FORUM West Sept. 6-7, Las Vegas
solutions ISSUE || May/June 2012
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Ochsner Cuts Costs, Improves Engagement With Wellness Strategy Defining the Next Stage of Health Care Consumerism: Defined Contribution Health Product Packaging: A Win-win-win Proposition The Supreme Decision: Why Employers Should Continue Offering Health Plans No Matter How the Court Rules
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Implemented Healthstat for his company last year.
Reduced his health claims. Saved the company $700.
Found out he had diabetes. Learned to manage it at work.
FEATURES
INSIDE 39 Virgin HealthMiles Help Ochsner Cut Costs, Improve Engagement With Wellness Program
Ochsner Health System, a non-profit, multi-specialty health care system, comprised of eight hospitals and 38 clinics located throughout Louisiana, was facing a major challenge. How to create a measurable employee health program, which would lower health care costs, improve employee well-being and create a high percentage of engagement in a wellness program? The 10,000-plus employee health care system scrapped its home-grown manual program and engaged Virgin HealthMiles to design a new wellness program. The end result was an 89 percent employee engagement rate and a $3 million decrease in employee-only medical claims. By Susan Piglia
43 Defining the Next Stage of
Health Care Consumerism: Defined Contribution Health There are fundamental health care changes ahead involving a shift from traditional “defined benefit” plans to “defined contribution” plans. This shift is similar in nature to the historical change from defined benefit pension plans to more consumer-centric defined contribution—401(k) retirement plans. With defined benefit health care, an institutional purchaser, such as an employer, determines what range of services it will cover, and then seeks or creates a plan providing those services for an acceptable price. It has become increasingly difficult for institutional purchasers to sustain a defined benefit approach due to a steady stream of emerging health care treatments and technologies requiring an equally steady stream of decisions about which ones will be covered by the plan. By Dr. John Reynolds
COMING UP NEXT: CDHC Solutions features FIS Healthcare Solutions President Dr. John Reynolds, who explores the development of private, state and federal insurance exchanges in part two of a two-part series. The Leapfrog Group showcases its annual Hospital Safety Scorecard and what it means for employers and their health plan design. The July/August issue also will feature a FitLinxx case study focusing on how a wellness program meshes into an employer’s self-funded strategy. ON THE COVER: Ochsner Health employee Angela Foster, right, and Dorothy Cain visit one of the 13 Virgin HealthMiles HealthZone measurement stations on the Ochsner campus to log in and record their participation in the health care system’s wellness program. This year Ochsner has enjoyed a robust 89 percent participation rate in the HealthMiles program among the health care system’s 10,000 employees. Cover and cover article photos by Stephen Legendre. www.TheIHCC.com I CDHC Solutions™ I May/June 2012
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INSIDE 8
DEPARTMENTS
Editor and Publisher’s Letter
25 HSA/FSA/HRA Administration & Finance
School is not out for Summer at The Institute
10 Bachman’s Banter
The ‘Super Bonus’ of Competitive Cross-state Selling of Individual Health Insurance Policies By Ronald E. Bachman
Constitutional or Not: ACA Creates Turbulent Times for Account-based Plans By John Hickman Natasha L. Rankin
13-19 IHC FORUM East/West
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27 Population Health Management
20-21 People on the Move 20-22 Briefs/Innovations
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47 Ask the Broker
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48 Who’s Who Profiles 50 Resource Guide/Ad Index
Events Inaugural Webinar
The Institute for HealthCare Consumerism, in conjunction with Medserv Global and its founder John Linss, presents a free webinar titled “Reducing Costs for Employers and Employees While Improving Patient Experience.� It is scheduled for June 19 and 21 at 2 p.m. (EDT). The 45-minute webinar is free to IHC members.
The 2012 IHC FORUM West
www.theihccforum.com
Our second annual IHC FORUM West has expanded and will be in Las Vegas on Sept. 6-7 at the Red Rock Resort and Casino. Don’t gamble on your health and benefit management. An employer can lose money on a badly managed health plan quicker than a casino slot machine. Join us in the desert to LEARN, CONNECT and SHARE with the top thought leaders in health care and key leaders in the health care consumerism megatrend. FORUM West also features and expanded pre-conference agenda that includes HealthCare Consumerism 101 and a CDHC Certification Course produced by NAHU. Both begin at 1 p.m. on Sept. 5. For more information visit www.theihccforum.com.
 Become a Member and Reap the Rewards
Have you become a member of The Institute Yet? What are you waiting for? It is free to join and the benefits are limitless. Become a member and post a blog on www.theihcc.com.
4
May/June 2012 I CDHC Solutions™ I www.cdhcsolutionsmag.com
Making Wellness Work By Jeff Brown
29 Pharmacy Benefit Management Being Proactive When Making Better Pharmacy-related Spending Decisions By Dr. Sharon Glave Frazee
31 Health Plan Communication Employee Benefits Communications: Say Something By Bryan K. Brenner
33 Health Decision Support Tools Save $36 Billion in U.S. Health Care Spending Through Price Transparency By Bobbi Coluni
35 Supplemental Health Benefits Product Packaging: A Win-win-win Proposition By Steve Howard
MINI-FEATURES 36 Health Access Alternatives Transforming an On-site Health Center into a Total Health Cost Containment Center By Dr. Jonathan Spero
37 Commentary Technology is the Only True Health Reform By William R. Boyles
Allstate protects employees, too. Surprised? Allstate Benefits is one of the fastest-growing ÂŽ
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Call Walter Jones today at 904-992-3443.
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Life Disability Critical Illness Accident 2011 U.S. Worksite Sales, LIMRA. Allstate Benefits is the marketing name used by American Heritage Life Insurance Company (Home Office, Jacksonville, FL), a subsidiary of The Allstate Corporation. Š 2012 Allstate Insurance Company
WHAT’S HAPPENING AT THE THE CEO’S DESK members  speak  out The industry is currently at a tipping point where we’re seeing the rapid adoption of health care consumerism across the marketplace regardless of health care law developments.
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Within The Institute for HealthCare Consumerism you will find yourself at the forefront of the latest updates regarding health care law and how it may or may not impact your business and the industry as a whole. All of this is happening within our 24-7, collaborative online environment where all facets of this industry are currently learning, connecting and sharing.
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If you’re reading this magazine and have not yet signed up for your free membership to The Institute for HealthCare Consumerism online, you’re missing out on being part of the one place that aggregates all stakeholders within the health and benefits management industry and allows you to connect with your peers, brokers, advisors, consultants and solution providers with a quick log-in.
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Through articles, white papers, surveys, member contributed blog posts, forum discussions, video content and HealthCare Consumerism Radio, you’ll immediately benefit from a collaborative environment that speaks to health care consumerism related growth, best practices and pain points.
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Sign up today for your FREE Membership to The Institute for HealthCare Consumerism at: theihcc.com/membership Sincerely, Doug Field Founder & CEO, The Institute for HealthCare Consumerism Publisher, CDHC Solutions Magazine
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spotlight If  surviving  and  thriving  in  this  economy  is  high  on  the  Richter  scale,  spend  less  time  in  meetings  and  more  time  resolving  employee  issues.  In  fact,  this  is  the  motto  that  bright  star  CEOs  are  taking  into  consideration.  A  business  can  go  from  good  to  great  by  taking  risks;  not  being  afraid  of  failure  is  what  Joel  Bomgar,  CEO  of  Bomgar  Corporation  did  when  deciding  WR FXW HPSOR\HH KHDOWK FDUH EHQHÂżWV RU SD\ LW IRUZDUG “He  is  a  huge  supporter  of  health  care  consumerism  and  today  we  offer  both  a  PPO  plan  and  HDHP/HSA  plan,  with  the  latter  being  the  plan  of  choice  for  our  employees.  What  makes  our  HDHP/HSA  option  so  attractive  is  the  fact  that,  not  only  are  the  premiums  lower,  but  Bomgar  contributes  to  an  employee’s  Health  Savings  Account  at  the  rate  of  what  Bomgar  would  be  saving  in  premiums,â€?  said  Linda  Benedict,  director  of  human  resources  for  Bomgar  Corporation.
6
May/June 2012 I CDHC Solutions™ I www.TheIHCC.com
Knowing  full  well  the  risk  the  company  was  taking  if  an  employee  were  to  leave  the  company  and  those  funds  could  not  EH UHWULHYHG KH IHOW WKH XSVLGH EHQHÂżW to  their  employees  outweighed  the  downside.  This  security  gives  Bomgar  employees  and  their  families’  peace  of  mind  every  January.  Â
Joel Bomgar Bomgar Corporation; Ridgeland, Miss. Key Solution Provider: United Healthcare
To  learn  more  about  this  year’s  Superstar  Awards  and  to  nominate  today,  please  visit  www.theihcc.com.
INSTITUTE?
LEARN. CONNECT. SHARE.
online  exclusives The Road to Health Care Consumerism is Getting Crowded
In  September  2009  when  CDHC  Solutions  launched  its  conference  series,  the  event  was  held  in  a  sectioned-Âoff  portion  of  the  ballroom  at  the  Cobb  Galleria  Centre  in  Atlanta.  Fast-Âforward  to  less  than  three  years  later  and  the  conference,  dedicated  100  percent  to  innovative  KHDOWK DQG EHQHÂż W PDQDJHPHQW LV KDUGO\ UHFRJQL]DEOH Branded  The  Institute  for  HealthCare  Consumerism  (IHC)  FORUM  East,  the  event  has  taken  over  the  Galleria  Centre’s  entire  ballroom.  The  exhibit  hall  has  expanded  to  more  than  40  exhibitors,  partners  and  sponsor,  and  the  number  of  attendees  has  exploded  to  423  in  30  months  since  the  inaugural  event‌
Customizing Your Benefits Communications; How to get Personal While Maintaining Employee Privacy
&RRNLH FXWWHU EHQHÂż WV FRPPXQLFDWLRQV DUH RXW RI VW\OH 7RGD\ÂśV employees  want  custom-Âbuilt  health  solutions—and  they’re  looking  to  their  employers  for  guidance  and  information  VSHFLÂż FDOO\ WDLORUHG WR WKHLU KHDOWK DQG ZHOOQHVV FLUFXPVWDQFHV Like  it  or  not,  it’s  time  to  get  personal.  Consider  that  half  RI HPSOR\HHV ZDQW D KHDOWK SODQ WKDW UHFRPPHQGV VSHFLÂż F actions  they  can  take  to  improve  their  health—and  more  than  a  third  are  hungry  for  health  tips  and  reminders,  as  well  as  cost  estimating  tools‌
Romney is About to Make Bush’s Health-Care Blunder
Mitt  Romney,  so  long  bedeviled  by  the  politics  of  health  care,  may  be  about  to  make  another  serious  mistake.  He  is  on  the  verge  of  spelling  out  a  plan  to  replace  President  Barack  Obama’s  health  plan.  Romney’s  advisers,  both  inside  and  outside  the  formal  campaign,  want  the  main  component  of  his  alternative  to  be  a  change  in  the  tax  code’s  treatment  of  health  care.  But  there  are  two  versions  on  the  table,  and  Romney  is  leaning  toward  the  one  that  would  offer  much  less  help  to  the  uninsured‌
Smart Benefits: The Secret to a Winning Wellness Program
The  goal  of  workplace  wellness  programs  is  to  improve  health  and  slow  healthcare  costs.  And  to  get  there,  a  clear  communication  strategy  is  a  must.  The  key?  Frequent,  action-Âoriented,  deliberate  and  detailed  outreach.  Announce  the  program.  Don’t  be  shy  when  rolling  out  a  wellness  program;  make  it  an  event.  In  a  kick- RII PHHWLQJ SRVLWLRQ WKH SURJUDP DV DQ HPSOR\HH EHQHÂż W WKH employer  fully  supports  and  be  sure  to  involve  leadership‌
Follow us on Twitter: Twitter.com/ The_IHC
Join the discussion in LinkedIn Group: HealthCare Consumerism FORUM by IHC
Join our Facebook Group: The Institute for HealthCare Consumerism
DISCUSSIONS Health Care and Health Risk Assessments 0DUN 5REHUWV
When employers are concerned about having a healthy workforce, they offer various incentives in their benefits offerings to employees that can be preventive in nature and increase the potential for healthier living and overall improved health behavior. These wellness measures can be a great Return on Investment, and employees are able to get a reality check concerning their current health status‌
Critical Illness and Accident Plans are becoming Essential Components in Employee Benefit Plans 'DYLG *ROGIDUE
It’s no secret that employers have been forced to decrease or even eliminate some employee benefits. But doing business in an economy that’s still stuck in neutral requires great resolve, including a commitment to avoid any knee-jerk reactions that serve as pennywise but pound-foolish within the larger context of talent management‌
On the Health Care Reform Horizon: New Info on W-2s /L] 5RZHOO
With the slew of other new legal disclosures coming up this summer, adding the full cost of medical coverage on W-2s in January 2013 may have fallen off your radar. We agree that between 401(k) fee disclosures and the Summary of Benefits and Coverage notices, the new mandated information on W-2s is definitely a blip. Yet, it really is the bright spot. Just a bit of your effort will go a long way‌
events 2012 Register Now and Save Don’t miss this opportunity to be at the forefront of the health and benefit management movement. Reserve your spot at FORUM West before July 20, 2012 to receive our special Early Bird rates.
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The offical publication of the Institute for HealthCare Consumerism
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7
LETTER
EDITOR & PUBLISHER
www.theihcc.com VOLUME Â 8 Â Â Â NO. Â 4 Â Â Â MAY/JUNE Â 2012
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Published  by  FieldMedia  LLC 292  South  Main  Street,  Suite  400  Alpharetta,  GA  30009  7HO ‡ Fax:  770.663.4409 CEO/  P UBLISHER/EDITOR-ÂIN-ÂCHIEF
Doug  Field  H[W Ăą GÂżHOG@ ÂżHOGPHGLD FRP ASSOCIATE  PUBLISHER Â
Brent  Macy  H[W ù EPDF\#¿HOGPHGLD FRP EDITORIAL  DIRECTOR
Todd  Callahan H[W ù WFDOODKDQ#¿HOGPHGLD FRP
School may be out for the summer, but class is still in session at The Institute for HealthCare Consumerism, as we continue to provide a place on the Internet to LEARN, CONNECT and SHARE. We want to thank those who helped make IHC FORUM East so successful. It was a conference where a record number of attendees came to the Cobb Galleria Centre in Atlanta for the opportunity to LEARN, CONNECT and SHARE with the top thought leaders and solution providers in the health care consumerism space. In addition to having more sponsors at the conference than ever before, a record number of employers and brokers also made it a point to attend IHC FORUM East. For those who missed out on being in Atlanta in April, there is plenty of time to make plans to join us Sept. 6-7 at the Red Rock Resort & Casino for IHC FORUM West in Las Vegas. In addition to five general sessions, 24 workshops and an opening night reception at one of the premiere resorts in Sin City, attendees have the option of attending a CDHC Certification Course, produced by NAHU, or the debut of a four-hour, hands-on pre-conference titled, “A Consultant’s Road Map; Health Care Consumerism 101.� This not only offers an introduction to the health care consumerism megatrend, but it also provides attendees with a detailed plan on what employers need to know, and how an employer can choose among multiple plan designs, wellness programs, disease management initiatives, incentives, account-based plan options and health literacy campaigns. Not only do attendees get several takeaway points to take back to their company, they also receive a booklet, considered “The Bible� of health care consumerism. Attendees get this and more for just $99 if they register for the pre-con before July 20. However, you don’t have to wait until September in order to LEARN, CONNECT and SHARE. This summer The IHC is launching its webinar series beginning June 19. An encore presentation of the 45-minute webinar is slated for June 21. The inaugural webinar, co-presented by the IHC and MedServ Global, is titled, “Reducing Costs for Employers and Employees While Improving Patient Experience.� The webinar is free for members of The IHC. Membership to The IHC also is free. So what do you have to lose? Visit www.theihcc.com today and become a free member, then let the learning, connecting and sharing begin. Future IHC webinars will showcase a discussion on the U.S. Supreme Court’s verdict in regard to the PPACA. The Institute’s Ron Bachman, and legal expert and keynote IHC FORUM speaker John Hickman will analyze the court’s decision and what it means for the future of health care in this country. The IHC also will highlight the Leapfrog Group’s Hospital Safety Card Survey later in the summer and what this survey means to employers looking to cut health care costs. It’s a summer of learning at The Institute. Come be a part of it.
DIRECTOR Â OF Â CONTENT Â & Â EDUCATION
Mavian  Arocha-ÂRowe  H[W Ăą PDURFKD#ÂżHOGPHGLD FRP ASSOCIATE  EDITOR
Matt  Macy ‡ PPDF\#ÂżHOGPHGLD FRP VICE  PRESIDENT  OF  BUSINESS  DEVELOPMENT Â
Susan  Yakots H[W ù VXEVFULEHUVHUYLFH#¿HOGPHGLD FRP MANAGER  OF  MARKETING  &  SALES  SUPPORT
David  Cerri  H[W ù GFHUUL#¿HOGPHGLD FRP ACCOUNT  MANAGER
Joni  Lipson  ù MOLSVRQ#¿HOGPHGLD FRP Rogers  Beasley  ù UEHDVOH\#¿HOGPHGLD FRP Joe  Tomaszewski ù MRHW#¿HOGPHGLD FRP ART  DIRECTOR
Kellie  Frissell H[W ù NIULVVHOO#¿HOGPHGLD FRP CHAIRMAN  OF  IHC  ADVISORY  BOARD
Ronald  E.  Bachman,  CEO,  Healthcare  Visions EDITORIAL  ADVISORY  BOARD
Kim  Adler,  Allstate;  Diana  Andersen,  Zions  Bancorporation;  Bill  Bennett;  Doug  Bulleit,  DCS  Health;  Jon  Comola,  Wye  River  Group;  John  Hickman,  Alston+Bird  LLP;  Tony  Holmes,  Mercer  +HDOWK %HQHÂżWV 0DUF .XWWHU 3LORW+6$ 6DQGHUV 0F&RQQHOO My  HSA  Rewards;  Roy  Ramthun,  HSA  Consulting  Services  LLC;  John  Young,  CIGNA WEBMASTER Â
Kevin  Carnegie NFDUQHJLH#¿HOGPHGLD FRP Tom  Becher ZHEPDVWHU#¿HOGPHGLD FRP COPY  WRITER  +  PR
Lana  Perry  ù OSHUU\#¿HOGPHGLD FRP Rochelle  Porter  ù USRUWHU#¿HOGPHGLD FRP REPRINTS
Susan  Yakots  H[W ù VXEVFULEHUVHUYLFH#¿HOGPHGLD FRP BUSINESS  MANAGER
Karen  Raudabaugh H[W Ăą NUDXGDEDXJK#ÂżHOGPHGLD FRP &'+& 6ROXWLRQV ™  Volume  8  Issue  4 Copyright  Š 2012  by  FieldMedia  LLC.  All  rights  reserved. &'+& 6ROXWLRQV ™  is  a  trademark  of  FieldMedia  LLC.  &'+& 6ROXWLRQV ™  is  published  eight  times  yearly  by  FieldMedia  LLC.,  292  South  Main  Street,  Suite  400,  Alpharetta,  GA  30009.  Periodical  postage  paid  at  Alpharetta,  GA  and  DGGLWLRQDO PDLOLQJ RIÂżFHV TO  SUBSCRIBE:  Make  checks  and  money  orders  payable  to  &'+& 6ROXWLRQV ™  PDJD]LQH 6 0DLQ 6WUHHW 6XLWH $OSKDUHWWD *$ RU YLVLW ZZZ FGKFVROXWLRQVPDJ FRP 1RQ TXDOLÂżHG SHUVRQV PD\ VXEVFULEH DW WKH IROORZLQJ 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@ ÂżHOGPHGLD FRP IRU QDPH DGGUHVV FKDQJHV PRINTED  IN  THE  U.S.A. &'+& 6ROXWLRQV ™  is  designed  to  provide  both  accurate  and  authoritative  information  with  regard  to  the  understanding  that  the  publisher  is  not  engaged  LQ UHQGHULQJ OHJDO ÂżQDQFLDO RU RWKHU SURIHVVLRQDO VHUYLFH ,I OHJDO DGYLFH LV required,  the  services  of  a  professional  adviser  should  be  sought. Â
Todd Callahan Editorial Director tcallahan@fieldmedia.com 8
May/June 2012 I CDHC Solutions™ I www.TheIHCC.com
Doug Field CEO/Publisher dfield@fieldmedia.com
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Smarter is helping the 3% of your employees who are driving 50% of your medical costs.1
Aetna motivates members to take charge of their health. r r r
26% fewer inpatient admissions for diabetes, coronary artery disease and strokes.2 Proven fewer inpatient hospitalizations.3 Proven 18.4% medical cost savings.4
See the proof at smarteris.aetna.com/caremanagement 1 3
Aetna Informatics®, June 2010 study. 2 Aetna Health Analytics, DM Matched Cohort Study, November 2008. 2010, Health Leaders Data, HMO Group. 4 Aetna Behavioral Health Clinical Program Development, Q4 2009. © 2012 Aetna Inc. 3ODQV RƪHUHG E\ $HWQD /LIH ,QVXUDQFH &RPSDQ\ DQG LWV DƯOLDWHV +HDOWK EHQHƬWV DQG health insurance plans contain exclusions and limitations. 2012001
BACHMAN’S BANTER
BY RONALD E. BACHMAN FSA, MAAA CHAIRMAN EDITORIAL ADVISORY BOARD THE INSTITUTE FOR HEALTHCARE CONSUMERISM
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onservatives have long promoted the expansion of individual not meet basic requirements, such as having a state guarantee association health insurance over employer-based health insurance. Interstate or policies that do not have adequate provider networks. Not every state has insurance purchasing of individual policies was a key item in the a health insurance guarantee association requiring other insurers to assume Republican “Pledge to America,â€? right after tort reform. Cross-state selling of policies if the issuing company goes bankrupt. It is reasonable for other states health insurance also is part of Mitt Romney’s “Repeal and Replaceâ€? health to not want policies from those states be sold to their citizens. If enough states’ vetoes overlapped, insurers based in those frequently reform proposal. Individual ownership makes sense, but only about 5 percent of the vetoed states would be at a competitive disadvantage for selling nationally. policies sold in the United States are to individuals. There are a lot of reasons Those states would have to improve their insurance laws and consumer for the paucity of sales. They lack the same employer-based tax advantages protections to be competitive nationally. Conversely, states with high cost and there is an inadequate financial value for agents selling policies one coverage and regulatory mandates would have to lessen those burdens for at a time. Group sales reach more people faster, and it is a more efficient their in-state companies to compete nationally. Here is the distribution system. “Super Bonusâ€? to this However, there %\ SXWWLQJ VWDWHV LQ FRPSHWLWLRQ IRU QDWLRQDO PDUNHWLQJ RI competitive version of are compelling reasons to promote individual WKHLU KRPH VWDWH LQVXUDQFH FRPSDQLHV WKHUH LV QR VLQJOH RU cross-state selling. The major problem of any sales. Individual policies are portable, while the FHQWUDOL]HG VRXUFH ERDUG RU EXUHDXFUDF\ VHWWLQJ WKH EHQHÂżWV national health reform legislation is at some employer owns group policies. Employees and covered family members are at risk of losing their point the federal government usually defines what is covered and what is not insurance if they change jobs, are laid off, the company drops coverage or covered. Both Republicans and Democrats have fallen into this inevitable trap goes out of business. Additionally, employees only have the coverage choices of national reform. Under ObamaCare, the “essential benefitsâ€? is so controversial the hot the employer makes available to them. The original author of pure cross-state selling concept was the now potato was passed in legislation to the Secretary of Health & Human Services. retired Congressman John Shadegg of Arizona. The federal bill he developed, More than two years after passage, we still do not know the coverage details allowed individuals to purchase insurance from any state, thus in theory, of the ObamaCare insurance plans. But, it’s coming. Under HillaryCare, the benefits were defined in the legislation. The cost increasing choice and circumventing some burdensome and expensive state coverage mandates. The argument against this approach was insurance impact of the legislated benefits ultimately was the cause of that legislation products will be promoted from states with the worst coverages and the fewest being defeated. Under a previous Republican proposal by U.S. Senator Mike consumer protections. That is, cross-state selling would create a “rush to the Enzi (R-Wyo.), states were provided three options for coverage. This is the ultimate evil of federal health reform, the defining of insurance coverage. bottom.â€? By putting states in competition for national marketing of their home One solution to the concerns of pure cross-state selling is to accept the laissez-faire concept of “buyer beware.â€? But insurance is a very complicated state insurance companies, there is no single or centralized source, board or bureaucracy setting the benefits. Benefit provisions and coverages will contract that can and has been easily misunderstood and misrepresented. Until there is more health insurance literacy, another conservative option be developed based on market demands and competition, not lobbyist and is possible. Let the states compete. Today, in a given state, products in all of politically connected vendors. The interstate competition for optimum national the other 49 states are excluded. Under pure cross-state selling, products marketing will create a rush to the acceptable “consensus middle.â€? The concept of a competitive cross-state selling approach would create a in all of the other 49 states would be available for sale. The middle ground free market framework for expanded sales of individual insurance policies. It is of state-based competition offers a solution with a surprise “Super Bonus.â€? The same population who voted for federal officials also elected state not a silver bullet. The discriminatory tax and an effective distribution system insurance commissioners. Any federal cross-state legislation should respect for selling individual polices also have solutions. The competitive cross-state the state laws and state officials elected to protect consumers. Federal cross- idea is not a silver bullet, but it is a darn good start. Let’s get away from the state legislation should give each state insurance commissioner the right to bumper sticker slogans targeting voters and develop real solutions that benefit “vetoâ€? the sale from some number of other states (i.e. up to 25) if they do consumers.
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The Journey to HealthCare Consumerism: $ /RRN %DFN DW ,+& )2580 (DVW Atlanta - Cobb Galleria Centre - April 12-13
LEARN.
A record number of attendees learned from industry thought leaders, Washington insiders and peers who’ve already implemented thriving health care consumerism plans. As the only event 100 percent dedicated to innovative health and benefit management, FORUM East offered 24 workshops and five cutting-edge general sessions focused on the issues that matter most to today’s employers. Visit www.theihccforum.com to see video of our speakers in action.
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CONNECT.
Attendees had the unprecedented opportunity to connect with professionals from across the board, from employers to brokers to health plan providers. But the networking doesn’t have to stop at FORUM. IHC members can stay in touch 24 hours a day, seven days a week via our online community at www.theihcc.com. Register for your free membership today.
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SHARE.
Experts shared best practices, valuable insights and real, actionable solutions. The conversation continues every week on HealthCare Consumerism Radio. Tune in to www.theihcc.com/radio for the latest on the health care consumerism megatrend.
Ready to cut health care costs, engage your employees and get the skinny on current health care legislation? Don’t miss another opportunity to LEARN. CONNECT. SHARE. Register today for 2012 IHC FORUM West in Las Vegas on Sept. 6-7. www.theihccforum.com www.TheIHCC.com I CDHC Solutions™ I May/June 2012
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Couldn’t make it to FORUM East this year? Join us in Las Vegas For FORUM West 2012...
Your Guide on the Journey to HealthCare Consumerism
REGISTER TODAY AND SAVE FORUM WEST 2012
September 6-7
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LEARN. CONNECT. SHARE. FieldMedia LLC is the parent company to CDHC Solutions magazine, EmployersWeb.com, IHC FORUM and The Institute for HealthCare Consumerism. 292 South Main St., Ste 400, Alpharetta, GA 30009
2012
www.theihccforum.com
The Only Conference 100% Dedicated to Innovative Health and Benefit Management LEARN. CONNECT. SHARE. Whether you’re an HR professional, C-suite executive, broker or solution provider, FORUM West offers workshops, general sessions and networking opportunities that address your unique business needs and bottom line. You’ll get up-to-the-minute insights on cutting health care costs, turning disengaged employees into savvy health care consumers and navigating potential policy changes. Speakers include Washington insiders, medical and legal experts, and peers with thriving health care consumerism programs already in place. This year’s general sessions include: t Health Care Reform: A Potential Pothole in the Journey to Health Care Consumerism t Population Health Management: Implementing a Successful Wellness Program t Health Care Cost Transparency Panel: “Right to Know” t Employer Panel: What Health Care Consumerism Means to You Plan to attend a day early for CEU-eligible pre-conference sessions on Health Care Consumerism, Consumerism 101 and Population Health Management. Additional fees apply. Visit www.theihccforum.com for details.
Your Guide on the Journey to HealthCare Consumerism Our opening keynote address, “The Journey to HealthCare Consumerism,” led by industry experts Ron Bachman, Dr. John Reynolds and Dr. Wendy Lynch, will give you a roadmap of the new health and benefit landscape and help you avoid common pitfalls along the way. Gain valuable insights into the current state of health care consumerism, cost-effective plan design and implementation tips, and strategies to engage your workforce in consumer-driven health care. This information-packed session will set the tone for FORUM West, equipping you with the tools you need to successfully navigate your Dr. Wendy Lynch, Ron Bachman, FSA, Dr. John Reynolds, company’s President, Co-director, MAAA, Chairman, health care FIS Healthcare Altarum Center for CDHC Solutions consumerism Solutions Consumer Choice in Editorial Advisory journey. Health Care Board
FORUM WEST 2012
LAS VEGAS
Top 10 Reasons to Attend FORUM West 2012 Don’t gamble with your company’s health and benefit budget. Here are just a few reasons to join us in Las Vegas:
1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
An unprecedented opportunity to LEARN, CONNECT and SHARE with professionals from across the health care consumerism spectrum. Real-life, actionable solutions from peers who have successfully implemented consumer-driven health care programs. What happens in Vegas…can boost your company’s bottom line and help you stay compliant with current health care laws. Access to five cutting-edge general sessions and 24 subject-matter specific workshops to help you design and implement the best possible health plan for your business. An exhibit hall packed with more than 50 industryleading exhibitors, showcasing the latest equipment and technology. The skinny on corporate wellness, employee engagement, incentive programs, HSAs, HRAs, supplemental health coverage and more. The country’s leading health care consumerism thinkers and policy makers—and Wayne Newton—all in one town. Everything you ever wanted to know about consumerdriven health care—including specialized pre-conference sessions and opportunities to earn CEUs from the HR Certification Institute—in just a day and a half. The latest on the 2012 presidential election, the Supreme Court’s decision on the Affordable Care Act and what your company should do to prepare for both. Innovative strategies on how to keep health care costs down (For once, a trip to Vegas will save you money).
YOUR GUIDE ON THE JOURNEY TO HEALTHCARE CONSUMERISM Register Now and Save Don’t miss this opportunity to be at the forefront of the health and benefit management movement. Reserve your spot at FORUM West before July 20, 2012 to receive our special Early Bird rates. FORUM 8FTU t 4FQUFNCFS t 3FE 3PDL 3FTPSU t -BT 7FHBT No industry event offers you more for your money. Join The Institute for HealthCare Consumerism for free and save even more. Already an IHC member? Check your inbox for our weekly e-blast and save using your exclusive member discount code. Visit www.theihccforum.com for details.
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Visit www.theihccforum.com to preview the agenda and register for the conference.
BRIEFS
PEOPLE ON THE MOVE
PEOPLE ON THE MOVE MedEncentive is pleased to announce Cecily M. Hall has joined the DPNQBOZ BT FYFDVUJWF WJDF QSFTJEFOU )BMM UIF GPSNFS EJSFDUPS PG FNQMPZFF CFOFmUT GPS UIF .JDSPTPGU $PSQPSBUJPO IBE CFFO B DPOTVMUBOU UP .FE&ODFOUJWF TJODF 4FQUFNCFS 4IF XJMM BTTVNF IFS OFX QPTJUJPO JO 3FENPOE 8BTI )BMM TQFOU ZFBST BU .JDSPTPGU XIFSF IFS DPOUSJCVUJPOT UP FNQMPZFF CFOFmU design and health care strategies gained national recognition and audiences BU UIF 8IJUF )PVTF XJUI CPUI 1SFTJEFOU $MJOUPO BOE 1SFTJEFOU 0CBNB 1SJPS UP IFS DBSFFS XJUI .JDSPTPGU )BMM IFME NBOBHFNFOU BOE IVNBO SFTPVSDF QPTJUJPOT XJUI SFUBJM HJBOU /PSETUSPN
CDHC INNOVATIONS
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Thomson Reuters Sales Health Care Business to Veritas Capital Thomson  Reuters,  the  world’s  leading  source  of  intelligent  information  IRU EXVLQHVVHV DQG SURIHVVLRQDOV DQQRXQFHG LW KDV HQWHUHG LQWR D GHÂżQLWLYH DJUHHPHQW WR VHOO LWV KHDOWK FDUH EXVLQHVV WR DQ DIÂżOLDWH RI 9HULWDV &DSLWDO for  $1.25  billion  in  cash.  The  sale  is  subject  to  regulatory  approval  and  customary  closing  conditions,  including  the  expiration  or  termination  of  applicable  waiting  periods  under  the  Hart-ÂScott-ÂRodino  Antitrust  Improvements  Act,  and  is  expected  to  close  in  the  next  few  months.  The  sale  is  not  subject  to  any  ¿QDQFLQJ FRQGLWLRQ 9HULWDV KDV REWDLQHG GHEW ÂżQDQFLQJ FRPPLWPHQWV IRU the  transaction.  The  health  care  business  provides  data,  analytics  and  performance  benchmarking  solutions  and  services  to  hospitals,  health  systems,  employers,  health  plans,  government  agencies  and  health  care  professionals.  With  leading  assets  and  solutions  such  as  MarketScan,  Advantage  Suite,  Micromedex,  CareDiscovery  and  ActionOI,  coupled  with  expert  services  and  analysis,  the  health  care  business  provides  its  customers  with  solutions  WR LGHQWLI\ VDYLQJV LPSURYH RXWFRPHV ÂżJKW IUDXG DQG DEXVH DQG PRUH HIÂżFLHQWO\ PDQDJH WKHLU KHDOWK FDUH RSHUDWLRQV “We  are  proud  of  our  colleagues  who  built  a  very  strong  health  care  EXVLQHVV ´ VDLG -DPHV & 6PLWK FKLHI H[HFXWLYH RIÂżFHU RI 7KRPVRQ 5HXWHUV “I  know  they  will  continue  to  serve  their  customers  with  the  same  high  standards  under  new  ownership.  With  the  completion  of  the  divestiture,  Thomson  Reuters  will  be  even  more  focused  on  our  core  global  businesses.â€? Â
Express Scripts, Medco Health Solutions Complete Merger Express  Scripts  completed  its  previously  announced  $29.1  billion  acquisition  of  Medco  Health  Solutions,  creating  the  country’s  leading  health  care  services  company.  The  new  Express  Scripts  combines  best-Âin-Âclass  clinical  expertise  and  innovative  applications  of  behavioral  science  to  improve  patient  health  while  driving  down  the  cost  of  health  care.  Combining  the  companies’  complementary  offerings  will  create  better  models  of  care  and  improve  patients’  adherence  to  prescribed  treatment  regimens.  ³2XU PHUJHU LV H[DFWO\ ZKDW WKH FRXQWU\ QHHGV QRZ ´ VDLG *HRUJH 3D] FKDLUPDQ DQG FKLHI H[HFXWLYH RIÂżFHU ([SUHVV 6FULSWV Âł,W UHSUHVHQWV WKH next  chapter  of  our  mission  to  lower  costs,  drive  out  waste  in  health  care  and  improve  patient  health.  We  remain  focused  on  formulary  management,  20
May/June 2012 I CDHC Solutions™ I www.TheIHCC.com
Castlight Health UIF MFBEJOH QSPWJEFS PG IFBMUI DBSF USBOTQBSFODZ TPMVUJPOT GPS FNQMPZFST BOE QBZFST IBT BOOPVODFE UIF BQQPJOUNFOU PG John Driscoll BT QSFTJEFOU %SJTDPMM CSJOHT NPSF UIBO ZFBST PG IFBMUI DBSF FYQFSJFODF UP UIF QPTJUJPO BOE NPTU SFDFOUMZ TFSWFE BT B HSPVQ QSFTJEFOU BU QIBSNBDZ CFOFmUT MFBEFS .FEDP )FBMUI 4PMVUJPOT 5IF BOOPVODFNFOU DMPTFMZ GPMMPXT $BTUMJHIU T NJMMJPO 4FSJFT % SPVOE PG GVOEJOH 5IF SFDFOU JOWFTUNFOU XJMM FOBCMF UIF DPNQBOZ UP DPOUJOVF JUT TUFFQ HSPXUI USBKFDUPSZ BHHSFTTJWFMZ DBQJUBMJ[F PO UIF TUSPOH EFNBOE GPS IFBMUI DBSF TPGUXBSF TPMVUJPOT BOE FYQBOE JUT TFSWJDFT UP IFMQ DVTUPNFST MPXFS IFBMUI DBSF DPTUT BOE JNQSPWF PVUDPNFT 1SJPS UP $BTUMJHIU %SJTDPMM TFSWFE BT HSPVQ QSFTJEFOU GPS /FX .BSLFUT BU .FEDP
channel  management  and  closing  gaps  in  care,  which  will  allow  us  to  further  improve  the  health  of  people  with  chronic  and  complex  medical  conditions.â€?  As  previously  announced,  the  company  expects  synergies  of  $1  billion  once  fully  integrated,  which  represents  approximately  1  percent  of  the  combined  company’s  costs.  The  transaction  is  expected  to  be  slightly  accretive  to  earnings  per  share  (excluding  integration  and  deal-Ârelated  costs  DQG FKDUJHV LQ WKH ÂżUVW IXOO \HDU DIWHU FORVLQJ DQG PRGHUDWHO\ DFFUHWLYH once  fully  integrated. Â
Catalyst Health Solutions Selected as Pharmacy Benefits Provider for Mercer Collective Catalyst  Health  Solutions  Inc.,  announced  that  Mercer,  one  of  the  ZRUOGÂśV OHDGLQJ KXPDQ UHVRXUFH FRQVXOWLQJ ÂżUPV KDV VHOHFWHG &DWDO\VW Rx  to  participate  in  the  Mercer  Pharmacy  Collective,  making  them  a  SUHIHUUHG SURYLGHU RI SKDUPDF\ EHQHÂżW PDQDJHPHQW 3%0 VHUYLFHV IRU WKH employers  belonging  to  the  Mercer  Pharmacy  Collective.  The  Mercer  Pharmacy  Collective  is  a  group  purchasing  service  focused  RQ LPSURYLQJ WKH PDQDJHPHQW RI HPSOR\HH KHDOWK EHQHÂżWV DQG FXUUHQWO\ includes  240  different  employers  representing  2.2  million  members.  As  a  result  of  being  selected  for  the  collective,  any  plan  sponsor  interested  in  Mercer’s  collective  purchasing  solutions  will  have  access  to  the  new  Catalyst  option  as  well  as  the  existing  options.  ³0HUFHU LV RQH RI WKH OHDGLQJ QDPHV LQ EHQHÂżWV FRQVXOWLQJ DQG WKHLU decision  to  pull  us  into  the  Mercer  Pharmacy  Collective  is  proof  that  the  work  we  have  been  doing  to  maintain  and  enhance  Catalyst’s  position  as  a  world-Âclass  PBM  is  paying  off,â€?  said  Rick  Bates,  president  and  chief  RSHUDWLQJ RIÂżFHU RI &DWDO\VW +HDOWK 6ROXWLRQV Âł%HLQJ FKRVHQ WR SDUWLFLSDWH opens  up  a  new  world  of  opportunity  for  our  business  and  we  are  excited  to  put  our  proven  cost  management  and  clinical  strategies  to  work  for  these  employers.â€? Â
Kaiser Permanente Launches Mix It Up Online Nutrition Program to Encourage Better Eating in Workplace Kaiser  Permanente  has  launched  a  new  online  nutrition  program  designed  for  employers  to  help  their  employees  improve  their  daily  eating  habits  by  including  more  fruits  and  vegetables.  The  Mix  It  Up  program,  IURP +HDOWK:RUNV E\ .DLVHU 3HUPDQHQWH HPSKDVL]HV D YDULHG VHOHFWLRQ
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SpaFinder Inc. BOOPVODFE Betty Weinkle IBT CFFO BQQPJOUFE UP UIF OFXMZ DSFBUFE QPTJUJPO PG WJDF QSFTJEFOU DPSQPSBUF XFMMOFTT 8JUI EFFQ JODFOUJWF JOEVTUSZ FYQFSJFODF 8FJOLMF XJMM TQFBSIFBE UIF DPNQBOZ T OFX DPSQPSBUF XFMMOFTT EJWJTJPO BOE JUT VOJRVF FNQMPZFF NPUJWBUJPO TPMVUJPO GPS UIF CJMMJPO XPSLQMBDF XFMMOFTT JOEVTUSZ 4QB'JOEFS T OFX EJWJTJPO MBVODIFT BT FNQMPZFF XFMMOFTT QSPHSBNT BSF HBUIFSJOH VOQSFDFEFOUFE TUFBN 8JUI FNQMPZFS IFBMUI DBSF DPTUT TQJSBMJOH PVU PG DPOUSPM BOE QFSDFOU PG IFBMUI DBSF EPMMBST HPJOH UP QSFWFOUBCMF DPOEJUJPOT QFSDFOU PG MBSHFS CVTJOFTTFT XPSMEXJEF IBWF OPX JNQMFNFOUFE BO FNQMPZFF XFMMOFTT TUSBUFHZ‰XJUI QFSDFOU PG 6 4 DPSQPSBUJPOT PO CPBSE "OE XJUI TUVEZ BGUFS TUVEZ SFWFBMJOH UIBU FNQMPZFF JODFOUJWFT BSF DSJUJDBM UP QSPHSBN TVDDFTT POMZ POF JO mWF XPSLFST XJMM QBSUJDJQBUF XJUIPVU FRQWLQXHG RQ SDJH
6 5 * 0 / 4 Âť . & 3 $ & 3 $ 0 - - & $ 5 * 7 & Âť ) * ( ) . " 3 , * / $ Âť 7 & 3 * 4 , ) & " - 5 ) Âť & : & . & % 7 * 4 * 0 / $ " 3 & of  colorful  produce  and  introduces  participants  to  healthy  eating  patterns  anyone  can  readily  and  easily  adopt.  There’s  no  calorie  counting,  fat-Âgram  measuring  or  food  weighing  involved. The  Centers  for  Disease  Control  and  Prevention  research  shows  IHZHU WKDQ SHUFHQW RI $PHULFDQ DGXOWV FRQVXPH WKH LGHDO ÂżYH SOXV GDLO\ servings  of  fruits  and  vegetables.  “Employers  are  uniquely  positioned  to  support  employees  in  making  healthy  changes,â€?  says  Jennifer  Christian-ÂHerman,  P.hD.,  executive  director,  HealthWorks  by  Kaiser  Permanente.  “Employees  spend  about  2,000  hours  a  year  at  work,  so  businesses  are  in  a  good  position  to  SURPRWH SUHYHQWLRQ LQĂ€XHQFH HPSOR\HH GHFLVLRQ PDNLQJ DQG VXSSRUW their  workforce  in  living  healthier  lives.â€?   (PSOR\HHV VLJQ XS RQOLQH ZLWK WKH JRDO RI HDWLQJ DW OHDVW ÂżYH VHUYLQJV of  produce  each  day.  Easy-Âto-Âremember  daily  food  selections  include  more  than  120  possible  fruits  and  vegetables. Â
Highmark Inc. Selects Verisk Health’s Analytics Engine to Drive Member Identification, Stratification Verisk  Health  announced  Highmark  Inc.  has  implemented  Verisk  Health’s  analytics  and  clinical  intelligence  solution  to  fuel  Highmark’s  internal  care  management  process.  Highmark,  a  leading  health  plan  serving  more  than  4.9  million  people,  will  use  the  solution  to  improve  the  LGHQWLÂżFDWLRQ DQG VWUDWLÂżFDWLRQ RI KLJK ULVN SRSXODWLRQV WR RSWLPL]H WKH outcomes  of  its  intervention  and  member  engagement  initiatives.  Verisk  Health  is  a  global  leader  in  using  clinical  analytics  and  advanced  technology  to  help  customers  understand  and  use  their  data  to  drive  key  business  goals. “Highmark  is  focused  on  delivering  the  right  care  to  the  right  person,â€?  said  Brian  Day,  Ph.D.,  director  of  advanced  analytics  at  Highmark.  “The  Verisk  Health  intelligence  solution  allows  us  to  identify  proactively  those  individuals  as  well  as  pinpoint  the  appropriate  course  of  action.  The  Verisk  +HDOWK ,GHQWLÂżFDWLRQ DQG 6WUDWLÂżFDWLRQ HQJLQH IHHGV RXU FDUH PDQDJHPHQW ZRUNĂ€RZ WRRO VXSSRUWLQJ FOLQLFDO DQDO\VLV DQG WDUJHWHG RXWUHDFK 7KDW OHDGV WR PHGLFDOO\ VRXQG ÂżQDQFLDOO\ HIIHFWLYH LQWHUYHQWLRQV IRU ERWK RXU commercial  and  Medicare  populations.â€? As  part  of  the  program,  Verisk  Health  will  combine  claims  data  with  care  management  information,  health  risk  assessment  details,  and  other  key  elements  to  create  monthly  extracts  that  support  Highmark’s  clinical  initiatives.  In  addition,  Highmark  will  link  directly  to  member- OHYHO LQIRUPDWLRQ ZLWKLQ LWV FDUH PDQDJHPHQW ZRUNĂ€RZ SURJUDP WR DOORZ clinicians,  at  the  point  of  outreach,  to  gain  a  complete  view  of  a  member’s Â
care,  including  medication  compliance  and  quality  gaps.   “Highmark  has  a  long  track  record  of  driving  business  performance  WKURXJK WKH HIÂżFLHQW LQWHJUDWLRQ RI ULVN PDQDJHPHQW WHFKQRORJLHV DQG LQWHUQDO SURFHVVHV ´ VDLG 1DWKDQ *XQQ 0 ' FKLHI RSHUDWLQJ RIÂżFHU DW 9HULVN +HDOWK Âł7KH RUJDQL]DWLRQ LV QRZ LPSOHPHQWLQJ DQ LQQRYDWLYH approach  to  population  health  management,  which  will  improve  outcomes  for  its  members,  its  clients,  and  its  bottom  line.â€?
EyeMed Vision Care Website Goes Mobile, Offering Convenient Member Accessibility Easily  accessible  vision  care  is  a  hallmark  of  EyeMed  Vision  Care,  where  meeting  members’  needs  is  a  priority.  That’s  why  EyeMed,  part  of  Luxottica  S.p.A.,  a  leader  in  vision  care  and  eyewear,  has  launched  a  mobile  version  of  its  member  website  www.eyemedvisioncare.com  to  provide  members  with  even  greater  convenience. EyeMed  is  known  throughout  the  managed  vision  care  industry  for  making  vision  care  accessible  with  a  robust  network  of  eyecare  professionals,  both  independent  and  retail,  and  many  of  whom  offer  evening  and  weekend  hours.  Independent  studies  have  shown  many  FRQVXPHUV SUHIHU WR XWLOL]H WKHLU YLVLRQ EHQH¿WV RQ HYHQLQJ DQG ZHHNHQGV With  the  enhanced  mobile  website,  EyeMed  now  gives  members  DFFHVV WR YLVLRQ FDUH EHQH¿W LQIRUPDWLRQ VHOI VHUYLFH WRROV WKDW DUH DYDLODEOH anytime  and  anywhere  using  their  mobile  device. Members  can  access  the  site  by  visiting  www.eyemedvisioncare.com  using  their  iPhone,  Android,  Blackberry  or  similar  mobile  device,  whether  at  work,  at  home  or  on  the  road.
UnitedHealthcare Offers New Health Plan Featuring ‘High-Performance Networks’ in California UnitedHealthcare  is  offering  “SignatureValue  Allianceâ€?  in  California,  D QHZ KHDOWK EHQHÂżWV SODQ IHDWXULQJ KLJK SHUIRUPDQFH FDUH SURYLGHU networks  committed  to  delivering  effective,  evidence-Âbased  and  cost- HIÂżFLHQW FDUH The  SignatureValue  Alliance  plan  enables  employers  and  plan  participants  to  save  on  their  health  care  costs  through  lower  premiums  while  still  having  access  to  a  wide  range  of  traditional  and  deductible  HMO  plans.  FRQWLQXHG RQ SDJH www.TheIHCC.com I CDHC Solutions™ I May/June 2012
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UIFN BOE UIFZ JODSFBTF QBSUJDJQBUJPO CZ B NJOJNVN PG QFSDFOU GPVS JO mWF companies now offer some form of corporate incentive reward. Dr. Christine Cassel XJMM MFBWF IFS QPTUT BT QSFTJEFOU BOE $&0 PG UIF American Board of Internal Medicine and the ABIM Foundation JO +VMZ XIFO IFS DVSSFOU UFSN FOET $BTTFM BTTVNFE "#*. T UPQ QPTU JO %VSJOH IFS UFOVSF TIF TQFBSIFBEFE B OVNCFS PG QSPHSBNT PO DFSUJmDBUJPO BOE RVBMJUZ JNQSPWFNFOU JODMVEJOH UIF "#*. 'PVOEBUJPO T SFDFOUMZ MBVODIFE $IPPTJOH 8JTFMZ DBNQBJHO BJNFE BU SFEVDJOH IFBMUI DBSF XBTUF BOE PWFSVTF "O FYQFSU JO UIF mFMET PG HFSJBUSJDT RVBMJUZ JNQSPWFNFOU BOE NFEJDBM FUIJDT $BTTFM T QBTU SPMFT JODMVEF TUJOUT BT QSFTJEFOU PG UIF "NFSJDBO 'FEFSBUJPO GPS "HJOH 3FTFBSDI BOE QSFTJEFOU PG UIF "NFSJDBO $PMMFHF PG 1IZTJDJBOT 4IF IBT TFSWFE PO B OVNCFS PG HSPVQT BOE DPNNJUUFFT JODMVEJOH UIF $PNNPOXFBMUI 'VOE T $PNNJTTJPO PO B )JHI 1FSGPSNBODF )FBMUI 4ZTUFN BOE UIF *OTUJUVUF PG .FEJDJOF T $PNQBSBUJWF &GGFDUJWFOFTT $PNNJUUFF The Patient-Centered Primary Care Collaborative has tapped Beverley H. Johnson and Harlan Levine, M.D. GPS JUT CPBSE PG EJSFDUPST +PIOTPO PG UIF *OTUJUVUF GPS 1BUJFOU BOE 'BNJMZ $FOUFSFE $BSF XJMM BTTVNF UIF
CDHC INNOVATIONS
SXC, Catalyst to Combine, Creating Leading Provider of PBM Services and Health Care Info Tech SXC  Health  Solutions  Corp.  and  Catalyst  Health  Solutions  Inc.  announced  their  boards  of  directors  have  unanimously  approved  a  GHÂżQLWLYH PHUJHU DJUHHPHQW XQGHU ZKLFK 6;& DQG &DWDO\VW ZLOO FRPELQH LQ a  cash  and  stock  transaction  valued  at  approximately  $4.4  billion.  Under  the  terms  of  the  agreement,  Catalyst  shareholders  will  receive  $28.00  in  cash  and  0.6606  shares  of  SXC  stock  for  each  Catalyst  share,  which  implies  a  purchase  price  of  $81.02  per  Catalyst  share  and  a  premium  of  approximately  28  percent  based  on  the  closing  stock  prices  of  SXC  and  Catalyst  on  April  17,  2012. 7KH WUDQVDFWLRQ ZLOO MRLQ 6;&ÂśV LQGXVWU\ OHDGLQJ SKDUPDF\ EHQHÂżW management  (PBM)  tools,  technology  and  expertise  with  Catalyst’s  local  and  collaborative  client-Âcentric  PBM  business  model,  creating  a  leading  independent  provider  of  PBM  solutions.  Together,  SXC  and  Catalyst  will  provide  plan  sponsors,  members  DQG SK\VLFLDQV ZLWK D FRPSUHKHQVLYH VXLWH RI FXVWRPL]HG VROXWLRQV WR reduce  pharmacy  and  health  care  costs  and  improve  patient  outcomes.  Upon  completion  of  the  transaction,  the  combined  company  will  be  an  RUJDQL]DWLRQ ZLWK ELOOLRQ LQ UHYHQXH ZKLFK ZLOO EH KHDGTXDUWHUHG May/June 2012 I CDHC Solutions™ I www.TheIHCC.com
Regence B MFBEJOH IFBMUI QMBO JO UIF /PSUIXFTU *OUFSNPVOUBJO SFHJPO IBT named Lisa Brubaker BT TFOJPS WJDF QSFTJEFOU PG HPWFSONFOU QSPHSBNT TVDDFFEJOH +PBOOF -POH XIP SFUJSFE FBSMJFS UIJT ZFBS *O UIJT SPMF #SVCBLFS XJMM MFBE 3FHFODF T .FEJDBSF .FEJDBJE BOE PUIFS HPWFSONFOU CVTJOFTT #SVCBLFS DPNFT UP 3FHFODF GSPN .71 )FBMUI $BSF B OPU GPS QSPmU IFBMUI QMBO GPDVTJOH PO $PNNFSDJBM .FEJDBSF BOE .FEJDBJE TBGFUZ OFU QSPEVDUT .PTU SFDFOUMZ TIF IFME UIF QPTJUJPO PG FYFDVUJWF WJDF QSFTJEFOU PG HPWFSONFOU QSPHSBNT GPS .71 )FBMUI $BSF ø*O UIJT SPMF #SVCBLFS XBT SFTQPOTJCMF GPS UIF DPNQBOZ T QSPEVDUT QSPmU BOE MPTT PWFSTJHIU .FEJDBSF "EWBOUBHF QSPEVDU FYQBOTJPO BOE NFNCFSTIJQ HSPXUI BOE BDIJFWJOH JUT DPNQFUJUJWF 4UBS 3BUJOHT
6/*5&%)&"-5)$"3& Âť SXC Âť $"5"-:45 Âť )&"-5)45"5
The  Alliance  network  includes  six  large  physician  groups  in  southern  California  and  parts  of  northern  California,  including  90  hospitals  and  about  26,000  physicians  and  specialists.  “UnitedHealthcare  SignatureValue  Alliance  offers  the  quality  and  value  employers  are  looking  for  when  choosing  their  health  coverage  because  it  combines  the  affordability  of  an  HMO  with  access  to  high-Âquality  health  care  professionals,â€?  said  David  Anderson,  CEO,  UnitedHealthcare  of  Southern  California.  “Plan  participants  enjoy  comprehensive  health  EHQHÂżWV FRYHUDJH DQG DFFHVV WR D ZLGH ORFDO FDUH SURYLGHU QHWZRUN RI quality  doctors  and  hospitals.â€? Â
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in  Lisle,  Ill.,  and  will  maintain  a  presence  in  Rockville,  Md.  SXC  also  is  FRPPLWWHG WR &DWDO\VWÂśV LQGXVWU\ UHFRJQL]HG DSSURDFK WR FOLHQW VHUYLFH DQG intends  to  maintain  and  expand  Catalyst’s  proven  ‘’Centers  of  Excellence’’  strategy.
Healthstat Introduces Nation’s First Next Generation Primary Care Center The  latest  game  changer  in  the  quest  to  reform  the  nation’s  health  care  LQGXVWU\ LV D RQH RI D NLQG IXOO VHUYLFH SULPDU\ FDUH RIÂżFH WKDW UHFHQWO\ opened  in  Pensacola,  Fla. Owned  by  Health  Option  Inc.,  a  subsidiary  of  Blue  Cross  and  Blue  Shield  of  Florida  (BCBSF),  and  operated  by  the  country’s  leading  provider  of  on-Âsite  health  centers,  Healthstat  Inc.,  Florida  Blue  Health  Care  Services  LV WKH QDWLRQÂśV ÂżUVW UHWDLO KHDOWK FHQWHU WR SURYLGH D EURDG UDQJH RI SULPDU\ care  services,  such  as  wellness  and  prevention,  care  coordination  and  referral  management,  dispensing  of  most  commonly  prescribed  generic  medications  and  on-Âsite  Quest  Diagnostics  laboratory  services  alongside  health  insurance  plan  offerings. Florida  Blue  Health  Care  Services  is  located  within  the  Florida  Blue  retail  store  in  the  Cordova  Commons  shopping  center  in  Pensacola.  At  the  retail  store,  individuals  may  purchase  health  insurance,  have  face-Âto- face  consultations,  take  advantage  of  basic  health  screenings  and  wellness  events  and  learn  about  various  health  care  options.  Healthstat  physicians,  nurse  practitioners,  care  coordinators  and  support  staff  that  work  at  the  clinic  deliver  a  new  dimension  of  service  by  treating  both  acute  and  long-Âterm  health  conditions  with  a  focus  on  prevention.  The  clinical  staff  places  particular  emphasis  on  high-Ârisk  health  and  disease  management,  which  has  the  greatest  impact  on  improving  patient  health  and  reducing  medical  costs.  Medical  services  are  available  to  individuals  age  12  and  up,  who  are  covered  under  a  Blue  Cross  and  Blue  Shield  health  plan.
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NOMINATE & RECOGNIZE INNOVATIVE HEALTH & BENEFITS MANAGERS
The  Leading  Annual  Awards  Issue  from  TheIHCC.com  —  Publishers  of  CDHC  Solutions  Magazine
Do you know someone who goes the extra mile as a creative problem solver and innovator? The  Institute  for  HealthCare  Consumerism  (www.theihcc.com)  is  looking  for  the  industry’s  true  superstars—professionals  in  health  care  DQG EHQH¿ W PDQDJHPHQW LQFOXGLQJ HPSOR\HUV VROXWLRQV SURYLGHUV brokers,  TPAs  and  HR  managers,  who  have  excelled  at  implementing  solutions  to  complex  W! KHDOWK FDUH EHQH¿ WV NE      HR  Visionary  of  the  Year   issues.  Superstars      Award,  Sponsored  by:  will  be  published  December  2012  in  our  annual  HealthCare  Consumerism  Superstars  issue  and  To  formally  recognize  human  will  be  accessible  to  UHVRXUFH DQG EHQH¿ WV SURIHVVLRQDOV more  than  70,000  who  are  promoting  healthy  sight  to  readers.
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John  J.  Robbins  Sr.,  Memorial  CEO  Leadership  Award:  To  an  outstanding  leader  of  any  size  organization  who  is  an  exceptional  businessperson,  as  well  as  a  successful  parent  and  pillar  of  the  com- munity. CEO  Leadership  Award:  To  an  outstanding  leader  of  any  size  organization,  who  embraces  supports  and  endorsed  an  innovative  KHDOWK FDUH RU EHQH¿ WV SURJUDP Most  Innovative  Plan  Design  Award 7R DQ +5 %HQH¿ WV H[HFX WLYH ZKR LGHQWL¿ HG DQG VROYHG D SUREOHP XVLQJ DQ LQQRYDWLYH KHDOWK FDUH RU EHQH¿ WV SURJUDP Most  Effective  Plan  Implementation  Award:  To  an  HR/Ben- H¿ WV WHDP WKDW VXFFHVVIXOO\ LPSOHPHQWHG D KHDOWK FDUH RU EHQH¿ WV program  and  exceeded  goals  or  reaped  unanticipated  awards. Most  Innovative  Employee  Education/Communication  Award:  To  an  employer,  who  designed  and  implemented  tools  for  their  employees  that  exceeded  plan  participation.
their  workforce  through  superior  YLVLRQ FDUH EHQH¿ WV RIIHULQJV DQG education.
Most  Innovative  Employee  Empowerment  Award:  To  an  employer,  who  designed  and  implemented  tools  that  had  a  high  HQJDJHPHQW RI HPSOR\HH SDUWLFLSDWLRQ LQ D KHDOWK FDUH RU EHQHÂż WV program.  ■ Most  Effective  Population  Health  &  Wellness  Award:  To  an  employer  who  uses  the  most  innovative  method  to  reduce  absentee- ism  and  chronic  disease  costs  to  improve  overall  employee  health.  ■ Public  Policy  Leadership  Award:  An  individual  who  encourages  health  care  consumerism  in  public  policy  through  legislation.  ■ Most  Effective  Solution  Provider  Award:  To  a  solution  provider  ZKR LQWURGXFHV WKH PRVW LQQRYDWLYH KHDOWK FDUH RU EHQHÂż W VROXWLRQ â– Â Most  Innovative  Partner-ÂConsultant  Award;  To  a  consultant  ZKR ZRUNHG PRVW HIIHFWLYHO\ ZLWK DQ +5 %HQHÂż WV WHDP WR LPSOHPHQW D KHDOWK FDUH RU EHQHÂż WV SURJUDP â– Â Most  Innovative  Broker  Award:  To  a  broker,  who  learned  a  cli- ent’s  needs  and  provided  the  most  effective  solution  for  the  employer. â– Â
NOMINATION CATEGORIES: Nomination  Categories  for  500  -  2500  employees,  2501  -  7500  employees,  and  7500+  employees
For details, please visit www.theihcc.com. Nominations close October 1, 2012. E-mail your Superstar nomination to nominations@fieldmedia.com or nominate online.
JOHN HICKMAN Âť PARTNER Âť ALSTON & BIRD, LLP NATASHA L. RANKIN Âť EXECUTIVE DIRECTOR THE EMPLOYERS COUNCIL ON FLEXIBLE COMPENSATION
HSA/FSA/HRA ADMIN AND FINANCE
Constitutional or Not: ACA Creates Turbulent Times for Account-based Plans
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PSOR\HUV RI DOO VL]HV FRQWLQXH WR WXUQ WR FRQVXPHU GLUHFWHG DFFRXQW cases.  For  that  reason,  it  should  be  noted  current  regulations  provide  an  EDVHG SODQV VSHFLÂżFDOO\ Ă€H[LEOH VSHQGLQJ DUUDQJHPHQWV )6$V DSSDUHQW H[FHSWLRQ IURP WKH FDS SURKLELWLRQ IRU DQ\ +5$ VDWLVI\LQJ WKH GHÂż- health  reimbursement  arrangements  (HRAs)  and  health  savings  QLWLRQ RI D ³ÀH[LEOH VSHQGLQJ DFFRXQW´ XQGHU ,5& 6HFWLRQ F 7KLV PHDQV DQ +5$ ZLWK D PD[LPXP EHQHÂżW RI OHVV WKDQ ÂżYH WLPHV WKH DQQXDO &2%5$ accounts  (HSAs)  to  help  address  increasing  health  care  costs. Now,  more  than  two  years  after  the  passage  of  health  care  reform,  a  cost  of  such  coverage  may  be  exempt  from  the  annual  cap  prohibition. HRAs  also  must  begin  compliance  initiatives  with  a  host  of  additional  number  of  looming  Affordable  Care  Act  (ACA)  deadlines  and  mandates  must  be  addressed  in  order  for  such  plans  to  continue  to  be  in  compliance.  While  ACA  requirements  including: ‡ H[WHUQDO UHYLHZ REOLJDWLRQV IRU +5$V WKDW PDNH PHGLFDO MXGJPHQW many  may  hope  the  ACA  will  ultimately  be  found  to  be  unconstitutional,  we  decisions; highlight  several  of  these  compliance  issues  below—just  in  case. ‡ ÂżUVW GROODU FRYHUDJH IRU SUHYHQWLYH FDUH PDQGDWHV LQFOXGLQJ SRVVLEO\ 0RVW )6$V DUH H[FHSWHG EHQHÂżWV DV GHÂżQHG XQGHU +,3$$ UHJXODWLRQV IXQGLQJ FRQWUDFHSWLYH EHQHÂżWV IRU H[HPSW UHOLJLRXV SODQ VSRQVRUV and  are  exempt  from  the  more  troublesome  aspects  of  the  ACA.  FSA  ‡ UHSRUWLQJ DQG GLVFORVXUH UHTXLUHPHQWV LQFOXGLQJ WKH VXPPDU\ RI SODQ VSRQVRUV DQG DGPLQLVWUDWRUV DUH VXIÂżFLHQWO\ HTXLSSHG WR KDQGOH WKH EHQHÂżWV FRYHUDJH DQG HPSOR\HU FUHGLWDEOH FRYHUDJH UHSRUWLQJ prescription  requirement  for  over-Âthe-Âcounter  drugs,  the  $2,500  cap  for  FSA  ‡ SD\PHQW RI &(5 IHHV IRU WKH SODQ \HDU DQG salary  reductions  and  eligibility  issues  for  children  up  to  age  26.  There  is  even  ‡ UHLQVXUDQFH SRRO DVVHVVPHQWV EHJLQQLQJ LQ a  bit  of  potential  good  news  for  health  FSAs  in  that  the  agencies  are  carefully  considering  allowing  some  funds  to  carryover  and  not  be  subject  to  use-Âit  +5$ EHQHÂżWV DOVR ZLOO QHHG WR EH UHSRUWHG RQ : XSRQ H[SLUDWLRQ RI or-Âlose  it  due  to  the  ACA’s  $2,500  cap. /LNHZLVH )6$V WKDW DUH H[FHSWHG EHQHÂżWV DYRLG WKH RQHURXV VXP- WKH FXUUHQW WUDQVLWLRQ SHULRG UXOH )LQDOO\ OLNH )6$V +5$ EHQHÂżWV PXVW EH PDU\ RI EHQHÂżWV FRYHUDJH 6%& UHTXLUHPHQW DQG VDODU\ UHGXFWLRQ )6$V included  for  purposes  of  calculating  the  Cadillac  plan  tax. HSAs  avoid  many  of  the  regulatory  requirements  under  the  ACA  will  generally  be  exempt  from  the  W-Â2  reporting  requirement.  The  biggest  because  they  are  not  generally  LVVXH IRU H[FHSWHG EHQHÂżW )6$V is  the  uncertain  impact  of  the  7KH $&$ KDV PDGH WKH DGPLQLVWUDWLRQ RI DFFRXQW considered  to  be  health  plan  coverage.  By  way  of  direct  regu- so-Âcalled  “Cadillac  taxâ€?  in  2018. In  addition,  certain  FSAs  EDVHG SODQV PRUH FRPSOH[ %XW HPSOR\HU LQWHUHVW LQ lation,  the  ACA  did  increase  the  that  fail  to  qualify  as  HIPAA  VXFK DUUDQJHPHQWV ZLOO FRQWLQXH WR LQFUHDVH SHUKDSV penalty  for  using  HSA  funds  for  non-Âmedical  purposes  to  a  20  H[FHSWHG EHQHÂżWV H J EHFDXVH they  extend  coverage  to  a  broad- GUDPDWLFDOO\ LI WKH $&$ LV IRXQG WR EH &RQVWLWXWLRQDO percent  excise  tax,  plus  applica- ble  income  taxes,  and  it  requires  er  “footprintâ€?  of  employees  than  a  prescription  for  OTC  drugs. primary  health  coverage  or  are  However,  more  dramatically  is  the  potential  for  collateral  damage  to  funded  by  non-Âmatching/non-Âcashable  employer  credits  of  over  $500)  are  HSA  viability  as  a  result  of  ACA’s  regulation  of  the  underlying  high-Âdeductible  subject  to  the  full  panoply  of  ACA  mandates. +5$V KDYH D VLJQLÂżFDQWO\ JUHDWHU FRPSOLDQFH EXUGHQ XQGHU WKH $&$ health  plan  (HDHP)  coverage,  especially  in  the  fully-Âinsured  market.  Some  LI WKH\ IDLO WR TXDOLI\ DV +,3$$ H[FHSWHG EHQHÂżWV )RU WKLV SXUSRVH RQO\ of  this  concern  has  been  allayed  recently  when  the  agencies  indicated  that  a  D VPDOO SHUFHQWDJH RI +5$V ZLOO TXDOLI\ DV H[FHSWHG EHQHÂżWV L H +5$V portion  of  an  employer’s  contribution,  but  not  salary  reductions,  to  an  HSA  restricted  to  retirees  only,  or  HRAs  that  reimburse  solely  vision  or  dental  could  count  toward  the  actuarial  valuation  requirements  for  the  underlying  coverage.  In  most  cases,  general  purpose  HRAs  will  be  subject  to  all  of  the  HDHP  plans. Finally,  as  with  FSAs  and  HRAs,  in  2018,  employer  contributions  to  ACA  requirements. Most  troublesome  is  the  ACA’s  prohibition  on  annual  or  lifetime  an  HSA,  likely  including  salary  reductions,  must  be  counted  for  purposes  of  EHQHÂżW FDSV 7KH (PSOR\HUV &RXQFLO RQ )OH[LEOH &RPSHQVDWLRQ (&)& KDV the  Cadillac  tax. The  ACA  has  made  the  administration  of  account-Âbased  plans  more  commented  to  the  agencies  that  the  annual  cap  prohibition  should  not  apply,  complex.  But,  employer  interest  in  such  arrangements  will  continue  to  DV DQ +5$ DFFRXQW EDODQFH LV QRW WKH HTXLYDOHQW RI DQ DQQXDO EHQHÂżW FDS Unfortunately,  the  agencies  seem  to  have  taken  a  less  favorable  view,  increase,  perhaps  dramatically,  if  the  ACA  is  found  to  be  Constitutional. %H VXUH WR MRLQ (&)& LQ $XJXVW DW WKH WK )OH[LEOH %HQHÂżWV including  HRAs  generally  but  clarifying  HRAs  linked  to  or  otherwise  inte- grated  with  compliant  coverage  can  continue.  Stand-Âalone  HRAs,  other  than  Administrators’  Symposium  in  Chicago,  as  we  provide  a  timely  update  that  +,3$$ H[FHSWHG EHQHÂżWV ZLOO EH VXEMHFW WR WKH SURKLELWLRQ RQ FDSV LQ PRVW you  won’t  want  to  miss.  For  more  information,  go  to  www.ecfc.org.   www.TheIHCC.com I CDHC Solutions™ I May/June 2012
25
BY JEFF BROWN SENIOR VICE PRESIDENT & CHIEF MARKETING OFFICER COLONIAL LIFE & ACCIDENT INSURANCE COMPANY
POPULATION HEALTH MANAGEMENT
Making Wellness Work &NQMPZFST DBO .BYJNJ[F &NQMPZFF 8FMMOFTT *OJUJBUJWFT 8JUI (PPE #FOFmUT $PNNVOJDBUJPO
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HDUFKLQJ IRU ZD\V WR WULP EHQHÂżWV FRVWV HPSOR\HUV DUH ORRNLQJ PRUH closely  at  wellness  initiatives. (PSOR\HUV RI DOO VL]HV DUH IHHOLQJ WKH VTXHH]H IURP ULVLQJ EHQHÂżWV costs—as  if  the  economy,  expense  management  and  ever-Âshrinking  resources  weren’t  bad  enough.  And  while  there’s  no  single  answer  to  NHHSLQJ EHQHÂżWV FRVWV XQGHU FRQWURO PDQ\ FRPSDQLHV ÂżQG ZHOOQHVV initiatives,  when  done  right  and  communicated  properly,  can  offer  an  effective  way  to  save  money.
Wellness Initiatives Popular Among Employers as a Cost-control Strategy Wellness  initiatives  were  among  the  top  cost-Âcontrol  strategies  implemented  by  employers,  according  to  a  2011  survey  by  the  Government  )LQDQFH 2IÂżFHUV $VVRFLDWLRQ DQG &RORQLDO /LIH $FFLGHQW ,QVXUDQFH Company.  Nearly  80  percent  of  respondents  say  they  added  wellness  LQLWLDWLYHV WR WKHLU EHQHÂżWV SURJUDPV DQG SHUFHQW RI WKRVH UHVSRQGHQWV would  recommend  them  to  others.  Nearly  two-Âthirds  strongly  recommend  them.  This  aligns  with  last  year’s  Society  for  Human  Resources  Management  report  that  showed  75  percent  of  employers  supply  their  workforce  with  wellness  resources  and  information.  Companies  not  already  on  board  the  wellness  bandwagon  plan  to  hop  on  soon.  A  2011  survey  of  government  employers  by  the  International  Public  Management  Association  for  Human  Resources  showed  51  percent  plan  to  implement  wellness  programs  or  promote  healthy  behaviors  within  a  year. It’s  not  hard  to  understand  why  employers  are  embracing  wellness.  The  return  on  investment  for  companies  offering  wellness  programs  looks  SUHWW\ FRPSHOOLQJ UHJDUGOHVV RI FRPSDQ\ VL]H )RU HYHU\ GROODU LQYHVWHG in  wellness  programs,  companies  save  up  to  $6  on  health  insurance  costs,  according  to  a  2010  University  of  Michigan  study.
Employees Also Like Wellness Programs Employees  respond  positively  to  wellness  programs  and  are  motivated  by  them.  A  2010  Principal  Financial  survey  of  employees,  who  ZRUN DW VPDOO DQG PLG VL]HG FRPSDQLHV XQGHUVFRUHV WKH YDOXH RI KHDOWK oriented  initiatives. ‡ 1HDUO\ KDOI RI HPSOR\HHV SHUFHQW VWURQJO\ DJUHH RU VRPHZKDW agree  having  an  employer-Âsponsored  wellness  program  would  encourage  them  to  stay  in  their  current  job. ‡ )RUW\ WKUHH SHUFHQW VWURQJO\ DJUHH RU VRPHZKDW DJUHH ZHOOQHVV EHQHÂżWV HQFRXUDJH WKHP WR ZRUN KDUGHU DQG SHUIRUP EHWWHU ‡ 7KLUW\ VHYHQ SHUFHQW RI HPSOR\HHV DJUHH WKH\ KDYH PRUH HQHUJ\ to  be  more  productive  at  work  by  participating  in  a  wellness  program.
Benefits Communication Helps Increase Participation )RU ZHOOQHVV SURJUDPV WR EH HIIHFWLYH HPSOR\HHV PXVW ¿UVW NQRZ DERXW them.  They  can’t  participate  if  they  don’t  know  what’s  offered.  According  to  Towers  Watson,  58  percent  of  employers  report  low  engagement  as  the  greatest  obstacle  to  their  wellness  initiatives.  Some  possible  reasons  for  poor  participation  include: ‡ (PSOR\HHV PD\ DVVXPH ZHOOQHVV SURJUDPV DUH RQO\ PHDQW IRU individuals  with  existing  health  conditions. ‡ (PSOR\HHV ODFN DGHTXDWH HGXFDWLRQ DERXW WKH UHVRXUFHV DYDLODEOH to  them. ‡ (PSOR\HHV GRQœW UHFHLYH FOHDU FRPPXQLFDWLRQ ZKHQ WKH ZHOOQHVV SURJUDP LV ¿UVW LQWURGXFHG DQG LPSOHPHQWHG
A Personal Approach to Benefits Communication Improves Participation 6RPHWLPHV DOO WKDWÂśV QHHGHG WR JHW HPSOR\HHV LQYROYHG LV MXVW ÂżQH WXQLQJ D FRPSDQ\ÂśV EHQHÂżWV FRPPXQLFDWLRQ HIIRUWV &RPPXQLFDWLRQ activities  can  take  many  forms.  Some  companies  adopt  wellness  “cham- pionsâ€?  or  ambassadors  who  help  spread  enthusiasm  about  the  program  WKURXJKRXW WKH RUJDQL]DWLRQ 2WKHU EXVLQHVVHV LQFOXGH UHJXODU DUWLFOHV LQ WKHLU FRPSDQ\ QHZVOHWWHUV RU GLVWULEXWH SHUVRQDO EHQHÂżWV VWDWHPHQWV KLJK- lighting  their  total  compensation  package.  Some  companies  simply  turn  to  outside  resources  for  communication  support.  6RPH EHQHÂżWV FDUULHUV RIIHU RQH WR RQH EHQHÂżWV FRXQVHOLQJ VHUYLFHV DV SDUW RI WKHLU HQUROOPHQW SDFNDJH 7KLV LQGLYLGXDO SHUVRQDOL]HG FRPPX- nication  provides  consistent  messages  to  help  employees  understand  the  ZHOOQHVV VHUYLFHV DYDLODEOH WR WKHP DQG WKH EHQHÂżWV RI SDUWLFLSDWLRQ 6RPH carriers  even  offer  these  communication  services  at  no  cost.  6XUYH\V RI HPSOR\HHV ZKR PHHW LQGLYLGXDOO\ ZLWK EHQHÂżWV FRXQVHORUV during  enrollment  prove  the  effectiveness  of  the  one-Âto-Âone  method.  Virtually  all  (96  percent)  employees  surveyed  by  Colonial  Life  say  personal  EHQHÂżWV FRXQVHOLQJ LPSURYHG WKHLU XQGHUVWDQGLQJ RI WKHLU EHQHÂżWV and  this  type  of  communication  is  important  (98  percent).  In  addition,  employee  morale  can  improve  as  workers  begin  to  feel  better  about  themselves  and  their  employers.
Make Wellness Work for Your Company Rising  costs  don’t  have  to  take  a  toll  on  your  employee  wellness  LQLWLDWLYHV 0D[LPL]H ZKDW \RX DOUHDG\ RIIHU ZLWK SHUVRQDO EHQH¿WV communications  that  make  wellness  work  for  you.   )RU PRUH LQIRUPDWLRQ FDOO &RORQLDO /LIH DW &RORQLDO /LIH RIIHUV H[FHSWLRQDO RSSRUWXQLWLHV WR MRLQ LWV H[SDQGLQJ VDOHV IRUFH RI PRUH WKDQ FDUHHU DJHQWV LQ RQH RI WKH IDVWHVW JURZLQJ VHJPHQWV RI WKH LQVXUDQFH LQGXVWU\ 7KH FRPSDQ\ SURYLGHV DZDUG ZLQQLQJ WUDLQLQJ WKDW KDV UHFHLYHG QDWLRQDO UHFRJQLWLRQ IRU H[FHOOHQFH )RU PRUH LQIRUPDWLRQ YLVLW ZZZ &RORQLDO/LIH FRP RU FDOO www.TheIHCC.com I CDHC Solutions™ I May/June 2012
27
BY SHARON GLAVE FRAZEE, PHD, MPH VICE PRESIDENT RESEARCH & ANALYSIS EXPRESS SCRIPTS
PHARMACY BENEFITS MANAGEMENT
Being Proactive When Making Better Pharmacy-related Spending Decisions
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Another  area  of  waste  ost  consumers  $ UHFHQW VXUYH\ RI FRQVXPHUV FXUUHQWO\ WDNLQJ in  pharmacy-Ârelated  spend- think  of  themselves  ing  is  medication  adherence.  as  making  smart,  DW OHDVW RQH SUHVFULSWLRQ PHGLFDWLRQ UHJXODUO\ Express  Scripts  research  esti- informed  choices  based  on  their  preferences.  And  yet,  VKRZHG SHUFHQW FXUUHQWO\ XVLQJ D EUDQG QDPH mates  non-Âadherence  waste  to  be  $317  billion  annually.  as  research  often  shows,  we  GUXJ ZRXOG SUHIHU D ORZHU FRVW JHQHULF When  a  patient  does  not  take  allow  decisions  to  be  made  by  medications  as  prescribed,  it  default.  That’s  because  people  can  lead  to  worse  medical  out- are  wired  for  inattention.  The  human  brain  can  process  10  to  12  million  bits  per  second—about  comes  along  with  unnecessary  hospital  admissions,  physician  visits  and  the  same  as  the  original  Ethernet  cable.  Of  that,  conscious  thought,  the  lab  tests  and  related  expenses.  There  are  simple  steps  you  can  take  that  will  save  you  money,  reduce  portion  of  the  brain  of  which  we  are  directly  aware,  is  capped  at  50  bits  health  care  waste  and  curb  escalating  health  care  costs:  per  second. Saving  for  retirement  is  a  good  example  of  this  50  bits  constraint.  t 'JOE MFTT FYQFOTJWF BMUFSOBUJWFT Most  people  know  they  should  invest  in  their  401(k).  It  is  an  important   If  you’re  interested  in  a  lower-Âcost  option,  commit  to  calling  your  step  for  the  future  and  the  contribution  match  offered  by  many  employers  doctor  today.  If  you  don’t,  you’re  likely  to  keep  putting  it  off.  amounts  to  tax-Âfree  income.  And  yet,  when  offered  the  opportunity  to  participate,  only  30  to  40  percent  of  eligible  employees  enroll.  t )BWF QSFTDSJQUJPOT EFMJWFSFE UP ZPVS IPNF The  same  concept  holds  true  for  pharmacy-Ârelated  spending   Home  delivery  for  maintenance  medications—those  treating  decisions,  such  as  where  to  purchase  prescription  medication  and  whether  chronic  diseases  like  diabetes,  high  blood  pressure  or  high  or  not  to  choose  a  lower-Âcost  alternative.  Such  choices  never  rate  highly  cholesterol—can  save  money.  Copays  for  home  delivery  are  usually  enough  for  our  “50  bitsâ€?  to  be  actively  engaged.  lower  because  mail-Âorder  pharmacies  have  lower  dispensing  fees  More  often  than  not  the  only  choices  we  make  are  about  things  either  and  can  obtain  better  unit  pricing.  pressing  or  pleasurable.  Everything  else  gets  put  off  for  later,  or  decided  by  default.  That  is  why,  rather  than  sign  up  to  receive  routine  medications  t 4JHO VQ GPS BVUP SFmMMT E\ KRPH GHOLYHU\²ZKLFK LV OHVV H[SHQVLYH DQG PRUH HIÂżFLHQW²ZH ÂłGHIDXOW´ ,WÂśV IUHH DQG FUHDWHV D UHJXODU UHÂżOO VFKHGXOH ,W DOVR VDYHV WLPH DQG LQWR ÂżOOLQJ SUHVFULSWLRQV DW UHWDLO SKDUPDFLHV money,  and  it  reduces  the  changes  of  missing  a  dose.  A  recent  survey  of  consumers,  currently  taking  at  least  one  prescription  medication  regularly,  showed  82  percent  currently  using  a  t #F BEIFSFOU brand-Âname  drug  would  prefer  a  lower-Âcost  generic.  And  yet,  in  research   Consider  using  a  timer  or  other  reminder  device  to  help  you  take  published  in  the  ([SUHVV 6FULSWV 'UXJ 7UHQG 5HSRUW,  as  a  nation  we  your  medication  as  prescribed.  Make  sure  you  have  scheduled  waste  $49.8  billion  a  year  by  continuing  to  use  higher-Âcost  medication  your  next  visit  to  your  physician  in  advance  of  when  you  will  need  when  a  clinically  equivalent,  lower-Âcost  generic  is  available.  any  prescriptions  renewed;  if  you  wait  until  you  have  no  more  Clearly,  there  is  a  gap. UHÂżOOV \RX PD\ QRW EH DEOH WR JHW DQ DSSRLQWPHQW LQ WLPH One  of  the  challenges  is  consumers  often  think  of  cost  in  terms  of  the  present,  not  cumulatively,  but  the  difference  can  add  up.  Pharmaceutical  6KDURQ *ODYH )UD]HH 3K' 03+ LV YLFH SUHVLGHQW UHVHDUFK DQDO\VLV IRU ([SUHVV 6FULSWV 'U Research  and  Manufacturers  of  America  (PhRMA)  estimates  32  million  )UD]HH MRLQHG ([SUHVV 6FULSWV LQ 6KH LV UHVSRQVLEOH IRU WKH GHYHORSPHQW DQG H[HFXWLRQ RI Americans  take  three  or  more  medications  daily.  If  the  difference  in  cost  ([SUHVV 6FULSWV UHVHDUFK VWUDWHJ\ WR HYDOXDWH WKH LPSDFW RI SURJUDPV DQG VHUYLFHV RQ KHDOWK between  a  brand-Âname  drug  and  a  lower-Âcost  option  is,  on  average,  $10  RXWFRPHV XWLOL]DWLRQ DQG FRVW 'U )UD]HH KDV DQ HDUQHG GRFWRUDWH IURP 1RUWK &DUROLQD 6WDWH 8QLYHUVLW\ DQG D 03+ IURP WKH 8QLYHUVLW\ RI 1RUWK &DUROLQD Âą &KDSHO +LOO *LOOLQJV SHU PHGLFDWLRQ IRU HDFK GD\ UHÂżOO WKDW DGGV XS WR LQ DGGLWLRQDO 6FKRRO RI *OREDO 3XEOLF +HDOWK +HU DUHDV RI H[SHUWLVH LQFOXGH PHGLFDO VRFLRORJ\ VWDWLVWLFV unnecessary,  spending  annually.  Multiplied  by  millions  of  patients,  the  UHVHDUFK PHWKRGV SUHGLFWLYH PRGHOLQJ DQG SURJUDP HYDOXDWLRQ 'U )UD]HH KDV ERWK DQ H[WHQVLYH EDFNJURXQG LQ KHDOWK FDUH DQG RXWFRPHV UHVHDUFK DQG KDV DXWKRUHG QXPHURXV cost  soars.  UHVHDUFK DUWLFOHV ERRN FKDSWHUV DQG ZKLWH SDSHUV LQ KHDOWK FDUH DV ZHOO DV LQ YDULRXV DUHQDV RI KXPDQ EHKDYLRU
www.TheIHCC.com I CDHC Solutions™ I May/June 2012
29
BENEFIT COMMUNICATIONS
BY BRYAN K. BRENNER Âť CEO FIRSTPERSON
Employee Benefits Communications: Say Something
E
IIHFWLYHO\ FRPPXQLFDWLQJ HPSOR\HH EHQHÂżWV LV DQ HYROYLQJ task,  shifting  with  each  new  social  media  outlet,  technological  advancement  and  health  care  reform  mandate. Employers  get  the  most  of  workplace  engagementâ&#x20AC;&#x201D;and  protect  their  bottom  lineâ&#x20AC;&#x201D;by  using  online  platforms  to  their  advantage,  while  UHFRJQL]LQJ WKH GLIIHUHQFH LQ EHQHÂżWV FRPPXQLFDWLRQ DQG GHOLYHU\ preferences  among  employees  of  varying  generations. ,Q LQ WKH WK DQQXDO 0HĂ&#x20AC;LIH 6WXG\ RI (PSOR\HH %HQHÂżW 7UHQGV 70  percent  of  Gen  Y  workers  expressed  interest  in  employers  providing  RQOLQH WRROV IRU ÂżQDQFLDO HGXFDWLRQ FRPSDUHG WR SHUFHQW RI ROGHU employees  in  the  survey. +DYLQJ D FOHDU EHQHÂżW FRPPXQLFDWLRQV VWUDWHJ\ DOVR LV NH\ WR UHWHQWLRQ $FFRUGLQJ WR WKH $Ă&#x20AC;DF :RUN)RUFHV 5HSRUW SHUFHQW of  workers  said  they  would  be  less  likely  to  leave  if  they  had  a  well- FRPPXQLFDWHG EHQHÂżWV SURJUDP ,Q RWKHU ZRUGV 6D\ VRPHWKLQJ +HUH DUH QLQH ZD\V WR FDSLWDOL]H RQ WUHQGV LQ VSUHDGLQJ WKH ZRUG DERXW HPSOR\HH EHQHÂżWV t 6TF UFDIOPMPHZ UP JNQSPWF FOHBHFNFOU  Overwhelming  your  employees  with  information  via  email  is  counterproductive.  Use  email  sparingly  and  only  for  important  information.  Instead,  turn  to  your  intranet,  a  blog,  Twitter,  YouTube  and  even  Facebook  to  get  in  front  of  employees.  The  New  York  Times  reported  roughly  200  million  Americans,  or  two-Âthirds  of  the  population  currently  use  Facebook,  spanning  Gen  Y  to  older  employees  in  the  workplace.  Your  employees  already  are  thereâ&#x20AC;&#x201D;you  just  need  a  way  to  get  in  front  of  them.  If  your  legal  department  is  worried  about  privacy,  commit  to  sharing  only  general  information  and  donâ&#x20AC;&#x2122;t  forget  about  incentives  for  your  followers.  The  employer  should  hold  drawings  on  a  monthly  basis  on  Facebook  and  Twitter  to  keep  up  interest.  Create  a  fun  YouTube  video  to  break  the  ice,  or  regular  education  videos  to  engage  younger  employees.  t 3FNPWF CBSSJFST UP JOGPSNBUJPO  Do  employees  need  login  credentials  WR YLHZ HYHQ EDVLF EHQHÂżW LQIRUPDWLRQ" &RQVLGHU SRVWLQJ LPSRUWDQW documents  in  areas  where  passwords  are  not  required.  Spouses  should  be  able  to  access  items  with  ease,  as  will  as  prospective  employees.  If  youâ&#x20AC;&#x2122;re  worried  about  privacy  or  a  competitor  viewing  your  companyâ&#x20AC;&#x2122;s  information,  pare  down  your  existing  communication  items  so,  at  the  minimum,  itâ&#x20AC;&#x2122;s  easy  to  see  who  your  third  party  administrator  or  carrier  is  and  how  to  contact  them.  t &EVDBUJPO JT B ZFBS SPVOE JOJUJBUJWF  Donâ&#x20AC;&#x2122;t  wait  until  your  next  open  HQUROOPHQW WR EHJLQ WKH EHQHÂżWV GLVFXVVLRQ +HDOWK FDUH UHIRUP is  constantly  in  the  mediaâ&#x20AC;&#x201D;use  hot  topics  as  a  starting  point  for  your  conversations.  Consumerism  also  is  an  area  employees  will  LGHQWLI\ ZLWK ,I \RXÂśUH RQO\ WDONLQJ DERXW EHQHÂżWV RQH WLPH D \HDU youâ&#x20AC;&#x2122;re  missing  opportunities. t 5BLF B TUBOE :K\ GRHV \RXU FRPSDQ\ RIIHU EHQHÂżWV LQ WKH ÂżUVW SODFH" <RX GRQÂśW KDYH WR FRPPLW WR RIIHULQJ EHQHÂżWV IRUHYHU RU
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promising  something  you  canâ&#x20AC;&#x2122;t  deliver.  Create  and  share  a  mission  VWDWHPHQW IRU \RXU EHQHÂżW SODWIRUP ,V \RXU JRDO WR LPSURYH WKH lives  of  employees  and  their  families?  To  attract  and  retain  key  talent?  To  improve  productivity  and  make  your  company  a  leader  LQ WKH ÂżHOG" 3RVW WKDW PLVVLRQ VWDWHPHQW ZKHUH DOO FDQ VHH .BLF JU BCPVU UIF FOE VTFS /RRN EH\RQG ÂżFWLWLRXV H[DPSOHV OLNH â&#x20AC;&#x153;John  Doeâ&#x20AC;?  to  illustrate  how  plan  changes  will  affect  employees.  For  example,  if  you  start  a  blog  connected  with  your  companyâ&#x20AC;&#x2122;s  EHQHÂżW LQIRUPDWLRQ VHFWLRQ RU +5 GHSDUWPHQW KLJKOLJKW UHFHQW stories  in  the  news  and  how  it  will  directly  matter  to  employees.  'RQÂśW EH DIUDLG WR WDON LQ ÂżUVW SHUVRQ DQG VD\ Âł\RX ´ %\ WDNLQJ the  big  picture  and  applying  it  to  them,  your  employees  will  understand  exactly  what  these  changes  mean. 4IBSF JOGPSNBUJPO FWFO XIFO JU T OPU QPTJUJWF  When  your  health  care  costs  are  especially  high,  use  benchmark  data  to  compare  your  costs  to  other  employers  in  the  same  industry  or  location.  Drastic  increases  to  employee  premium  contributions  should  never  be  a  surprise.  As  youâ&#x20AC;&#x2122;re  evaluating  renewal  options,  share  status  updates,  even  informally.  Doing  so  will  start  to  temper  expectations  for  costs  and  coverage. 5FMM FNQMPZFFT XIBU UP FYQFDU  This  is  particularly  true  for  new  LWHPV HPSOR\HHV ZLOO UHFHLYH OLNH WKH QHZ 6XPPDU\ RI %HQHÂżWV Coverage  (SBC)  that  employers  and  carriers  have  to  use  for  renewals  after  Sept.  23,  2012.  Consider  crafting  a  general  overview  on  this  item  in  particular  so  your  employees  arenâ&#x20AC;&#x2122;t  confused  by  another  piece  of  paper.  &OMJTU QBSUOFST UP IFMQ  You  partner  with  companies  to  provide  VHUYLFHV²QRZ LV WKHLU FDOO WR DFWLRQ <RXU EURNHU FRQVXOWLQJ ÂżUP wellness  vendor,  attorney  and  carrier  or  TPA  are  all  great  places  to  ask  for  help.  Ask  them  to  help  with  employee  meetings,  crafting  employee  FAQ  documents  or  just  by  giving  you  their  opinion.  7KH ÂżQDO SLHFH LV WKH PRVW LPSRUWDQW  Say  VRPHWKLQJ. Â
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www.TheIHCC.com I CDHC Solutionsâ&#x201E;˘ I May/June 2012
31
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
BOBBI COLUNI SENIOR DIRECTOR, CONSUMER INNOVATIONS THOMSON REUTERS
DECISION SUPPORT TOOLS
Save $36 Billion in U.S. Health Care Spending Through Price Transparency
H
ealth  care  in  the  United  States  is  a  $2  trillion  industry  accounting  for  17  percent  of  the  gross  domestic  product  (GDP).  Health  care  spending  continues  to  increase  at  a  rate  of  nearly  10  percent  annually.  By  2020,  experts  estimate  it  will  grow  to  consume  21  percent  of  GDP. Finding  ways  to  better  manage  health  care  spending  is  critical  to  WKH QDWLRQÂśV ÂżQDQFLDO IXWXUH DQG LWV DELOLW\ WR UHPDLQ FRPSHWLWLYH 5HFHQW FKDQJHV WR KHDOWK FDUH EHQHÂżWV LQFOXGLQJ WKH RSSRUWXQLW\ IRU FRQVXPHUV to  exercise  more  choice  in  selecting  providers  and  treatments,  have  the  potential  to  help  reduce  costs.  Providing  consumers  with  clear,  comparative  information  on  the  cost  of  services  is  key  to  further  engaging  them  in  the  decision-Âmaking  process  and,  ultimately,  reducing  health  care  spending  in  the  U.S.  Our  latest  white  paper  explores  how  reducing  price  variation  for  the  108  million  Americans  with  employer-Âsponsored  insurance  could  save  the  nation  as  much  as  $36  billion  per  year.  It  also  highlights  best  practices  for  implementing  successful  price  transparency  initiatives.
Price Variation for Health Care Procedures 2QH VSHFLÂżF IDFWRU GULYLQJ WKH KLJK FRVW RI KHDOWK FDUH LV WKH VLJQLÂżFDQW price  variationâ&#x20AC;&#x201D;sometimes  more  than  100  percentâ&#x20AC;&#x201D;or  the  same  health  care  services  in  the  same  geographic  market.  But  higher  prices  donâ&#x20AC;&#x2122;t  equal  better  quality.  Since  price  variation  often  results  from  separate  contract  negotiations  between  insurers  and  providers,  it  is  not  necessarily  correlated  with  quality,  burden  of  illness  or  cost. Â
PRICE VARIATION FOR A CHICAGO, Ill.-BASED EMPLOYER $6,000
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$5,000 $4,000 $3,000 $2,000 $1,000 $0 MRI - Lower Back w/o Dye
Diagnostic Colonoscopy
Knee Arthroscopy
Reducing U.S. Health Care Costs by $36 Billion Using  our  MarketScanŽ  database,  we  observed  variation  in  prices  in  HYHU\ PDUNHW RI WKH FRXQWU\ %\ DQDO\]LQJ WKH YDULDWLRQ LQ SULFHV LQ HDFK
market  for  a  set  of  300  â&#x20AC;&#x153;shoppableâ&#x20AC;?  procedures  (high-Âvolume  procedures  FRQVXPHUV ZRXOG SODQ IRU DQG VFKHGXOH LQ DGYDQFH ZH LGHQWLÂżHG D VLJQLÂżFDQW VDYLQJV RSSRUWXQLW\ DVVRFLDWHG ZLWK UHGXFHG KHDOWK FDUH FRVWV In  each  market,  we  modeled  the  cost  savings  found  by  reducing  prices  for  the  targeted  services  that  were  above  the  median  to  the  median  price,  after  removing  high-Âcost  outliers.  This  price  reduction  would  reduce  overall  medical  spending  by  3.5  percent.  When  we  apply  this  savings  opportunity  nationally  to  the  108  million  Americans  under  65  who  receive  insurance  through  their  employer,  the  savings  potential  is  largeâ&#x20AC;&#x201D;$36  billion. One  way  to  remove  waste  from  the  system  is  by  increasing  consumer  engagement.  Put  simply,  for  consumers  to  be  actively  involved  in  choosing  between  treatment  options,  they  must  be  privy  to  information  on  costs,  services  and  quality. Â
Best Practices for Implementing Price Transparency Solutions Price  transparency  provides  consumers  with  the  information  they  need  to  be  more  fully  engaged  in  their  health  care  decision-Âmaking  and  to  make  ¿QDQFLDOO\ SUXGHQW KHDOWK FDUH FKRLFHV 7KH KRSH LV SULFH WUDQVSDUHQF\ ZLOO ignite  a  transformational  trend  in  care  delivery  that  reshapes  the  process  and  leads  to  lower  costs.  The  following  best  practices  can  inform  health  care  information  gathering  to  ensure  it  is  as  useful  as  possible  to  the  consumer  and  to  the  long-Âterm  quest  of  lowering  health  care  costs.  3URYLGH ,QIRUPDWLRQ RQ %RWK 3ULFH DQG 4XDOLW\ 9DULDWLRQ E\ 3URYLGHU Consumers  value  information  on  convenience,  such  as  location,  RIÂżFH KRXUV DQG ODQJXDJHV VSRNHQ ,QWHJUDWLQJ WKLV LQIRUPDWLRQ LQ RQH SODFH provides  the  context  necessary  to  make  informed  decisions.  &DOFXODWH 2XW RI SRFNHW &RVWV DQG 6KRZ +RZ %HQHÂżWV $SSO\ To  make  the  information  you  provide  to  consumers  as  valuable  as  possible,  use  a  tool  that  starts  with  relevant  geographic  pricing  and  then  integrates  real- WLPH EHQHÂżWV LQIRUPDWLRQ VXFK DV UHPDLQLQJ GHGXFWLEOH DQG RXW RI SRFNHW obligations,  to  accurately  calculate  costs.  6KRZ 7RWDO &RVWV DQG &RPSRQHQWV For  price  transparency  to  be  RI PD[LPXP EHQHÂżW WR WKH FRQVXPHU LW LV YLWDO WKH WRWDO FRVWV DVVRFLDWHG ZLWK a  particular  service  or  treatment,  as  well  as  how  they  vary  based  on  where  a  provider  practices,  are  clearly  illustrated  since  consumers  often  have  a  choice.  +LJKOLJKW :D\V WR 6DYH 0RQH\  For  consumers  to  understand  how  they  can  control  or  impact  costs,  itâ&#x20AC;&#x2122;s  important  to  convey  options,  such  as  the  pros  and  cons  of  various  care  settings,  treatments  and  provider  choices. Â
CONCLUSION 3ULFH WUDQVSDUHQF\ WRROV HQFRXUDJLQJ PRUH LQIRUPHG ÂżQDQFLDOO\ LQWHOOLJHQW KHDOWK FDUH GHFLVLRQV FRPELQHG ZLWK EHQHÂżW SODQV GHVLJQHG WR require  more  conscious  health  care  choices  by  consumers,  will  help  create  engaged,  informed,  educated  consumersâ&#x20AC;&#x201D;and  by  our  estimate,  save  $36  billion  (3.5  percent)  from  annual  health  care  expenditures.   www.TheIHCC.com I CDHC Solutionsâ&#x201E;˘ I May/June 2012
33
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BY STEVE HOWARD CHIEF MARKETING OFFICER AIG BENEFIT SOLUTIONS
SUPPLEMENTAL HEALTH & VOLUNTARY BENEFITS
Product Packaging: A Win-Win-Win Proposition
I
tâ&#x20AC;&#x2122;s  not  hyperbole  to  say  in  recent  years  employers  have  faced  the  most  employees.  Products  available  include:  term  life,  accident,  critical  illness,  short-Âterm  disability  and  vision.  During  enrollment,  employees  can  choose  complex  and  challenging  environment  since  the  Great  Depression.  While  some  economic  indicators  have  slowly  improved,  other  IURP DPRQJ WKUHH EHQHÂżW WLHUV RI ORZ PLG DQG KLJK ZLWK EHQHÂżWV IRU HDFK areas,  including  job  data  and  prices,  remain  troubling,  and  thereâ&#x20AC;&#x2122;s  product  getting  richer  by  tier.  Employees  also  can  choose  to  purchase  still  considerable  anxiety  and  uncertainty  about  the  economy  and  the  coverage  for  himself  or  herself,  a  spouse  or  a  child.  In  a  lot  of  ways,  this  mimics  the  process  for  choosing  traditional  QDWLRQDO GHEW &RVWV UHPDLQ D VLJQLÂżFDQW FRQFHUQ IRU HPSOR\HUV ZKR also  must  contend  with  complicated  national  health  care  reform  and  health  insurance,  making  employees  feel  comfortable  with  the  process. Packaging  provides  savings  because  the  rates  are  composite  and  LWV UDPLÂżFDWLRQV 0HDQZKLOH LQ VRPH LQGXVWULHV ZKHUH WKH MRE PDUNHW underwriting  is  simplified  or  has  improved,  employers  face  new  7KH FRQFHSW EHKLQG SDFNDJLQJ LV VLPSOH  guaranteed,  depending  on  the  challenges  in  attracting  and  retaining  JURXS VL]H DQG SDUWLFLSDWLRQ ,Q a  capable  workforce. 6HYHUDO NH\ YROXQWDU\ SURGXFWV DUH  addition  to  the  savings,  there  also  It  is  within  this  framework  are  advantages  for  employers  and  product  packaging  of  voluntary  SDFNDJHG WRJHWKHU DQG RIIHUHG WKURXJK  EHQHÂżW EURNHUV LQ WHUPV RI HIÂżFLHQF\ EHQHÂżWV KDV HPHUJHG DV DQ LQQRYDWLYH Instead  of  coordinating  enrollment  solution  that  allows  employers  to  RQH HQUROOPHQW DSSOLFDWLRQ and  administration  with  two  or  three  UHGXFH WKHLU EHQHÂżW FRVWV ZKLOH DOVR carriers,  employers  and  brokers  can  giving  employees  more  choices  to  select  the  protections  that  best  suit  their  familiesâ&#x20AC;&#x2122;  needs.  Several  carriers,  DFFRPSOLVK PXFK RI ZKDW WKH\ÂśUH WU\LQJ WR DFKLHYH ZLWK D EHQHÂżW SODQ E\ LQFOXGLQJ $,* %HQHÂżW 6ROXWLRQV QRZ RIIHU VRPH YDULDWLRQ RQ SURGXFW using  one  carrier. Employers  who  are  moving  toward  higher-Âdeductible  plans  and  SDFNDJLQJ ZLWK SDFNDJHV UDQJLQJ IURP WZR WR ÂżYH SURGXFWV Think  of  packaging  as  a  win-Âwin-Âwin  proposition  for  the  employer,  SDVVLQJ PRUH H[SRVXUH RQ WR WKHLU HPSOR\HHV DOVR FDQ EHQHÂżW VLQFH voluntary  products,  such  as  accident  or  critical  illness  insurance,  will  the  employee  and  the  producer: t (PSOR\HHV JDLQ DIIRUGDEOH DFFHVV WR FRYHUDJH ÂżOOLQJ YRLGV WKH\ offset  that  exposure.  In  this  way,  packaging  helps  the  employer  move  toward  a  cost-Âeffective  strategy  for  them  but  is  not  punitive  for  employees,  may  have  under  their  current  coverage, t (PSOR\HUV FDQ RIIHU VXEVWDQWLDOO\ LPSURYHG EHQHÂżW SDFNDJHV DW QR since  employees  can  choose  to  offset  those  out-Âof-Âpocket  expenses  with  VXSSOHPHQWDO SODQV WKDW SURYLGH OXPS VXP EHQHÂżWV IRU D VSHFLÂżHG LOOQHVV cost  since  the  products  are  fully  paid  by  the  employee,  and  t %HQHÂżW EURNHUV KDYH DQ RSSRUWXQLW\ WR KHOS HPSOR\HUV LGHQWLI\ or  accidents.  In  that  way,  packaging  corresponds  with  the  broader  changes  in  opportunities  for  packaging  and  then  create  an  enrollment  WKH HPSOR\HH EHQHÂżWV PDUNHW LQ ZKLFK YROXQWDU\ SURGXFWV DUH SOD\LQJ D SDFNDJH EHVW VXLWHG WR D VSHFLÂżF ZRUNIRUFH JUHDWHU UROH LQ FRPSDQ\ EHQHÂżW SODQV 3DFNDJLQJ DOVR KDV DGYDQWDJHV IRU EHQHÂżW EURNHUV ZKRVH SULPDU\ There  also  is  the  advantage  of  an  easier  enrollment  process,  since  several  products  can  be  combined  on  one  application.  Minimum  responsibility  is  to  safeguard  their  client,  the  employer.  Leading  an  participation  requirements  and  availability  of  guarantee  issue  are  other  employer  to  a  solution  that  increases  their  savings,  makes  administration  PRUH HIÂżFLHQW DQG SURYLGHV HPSOR\HHV ZLWK JUHDWHU FKRLFHV UHLQIRUFHV WKH XQLTXH EHQHÂżWV The  concept  behind  packaging  is  simple:  Several  key  voluntary  brokerâ&#x20AC;&#x2122;s  role  as  a  trusted  advisor  to  his  or  her  clients.   products  are  packaged  together  and  offered  through  one  enrollment  6WHYH +RZDUG LV FKLHI PDUNHWLQJ RIILFHU IRU $,* %HQHILW 6ROXWLRQV +H FDQ EH UHDFKHG DSSOLFDWLRQ /LNH WUDGLWLRQDO EHQHÂżWV GHSHQGLQJ RQ WKH FDUULHU WKH DW VWHYH KRZDUG#DLJEHQHILWV FRP packages  may  be  available  in  tiers  ranging  from  low  to  high  levels  of  $,* %HQHILW 6ROXWLRQVÂ&#x160; LV WKH PDUNHWLQJ QDPH IRU WKH GRPHVWLF EHQHILWV GLYLVLRQ RI EHQHÂżWV (PSOR\HHV FDQ FKRRVH WKH SDFNDJH WKDW EHVW ÂżWV WKHLU EXGJHW DQG $PHULFDQ ,QWHUQDWLRQDO *URXS ,QF 8QGHUZULWLQJ ULVNV ILQDQFLDO DQG FRQWUDFWXDO familyâ&#x20AC;&#x2122;s  needs.  The  packages  also  can  be  available  at  a  single  composite  REOLJDWLRQV DQG VXSSRUW IXQFWLRQV DVVRFLDWHG ZLWK SURGXFWV PDUNHWHG E\ $,* %HQHILW 6ROXWLRQV DUH WKH UHVSRQVLELOLW\ RI WKH XQGHUZULWLQJ FRPSDQLHV ZKLFK rate  that  hits  the  consumer  price  point  of  between  one  and  four  hoursâ&#x20AC;&#x2122;  LQFOXGH $PHULFDQ *HQHUDO /LIH ,QVXUDQFH &RPSDQ\ RI 'HODZDUH :LOPLQJWRQ worth  of  wages  per  week. 'HO $PHULFDQ *HQHUDO $VVXUDQFH &RPSDQ\ 6FKDXPEXUJ ,OO $PHULFDQ *HQHUDO +HUH LV D YHU\ JHQHUDO H[DPSOH EDVHG RQ $,* %HQHÂżW 6ROXWLRQVÂś ,QGHPQLW\ &RPSDQ\ 6FKDXPEXUJ ,OO $PHULFDQ *HQHUDO /LIH ,QVXUDQFH &RPSDQ\ +RXVWRQ 7KH 8QLWHG 6WDWHV /LIH ,QVXUDQFH &RPSDQ\ LQ WKH &LW\ RI 1HZ <RUN 1HZ 3URWHFW3DN VHULHV )URP D FKRLFH RI SDFNDJHV ZLWK WKUHH IRXU RU ÂżYH <RUN DQG 1DWLRQDO 8QLRQ )LUH ,QVXUDQFH &RPSDQ\ RI 3LWWVEXUJK ZLWK LWV SULQFLSDO products,  employers  can  choose  which  package  to  make  available  to  SODFH RI EXVLQHVV LQ 1HZ <RUN 7KHVH FRPSDQLHV GR QRW VROLFLW EXVLQHVV LQ 1HZ <RUN
www.TheIHCC.com I CDHC Solutionsâ&#x201E;˘ I May/June 2012
35
Transforming an On-site Health Center Into a Total Employee Health Cost Containment Center
S
o  letâ&#x20AC;&#x2122;s  say  you  are  the  CFO  for  a  manu- facturing  company  and  have  had  an  on- site  occupational  health  center  for  years,  maybe  decades.  To  date,  you  have  only  realized  a  OLPLWHG ÂżQDQFLDO EHQHÂżW IURP WKLV FHQWHU UHODWHG WR workers  compensation  and  disability.   You  talk  to  your  HR  folks  and  ask  them  if  the  center  can  be  used  for  non-Âoccupational  employee  health  issues.  They  tell  you  the  center  does  not  fall  under  their  jurisdiction.  It  falls  under  safety  and  security.  The  safety  and  security  director  has  no  idea  if  this  is  possible.  What  should  the  CFO  do  now? Well,  it  turns  out  this  forward- thinking  CFO  is  on  to  something.  Employers  with  occupational  health  centers  have  an  enormous  opportunity  to  leverage  these  FHQWHUV WR GULYH VLJQLÂżFDQWO\ JUHDWHU VDYLQJV focused  on  total  employee  health  cost  containment. However,  the  ability  to  realize  these  gains  requires  a  major  transformation  of  these  facilities  and  their  services  from  strictly  occupational  health  centers  to  population  health  management  centers.  A  successful  transformation  program  must  effectively  satisfy  three  elements: Â&#x2021; 3DUW Âą ,PEHGGLQJ :HOOQHVV LQWR WKH Occupational  Health  Services Â&#x2021; 3DUW Âą %XLOGLQJ D 3RSXODWLRQ +HDOWK Management  System Â&#x2021; 3DUW Âą ,QWHJUDWLQJ 2FFXSDWLRQDO DQG Non-Âoccupational  Health  Services
PART  1  â&#x20AC;&#x201C;  As  demonstrated  by  many  research  papers  such  as  the  â&#x20AC;&#x153;Duke  Study,â&#x20AC;?  general  health  issues  such  as  obesity,  arthritis  and  asthma  can  negatively  impact  work-Ârelated  injury  and  illness  prevalence  within  a  population.  Through  the  introduction  of  wellness  into  traditional  occupational  health  services,  an  employer  can  reduce  the  incidence  of  work-Ârelated  injuries  and  illnesses.  A  successful  transformation  program  must  provide  a  method  to  imbed  targeted  wellness  protocols  and  services  into  an  occupational  health  clinic.  This  should  be  done  in  a  way  that  offers  both  SUHYHQWDWLYH DQG LQFLGHQW UHODWHG EHQHÂżWV IRU DQ employer.  The  end  resultâ&#x20AC;&#x201D;decrease  in  disability  and  workers  compensation  claims. PART  2  â&#x20AC;&#x201C; %XLOGLQJ D SRSXODWLRQ KHDOWK PDQDJH- PHQW V\VWHP LV WKH VHFRQG VWHS 3RSXODWLRQ KHDOWK management  consists  of  the  following  capabilities: 36
May/June 2012 I CDHC Solutionsâ&#x201E;˘ I www.TheIHCC.com
Â&#x2021; $FXWH DPEXODWRU\ FDUH Â&#x2021; 3RSXODWLRQ 5LVN 6WUDWLÂżFDWLRQ *DSV LQ Care  Analysis) Â&#x2021; &KURQLF 0HGLFDO &DUH 0HGLFDO +RPH Model) Â&#x2021; 3ULFH 7UDQVSDUHQF\ DQG 3DWLHQW $GYRFDF\ Â&#x2021; :HOOQHVV 6HUYLFHV
To  effectively  introduce  all  of  these  capa- bilities,  the  transformation  team  or  transition  team,  comprised  of  physicians,  nurse  practitioners,  nurs- es,  software  engineers,  trainers  and  health  coaches,  needs  to  provide  the  occupational  health  staff  with  comprehensive  training  and  IT  systems  necessary  to  manage  the  health  of  the  entire  population.  The  goal  is  to  train  the  existing  medical  staff  on  the  new  services.  However,  additional  medical  staff  may  be  necessary.  The  end  result  is  a  re-Âengineered  medi- cal  center  able  to  address  all  the  medical  needs  of  WKH SRSXODWLRQ DQG GULYH VLJQLÂżFDQW FRVW VDYLQJV RQ total  health  claims. PART  3 Âą 7KHUH DUH QXPHURXV FURVVRYHUV EHWZHHQ occupational  health  and  population  health  man- agement  services.  As  such,  integration  of  these  two  services  offers  enormous  potential  for  further  improvement  in  employee  health  and  cost  savings.  Though  the  division  of  these  services  needs  to  be  maintained  for  certain  legal  and  regulatory  issues,  there  must  be  a  way  for  both  services  to  communi- cate  work  collectively.  To  this  end,  the  transformation  team  must  create  a  comprehensive  set  of  protocols  to  allow  this  communication  to  occur,  thus  enhancing  the  effectiveness  of  both  services.  The  protocols  need  to  ensure  the  employer  continues  to  comply  with  both  legal  and  regulatory  requirements.  Now  patients  with  occupational  health  issues, Â
BY JONATHAN SPERO, M.D., INHOUSE PHYSICIANS
exacerbated  by  medical  issues,  have  a  center  that  can  simultaneously  address  both  issues  leading  to  improved  employee  health  and  decreased  claims  for  the  employer. Following  the  transformation,  the  re-Âengineered  health  center  requires  oversight  and  management  to  ensure  its  HIIHFWLYHQHVV 7KLV PD\ EH VDWLVÂżHG ZLWK an  internal  medical  team  or  a  third  party  worksite  vendor.  Functions  of  the  team  assigned  to  oversight  include:  quality  control,  medical  director  chart  reviews,  medical  home  model  supervision,  data  analytics  services,  price  transparency  and  patient  advocacy  management,  privacy  and  security  audits,  occupational  health  audits,  short-Âterm  disability  review  and  many  other  functions. In  summary,  employers  with  on-Âsite  occupational  health  centers  are  well  positioned  to  transform  these  centers  into  total  population  health  management  centers,  offering  much  greater  ¿QDQFLDO XSVLGH 7KH SRWHQWLDO EHQHÂżW WR HPSOR\HUV is  not  only  decreased  workers  compensation  and  disability  claims,  but  also  a  powerful  cost  containment  tool  for  employee  health  care  claims.  7KH WRWDO KHDOWK FDUH FRVW VDYLQJV DUH W\SLFDOO\ ÂżYH WR WLPHV JUHDWHU WKDQ VDYLQJV IURP RFFXSDWLRQDO health-Ârelated  matters. The  key  to  successfully  executing  this  trans- formation  requires  an  effective  transformation  team  that  imbeds  wellness  into  the  occupational  health  services,  build  a  population  health  manage- ment  system  and  integrate  occupational  and  non- occupational  health  services. 'U -RQDWKDQ 6SHUR LV D WKRXJKW OHDGHU LQ WKH ÂżHOG RI ROI  driven  worksite  health  centers  and  targeted  employee  wellness  programs.  InHouse  Physicians  is  a  global  employee  health  and  wellness  provider  delivering  innovative  cost  containment  solutions  to  corporations  around  the  world.  InHouse  Physicians  high  touch  employee  health  services  LQFOXGH D ZLGH UDQJH RI RIIHULQJV VXFK DV FRVW HIIHFWLYH worksite  health  centers,  evidence  based  â&#x20AC;&#x153;pre-Âdiseaseâ&#x20AC;?  wellness  initiatives,  health  screenings  plus  DQDO\WLFV Ă&#x20AC;X YDFFLQDWLRQV DQG travel  medicine.  To  learn  more  about  InHouse  Physicians  visit  their  website  at  www.inhousephysicians. com  or  Dr.  Spero  can  be  reached  at  jspero@ihphysicians.com.
COMMENTARY: HEALTH CARE ACCESS ALTERNATIVE
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Technology Is The Only True Health Reform
ou  almost  never  see  either  of  the  technology.  We  have  become  immunized  to  BY WILLIAM R. BOYLES Âť EXECUTIVE EDITOR political  parties  in  Washington  talk- ideas  not  framed  by  politics. INTERPRO PUBLICATIONS INC. Doctors  and  caregivers  are  sidetracked  by  ing  about  how  information  technol- ogy  is  radically  changing  how  and  political  solutions  that  are  destined  to  fail,  but  Itâ&#x20AC;&#x2122;s  coming.  Rates  of  electronic  health  where  we  receive  medical  care.  This  has  always  they  strongly  resist  the  technology  they  should  astounded  me.  The  Obama  administration  and  embrace:  email  exchanges  with  patients,  mobile  record  (EHR)  adoption  among  physicians  in  the  the  Democrats  in  Congress  preside  over  the  most  apps  that  increase  the  ability  to  treat  more  Northeast  United  States  grew  from  19.9  percent  patients  at  lower  cost  and  digital  medicine  that  in  2002  to  52.1  percent  in  2011,  while  EHR  awesome  shift  in  digital  health  care  in  history.   Mitt  Romney  and  the  Republicans  are  ide- creates  patient  loyalty  and  a  stronger  devotion  to  adoption  rates  among  physicians  in  the  Western  U.S.  grew  from  19.5  percent  in  2002  to  60.8  ally  positioned  to  make  health  tech  a  cornerstone  their  own  skills. Two  examples  are  telemedicine  and  percent  in  2011,  according  to  a  recent  Health  of  their  alternative  to  ObamaCare.  Yet  all  both  sides  talk  about  is  killing  off  the  Affordable  Care  WHOHKHDOWK ZKLFK DUH UHGHÂżQLQJ KRZ SDWLHQWV Affairs  study.  Physician  use  of  tablet  computers  has  Act,  or  how  wonderful  health  exchanges  will  be  interact  with  their  doctors.  The  American  Telemedicine  Association  meeting  in  April  nearly  doubled  from  35  to  62  percent  since  for  consumers. Think  about  how  off-Âmessage  this  posing  attracted  more  than  5,000  attendees,  and  the  2011,  according  to  a  new  report  by  Manhattan  has  become  in  the  real  world.  Technology  is  proliferation  of  clinical  studies  and  new  products  Research.  About  half  of  surveyed  physicians,  who  not  only  the  best  solution,  it  is  the  only  solution  coming  on-Âstream  are  astounding.  Yet  health  use  tablets,  said  they  have  used  their  device  at  the  in  many  cases.  Plainly  stated,  information  plan  technology  has  barely  begun  to  scratch  point  of  care  and  to  research  journals. It  used  to  be  telehealth  was  about  rural  doc- the  surface  of  what  will  surely  be  a  renaissance  technology  is  the  only  real  health  reform. A  new  study  by  Rand  Corporation  about  con- in  products  that  patients  will  embrace  for  tors  or  the  â&#x20AC;&#x2DC;bestâ&#x20AC;&#x2122;  doctors,  but  those  days  are  gone.  Increasingly  the  early  adopters,  like  Teladoc,  are  sumer-Âdriven  health  plan  employer  costs  found  controlling  their  own  health  care.  expanding  their  growing  lists  of  â&#x20AC;&#x2DC;volunteerâ&#x20AC;&#x2122;  that  an  increase  in  market  share  from  the  â&#x20AC;Śemployers and consumers providers  to  take  telehealth  phone  calls  current  level  of  13  percent  of  employer- from  all  physicians  in  a  network  who  sign  sponsored  insurance  to  50  percent  could  will very soon have a new up.  I  expect  all  insurers  in  the  U.S.  to  do  the  reduce  annual  health  care  spending  by  Telemed  is  moving  away  from  the  about  $57  billion.  That  decrease  would  â&#x20AC;&#x2DC;health reformâ&#x20AC;&#x2122; channel to tune same.  early  models  and  becoming  simply  a  new  be  the  equivalent  of  a  4  percent  decline  medical  delivery  system  or  medical  app.  in  total  health  care  spending  for  the  non- into and link to the rapidly In  our  preliminary  estimation,  possibly  25  elderly.  None  of  the  proposals  on  Capitol  percent  of  all  practicing  physicians  in  the  Hillâ&#x20AC;&#x201D;not  oneâ&#x20AC;&#x201D;has  a  remote  chance  of  moving mobile world. U.S.  will  be  doing  telemed  visits  by  2015.  achieving  that  level  of  savings.  These  esti- +RZ GRHV WKLV DSSO\ WR KHDOWK ÂżQDQF- mates  donâ&#x20AC;&#x2122;t  even  factor  in  the  arrival  of  ing?  As  the  patient  connection  shifts  so  things  like  telemedicine  and  â&#x20AC;&#x153;iplans.â&#x20AC;? does  the  need  for  patients  to  pay  for  their  Employers  and  consumers  know  out-Âof-Âpocket  costs  and  premiums  with  a  intuitively  that  technology  is  at  least  part  mix  of  new  and  old  technology.  Maybe  all  of  the  solution  to  their  suffering  with  out- of  it  will  be  paid  for  by  insurance  cover- of-Âpocket  costs  and  barriers  to  accessing  age,  but  donâ&#x20AC;&#x2122;t  bet  on  it.  Most  likely  it  will  medical  care,  but  they  watch  as  the  EH D PL[ RI EHQHÂżWV DQG JUHDWHU GLUHFW politicians  debate  irrelevant  ideas. payments.   Itâ&#x20AC;&#x2122;s  obvious  outside  of  Washington  We  are  heading  for  a  merged  world:  the  most  important  solutions  to  problems  7HOHFRPP WHOHPHG DQG ÂżQDQFLDO VHUYLFHV like  health  costs,  quality  and  access  will  all  work  together.  So  employers  and  reside  in  the  private  sector,  beyond  consumers  will  very  soon  have  a  new  the  reach  of  any  piece  of  legislation,  â&#x20AC;&#x2DC;health  reformâ&#x20AC;&#x2122;  channel  to  tune  into  and  however  well  designed  it  may  be.  I  have  link  to  the  rapidly  moving  mobile  world.  become  convinced  the  biggest  roadblock  Real  world  patients  are  ready  to  be  plugged  to  reaching  a  higher  plane  of  digital  in.  Itâ&#x20AC;&#x2122;s  the  only  true  health  reform. medicine  is  our  own  failure  to  embrace Â
www.TheIHCC.com I CDHC Solutionsâ&#x201E;˘ I May/June 2012
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Give Your New Employees a Healthy Start Educating your new employees about health insurance within their first year at your organization helps motivate and retain them. It can also bring them up to speed much more quickly and help them become more productive members of your staff sooner.
Introducing Health Insurance 101: An Orientation This online course provides your new employees with a basic foundation of health insurance knowledge. It’s broken into bite-sized modules making it easy for people to fit it into their busy lives. Students move through the materials at their own pace and in the sequence they choose, maximizing both interest and comprehension. Make It Your Organization’s Orientation Course If your organization has unique training needs or you wish to supplement the course with your exclusive products and services, we will work with you to mold the course into one that’s designed specifically for your employees.* * For bulk purchases only
Want to Know More? For answers to your questions about the course curriculum, visit www.ahip.org/courses, contact our Support Team at 800.509.4422, or e-mail Support@AHIPInsuranceEducation.org. Learn. Achieve. Succeed. www.ahip.org/courses 800.509.4422
For questions about customization and bulk pricing, e-mail Lindsey Miranda Canaley at LMirandaCanaley@ahip.org.
Support@AHIPInsuranceEducation.org Content and Design AHIP—All Rights Reserved: © AHIP 2012
WELLNESS
Virgin HealthMiles Help Ochsner Cut Costs, Improve Engagement With Wellness Program BY SUSAN PIGLIA DIRECTOR, CORPORATE PROGRAMS OCHSNER HEALTH SYSTEM
O
chsner Health System, a nonprofit multispecialty health care system comprised of eight hospitals and 38 clinics located throughout Louisiana, was facing a major challenge. Since 2003, Ocshner had been monitoring its rising health care costs and the declining health of its workforce. The organization had quickly grown to 10,000 employees after several postHurricane Katrina acquisitions. As Ochsner expanded, it became apparent it needed a more integrated and accessible wellness program to replace the home-grown manual program. Most importantly, with so many entities under its umbrella, Ochsner aggressively sought to create a measureable employee health program with a goal to improve overall employee health and reduce health care costs company-wide. www.TheIHCC.com I CDHC Solutionsâ&#x201E;˘ I May/June 2012
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This  was  a  major  strategic  initiative  since  RI 2FKVQHUÂśV HPSOR\HHV DUH SDUW RI LWV $62 VHOI LQVXUHG JURXS 2FKVQHU SURYLGHV a  generous  premium  subsidy  to  all  levels  of  coverage,  employee  up  to  family  coverage.  As  such,  engaging  employees  in  taking  accountability  for  their  own  health,  in  partnership  with  the  company,  is  a  top  priority.  The  magic  was  aligning  the  medical  plan  premiums  in  favor  of  those  who  participated  in  the  wellness  initiative.  To  achieve  these  goals,  Ochsner  recognized  there  were  a  few  important  challenges  to  overcome.  First,  Ochsner  required  a  more  systematic  approach  to  help  employees  track  and  measure  their  physical  activity  in  order  to  substantiate  employee  participation  and  health  improvements.  Although  Ochsnerâ&#x20AC;&#x2122;s  previous  wellness  program  enabled  employees  to  earn  rewards  for  staying  active,  the  program  relied  on  employees  manually  recording  activities  over  the  course  of  the  year  and  submitting  the  tracking  logs  to  Ochsnerâ&#x20AC;&#x2122;s  wellness  staff  for  approval.  Although  this  process  was  administratively  IHDVLEOH ZLWK SDUWLFLSDQWV 2FKVQHU NQHZ it  needed  a  technology-Âbased  program  to  be  prepared  for  the  companyâ&#x20AC;&#x2122;s  growth.  It  also  was  important  to  be  able  to  track  and  monitor  improvements  to  overall  employee  health  and  ultimately  reward  those  employees  who  took  their  health  seriously. The  second  challenge  was  identifying  how  to  raise  employee  participation.  Historically,  Ochsnerâ&#x20AC;&#x2122;s  wellness  program  participation  rates  KRYHUHG DURXQG WR SHUFHQW 7KRXJK KLJKHU than  traditional  industry  average  rates,  Ochsner  believed  there  was  ample  room  for  improvement.  Employee  engagement  was  critical  given  the  companyâ&#x20AC;&#x2122;s  goal  to  lower  overall  health  care  costs,  and  Ochsner  believed  more  participation  would  lead  to  greater  reductions.  The  last  challenge  was  determining  how  to  excite  employees  about  wellness  and  then  make  the  programs  as  far  reaching  as  possible.  With  DQ RSHQ EHQHÂżWV GHDGOLQH ORRPLQJ WLPH ZDV RI the  essence.
SOLUTION: Enabling Employees to Earn Health Care Premium Discounts Based on Wellness Program Participation.
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May/June 2012 I CDHC Solutionsâ&#x201E;˘ I www.TheIHCC.com
,Q 'HFHPEHU 2FKVQHU HQJDJHG 9LUJLQ HealthMiles,  a  leading  provider  of  employee  health  programs  and  technologies  that  engage  employees  in  good  health.  Ochsner  found  the  HealthMiles  programâ&#x20AC;&#x2122;s  easy-Âto-Âuse  activity  tracking  devices,  biometric  measurement  stations  and  online  platform  provided  employees  with  a  better  way  to  capture  their  daily  activity  and  key  KHDOWK PHDVXUHV LQ D PRUH DFFXUDWH DQG YHULÂżDEOH way.  The  program  also  enabled  employees  to  monitor  their  progress  and  provided  a  variety  of  fun  and  rewarding  activities  designed  to  drive  on-Âgoing  program  participation.  With  this  new  program,  Ochsner  employees  had  the  opportunity  to  earn  â&#x20AC;&#x2DC;HealthMilesâ&#x20AC;&#x2122;â&#x20AC;&#x201D;or  pointsâ&#x20AC;&#x201D;for  their  participation  in  the  program.  The  HealthMiles  employees  earned  helped  them  SURFHHG WKURXJK WKH SURJUDPÂśV ÂżYH 5HZDUG Levels.  Since  these  Reward  Levels  were  designed  to  reinforce  the  Center  for  Disease  Control  and  3UHYHQWLRQÂśV &'& UHFRPPHQGHG DFWLYLW\ OHYHOV Ochsner  offered  participants  the  opportunity  WR HDUQ VLJQLÂżFDQW GLVFRXQWV RII WKHLU KHDOWK LQVXUDQFH SUHPLXPV RQFH WKH\ UHDFKHG /HYHO ²D program  milestone  indicating  the  participating  employee  was  getting  enough  activity  to  meet  recommended  levels  for  good  health.
Leveraging a Multi-pronged Communications Approach to Spur Employee Engagement Ochsner  employed  a  multi-Âpronged  communications  approach  to  educate  employees  about  the  new  program  and  accelerate  participation.  In  addition  to  visiting  the  different  satellite  clinics  with  an  information  table  situated  LQ KLJK WUDIÂżF DUHDV VXFK DV IR\HUV DQG FDIHWHULDV 2FKVQHU DOVR FUHDWHG D VHFWLRQ GHGLFDWHG WR 9LUJLQ HealthMiles  on  â&#x20AC;&#x153;Ochweb,â&#x20AC;?  the  organizationâ&#x20AC;&#x2122;s Â
internal  website.  Here,  Ochsner  provided  weekly  tips  on  how  to  join  the  program  and  how  to  earn  +HDOWK0LOHV SRLQWV :LWK VLJQLÂżFDQW LQFHQWLYHV LQ SODFH DQG D campaign  designed  to  get  as  many  of  its  eligible  employees  as  possible  to  participate  in  the  HealthMiles  program,  Ochsnerâ&#x20AC;&#x2122;s  participation  UDWH VN\URFNHWHG WR SHUFHQW RI DOO HOLJLEOH employees  within  just  three  months  of  the  program  launch.  â&#x20AC;&#x153;We  were  blown  away  by  the  participation,â&#x20AC;?  said  Dorothy  Cain,  R.N.  and  system  coordinator  IRU 2FKVQHUÂśV (PSOR\HH :HOOQHVV 3URJUDP Âł,Q a  few  months,  we  had  doubled  participation  rates  from  the  previous  year  and  today  we  have  QHDUO\ SHUFHQW RI RXU HOLJLEOH ZRUNIRUFH participating  in  the  program.  Deployment  was  easy,  maintenance  is  easy  and  we  have  been  DEOH WR ZRUN ZLWK RXU 9LUJLQ +HDOWK0LOHV WHDP WR WDLORU LW WR RXU VSHFLÂżF QHHGV $QG EHVW RI DOO our  employees  are  excited  about  the  wellness  initiative  and  their  opportunity  to  earn  discounts  on  health  insurance  premiums.â&#x20AC;?  Since  HealthMiles  replaced  Ochsnerâ&#x20AC;&#x2122;s  previous  wellness  program,  Ochsner  also  offered  an  additional  cash  incentive  to  encourage  employee  participation  in  the  new  program.  If  employees  enrolled  in  the  HealthMiles  program  within  a  three-Âmonth  period,  they  could  earn  D UHEDWH RI SHU PRQWK RII WKHLU FXUUHQW insurance  premium.  To  help  motivate  employees  WR UHDFK /HYHO WKH FRPSDQ\ IXUWKHU HQFRXUDJHG employees  to  use  the  HealthMiles  programâ&#x20AC;&#x2122;s  online  challenges  to  spark  some  friendly  competition  between  groups  and  departments.  â&#x20AC;&#x153;Itâ&#x20AC;&#x2122;s  extremely  rewarding  to  see  so  PDQ\ SHRSOH LPSURYH WKHLU KHDOWK ZLWK 9LUJLQ HealthMiles,â&#x20AC;?  Cain  said.  â&#x20AC;&#x153;I  receive  emails  every  day  about  how  the  program  has  helped Â
Ochsnerâ&#x20AC;&#x2122;s participation rate skyrocketed to 78 percent of all eligible employees within just three months of the program launch
employees  manage  their  weight  or  lower  their  blood  pressure,  and  I  see  more  and  more  walking  groups  during  lunch  breaks.  Many  employees  have  also  made  new  friends  in  other  departments  or  locations  thanks  to  the  online  community  features  built  into  the  HealthMiles  program.â&#x20AC;? Â
Online Features Promote Participation, Streamline Processes 2QH RI WKH JUHDWHVW EHQHÂżWV 2FKVQHU KDV realized  from  the  HealthMiles  program  is  its  online  delivery,  which  has  enhanced  company- ZLGH HQJDJHPHQW D RQFH GLIÂżFXOW JRDO WR achieve.  The  program  has  enabled  employees  to  accurately  capture  their  daily  activity  and  key  health  measures  with  activity  tracking  devices  and  biometrics  measurement  stations  providing  validated  data.  Employees  also  have  access  to  their  own  online  program  portal  where  they  view  their  progress,  upload  steps  captured  by  their  pedometers  and  log  any  other  activities  theyâ&#x20AC;&#x2122;ve  participated  in,  such  as  an  aerobics  class  or  cycling  to  work  from  home. (PSOR\HHV XVH DQ\ RI WKH +HDOWK=RQHÂ&#x160; measurement  stations,  set  up  within  Ochsnerâ&#x20AC;&#x2122;s  satellite  clinics  and  hospitals,  to  take  key  health  measurements  regularly  and  earn  HealthMiles  IRU GRLQJ VR :LWK WKH +HDOWK=RQHV 2FKVQHUÂśV HR  and  wellness  team  discovered  employees  were  able  to  monitor  their  health  in  a  more  YDOLGDWHG DQG PHDVXUHDEOH ZD\ +HDOWK=RQHV capture  key  biometric  measurements,  including  weight,  blood  pressure  and  body  fat  percentage.  The  measurements  employees  take  on  the  +HDOWK=RQHV DUH LQVWDQWO\ XSORDGHG WR WKHLU RZQ RQOLQH SURJUDP SRUWDO ZLWKLQ WKH 9LUJLQ HealthMiles  program.  Reporting  also  became  easier  and  timelier  IRU 2FKVQHU 9LUJLQ +HDOWK0LOHVÂś UHSRUWLQJ WRROV
provided  Ochsnerâ&#x20AC;&#x2122;s  wellness  director  with  more  control  over  managing  and  understanding  the  impact  of  its  wellness  program  and  strategy.  The  tools  also  enabled  Ochsner  to  create  department  HIÂżFLHQFLHV E\ JUHDWO\ UHGXFLQJ WKH QXPEHU of  staff  needed  to  manage  Ochsnerâ&#x20AC;&#x2122;s  overall  wellness  strategy.  $GGLWLRQDOO\ WKH Ă&#x20AC;H[LELOLW\ RI WKH 9LUJLQ HealthMiles  platform  enabled  Ochsner  to  reward  employees  for  positive  achievements  that  supported  healthy  behaviors.  For  example,  employees  could  earn  additional  HealthMiles  for  an  annual  physical,  having  necessary  gender- VSHFLÂżF WHVWV VXFK DV DQQXDO PDPPRJUDPV DQG or  for  donating  blood. Â
RESULTS: Engaged Employees Make Significant Health Improvements, Health Care Cost Savings. Much  of  the  HealthMiles  programâ&#x20AC;&#x2122;s  success  at  Ochsner  can  be  attributed  to  its  evolution.  As  the  needs  of  Ochsner  and  its  employees  changed,  so  did  the  HealthMiles  programâ&#x20AC;&#x2122;s  design.  After  LWV LQLWLDO VXFFHVV WKH 9LUJLQ +HDOWK0LOHV WHDP worked  hand-Âin-Âhand  with  Ochsnerâ&#x20AC;&#x2122;s  HR  and  wellness  leaders  to  adapt  the  program  to  the  changing  business  needs  and  optimize  program  design  to  continue  enhancing  employee  engagement.  Together,  the  team  worked  to  make  the  program  more  robust,  while  keeping  it  simple  and  easy  for  employees  to  understand.  Whatâ&#x20AC;&#x2122;s  more,  Ochsner  now  uses  the  HealthMiles  platform  to  integrate  additional  employee  health  programs  and  incentives  under  one  umbrellaâ&#x20AC;&#x201D; FUHDWLQJ D VLQJOH XQLÂżHG H[SHULHQFH DQG incentives  platform  for  employees.  7RGD\ SHUFHQW RI 2FKVQHUÂśV HOLJLEOH employees  have  enrolled  in  the  HealthMiles  SURJUDP 0RUHRYHU LQ PRUH WKDQ SHUFHQW RI HQUROOHG HPSOR\HHV TXDOLÂżHG IRU SUHPLXP GLVFRXQWV UDQJLQJ IURP 2FKVQHU ZDV H[FLWHG WR VHH SHUFHQW RI SDUWLFLSDQWV DUH getting  enough  activity  to  meet  recommended  levels  for  good  health.  Whatâ&#x20AC;&#x2122;s  more,  of  those  participants  whoâ&#x20AC;&#x2122;ve  taken  their  biometric  measurements,  57  percent  have  improved  their  EORRG SUHVVXUH SHUFHQW KDYH LPSURYHG WKHLU ERG\ IDW SHUFHQWDJH DQG SHUFHQW KDYH LPSURYHG WKHLU ERG\ PDVV LQGH[ %0,
The  HealthMiles  program  has  become  D VLJQLÂżFDQW ODXQFKLQJ SDG LQ HQDEOLQJ WKH company  to  track  its  wellness  efforts  and  more  effectively  contain  health  care  costs  year  over  year.  The  program  is  helping  the  health  care  system  achieve  its  long-Âterm  strategic  goal.  $IWHU WKH ÂżUVW \HDU 2FKVQHU ZLWQHVVHG D VKDUS PLOOLRQ GHFUHDVH LQ HPSOR\HH RQO\ medical  claims.  Moreover,  while  national  health  FDUH FRVWV KDYH LQFUHDVHG SHUFHQW RQ DYHUDJH RYHU WKH ODVW \HDUV RU VR 2FKVQHUÂśV FRVWV UHPDLQHG Ă&#x20AC;DW ODVW \HDU 2YHU WLPH 2FKVQHU expects  to  see  even  more  reductions  in  health  care  costs,  especially  around  pharmacy  costs  as  employees  become  healthier  and  are  able  to  reduce  their  reliance  on  or  eliminate  certain  medications  altogether,  with  their  doctorâ&#x20AC;&#x2122;s  approval.  Culturally,  the  HealthMiles  program  has  provided  the  foundation  for  more  sweeping  changes  across  Ochsnerâ&#x20AC;&#x2122;s  campuses.  The  organization  has  taken  the  proverbial  â&#x20AC;&#x153;next  stepâ&#x20AC;?  with  respect  to  encouraging  healthy  behaviors.  Ochsner  now  is  entirely  smoke-Âfree,  a  rule  applying  not  only  to  employees  but  also  to  the  health  systemâ&#x20AC;&#x2122;s  patients  and  visitors.  Employees,  who  do  not  smoke  or  who  chose  to  enroll  in  a  smoking  cessation  program,  receive  rebates  on  their  insurance  premiums.  The  organization  also  has  completely  revamped  its  cafeterias  and  vending  machines  to  eliminate  or  PLQLPL]H XQKHDOWK\ RSWLRQV Âą WKHUHÂśV QRW D GHHS fried  food  to  be  found  on  its  main  campus.  ³2XU 9LUJLQ +HDOWK0LOHV SURJUDP LV ÂżQDOO\ the  system-Âwide  wellness  program  we  always  wanted,  and  we  are  thrilled  with  the  results,â&#x20AC;?  Cain  concluded.  â&#x20AC;&#x153;We  have  been  able  to  help  our  employees  stay  healthy  while  putting  more  money  in  their  pockets  and  lowering  our  overall  health  care  costs.â&#x20AC;?  Innovation  is  a  key  strategy  at  Ochsner.  The  HealthMiles  program  and  Ochsnerâ&#x20AC;&#x2122;s  creative  HR  and  wellness  team  are  making  a  difference  in  the  quality  of  life  for  employees,  which  lead  to  better  employee  engagement,  patient  satisfaction  and  loyalty. Â
www.TheIHCC.com I CDHC Solutionsâ&#x201E;˘ I May/June 2012
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Defining the Next Stage of Health Care Consumerism: Defined Contribution Health 7KLV LV 3DUW 2QH RI D 7ZR SDUW 6HULHV BY DR. JOHN REYNOLDS, PRESIDENT, FIS HEALTHCARE SOLUTIONS
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here  are  fundamental  health  care  changes  ahead  involving  D VKLIW IURP WUDGLWLRQDO ÂłGHÂż QHG EHQHÂż W´ SODQV WR ÂłGHÂż QHG contributionâ&#x20AC;?  plans.  This  shift  is  similar  in  nature  to  the  KLVWRULFDO FKDQJH IURP GHÂż QHG EHQHÂż W SHQVLRQ SODQV WR PRUH FRQVXPHU FHQWULF GHÂż QHG FRQWULEXWLRQ² . UHWLUHPHQW SODQV With  defined  benefit  health  care,  an  institutional  purchaser,  such  as  an  employer,  determines  what  range  of  services  it  will  cover,  and  then  seeks  or  creates  a  plan  providing  those  services  for  an  acceptable  price.  It  has  EHFRPH LQFUHDVLQJO\ GLIÂż FXOW for  institutional  purchasers  WR VXVWDLQ D GHÂż QHG EHQHÂż W approach  due  to  a  steady  stream  of  emerging  health  care  treatments  and  technologies  requiring  an  equally  steady  stream  of  decisions  about  which  ones  will  be  covered  by  the  plan.  Moreover,  from  an  economic  standpoint,  it  has  become  nearly  impossible  WR SURYLGH VXFK EHQHÂż WV LQ WKH IDFH RI ULVLQJ KHDOWK FDUH LQĂ&#x20AC; DWLRQ DQG increasingly  impotent  cost-Âcutting  tools.  ,Q FRQWUDVW ZLWK D GHÂż QHG FRQWULEXWLRQ DSSURDFK WKH HPSOR\HU determines  up  front  how  much  it  will  spend  for  health  care,  and  then  W\SLFDOO\ SURYLGHV DQ DUUD\ RI RSWLRQV IURP ZKLFK EHQHÂż FLDULHV FDQ choose.  Those  options  can  assume  various  forms.  In  the  oldest,  most  familiar  version,  the  contribution  essentially  represents  a  voucher  for  a  conventional  health  plan.  The  employer  assembles  a  collection  of  plans  HPSOR\HHV FDQ FKRRVH DQG WKHQ GHÂż QHV LWV RZQ FRQWULEXWLRQ DFFRUGLQJ WR the  least  expensive  of  those  plans.  7KH )HGHUDO (PSOR\HHV +HDOWK %HQHÂż WV 3URJUDP )(+%3 LV D OHDGLQJ H[DPSOH ,Q WKH )(+%3 WKH IHGHUDO JRYHUQPHQW VFUHHQV SODQV WR ensure  they  cover  an  adequate  range  of  services,  but  employees  then  are  free  to  choose  whichever  plan  they  want,  paying  the  difference  out-Âof- pocket  for  costlier  plan.  In  the  private  sector,  corporations  and  purchasing  pools  have  developed  similar  program.  1HZHU YHUVLRQV RI GHÂż QHG FRQWULEXWLRQ SODQV FRPPRQO\ LPSOHPHQWHG DV ÂłFRQVXPHU GLUHFWHG KHDOWK FDUH EHQHÂż WV ´ IHDWXUH Âż QDQFLDO accounts,  in  conjunction  with  a  scaled  down  traditional  health  care  SODQ²DND KLJK GHGXFWLEOH FDWDVWURSKLF SODQ RQ ZKLFK WKH EHQHÂż FLDU\ FDQ GUDZ 7KH DFFRXQW PLJKW EH D Ă&#x20AC; H[LEOH VSHQGLQJ DFFRXQW )6$ RU KHDOWK VDYLQJV DFFRXQW +6$ ZKHUH HPSOR\HHV VHW DVLGH WKHLU RZQ SUH
tax  money  to  cover  expenses  of  designated  sorts,  including  health  care.  It  also  can  EH D SHUVRQDO KHDOWK DFFRXQW 3+$ RU KHDOWK UHLPEXUVHPHQW DUUDQJHPHQW +5$ an  employer  funds,  or  some  combination  of  spending  account  types. Within  this  spending  account  approach,  employees  can  simply  purchase  a  conventional  health  plan  or  buy  individual  services  and  products  or  use  the  funds  to  cobble  together  a  health  plan  to  suit  oneâ&#x20AC;&#x2122;s  preferences.  One  basic  approach  is  modeled  after  the  medical  savings  account:  The  employee  uses  some  of  the  funds  to  purchase  a  high-Âdeductible  insurance  plan,  and  then  draws  on  the  remainder  to  pay  for  individual  expenses  that  arise  throughout  the  year,  ideally  with  the  freedom  to  roll  over  any  funds  left  from  one  year  into  future  years.  The  spending  account  might  be  VXIÂż FLHQW WR FRYHU WKH HQWLUH GHGXFWLEOH RU LW PLJKW UHTXLUH WKH HPSOR\HH to  ante  up  some  expenses  out  of  pocket. Â
Limitless Possibilities in Plan Design 7KH SRVVLEOH YDULDWLRQV RI GHÂż QHG FRQWULEXWLRQ SODQV DUH HQGOHVV (PSOR\HUV PLJKW GHSRVLW DQ HPSOR\HHÂśV GHÂż QHG FRQWULEXWLRQ ZLWK DQ â&#x20AC;&#x153;Internet-Âbased  health  plan.â&#x20AC;?  These  plans  provide  an  array  of  services.  Many  provide  lists  of  providers  along  with  their  fees,  education,  credentials  and  perhaps  consumer  satisfaction  ratings.  Such  a  plan  might  then  invite  enrollees  to  assemble  their  own  provider  panel  based  on  price,  copay  expectations  and  other  considerations.  In  other  cases,  the  plan  might  indicate  what  payment  it  will  provide  for  a  given  service,  enabling  enrollees  to  choose  whatever  provider  they  want  and  pay  out  of  pocket  any  difference  between  the  planâ&#x20AC;&#x2122;s  allowance  and  the  providerâ&#x20AC;&#x2122;s  fee.  Such  a  plan  also  might  permit  the  enrollee  to  establish  a  special  account  to  cover  routine  services  and  preventive  care,  and  perhaps  set  up  other  sub-Âaccounts  to  cover  designated  medical  www.TheIHCC.com I CDHC Solutionsâ&#x201E;˘ I May/June 2012
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procedures,  such  as  carpal  tunnel  repair  or  knee  arthroscopy.  In  a  less  complex  version,  a  website  simply  offers  information  about  providers  willing  to  exchange  deep  discounts  for  direct  cash  payment.  3ODQV DOVR PD\ RIIHU RQOLQH RU SKRQH EDVHG KHDOWK FRXQVHORUV WR DVVLVW LQ making  decisions  about  which  health  services  to  seek.  In  addition  to  providing  access  to  plan,  medical,  and  provider  information  and  facilitating  consumer  enrollment  into  their  chosen  GHÂż QHG FRQWULEXWLRQ SODQ W\SLFDOO\ VXFK ,QWHUQHW EDVHG SODQV DOVR KHOS enrollees  keep  track  of  expenditures  as  they  draw  on  their  spending  account  for  various  services  and  plan  for  future  needs.  In  some  plans,  money  not  used  during  one  year  can  be  rolled  over  for  use  in  future  years,  although  the  exact  details  depend  on  funding  sources  and  applicable  tax  rules.  In  cases  where  enrollees  spend  all  the  money  in  their  spending  account  and  still  need  care,  or  where  they  use  out-Âof-Âarea  services,  traditional  insurance  coverage  takes  over.  That  coverage  might  begin  immediately,  or  enrollees  might  be  required  to  spend  some  of  their  own  money  as  a  â&#x20AC;&#x153;bridgeâ&#x20AC;?  before  catastrophic  insurance  coverage  begins.  In  sum,  self-Âdirected  plans  permit  enrollees  to  become  their  own  KHDOWK DGYRFDWH EHQHÂż WV PDQDJHU DQG XWLOL]DWLRQ UHYLHZHU GHFLGLQJ which  services  are  worth  purchasing  at  what  price  and  from  whom,  and  managing  the  money  in  their  account  to  promote  prudent  purchasing  of  the  health  care  they  value. Â
for  nonstandard  services  such  as  acupuncture  or  laser  vision  correction,  because  patients  cover  these  directly  from  their  own  account.  Self-Âcontrol  replaces  external  control.    Admittedly,  the  control  exerted  by  managed  care  organizations  0&2V RYHU VSHFLÂż F KHDOWK EHQHÂż WV KDV ORRVHQHG LQ UHFHQW years,  but  that  loosening  has  come  at  the  cost  of  substantial  premium  increase  employers  are  unlikely  to  shoulder  for  long  during  an  economic  downturn.  If  so,  then  MCOs  wanting  to  stay  LQ EXVLQHVV ZLOO EH IRUFHG WR UH LQLWLDWH VLJQLÂż FDQW FRQWURO RYHU PHGLFDO VSHQGLQJ GHFLVLRQV WR SODFH SHUYDVLYH PRQHWDU\ FDSV RQ YDULRXV NLQGV RI VHUYLFHV RU WR Âż QG VRPH RWKHU ZD\ WR FODPS down  on  the  rising  costs  of  care.  If  costs  must  be  contained,  and  patients  are  not  incentivized  to  do  it  for  themselves,  someone  will  do  it  for  them. Â
Consistency
Top 10 Advantages of Defined Contribution Plans )RU HPSOR\HUV WKH REYLRXV DGYDQWDJH RI GHÂż QHG FRQWULEXWLRQ LV the  ability  to  limit  expenditures  at  the  outset,  rather  than  promising  a  OHYHO RI EHQHÂż WV DQG WKHQ KRSLQJ WR Âż QG DQ DIIRUGDEOH SULFH $W WKH VDPH WLPH EHQHÂż FLDULHV IDFH DQ REYLRXV SRWHQWLDO GLVDGYDQWDJH %HFDXVH WKH employer  no  longer  accepts  increased  costs  to  support  a  given  level  of  care,  EHQHÂż FLDULHV PD\ HQG XS ZLWK ZKDWHYHU OHVVHU OHYHO RI FDUH WKH GHÂż QHG sum  will  buy.  +RZHYHU WKDW GRZQVLGH LV KDUGO\ WKH Âż QDO DQDO\VLV )RU RQH WKLQJ HYHQ GHÂż QHG EHQHÂż W SODQV GR QRW HQVXUH D JLYHQ OHYHO RI EHQHÂż WV Worsening  economic  conditions  have  prompted  many  employers  to  make  marked  cuts  from  one  year  to  the  next.  Even  within  a  given  year,  HQUROOHHV FDQQRW EH VXUH WKHLU EHQHÂż W OHYHOV DFWXDOO\ UHPDLQ LQWDFW 6R ORQJ as  health  care  contracts  provide  only  vague  promises  to  cover  â&#x20AC;&#x153;medically  necessaryâ&#x20AC;?  services,  health  plans  can  steadily  erode  the  actual  level  of  coverage  within  any  given  plan  simply  by  declaring  this  or  that  service  to  EH XQQHFHVVDU\ 2Q WKH RWKHU KDQG WKH DGYDQWDJHV RI GHÂż QHG FRQWULEXWLRQ planâ&#x20AC;&#x201D;particularly  the  spending  account  versionâ&#x20AC;&#x201D;can  be  substantial.  When  patients  pay  for  the  daily,  mundane  health  care  expenses  out  of  a  dedicated  account,  they  face  QR VLJQLÂż FDQW Âż QDQFLDO EDUULHUV WR DFFHVVLQJ FDUH $VVXPLQJ WKH GHGLFDWHG KHDOWK DFFRXQW LV VXIÂż FLHQW WR FRYHU most  routine  expenses  plus  purchase  a  catastrophic  plan,  even  an  otherwise  impecunious  patient  need  not  forego  ordinary  care  RQ DFFRXQW RI FRVW 5HFLSURFDOO\ SDWLHQWV HQMR\ WKH Âż QDQFLDO savings  of  prudent  purchasing.  In  conventional  plans,  when  coverage  for  a  service  is  refused  as  â&#x20AC;&#x153;unnecessary,â&#x20AC;?  it  is  plans,  employers  or  governments,  not  patients,  pocketing  the  savings. Â
Availability
Accountability
3DWLHQWV KDYH YLUWXDOO\ FRPSOHWH FRQWURO RYHU ZKLFK services  they  receive,  at  least  for  routine  expenses  covered  directly  by  the  personal  savings  account.  There  is  no  need  for  an  HMO  or  other  health  plan  to  dictate  which  tests,  treatments  and  drugs  patients  may  receive,  or  to  deny  coverage Â
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May/June 2012 I CDHC Solutionsâ&#x201E;˘ I www.TheIHCC.com
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3DWLHQWV FRQWURO ZKLFK SURYLGHUV WKH\ VHH because  the  patient,  not  the  plan,  directly  LQFXUV WKH H[SHQVH 3DWLHQWV FDQ FKRRVH DQ\ SK\VLFLDQ RU specialist,  any  time  they  wish,  without  begging  for  gatekeeper  approval.  More  important,  patients  are  free  to  continue  in  a  physician-Âpatient  relationship  of  their  choosing.  One  of  the  PRUH HJUHJLRXV Ă&#x20AC; DZV RI PLG V PDQDJHG FDUH ZDV IUHTXHQW changes  in  provider  networks.  Sometimes  they  occurred  when  employers  shifted  employees  to  a  new  health  plan,  with  a  different  provider  network,  and  other  times  when  health  plans  discontinued  contracts  with  particular  providers  or  provider  groups.  Either  way,  many  patients  and  physicians  were  deeply  distressed  by  being  forced  to  sever  long-Âstanding  relationships  simply  because  this  yearâ&#x20AC;&#x2122;s  plan  had  changed.  Such  disruptions  can  be  medically  and  economically  counterproductive.  Studies  show  continuity  of  relationships  yields  better  outcomes,  lower  costs  and  greater  satisfaction  for  patients  and  physician.  +HDOWK SODQV FDQ EHQHÂż W ZKHQ SDWLHQWV UHPDLQ ZLWK D particular  plan  over  time.  When  patients  frequently  shift  from  one  plan  to  the  next,  plans  providing  excellent  care  for  chronic  GLVHDVHV VXFK DV GLDEHWHV FDQ VXIIHU VLJQLÂż FDQW Âż QDQFLDO losses.  This  is  because  years  in  the  future,  some  other  plan  ZLOO HQMR\ WKH Âż QDQFLDO UHZDUGV RI WKLV SODQÂśV IRUZDUG ORRNLQJ preventive  care.    However,  once  patients  have  the  power  to  choose  their  own  health  plan,  including  choosing  the  same  plan  from  one  year  to  the  next,  plans  have  an  incentive  to  please  the  patient  rather  than  the  employer  and  to  attract  that  patientâ&#x20AC;&#x2122;s  continued  business.  Ultimately,  such  relationships  might  even  make  multiyear  contracts  possible,  thereby  enhancing  plansâ&#x20AC;&#x2122;  ability  to  improve  service  and  control  long-Ârange  costs. Â
Integrity
2QFH SDWLHQWV DUH Âż QDQFLDOO\ IUHH WR FRQWUDFW directly  with  the  physician  of  their  choice  to  buy  the  services  they  want,  the  physician-Âpatient  relationship  can  EH RQ D VRXQGHU HWKLFDO IRRWLQJ WKDQ LQ PDQ\ 0&2V 3K\VLFLDQV need  not  labor  under  odious  external  micro-Âmanagement,  nor  spend  endless  hours  begging  and  haranguing  permission  to  provide  the  simplest  interventions.  Neither  do  health  plans  need  to  pay  physicians  insidious  incentives  for  withholding  care.  In  the  routine  care  covered  by  a  spending  account,  the  only  ¿ QDQFLDO UHODWLRQVKLS LV EHWZHHQ WKH SK\VLFLDQ ZKR UHFRPPHQGV an  intervention  and  the  patient  who  receives  and  directly  pays Â
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for  it.  If  the  physician  says,  â&#x20AC;&#x153;You  donâ&#x20AC;&#x2122;t  need  the  costly  brand- name  drug,â&#x20AC;?  the  patient  need  not  wonder  about  ulterior  motives.  If  the  physician  says,  â&#x20AC;&#x153;You  really  do  need  this  test,â&#x20AC;?  the  patient  knows  the  only  incentive  is  the  traditional  fee-Âfor-Âservice  incentive  encouraging  physicians  to  do  more  than  is  needed.    However,  when  the  physician  knows  any  excess  comes  from  the  patientâ&#x20AC;&#x2122;s  own  account,  and  not  from  a  rich,  distant  insurance  FRPSDQ\ WKH SURIHVVLRQDO HWKLFV RI SHUVRQDO Âż GHOLW\ DUH IDU more  likely  to  shape  his  recommendations.  Moreover,  patients,  who  are  spending  from  their  own  account,  are  more  likely  to  ask  whether  something  is  really  needed,  whether  it  can  wait  or  whether  there  is  a  more  conservative  alternative. Â
Accuracy
Â
Opportunities  for  fraud  are  greatly  reduced.  When  third  parties  cover  the  expenses  and  the  bills  are  breathtakingly  complex,  patients  have  little  reason  to  scrutinize  bills  to  ensure  every  entry  is  correct.  Third-Âparty  payment  encourages  providers  to  continue  their  inscrutable  billing  practices  so  errors  are  not  readily  noticeable.   In  contrast,  when  patients  pay  their  own  bills  immediately  DIWHU VHUYLFHV WKH\ NQRZ ZKRVH Âż QDQFLDO DFFRXQW LV EHLQJ GUDLQHG DQG WKH\ NQRZ RU FDQ LPPHGLDWHO\ DVN ZKHWKHU WKH\ are  being  properly  charged.  Moreover,  even  providers,  who  might  be  inclined  to  cheat  a  large,  anonymous  insurer,   may  be  much  more  reluctant  to  defraud  a  patient  with  whom  they  have  a  personal  relationship. Â
Efficiency
Spending  accounts  can  yield  administrative  cost  savings.  When  patients  are  empowered  to  make  their  own  decisions,  there  is  no  need  for  costly  claims  processing  procedures,  eligibility  determinations,  utilization  review  or  DSSHDOV IROORZLQJ GHQLDOV RI FRYHUDJH 3DWLHQWV FDQ VLPSO\ present  a  debit  card  to  the  physician,  pharmacist  or  whomever,  and  payment  is  instant.  In  the  process,  providers  need  not  wait  ZHHNV WR PRQWKV QRU ¿ OH PXOWLSOH FODLPV EHIRUH WKH\ DUH SDLG
Choice
3DWLHQWV ZKR ZDQW H[WUDYDJDQW RU QRQVWDQGDUG FDUH are  not  imposing  on  other  people,  at  least  within  the  ambit  of  the  spending  account.  If  patients  want  the  costliest  drugs,  they  pay  out  of  their  own  funds,  not  common  resources.  At  the  same  time,  the  fact  the  patient  pays  means  most  decisions  will  be  considered  more  carefully  than  they  are  at  present.  It  is  easy  to  demand  antibiotics  for  a  viral  illness  or  insist  on  the  expensive  new  drug  advertised  on  the  television  when  others  bear  the  costs.  It  is  another  thing  when  the  cost  of  that  drug  comes  directly  out  of  oneâ&#x20AC;&#x2122;s  own  funds.  With  more  prudent  decision-Âmaking,  it  may  even  be  possible  to  avoid  some  of  the  problems  of  medical  excess,  such  as  the  emergence  of  resistant  organisms  resulting  from  overuse  of  antibiotics. Â
Advances
When  health  plans  no  longer  need  to  govern  myriad  small  expenses,  they  are  free  to  focus  on  the  important  realm:  costly  care  for  people  with  serious  illness  or  injury,  i.e.,  the  people  who  dip  into  their  catastrophic  FRYHUDJH $V RI SHUFHQW RI SDWLHQWV FRQVXPHG SHUFHQW RI WRWDO KHDOWK H[SHQGLWXUHV ZKLOH WKH WRS SHUFHQW RI SDWLHQWV FRQVXPHG QHDUO\ SHUFHQW 7KH WRS SHUFHQW FRQVXPHG SHUFHQW 7KLV SLFWXUH KDV QRW FKDQJHG VLJQL¿ FDQWO\ RYHU VHYHUDO
GHFDGHV 3ODQV QHHG WR VWRS QLJJOLQJ RYHU PLQRU PDWWHUV DQG take  the  lead  in  assessing  costly  new  technologies  and  innovative  interventions  to  ensure  evidence-Âbased  approaches  make  the  best  possible  uses  of  the  great  majority  of  common  funds. Â
Portability
'HÂż QHG FRQWULEXWLRQ DSSURDFKHV DUH FRQVLGHUDEO\ more  portable  than  many  current  health  plans.  3DUWLFXODUO\ ZKHQ VHOI LQVXUHG HPSOR\HUV HVWDEOLVK WKHLU RZQ GLVWLQFWLYH VHW RI EHQHÂż WV DQG SURYLGHU QHWZRUNV ZRUNHUV ZKR change  jobs,  usually  begin  a  completely  new  plan,  often  with  QHZ SURYLGHUV ,Q FRQWUDVW EHFDXVH GHÂż QHG FRQWULEXWLRQ SODQV generally  permit  enrollees  to  choose  their  own  providers  and  treatments,  at  least  at  the  lower  levels  within  the  deductible  range,  they  offer  considerably  more  continuity  across  job  changes. Â
Participation
3DWLHQWV FRQWUROOLQJ WKHLU RZQ GROODUV KDYH considerably  greater  reason  to  be  informed  participants  in  their  own  care.  When  employers  choose  the  health  plan,  and  when  plans  determine  which  care  is  â&#x20AC;&#x153;necessaryâ&#x20AC;?  from  what  kind  of  provider  and  in  which  setting,  patients  have  relatively  little  reason  or  opportunity  to  become  full  partners  in  their  care.  Active  participation  in  oneâ&#x20AC;&#x2122;s  care  can  be  medically  salutary. Â
Conclusion &RQVXPHUV SDWLHQWV FDQ PDNH PLVWDNHV VXFK DV IRUHJRLQJ XVHIXO FDUH in  order  to  save  money.  However,  it  is  not  clear  that  patientsâ&#x20AC;&#x2122;  decisions  DERXW ZKLFK FDUH LV XQ QHFHVVDU\ ZLOO EH DQ\ ZRUVH WKDQ WKH GHQLDOV QRZ issued  by  health  plans,  often  for  medically  dubious  reasons.  Moreover,  it  is  not  always  so  clear  when  a  given  intervention  is  actually  useful,  let  alone  â&#x20AC;&#x153;necessary.â&#x20AC;?  The  science  behind  the  guidelines  and  recommendations  issued  by  plans  and  by  providers  are  often  scanty  in  both  quality  and  quantity,  and  one  dayâ&#x20AC;&#x2122;s  gospel  becomes  the  next  dayâ&#x20AC;&#x2122;s  heresy.  When  patients  are  restored  to  a  mutually  trusting  relationship  with  their  physicians,  and  with  increasing  access  to  solid  medical  information,  they  may  be  more  amenable  to  persuasion  about  which  care  is  most  important  and  thereby  worthy  of  dipping  into  their  medical  spending  DFFRXQW %HFDXVH GHÂż QHG FRQWULEXWLRQ IXQGV FDQ EH GHGLFDWHG WR KHDOWK care  and  made  immediately  available,  patients  have  far  less  reason  to  forego  important  care  than  in  standard  plans  requiring  patients  to  pay  deductibles  RXW RI SRFNHW IRU Âż UVW GROODU KHDOWK H[SHQVHV The  past  two  decadesâ&#x20AC;&#x2122;  extraordinary  turmoil  has  taught  some  important  lessons.  It  has  been  a  time  of  trial  and  error  in  which  the  medical  communityâ&#x20AC;&#x2122;s  failure  to  constrain  its  spending  gave  way  to  a  business   orientation  failing  to  appreciate  clinical  realities.  Doctors  did  not  make  good  business  people,  and  business  people  did  not  make  good  doctors.  The  transition  is  far  from  complete,  but  there  has  been  tremendous  progress  over  the  past  few  years,  and  we  are  likely  to  see  a  happy  ending.  The  time  has  arrived  to  integrate  patients  into  the  equation  and  restore  to  them  the  power  and  responsibility  of  the  purse  that  can  permit  them  the  freedom  to  shape  their  care  according  to  their  own  values.  'U -RKQ 5H\QROGV LV SUHVLGHQW RI ),6Âś +HDOWKFDUH 6ROXWLRQV GLYLVLRQ +H ZDV QDPHG WR WKLV SRVLWLRQ LQ -DQXDU\ ,Q WKLV UROH 5H\QROGV LV UHVSRQVLEOH IRU setting  and  overseeing  strategic  marketing,  sales,  product  development,  RSHUDWLRQV DQG WHFKQRORJ\ 5H\QROGVÂś GLYLVLRQ LQFRUSRUDWHV VHYHUDO FRPSDQLHV DFTXLUHG E\ ),6 DV ZHOO DV RWKHU LQWHUQDOO\ GHYHORSHG SURGXFWV DQG VHUYLFHV 3ULRU WR MRLQLQJ ),6 5H\QROGV ZDV VHQLRU YLFH SUHVLGHQW DQG EXVLQHVV GLUHFWRU IRU ,QVWLWXWLRQDO &XVWRG\ %HQHÂż WV &RQVXOWLQJ DQG +HDOWK %HQHÂż WV 6HUYLFHV DW :HOOV )DUJR &R
www.TheIHCC.com I CDHC Solutionsâ&#x201E;˘ I May/June 2012
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FREE WEBINAR! +VOF t Q N &%5
REDUCING COSTS FOR EMPLOYERS AND EMPLOYEES WHILE IMPROVING PATIENT EXPERIENCE As part of the Instituteâ&#x20AC;&#x2122;s membership preview, we will be bringing you educational programs focused on solutions to challenges employers are facing in the health care arena. These programs will provide insights into benefit designs and other concepts focused on addressing the challenges of rising cost, eroding quality, and impacts to employee relations through health care consumerism. Â Our inaugural program will explore innovations in benefit design related to reducing costs for both employers and employees while improving patient experience.
Membership is FREE and allows participants unrestricted access to the rich content and networking capabilities within, including latest articles, case studies, white papers, press releases, podcasts, videos and blogs focused on innovative health benefit management. Members also are able to post and share content and contribute to the collaborative environment within The Institute.
Sign Up Today to attend and receive your FREE Membership to The Institute for HealthCare Consumerism at: theihcc.com/UniversityEvent
Faculty:
Learning Objectives:
t How to create innovative benefit designs that can reduce costs up to 80 percent and improves quality by combining Personal Patient Advocates with access to affordable, high-quality imaging and surgical networks. t How to drive adoption of cost saving benefit features. t How implementation of behavioral sciences and techniques can drive real savings t John Linss, Founder â&#x20AC;&#x201C; MedServ Global t Gordon Church, CEO â&#x20AC;&#x201C; MedServ Global t Don Doster, President â&#x20AC;&#x201C; gBehavior
Those who should attend include Managers and Senior Executives in: t t t t
Self-Insured Employers Consulting Companies Brokerages Third Party Administrators (TPAs)
Linss
Church
Doster
BY SCOTT M. WOOD PRINCIPAL BENEFIT COMMERCE GROUP
ASK THE BROKER
The Supreme Decision: Why Employers Should Continue Offering Health Plans No Matter How the Court Rules
O
ne of the most pressing questions employers are asking now is whether they should consider dropping employee health plans in 2014 and just pay the penalty, under the Patient Protection and Affordable Care Act (PPACA). The upcoming Supreme Court decision on the constitutionality of the individual mandate and the PPACA as a whole has center court attention. Health care costs and health insurance premiums continue to rise at a faster rate than overall inflation. For most companies, the second or third highest expense item in their budget is health care. When you weigh those rising costs against a $2,000 per employee penalty for not offering a health plan, the $2,000 may initially look like an appealing option. However, take a closer look at all the costs and you discover the best strategy is to continue offering an employee health plan. But be sure it is the right plan, with benefits and incentives that align employee and employer goals and responsibilities. With the right strategy, employers can save money, improve the health of their employees and improve productivity.
Pay or Play – The $2,000 Penalty Is Only One of the Costs Employers need to consider the following additional costs, if they think they may want to drop their employee health plan under PPACA: t The $2,000 per employee penalty is not tax-deductible. t With no employer-sponsored health plan, employees will pay federal and state taxes on the money they use to buy their own health insurance. Employers also will pay FICA and Medicare taxes on these wages that previously were on a pre-tax basis. t If an employer increases salaries to offset the cost of employees buying their own insurance, both the employee and employer also will pay additional taxes on these amounts. t This is tantamount to the government collecting taxes on the value of health care benefits. t Sixty percent of employees said medical benefits are top criteria for a job, according to a SHRM survey. Employers deciding to drop health plans risk losing their top talent. Who wants to be the first one not to offer a health plan? Chances are, that employer will lose valued employees to competitors still offering coverage.
How to Keep Health Plans Affordable When the math convinces employers to continue offering employee health plans, they still must determine how to control these runaway costs. For years, some employers have chosen to pass costs on to employees, through higher deductibles and higher copays. But this is not saving. The only way to save on health care costs is to get at the core issues
driving health care spending. That means establishing a workable strategy for the employer this year and for the long term. It means using proven and established “best practices” to lower health care costs, including: consumer-driven health plan enrollment, annual biometric screenings, health risk assessments, disease management and health advocacy programs, healthy lifestyle programs, premium differential for tobacco use vs. non-tobacco use and employer-sponsored health events. Four health conditions (coronary artery disease, cancer, diabetes and obesity) cause about 74 percent of our nation’s total health care costs. By identifying risks contributing to those diseases and controlling them, companies lower their costs, improve the health of their employees and increase productivity.
:HOOQHVV 3URJUDP 6DYLQJV &DQ 1RZ %H 4XDQWL¿HG When wellness programs began many years ago, it was difficult to quantify their value. However, there are now programs that show, in dollars, how these efforts actually save money on health plan premiums. In fact, there are programs available guaranteeing premium savings for employers implementing consumer-directed plans and comprehensive wellness programs. These programs measure and provide credits based on the level of employee engagement and participation.
Mid-sized Employers Can Lower Health Care Costs, Too Strategies for lowering health care costs work just as well with 300 employees as they do for organizations with tens of thousands of employees. Yes, large companies have large numbers to report. Safeway Inc. has followed a strategy of health, wellness and fitness for the past six years, keeping the company’s and its more than 30,000 non-union employees’ costs flat per capita—while health care costs increased nationally by 8.5 percent annually. However, there are many examples of mid-sized companies (100 to 2,000 employees), and even smaller ones, achieving as good or better results. For example, an industrial equipment company in Arizona, with 500 covered members, saved nearly $750,000 in 2010 and again in 2011, with expected savings for 2012 projected to be nearly $1 million, while at the same time improving benefits for employees and families. In summary, when it is decision time for employers, they need to look at all the costs for continuing or dropping coverage. With the right strategy, a comprehensive health plan strategy can be an investment in the organization and its employees, an investment that pays off in lower costs and increased productivity. Scott M. Wood is a Principal of Benefit Commerce Group LLC, an award-winning Scottsdale, Ariz. based employee benefits firm with more than 25 years of experience. Benefit Commerce Group is changing the health care cost paradigm with sustainable strategies to lower health care costs first-year and long-term. www.cdhcsolutionsmag.com I CDHC Solutions™ I May/June 2012
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WHO’S WHO PROFILES
WWW.THEIHCC.COM
6ROXWLRQV WR KHOS \RXU LQQRYDWLYH KHDOWK DQG EHQH¿W SURJUDPV DECISION SUPPORT & COST-SAVINGS TOOLS
HSA/HRA/FSA TECHNOLOGY: ADMINISTRATION & MANAGEMENT
TSYS Healthcare® provides end-toTSYS HEALTHCARE end strategic payment solutions for 706.649.5080 consumer directed healthcare. We www.tsyshealthcare.com partner with benefits administrators, healthcare@tsys.com financial institutions, health plans, and software providers to navigate all aspects of HSAs, HRAs, FSAs, transportation accounts, 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 can 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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May/June 2012 I CDHC Solutions™ I www.TheIHCC.com
WWW.THEIHCC.COM
WHO’S WHO PROFILES
$FFHVV WKHVH SUR¿OHV RQOLQH DW ZZZ 7KH,+&& FRP DQG ZZZ (PSOR\HUV:HE FRP HSA/HRA/FSA TECHNOLOGY: ADMINISTRATION & MANAGEMENT
HSA/HRA/FSA TECHNOLOGY: ADMINISTRATION & MANAGEMENT
Ceridian provides CDHC administration CERIDIAN with your business in mind. As a leading 3201 34th Street South provider of human resource, benefits and payment solutions, Ceridian helps St. Petersburg, FL 33711 organizations control costs, save time, optimize their workforce, grow revenue and 727-395-1764 minimize financial risk. Ceridian’s CDHC ernie.harris@ceridian.com administration services are designed to generate significant, sustainable savings through increased employee engagement. Our solution includes innovative features such as integrated account access, promotional communications, online claims and receipt uploads, and a mobile application coming soon.
DataPath, Inc., is one of nation’s largest providers of CDH solutions specializing in account-based administration systems.
®
HSA/HRA/FSA TECHNOLOGY: ADMINISTRATION & MANAGEMENT
TOTAL POPULATION HEALTH MANAGEMENT
– Sean Slovenski, President of LifeSynch,
501.296.9990 www.dpath.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.”
– Ernie Harris, Senior Product Manager for CDHC, Ceridian
“Whether it’s LifeSynch’s health coaching, EAP/Work-life, integrated medical-behavioral health or utilization management services, we integrate our behavioral health and behavior change expertise to ensure our members reach their goals and achieve sustainable, long-term improvements toward their health and well-being.”
1601 WestPark Drive, Suite 9 Little Rock, AR 72204
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.
“The key to controlling health care costs is also an employer’s most valuable resource – their employees. Ceridian goes beyond typical benefits administration to help employers form a phased, multiyear plan for engaging employees in their health and health care, which significantly lowers costs in the long term.”
LifeSynch changes behaviors to improve lives. LIFESYNCH Our approach integrates care of the mind and body to enhance health, increase productivity and 2101 W. John Carpenter Frwy Irving, Texas 75063 minimize unnecessary medical expenses. Built 800-207-5101 on a solid foundation of understanding human www.lifesynch.com behavior and how to motivate behavior change, we deliver proven outcomes through: Q Proven methods that lead to increased Q Customizable programs that easily engagement and sustained behavior incorporate into existing benefits and change. services. Q Clinicians and coaches who provide Q Scientifically proven best-practice personalized attention and form trusted guidelines to proactively manage care. relationships with members. Q Scalable, user-friendly technology.
DATAPATH, INC.
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 Q Flexible Spending Accounts (FSAs) Q Health Reimbursement Arrangements (HRAs) Q Health Savings Accounts (HSAs) – Employer & Individual Solutions! Q Transit/Parking Reimbursement Accounts (TRAs) Q And more! Q
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. www.TheIHCC.com I CDHC Solutions™ I
May/June 2012
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WHOâ&#x20AC;&#x2122;S WHO PROFILES
6ROXWLRQV WR KHOS \RXU LQQRYDWLYH KHDOWK DQG EHQHÂżW SURJUDPV 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 organizationâ&#x20AC;&#x2122;s specific learning requirements.
AMERICAâ&#x20AC;&#x2122;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 â&#x20AC;&#x153;differentâ&#x20AC;? PBM!
â&#x20AC;&#x153;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.â&#x20AC;? â&#x20AC;&#x201D; Kevin M. Nagle, President & CEO, Envision Pharmaceutical Services/Rx Options
R E S O U R C E If  you  use  the  services  of  our  solutions  providers,  please  tell  them  you  saw  their   ad  in  &'+& 6ROXWLRQVâ&#x201E;˘.
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ADVERTISING INDEX Aetna ...........................................................9
HealthCare Consumerism Radio ..................28
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AIG........................................................... 16
IHC FORUM West .................................. 17-19
Allstate ...................................................... 5
IHC Health and Wellness Library ................30
Best Buy ............................Inside Back Cover
IHC Membership.........................................34
CDHC Solutions Call for Content .................30
IHC Solutions Superstars ............................24
Ceridian .....................................................49
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Doug  Field   G¿HOG@¿HOGPHGLD FRP ù H[W ASSOCIATE  PUBLISHER
Brent  Macy EPDF\#¿HOGPHGLD FRP ù H[W VICE  PRESIDENT  OF  BUSINESS  DEVELOPMENT
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UnitedHealthCare ......................... Back Cover
Susan  Yakots V\DNRWV#¿HOGPHGLD FRP H[W 50
May/June 2012 I CDHC Solutionsâ&#x201E;˘ I www.TheIHCC.com
Engaging consumers to make informed health care decisions UnitedHealthcareâ&#x20AC;&#x2122;s consumer-driven health (CDH) plans were designed to get employees on the path to good health with improved lifestyle habits and use of the health care system, and greater transparency to help drive better decisions. Thatâ&#x20AC;&#x2122;s why our plans offer: t NZ)FBMUIDBSF $PTU &TUJNBUPS B UPPM UIBU HJWFT NFNCFST VMUSB TQFDJmD FTUJNBUFT CBTFE PO MPDBUJPO QSPDFEVSF and even doctor; as well as expenses related to possible care paths t OFUXPSL QSFWFOUJWF DPWFSBHF BOE QFSTPOBMJ[FE NFTTBHJOH CBTFE PO JOEJWJEVBM IFBMUI DBSF OFFET
t &BTZ UP VTF SFTPVSDFT GPS FNQMPZFFT JODMVEJOH B 6OJUFE)FBMUIDBSF )FBMUI .F4. BQQ B IFBMUI FYQFOTF USBDLFS BOE )FBMUI $BSF -BOFÂĽ UP IFMQ NFNCFST VOEFSTUBOE BOE NBYJNJ[F UIFJS IFBMUI DBSF CFOFmUT t #BOLJOH UISPVHI PVS PXO 0QUVN)FBMUI #BOL .FNCFS PG UIF '%*$ PÄ&#x160;FSJOH JOUFHSBUFE BDDFTT UP BDDPVOU CBMBODFT BOE B EFCJU DBSE UIBU NBLFT QBZNFOUT FBTJFS
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'PS NPSF JOGPSNBUJPO PO 6OJUFE)FBMUIDBSF T $%) QMBOT WJTJU uhctogether.com/CDH or call 1.866.438.5651.
READY. SET. GROW HEALTHY. UHCTOGETHER.COM/CDH
myHealthcare Cost Estimator is currently available to many UnitedHealthcare members, and will launch in additional markets throughout the remainder of the year. Š2012 United HealthCare Services, Inc. Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by United HealthCare Services, Inc. or their affiliates. Health plan coverage provided by or through a UnitedHealthcare company. UHCEW506202-002