teach health insurance basics to those new to health care or individuals who wish to review the fundamentals. The course is formatted in short modules; you learn at your own pace and on your own time, moving through the materials as you choose. Plus, AHIP will customize the course to fit your organization’s specific learning requirements.
America’s Health Insurance Plans 601 Pennsylvania Ave., NW South Building, Suite 500 Washington, D.C. 20004 Lindsey Miranda Canaley Tel: 800.509.4422 Fax: 202.861.6354 lmirandacanaley@ahip.org www.ahip.org/courses
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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HealthStat......................... Inside Front Cover
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Benefit Software........................................ 41
IHC Call for Content....................................30
advertising contacts
Best Buy.................................................... 24
IHC HealthCare Consumerism Radio............18
404.671.9551
DataPath................................................... 40
IHC Health & Wellness Library....................26
DSS Research............................................ 40
IHC Membership Benefits............................20
Envision Pharmaceutical Services........... 7, 40
IHC Solutions FORUM East..................... 11-15
Evolution1...................................................41
My HSA Rewards.................................. 39, 42
Flexible Benefit Service Corporation.................. 40, Inside Back Cover
Transitions..................................................30
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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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TSYS Healthcare.................................. 10, 41 FIS Healthcare Solutions...............................5 UnitedHealthCare.......................... Back Cover
FLEXIBLE BENEFIT SERVICE CORPORATION
Your Benef its Administraton Expert
FSAs
HRAs
HSAs
Transit/Parking
COBRA
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Flexible Benefit Service Corporation (Flex) 10275 W. Higgins Road, Suite 500 Rosemont, IL 60018
© Flexible Benefit Service Corporation 2011
*The use of this seal is not an endorsement by the HR Certification Institute of the quality of the program. It means that this program has met the HR Certification Institute’s criteria to be pre-approved for recertification credit.