HealthCare Consumerism Solutions Jan/Feb '13

FORUM East · May 9-10, Atlanta Formerly CDHC Solutions

ISSUE || January/February 2013

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EXCHANGES Transforming How Insurance is Purchased, Received

The Value of Private Exchanges Defined Contribution Model, Private Exchanges Shifting Power to Consumers How Health Care Reform Will Impact Vision Benefits – Bringing the Facts Into Focus

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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.

INSIDE

FEATURES

28-36 EXCHANGES Transforming How Insurance is Purchased, Received The emergence of public and private health insurance exchanges will be a true game changer in the way employers offer insurance to their employee population, how brokers sell insurance and how consumers purchase insurance. HealthCare Consumerism Solutions offers three different prospectuses in this issue on private exchanges; private exchanges using the defined contribution model and the public exchanges, created and managed by state and/or federal governments.

28 The Value of Private Exchanges

Much of the media focus of late has been on the value of public health care exchanges, the costs to taxpayers associated with them and the readiness of various states and the federal government to operate them. For more than a decade various entities have been operating private exchanges that are cost effective and have benefited employers and employees alike without burdening taxpayers. The value of an exchange, public or private, goes well beyond the introduction of a defined contribution account that allows employers to better manage their portion of health care costs.

Ernie Harris

32 Defined Contribution Model, Private Exchanges Shifting Power to Consumers

35 Public Exchanges Must Answer Multiple Questions Under Tight Deadlines

Challenging economic times in the United States have had an impact on nearly every American. For millions of people, health care—and its related costs—are a significant financial concern. Businesses, of course, also have felt these challenges and have looked for new and innovative ways to help keep health care costs in check.

One solution getting a great deal of attention is the defined contribution model, where the employer makes a fixed dollar contribution to each employee.

Signed into law by President Obama on March 23, 2010, the Affordable Care Act (ACA) aims to dramatically reduce the ranks of the uninsured population in the U.S. within the next few years. The passage of the law has set into motion a flurry of activity at the state and federal levels to accommodate the millions of consumers who will find health coverage accessible for the first time. The ACA establishes a vital role of health benefit exchanges (HBE) that are to manage standardized, state-regulated U.S. health care plans and be fully certified and operational by Jan. 1, 2014.

Craig Tobin

David Urbaniak

40 How Health Care Reform Will Impact Vision Benefits – Bringing the Facts Into Focus What’s the first thought that comes to your mind when you hear the term “health care reform”? If you’re like most HR or benefit professionals, your mind probably darts to the impact of the heavily debated legislation on employee medical benefits. That makes a lot of sense; after all, health care reform will have its greatest effect in this area. However, the Patient Protection and Affordable Care Act (PPACA) also will trigger a “ripple effect” for ancillary benefits. In the case of vision, for example, employers are already starting to ask questions about whether their employee vision plans will need to change in terms of structure, coverage and costs to both them and their workforce.

Jeff Spahr

COMING UP NEXT: The Institute for HealthCare Consumerism and its official publication, HealthCare Consumerism Solutions, will launch HealthCare Exchange Solutions, a 16-page supplement focusing on the latest news on the emergence of both public and private health insurance exchanges and what it means for employers, brokers, advisors, consultants, TPAs and regional health plans.

ON THE COVER: While it may not be realistic that employees will be able to go to the market and pick up health insurance like picking up a loaf of bread or milk at the neighborhood grocery store, the emergence of insurance exchanges will make insurance more accessible and put the power back into the hands of the consumer on making health care decisions. www.TheIHCC.com I HealthCare Consumerism Solutions™ I January/February 2013

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INSIDE

DEPARTMENTS

6-7 What’s Happening at The Institute 8

21 Regulatory & Compliance

Editor and Publisher’s Letter

HealthCare Consumerism Solutions Expanding to Include Exchange Solutions

Development of Private Health Insurance Exchanges Predate PPACA Ron Bachman

11 Guest Commentary Fifty-two Card Pickup

Greg Scandlen

13-17 IHC FORUM East Preview t t t t

Making Consumerism Work Speakers and FORUM agenda Benefits for attending FORUM Super Saver and Early Bird Rates

23 HSAs Evolutionary Health Care Financing: The Global Switch to HSAs J. Kevin A. McKechnie

18-20 People on the Move 18-20 Briefs/Innovations

t Aetna Consumer-directed Health Plans Continue to Save Millions for Employers t Truven Health Analytics Develops Solution to Evaluate Wellness Program Effectiveness t United Airlines Opens Free Workplace Health Clinic at O’Hare t Mercer Selects Benefitfocus to Provide Technology Platform for Private Exchange

24 Population Health Management Corporate Wellness: 2013 is Time for an Upgrade Dr. Dee Edington

43 Who’s Who Profile 50 Resource Guide/Ad Index

Events

25 Supplemental Health Ease the Sting of High-deductible Health Plans with Voluntary Benefits and Effective Communication Randy Finn

The 2013 IHC FORUM East www.theihccforum.com

For the fourth year in a row, IHC FORUM East returns to the Cobb Galleria Centre in Atlanta on May 9-10. The only conference series 100 percent dedicated to innovative health and benefit management has an expanded preconference, including a one-day Employee Benefits FORUM on May 8 from 7:30 a.m. to 5:15 p.m. that is exclusively for employers. This preconference is coproduced by the Atlanta Chapter of Worldwide Employee Benefits Network (WEB). The theme for this year’s conference series is “Making HealthCare Consumerism Work.” Registration is now open. Come LEARN, CONNECT and SHARE with the top thought leaders in the rapidly growing health care consumerism megatrend.

26 Pharmacy Benefit Management Pharmacy Benefit Management Business Adapting to Dramatic Demand for Specialty Medications Sumit Dutta

Become a Member and Reap the Rewards

Have you become a member of The Institute for HealthCare Consumerism (www.theihcc.com)? Why wait? Visit The IHC website today and sign up for a premium membership.

Got a story to tell about an innovative health and benefit program or best practice in health care consumerism?

Share it with fellow members of The Institute for HealthCare Consumerism. Share a case study, white paper, article or post a blog at www.theihcc.com. Members of The IHC also receive special discounts to attend Institute events, such as IHC FORUM.

4 January/February 2013 I HealthCare Consumerism Solutions™ I www.TheIHCC.com

27 Health Care Access Alternative Consider an On-site Wellness/Telemedicine Team for Better Employee Engagement Tony Chandler

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.

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.

If you’re reading this magazine and have not yet signed up for your 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.

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.

Sign up today for your Membership to The Institute for HealthCare Consumerism at: theihcc.com/membership Sincerely, Doug Field Founder & CEO, The Institute for HealthCare Consumerism Publisher, HealthCare Consumerism Solutions Magazine

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spotlight Minneapolis  this  week,  Boston  the  next,  a  layover  in  Atlanta  and  then  it’s  off  to  Dallas  and  a  West  Coast  swing  for  meetings  in  Phoenix,  Los  Angeles  and  Seattle.

airports  and  company  board  rooms  than  probably  any  other  person  in  the  health  care  industry.

That  is  not  the  itinerary  for  the  last  leg  of  the  latest  U2  tour.  It  is  just  another  business  week  in  the  life  of  John  Young,  who  has  been  honored  by  The  Institute  for  HealthCare  Consumerism  with  the  2012  John  J.  Robbins  Senior  Memorial  HealthCare  Consumerism  Leadership  Award.

<RXQJ¶V WUDYHOV KDV PDGH KLP D ¿[WXUH as  a  speaker  and  moderator  at  The  Institute  for  HealthCare  Consumerismâ&#x20AC;&#x2122;s  FORUM  conference  series.  Young  blends  educational  and  insightful  tools  into  an  informative  and  entertaining  presentation.  He  has  been  an  attendee  favorite  when  he  takes  the  stage.

For  more  than  a  decade,  Young  has  been  a  tour  de  force  in  the  health  care  consumerism  movement.  It  is  not  only  a  job  but  a  passion  and  way  of  life  for  Young,  who  has  been  involved  with  this  megatrend  since  2000.

During  his  professional  career,  Young  has  logged  several  miles  on  the  odometer  of  countless  rental  cars,  accumulated  WKRXVDQGV RI IUHTXHQW Ã&#x20AC;\HU SRLQWV DQG VSHQW PRUH WLPH LQ 6 January/February 2013 I HealthCare Consumerism Solutionsâ&#x201E;¢ I www.TheIHCC.com

John Young, 2012 John J. Robbins Senior Memorial HealthCare Consumerism Leadership Award winner

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DISCUSSIONS

Costco Offers Pharmacy Benefit Management Services Costco  Wholesale,  the  business  known  for Â

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its  low  prices  and  oversized  products,  has  entered  in  WKH SKDUPDF\ EHQH¿ W PDQDJHPHQW 3%0 PDUNHW ZLWK &RVWFR +HDOWK 6ROXWLRQV &+6 &RVWFR LV looking  to  drive  demand  and  increase  revenues  from  their  pharmacies  and  prescription  drug  sales.  Costco  is  leveraging  their  brand  name,  going  after  the  6.4  million  business  members  that  are  already  with  Costco  Wholesale  and  bringing  them  over  to  CHS.  This  strategy  of  focusing  on  existing  business  members,  and  businesses  located  near  Wholesale  stores,  means  Costco  is  focusing  on  the  mid-­market,  businesses  with  under  20,000  employees  being  covered.  Costco  is  able  to  separate  itself  from  the  competition  by  following  the  same  business  model  that  has  made  Costco  Wholesale  a  success;͞  selling  their  products  a  modest  margin  above  cost.  CHS  offers  prescriptions  through  Costco  in-­warehouse  pharmacies  and  an  extensive  network  of  64,000  independent  pharmacies  working  with  Costco  to  offer  low  cost  prescriptions.  Participants  of  the  plan  also  receive  other  exclusive  services  from  in-­ warehouse  pharmacies  including  clinical  services,  walk-­up  immunization  services  and  free  health  screenings.

Your  wellness  campaign  may  be  missing  a  huge  RSSRUWXQLW\ $QG LWÂśV DOO EHFDXVH RI KRZ \RX GHÂż QH WKH ZRUG ÂłZHOOQHVV ´ 2U UDWKHU KRZ \RX GRQÂśW GHÂż QH LW Employers  use  it  in  their  communication  as  their  go-­to  term  for  physical  health.  Thereâ&#x20AC;&#x2122;s  nothing  wrong  with  that.  But  for  your  employees  and  their  families,  a  healthy  life  is  about  much  more  than  a  healthy  Body  Mass  Index  %0, *RRG KHDOWK PHDQV QRW VWUHVVLQJ DERXW ELOOV or  retirement  and  having  enough  money  to  enjoy  the  weekends  with  the  kids.  Your  campaign  should  address  WKH ZKROH SHUVRQ ,W VKRXOG SURPRWH Âż QDQFLDO OLWHUDF\ as  equal  to  physical  health.  That  means  encouraging  HPSOR\HHV WR FRQWULEXWH WR WKHLU N RSHQLQJ D WD[ DGYDQWDJHG KHDOWK VDYLQJV DFFRXQW +6$ WR SD\ IRU HOLJLEOH PHGLFDO H[SHQVHV LI WKH\ KDYH D KLJK GHGXFWLEOH SODQ DQG SDUWLFLSDWLQJ LQ WKH Âż QDQFLDO SURJUDPV WKDW \RX offer.

Whole Foods CEO Mackey Continues Leadership in Free Market Health Reform John  Mackey,  Whole  Foods  CEO  and  Co-­founder,  has  received  a  lot  of  publicity  lately  for  his  brazen  comments  about  PPACA  and  the  state  of  the  nationâ&#x20AC;&#x2122;s  health  care  system.  But,  while  some  have  criticized  him  for  poor  word  choice,  Mackey  has  been  a  consistent  innovator  and  leader  in  the  free  marketâ&#x20AC;&#x2122;s  approach  to  health  reform.  While  health  care  costs  have  sky-­rocketed  in  UHFHQW \HDUV DQG FRPSDQLHV KDYH VWUXJJOHG WR Âż QG ZD\V to  keep  costs  down,  Mackey  has  personally  taken  the  role  of  curbing  health  costs  and  improving  employeesâ&#x20AC;&#x2122;  health  to  heart.  And  he  has  done  it  not  by  mandates,  but  through  incentivizing  wellness,  engaging  employees  and  offering  innovative  health  plans.  In  December  of  2011,  The  Institute  for  HealthCare  Consumerismâ&#x20AC;&#x2122;s  Editorial  Advisory  Board  selected  John  Mackey  for  the  cover  of  the  annual  HealthCare  Consumerism  Superstars  issue.  In  the  cover  story,  the  Institute  published  a  piece  written  by  Mackey  simply  entitled  â&#x20AC;&#x153;Health  Care  Reform,â&#x20AC;?  wherein  he  OD\V RXW KLV WKRXJKWV RQ Âż [LQJ WKH 8 6 KHDOWK FDUH V\VWHP

Why I Am More Egalitarian Than Most Liberals on Health Care -RKQ *RRGPDQ

Most  people  would  place  me  on  the  political  right.  Yet  when  it  comes  to  health  care,  I  am  more  egalitarian  than  almost  everybody  on  the  left.  I  always  have  been.  By  that  I  mean  I  am  more  egalitarian  than  the  defenders  of  the  %ULWLVK 1DWLRQDO +HDOWK 6HUYLFH 1+6 DQG WKH GHIHQGHUV of  Canadaâ&#x20AC;&#x2122;s  system  of  socialized  medicine.  Iâ&#x20AC;&#x2122;m  also  more  egalitarian  than  Paul  Krugman  and  the  leaders  of  the  Physicians  for  a  National  Health  Program.  Not  only  that,  but  a  great  many  Republicans  agree  with  my  approach  to  health  care  â&#x20AC;&#x201D;  even  as  they  oppose  ObamaCare. Â

events

Transparency + Accountability

5D\ )DELXV 0 ' 7UXYHQ +HDOWK $QDO\WLFV I  celebrate  the  efforts  of  the  state  of  Massachusetts  to  advance  price  transparency  within  health  care.  With  the  ZLGH YDULHW\ RI KHDOWK SODQ DOWHUQDWLYHV DQG EHQH¿ W GHVLJQV it  has  never  been  easy  for  consumers  to  estimate  what  their  out  of  pocket  costs  will  be  before  accessing  elective  care.  In  many,  maybe  most  cases,  the  information  is  not  available.  Truven  Health  data  analysis  has  shown  wide  and  unexplained  variation  in  the  cost  of  the  same  service  within  metropolitan  service  areas  -­  sometimes  this  variation  can  be  three  fold  or  more,  and  patients  are  generally  unaware  of  this.  Providing  online  tools  to  disclose  a  price  is  a  good  start.  Enhancing  these  tools  to  allow  for  price  comparisons  is  the  next  step.  Studies  show  that  tools  like  our  Treatment  Cost  Calculator  KDYH WKH SRWHQWLDO WR VLJQL¿ FDQWO\ UHGXFH WRWDO KHDOWK FDUH FRVWV IRU HPSOR\HUV E\ providing  their  workers  the  ability  to  compare  prices.

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Donâ&#x20AC;&#x2122;t miss the opportunity to be at the forefront of the continued growth of health care consumerism.

Registration is now open for IHC FORUM East in Atlanta on May 9-10. Register today to take advantage of Early Bird rates.

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LETTER

EDITOR & PUBLISHER www.theihcc.com VOLUME Â 9 Â NO. Â 1 Â | Â JANUARY/FEBRUARY Â 2013

+HDOWK&DUH &RQVXPHULVP 6ROXWLRQV ([SDQGLQJ WR ,QFOXGH ([FKDQJH 6ROXWLRQV Since its creation, this publication has been dubbed by the health care industry as the voice for innovative health and benefit management. As the health insurance arena expands with the creation of public and private exchanges, The Institute for HealthCare Consumerism, and its official publication, HealthCare Consumerism Solutions, are growing to meet the dynamic needs of the health care consumerism market.

On Feb. 18, www.theihcc.com, the online community of The IHC providing a place for its members to LEARN, CONNECT and SHARE in a 24/7, global environment helping them continue their journey toward health care consumerism, launched the HealthCare Exchange Solutions community. Like the other communities at The IHC, HealthCare Exchange Solutions community provides highlights of the emerging private and public health insurance marketplaces with an emphasis on helping employersâ&#x20AC;&#x201D;and the multi-stakeholders working with themâ&#x20AC;&#x201D;understand defined contribution model and the different exchanges. The community includes industry trends, compliance issues, solutions and perspectives from each stakeholder.

In addition to the community, The Institute will launch a biweekly enewsletter to its members, highlighting articles and blogs from the top thought leaders and the latest news in regard to the creation and development of private as well as state-and federally-run health insurance exchanges.

Coming in the next issue of HealthCare Consumerism Solutions, we are proud to launch â&#x20AC;&#x153;HealthCare Exchange Solutions,â&#x20AC;? a 16-page supplement within this publication designed to further educate our members on this emerging trend reshaping the way employers, brokers, consumers and all stakeholders receive health insurance.

In this issue we preview what readers can expect from â&#x20AC;&#x153;HealthCare Exchange Solutions.â&#x20AC;?

There are three articles in this issue discussing defined contribution, private exchanges and the emergence of government-run exchanges on the state and federal level. The public-exchange article also tackles the obstacles and challenges the government is facing to establish insurance exchanges under a tight Jan. 1, 2014, deadline.

The Conversation Continues at The IHC Continuing to utilize our multi-media platform at The Institute, HealthCare Consumerism Radio is back and new and improved. With our new radio partner, Americaâ&#x20AC;&#x2122;s Web Radio, the conversation on innovative health and benefit management continues live every Friday from 11 a.m. to noon (EDT). The shows also are archived on The Institute website for our membersâ&#x20AC;&#x2122; convenience.

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Kellie  Frissell H[W Ä NIULVVHOO#ÂżHOGPHGLD FRP CHAIRMAN  OF  IHC  ADVISORY  BOARD

Ronald  E.  Bachman,  CEO,  Healthcare  Visions EDITORIAL  ADVISORY  BOARD

Kim  Adler,  Allstate;Íž  Diana  Andersen,  Zions  Bancorporation;Íž  Bill  Bennett;Íž  Doug  Bulleit,  DCS  Health;Íž  Jon  Comola,  Wye  River  *URXS -RKQ +LFNPDQ $OVWRQ %LUG //3 7RQ\ +ROPHV 0HUFHU +HDOWK %HQHÂżWV 0DUF .XWWHU $Ă&#x20AC;DF 6DQGHUV 0F&RQQHOO 0\ HSA  Rewards;Íž  Roy  Ramthun,  HSA  Consulting  Services  LLC;Íž  -RKQ <RXQJ &,*1$ WEBMASTER Â

Kevin  Carnegie NFDUQHJLH#¿HOGPHGLD FRP Tom  Becher ZHEPDVWHU#¿HOGPHGLD FRP REPRINTS

Rogers  Beasley Â Ä UEHDVOH\#ÂżHOGPHGLD FRP %86,1(66 0$1$*(5

Register for Forum and Save After visiting The IHC website, browse the Exchange Solutions community and read the â&#x20AC;&#x153;HealthCare Consumerism Exchange Solutions,â&#x20AC;? employers, brokers, advisors, consultants and TPAs can further sharpen their saw by attending IHC FORUM East coming May 9-10 in Atlanta.

The discussion on exchanges will be at the forefront of the program, as the topic will be featured in a general session and also in an innovative share session. These discussions will showcase the top thought leaders in the private and public exchange arenas.

Visit www.theihccforum.com to register and take advantage of great savings to attend the forum and pre-conference events. We look forward to seeing you in Atlanta this spring.

Karen  Raudabaugh H[W Ä NUDXGDEDXJK#ÂżHOGPHGLD FRP +HDOWK&DUH &RQVXPHULVP 6ROXWLRQVâ&#x201E;˘  Volume  9  Issue  1 Copyright  Š 2013  by  FieldMedia  LLC.  All  rights  reserved. +HDOWK&DUH &RQVXPHULVP 6ROXWLRQVâ&#x201E;˘  is  a  trademark  of  FieldMedia  LLC.  +HDOWK&DUH &RQVXPHULVP 6ROXWLRQVâ&#x201E;˘  is  published  eight  times  yearly  by  FieldMedia  LLC 6RXWK 0DLQ 6WUHHW 6XLWH $OSKDUHWWD *$ 3HULRGLFDO SRVWDJH SDLG DW $OSKDUHWWD *$ DQG DGGLWLRQDO PDLOLQJ RIÂżFHV TO  SUBSCRIBE:  Make  checks  and  money  orders  payable  to  +HDOWK&DUH Consumerism  Solutions â&#x201E;˘  magazine  292  S.  Main  Street,  Suite  400,  Alpharetta,  *$ RU YLVLW ZZZ WKHLKFF FRP 1RQ TXDOLÂżHG SHUVRQV PD\ VXEVFULEH at  the  following  rates:  single  copy  $7.50;Íž  $75.00/yr  in  the  U.S.,  $105/yr  in  Canada  and  $170/yr  international.  Please  contact  FieldMedia  at  404.671.9551  RU VXEVFULEHUVHUYLFH#ÂżHOGPHGLD FRP IRU QDPH DGGUHVV FKDQJHV PRINTED  IN  THE  U.S.A.

Todd Callahan Editorial Director tcallahan@fieldmedia.com 8 January/February 2013 I HealthCare Consumerism Solutionsâ&#x201E;˘ I www.TheIHCC.com

Doug Field CEO/Publisher dfield@fieldmedia.com

+HDOWK&DUH &RQVXPHULVP 6ROXWLRQVâ&#x201E;˘  is  designed  to  provide  both  accurate  and  authoritative  information  with  regard  to  the  understanding  that  the  publisher  LV QRW HQJDJHG LQ UHQGHULQJ OHJDO ÂżQDQFLDO RU RWKHU SURIHVVLRQDO VHUYLFH ,I legal  advice  is  required,  the  services  of  a  professional  adviser  should  be  sought.  The  magazine  is  not  responsible  for  unsolicited  manuscripts  or  photographs.  Send  letters  to  the  editor  and  editorial  inquiries  to  the  above  address  or  to  WFDOODKDQ#ÂżHOGPHGLD FRP 3HUPLVVLRQ WR UHXVH FRQWHQW VKRXOG EH VHQW WR WFDOODKDQ#ÂżHOGPHGLD FRP

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BY GREG SCANDLEN FOUNDER CONSUMERS FOR HEALTH CARE CHOICES

GUEST COMMENTATOR

Fifty-­two  Card  Pickup

R

emember when you were a kid and someone asked you if you wanted to play â&#x20AC;&#x153;fifty-two pickupâ&#x20AC;? with your new deck of cards? He would throw them all into the air and you would pick them up. Fun! The health care industry today resembles this game. All of the cards have been thrown into the air and we are gradually picking them up. But the order has changed completely. Things are no longer assembled in tidy boxes by suit and number but completely re-ordered into new relationships.

I am not speaking here about â&#x20AC;&#x153;health reformsâ&#x20AC;? as envisioned by Washington, but about what is happening in the market. The â&#x20AC;&#x153;reformsâ&#x20AC;? just add to the complexity of the environment for the real players in health care. If anything, Washington will serve to retard the transforming re-arrangements.

This notion has been nagging at me ever since consumer-driven care started becoming a reality, but was focused especially by Bill Boylesâ&#x20AC;&#x2122; latest issue of â&#x20AC;&#x153;Consumer Driven Market Report.â&#x20AC;? (For subscription information, e-mail Bill Boyles at Interpro Publications editor@xintrak.com) Things had been quite stable for half a century before Consumerdriven Health. On the financing side there were insurance companies doling out benefits. Even Medicare and Medicaid did not alter that fundamental arrangement. These companies paid benefits to doctors, hospitals, maybe also to some â&#x20AC;&#x153;allied professionals,â&#x20AC;? labs and drug stores. And that was the â&#x20AC;&#x153;system.â&#x20AC;?

All this began to change with the advent of cash accounts in health care financingâ&#x20AC;&#x201D;first flexible spending accounts (FSAs), then medical savings accounts (MSAs), then health reimbursement arrangements (HRAs), then health savings accounts (HSAs). Suddenly the banks were involved in financing health care. There may not have been much competition between insurers (all offering virtually identical products at virtually identical prices), but the new players (banks) started working hard to get a piece of the pie.

They brought in the card companies (credit, debit and discount), which began to blend with wellness and incentive programs, which relied on infotech companies. Boyles says the â&#x20AC;&#x153;new configurationâ&#x20AC;? is â&#x20AC;&#x153;ACCOUNTSCARDS-INCENTIVES,â&#x20AC;? all powered by technology. Notice that he gives insurers barely a mention.

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At the same time all of this is being supercharged by employers moving to defined contribution and private exchanges.

Boyles wraps up his newsletter with an essay on three â&#x20AC;&#x153;Lookoutsâ&#x20AC;? (not â&#x20AC;&#x153;outlooksâ&#x20AC;?) for 2013.

The first is the entirely new environment for employers and insurers.

They will have to start reserving for the new federal premium tax, limit premium increases to avoid a federal rate review, add costs to comply with exchange data requirements, and deal with new underwriting uncertainty

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as they can no longer ask medical questions of applicants. He concludesâ&#x20AC;&#x201D; Chances are very good that employers and insurers will have no choice but to cut benefits even more to subsidize all the new sources of costs.

The next lookout isâ&#x20AC;&#x201D;Everybody will be looking for relief from the incredible complexity of the â&#x20AC;&#x2DC;newâ&#x20AC;&#x2122; U.S. health system coming this year, and rising costs will make simplicity a lovely word to the ears of employers and consumers.

Concerns include a new emphasis on coordination of benefits across payers, cost shifting from expanded Medicaid programs, the complexity of dealing with different exchanges in different areas with a portion of employees in them while others are not, plus the complexity of subsidies for some and not others and the prospect of having three different account arrangements (FSA, HSA, HRA) across all these platforms. A vendor who can smooth all this out will be very popular.

Finally, Boyles discusses the likelihood of market consolidation of the various vendors. He doesnâ&#x20AC;&#x2122;t expect any winner-take-all consolidation in the near future. There is too much innovation going on for the market to become that settled. Instead, he expects that some breakthrough innovations will become standard across all of the market, enhancing everyoneâ&#x20AC;&#x2122;s market position.

I havenâ&#x20AC;&#x2122;t mentioned yet, but it is worth noting, that similar realignments are happening in the medical service delivery side. Some of this is due to the ACO push that merges physicians and hospitals, but the real revolution was already happening before ACOs were even thought of. This includes the advent of retail clinics, medical tourism both foreign and domestic, concierge medicine, physician-owned hospitals, at-home testing and monitoring, and many other innovations.

Much of this was anticipated years ago when I was running Consumers for Health Care Choices. Here are some links for extra reading you can visit while at www.theihcc.com. t +PIO (PPENBO TQFBLJOH BU PVS BOOVBM NFFUJOH JO 8BTIJOHUPO JO 2006. t #JMM #PZMFT TQFBLJOH BU PVS BOOVBM NFFUJOH JO 8BTIJOHUPO JO t 5POZ .JMMFS GPVOEFS PG %FmOJUZ )FBMUI BU UIF TBNF FWFOU t (BSZ "IMRVJTU PG #PP["MMFO )BNJMUPO BU B CBORVFU JO -BT 7FHBT in 2007.

We canâ&#x20AC;&#x2122;t know how all this will settle out or even when it will become settled. All we know now is that the entire health sector is going to look very different in the future than it was just a few years ago when all the cards were neatly organized in a little package.

Note: This article was originally posted at www.ncpa.org on Feb. 11, 2013. www.TheIHCC.com I HealthCare Consumerism Solutionsâ&#x201E;˘ I January/February 2013

11

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valuable tools I’ve ever received. The analysis medical costs, prediction for next year’s out-ofpocket expenses, and recommendation for the best plan for me has taken the worry out of open enrollment.

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ATLANTA MAY 9-10, 2013

2013

MAKING HEALTHCARE CONSUMERISM WORK In the Year Ahead and Beyond FEATURED SPEAKERS: Ron Bachman

Roy Ramthun

FSA,  MAAA,  Sr.  President,  Healthcare  Visions;͞  Chairman  of  The  Institute  For  HealthCare  Consumerism  Editorial  Advisory  Board

An  expert  on  health  savings  accounts  and  consumer  directed  health  care  issues

Wendy Lynch

Partner Alston+Bird  LLP

Co-­director,  Altarum  Center  for  Consumer  Choice  in  Health  Care

Chris Covill Exchange  Product  Leader  and  Partner Mercer

Dawn Bading Vice  President,  Human  Resources Kaiser  Permanente

John Hickman

Cindy Gillespie Senior  Managing  Director McKenna  Long  &  Aldridge  LLP

Patti Taylor 'LUHFWRU *OREDO %HQH¿ WV Newell  Rubbermaid

Steve Lafferty, Sr. Director  of  Clinics  and  Health  Partnerships,  Target )RUPHU 'LUHFWRU 7DUJHW %HQH¿ WV

WHO SHOULD ATTEND? CEOs/Presidents/CFOs +5 DQG %HQH¿ WV ([HFXWLYHV Health  Plan  Administrators Corporate  Wellness  and  Medical  Directors

%HQH¿ W %URNHUV Third  Party  Administrators %HQH¿ W &RQVXOWDQWV %DQNHUV

WWW.THEIHCCFORUM.COM

2013 NO OTHER CONFERENCE IS DOING WHAT THE IHC FORUM DOES!

Learn how to get your employees to become better health care consumers and lower your health care benefit costs.

LEARN FROM EXPERTS AND EACH OTHER AT THE IHC FORUM t -FBSO OFX TUSBUFHJFT UP FOIBODF ZPVS DVSSFOU health and benefit offering t )FBS UIF MBUFTU VQEBUFT BOE DIBOHFT UP UIF health care law t $POOFDU XJUI LFZ JOEVTUSZ MFBEFST TFF UIF MBUFTU TPMVUJPOT BOE CF BCMF UP JNQMFNFOU UIFN SJHIU BXBZ t #VJME ZPVS IFBMUI CFOFmU TLJMMT JO PVS FEVDBUJPOBM XPSLTIPQT FBSO $& BOE 41)3 DSFEJUT t /FUXPSL XJUI ZPVS QFFST Â&#x2030; )FBS XIBU IBT XPSLFE GPS UIFN BOE TIBSF ZPVS TVDDFTTFT

WHAT YOUâ&#x20AC;&#x2122;LL LEARN The FORUM EAST and WEST conferences will be day and a half events plus valuable pre-conferences the day before, with 40 speakers participating in five general sessions and your choice of 24 workshops.

In addition to networking with top industry leaders, you will learn how to successfully be on the cutting edge of new health care benefits through topics and discussions, such as: t .BLJOH )FBMUI$BSF $POTVNFSJTN 8PSL t )FBMUI$BSF 3FGPSN )PX UP $PNQMZÂ&#x2030;-BUFTU 6QEBUFT GSPN Experts t 1PQVMBUJPO )FBMUI .BOBHFNFOU *NQMFNFOUJOH B 4VDDFTTGVM 8FMMOFTT 1SPHSBN t &YQFSU 1BOFM $SFBUJOH $POTVNFST PG )FBMUI BOE )FBMUI$BSF t 1VCMJD WFSTVT QSJWBUF FYDIBOHFT GSPN QMBO EFTJHO UP FNQMPZFF participation t &NQMPZFS 1BOFM 8IBU -FBEJOH &NQMPZFST BSF %PJOH UP .BLF )FBMUI$BSF $POTVNFSJTN 8PSL

Visit www.theihccforum.com to preview the agenda and register for the conference.

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Doug Field Founder and CEO The Institute for HealthCare Consumerism

NEW AT THE FORUM Our Employee Benefits Forum Pre-Conference (produced in conjunction with WEB Atlanta) is exclusively designed for employers.

This is your chance to talk shopâ&#x20AC;&#x201D; uncensoredâ&#x20AC;&#x201D;with your professional counterparts.

IF YOU CANâ&#x20AC;&#x2122;T MAKE EAST, THEN START PLANNING NOW FOR IHC FORUM WEST 2013 AT THE RED ROCK RESORT IN LAS VEGAS! DETAILS WILL BE AVAILABLE SOON AT

WWW.THEIHCCFORUM.COM

LAS VEGAS

DEC 5-6, 2013

DOES YOUR PROFESSIONAL CHECKLIST INCLUDE ISSUES DEALING WITH HEALTH CARE SPEND, HEALTH INCENTIVES, COMPLIANCE, ENGAGEMENT IN HEALTH CARE CONSUMERISM AND UNDERSTANDING DEFINED CONTRIBUTION AND PRIVATE/PUBLIC EXCHANGES? IF SO, YOU AND YOUR TEAM WILL FIND IMMEDIATE AND LONG-TERM VALUE FROM ATTENDING THE IHC FORUM EAST.

2013 FORUM EAST AGENDA AT A GLANCE WEDNESDAY, MAY 8, 2013 7:30 am â&#x20AC;&#x201C; 5:15 pm

Pre-Conference: Employee Benefits Forum 2013

1:00 pm â&#x20AC;&#x201C; 5:00 pm

Pre-Conference: A Roadmap for Making Healthcare Consumerism Work

12:00 pm â&#x20AC;&#x201C; 7:00 pm

Exhibitor Set Up

THURSDAY, MAY 9, 2013 7:30 am

Registration

7:30 am â&#x20AC;&#x201C; 8:45 am

Networking Breakfast / Exhibits Open

8:45 am â&#x20AC;&#x201C; 9:00 am

Welcome by Doug Field, CEO, The Institute for HealthCare Consumerism

9:00 am â&#x20AC;&#x201C; 10:30 am

Opening General Session: â&#x20AC;&#x153;Making Health Care Consumerism Workâ&#x20AC;?

10:30 am â&#x20AC;&#x201C; 11:00 am

Networking Break / Exhibits Open

11:00 am â&#x20AC;&#x201C; Noon

Track No. 1 Workshops (Choose One) Âą $FKLHYLQJ 0\ *RDOV $ 7ULS 7KURXJK WKH )LQDQFLDO :HOOQHVV :RUNVKRS 102  â&#x20AC;&#x201C;  HSAs:  A fter  2014 Âą 6+$5( 6(66,21 (YROYLQJ 5HODWLRQVKLS %HWZHHQ %URNHU DQG (PSOR\HU DQG +RZ WR %HQHÂżW WKH PRVW IURP a  Partnership Âą &RQWUROOLQJ &RVWV DQG ([SDQGLQJ &KRLFH 8VLQJ 'HÂżQHG &RQWULEXWLRQ +HDOWK &DUH 105  â&#x20AC;&#x201C;  Health  Pays:  Using  Incentives  to  Drive  Wellness  and  Behavior  Change 106  â&#x20AC;&#x201C;  The  R ight  Care  (Not  Just  Cost)!

107  â&#x20AC;&#x201C;  Pre-­Paid  Card  Programs  to  Engage  Consumers  and  Help  Employers  Manage  Costs  in  2014  &  Beyond Âą %HDWLQJ WKH (QUROOPHQW %OLW] +RZ WR 'HOLYHU <HDU 5RXQG %HQHÂżWV &RPPXQLFDWLRQ

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Table Topic Lunch Discussion

Noon â&#x20AC;&#x201C; 1:30 pm

Lunch / Exhibit Open

1:30 pm â&#x20AC;&#x201C; 2:45 pm

Afternoon General Session: â&#x20AC;&#x153;HealthCare Consumerism is Here to Stay!â&#x20AC;?

2:45 pm â&#x20AC;&#x201C; 3:00 pm

Networking Break / Exhibits Open

3:00 pm â&#x20AC;&#x201C; 4:00 pm

Track No. 2 Workshops (Choose One) Âą $GYDQFHG %URNHU &RXUVH 202  â&#x20AC;&#x201C;  Ownership  and  Incentives:  Creating  Multiple  Incentive  Channels Âą 7KH 9DOXH RI &RQQHFWLQJ &RQVXPHU 1HHGV ZLWK %HQHÂżWV WKURXJK (QUROOPHQW 7HFKQRORJ\ 204  â&#x20AC;&#x201C;  SHARE  SESSION:  Health  Care  Access  When  You  Want  It,  How  You  Want  It 205  â&#x20AC;&#x201C;  The  MedEncentive  Solution:  Achieving  the  Triple  A im  by  Triangulating  the  Interests  of  Payors,  Providers  and  Patients 206  â&#x20AC;&#x201C;  SHARE  SESSION:  How  to  More  Effectively  Engage  Consumers  and  get  Increased  Participation  from  your  Employee  Population  207  â&#x20AC;&#x201C;  Consumer  Engagement:  The  Key  to  a  Successful  Exchange  208  â&#x20AC;&#x201C;  Ten  Steps  to  Delivering  on  the  Promise  to  Employers:  ACOs  Enhance  Quality  of  Care,  Improve  Patient  2XWFRPHV DQG 'ULYH &RVW HIÂżFLHQF\

4:00 pm â&#x20AC;&#x201C; 4:15 pm

Networking Break / Exhibits Open

4:15 pm â&#x20AC;&#x201C; 5:15 pm

Closing General Session: Defined Contribution and Public/Private Exchanges: A Panel Discussion with Leading Experts

5:15 pm â&#x20AC;&#x201C; 7:15 pm

Opening Night Reception / Exhibits Open

2013 FORUM EAST AGENDA CONTINUED FRIDAY, MAY 10, 2013 7:30 am â&#x20AC;&#x201C; 8:30 am

Networking Breakfast / Exhibits Open

8:30 am â&#x20AC;&#x201C; 10:00 am

Opening General Session: Helping Employees Become Better Consumers of Health Care and Health Leading Employers and Experts will discuss the leading trends, challenges and opportunities in building better Consumers of Health

10:00 am â&#x20AC;&#x201C; 10:30 am

Networking Break / Exhibits Open

10:30 am â&#x20AC;&#x201C; 11:30 am

Track No. 3 Workshops (Choose One) Âą 0DNLQJ WKH +HDOWK &RPPLWPHQW 302  â&#x20AC;&#x201C;  The  Economics  of  Healthy  Sleep Âą 6+$5( 6(66,21 ([FKDQJHV RU 0DUNHWSODFH" :KDWHYHU LWÂśV &DOOHG *HW WR .QRZ LW 304  â&#x20AC;&#x201C;  Improving  Consumer  Health  Through  Value-­Based  Plan  Design Âą *HWWLQJ WKH 0RVW IURP \RXU %URNHU 5HODWLRQVKLS DQG +RZ WKDW LV &KDQJLQJ 306  â&#x20AC;&#x201C;  The  Role  of  Mobile  Health  in  Changing  Behavior Âą *DPH 0HFKDQLFV DQG 2WKHU *DPH &KDQJHUV LQ %HQHÂżWV (GXFDWLRQ 308  â&#x20AC;&#x201C;  SHARE  SESSION:  Building  Better  Consumers  of  Health  Care  and  Health

11:30 am â&#x20AC;&#x201C; Noon

Final Break and Sponsor/Exhibitor Drawings

Noon â&#x20AC;&#x201C; 1:00 pm

Closing General Session: Employer Panel: â&#x20AC;&#x153;What leading Employers are doing to Make HealthCare Consumerism Work

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Hotel Information Renaissance  Waverly  Hotel  *DOOHULD 3DUNZD\ 800.228.9290  or  770.953.4500 Special  FORUM  Rate  $153  (Cutoff  Date  4/17/13) Â

Conference Location Cobb  Galleria  Center 7ZR *DOOHULD 3DUNZD\ Atlanta,  GA  30339

Register for the IHC FORUM at www.theihccforum.com. Group rates are available.

Receive a 25% discount when you sign up two or more attendees.

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Professional Credits Available for CRCs and HR Professionals

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PEOPLE ON THE MOVE

PEOPLE ON THE MOVE MedConnections, one of the worldâ&#x20AC;&#x2122;s leading mobile health application development companies, announced the appointment of Kevin Woodard as president. Woodard brings more than 25 years of health care financial management and business development expertise to MedConnections.

Prior to joining MedConnections, Woodard was chief financial officer of Avivia Health from Kaiser Permanente, where he oversaw finance and business development functions. During his tenure there, revenues grew from zero to $20 million per year, servicing 1.5 million participants per year.

MedConnectionsâ&#x20AC;&#x2122;s flagship application, iPharmacy, has already helped more

HEALTHCARE CONSUMERISM SOLUTIONS

Aetna Consumer-directed Health Plans Continue to Save Millions for Employers The  ninth  annual  Aetna  HealthFund  study  shows  that  employers  UHSODFLQJ WKHLU WUDGLWLRQDO KHDOWK EHQH¿WV SODQV ZLWK $HWQD +HDOWK)XQG consumer-­directed  plans  saved  nearly  $350  per  member  per  year.  The  lower  health  care  costs  result  in  savings  of  $20.8  million  over  a  six-­ year  period  for  every  10,000  members.  The  Aetna  HealthFund  study  is  the  longest  running  review  of  consumer-­directed  plans  in  the  industry,  drawing  experience  from  a  decade  of  claims  data.

Members  with  Aetna  HealthFund  plans  spent  less  on  most  types  of  health  care  services,  including  specialist  doctorâ&#x20AC;&#x2122;s  visits,  emergency  room  visits  and  total  pharmacy  costs.  Despite  lower  overall  health  care  costs,  members  with  Aetna  HealthFund  plans  received  routine  preventive  care  from  their  primary  care  doctors  11  percent  more  than  members  ZLWK WUDGLWLRQDO 3UHIHUUHG 3URYLGHU 2UJDQL]DWLRQ 332 SODQV $HWQD HealthFund  members  also  had  higher  rates  of  screenings  for  cervical  FDQFHU QHDUO\ SHUFHQW KLJKHU FRORUHFWDO FDQFHU SHUFHQW DQG SURVWDWH FDQFHU SHUFHQW DV ZHOO DV PDPPRJUDPV SHUFHQW DQG LPPXQL]DWLRQV SHUFHQW

â&#x20AC;&#x153;Employers  are  trying  to  control  rising  health  care  costs  by  getting  their  employees  to  be  more  empowered  when  making  health  care  decisions,â&#x20AC;?  says  Tom  Mafale,  head  of  national  accounts  sales  operations  for  Aetna.  â&#x20AC;&#x153;Aetna  HealthFund  plans  continue  to  be  a  proven  solution  to  achieve  that  important  goal.  Encouraging  people  to  receive  the  right  care  at  the  right  time  is  one  important  way  to  help  reduce  health  care  costs  for  both  employers  and  individuals.  Health  care  reform  has  increased  access  to  preventive  care,  but  Aetna  HealthFund  members  still  use  this  type  of  care  more  frequently  than  other  members.â&#x20AC;?

Employers  that  completely  transitioned  their  employees  to  Aetna  HealthFund  plans  saw  the  most  dramatic  cost  savings.  However,  HPSOR\HUV ZKR XVHG VHYHUDO ÂłEHVW SUDFWLFHV´ LGHQWLÂżHG WKURXJK WKH study  had  cost  savings  that  were  almost  as  high  as  the  employers  who  completely  switched  over  to  HealthFund  plans. Â

Truven Health Analytics Develops Solution to Evaluate Wellness Program Effectiveness Truven  Health  Analytics,  formerly  the  health  care  business  of  Thomson  Reuters,  announced,  in  collaboration  with  Emory  University,  WKH UHOHDVH RI D QHZ PRGHO WR HYDOXDWH WKH UHWXUQ RQ LQYHVWPHQW 52,

of  population  health  and  wellness  programs.  The  Truven  Health  ROI  18 January/February 2013 I HealthCare Consumerism Solutionsâ&#x201E;˘ I www.TheIHCC.com

than two million users improve medication literacy, medication adherence and reducing their medical and pharmacy costs.

Aflac, the No. 1 provider of voluntary and guaranteed-renewable insurance in the United States, announced the hiring of Drew J. Niziak, a 20-year veteran of the insurance industry, as its new senior vice president of broker sales and Aflac Benefits Solutions Niziak (ABS), a wholly owned subsidiary of Aflac. In his new role, Niziak will oversee the broker sales strategy and lead the development of national and regional marketing relationships with insurance brokers through ABS and Aflac. ABS provides specialized services to the companyâ&#x20AC;&#x2122;s most

AETNA  TRUVEN HEALTH ANALYTICS  UNI Model  is  designed  to  help  organizations  identify  which  health  risks  are  most  prevalent  and  costly  to  their  company,  quantify  the  relationships  EHWZHHQ PRGL¿DEOH ULVN IDFWRUV DQG PHGLFDO H[SHQGLWXUHV DQG GHYHORS FRVW EHQH¿FLDO KHDOWK SURPRWLRQ DQG GLVHDVH SUHYHQWLRQ SURJUDPV EDVHG on  the  results.

7KH 7UXYHQ +HDOWK 52, 0RGHO LQFRUSRUDWHV RUJDQL]DWLRQ VSHFLÂżF demographic,  health  risk,  and  program  impact  data,  plus  data  from  peer-­ reviewed  studies.  It  shows  the  relationship  between  health  risk  and  cost,  DQG SUHGLFWV FRVW VDYLQJV IURP SURJUDPV GHVLJQHG WR DGGUHVV PRGLÂżDEOH health  risks:  high  blood  glucose,  obesity,  physical  inactivity,  depression,  poor  nutrition/eating  habits,  tobacco  use,  high  total  cholesterol,  high  stress,  high  blood  pressure,  and  high  alcohol  consumption.  The  model  incorporates  both  prospective  and  retrospective  estimates  to  calculate  the  ¿QDQFLDO UHWXUQ RI D FRPSDQ\ÂśV ZHOOQHVV SURJUDP Âł:H NQRZ WKDW LQGLYLGXDOV ZLWK RQH ULVN IRU D VSHFLÂżF SUREOHP RIWHQ have  additional  risks  also  associated  with  that  problem.  For  example,  there  are  seven  combined  risk  factors  that  contribute  to  heart  disease:  obesity,  high  stress,  tobacco  use,  high  blood  pressure,  high  blood  glucose,  KLJK WRWDO FKROHVWHURO DQG SK\VLFDO LQDFWLYLW\ ´ VD\V 5RQ *RHW]HO 3K ' research  professor  at  Emory  University,  director  of  the  Institute  for  Health  and  Productivity  Studies,  and  vice  president  of  consulting  and  applied  research  at  Truven  Health  Analytics. Â

United Airlines Opens Free Workplace Health Clinic at Oâ&#x20AC;&#x2122;Hare United  Airlines  announced  the  opening  of  the  airlineâ&#x20AC;&#x2122;s  new  employee  health  clinic  at  Oâ&#x20AC;&#x2122;Hare  International  Airport.  The  clinic,  managed  by  Walgreens,  will  serve  a  broad  scope  of  employeesâ&#x20AC;&#x2122;  health  needs,  such  as  urgent  care  for  routine  illness,  travel  and  other  immunizations  including  Ă&#x20AC;X VKRWV SUHSDFNDJHG PHGLFDWLRQV MRE UHODWHG SK\VLFDO WUDLQLQJ DQG SUH employment  physicals,  at  no  cost  to  employees.  The  convenient  access  to  these  and  other  health  care  services  is  available  to  all  United  employees,  including  the  more  than  10,000  co-­workers  in  the  Chicago  area. Âł:HÂśUH FRQWLQXLQJ WR PDNH VLJQLÂżFDQW LQYHVWPHQWV LQ 8QLWHG LQFOXGLQJ investments  in  our  co-­workers,â&#x20AC;?  said  Unitedâ&#x20AC;&#x2122;s  Chairman,  President  and  CEO  Jeff  Smisek.  â&#x20AC;&#x153;This  clinic  will  offer  convenient  health  services  at  no  charge  to  keep  our  co-­workers  feeling  and  performing  well.â&#x20AC;?

The  5,200-­square-­foot  facility,  located  in  the  airportâ&#x20AC;&#x2122;s  Terminal  2  arrivals  area,  is  the  only  one  of  its  kind  for  any  airline  at  Oâ&#x20AC;&#x2122;Hare.  United Â

significant brokerage partners through an experienced team of business developers, consultants, strategic account managers and broker service professionals while Aflac provides dedicated services and support to mid-tier and regional brokers in partnership with Aflacâ&#x20AC;&#x2122;s sales force.

Walgreens announced the promotion of Joseph Magnacca from senior vice president to executive vice president. Magnacca also retains his title as president of daily living products and solutions. Magnacca oversees Walgreens merchandising and inventory strategy, private brands, insights and analytics, and Magnacca the New York-based Duane Reade drugstore chain, which Walgreens acquired

in 2010. A retail industry veteran of more than 20 years, Magnacca joined Duane Reade in 2008 as senior vice president and chief merchandising officer.

He was later promoted to executive vice president at Duane Reade and then to president of the drugstore chain following its acquisition by Walgreens. He was named Walgreens president of daily living products and solutions in 2011.

Brian Griffin has been named president and general manager of Empire BlueCross BlueShield. In this position, Griffin will be responsible for the management of Empireâ&#x20AC;&#x2122;s local group and individual business in New York, including sales, account management, provider relations and contracting, FRQWLQXHG RQ SDJH

ITED AIRLINES Âť MERCER Âť BENEFITFOCUS Âť TEXAS HEALTH RESOURCES Âť HEALTHWAYS also  offers  health  care  clinics  for  its  employees  at  its  Cleveland,  Houston,  *XDP DQG 1HZDUN 1HZ <RUN KXEV Âł0RUH HPSOR\HUV DUH UHFRJQL]LQJ WKH EHQHÂżWV RI ZRUNVLWH KHDOWK centers  and  wellness  programs  to  improve  the  overall  health,  satisfaction  and  productivity  of  their  employees,  while  also  reducing  costs,â&#x20AC;?  says  :DOJUHHQV 3UHVLGHQW DQG &(2 *UHJ :DVVRQ Âł7KLV SURMHFW EULQJV WRJHWKHU two  companies  with  deep  Chicago  roots  to  make  health  and  wellness  a  top  priority.â&#x20AC;?

7KLV PDUNV WKH ÂżIWK ZRUNSODFH KHDOWK FOLQLF IRU 8QLWHG DOO PDQDJHG by  Walgreens.  Unitedâ&#x20AC;&#x2122;s  Oâ&#x20AC;&#x2122;Hare  facility  adds  to  the  more  than  370  employer-­based  worksite  health  and  wellness  centers  managed  and  RSHUDWHG E\ :DOJUHHQV (PSOR\HU 6ROXWLRQV *URXS

Mercer Selects Benefitfocus to Provide Technology Platform for Private Exchange %HQHÂżWIRFXV WKH QDWLRQÂśV ODUJHVW SURYLGHU RI KHDOWK FDUH DQG EHQHÂżWV technology,  announced  it  will  provide  the  technology  platform  for  the  SULYDWH EHQHÂżWV H[FKDQJH WR EH RIIHUHG E\ 0HUFHU D JOREDO FRQVXOWLQJ leader  in  talent,  health,  retirement  and  investments.  Mercer  Marketplace  is  a  cloud-­based  private  exchange  designed  to  lower  employer  costs  DVVRFLDWHG ZLWK FRPSHWLWLYH HPSOR\HH EHQHÂżW SDFNDJHV 7KH %HQHÂżWIRFXV 3ODWIRUP ZKLFK VXSSRUWV WKH SULYDWH EHQHÂżWV exchange,  will  provide  Mercerâ&#x20AC;&#x2122;s  clients  the  convenience  of  an  online  retail  marketplace  where  they  can  shop,  enroll,  manage  and  exchange  all  EHQHÂżWV UHODWHG LQIRUPDWLRQ â&#x20AC;&#x153;Mercer  Marketplace  is  an  important  addition  to  the  suite  of  solutions  that  Mercer  provides  to  clients,â&#x20AC;?  says  Sharon  Cunninghis,  1RUWK $PHULFD +HDOWK %HQHÂżW 5HJLRQ /HDGHU RI 0HUFHU Âł,W ZLOO DOORZ HPSOR\HUV WR FRQWLQXH RIIHULQJ FRPSHWLWLYH EHQHÂżWV WR WKHLU HPSOR\HHV which  is  an  important  attraction  and  retention  tool,  while  actively  managing  spending  and  reducing  their  administrative  responsibilities.  (PSOR\HHV ZLOO KDYH DFFHVV WR D EURDGHU DUUD\ RI EHQHÂżWV DV ZHOO DV WKH DELOLW\ WR WDLORU WKRVH EHQHÂżWV WR WKHLU SDUWLFXODU QHHGV ZLWK WKH QHFHVVDU\ support  to  make  appropriate  decisions.â&#x20AC;?

'HYHORSHG ZLWK %HQHÂżWIRFXV WHFKQRORJ\ 0HUFHU 0DUNHWSODFH GHOLYHUV WKH Ă&#x20AC;H[LELOLW\ DQG FXVWRPL]DWLRQ UHTXLUHG IRU QDYLJDWLQJ FRPSOH[ EHQHÂżW SRUWIROLRV $GGLWLRQDOO\ WKH %HQHÂżWIRFXV 3ODWIRUP HQDEOHV 0HUFHU 0DUNHWSODFH WR VXSSRUW GHÂżQHG FRQWULEXWLRQ PRGHOV EDVHG RQ D SHUFHQWDJH of  an  employeeâ&#x20AC;&#x2122;s  income  or  a  standard  amount  set  by  the  employer,  further  VLPSOLI\LQJ EHQHÂżW DGPLQLVWUDWLRQ IRU 0HUFHUÂśV FOLHQW EDVH

Texas Health Resources, Healthways Advance Physiciandirected Population Health Initiatives Supporting Commercial ACO Design and Deployment Texas  Health  Resources  and  Healthways  announced  the  launch  of  two  initiatives  in  their  ongoing  strategic  alignment  to  deploy  an  integrated  physician-­directed  population  health  solution  to  drive  health  outcomes  and  cost  savings.  7KH ÂżUVW LQLWLDWLYH LV LPSOHPHQWDWLRQ RI D FRQVLVWHQW V\VWHP ZLGH approach  to  optimize  the  care  of  inpatients  with  diabetes  and  improve  coor-­ dination  of  care  after  the  patient  is  discharged.  Texas  Health  launched  the  GLDEHWHV FDUH FRRUGLQDWLRQ LQLWLDWLYH LQ -DQXDU\ DW ÂżYH 7H[DV +HDOWK KRV-­ pitals  in  Dallas,  Plano,  Arlington,  Hurst-­Euless-­Bedford  and  Fort  Worth.  7KH VHFRQG LQLWLDWLYH LGHQWLÂżHV LQSDWLHQWV ZKR DUH PRVW DW ULVN IRU readmissions,  and  aligns  inpatient  and  post-­hospital  care  teams  around  the  patientâ&#x20AC;&#x2122;s  needs.  Effective  coordination  of  care  after  the  patient  is  discharged  can  improve  quality  and  patient  safety,  lower  cost,  improve  patient  outcomes  and  help  prevent  costly  readmissions.  Coordination  of  care  across  the  continuum  of  services  is  part  of  Texas  Healthâ&#x20AC;&#x2122;s  overall  strategy  to  integrate  health  services  and  help  patients  navigate  through  the  complex  environment  of  care.  Both  approaches  involve  the  patientâ&#x20AC;&#x2122;s  primary  care  provider  to  facilitate  monitoring  and  timely  interventions.  These  initiatives  are  critical  elements  supporting  the  construct  of  the  accountable  care  agreement  announcement  made  by  Texas  Health  last  week  and  the  ACO  agreement  announced  in  mid-­January  between  Texas  Health  and  Blue  Cross  and  Blue  Shield  of  Texas.  â&#x20AC;&#x153;Texas  Health  is  collaborating  with  physicians,  commercial  insurers  and  employers  to  develop  an  accountable  care  model  that  not  only  cares  for  people  when  they  are  ill,  but  also  focuses  on  keeping  people  healthy  and  out  of  the  hospital  unless  they  are  acutely  sick  or  injured,â&#x20AC;?  Doug  Hawthorne,  CEO  of  Texas  Health  Resources,  says.  â&#x20AC;&#x153;Beginning  with  the  physicians,  nurse  practitioners  and  physician  assistants  of  Texas  +HDOWK 3K\VLFLDQV *URXS ZH DUH OHDGLQJ WKH ZD\ LQ WUDQVIRUPLQJ IURP the  fee-­for-­service  model  to  a  value-­based  model.  We  are  creating  a  physician-­directed  care-­team  approach  that  we  believe  will  foster  more  accountability  across  the  continuum  of  care,  from  the  individual  patient  to  the  physician  to  every  other  provider  on  the  team.  Our  ultimate  goal  is  to  help  physicians  manage  the  health  of  their  patient  populations  and  improve  their  health  and  well-­being.â&#x20AC;?  FRQWLQXHG RQ SDJH www.TheIHCC.com I HealthCare Consumerism Solutionsâ&#x201E;˘ I January/February 2013 19

BRIEFS

PEOPLE ON THE MOVE

3HRSOH RQ WKH 0RYH FRQWLQXHG IURP SDJH

underwriting and product delivery, as well as maintaining customer relationships. In addition, he will be responsible for the development of Empireâ&#x20AC;&#x2122;s long-term strategic direction and collaborating with local and state elected officials and thought leaders to improve the health of New Yorkers. Griffin brings deep experience to his new role, with more than 30 years of health plan experience. He has held senior leadership positions with significant strategic and profit and loss (P&L) responsibility with Medco Health Solutions and US Healthcare (now Aetna). Griffin started his career as a sales representative for Empire BlueCross BlueShield.

Truven Health Analytics, formerly the health care business of Thomson Reuters, announced that Dr. Michael Taylor, M.D., has been appointed chief medical officer. He was previously vice president and national business leader for Truven Health Analytics. As chief medical officer, Dr. Taylor will develop and deepen relationships Taylor with customers, advise on product development and provide counsel to Truven Health Analytics management on business strategy and medical issues. Dr. Taylor is a physician executive with extensive experience in population health. He joined Truven Health Analytics in 2011 from Caterpillar Inc., where he was the medical director for health promotion and disease management. Dr. Taylor was directly responsible for Caterpillarâ&#x20AC;&#x2122;s wellness program, with more than 100,000 participants in the U.S. This comprehensive program, which included health promotion exams, biometric screening, tobacco cessation, and diabetes prevention and management programs, was part of

an overall effort that led to a health care cost trend well below the national average over an eight-year period at Caterpillar.

Aetna announced it has named David A. Queller as the new head of national accounts. Queller will lead the national accounts organization in delivering innovative and integrated benefit solutions that drive measurable health and productivity improvement for its large employer customers, and help them adapt to a rapidly changing marketplace. He assumes his new role immediately. Queller has spent the last two years as president of Aetnaâ&#x20AC;&#x2122;s Southeast region. In this role, he has been accountable for network, profit and loss, and sales for the region. In addition to his regional responsibilities, he plays an active leadership role in Aetnaâ&#x20AC;&#x2122;s enterprise strategic planning, performance management, and business operations council. Previously, Queller spent eight years in Aetna National Accounts. He led the National Accounts organization for the entire Eastern region of the country for five years, consistently demonstrating positive results for the company.

The DentaQuest Institute is pleased to welcome Robert D. Compton, DDS as its new executive director. The DentaQuest Institute is a national leader in improvement strategies that are advancing the effectiveness and efficiency of dental programs in safety net centers, hospital dental programs and private practice dentistry. Dr. Compton will lead the DentaQuest Institute in its work with oral health professionals across the United States on quality, prevention FRQWLQXHG RQ SDJH

Treatment Selection & Shared Decision Support Platform Web + Mobile

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www.

January/February 2013 I HealthCare Consumerism Solutionsâ&#x201E;˘ I www.TheIHCC.com

diabetes

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

REGULATORY & COMPLIANCE

Development of Private Health Insurance Exchanges Predate PPACA Who:  Individuals,  small  employers  and  large  groups.  Private  exchanges  target: Â&#x2021; Employers  who  want  to  better  control  their  health  care  costs, Â&#x2021; (PSOR\HHV ZKR ZDQW WR FKRRVH WKH EHQHÂżW SURJUDP WKDW ZRUNV EHVW for  their  own  families, Â&#x2021; The  need  for  portability  as  workers  move  between  jobs,  and Â&#x2021; The  need  for  two-­income  families  to  combine  their  resources  into  a  VLQJOH EHQHÂżWV SURJUDP IRU WKH ZKROH IDPLO\ When:  Some  local  exchanges  have  been  operating  for  many  years.  New  regional  and  national  private  exchanges  may  start  operating  in  2013  and  2014.  PPACA  increased  awareness  and  the  need  for  a  new  health  insurance  purchasing  system.  In  addition,  some  of  the  private  exchange  developers  KRSH WR JHW D VKDUH RI WKH 33$&$ IHGHUDO H[FKDQJH EXVLQHVV *RYHUQPHQW GHÂżQHG 33$&$ H[FKDQJHV DUH VFKHGXOHG WR EHJLQ -DQ What:  The  development  of  private  exchanges  predates  PPACA  and  is  growing  independent  of  PPACA.  Exchanges  produce  a  new  process  of  shopping  for  health  insurance.  Like  any  business,  consumers  seeking  value  will  ultimately  decide  which  exchanges  will  succeed.  Exchanges  will  process  traditionally  funded  health  insurance.  However,  an  important  impetus  for  exchanges  is  the  potential  use  of  health  reimbursement  arrangements  +5$V WKDW DOORZ HPSOR\HUV WR GHVLJQDWH D VXP RI PRQH\ WR SD\ IRU WKH health  care  needs  of  employees,  whether  through  an  insurance  program  or  through  the  direct  payment  of  medical  services.  Private  exchanges  can  combine  employer-­paid  HRA  contributions  with  employee-­paid  Section  125  contribution  to  allow  for  individual  health  plans  to  be  paid  on  a  tax-­free  basis.  Executive  Summary:  Developing  private  exchanges  may  be  grouped  into  three  categories.  Some  are  focused  on  the  small  group  market,  others  on  ODUJH JURXSV DQG VWLOO RWKHUV RQ UHWLUHH KHDOWK EHQHÂżWV Business  group  exchanges:  Developed  from  existing  employer  associations.  They  typically  will  ensure  portability  for  employees,  but  only  when  the  employee  moves  between  participating  employers  and  health  plans.

Insurer-­sponsored  exchanges:  Developed  for  insured  policyholder,  making  it  easy  to  move  current  small  employers  into  an  exchange  and  allow  individual  employees  a  wider  choice  of  health  plan  design.  The  portability  WKH DELOLW\ RI D FRQVXPHU WR NHHS WKH VDPH FRYHUDJH DV WKH\ PRYH EHWZHHQ MREV LV DYDLODEOH WR LQGLYLGXDOV PRYLQJ DPRQJ FRPSDQLHV FRYHUHG E\ WKH same  insurer.  Independent  companies:  Developed  with  various  sponsorships,  existing  relationships,  and  business  models.  These  companies  include  existing Â

information  technology  vendors,  consultants/brokers,  and  entrepreneurs.  These  players  seek  to  meet  the  needs  of  existing  health  industry  customers,  employer  groups,  and  broker  clients.  They  see  the  opportunity  to  expand  on  existing  services  and  technology  to  create  new  businesses  in  a  growing  market.  The  potential  for  private  exchanges  comes  from  the  mid-­  and  large-­ group  markets  that  will  not  be  involved  in  the  state-­based  federal  PPACA  exchanges.

Private  exchanges  can  address  some  of  the  existing  problems  in  our  current  system. Â&#x2021; (PSOR\HU FRVWV ZLOO EH Âż[HG DQG FRQWUROODEOH $Q HPSOR\HU ZLOO EH able  to  contribute  only  what  it  can  afford. Â&#x2021; Employees  will  be  able  to  choose  their  plan  design,  the  one  that  works  best  for  their  own  family. Â&#x2021; Coverage  will  eventually  be  portable,  so  employees  can  keep  the  same  coverage  as  they  change  jobs,  or  lose  their  job  altogether. Â&#x2021; Unlike  individual  coverage  today,  the  employee  contribution  may  be  tax  free  through  using  a  Section  125  payroll  deduction.  Â&#x2021; Two-­income  families  may  be  able  to  use  contributions  from  different  employers  to  purchase  a  single  plan  for  the  whole  family.

Private  exchanges  can  move  health  insurance  to  a  system  of  individual  choice  and  ownership  and  allow  employers  to  concentrate  on  their  core  EXVLQHVV 7KHUH PD\ EH OHJDO RU UHJXODWRU\ FODULÂżFDWLRQV WR DFFRPPRGDWH WKH effective  uses  of  private  exchanges.  :LWK RU ZLWKRXW 33$&$ HPSOR\HUV DUH ÂżQGLQJ ZD\V WR PDNH ÂłFRQVXPHU empowermentâ&#x20AC;?  a  reality.  People  want  to  have  more  control  over  their  own  lives.  They  are  demanding  choice  and  individual  ownership  of  their  health  EHQHÂżWV DV WKH\ DUH LQ HYHU\ RWKHU DVSHFW RI WKHLU OLYHV +5$V DQG 'HÂżQHG Contribution  plans  with  personal  choice  and  ownership  of  health  coverage  is  the  latest  iteration  of  this  demand  for  health  care  consumerism.

Actions:  Employers  will  need  to  determine  the  value  of  considering  private  H[FKDQJHV DV DQ DOWHUQDWLYH WR WKHLU FXUUHQW KHDOWK EHQH¿W SODQV (PSOR\HUV will  need  to  determine  the  economics  and  employee  attitudes  in  moving  to  a  GLIIHUHQW V\VWHP RI KHDOWK LQVXUDQFH SXUFKDVLQJ 7KHUH DUH PDQ\ EHQH¿WV DQG some  drawbacks  that  need  to  be  considered.  Employers  should  check  with  their  compliance  and  legal  teams,  insurance  brokers,  agents,  consultants,  and  insurers  before  reviewing  or  deciding  to  use  a  private  health  insurance  exchange  approach  to  health  coverages.  The information presented and contained within this article was submitted by Ronald E. Bachman, President & CEO of Healthcare Visions and the Chairman of the IHC Editorial Advisory Board. This information is general information only, and does not, and is not intended to constitute legal advice. You should consult your legal advisors to determine the laws and regulations impacting your business.

www.TheIHCC.com I HealthCare Consumerism Solutionsâ&#x201E;˘ I January/February 2013

21

BY J. KEVIN A. McKETCHNIE EXECUTIVE DIRECTOR AMERICAN BANKERS ASSOCIATIONâ&#x20AC;&#x2122;S HSA COUNCIL

HSAs

Evolutionary Health Care Financing: The Global Switch to HSAs

W

inter  in  Edmonton,  Alberta  isnâ&#x20AC;&#x2122;t  for  the  weak  at  heart.  We  arrived   in  the  fall  of  2006  after  a  quick  layover  in  already  chilly  Chicago.  7KLV ZDV WKH ÂżQDO VWRS LQ ZKDW ZDV D PXOWL FLW\ PXOWL FRQWLQHQWDO tour  of  national  health  care  systems  and  their  weaknesses.

The  provincial  government  invited  us  to  solve  a  problem  that  the  embarrassment  of  energy  riches  in  Alberta  was  making  acute:  How  to  operate  a  single-­payer  system  trying  to  serve  a  population  that  was  doublingâ&#x20AC;&#x201D;at  least  in  Red  Deerâ&#x20AC;&#x201D;every  18  months?  The  call  on  Albertaâ&#x20AC;&#x2122;s  treasury  was  enormous,  as  was  the  inability  of  what  remains  a  systemic  issue  in  the  provinceâ&#x20AC;&#x2122;s  health  care  delivery  V\VWHP $V WKH VHUYLFHV HOLJLEOH SRSXODWLRQ JUHZ ZLWK WKH RLO ÂżHOGV WKH infrastructure  of  hospitals,  doctors,  nurses  and  even  bedpans  remained  relatively  static.  Collapse  was  imminent.

With  too  many  oil  sands  workers  pushing  through  the  doors  of  KRVSLWDOV HQHUJ\ FRPSDQLHV ZHUH EHJLQQLQJ WR Ă&#x20AC;\ ZRUNHUV WR QHLJKERULQJ provinces  or  even  out  of  Canada  to  the  United  States  for  care.  Once  the  other  Canadian  provinces  realized  they  were  treating  Albertaâ&#x20AC;&#x2122;s  workforce  without  gaining  Albertaâ&#x20AC;&#x2122;s  revenue  in  return,  the  other  provinces  tried  charging  a  fee.  They  quickly  discovered  such  charges  were  actually  illegal  in  Canada.  The  United  States  became  the  only  option.

However,  the  challenge  in  America  was  a  foreign  worker,  even  a  Canadian,  doesnâ&#x20AC;&#x2122;t  have  access  to  American  health  insurance  products.  But  since  most  oil  workers  were  only  looking  for  routine  care,  energy  companies  negotiated  with  provider  networks  and  armed  their  employees  with  cash.  The  purpose  of  this  cash  was  to  be  used  for  health  care  in  newly  created  accounts.  Employees  could  keep  this  cash  and  it  would  be  replenished  every  year.

The  HSA  community  is  bracing  for  record  enrollments,  probably  up  by  as  much  as  30  percent,  insuring  around  16  million  Americans,  according  to  some  estimates.  And  thus  begins  the  new  class  war:  Americans  who  can  pay  for  health  care  with  cash  and  insurance  versus  Americans  who  have  to  rely  on  what  the  government  wants  to  pay  the  same  providers  through  entitlement  reimbursements. Â

Sound Familiar?

It  means  that  the  administration  has  taken  the  positive  steps  the  HSA  Council  asked  them  to  make  to  ensure  the  most  affordable  plansâ&#x20AC;&#x201D; DOZD\V +6$ TXDOLÂżHG SODQV²DUH DYDLODEOH LQ WKH H[FKDQJHV DQG LQVXUDQFH companies  wonâ&#x20AC;&#x2122;t  be  penalized  in  their  MLR  performance  for  continuing  to  RIIHU +6$ TXDOLÂżHG SODQV %XW LW DOVR PHDQV $PHULFDQV LQVXUHG LQ WKHVH plans  will  not  only  have  a  way  to  save  for  future  care  but  also  will  have  a  ZD\ WR FRPSHWH IRU FDUH ZKHQ WKH Ă&#x20AC;RRG JDWHV RSHQ LQ The  regulatory  environment  remains  a  stormy  one.  But  at  least  the  millions  of  Americans  insured  with  HSAs  will  be  better  equipped  than  most  to  manage  the  coming  provider  shortage.  Â

7KH $IIRUGDEOH &DUH $FW $&$ PDNHV WKH DFFRXQW EDVHG ÂżQDQFLQJ system  even  more  attractive  to  American  government  than  the  oil  boom  makes  it  to  Alberta.  As  the  uninsured  gain  access  to  subsidized  health  care  ¿QDQFLQJ WKH FUXVK RQ $PHULFDQ UHVRXUFHV ZLOO EH OLNH 5HG 'HHUÂśV -XVW like  in  the  single-­payer  environment,  everyone  will  be  insured,  but  instead  of  relying  on  the  ever-­diminishing  reimbursements  of  an  entitlement  regime,  some  will  have  what  Albertaâ&#x20AC;&#x2122;s  oil-­workers  haveâ&#x20AC;&#x201D;cash.

Why is that Going to be Such an Advantage?

The  ACA  marches  the  reach  of  Americaâ&#x20AC;&#x2122;s  entitlements  upward,  in  terms  of  Medicaid  eligibility  with  respect  to  income  and  downward,  in  terms  of  Medicare  eligibility  in  terms  of  age.  These  patients  canâ&#x20AC;&#x2122;t  have  an  HSAâ&#x20AC;&#x201D;at  least  not  yet;Íž  but  give  me  and  my  team  a  year  and  weâ&#x20AC;&#x2122;ll  seeâ&#x20AC;&#x201D;so  they  only  have  what  the  government  will  reimburse  to  offer  a  provider  for  care.  The  insured  marketplace,  largely  the  employer-­sponsored  space,  has  more  attractive  reimbursements  but  also  has  HSAs,  which  are  cash  accounts  earmarked  for  health  care.  A  lot  of  them.

Who Will Win? The  government  is  hedging  its  bets.  Before  the  Christmas  holidays,  two  major  changes  in  administration  regulatory  posture  gave  this  industry  D KXJH ERRVW 7KH ¿UVW DQG EHWWHU NQRZQ RXWFRPH LV WKH $FWXDULDO 9DOXH $9 UXOH ZKLFK DV ZULWWHQ VHHPV XQKHOSIXO WR +6$V LV SDUWQHUHG ZLWK D calculator  making  it  nearly  impossible  to  disqualify  an  HSA-­plan  from  sale  in  an  exchange.

8QEHOLHYDEO\ WKH FDOFXODWRU ZRUNV LQ VXFK D ZD\ WKDW +6$ TXDOLÂżHG plans,  without  any  contributions  to  the  account,  generally  qualify  as  bronze  plans.  If  contributions  are  made,  HSAs  score  higher,  sometimes  even  as  high  as  platinum  plans. /HVV QRWHG LV WKH WHVWLPRQ\ RI *DU\ &RKHQ GLUHFWRU RI WKH &HQWHU IRU Consumer  Information  &  Insurance  Oversight,  who  appeared  before  the  House  of  Representatives  on  Dec.  13,  2012.  â&#x20AC;&#x153;The  [MLR  Rule]  80/20  rule  says  insurance  companies  have  to  spend  80  cents  of  every  premium  dollar  on  care,â&#x20AC;?  says  Cohen  about  the  RSHUDWLRQ RI WKH PHGLFDO ORVV UDWLR 0/5 UXOH Âł7R WKH H[WHQW WKDW WKH +6$ dollars  are  actually  expended,  they  will  be  counted  toward  that  80  cents  that  the  insurance  company  has  to  spend.â&#x20AC;?

What Does this all Mean?

- .HYLQ $ 0F.HFKQLH LV ([HFXWLYH 'LUHFWRU RI WKH $PHULFDQ %DQNHUV $VVRFLDWLRQÂśV +6$ &RXQFLO FRPSRVHG RI LQGXVWU\ OHDGHUV GUDZQ IURP PHPEHU EDQNV LQVXUHUV DQG WKHLU WHFKQRORJ\ SDUWQHUV 7KH +6$ &RXQFLO LV GHGLFDWHG WR SURWHFWLQJ DQG H[SDQGLQJ WKH +6$ LQGXVWU\ WR EHFRPH D PHPEHU RU OHDUQ PRUH DERXW XV KWWS ZZZ DED FRP ,VVXHV +6$ 3DJHV KVDFRXQFLO DVS[

www.TheIHCC.com I HealthCare Consumerism Solutionsâ&#x201E;˘ I January/February 2013

23

POPULATION HEALTH MANAGEMENT

BY DR. DEE W. EDINGTON FOUNDER EDINGTON ASSOCIATES

Corporate Wellness: 2013 is Time for an Upgrade

D

DQ (OOLRWW RI 5DOSK %HQHÂżWV LQ FHQWUDO 1HZ <RUN &RUSRUDWH DQG SROLWLFDO informs  individuals  of  potential  debilitating  chronic  disease  that  could  rob  them  of  their  health  and  meets  with  each  employee  and  their  spouse  GXULQJ EHQHÂżWV VHOHFWLRQ SHULRGV WR H[SODLQ OHDGHUV KDYH QHYHU EHHQ retirement  security.â&#x20AC;? $ ÂżQDQFLDO WRRO IRU IXOO\ LQVXUHG FRPSDQLHV ZDV their  options.  He  has  a  nearly  100  percent  client  retention  rate  and  close  to  100  percent  employer  VR LQWHUHVWHG LQ KRZ JRRG created  and  implemented  by  Chris  Hogan  and  Scott  :RRG DW WKH %HQHÂżW &RPPHUFH *URXS LQ 3KRHQL[ satisfaction  rates.

KHDOWK FDQ LPSDFW FRVWV Their  â&#x20AC;&#x153;Trend  Neutralizerâ&#x20AC;?  system  was  developed  )DFH WR IDFH WLPH EHWZHHQ D EHQHÂżWV FRQVXOWDQW to  show  the  50-­250  employee  companies  the  role  and  employees  may  not  seem  like  a  wellness  strategy,  but  it  is  oneâ&#x20AC;&#x201D;if  not  the  bestâ&#x20AC;&#x201D;investment  in  engaging  DQG SURGXFWLYLW\ PDNLQJ cost  trend  plays  in  the  calculation  of  future  costs.  HPSOR\HHV DQG WKHLU IDPLOLHV LQ WKHLU EHQHÂżWV DQG QRZ DQ RSSRUWXQH WLPH WR The  need  for  this  system  arose  from  the  inability  of  the  carriers  to  provide  the  utilization  cost  data.  The  their  health.  Elliottâ&#x20AC;&#x2122;s  approach  is  an  important  step  in  the  right  direction  as  we  strive  to  help  our  corporate  EULQJ ZHOOQHVV SURJUDPV Trend  Neutralizer  provides  the  underwriter  with  the  opportunity  to  retrospectively  evaluate  a  clientâ&#x20AC;&#x2122;s  clients  establish  a  culture  of  health  within  their  performance  in  seven  areas  that  all  parties  agree  organizations.

WR D KLJKHU OHYHO RI leads  to  better  outcomes.  If  the  client  performs  Corporate  wellness  initiatives  have  been  around  consistent  with  best  practice,  their  trend  factor  may  for  40  years,  beginning  in  the  early  1970s.  The  HQJDJHPHQW be  reduced  to  zero.  The  carrier  has  none  of  the  risks  early  wellness  programs  and  those  leading  up  to  of  a  prospectively  based  pricing  strategy;͞  however,  2013  concentrated  on  tactical  individual  behavioral  change.  After  four  decades  of  programming,  it  is  clear  the  results  have  been  the  carrier  is  able  to  reward  the  groups  who  are  doing  what  the  carrier  wants  disappointing  and,  in  fact,  are  stuck  at  a  less-­than-­optimal  position  within  them  to  do  without  having  to  subsidize  the  expenses  for  groups  that  are  not  nearly  every  organization.  There  is  little  to  no  evidence  our  population  is  in  compliance. $ODQ :DQJ DW $),6 %HQH¿WV D EHQH¿WV DQG ZHOOQHVV FRPSDQ\ LQ healthier  or  more  productive  today  than  when  the  programs  began.  However,  what  has  emerged  is  a  growing  awareness  of  the  potential  Emeryville,  Calif.,  in  considering  the  impact  of  PPACA  to  small  businesses,  of  a  healthy  workforce.  Corporate  and  political  leaders  have  never  been  came  to  the  conclusion  the  employer  will  never  be  absolved  of  the  so  interested  in  how  good  health  can  impact  costs  and  productivity,  responsibility  to  have  a  healthy  workforce  whether  the  employees  get  their  making  now  an  opportune  time  to  bring  wellness  programs  to  a  higher  insurance  from  the  exchanges  or  through  the  employer.  Regardless  the  level  of  engagement.  Realizing  this  opportunity  is  the  responsibility  of  HPSOR\HU ZLOO ZDQW WR FUHDWH D FXOWXUH RI KHDOWK DQG SURYLGH RWKHU EHQH¿WV WR LQGLYLGXDOV ZKR UHFRPPHQG ZHOOQHVV KHDOWK DQG GLVDELOLW\ EHQH¿W GHVLJQV drive  down  costs  and  improve  workplace  effectiveness  because  the  employer  will  have  very  little  control  to  affect  premium  outcome  in  the  exchanges.  to  organizations.  Purchasing  insurance  in  the  traditional  sense  will  likely  result  in  lower  costs  when  the  employer  becomes  engaged  in  promotion  a  culture  of  health.

New and Progressive Strategies for 2012 Âł*RRG +HDOWK LV *RRG %XVLQHVV´ KDV DOZD\V EHHQ RXU IRFXV ZKHQ Developing  low-­risk  maintenance  strategies  illustrates  the  type  of  widespread,  culture-­based  thinking  that  is  critical  as  companies  move  working  with  clients  says  David  Rearick  and  Stephen  Cherniak  at  Marsh  &  toward  the  successful  implementation  of  new,  inspired  approaches  to  McLennan  Agency  LLC  in  Atlanta.  We  achieve  that  by  assisting  our  clients  with  a  focus  on  vision  and  helping  individuals  and  the  workplace  thrive  in  a  sustainable  way.  That  opens  the  door  to  Elliottâ&#x20AC;&#x2122;s  approach  to  engaging  employees  in  their  health  environment.  A  vision  from  leadership  that  supports  the  principle  that  DQG EHQHÂżWV FKRLFHV ZKLFK SURYLGHV D PDMRU FRPSHWLWLYH HGJH HYHQ DJDLQVW â&#x20AC;&#x153;good  health  is  expectedâ&#x20AC;&#x201D;not  hoped  forâ&#x20AC;?;Íž  and  an  environment  that  focuses  on  and  is  supportive  of  the  workforceâ&#x20AC;&#x2122;s  ability  to  do  their  job  and  manage  less  expensive  programs.  An  idea  that  will  gain  traction  over  the  next  few  years  is  focusing  on  the  their  lifestyle.  Finally,  today  it  isnâ&#x20AC;&#x2122;t  about  wellnessâ&#x20AC;&#x201D;it  is  about  well-­being.  We  need  ¿QDQFLDO ZHOOQHVV RI HPSOR\HHV 6LPSOLFLW\ +HDOWK 3ODQ KDV GHYHORSHG D WRRO WR KHOS HPSOR\HHV XQGHUVWDQG WKH ÂżQDQFLDO LPSOLFDWLRQV RI WKHLU KHDOWK DQG the  objective  data  like  biometrics;Íž  but  a  high  blood  pressure  or  BMI  is  EHQHÂżWV GHFLVLRQV LQ D FRPSHOOLQJ ZD\ 7KH FRPSDQ\ÂśV KDQGKHOG PRELOH DQG often  the  result  of  an  unhappy  marriage,  someone  with  an  abuse  problem,  web-­based  applications  assess  an  individualâ&#x20AC;&#x2122;s  health  risks  and  behaviors,  ¿QDQFLDO LQVHFXULW\ RU PHQWDO LOOQHVV²WKHVH DUH WKH URRW FDXVHV DQG KXPDQ calculate  the  excess  costs  of  any  risks  and  demonstrate  potential  savings.  resource  challenges  that  every  health  enhancement  strategy  must  look  for  *UHJ +XPPHU 0 ' DQG &(2 VWDWHV ³WKH +HDOWK ,QGH[ &DOFXODWRU and  address.â&#x20AC;?  24

January/February 2013 I HealthCare Consumerism Solutionsâ&#x201E;˘ I www.TheIHCC.com

BY RANDY FINN ASSISTANT VICE PRESIDENT, PRODUCT DEVELOPMENT COLONIAL LIFE & ACCIDENT INSURANCE COMPANY

SUPPLEMENTAL HEALTH MANAGEMENT

Ease the Sting of High-deductible Health Plans with Voluntary Benefits and Effective Communication

T

KH FRVW RI SURYLGLQJ DIIRUGDEOH KHDOWK EHQH¿WV WR HPSOR\HHV WRSV HYHU\ H[HFXWLYH¶V OLVW RI ZRUULHV 7KDW¶V ZK\ FRQVXPHU GULYHQ EHQH¿WV including  high-­deductible  health  plans  and  health  savings  accounts,  are  gaining  traction.  These  options  can  help  employers  drive  down  the  cost  of  PDMRU PHGLFDO FRYHUDJH EXW DGGLQJ YROXQWDU\ EHQH¿WV WR WKH PL[ FDQ RIIHU even  more  advantages  for  employers  and  employees.

High-deductible Plans are Growing in Popularity Statistics  from  the  Kaiser  Family  Foundation  and  Health  Research  &  Educational  Trust  show  the  number  of  workers  enrolled  in  HDHPs  grew  from  8  percent  in  2009  to  19  percent  in  2012.  These  plans  tend  to  be  more  SRSXODU DPRQJ VPDOOHU ¿UPV XQGHU HPSOR\HHV +'+3V DUH RIWHQ offered  in  conjunction  with  HSAs,  tax-­preferred  accounts  employees  can  use  WR SD\ IRU TXDOL¿HG PHGLFDO H[SHQVHV How  large  is  the  average  deductible  for  employees  in  todayâ&#x20AC;&#x2122;s  world?  For  those  with  HDHPs,  it  was  nearly  $2,100  in  2012.  Overall,  34  percent  of  employees  have  an  average  deductible  of  $1,000  or  more  for  single  coverageâ&#x20AC;&#x201D;a  number  that  has  tripled  since  2006.

Increasing  the  deductible  on  a  company  health  plan  can  help  employers  VLJQL¿FDQWO\ ORZHU WKHLU FRVW IRU PDMRU PHGLFDO FRYHUDJH %XW UDLVLQJ GHGXFWLEOHV SXW DGGLWLRQDO ¿QDQFLDO EXUGHQ RQ HPSOR\HHV ,I QRW PDQDJHG and  communicated  properly,  such  a  move  can  be  highly  unpopular  with  the  employee  population. Â

Voluntary Products Can Pair Nicely With HDHPs To  help  offset  the  high  deductibles  workers  face  with  an  HDHP,  many  employers  have  turned  to  voluntary  products  for  a  much-­needed  solution.  Though  voluntary  products  are  typically  employee-­paid,  employers  often  ¿QG WKH\ FDQ SD\ IRU DOO RU SDUW RI WKHVH EHQH¿WV IURP WKH FRVW VDYLQJV WKH\ realize  from  redesigning  their  health  plans.

No  matter  who  pays  the  premium,  voluntary  products  can  help  offset  the  deductibles,  co-­insurance  and  other  out-­of-­pocket  medical  and  nonmedical  costs  associated  with  hospital  stays,  injuries  and  illnesses.  By  offering  employees  a  soft  landing  with  a  voluntary  product,  employers  are  able  to  take  the  edge  off  the  increased  deductible  associated  with  an  HDHP. Â

What Types of Voluntary Products Work well with High-deductible Health Plans There  are  several  types  of  voluntary  products  complementing  HDHPs,  and  many  of  these  plans  are  HSA-­compliant. Â&#x2021; +RVSLWDO FRQ¿QHPHQW LQGHPQLW\ LQVXUDQFH  Voluntary  KRVSLWDO FRQ¿QHPHQW FRYHUDJH KHOSV SD\ WKH QRQPHGLFDO DQG medical  out-­of-­pocket  expenses  related  to  a  hospital  stay. Â&#x2021; Cancer  and  critical  illness  insurance:  Employees  diagnosed  with  cancer  or  another  covered  critical  illness,  such  as  a  stroke Â

RU KHDUW DWWDFN FDQ XVH WKH SODQ¶V EHQH¿WV WR KHOS SD\ IRU KHDOWK insurance  deductibles  and  copayments  as  well  as  nonmedical  expenses. Â&#x2021; Accident  insurance: $FFLGHQW LQVXUDQFH SD\V EHQH¿WV ZKHQ DQ insured  is  injured  as  a  result  of  a  covered  accident  â&#x20AC;&#x201D;  injuries  such  as  joint  dislocations,  broken  bones,  burns,  lacerations  DQG UXSWXUHG GLVFV (PSOR\HHV FDQ XVH WKH EHQH¿WV WR KHOS SD\ for  nonmedical  and  medical  out-­of-­pocket  expenses  such  as  deductibles  and  copayments  resulting  from  a  covered  accident.

Donâ&#x20AC;&#x2122;t Overlook the Importance of Benefits Communication When  employees  are  faced  with  picking  up  the  tab  for  a  larger  portion  of  their  medical  expenses,  they  need  help  understanding  why  changes  were  made  and  how  their  coverage  is  impacted.  Thatâ&#x20AC;&#x2122;s  why  offering  clear  and  HIIHFWLYH EHQH¿WV FRPPXQLFDWLRQ LV PRUH LPSRUWDQW WKDQ HYHU Choosing  a  voluntary  carrier  offering  complimentary  one-­to-­one  counseling  as  part  of  its  enrollment  services  help  employees  understand  WKH FKDQJHV PDGH WR WKHLU EHQH¿WV DQG WKH QHZ RSWLRQV DYDLODEOH WR WKHP $ SURYLGHU WKDW FDQ HQUROO DOO HPSOR\HH EHQH¿WV LQFOXGLQJ FRUH EHQH¿WV DOVR removes  a  major  hassle  for  the  employer. ,Q IDFW VXUYH\V RI HPSOR\HHV ZKR PHHW LQGLYLGXDOO\ ZLWK EHQH¿WV counselors  during  their  enrollments  prove  the  effectiveness  of  the  one-­ WR RQH PHWKRG 9LUWXDOO\ DOO HPSOR\HHV SHUFHQW VXUYH\HG E\ &RORQLDO /LIH VD\ SHUVRQDO EHQH¿WV FRXQVHOLQJ LPSURYHG WKH XQGHUVWDQGLQJ RI WKHLU EHQH¿WV DQG SURYLQJ WKLV W\SH RI FRPPXQLFDWLRQ LV LPSRUWDQW SHUFHQW

(PSOR\HUV DOVR ¿QG YDOXH LQ RQH WR RQH EHQH¿WV FRXQVHOLQJ $OPRVW SHUFHQW RI HPSOR\HUV EHOLHYH SHUVRQDO EHQH¿WV FRXQVHOLQJ VHVVLRQV VWURQJO\ LPSURYH HPSOR\HHV¶ XQGHUVWDQGLQJ RI WKHLU EHQH¿WV DQG FRYHUDJH needs.

The Role of Employers is Changing 7KH PRYH WRZDUG FRQVXPHU GULYHQ EHQH¿WV FKDQJHV WKH UROH RI employers.  No  longer  are  they  always  providing  and  paying  for  traditional  EHQH¿WV ,QVWHDG WRGD\¶V HPSOR\HUV PXVW QRZ SURYLGH DFFHVV WR DQ DUUD\ RI TXDOLW\ EHQH¿WV²ERWK FRUH DQG YROXQWDU\ $QG WR NHHS HPSOR\HHV KDSS\ DQG HQJDJHG WKH\ PXVW SURYLGH HIIHFWLYH EHQH¿WV FRPPXQLFDWLRQ KHOSLQJ ZRUNHUV EHWWHU XQGHUVWDQG DQG DSSUHFLDWH WKH EHQH¿WV WKH\¶UH RIIHUHG 5DQG\ )LQQ LV DVVLVWDQW YLFH SUHVLGHQW RI SURGXFW GHYHORSPHQW DW &RORQLDO /LIH &RORQLDO /LIH LV D PDUNHW OHDGHU LQ SURYLGLQJ ILQDQFLDO SURWHFWLRQ EHQHILWV WKURXJK WKH ZRUNSODFH LQFOXGLQJ GLVDELOLW\ OLIH DFFLGHQW FDQFHU FULWLFDO LOOQHVV DQG VXSSOHPHQWDO KHDOWK LQVXUDQFH 7KH FRPSDQ\¶V EHQHILW VHUYLFHV DQG HGXFDWLRQ LQQRYDWLYH HQUROOPHQW WHFKQRORJ\ DQG SHUVRQDO VHUYLFH VXSSRUW PRUH WKDQ EXVLQHVVHV DQG RUJDQL]DWLRQV UHSUHVHQWLQJ QHDUO\ PLOOLRQ ZRUNLQJ $PHULFDQV DQG WKHLU IDPLOLHV )RU PRUH LQIRUPDWLRQ YLVLW ZZZ FRORQLDOOLIH FRP RU FRQQHFW ZLWK XV DW ZZZ IDFHERRN FRP FRORQLDOOLIHEHQHILWV ZZZ WZLWWHU FRP FRORQLDOOLIH DQG ZZZ OLQNHGLQ FRP FRPSDQ\ FRORQLDO OLIH www.TheIHCC.com I HealthCare Consumerism Solutionsâ&#x201E;¢ I January/February 2013

25

PHARMACY BENEFIT MANAGEMENT

BY SUMIT DUTTO SENIOR VICE PRESIDENT AND OFFICER CATAMARAN

Pharmacy Benefit Management Business Adapting to Demand for Specialty Medications

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KH SKDUPDF\ EHQH¿WV PDQDJHPHQW 3%0 EXVLQHVV FDQ EH GLI¿FXOW WR understand.  This  is  especially  true  during  periods  of  transition,  like  now,  when  the  health  care  industry  is  adapting  to  dramatic  changes.  7KH PRVW VLJQL¿FDQW LQFOXGH LQFUHDVLQJ GHPDQG IRU VSHFLDOW\ SKDUPDF\ medications,  changes  stemming  from  the  Affordable  Care  Act,  and  shifts  toward  value/outcomes-­based  payment  models  and  dynamic  provider  care  delivery  models.  Employers,  TPAs  and  managed  care  executives  are  all  carefully  examining  these  areas  to  ensure  they  are  prepared  for  the  future  consumer-­centric  health  care  environment.

touch  clinical  programs.  BriovaRx  has  specialty  pharmacies  in  locations  throughout  the  United  States,  which  serve  to  promote  close  relationships  with  providers  and  patients  regionally. Â

Outcomes Focus

The  United  States  spends  more  money  per  person  on  health  care  than  any  other  prosperous  nation  in  the  world,  yet  the  health  care  outcomes  are  not  necessarily  better.  This  situation  is  leading  a  push  toward  developing  new  payment  models  that  reward  positive  outcomes  or  penalize  negative  ones.  In  2012,  Medicare  &DWDPDUDQÂśV UHVSRQVH LV WR  began  adjusting  downward  reimbursement  Health Care Reform for  hospitalizations  for  three  conditions:  There  are  more  than  48  million  uninsured  IRFXV RQ FOLQLFDO RIIHULQJV WKDW rates  heart  attack,  heart  failure  and  pneumonia.  Americans  today.  Although  many  of  the  uninsured  are  working,  some  employers  may  not  DOORZ Ă&#x20AC;H[LELOLW\ IRU SKDUPDF\ Managed  care  organizations  are  experimenting  with  new  contracting  models  with  accountable  offer  health  insurance  or  employees  may  not  be  eligible.  We  know  the  uninsured  are  more  likely  EHQHÂżW VHUYLFHV WR EH GHOLYHUHG care  organizations  to  reimburse  based  on  new  outcome  measures.  Catamaran  is  partnering  to  forego  health  care  services  when  they  are  ill,  but  starting  in  2014,  nearly  all  Americans  will  be  ZKHUH EHQHÂżFLDULHV FKRRVH WR with  its  clients  to  provide  pharmacy  information  and  reporting  to  their  membersâ&#x20AC;&#x2122;  physicians  to  required  to  obtain  health  care  insurance.  For  the  HQJDJH LQGHSHQGHQW RI GUXJ  support  these  new  contracts.  working  uninsured,  if  their  employer  does  not  As  we  move  forward  in  this  evolution  offer  a  plan,  employees  will  be  able  to  purchase  GLVWULEXWLRQ FKDQQHO VXFK DV  of  health  care,  Catamaran  is  continuously  insurance  through  a  health  care  exchange.  focused  on  bringing  more  value  to  the  clients  7KLV LQĂ&#x20AC;X[ RI QHZ FRQVXPHUV RI KHDOWK FDUH UHWDLO LQGHSHQGHQW  we  serve.  Recent  investments  include  mobile  ZLOO DIIHFW KRZ KHDOWK FDUH LQVXUDQFH EHQHÂżWV technologies  that  provide  smart  phone  users  are  structured,  but  not  just  for  the  previously  FKDLQ RU PDLO VHUYLFH  with  myriad  capabilities  such  as  medication  uninsured.  Catamaranâ&#x20AC;&#x2122;s  response  is  to  focus  adherence  reminders,  drug  interaction  alerts  RQ FOLQLFDO RIIHULQJV WKDW DOORZ Ă&#x20AC;H[LELOLW\ IRU SKDUPDFLHV and  information  on  cost-­effective  medications.  SKDUPDF\ EHQHÂżW VHUYLFHV WR EH GHOLYHUHG ZKHUH We  also  utilize  patient  risk  scoring  models  EHQHÂżFLDULHV FKRRVH WR HQJDJH LQGHSHQGHQW RI drug  distribution  channel  such  as  retail,  independent,  chain  or  mail  in  order  to  better  allocate  our  clientsâ&#x20AC;&#x2122;  health  care  dollar  on  patient  engagement  that  is  more  likely  to  bring  near-­time  value.  Catamaran  offers  service  pharmacies.

D WUXH DOWHUQDWLYH WR WKH VWDWXV TXR LQ SKDUPDF\ EHQHÂżW PDQDJHPHQW DQG GHOLYHUV LQQRYDWLRQ Ă&#x20AC;H[LELOLW\ DQG SRZHUIXO UHVXOWV $V ZH FRQWLQXH Specialty Trend For  many  payers,  specialty  drug  trend  exceeded  20  percent  in  to  closely  monitor  industry  dynamics,  our  focus  remains  on  building  a  2012,  and  this  included  drugs  where  the  average  annual  costs  are  tens  of  Ă&#x20AC;H[LEOH \HW FRPSUHKHQVLYH VHW RI SURJUDPV WR VXSSRUW WKH GHOLYHU\ RI thousands  of  dollars.  In  fact,  specialty  drugs  can  even  reach  hundreds  of  HVVHQWLDO KHDOWK EHQHÂżWV IRU RXU FOLHQWV thousands  of  dollars  annually  on  the  extreme  end  of  the  cost  spectrum.  Large  PBMs  have  dedicated  specialty  pharmacy  divisions,  like  Catamaranâ&#x20AC;&#x2122;s  'U 6XPLW 'XWWD LV UHVSRQVLEOH IRU FOLQLFDO SURGXFWV VHUYLFHV DQG PHGLFDO DIIDLUV DQG OHDGV RYHUDOO KHDOWK FDUH VWUDWHJ\ DW &DWDPDUDQ +H KHDGV WKH WHDP UHVSRQVLEOH BriovaRx  Specialty  Pharmacy,  to  help  payers,  providers  and  patients,  with  IRU WKH GHYHORSPHQW RI &DWDPDUDQÂśV FOLQLFDO SURJUDPV FOLQLFDO UHSRUWLQJ GUXJ LQIRUPDWLRQ SXEOLFDWLRQV IRUPXODU\ PDQDJHPHQW SURFHVV DQG SURIHVVLRQDO SUDFWLFHV the  complexities  involved  in  managing  these  expensive  medications.  The  strategies  employed  by  specialty  pharmacies  to  manage  rising  &DWDPDUDQ WKH LQGXVWU\ÂśV IDVWHVW JURZLQJ SKDUPDF\ EHQHILW PDQDJHU KHOSV drug  trends  include  narrowing  the  specialty  pharmacy  distribution  RUJDQL]DWLRQV DQG WKH FRPPXQLWLHV WKH\ VHUYH WDNH FRQWURO RI SUHVFULSWLRQ GUXJ FRVWV 0DQDJLQJ PRUH WKDQ PLOOLRQ SUHVFULSWLRQV HDFK \HDU RQ EHKDOI RI network,  prior  authorization  and  step  therapy,  determining  appropriate  PLOOLRQ PHPEHUV WKH FRPSDQ\ÂśV IOH[LEOH KROLVWLF VROXWLRQV LPSURYH SDWLHQW FDUH DQG plan  design,  preferred  products  in  certain  specialty  classes  and  high  HPSRZHU LQGLYLGXDOV WR WDNH FKDUJH RI WKHLU KHDOWK

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January/February 2013 I HealthCare Consumerism Solutionsâ&#x201E;˘ I www.TheIHCC.com

BY TONY CHANDLER PARTNER HEALTH SOLUTIONS INSURANCE AGENCY

HEALTH CARE ACCESS ALTERNATIVE

Consider an On-site Wellness/Telemedicine Team for Better Employee Engagement

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Another  incentive  is  cash  rewards  for  proof  an  employee  has  had  his  ellness  programs  are  here  to  stay.  There  are  many  different  types  and  paths  to  follow,  each  company  needs  to  strongly  look  at  what  or  her  annual  physical  and  all  testing  associated  with  the  exam.  This  is  not  meant  to  be  invasive  or  intrude  on  someoneâ&#x20AC;&#x2122;s  privacy,  but  it  is  used  they  need  for  a  wellness  plan.  What  results  are  they  after?

Telemedicine  also  is  an  up-­and-­coming  strategy  used  by  many  as  a  method  to  prove  the  employee  has  complied.  Staying  with  the  cash  theme,  we  have  seen  a  remarkable  employer  successful  companies  to  improve  employee  satisfaction  both  at  home  incentive  where  they  offered  $50  for  every  and  work.  A  major  question  is  how  you  get  pound  lost  and  kept  off  during  a  contest  time  employees  to  actively  engage  in  both  wellness  $QRWKHU LQFHQWLYH LV FDVK frame.  One  employee  received  a  check  for  and  telemedicine  for  productive  results.  almost  $1600!  Now  thatâ&#x20AC;&#x2122;s  taking  wellness  One  of  the  most  successful  approaches  is  UHZDUGV IRU SURRI DQ seriously!  The  above  incentive  also  works  well  actually  having  a  wellness/telemedicine  team  where  the  employee  receives  a  gift  card  for  established  on-­site  at  the  employer  group.

HPSOR\HH KDV KDG KLV RU completing  a  health  risk  assessment.  It  is  important  to  choose  individuals  who  Based  on  the  common  promotion  of  have  power  or  the  respect  of  the  employees.  KHU DQQXDO SK\VLFDO DQG DOO health  reimbursement  accounts  within  group  Respect  is  the  key  factor.  In  this  way  it  is  easier  WHVWLQJ DVVRFLDWHG ZLWK WKH KHDOWK EHQHÂżWV ZH KDYH VHHQ HPSOR\HUV XVH to  engage  all  the  other  employees.  By  having  a  checklists  where  employees  get  points  for  team  of  employees  put  together  to  coordinate  H[DP 7KLV LV QRW PHDQW WR completing  items.  The  more  points  they  get  activities,  it  becomes  a  more  managed  process.  the  greater  reimbursement  they  receive  from  Setting  up  schedules  for  the  months  EH LQYDVLYH RU LQWUXGH RQ their  HRA.  Itâ&#x20AC;&#x2122;s  a  positive  program,  and  the  ahead  also  served  to  increase  engagement.  always  know  where  they  stand  with  Posters  in  the  lunch  rooms  or  common  meeting  VRPHRQHÂśV SULYDF\ EXW LW LV employees  their  HRA  bank.  places  of  the  employees  should  be  placed  as  Telemedicine  has  and  will  continue  ZHOO DV QRWLFHV WKURXJK LQWHURIÂżFH PDLO $OO XVHG DV D PHWKRG WR SURYH WKH to  reduce  health  care  claims.  Therefore  this  correspondence  is  put  together  to  get  the  employers  use  incentives  here  as  well  to  word  out,  but  it  must  be  communicated  by  the  HPSOR\HH KDV FRPSOLHG increase  engagement.  Once  it  is  communicated  wellness/telemedicine  teams  to  the  employees.  properly  in  a  group  setting  and  through  Some  groups  have  actually  implemented  a  cost  written  communication,  employees  will  approach  whereas  the  employee  would  pay  more  if  they  donâ&#x20AC;&#x2122;t  comply  to  a  wellness  plan,  such  as  quitting  smoking  understand  this  method.  No  longer  will  they  need  to  leave  work  in  the  or  entering  into  a  weight  cessation  program.  This  may  be  seen  as  middle  of  the  day  to  take  a  sick  child  to  the  doctor.  When  used  properly,  FRXQWHUSURGXFWLYH WR WU\LQJ WR LQFUHDVH SDUWLFLSDWLRQ DQG EDFNÂżUH ZLWK most  employers  will  reimburse  a  portion  of  the  expense  to  utilize  this  technology  as  an  incentive  to  increase  usage.  We  have  seen  rewards  given  regard  to  results.

Here  are  some  of  the  most  effective  methods  seen  to  engage  to  employees  at  the  end  of  the  year  when  they  can  see  the  reduction  in  employees  in  wellness  plans.  One  large  automotive  dealership,  emergency  room  visits.  As  you  can  see,  money  talks  and  will  continue  to  do  so  as  the  with  multiple  locations,  started  a  few  years  ago  by  installing  on-­site  gymnasiums  for  employee  use.  Not  a  full-­blown  gymnasium,  but  a  primary  incentive  to  engage  employees   in  these  phenomenal  programs.  treadmill,  exercise  bike  lightweights  and  basic  weight  training.  The  3URPRWLQJ D KHDOWKLHU DQG PRUH VDWLV¿HG ZRUNIRUFH LQ DGGLWLRQ WR treadmill  is  even  equipped  with  a  platform  for  a  laptop  computer  to  reducing  stress,  will  go  a  long  way  toward  bending  the  health  cost  curve  and  reducing  health  care  expenses.  PD[LPL]H ZRUN HI¿FLHQF\

www.TheIHCC.com I HealthCare Consumerism Solutionsâ&#x201E;˘ I January/February 2013

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28 January/February 2013 I HealthCare Consumerism Solutions™ I www.TheIHCC.com

LUE OF XCHANGES

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BY ERNIE HARRIS » CHIEF STRATEGY OFFICER WORKABLE SOLUTIONS

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uch  of  the  media  focus  of  late  has  been  on  the  value  of  public  health  care  exchanges,  the  costs  to  taxpayers  associated  with  them  and  the  readiness  of  various  states  and  the  federal  government  to  operate  them.  For  more  than  a  decade  various  entities  have  been  operating  private  exchanges  that  are  FRVW HIIHFWLYH DQG KDYH EHQH¿ WHG HPSOR\HUV DQG HPSOR\HHV DOLNH ZLWKRXW burdening  taxpayers.

The  value  of  an  exchange,  public  or  private,  goes  well  beyond  the  LQWURGXFWLRQ RI D GH¿ QHG FRQWULEXWLRQ DFFRXQW WKDW DOORZV HPSOR\HUV WR better  manage  their  portion  of  health  care  costs.  Exchanges,  or  perhaps  a  PRUH DSSURSULDWH WHUP ZRXOG EH RQOLQH EHQH¿ WV PDUNHWSODFHV RIIHU YDOXH WR PXOWLSOH SDUWLHV LQ DGGLWLRQ WR GH¿ QHG FRQWULEXWLRQ DFFRXQWV www.TheIHCC.com I HealthCare Consumerism Solutionsâ&#x201E;¢ I January/February 2013

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Costs are on the rise Controlling  health  care  costs  is  a  responsibility  that  falls  on  all  of  us:  individuals,  employers  and  insurance  carriers.  Similar  to  the  process  of  managing  budgets  for  your  department,  your  company  or  your  personal  household,  two  of  the  foundational  requirements  for  managing  health  care  FRVWV DUH DFFHVV WR LQIRUPDWLRQ DQG HI¿ FLHQF\

Online Benefits Marketplace Values Employer Benefits

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Employee Benefits

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Employer Benefits ,Q WRGD\ÂśV PDUNHWSODFH PRVW RQOLQH EHQHÂż WV HOLJLELOLW\ DQG HQUROOPHQW solutions  target  employers  with  more  than  1,000  employees.  This  is  due  in  large  part  to  the  inherent  complexity  of  these  systems  and  the  costs  associated  with  implementing  them.  3ULYDWH EHQHÂż WV PDUNHWSODFHV DOVR SURYLGH D FRVW HIIHFWLYH DOWHUQDWLYH IRU VPDOO DQG PLG VL]HG HPSOR\HUV ZKR GHVSHUDWHO\ ZDQW WKH HIÂż FLHQFLHV of  an  electronic  system  but  cannot  afford  the  high  costs  of  the  solutions  JHQHUDOO\ DYDLODEOH LQ WKH PDUNHW %\ DJJUHJDWLQJ EHQHÂż WV RIIHULQJV DFURVV D ODUJH SRSXODWLRQ RI HPSOR\HUV SULYDWH EHQHÂż WV PDUNHWSODFHV SURYLGH PXFK WKH VDPH Ă&#x20AC; H[LELOLW\ available  today  for  large  employers  for  a  fraction  of  the  cost.  According  to  the  U.S.  Census  Bureauâ&#x20AC;&#x2122;s  2010  report,  there  are  more  than  5.734  million  employers  in  the  U.S.â&#x20AC;&#x201D;5.725  million  of  them  employ  fewer  than  1,000.  These  employers  represent  99.8  percent  of  the  total  number  of  employers  in  the  U.S.  and  employ  60.9  million  individuals  or  SHUFHQW RI WKH ZRUNIRUFH $V DQ HPSOR\HU RXWVRXUFLQJ EHQHÂż WV HOLJLELOLW\ HQUROOPHQW maintenance  and  billing  saves  an  average  of  $165  per  employee  per  year.  1DWLRQDOO\ VPDOO DQG PLG PDUNHW HPSOR\HUV VWDQG WR VDYH a %1 DQQXDOO\ E\ PRYLQJ WR EHQHÂż WV PDUNHWSODFHV

Show Me the Money Employers  can  save  13  percent  or  more  by  moving  to  a  private  EHQHÂż WV PDUNHWSODFH LQ SHU HPSOR\HH EHQHÂż WV DGPLQLVWUDWLRQ IHHV DQG SURYLGH WKHLU HPSOR\HHV ZLWK D PRGHUQ DQG LQIRUPDWLYH EHQHÂż WV VKRSSLQJ and  management  experience.  For  the  average  company  employing  100  people,  thatâ&#x20AC;&#x2122;s  a  savings  of  almost  $2,000  per  year  in  administrative  FRVWV IRU GRLQJ VRPHWKLQJ WKDW \RXU HPSOR\HHV ZLOO VHH DV D PDUNHG improvement  over  the  traditional  paper  enrollment  process.

Convenience %H\RQG WKH VDYLQJV DVVRFLDWHG ZLWK EHQHÂż WV DGPLQLVWUDWLRQ WKH SULYDWH EHQHÂż WV PDUNHWSODFH DOVR FDQ RIIHU D FRQVROLGDWHG LQYRLFH IRU DOO 30

January/February 2013 I HealthCare Consumerism Solutionsâ&#x201E;˘ I www.TheIHCC.com

PDQDJHG EHQHÂż WV DOORZLQJ WKH HPSOR\HU WR PDNH D VLQJOH SD\PHQW )RU most  small  employers  remitting  payment  to  multiple  providers  monthly  LV RIWHQ LQFRQYHQLHQW DQG GLIÂż FXOW WR UHFRQFLOH 5HFRQFLOLDWLRQ LQ WKH PDUNHWSODFH LV SURYLGHG RQ D VLQJOH UHSRUW VLPSOLI\LQJ WKH MRE RI WKH Âż QDQFH GHSDUWPHQW DQG DOORZLQJ WKHP WR IRFXV RQ WKH EXVLQHVV DW KDQG Lastly,  all  activity  can  be  monitored  and  all  participants  can  be  managed  in  a  single  place  providing  consolidated  access  to  all  the  information  required  by  the  employerâ&#x20AC;&#x2122;s  leadership  team.

Employee Benefits Individuals  continue  to  feel  the  costs  associated  with  increased  insurance  premiums  every  year.  According  to  the  Kaiser  Family  Foundation  $QQXDO 5HSRUW RQ (PSOR\HU +HDOWK %HQH¿ WV HPSOR\HHV KDYH experienced  a  102  percent  increase  in  premium  costs  since  2002.  Although  heath  care  insurance  providers  often  are  maligned  as  being  driven  only  by  cost  and  not  by  compassion,  they  too  have  serious  challenges.  An  LQVXUDQFH FRPSDQ\ LV LQ WKH EXVLQHVV RI PDQDJLQJ ULVN DQG SURYLGLQJ protection  to  the  insured  against  unforeseen  events  that  may  occur  at  some  point  in  the  future.  This  is  where  the  individual  can  help  themselves,  their  employers  and  even  their  insurance  providers.

Fifty  years  ago,  individuals  bought  health  insurance  in  much  the  same  manner  as  they  did  auto,  life  or  disability.  They  purchased  pure  insurance  which,  according  to  Merriam-­Webster  is:  ³FRYHUDJH E\ FRQWUDFW ZKHUHE\ RQH SDUW\ XQGHUWDNHV WR LQGHPQLI\ RU JXDUDQWHH DQRWKHU DJDLQVW ORVV E\ D VSHFLÂż HG FRQWLQJHQF\ RU SHULO´ Insurance  is  not  a  vehicle  to  manage  the  day-­to-­day  expenditures  DVVRFLDWHG ZLWK WKH ÂłQRUPDO FRXUVH RI DFWLRQ´ +RZHYHU WKLV LV ZKDW KHDOWK insurance  has  evolved  into  over  the  past  50  yearsâ&#x20AC;&#x201D;a  payment  plan  more  WKDQ D PDQDJHU RI ULVN

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s ! TOOL COMMONLY USED TO EQUALIZE THE PAYMENT FOR ALL HEALTH CARE ACTIVITY FROM ROUTINE TO UNFORSEEN

6R ZKDW FDQ DQ LQGLYLGXDO GR WR XQZLQG ¿ YH GHFDGHV RI FKDQJH" ,WœV simple;͞  be  an  active  consumer  of  health  care.

Consumerism  is  the  fundamental  force  that  aligns  commercial  SURYLGHUV ZLWK WKH PDUNHW V WKH\ VHUYH 7RGD\ PRVW SHRSOH GRQÂśW NQRZ how  much  health  care  actually  costsâ&#x20AC;&#x201D;itâ&#x20AC;&#x2122;s  funny  money  because  under  the  PDQDJHG FDUH PRGHO ZH DV D VRFLHW\ DUH QRW UHTXLUHG WR NQRZ $OO ZH NQRZ is  that  we  need  health  insurance  and  it  should  cover  whatever  we  need.  ,I LW GRHVQÂśW ZH WKLQN LW LV EHFDXVH WKH LQVXUDQFH FRPSDQLHV DUH JUHHG\ Insurers  are  not  necessarily  greedy  but  they  are  businesses  that  must  SURYLGH D VHUYLFH WKDW LV Âż QDQFLDOO\ YLDEOH RU WKH\ FHDVH WR H[LVW A  2011  survey  of  hospital  emergency  room  costs  reported  the  cost  RI DQ (5 YLVLW UDQJHG IURP WR RU PRUH GHSHQGLQJ RQ WKH severity.  The  report  divided  the  range  of  visits  into  three  categories,  low-­ level,  moderate-­level  and  high-­level  with  no  hospital  reporting  a  cost  of  less  than  $150  for  a  low-­level  visit.  For  those  with  a  comprehensive  PHGLFDO SODQ DQ (5 YLVLW PLJKW UHTXLUH D RU FRSD\ ZLWK DQ\ FRVW beyond  that  paid  for  by  the  insurance  company  and  seen  as  â&#x20AC;&#x153;freeâ&#x20AC;?  by  the  consumer.  A  great  plan  for  the  consumer,  but  not  necessarily  a  long-­term  ¿ QDQFLDOO\ YLDEOH VROXWLRQ IRU WKH LQVXUHU

What are the Alternatives? <RX FDQÂśW JR ZLWKRXW WKH FDUH \RX QHHG $ Âż YH PLQXWH UHVHDUFK SURMHFW revealed  two  alternatives  for  low-­level  needs  in  my  area,  both  of  which  happen  to  be  national  programs.  CVS  and  Walgreens  both  offer  in-­store  health  clinic  services  with  many  open  24  hours.  Fees  range  from  $79  to  $89  for  a  â&#x20AC;&#x153;routineâ&#x20AC;?  visitâ&#x20AC;&#x201D;nearly  half  of  the  lowest  reported  cost  to  visit  DQ (5 )RU WKRVH ZLWK D KLJK GHGXFWLEOH KHDOWK SODQ WKLV ZRXOG EH D PRUH FRVW HIIHFWLYH DSSURDFK IRU URXWLQH QHHGV RYHU WKH (5

Managing Out-of-pocket Costs (YHQ ZLWK PRUH FRVW HIIHFWLYH RSWLRQV DYDLODEOH PDQ\ RI XV MXVW canâ&#x20AC;&#x2122;t  afford  to  bear  the  cost  of  health  care  needs  as  budgets  are  tight  in  a  down  economy;Íž  another  reason  many  families  gravitate  toward  more  comprehensive  health  plans.  There  are  other  options  though,  some  which  may  surprise  you.

The  Kaiser  annual  report  provides  estimates  for  the  national  average  cost  of  health  care  by  plan  type.  In  2012,  a  family  paid  an  estimated  $4,563  SHU \HDU IRU D WUDGLWLRQDO +02 ZKHUHDV WKH VDPH IDPLO\ ZRXOG KDYH SDLG DQ HVWLPDWHG IRU D TXDOL¿ HG KLJK GHGXFWLEOH SODQ +'+3 ²D GLIIHUHQFH RI SHU \HDU )RU WKRVH IDPLOLHV WKDW HQUROO LQ TXDOL¿ HG high-­deductible  plans,  they  also  can  participate  in  a  health  savings  account  RU +6$ ,Q IDPLOLHV FDQ FRQWULEXWH XS WR SUH WD[ WR WKHLU +6$ )RU D UHODWLYHO\ KHDOWK\ IDPLO\ HQUROOLQJ LQ DQ +'+3 DQG DQ +6$ would  allow  that  family  to  save  potentially  $843  per  year  with  no  change  LQ KLVWRULFDO RXW RI SRFNHW IHHV 6LQFH PRVW +'+3V FRYHU SUHYHQWDWLYH U.S. Employer Data - Number and Size 2010 U.S. Census Data 4,000,000

40,000,000

3,500,000

35,000,000

3,000,000

# of Employers

30,000,000

2,500,000

25,000,000

2,000,000

20,000,000

Benefits Marketplaces )LJXULQJ RXW DOO WKH RSWLRQV DQG SLFNLQJ WKH EHVW KHDOWK SODQ IRU \RXU VLWXDWLRQ LV QR HDV\ WDVN 7KDWœV ZKHUH EHQH¿ WV PDUNHWSODFHV FDQ KHOS WKH individual  employee.  They  provide  a  consolidated  health  portal  integrating  GHFLVLRQ VXSSRUW WRROV WDLORUHG WR DQ LQGLYLGXDOœV VSHFL¿ F QHHGV SODQ comparison  tools  and  integrated  access  to  health  care  reimbursement  DFFRXQWV OLNH +6$V DQG )6$V 7KHVH PDUNHWSODFHV DUH D RQH VWRS VKRS IRU DOO WKH QHHGV DQ LQGLYLGXDO PD\ KDYH DQG LW JRHV EH\RQG PDMRU PHGLFDO 0DQ\ EHQH¿ WV PDUNHWSODFHV DOVR DOORZ LQGLYLGXDOV WR UHYLHZ DQG HQUROO LQ DQFLOODU\ EHQH¿ WV DV ZHOO VXFK DV GHQWDO YLVLRQ GLVDELOLW\ DQG HYHQ SHW insurance.

Carrier Benefits :KLOH WKH EHQH¿ WV IRU HPSOR\HUV DQG HPSOR\HHV DUH VLJQL¿ FDQW WKHUHœV VRPHWKLQJ IRU LQVXUDQFH FDUULHUV DV ZHOO :LWK QHZ OHJLVODWLRQ PHGLFDO ORVV UDWLR RU 0/5 UXOHV UHTXLULQJ FDUULHUV WR ¿ [ WKHLU DGPLQLVWUDWLYH FRVWV coming  online,  many  providers  are  searching  for  ways  to  reduce  costs.  3ULYDWH EHQH¿ WV PDUNHWSODFHV RIIHU UHOLHI IRU VRPH RI WKH URXWLQH FRVWV currently  born  by  the  carrier.

Universal Electronic Enrollment 7RGD\ PRVW FDUULHUV SURYLGH HOHFWURQLF HQUROOPHQW WR ODUJH PDUNHW employers  but  the  relationship  is  typically  one-­to-­one  between  the  employer  and  the  carrier.  As  such,  carriers  have  been  reluctant  to  offer  WKLV VHUYLFH GRZQ PDUNHW EHFDXVH RI WKH LQFUHDVH LQ VXSSRUW FRVWV associated  with  managing  thousands  if  not  hundreds  of  thousands  of  HQUROOPHQW IHHGV 7KLV LV ZKHUH WKH EHQH¿ WV PDUNHWSODFH KHOSV WKH PRVW 7KH PDUNHWSODFH DFWV DV DQ DJJUHJDWRU RI HQUROOPHQW DFWLYLW\ SUHVHQWLQJ LWVHOI DV D MXPER HPSOR\HU WR WKH FDUULHU 7KLV DOORZV WKH FDUULHU WR VKLIW the  responsibility  of  managing  the  hundreds  of  thousands  of  individual  UHODWLRQVKLSV WR WKH PDUNHWSODFH DQG UHDS WKH EHQH¿ W RI VXEVWDQWLDOO\ increased  electronic  enrollment. )RU WKHLU SDUW WKH PDUNHWSODFH DOUHDG\ KDV WKH H[SHUWLVH WR PDQDJH this  type  of  interaction  and  delivers  value  to  the  employer  in  the  form  of  an  online,  electronic  shopping  and  enrollment  experience.

Billing and Commissions Payments 1,500,000

15,000,000

1,000,000

10,000,000

500,000

5,000,000

-

0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-74 75-99 100-149 150-199 200-299 300-399 400-499 500-749 750-999 1,000-1,499 1,500-1,999 2,000-2,499 2,500-4,999 5,000 +

# of Employers

# of Employees

FDUH Âż UVW GROODU WKDW PRQH\ FDQ DFFXPXODWH WR VDYH IRU IXWXUH KHDOWK care  events  that  may  arise.  Families  also  have  the  option  to  contribute  additional  monies  above  the  $833  to  cover  routine  costs  that  are  covered  WRGD\ E\ Ă&#x20AC; H[LEOH VSHQGLQJ DFFRXQWV )6$ DQG VDYH XS WR SHUFHQW 7KLV LV MXVW RQH RSWLRQ DQG RQH VFHQDULR 1RW DOO LQGLYLGXDOV ZLOO UHFHLYH WKH VDPH Âż QDQFLDO EHQHÂż WV DV HDFK VLWXDWLRQ LV XQLTXH

7KH PDUNHWSODFH DOVR DFWV DV WKH FHQWUDOL]HG ELOOLQJ VROXWLRQ IRU DOO providers.  It  provides  a  single  invoice  to  the  group  and  remits  premium  SD\PHQWV WR WKH EHQH¿ WV SURYLGHU V 0DQ\ PDUNHWSODFHV DOVR KDYH WKH DELOLW\ WR GLVEXUVH EURNHU FRPPLVVLRQ SD\PHQWV 3UHPLXP ELOOLQJ DQG commissions  payments  are  two  large  cost  items  in  any  carriers  operating  EXGJHW ERWK RI ZKLFK FDQ EH KDQGOHG E\ WKH EHQH¿ WV PDUNHWSODFH

The Good, the Bad and the Healthy 5HJDUGOHVV RI \RXU LQGLYLGXDO SRVLWLRQ RQ KHDOWK FDUH UHIRUP RQH thing  is  clear:  individuals  and  their  employers  continue  to  feel  the  crunch  of  increasing  health  care  costs.  There  are  certainly  many  potential  options  WR PDQDJH WKHVH LQFUHDVHV RYHU WLPH EXW SULYDWH EHQHÂż WV PDUNHWSODFHV DUH available  today  and  promise  to  deliver  at  least  some  relief.  As  the  ancient  proverb  says,  â&#x20AC;&#x153;A  bird  in  the  hand  is  worth  two  in  the  bush.â&#x20AC;?  Â

Employer Size

www.TheIHCC.com I HealthCare Consumerism Solutionsâ&#x201E;˘ I January/February 2013

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Defined Contribution Model, Private Exchanges Shifting Power to Consumers

BY DAVID URBANIAK » PRODUCT MANAGER » EVOLUTION1

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January/February 2013 I HealthCare Consumerism Solutions™ I www.TheIHCC.com

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KDOOHQJLQJ HFRQRPLF WLPHV LQ WKH 8QLWHG 6WDWHV KDYH KDG DQ LPSDFW RQ QHDUO\ HYHU\ $PHULFDQ )RU PLOOLRQV RI SHRSOH KHDOWK FDUH²DQG LWV UHODWHG FRVWV²DUH D VLJQL¿FDQW ¿QDQFLDO FRQFHUQ %XVLQHVVHV RI FRXUVH DOVR KDYH IHOW WKHVH FKDOOHQJHV DQG KDYH ORRNHG IRU QHZ DQG LQQRYDWLYH ZD\V WR KHOS NHHS KHDOWK FDUH FRVWV LQ FKHFN 2QH VROXWLRQ JHWWLQJ D JUHDW GHDO RI DWWHQWLRQ LV WKH GH¿QHG FRQWULEXWLRQ PRGHO ZKHUH WKH HPSOR\HU PDNHV D ¿[HG GROODU FRQWULEXWLRQ WR HDFK HPSOR\HH (PSOR\HHV WKHQ XVH WKDW PRQH\ WR SXUFKDVH LQVXUDQFH PDNLQJ LQGLYLGXDO FRVW EDVHG GHFLVLRQV DERXW WKH W\SH RI LQVXUDQFH WKDW EHVW PHHW WKHLU XQLTXH QHHGV 7KH GH¿QHG FRQWULEXWLRQ PRGHO DOORZV HPSOR\HUV WR VHW WKHLU DQQXDO EHQH¿WV EXGJHW KHOSLQJ WKHP WR UHGXFH RU VWDELOL]H HYHU LQFUHDVLQJ KHDOWK FDUH FRVWV $W WKH VDPH WLPH LW JLYHV HPSOR\HHV PRUH FKRLFHV WKDQ HYHU EHIRUH DQG WKH RSSRUWXQLW\ WR VKRS IRU WKH FRYHUDJH WKH\ QHHG 7KH\ DOVR FDQ FRQWULEXWH WKHLU RZQ SD\UROO GROODUV LQ D WD[ DGYDQWDJHG ZD\ WR FRYHU UHPDLQLQJ SUHPLXP DPRXQWV DV ZHOO DV RWKHU HOLJLEOH RXW±RI SRFNHW H[SHQVHV 6RXQGV UHYROXWLRQDU\ ULJKW" 1RW HQWLUHO\ Defined Contributionâ&#x20AC;&#x201D;Why Now? $ GH¿QHG FRQWULEXWLRQ PRGHO LV QRW D QHZ LGHD 7KH FRQFHSW KDV EHHQ DURXQG IRU PRUH WKDQ \HDUV EXW WKH FXUUHQW PDUNHW FRQGLWLRQV resulting  from  the  passing  of  the  Patient  Protection  and  Affordable  Care  $FW 33$&$ DQG JXDUDQWHHG LVVXH FRXSOHG ZLWK WKH FRQWLQXHG ULVLQJ FRVW of  health  care,  have  been  catalysts  for  businesses  to  reexamine  their  health  EHQH¿W PRGHOV LQ DQ DWWHPSW WR ¿JXUH RXW WKHLU UROH LQ WKH FKDQJLQJ KHDOWK care  ecosystem.  Another  factor  to  consider  is  an  emerging,  technology-­rich  environment  enabling  new  and  effective  ways  for  consumers  to  shop  for  DQG FRPSDUH KHDOWK FDUH SODQV DV ZHOO DV PDQDJH WKH ¿QDQFLDO DFFRXQWV used  to  pay  for  these  plans.  Consider  this: Â&#x2021; More  than  85  percent  of  the  worldâ&#x20AC;&#x2122;s  online  population  has  used  WKH ,QWHUQHW WR PDNH D SXUFKDVH 1LHOVHQ

Â&#x2021; Four  out  of  10  large  companies  offer  a  single  web-­based  portal  access  to  employees  for  a  wide  variety  of  informationâ&#x20AC;&#x201D; LQFOXGLQJ EHQH¿WV SD\ VWXEV WLPH DQG DWWHQGDQFH WD[ ZLWKKROGLQJ DQG PRUH 7RZHUV :DWVRQ

Â&#x2021; Ninety-­one  percent  of  consumers  said  researching  products  RQOLQH PDGH WKHP IHHO PRUH FRQ¿GHQW DERXW WKHLU SXUFKDVHV 3ULFH*UDEEHU FRP

Since  the  concept  of  using  dollars  provided  by  an  employer  to  VKRS IRU KHDOWK FDUH LQVXUDQFH LV D UHODWLYHO\ QHZ ZD\ WR WKLQN DERXW GHOLYHULQJ DQG HQUROOLQJ LQ HPSOR\HH EHQH¿WV XVHU IULHQGO\ WRROV WKDW help  consumers  navigate  their  insurance  plan  will  be  critical.  The  tools  need  to  illustrate  the  employeeâ&#x20AC;&#x2122;s  coverage  options,  while  at  the  same  time  SURYLGLQJ FOHDU YLVLELOLW\ LQWR WKHLU FRPSOHWH ¿QDQFLDO KHDOWK FDUH SLFWXUH Technology  offerings  that  include  planning,  budgeting,  consumer-­decision  support  tools  and  the  facilitation  of  electronic  premium  payments,  all  in  D PXOWL FKDQQHO HQYLURQPHQW ZLOO EH WKH EDVH OHYHO IRU FRQVXPHU PDUNHW entry.

7KH GH¿QHG FRQWULEXWLRQ PRGHO LV an  evolution  of  consumer-­directed  health  care  plans  such  as  a  health  savings  account  +6$ RU Ã&#x20AC;H[LEOH VSHQGLQJ DFFRXQW )6$

that  exist  and  are  widely  available  today.  Accessing  consumer-­driven  health  care  information  is  increasingly  common,  with  85  percent  of  companies  providing  such  access.  At  the  same  time,  the  need  for  technology  to  facilitate  and  service  these  new  distribution  channels  creates  both  D PDUNHW JDS DQG DQ RSSRUWXQLW\ IRU DGPLQLVWUDWLRQ WRROV UHFRUG NHHSLQJ DQG reporting  features  for  administrators  and  HPSOR\HUV $V WKH GH¿QHG FRQWULEXWLRQ PRYHPHQW FRQWLQXHV WR JURZ WKH PDUNHW can  expect  to  see  even  more  advanced  technology  solutions.  This  is  good  QHZV IRU WKH FRQVXPHU ZKR LV WDNLQJ RQ LQFUHDVHG ¿QDQFLDO DQG EHQH¿W SODQ GHFLVLRQ PDNLQJ UHVSRQVLELOLW\ According  to  health  care  insurer  :HOO3RLQW ,QF GH¿QHG FRQWULEXWLRQ plans  will  be  mainstream  within  two-­ to-­three  years.  The  company  is  close  to  signing  30  midsize  and  large  employers,  including  one  with  more  than  50,000  ZRUNHUV 6LPLODUO\ 0HUFHU D JOREDO FRQVXOWLQJ OHDGHU LQ WDOHQW KHDOWK retirement,  and  investments,  found  56  percent  of  employers  are  FRQVLGHULQJ D SULYDWH H[FKDQJH WR SURYLGH EHQH¿WV WR HLWKHU FXUUHQW employees  and/or  retirees.  7ZR ODUJHU HPSOR\HUV 6HDUV +ROGLQJV &RUS DQG 'DUGHQ 5HVWDXUDQWV ,QF ²WKH SDUHQW FRPSDQ\ IRU UHVWDXUDQW FKDLQV LQFOXGLQJ 2OLYH *DUGHQ 5HG /REVWHU DQG PDQ\ RWKHUV²PRYHG WR GH¿QHG FRQWULEXWLRQ SODQV IRU their  full-­time  employees  on  Jan.  1,  2013.  ,I WKLV QHZ PHWKRG RI RIIHULQJ D GH¿QHG FRQWULEXWLRQ SODQ WR IDFLOLWDWH KHDOWK EHQH¿WV SURYHV WR EH HIIHFWLYH DQG D FRVW VDYHU IRU HPSOR\HUV PDQ\ PRUH RUJDQL]DWLRQV ZLOO OLNHO\ PDNH WKH VZLWFK ZLWKLQ WKH QH[W WR months.  A  2011  McKinsey  survey  of  1,300  employers  found  30  percent  will  GH¿QLWHO\ RU SUREDEO\ VWRS RIIHULQJ HPSOR\HU VSRQVRUHG JURXS LQVXUDQFH in  the  years  after  2014. Â

Health Insurance Exchanges: A New Household Term 'H¿QHG FRQWULEXWLRQ SODQV DQG SULYDWH H[FKDQJHV DUH WZR VLGHV RI the  same  coin.  Private  health  insurance  exchanges  as  a  component  to  GH¿QHG FRQWULEXWLRQ SODQV DUH VSULQJLQJ XS LQ UHVSRQVH WR WKH SDVVDJH RI WKH KHDOWK FDUH ODZ DQG WKH FKDQJH LQ KHDOWK EHQH¿W PDUNHW FRQGLWLRQV A  private  exchange  is  a  private  business  owned  and  operated  by  EURNHUV SD\HUV RU WKLUG SDUW\ DGPLQLVWUDWRUV 73$V $ SULYDWH H[FKDQJH generally  consists  of  an  online  shopping  experience  for  health  care,  dental,  YLVLRQ DQG RWKHU EHQH¿WV 7KH SULYDWH H[FKDQJH DOORZV FRQVXPHUV WR VKRS and  compare  servicesâ&#x20AC;&#x201D;similar  to  how  consumers  today  shop  and  compare  DLUIDUH SXUFKDVHV :KHQ SXUFKDVLQJ D SODQH WLFNHW FRQVXPHUV DOPRVW H[FOXVLYHO\ XVH WKH ,QWHUQHW WR FRPSDUH WLFNHW SULFHV DLUOLQHV DQG GHSDUWXUH and  arrival  times.  With  an  exchange,  consumers  are  able  to  select  and  compare  critical  insurance  plan  factors  to  suite  their  particular  familyâ&#x20AC;&#x2122;s  QHHGV VXFK DV SURYLGHU QHWZRUN EHQH¿WV FRYHUHG TXDOLW\ RI FDUH DQG SULFH www.TheIHCC.com I HealthCare Consumerism Solutionsâ&#x201E;¢ I January/February 2013

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,Q UHVSRQVH WR WKH PDUNHW Currently, public exchanges at be  worth  nearly  $60  billion  in  premium  revenues  in  2014,  according  to  PwC  opportunity,  a  variety  of  business  the state level appear to be +HDOWK 5HVHDUFK ,QVWLWXWH HVWLPDWHV 7KH entities  are  launching  their  own  private  H[FKDQJH PDUNHW LV H[SHFWHG WR WULSOH LQVXUDQFH H[FKDQJHV &RPSDQLHV OLNH in various phases, with some WR QHDUO\ ELOOLRQ E\ *LYHQ $RQ +HZLWW DQG :DOJUHHQV DUH JHWWLQJ WKDW VR PXFK LV DW VWDNH SURIHVVLRQDOV LQWR WKH H[FKDQJH PL[ 8QLWHG+HDOWK states already putting their HPSOR\HUV DQG FRQVXPHUV DOLNH *URXSœV H[FKDQJH SURJUDPV DOUHDG\ DUH trying  to  get  a  true  sense  of  how  EHLQJ RIIHUHG LQ VWDWHV ZKLOH EHQH¿ WV exchange plan into action while are  exchanges  will  operate.  consulting  firm  Mercer  announced  ,Q -DQXDU\ WKH 8 6 'HSDUWPHQW in  January  it  was  building  a  health  others are just beginning to RI +HDOWK DQG +XPDQ 6HUYLFHV '++6

insurance  exchange  for  employers.  gave  four  more  states  the  approval  to  set  Wal-­Mart  also  is  investigating  consider how they will get up  their  own  exchanges.  Idaho,  Nevada,  the  idea  of  building  a  private  health  their arms around an 1HZ 0H[LFR DQG 8WDK MRLQHG VWDWHV insurance  exchange,  which  would  be  DV ZHOO DV WKH 'LVWULFW RI &ROXPELD WKDW geared  toward  small  businesses.  Wal-­ all-encompassing regulation. have  been  granted  approval  to  set  up  Mart  would  use  its  size  as  leverage  state-­run  exchanges.  So  far  temporary  WR PDNH DQ LQVXUDQFH PDUNHWSODFH federal  grants,  totaling  $964  million,  competitive  and  available  to  a  broader  KDYH EHHQ GLVWULEXWHG WR VWDWHV +RZHYHU VWDWH UXQ H[FKDQJHV PXVW EH base  of  companies  and  individuals.  1R WZR SULYDWH H[FKDQJHV DUH DOLNH KDYLQJ D YDU\LQJ OHYHO RI VHOI VXIÂż FLHQW E\ -DQXDU\ Currently,  public  exchanges  at  the  state  level  appear  to  be  in  various  capabilities  within  the  individual,  small  group,  large  group,  and/or  retiree  PDUNHWV 3ULYDWH H[FKDQJHV GLIIHUHQWLDWH WKHPVHOYHV LQ D YDULHW\ RI ZD\V phases,  with  some  states  already  putting  their  exchange  plan  into  action  including  distribution  channel  strategy,  product  offerings,  and  robust  ZKLOH RWKHUV DUH MXVW EHJLQQLQJ WR FRQVLGHU KRZ WKH\ ZLOO JHW WKHLU DUPV tools  that  integrate  with  wellness,  educational  materials,  and  consumer-­ around  an  all-­encompassing  regulation.  Minnesota,  for  example,  recently  unveiled  legislation  that  will  lay  the  driven  health  care  account  platforms.  Common  ways  to  segment  are: JURXQGZRUN IRU KHDOWK LQVXUDQFH H[FKDQJHV DOORZLQJ PLOOLRQ UHVLGHQWV Â&#x2021; 6LQJOH FDUULHU ([FKDQJHV  These  exchanges  are  generally  RI WKH VWDWH WR VKRS FRPSDUDWLYHO\ IRU KHDOWK LQVXUDQFH HIIHFWLYH 2FW promoted  by  a  single  carrier  such  as  BlueCross  BlueShield  +RZHYHU 0LVVLVVLSSL KDG DSSOLHG IRU DSSURYDO WR EHJLQ PRYLQJ and  target  employers  who  wish  to  continue  to  play  an  active  role  in  both  the  selection  of  insurance  carrier  and  plan  design.  forward  on  its  state  exchange,  but  faced  a  disagreement  over  how  much  DXWKRULW\ VWDWH RIÂż FLDOV VKRXOG ZLHOG RYHU WKH RSHUDWLRQV 'HSHQGLQJ RQ WKH OHYHO RI HPSOR\HU HQJDJHPHQW LQ WKH 6RPH VWDWHV²VXFK DV $UNDQVDV DQG 'HODZDUH²KDYH GHFLGHG WR RSW EHQHÂż W GHVLJQ LQVXUDQFH SURGXFWV PD\ EH FXVWRPL]HG IRU WKH out  of  a  state  exchange  and  instead  have  chosen  to  participate  in  a  federal  employee  group  or  individuals.

SDUWQHUVKLS H[FKDQJH 7KH IHGHUDO JRYHUQPHQW DQWLFLSDWHV LW ZLOO OLNHO\ Â&#x2021; 0XOWL FDUULHU ([FKDQJHV These  exchanges  typically  offer  end  up  operating  exchanges  in  at  least  32  states.  The  deadline  for  states  to  D UDQJH RI LQVXUDQFH FDUULHUV SURPRWHG E\ D EURNHU EHQHÂż W declare  their  intentions  to  participate  in  the  federal  partnership  exchange  consultant  or  administrator.  These  exchanges  offer  a  broad  was  Feb.  15. array  of  insurance  plan  types  and  plan  designs.  Employers,  ZKR ZLVK WR WDNH D PRUH KDQGV RII DSSURDFK WR EHQHÂż W selection  for  their  employees,  gravitate  to  this  model.

In Conclusion ,I HGXFDWLQJ FRQVXPHUV DERXW WRGD\ÂśV KHDOWK FDUH EHQHÂż WV LV challenging,  trying  to  ensure  every  American  fully  understands  and  Private Versus Public Exchanges The  private  exchange  world  is  fully  functioning  today,  and  is  not  to  JUDVSV²DQG LQ WXUQ IXOO\ XWLOL]HV²WKHLU EHQHÂż W RIIHULQJ LV HTXDOO\ be  confused  with  the  public  exchanges  that  are  still  being  created  due  to  demanding.  In  the  coming  months  and  years,  employers  and  consumers  mandates  by  PPACA.  In  the  â&#x20AC;&#x153;pay  or  playâ&#x20AC;?  concept,  private  exchanges  allow  will  face  many  education  hurdles.  7KH KHDOWK EHQHÂż WV LQGXVWU\ LV PRELOL]LQJ YHU\ TXLFNO\ LQ SDUDOOHO DQ HPSOR\HU WR FRQWLQXH WR ÂłSOD\´ DQG RIIHU EHQHÂż WV WR WKHLU HPSOR\HHV Whereas  the  public  exchange  will  support  government-­funded  health  ZLWK GHIHQVH RI RU LQ VSLWH RI WKH 33$&$ $V WKH FROOHFWLYH KHDOWK EHQHÂż WV LQVXUDQFH DQG WKH VXEVLG\ ÂłSDLG´ E\ HPSOR\HUV ZKR RSW RXW RI WKH EHQHÂż WV industry  begins  to  plan  and  respond  to  the  mandates  found  within  the  UHJXODWLRQ RQH WKLQJ LV FHUWDLQ ([FKDQJHV DQG WKH GHÂż QHG FRQWULEXWLRQ game.  The  PPACA  mandates  the  creation  of  government-­funded  health  health  insurance  model  will,  without  a  doubt,  shift  the  entire  industry  insurance  exchanges.  A  public  exchange  is  a  health  insurance  exchange  DV ZH NQRZ LW :KHWKHU KHDOWK LQVXUHU WHFKQRORJ\ SURYLGHU WKLUG SDUW\ run  by  a  government  or  government  contracted  agency.  These  â&#x20AC;&#x153;publicâ&#x20AC;?  DGPLQLVWUDWRU HPSOR\HU RU FRQVXPHU ZH FDQ DOO EHQHÂż W IURP WKLV VKLIW LI exchanges  will  allow  individuals,  families,  and  small  employers  to  we  educate  ourselves  and  fully  understand  the  impacts  of  this  model.  purchase  health  insurance  and,  for  those  with  incomes  between  133  and  SHUFHQW RI WKH IHGHUDO SRYHUW\ OHYHO )3/ WR KDYH DFFHVV WR SUHPLXP 'DYLG 8UEDQLDN LV D 3URGXFW 0DQDJHU IRU (YROXWLRQ Â&#x152; WKH OHDGLQJ SURYLGHU RI FRPSUHKHQVLYH HOHFWURQLF FDUG SD\PHQW RQ SUHPLVH DQG FORXG FRPSXWLQJ VROXWLRQV and  cost-­sharing  government  subsidies.  IRU WKH DGPLQLVWUDWLRQ RI IOH[LEOH VSHQGLQJ DFFRXQWV )6$V KHDOWK VDYLQJV DFFRXQWV By  Jan.  1,  2014,  public  run  exchanges  are  scheduled  to  begin  +6$V KHDOWK UHLPEXUVHPHQW DFFRXQWV +5$V GHILQHG FRQWULEXWLRQ 9(%$V RSHUDWLQJ DV SDUW RI WKH 33$&$ :KLOH WKH ODQGPDUN OHJLVODWLRQ LV ZHOOQHVV DQG WUDQVLW SODQV )RU PRUH LQIRUPDWLRQ SOHDVH YLVLW ZZZ HYROXWLRQ FRP FKDQJLQJ WKH KHDOWK FDUH EHQHÂż WV LQGXVWU\ LW DOVR LV RSHQLQJ XS D ZKROH RU FRQWDFW 'DYLG DW GXUEDQLDN#HYROXWLRQ FRP new  revenue  stream  for  insurers.  Public  health  insurance  exchanges  will Â

34

January/February 2013 I HealthCare Consumerism Solutionsâ&#x201E;˘ I www.TheIHCC.com

Public Exchanges Must Answer Multiple Questions Under Tight Deadlines

BY CRAIG TOBIN Âť FOUNDER, MANAGING DIRECTOR Âť EVENTUS SOLUTIONS GROUP

6LJQHG LQWR ODZ E\ 3UHVLGHQW 2EDPD RQ 0DUFK WKH $IIRUGDEOH &DUH $FW $&$ DLPV WR GUDPDWLFDOO\ UHGXFH WKH UDQNV RI WKH XQLQVXUHG SRSXODWLRQ LQ WKH 8 6 ZLWKLQ WKH QH[W IHZ \HDUV 7KH SDVVDJH RI WKH ODZ KDV VHW LQWR PRWLRQ D Ă&#x20AC; XUU\ RI DFWLYLW\ DW WKH VWDWH DQG IHGHUDO OHYHOV WR DFFRPPRGDWH WKH PLOOLRQV RI FRQVXPHUV ZKR ZLOO Âż QG KHDOWK FRYHUDJH DFFHVVLEOH IRU WKH Âż UVW WLPH

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that  are  to  manage  standardized,  state-­regulated  U.S.  health  care  SODQV DQG EH IXOO\ FHUWL¿ HG DQG RSHUDWLRQDO E\ -DQ 7KDW LV D rather  demanding  ramp-­up  deadline,  considering  the  combination  of  new  processes,  technologies  and  human  resources  that  must  be  aligned  and  ready  to  navigate  the  uncharted  territory.  7KH HPHUJLQJ RQOLQH PDUNHWSODFH IRU XQLQVXUHG DQG XQGHULQVXUHG will  offer  information  and  resources  for  individuals  and  small  businesses  to  compare  policies  and  premiums,  and  buy  affordable  insurance  directly  or  with  a  government  provided  subsidy  when  eligible;͞  qualifying  income  levels  DUH QRW WR H[FHHG SHUFHQW RI WKH SRYHUW\ OHYHO )3/ 6PDOO EXVLQHVVHV will  be  eligible  for  subsidies  as  well.  But  how  much  can  be  really  processed  RQOLQH"

The Role of a Customer Service Center Information  from  existing  private  exchanges  indicates  less  than  half  of  insurance  plan  shopping  and  enrollment  activities  are  fully  transacted  RQOLQH ,Q WKH PDMRULW\ RI SXUFKDVLQJ LQWHUDFWLRQV FXVWRPHUV ZLOO EHJLQ RQ an  exchange  website  but  ultimately  call  a  customer  service  representative.  In  terms  of  ongoing  costs,  customer  service  center  operations,  not  technol-­ RJ\ ZLOO EH WKH ODUJHVW SHUFHQWDJH RI RSHUDWLQJ FRVWV VLJQL¿ FDQWO\ DIIHFWLQJ WKH ¿ QDQFLDO VXVWDLQDELOLW\ RI VWDWH H[FKDQJHV ,Q IDFW FXVWRPHU FRQWDFW ZLOO represent  the  largest  ongoing  expenditure  after  the  development  and  imple-­ mentation  of  the  technology  and  initial  launch  cost.  7KDW LV VLJQL¿ FDQW EXW HYHQ WKRXJK WKH GHDGOLQH IRU WKH SURJUDP start  is  approaching,  many  exchanges  have  yet  to  consider  how  best  to  staff  service  centers  with  experienced  customer  service  agents  who  can  ensure  the  programs  indeed  provide  broader  coverage  for  the  eligible  population.

7R EH IXOO\ RSHUDWLRQDO E\ DQG Âż QDQFLDOO\ VHOI VXVWDLQDEOH E\ exchanges  must  rapidly  orchestrate  the  implementation  of  both,  enrollment  enabling  technology  and  personalized  multi-­channel  service  center  sup-­ port.  State-­operated  programs  must  strive  to  perform  with  administrative  RSHUDWLQJ HIÂż FLHQFLHV WKDW FRPSDUH IDYRUDEO\ ZLWK WKH SURJUDPV RSHUDWHG in  the  private  sector.  Most  of  the  general  public  doesnâ&#x20AC;&#x2122;t  understand  each  state-­based  exchange  needs  to  be  completely  self-­sustainable  with  no  state  or  federal  funding  effective  Jan.  1,  2015.  In  order  to  remain  viable  long-­term  exchange  each  state  needs  to  FRPSHWH LQ WKH FRPPHUFLDO KHDOWK FDUH PDUNHWSODFH DQG WKH FRVWV WR RSHUDWH WKH VWDWH H[FKDQJHV ZLOO QHHG WR EH HIÂż FLHQW VR WKDW LW ZLOO EH DEOH WR SURYLGH FRPSHWLWLYH LQVXUDQFH SURGXFWV WKURXJK TXDOLÂż HG KHDOWK SODQV WR LQGLYLGX als  and  small  group  businesses.  Â&#x2021; Software  solutions  will  integrate  many  aspects  of  health  insurance  deliveryâ&#x20AC;&#x201D;including  a  consumer  portal,  eligibility Â

determinations,  ¿ QDQFLDO VHUYLFHV SODQ enrollment,  and  billing  administration.  Â&#x2021; Service  centers  have  the  potential  to  greatly  LQĂ&#x20AC; XHQFH WKH SXEOLFÂśV perception  of  the  new  law.  They  must  include  an  integrated  &50 SODWIRUP LQ RUGHU WR provide  effective  personalized  support  to  facilitate  enrollments  DQG HIIHFWLYHO\ HGXFDWH LQGLYLGXDOV HPSOR\HUV DQG Âż HOG EDVHG resources  assisting  consumers  on  all  aspects  of  the  Affordable  Care  Act.  As  in  so  many  other  cases,  the  technology  is  merely  a  complement  to  the  human  resources  that  will  ultimately  determine  the  exchangeâ&#x20AC;&#x2122;s  effectiveness.  U.S.  residents  who  live  at  or  near  poverty  level  may  not  have  self-­service  access  or  experience  with  Web-­based  tools  and  technologies.  For  many  RI WKHP LW DOVR PD\ EH D Âż UVW WLPH H[SHULHQFH EX\LQJ D KHDOWK care  -­  or  in  fact  any  -­  insurance  product.  These  prospective  insurance  purchasers  will  require  assistance  with  understanding  the  health  insurance  terminology,  how  to  determine  eligibility  or  proceed  with  their  enrollment  and  will  require  an  educated  customer  service  professional  to  help  them  through  the  plan  evaluation  and  selection  process.  The  impact  of  the  customer  service  teams  is  unquestionably  profound. *XLGDQFH RQ SDUWLFLSDWLRQ LQ DOWHUQDWH SURJUDPV VXFK DV 0HGLFDLG DQG &KLOGUHQÂśV +HDOWK ,QVXUDQFH 3URJUDPV &+,3 UHSUHVHQWV DQRWKHU FULWLFDO contact  center  responsibility.  The  service  staff  must  develop  seamless  integration  strategies  with  existing  state  agencies  supporting  consumers  with  multiple  program  eligibility.  There  will  be  considerable  overlap  with  existing  assistance  programs,  and  service  center  staff  will  need  to  bring  clarity  to  the  confusion  many  residents  will  experience.  Additionally,  with  the  anticipated  policy  changes  that  will  occur  as  these  programs  mature,  the  caliber  of  the  staff  and  performance  of  the  service  center  will  largely  determine  customer  acceptance  and  satisfaction  with  the  entire  exchange  concept.

Many  states  are  contemplating  tiered  levels  of  agent  support,  combining  resources  who  are  trained  to  effectively  educate  and  inform  FDOOHUV DERXW WKH EHQHÂż WV RI WKH H[FKDQJH ZLWK RWKHU PRUH KLJKO\ VNLOOHG personnel  who  can  assist  with  the  eligibility  and  enrollment  processes.  www.TheIHCC.com I HealthCare Consumerism Solutionsâ&#x201E;˘ I January/February 2013

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Tightly Integrated Customer Contact Just in Time State  exchanges  must  ensure  the  service  center  is  a  â&#x20AC;&#x153;designed  inâ&#x20AC;&#x153;  rather  than  â&#x20AC;&#x153;bolted  onâ&#x20AC;?  component  of  the  solution,  and  it  is  managed  to  perform  at  or  above  the  level  of  commercial  contact  centers  to  enable  long-­ term  sustainability.  Established  customer  care  providers  will  leverage  years  of  experience  with  multi-­channel  contact  management,  tightly  embedded  in  insurance  customer  acquisition  and  retention  systems.  'XH WR WKH WLPHIUDPHV IRU FXUUHQW VWDWHG EDVHG H[FKDQJHV WR EH IXOO\ RSHUDWLRQDO E\ 2FW WKH\ KDYH GHFLGHG WR LQLWLDOO\ ODXQFK WKHLU VHUYLFH center  operations  with  an  outsourced  service  center  solution.  The  states  will  OHYHUDJH WKH RXWVRXUFHU WR DFTXLUH DQ H[SHULHQFHG VFDODEOH ZRUNIRUFH ZLWK built-­in  quality  control  mechanisms.  Failing  to  identify  the  right  customer  service  center  strategy  and  partner  early  in  the  process  will  increase  costs  DQG LPSDFW TXDOLW\ ZKLOH UHGXFLQJ Ă&#x20AC; H[LELOLW\ IRU H[FKDQJHV DQG XOWLPDWHO\ compromising  their  solution.

Selecting the Right Outsourced Service Center 'XH WR WKH FXVWRPHU VHUYLFH DQG WHFKQRORJ\ UHTXLUHPHQWV WKH H[FKDQJH service  centers  may  not  easily  integrate  into  current  state-­managed  contact  center  operations.  The  right  outsourced  service  center,  when  selected  and  PDQDJHG FDUHIXOO\ FDQ UHPRYH ULVN WR ODXQFK LQ D WLPHO\ PDQQHU DQG DOORZ IRU ZRUNIRUFH VFDODELOLW\ ZKLOH OHYHUDJLQJ H[LVWLQJ RSHUDWLRQDO SURFHVVHV and  technologiesâ&#x20AC;&#x201D;tight  performance  and  quality  control  with  visibility  into  status,  progress  and  performance  trends  are  typically  already  built  into  their  processes  through  best  practices  across  multiple  industries.  6WDWH SURFXUHPHQW WHDPV ZLOO QHHG WR PDNH DQ LQIRUPHG FKRLFH IURP D YDULHW\ RI DYDLODEOH RSWLRQV FRQVLGHULQJ TXDOLWLHV WKDW DUH PRVW OLNHO\ WR impact  the  success  of  the  stateâ&#x20AC;&#x2122;s  exchange:  Â&#x2021; 7UDFN UHFRUG RI ZHOO UXQ FRVW HIIHFWLYH RSHUDWLRQ WKDW FRQVLVWHQWO\ meets  contractual  service  levels Â&#x2021; Proven  contact  center  communication  technologies  in  place  to  ensure  capacity  and  reliability  Â&#x2021; 9HULÂż DEOH GLVDVWHU UHFRYHU\ DQG EXVLQHVV FRQWLQXLW\ SODQ Â&#x2021; 6\VWHPV DQG SURFHVVHV IRU LQWHJUDWHG &XVWRPHU 5HODWLRQVKLS 0DQDJHPHQW &50 4XDOLW\ 3URJUDPV DQG 7UDLQLQJ Â&#x2021; 6WURQJ 4XDOLW\ &RQWURO SURJUDP ZLWK H[FHOOHQW )LUVW &RQWDFW 5HVROXWLRQ SHUIRUPDQFH UHVXOWV Â&#x2021; (IÂż FLHQW &RPPDQG &HQWHU 2SHUDWLRQV WR IRUHFDVW PRQLWRU DQG UHSRUW RQ NH\ SHUIRUPDQFH LQGLFDWRUV WR UXQ DQ HIÂż FLHQW DQG cost-­effective  operations.  Â&#x2021; Transparency  and  visibility  into  real-­time  reporting  and  historical  SHUIRUPDQFH VWDWXV UHVXOWV DQG WUHQGV DQG WKH DELOLW\ WR TXLFNO\ analyze  data  for  this  new  program.  The  ability  to  adapt  and  OHDUQ IURP WKH Âż UVW RSHQ HQUROOPHQW SHULRG DQG PDNH WKH necessary  changes  prior  to  the  second  open  enrollment  period  LQ 2FW ZLOO EH WKH GLIIHUHQFH WR GULYH WRZDUG WKHLU ORQJ term  sustainability  that  will  be  required  by  Jan.  1,  2015 Â&#x2021; 2SWLRQV IRU LQ VWDWH FRQWDFW FHQWHU WR KHOS ZLWK ORFDO MRE FUHDWLRQ and  direct,  face-­to-­face  customer  service Ease  of  doing  business  through  contracting  and  ongoing  operations  is  critical  to  a  great  outsourcing  relationship.

Establishing Partner Relationships In  the  event  you  have  decided  to  move  in  the  direction  of  an  outsourced  SURYLGHU WKHUH DUH VRPH NH\ IDFWRUV WR HQVXUH WKH ULJKW RXWFRPH DW WKH HQG RI WKH SURFHVV 7KH SURFHVV RI LGHQWL¿ FDWLRQ HYDOXDWLRQ FRQWUDFWLQJ and  management  of  your  service  center  partner  will  include  the  following  elements: 36

January/February 2013 I HealthCare Consumerism Solutionsâ&#x201E;˘ I www.TheIHCC.com

Â&#x2021; $VVHPEOH DQG SXEOLVK VHOHFWLRQ FULWHULD LQ D IRUP RI 5)3 solicitation Â&#x2021; Understand  your  strategy  around  the  technology  to  enable  the  VHUYLFH FHQWHU 'R \RX ZDQW WR RZQ DQG PDQDJH WKH WHFKQRORJ\ RU OHYHUDJH WKH RXWVRXUFHUÂśV FDSDELOLWLHV" Â&#x2021; Evaluate  multiple  vendors  with  the  right  selection  criteria  and  weightings  based  on  costs,  technology,  quality,  operations  performance  and  culture  that  must  be  validated  through  site  visits  with  comprehensive  review  of  stated  capabilities.  0DNH VXUH WKH HYDOXDWLRQ WHDP KDV H[WHQVLYH RSHUDWLRQV DQG technology  experience  and  ideally  has  negotiated  previous  outsourcing  contracts. Â&#x2021; 0RGHO WKH HVWLPDWHG ODXQFK FRVWV UXQ FRVWV DQG ULVN UHZDUG pricing  impacts  in  order  to  gain  visibility  into  the  investment  required  to  maintain  long-­term  sustainability Â&#x2021; 1HJRWLDWH DQG RSWLPL]H WKH ULJKW FRQWUDFWXDO WHUPV 06$ 62: FRVW VWUXFWXUHV 6/$ÂśV DQG .3,ÂśV WKDW ZLOO GULYH WKH ULJKW behaviors  and  desired  outcomes.  Â&#x2021; 'HYHORS DQ LQWHJUDWHG 3URMHFW 0DQDJHPHQW 2IÂż FH WKDW LV HQJDJHG IURP 5)3 WKURXJK LPSOHPHQWDWLRQ Â&#x2021; 'HÂż QH YHQGRU PDQDJHPHQW VWUDWHJ\ IRU ODXQFK DQG RQJRLQJ service  delivery  'HVLJQLQJ DQG EXLOGLQJ DQ H[FKDQJH FRQWDFW FHQWHU FDSDELOLW\ LV a  critically  important  step  to  ensuring  long-­term  program  success  and  acceptance.  If  your  exchange  does  not  have  the  right  in-­house  expertise  to  start  and  manage  this  process,  consider  hiring  third  party  help.  When  considering  the  very  personal  nature  of  health  care  and  the  LQWHQVLW\ RI WKH QDWLRQDO GHEDWH DURXQG WKH UHIRUP OHJLVODWLRQ WKH VWDNHV DUH high  and  the  importance  of  delivering  a  comprehensive  and  well  planned  customer  service  solution  cannot  be  overstated.  By  collaborating  with  other  states  and  incorporating  proven  technology  solutions  and  best  practices  from  established,  best-­in-­class  service  providers,  the  customer  contact  centers  will  be  in  a  great  position  to  help  the  exchanges  ensure  long-­term  success  and  realize  their  full  potential.  (YHQWXV LV D SUHPLHU SURYLGHU RI DGYDQFHG FRPSUHKHQVLYH VROXWLRQV IRU &XVWRPHU 2SHUDWLRQV 0DQDJHPHQW 2XU YDQJXDUG WHFKQRORJLHV FRQVXOWLQJ DQG FORXG RSHUDWLRQV PDQDJHG VHUYLFHV KHOS RUJDQL]DWLRQV PRGHUQL]H DQG RSWLPL]H WKHLU &XVWRPHU 2SHUDWLRQV ZLWK WKH ULJKW VROXWLRQ WKDW WDUJHWV EXVLQHVV RXWFRPHV DQG VWUHQJWKHQV FXVWRPHU OR\DOW\

Are You Ready to Sell Dental Benefits in New Health Care Reform Environment?

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BY RENE CHAPIN » DIRECTOR OF MEMBERSHIP & COMMUNICATIONS » NATIONAL ASSOCIATION OF DENTAL PLANS

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www.TheIHCC.com I HealthCare Consumerism Solutionsâ&#x201E;¢ I January/February 2013

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Help employees see their best.

Learn more and find free vision savings calculators and employee education materials at HealthySightWorkingforYou.org.

Brought to you by Transitions Healthy Sight Working for You®, a public education program to raise awareness of the value of quality vision benefits.

©2013 Transitions Optical, Inc. All Rights Reserved. Transitions, the swirl, and Transitions Healthy Sight Working For You are registered trademarks of Transitions Optical, Inc. Photochromic performance is influenced by temperature, UV exposure and lens material.

38 September/October 2012 I HealthCare Consumerism Solutions™ I www.TheIHCC.com

Current Market Overview ,Q WKH FXUUHQW EXVLQHVV ODQGVFDSH SHUFHQW RI DOO GHQWDO EHQH¿WV VROG DUH RIIHUHG XQGHU VHSDUDWH SROLFLHV )LIW\ ¿YH SHUFHQW RI SODQV DUH offered  through  large  group  employers  while  small  group  employers,  with  OHVV WKDQ HPSOR\HHV PDNH XS SHUFHQW RI WKH PDUNHW 2QO\ SHUFHQW are  covered  under  individual  dental  policies;͞  the  rest  are  covered  through  SXEOLF SURJUDPV OLNH 0HGLFDLG DQG WKH &KLOGUHQœV +HDOWK ,QVXUDQFH 3URJUDP &+,3

Overview of Dental Marketsâ&#x20AC;&#x201D; A Work Still in Progress :KDW ZLOO EH GLIIHUHQW LQ " Â&#x2021; )LUVW HYHU\RQH PXVW HQUROO LQ D KHDOWK SODQ RU SD\ D WD[ penalty.  For  large  groups  and  public  programs,  there  are  no  PDQGDWHG FKDQJHV LQ EHQHÂżWV Â&#x2021; +RZHYHU KHDOWK SODQV LQ WKH VPDOO JURXS PDUNHW PXVW LQFOXGH D GHÂżQHG VHW RI EHQHÂżWV UHIHUUHG WR DV HVVHQWLDO KHDOWK EHQHÂżWV (+% ZKLFK LQFOXGH GHQWDO EHQHÂżWV IRU FKLOGUHQ Â&#x2021; 7KH SHGLDWULF GHQWDO EHQHÂżWV ZLOO EH RIIHUHG WKURXJK WKH QHZ exchanges  and  with  all  small  group  or  individual  policies.  Â&#x2021; $GXOW GHQWDO FRYHUDJH LV QRW LQFOXGHG DV SDUW RI WKH (+% requirement.  +HUHÂśV DQ DGGHG WZLVW $V WKH ODZ VWDQGV LQ )HEUXDU\ ERWK medical  plans  and  separate  dental  plans  may  provide  the  required  pediatric  coverage  inside  the  exchanges;Íž  however,  the  law  is  unclear  if  a  medical  plan  can  omit  the  required  pediatric  oral  services  outside  the  exchange.  Until  this  question  is  answered,  small  group  and  individual  dental  coverage  offered  by  a  stand-­alone  dental  plan  outside  the  exchange  could  duplicate  coverage  included  with  a  medical  policy.  This  will  affect  1.65  million  small  employers  who  today  provide  dental  coverage  for  43.7  million  consumers,  including  22.9  million  children.

States  will  decide  many  of  the  parameters  for  small  group  and  individual  coverage  offered  through  the  exchange,  such  as  scope  of  EHQHÂżWV DQG WKH DJH OLPLW IRU SHGLDWULF FRYHUDJH ,Q VWDWHV KDYH RSWHG WR GHÂżQH VPDOO JURXSV DV RU IHZHU HPSOR\HHV %\ VWDWH VPDOO JURXS GHÂżQLWLRQV DUH UHTXLUHG WR FRQIRUP WR WKH IHGHUDO GHÂżQLWLRQ RI or  less  employees.  This  will  move  an  additional  9  percent  of  the  dental  PDUNHW XQGHU WKH (+% UHTXLUHPHQW At  press  time,  19  is  the  proposed  federal  minimum  age  for  the  pediatric  dental  coverage  provisions  of  ACA.  Unless  regulatory  changes  DUH PDGH GHQWDO SROLFLHV LQ WKH VPDOO JURXS PDUNHW PD\ GXSOLFDWH EHQHÂżWV LQ PHGLFDO FRYHUDJH IRU FKLOGUHQ 7KH EHQFKPDUN IRU WKH VFRSH RI GHQWDO EHQHÂżWV LV GHÂżQHG E\ HLWKHU WKH )HGHUDO (PSOR\HHV 'HQWDO DQG 9LVLRQ ,QVXUDQFH 3URJUDP RU &+,3 ,Q DGGLWLRQ WR VFRSH RI EHQHÂżWV WKHUH DUH SURYLVLRQV LQ WKH $&$ ZKLFK OLPLW GHGXFWLEOHV DQG HVWDEOLVK D QHZ FRQVXPHU RXW RI SRFNHW 223 OLPLW in  medical  coverage.  There  also  are  proposed  rules  which  establish  a  GLIIHUHQW FRQVXPHU RXW RI SRFNHW PD[LPXP IRU GHQWDO FRYHUDJH 7KH $&$ limit  on  deductibles  for  medical  policies  is  $2,000  for  individuals  and  IRU IDPLOLHV 7KH PHGLFDO FRQVXPHU 223 OLPLW LV SHJJHG WR WKH RXW RI SRFNHW OLPLWV IRU KLJK GHGXFWLEOH KHDOWK SODQV DV GHÂżQHG E\ WKH KHDOWK VDYLQJV DFFRXQW SURYLVLRQV RI WKH ,56 &RGH )RU WKLV LV annually  for  a  family  of  four  and  $6,250  annually  for  an  individual  and  OLNHO\ WR EH LQFUHDVHG IRU 7KH GHQWDO FRQVXPHU 223 OLPLW LV UHTXLUHG to  be  â&#x20AC;&#x153;reasonableâ&#x20AC;?  and  is  proposed  to  be  $1000. Â

ACA QUICK FACTS Markets affected: t 4NBMM HSPVQ JOEJWJEVBM 4NBMM (SPVQ EFmOJUJPO t 4UBUF NBLFT EFDJTJPOÂ&#x2030;XBUDI GPS VQEBUFT t PS MFTT FNQMPZFFT

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Challenges and Opportunities ,Q WKH VPDOO JURXS DQG LQGLYLGXDO PDUNHW EURNHUV IDFH WKH WDVN RI selling  dental  coverage,  and  sorting  out  when  such  coverage  is  duplicative  of  the  required  pediatric  dental  coverage  offered  as  part  of  medical  plans  DV (+% 6RPH GHQWDO RQO\ FRPSDQLHV PD\ DGDSW E\ DOWHULQJ WKHLU FRYHUDJH VR DV WR PLQLPL]H GXSOLFDWLRQ DQG VWLOO SURYLGH D YDOXH DGGHG EHQH¿W IRU FKLOGUHQ ,Q HLWKHU HYHQW EURNHUV ZLOO FHUWDLQO\ KDYH DQ RSSRUWXQLW\ WR VHOO GHQWDO EHQH¿WV IRU WKH DGXOWV QRW FRYHUHG E\ WKHLU (+% PHGLFDO SROLFLHV Because  there  will  be  potential  overlap  and  gaps  in  policies,  small  HPSOR\HUV DQG LQGLYLGXDOV ZLOO WXUQ WR EURNHUV WR KHOS WKHP GHWHUPLQH WKH RSWLPXP GHQWDO EHQH¿WV SDFNDJH WR RIIHU WKHLU HPSOR\HHV At  the  beginning  of  2013,  many  questions  still  remain.  The  National  $VVRFLDWLRQ RI 'HQWDO 3ODQV 1$'3 LV ZRUNLQJ WRZDUG FODUL¿FDWLRQV DQG UHVROXWLRQV RI WKHVH LVVXHV )RU XSGDWHV UHJDUGLQJ GHQWDO EHQH¿WV XQGHU WKH $&$ YLVLW 1$'3 RUJ DQG ZDWFK IRU PRUH DUWLFOHV LQ WKH QH[W LVVXH RI +HDOWK&DUH &RQVXPHULVP 6ROXWLRQV.  7KH 1DWLRQDO $VVRFLDWLRQ RI 'HQWDO 3ODQV 1$'3 D 7H[DV QRQSUR¿W FRUSRUDWLRQ ZLWK KHDGTXDUWHUV LQ 'DOODV 7H[DV LV WKH ³UHSUHVHQWDWLYH DQG UHFRJQL]HG UHVRXUFH RI WKH GHQWDO EHQH¿WV LQGXVWU\ ´ 1$'3 LV WKH RQO\ QDWLRQDO WUDGH RUJDQL]DWLRQ WKDW LQFOXGHV WKH IXOO VSHFWUXP RI GHQWDO EHQH¿WV FRPSDQLHV RSHUDWLQJ LQ WKH 8QLWHG 6WDWHV 1$'3œV PHPEHUV SURYLGH 'HQWDO +02 'HQWDO 332 'HQWDO ,QGHPQLW\ DQG 'LVFRXQW 'HQWDO SURGXFWV WR PLOOLRQ $PHULFDQV SHUFHQW RI DOO $PHULFDQV ZLWK GHQWDO EHQH¿WV )RU PRUH XSGDWHV RQ WKH GHQWDO EHQH¿WV LQGXVWU\ VXEVFULEH WR WKH ZHHNO\ H QHZVOHWWHU 1$'3 6PDUW%ULHI YLD ZZZ QDGS RUJ

www.TheIHCC.com I HealthCare Consumerism Solutionsâ&#x201E;˘ I January/February 2013

39

How Health Care Reform

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+RZHYHU WKH 3DWLHQW 3URWHFWLRQ DQG $IIRUGDEOH &DUH $FW 33$&$ DOVR ZLOO WULJJHU D ³ULSSOH HIIHFW´ IRU DQFLOODU\ EHQH¿WV ,Q WKH FDVH RI vision,  for  example,  employers  are  already  starting  WR DVN TXHVWLRQV DERXW ZKHWKHU WKHLU HPSOR\HH vision  plans  will  need  to  change  in  terms  of  structure,  coverage  and  costs  to  both  them  and  WKHLU ZRUNIRUFH 7KLV DUWLFOH SURYLGHV DQ RYHUYLHZ RI the  anticipated  impact  of  health  care  reform  on  the  YLVLRQ EHQH¿W LQGXVWU\ DQG ZKDW HPSOR\HUV QHHG WR NQRZ LQ RUGHU WR HQVXUH WKHLU ZRUNIRUFH UHWDLQV access  to  this  highly-­valued  coverage  that  can  help  lower  medical  costs  and  boost  productivity,  as  well  as  increase  employee  attraction  and  retention.

The Impact of Pediatric Vision Coverage as an Essential Health Benefit The  PPACA  designates  pediatric  vision  VHUYLFHV DV RQH RI WKH HVVHQWLDO KHDOWK EHQHÂżWV WKDW DOO TXDOLÂżHG KHDOWK SODQV QHHG WR RIIHU LI WKH\ intend  to  sell  in  the  health  insurance  exchanges,  which  will  be  used  by  individuals  and  small  groups  to  shop  for  coverage  beginning  next  year.  In  short,  beginning  in  January  2014,  all  individual  and  small  groups  with  50  or  fewer  employees  must  provide  pediatric  vision  care  FRYHUDJH²HPEHGGHG LQ D PHGLFDO EHQHÂżW²IRU children  up  to  age  19.  In  January  2016,  this  will  extend  to  individual  and  small  groups  with  100  or  fewer  employees.  Self-­insured  plans,  large  group  SODQV DQG JUDQGIDWKHUHG SODQV SXUFKDVHG RQ RU EHIRUH 0DUFK DUH QRW UHTXLUHG WR RIIHU essential  pediatric  vision  care,  but  if  they  do,  the  coverage  must  be  embedded  in  their  medical  plan  and  cannot  have  annual  or  lifetime  dollar  limits.  :KDW LV WKH VWLFNLQJ SRLQW" 7KH 8 6 JRYHUQPHQW KDV FKRVHQ QRW WR GHÂżQH â&#x20AC;&#x153;pediatric  vision  careâ&#x20AC;?  but  has  left  it  to  the  discretion  RI LQGLYLGXDO VWDWHV WR GHÂżQH WKH FRYHUDJH WKURXJK WKH VHOHFWLRQ RI D EHQFKPDUN YLVLRQ SODQ RU E\ 40

BY JEFF SPAHR Âť PRESIDENT, VISION BUSINESS Âť WELLPOINT

defaulting  to  a  federal  plan.  Whatâ&#x20AC;&#x2122;s  covered  by  these  plans  varies  VLJQLÂżFDQWO\ IURP VWDWH to  state.  For  example,  &RORUDGRÂśV EHQFKPDUN medical  plan  includes  a  pediatric  eye  exam,  but  no  eyewear  materials.  Connecticut  has  decided  on  much  more  robust  coverage,  including  an  annual  exam  for  children  and  adults,  plus  annual  eyeglasses  or  contacts  for  children  as  well.  Employers  will  have  WR IROORZ WKH VSHFLÂżF UHTXLUHPHQWV IRU WKHLU VWDWHV FORVHO\ 3OHDVH 1RWH 7KHVH DUH ÂľLQLWLDO LQGLFDWLRQVÂś DQG QRW QHFHVVDULO\ ÂżQDO JXLGDQFH

A Game Changer for the Allowance-based Model Aside  from  mandatory  pediatric  vision  coverage,  health  care  reform  also  will  have  a  VLJQLÂżFDQW LPSDFW RQ WKH YLVLRQ SODQ PRGHO employers,  employees  and  eyecare  professionals  are  used  to,  which  has  traditionally  been  allowance-­ based  on  the  materials  side.  Through  an  allowance-­based  model,  employ-­ ees  are  given  an  allotted  amount  to  apply  toward  eyewear  and/or  contactsâ&#x20AC;&#x201D;allowing  freedom  of  choice,  but  placing  a  limit  on  the  total  exposure  for  the  plan.  Consider  that  PPACA  mandates  no  DQQXDO PD[LPXP RQ HVVHQWLDO KHDOWK EHQHÂżWV 7KLV requirement  could  really  stir  things  up  if  materi-­ DOV DUH LQFOXGHG LQ WKH SHGLDWULF YLVLRQ EHQHÂżW $ ÂłQR RXW RI SRFNHW OLPLW´ UXOH IRU PDWHULDOV FRXOG be  interpreted  as  meaning  patients  will  have  their  SLFN RI WKH KLJKHVW HQG IUDPHV DQG OHQVHV ZLWK DOO the  trimmings.  %XW EHIRUH \RX SODQ WKDW WULS WR JHW DOO WKH NLGV *XFFL IUDPHV NQRZ WKDW²ZLWKRXW D GROODU OLPLW RQ WKH H\HZHDU VLGH²KHDOWK SODQV DOUHDG\ DUH ORRNLQJ DW RWKHU EHQHÂżW GHVLJQV WKDW ZRXOG SURYLGH D JRRG selection  of  quality  glasses,  but  would  limit  the  ability  of  patients  to  buy  high-­end  designer  frames.  $QRWKHU FKDOOHQJH IRU WKH YLVLRQ EHQHÂżWV industryâ&#x20AC;&#x201D;one  that  you  may  have  heard  about  recentlyâ&#x20AC;&#x201D;is  the  debate  over  whether  and  how  stand-­alone  vision  plans  can  participate  in  the  exchanges.  Under  PPACA,  pediatric  essential  health  EHQHÂżWV PXVW EH HPEHGGHG LQ D PHGLFDO SODQ DQG

January/February 2013 I HealthCare Consumerism Solutionsâ&#x201E;˘ I www.TheIHCC.com

RXW RI SRFNHW YLVLRQ H[SHQVHV KDYH WR DFFXPXODWH as  part  of  an  employeeâ&#x20AC;&#x2122;s  medical  plan  deductible.  Many  medical  carriers  are  planning  buy-­up  options  so  materials  coverage  for  children  and  all  vision  coverage  for  adults  can  be  included  in  WKH PHGLFDO SODQ EH\RQG MXVW ZKDW LV GHÂżQHG DV â&#x20AC;&#x153;essentialâ&#x20AC;?.  This  will  help  ensure  a  family  can  KDYH FRQVLVWHQW FRYHUDJH LQFOXGLQJ WKH QHWZRUN RI H\H GRFWRUV DQG EHQHÂżWV EHWZHHQ WKH FKLOGUHQÂśV pediatric  vision  coverage  and  adult  coverage.  Without  these  options,  the  adults  in  the  family  may  have  to  go  to  one  eye  doctor  while  their  children  KDYH EHQHÂżWV DW D GLIIHUHQW H\H GRFWRU In  addition,  several  employers  have  already  raised  questions  about  whether  the  new  minimum  age  of  covered  dependents  under  PPACA  will  LPSDFW WKH YLVLRQ EHQHÂżW DV ZHOO Under  the  law,  medical  plans  must  allow  dependent  children  to  remain  on  their  parentsâ&#x20AC;&#x2122;  medical  plan  until  age  26,  though  they  lose  access  WR WKH SHGLDWULF EHQHÂżW DW DJH 9LVLRQ SODQV KDYH traditionally  had  similar  dependent  rules  to  medi-­ FDO SODQV DQG VHHP OLNHO\ WR FRQWLQXH WKLV WUHQG modifying  coverage  rules  to  allow  an  employeeâ&#x20AC;&#x2122;s  dependent  children  to  be  covered  on  the  vision  plan  until  age  26  to  stay  parallel  to  the  medical  coverage. Â

A Silver Lining Ahead There  is  no  doubt  health  care  reform  will  add  a  layer  of  complexity  when  it  comes  to  vision  coverage  for  individuals  and  small  groups.  There  are  still  several  parties  who  are  advocating  entirely  different  approaches  to  providing  pediatric  vision  EHQHÂżWV DOWKRXJK WKH WLPLQJ UHTXLUHG WR ÂżQDOL]H EHQHÂżW GHVLJQV DQG ÂżOH SURGXFWV WR EH UHDG\ IRU DQ 2FWREHU RSHQ HQUROOPHQW IRU SODQV HIIHFWLYH -DQ PDNH LW XQOLNHO\ WKDW FKDQJLQJ FRXUVH DW WKLV point  is  a  practical  option.  While  we  have  yet  to  see  the  result  of  efforts  OLNH WKHVH DQ LPSRUWDQW SLHFH RI DGYLFH WR HPSOR\HUV DQG EHQHÂżWV SURIHVVLRQDOV LV WR UHPDLQ Ă&#x20AC;H[LEOH DQG patient  while  some  of  the  issues  raised  by  the  SHGLDWULF HVVHQWLDO YLVLRQ EHQHÂżW DUH GHÂżQHG DQG ÂżQDOL]HG Plus,  a  silver  lining  to  consider  is  that  more  DWWHQWLRQ LV EHLQJ SODFHG RQ WKH YLVLRQ EHQHÂżW²D powerful  wellness  tool  and  way  for  employers  to  improve  their  bottom  line. Â

Will Impact Vision Benefits

)DFWV LQWR )RFXV With  health  care  reform  designating  vision  FDUH DV DQ HVVHQWLDO SHGLDWULF EHQHÂżW ZH DOVR ZLOO VHH PRUH FRYHUDJH IRU FKLOGUHQ VSHFLÂżFDOO\ ZKR DUH DW KLJKHU ULVN IRU ERWK YLVLRQ SUREOHPV DQG eye-­related  health  issues  that  can  negatively  impact  their  physical,  social  and  educational  development.  Many  eye  and  even  systemic  diseases  can  be  detected  through  an  eye  exam  before  symptoms  are  QRWLFHDEOH DQG ZKHQ VWHSV FDQ EH WDNHQ WR SUHYHQW or  delay  these  conditionsâ&#x20AC;&#x201D;before  permanent  vision  loss  or  other  side  effects  occur.  (PSOR\HUV KRSHIXOO\ NQRZ LWÂśV LPSRUWDQW WR NHHS XS ZLWK HPSOR\HH H[SHFWDWLRQV LQ WHUPV RI being  able  to  provide  quality  vision  coverage  for  themselves  and  their  children.  After  all,  according  WR DQ DQQXDO VXUYH\ E\ 7UDQVLWLRQV 2SWLFDO SURYLG-­

ing  eye  care  for  their  family  is  one  of  the  top  reasons  why  employees  enroll  in  their  vision  plan,  and  three  in  four  full-­time  parents  with  access  to  their  com-­ SDQ\ÂśV FXUUHQW YLVLRQ EHQHÂżW FKRRVH WR HQUROO LQ LW The  bottom  lineâ&#x20AC;&#x201D;employers  should  remain  committed  to  do  whatâ&#x20AC;&#x2122;s  right  in  terms  of  offering  quality  vision  care  and  vision  wear  to  employees Â

and  their  children,  regardless  of  the  outcome  of  health  care  reform  measures.  7KH\ DOVR VKRXOG WDNH VWHSV WR HQFRXUDJH HPSOR\HHV WR VHHN UHJXODU SUHYHQWDWLYH H\H H[DPV IRU WKHPVHOYHV DQG WKHLU FKLOGUHQ DQG WR WDNH WKH time  to  truly  understand  what  is  covered  in  their  vision  policy.  Â

Vision for Tomorrow: Insights from the Transitions Academy HR / Broker Panel Discussion

By Smith Wyckoff, Transitions Optical, Inc.

F

inalists for the Transitions HR Visionary of the Year (co-founded by The Institute for HealthCare Consumerism) and the Transitions Vision Benefits Broker of the Year recently weighed in on the future of vision benefits, as part of a panel discussion at the sixth annual Transitions Academy managed vision care track in Orlando.

On the employer side, the HR panelists felt health care reform would do little to change their commitment to providing high-quality vision plans that lower medical costs, and boost employee productivity, attraction and retention. However, they alluded to coming questions about aligning coverage for dependents between vision and health plans.

benefits to comply with new standards and therefore cut costs or raise prices elsewhere. t Maurice Evans, Jr., Director of HR, Integral Group LLC (award winner): Evans is not changing his already robust vision plan, and says health care reform reminds him that he needs to maintain quality benefit offerings to keep employees satisfied so they are using the plans and see the health benefits of preventative care. Evans also questioned whether vision benefits will change in the future to cover dependents up to age 26.

t Cyndee Blue, HR Director, Everence Financial: Blue is keeping her robust vision coverage for 2013, but recently updated the plan structure to cover dependents up to age 26 to coincide with the age 26 health care reform change. t Steve Browne, VP, Director of HR, Wiginton Fire Systems: Browne was already offering robust medical and vision plans, so believes his company will have a competitive advantage as competitors are forced to upgrade their

Meanwhile, the broker panelists said they anticipate health care reform and the move to defined contribution plans will create a shift in their role to a more consultative approach. They predict a greater focus on education, helping clients understand regulations and their benefits options, and they expect more brokers to step up their ancillary product promotion as a way to offer increased value while providing additional income. t Anthony Glaub, President, Professional Insurance Enrollers (award winner): Glaub believes health care reform is

pushing brokers to find new revenue streams, such as in voluntary products.

He reports seeing more bundling of vision and dental and other voluntary benefits. t Todd Hester, Account Executive, Neace Lukens: Hester started placing his focus on ancillary benefits a few years ago, recognizing product like vision and dental can provide a value add to employees amidst medical coverage cuts and increased employee cost sharing. t Mark Lambert, Senior Business Advisor, Conner Benefits: Lambert has already moved toward a more consultative approach, including in-house compliance and wellness departments, and an increased focus on employee education. He believes that vision benefits will have a significant role because of their importance to preventative health and high ROI for employers.

Additional perspectives from panel members on the future of vision benefits can be found in the Videos section of the Tools page of HealthySightWorkingForYou.org. Â Â

www.TheIHCC.com I HealthCare Consumerism Solutionsâ&#x201E;˘ I January/February 2013

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BRIEFS

PEOPLE ON THE MOVE

3HRSOH RQ WKH 0RYH FRQWLQXHG IURP SDJH

and disease management in dental care delivery. Dr. Compton is a nationally recognized leader on issues of dental quality, dental reimbursement, dental analytics and oral health. Â Most recently, Dr. Compton served as vice president of business intelligence for DentaQuest, one of the nationâ&#x20AC;&#x2122;s leading oral health companies. Dr. Compton also will serve as president of the DentaQuest Oral Health Center, a model dental office committed to prevention-focused care, which is co-located with the DentaQuest Institute in Westborough, Mass.

Health Catalyst (www.healthcatalyst.com), the leader in health care data warehousing and analytics, announced the appointment of John Haughom, M.D. as chief medical officer and senior vice president. Haughomâ&#x20AC;&#x2122;s appointment comes at a key time of substantial growth for Health Catalyst.

Trained in the same principles and methodologies Health Catalyst espouses, Haughom has decades of experience leading improvement efforts. While a senior executive at PeaceHealth for 18 of the last 20 years in various clinical and IT executive roles including SVP of Quality and CIO, Haughom led integrated clinical, IT and financial teams to realize a 20 percent reduction in harm across the entire system over three years.

HEALTHCARE CONSUMERISM SOLUTIONS

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Florida Blue and Cleveland Clinic Florida Create Accountable Care Arrangement Florida  Blue,  Floridaâ&#x20AC;&#x2122;s  Blue  Cross  and  Blue  Shield  company,  and  Cleveland  Clinic  Florida  are  proud  to  announce  the  execution  of  a  Letter  RI ,QWHQW ZKLFK VLJQLÂżHV WKHLU FRPPLWPHQW WR FUHDWH DQ DFFRXQWDEOH FDUH program.

The  overall  goals  of  accountable  care  arrangements  are  to  improve  individual  patient  care  and  overall  health,  as  well  as  decrease  medical  costs.  Florida  Blue  and  Cleveland  Clinic  Florida  will  strive  to  accomplish  WKHVH JRDOV E\ LQFUHDVLQJ FROODERUDWLRQ DQG HIÂżFLHQF\ In  addition,  the  program  will  aim  to  increase  patient  satisfaction  by  improving  partnerships  between  patients  and  their  doctors,  allowing  them  to  make  health  care  decisions  together.  It  also  will  improve  the  overall  health  of  the  population  by  enhancing  the  coordination  of  care  among  providers  in  the  health  care  delivery  system. â&#x20AC;&#x153;Cleveland  Clinic  has  been  a  leader  in  providing  high-­quality  health  care  at  a  lower  cost,â&#x20AC;?  says  Bernie  Fernandez,  M.D.,  CEO  of  Cleveland  Clinic  Florida.  â&#x20AC;&#x153;Our  organization  is  structured  around  quality  DQG HIÂżFLHQF\ DQG ZH DUH SOHDVHG WR SDUWQHU ZLWK )ORULGD %OXH RQ WKLV initiative.â&#x20AC;?

The  accountable  care  program  between  Cleveland  Clinic  and  Florida  Blue  will  utilize  a  value-­based  compensation  structure  and  serve  as  another  example  of  Florida  Blueâ&#x20AC;&#x2122;s  payment  innovation  efforts  being  deployed  in  the  south  Florida  market.  It  will  decrease  medical  costs  by  rewarding  the  right  combination  of  goals,  including  transparency,  care  coordination,  consumer  power  and  lack  of  redundancy. Â

HighRoads Solves Health Plan Data Management for Health Care Payers HighRoads,  the  industry  leader  in  health  care  compliance  and  benefits  management,  launched  the  HighRoads  Benefits  Plan  42

January/February 2013 I HealthCare Consumerism Solutionsâ&#x201E;˘ I www.TheIHCC.com

Liazon Corporation, operator of the market-leading private benefits exchange for businesses, announced the appointment of David Finkel as its chief operating officer, effective immediately. Finkel is a dynamic leader who brings 26 years of operations and business development experience in the health care and employee benefits market to Liazon. His objective is to scale the companyâ&#x20AC;&#x2122;s operations to support its rapid growth and services to brokers, carriers and employers. Finkel joins Liazon from Inovalon, a health care data analytics firm, where he served as chief operating officer responsible for managing day-to-day operations of all business units. Earlier he held senior positions at WellPoint, Coventry Health Care, CIGNA, Deloitte & Touche and Oxford Health Plans. Finkel earned a Bachelor of Arts degree in Community Health at the University of Rochester and an M.B.A. in Health Care Administration from Baruch College/ Mount Sinai School of Medicine in New York. Delta Dental of Minnesota Foundation has hired a new employee, Sharon Oswald, to manage and implement its programming. Oswald will manage philanthropic and community affairs related activities for Delta Dental of Minnesota. Delta Dental of Minnesota Foundation is designed to support Delta

FLORIDA BLUE Âť CLEVELAND CLINIC FLORIDA Âť HIGHROA Management  System.  The  new,  SaaS-­based  solution  automates  plan  design  management  and  eases  the  compliance  burden  for  todayâ&#x20AC;&#x2122;s  health  insurance  payers.  â&#x20AC;&#x153;Health  Care  Reform  has  created  new  complexities  for  health  care  payers  who  have  been  charged  with  communicating  new  regulations  in  an  easy-­to-­understand  language  to  their  customers,â&#x20AC;?  says  Michael  Byers,  CEO,  HighRoads.  â&#x20AC;&#x153;The  challenge  is  that  typical  payer  technologies  have  not  been  built  to  accommodate  the  plan  management  requirements  needed  to  easily  deliver  these  critical  compliance  documents.  HighRoads  has  been  a  leader  in  managing  health  plan  data  for  complex  environments  and  employers  for  over  a  decade.  We  are  now  bringing  this  technology  to  the  payer  market  with  a  customized  solution  designed  to  ease  the  burden  of  developing  compliant  materials  for  the  health  insurance  consumer.â&#x20AC;?

Todayâ&#x20AC;&#x2122;s  health  insurance  payer  has  complex  plan  data  residing  in  multiple  systems  and  in  multiple  formats.  To  combine  this  information  to  deliver  health  care  reform-­compliant  SBC  materials,  often  requires  PDVVLYH PDQXDO SURFHVVHV ZLWK OLPLWHG RU QR DXWRPDWHG ZRUNĂ&#x20AC;RZ 7KH +LJK5RDGV %HQHÂżWV 3ODQ 0DQDJHPHQW 6\VWHP LV D SDWHQWHG technology  that  enables  payers  to  become  more  competitive  and  adapt  to  the  frequent  changes  expected  in  the  consumer-­focused  health  care  market.  By  helping  payers  manage  data  holisticallyâ&#x20AC;&#x201D;rather  than  managing  individual  documentsâ&#x20AC;&#x201D;HighRoads  enables  payers  to  generate  EHQHÂżWV GRFXPHQWV PRUH HDVLO\ EDVHG RQ WKHLU XQLTXH EXVLQHVV UXOHV

Blue Zones Project Demonstration Sites Named Wellmark  Blue  Cross  and  Blue  Shield  and  Healthways  announced  six  additional  communities  have  been  named  as  Blue  Zones  Project  demonstration  sites  in  Iowa.  The  communities  are:  Cedar  Rapids,  Iowa  City,  Marion,  Muscatine,  Oskaloosa  and  Sioux  City.

These  communities  join  Cedar  Falls,  Mason  City,  Spencer  and  :DWHUORR ZKLFK ZHUH QDPHG LQ 0D\ DV WKH ÂżUVW %OXH =RQHV 3URMHFW demonstration  site  communities  in  Iowa  with  populations  greater  than  10,000  citizens.  Nine  additional  communities  with  populations  less  than Â

ADS

Dental of Minnesotaâ&#x20AC;&#x2122;s mission of improving the oral health of the people in Minnesota. Delta Dental of Minnesota Foundation was formed out of the proceeds of the 2009 sale of the dental benefit management company, DeCare Dental. Oswald has been involved Oswald in oral health issues in Minnesota since 2004, when at Greater Twin Cities United Way, she was a leader in developing their Bright Smiles initiative to address oral health disease among young children and pregnant women. Through Bright Smiles Oswald helped advocate for and organize the Minnesota effort that led to the passing of legislation enabling dental therapyâ&#x20AC;&#x201D;the first state to allow for this new type of providerâ&#x20AC;&#x201D;to expand the availability of dental care in underserved areas.

Health Care Service Corporation (HCSC) announced that Stephen Ondra, M.D., a nationally recognized leader in health care quality and policy, will join its executive management team. Effective April 1, Dr. Ondra will serve as senior vice president and chief medical officer reporting to Patricia Hemingway Hall, president and CEO of HCSC. In his new position Dr. Ondra will replace Dr. Paul Handel who announced his retirement last year. In his

new role Dr. Ondra will be a key national spokesperson for HCSC and a health policy advocate for HCSCâ&#x20AC;&#x2122;s policyholders. He also will be the clinical executive responsible for the strategy and oversight of the companyâ&#x20AC;&#x2122;s medical policies, quality improvement, and performance measurement programs delivered

by HCSCâ&#x20AC;&#x2122;s Blue Cross and Blue Shield health plans in Illinois, New Mexico, Oklahoma and Texas.

Health Catalyst (www.healthcatalyst.com), the leader in health care data warehousing and analytics, announced the appointment of John Haughom, M.D. as chief medical officer and senior vice president. Haughomâ&#x20AC;&#x2122;s appointment comes at a key time of substantial growth for Health Catalyst.

Trained in the same principles and methodologies Health Catalyst espouses, Haughom has decades of experience leading improvement efforts. While a senior executive at PeaceHealth for 18 of the last 20 years in various clinical and IT executive roles, including SVP of Quality and CIO, Haughom led integrated clinical, IT and financial teams to realize a 20 percent reduction in harm across the entire system over three years.

Âť WELLMARK BLUE CROSS BLUE SHIELD Âť HEALTHWAYS Âť HARVARD PILGRIM Âť CASTLIGHT Âť TOWERS WATSON 10,000  citizens  were  named  demonstration  sites  in  October  2012  for  a  total  of  19  communities  currently  working  formally  towards  Blue  Zones  &RPPXQLW\ FHUWLÂżFDWLRQ Âł:H DUH WKULOOHG WR DQQRXQFH WKH ÂżQDO VL[ GHPRQVWUDWLRQ VLWHV IRU the  Blue  Zones  Project  in  Iowa,â&#x20AC;?  says  Ben  R.  Leedle,  Jr.,  Healthways  president  and  CEO.  â&#x20AC;&#x153;The  commitment  to  improved  well-­being  exhibited  by  all  of  the  communities  participating  in  the  selection  process  has  been  inspiring,  and  we  look  forward  to  working  with  the  demonstration  sites  to  transform  the  lives  of  their  residents  through  the  application  of  Blue  Zones  principles.â&#x20AC;?

The  selected  communities  will  receive  assistance  from  experts  to  develop  and  implement  a  Blueprint  for  making  permanent  environmental,  social  and  policy  changes  that  transition  people  into  healthier  behaviors  WKDW FDQ OHDG WR ORQJHU KDSSLHU OLYHV 7KUHH RI WKH FRPPXQLWLHV &HGDU 5DSLGV 0XVFDWLQH DQG 6LRX[ &LW\ ZLOO EHJLQ WKLV ZRUN LPPHGLDWHO\ ZKLOH WKUHH ,RZD &LW\ 0DULRQ DQG 2VNDORRVD ZLOO EHJLQ WKHLU ZRUN LQ 2014.  The  progress  of  all  the  large  demonstration  site  communities  will  be  PHDVXUHG XVLQJ WKH *DOOXS +HDOWKZD\V :HOO %HLQJ ,QGH[Â&#x160; WKH ÂżUVW HYHU daily  assessment  of  U.S.  residentsâ&#x20AC;&#x2122;  health  and  well-­being.

Harvard Pilgrim Health Care Selects Castlight Health to Help Find High-quality, Affordable Health Care &DVWOLJKW +HDOWK DQQRXQFHG WKDW IXOO VHUYLFH KHDOWK EHQHÂżWV company  Harvard  Pilgrim  Health  Care  has  selected  Castlight  as  its  health  care  transparency  partner.  Through  the  partnership,  600,000  Harvard  Pilgrim  plan  participants  will  gain  access  to  a  customized  version  of  Castlightâ&#x20AC;&#x2122;s  health  care  management  suite,  providing  them  critical  insight  into  cost  and  quality  information  for  health  care  providers  and  common  procedures.  Castlight  is  the  leading  provider  of  Health  Care  Transparency  solutions  for  employers  and  payers. +DUYDUG 3LOJULP LV D QRW IRU SURÂżW KHDOWK SODQ WKDW SURYLGHV D YDULHW\ RI EHQHÂżW RSWLRQV DQG IXQGLQJ DUUDQJHPHQWV WR PRUH WKDQ RQH

million  members  in  Massachusetts,  Maine  and  New  Hampshire.  For  the  past  nine  years,  Harvard  Pilgrim  has  been  named  the  top  private  health  plan  in  the  country  by  the  National  Committee  for  Quality  Assurance  1&4$

Amid  recently  passed  legislation  in  Massachusetts  calling  for  increased  health  care  transparency,  Harvard  Pilgrim  is  dedicated  to  staying  ahead  of  the  regulatory  curve  and  maintaining  its  reputation  as  the  countryâ&#x20AC;&#x2122;s  leading  health  plan.  After  an  extensive  evaluation  process,  Harvard  Pilgrim  selected  Castlight  for  its  innovative  platform,  robust  data  and  intuitive  user  interface.  Through  the  partnership,  Harvard  Pilgrim  members  will  receive  access  to  a  specialized  version  of  Castlightâ&#x20AC;&#x2122;s  health  care  management  suite  that  features  out-­of-­pocket  pricing  and  quality  measures  for  all  in-­network  health  care  providers.

Towers Watson Announces OneExchange, a Health Benefit Solution for Full- and Part-time Employees Towers  Watson,  a  global  professional  services  company,  announced  the  launch  of  OneExchange.  Building  on  Towers  Watsonâ&#x20AC;&#x2122;s  2012  acquisition  of  Extend  Health,  OneExchange  offers  employers  both  private  and  public  exchange-­based  health  insurance  options  for  their  full-­  and  part-­time  workers,  and  for  all  retirees.

OneExchange  makes  it  easy  for  employers  to  manage  the  coverage,  quality  and  cost  of  private  and  public  health  plan  choices  for  all  segments  of  their  workforce  and  retiree  populations  through  a  single  exchange  platform. â&#x20AC;&#x153;Starting  in  2014,  the  Affordable  Care  Act  establishes  guaranteed  issue  and  standard  plan  designs  for  all  individuals,  and  federal  subsidies  for  those  who  meet  certain  eligibility  requirements,â&#x20AC;?  says  Bryce  Williams,  managing  director  for  Exchange  Solutions  at  Towers  Watson.  â&#x20AC;&#x153;It  also  creates  public  exchanges,  or  marketplaces,  as  a  mechanism  for  individuals  to  obtain  health  plans.â&#x20AC;? Â

www.TheIHCC.com I HealthCare Consumerism Solutionsâ&#x201E;˘ I January/February 2013

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WWW.THEIHCC.COM

6ROXWLRQV WR KHOS \RXU LQQRYDWLYH KHDOWK DQG EHQH¿W SURJUDPV 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.”

— Trey Jinks, Group Executive, TSYS Healthcare HSA / HRA / FSA ADMINISTRATION AND FINANCE

WageWorks helps employers

WAGEWORKS

support consumer directed

1100 Park Place, 4th Floor San Mateo, California 94403 United States of America

pre-tax benefit programs, including health care (FSA, HSA, HRA), wellness programs, commuting and

888-9905099 www.wageworks.com

child and elder care. Wage Works also offers retiree health care and COBRA Services.

More than 100 of America’s Fortune 500 employers and millions of their employees use WageWorks.

HSA ADMINISTRATION & FINANCE

At HSA Bank, we’ve been helping businesses HSA BANK optimize their health care spending for over 605 N. 8th Street Suite 320 15 years. We offer unmatched service and Sheboygan, Wisconsin 53081 expertise when it comes to health-based United States of America savings accounts. You can count on our 800.357.6246 dedicated business relations team for turnkey www.hsabank.com solutions and ongoing support that help your business and workforce save for a healthy future. To connect with your regional representative, call 866.357.5232 or visit hsabank.com.

“When implementing one of the first Medical Savings Account programs in the country, I had a belief that health care could be fixed with free-market principles. I still do. By adopting flexible and transparent practices that manifest core attributes of consumerism such as private exchanges, defined contributions, and self-funding; we will reform health care in our nation.”

— Kirk Hoewisch, Co-Founder and President, HSA Bank, a division of Webster Bank, N.A. HSA / HRA / FSA ADMINISTRATION AND FINANCE

Evolution1 and our Partners serve more than 8 million consumers, making us the nation’s largest electronic payment, on-premise and cloud computing healthcare solution that administers reimbursement accounts, including HSAs, HRAs, FSAs, VEBAs, PRAs, Wellness, Transit and Defined Contribution Health Plans.

EVOLUTION1, INC. 952.908.9056 www.evolution1.com sales@evolution1.com

It is the only solution that offers a single end-to-end user experience, provides innovative auto-substantiation technologies, and automates workflow for Partners, employers, and consumers.

“The combination of our innovative products will further our leadership position in a rapidly changing healthcare market. Together with our Partners we are committed to reducing costs and simplifying the business of healthcare.”

— Jeff Young Chairman and CEO, Evolution1

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WHO’S WHO PROFILES

$FFHVV WKHVH SUR¿OHV RQOLQH DW ZZZ 7KH,+&& FRP HEALTHCARE ACCESS

HealthPerx is a health and wellness marketing company specializing in creative non-insurance benefit solutions that reduce absenteeism, increase productivity and decrease healthcare costs.

Consultants: These benefits differentiate you from competitors.

HSA/HRA/FSA TECHNOLOGY: ADMINISTRATION & MANAGEMENT

HEALTHPERX Jeff Marks, CEO Jmarks@hperx.com Direct: 205 222-4062 Toll Free: 888 417-6187 www.hperx.com

Corporations: These will give you a far greater ROI than your wellness program while saving your employees thousands of dollars a year.

Differentiator: Q Telemedicine Services: offering the entire family unlimited calls with no consult fees 24/7/365—anytime from anywhere Q Additional Health Benefits: offering significant savings for pharmacy, dental, vision, medical advocacy, travel assistance, telephonic counseling (EAP) and more Q Turnkey Program: billing, administration, fulfillment, call center, marketing HealthPerx benefits complement any and all existing benefit plans.

— Jeff Marks, CEO

TOTAL POPULATION HEALTH MANAGEMENT

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.

“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.”

– Sean Slovenski, President of LifeSynch,

DataPath, Inc., is one of nation’s largest providers of CDH solutions specializing in account-based administration systems.

DATAPATH, INC.

1601 WestPark Drive, Suite 9 Little Rock, AR 72204 501.296.9990 www.dpath.com

Since 1984, service providers using DataPath systems have provided administrative solutions for over 1 million participants of FSA, HRA, HSA, and COBRA. DataPath is the only solutions provider to design and deliver a full Suite of systems for handling 125, 105, 132, COBRA, HSAs, Credit and Debit Cards all delivered to account holders through a single Internet portal, myRSC.com.

“With the significant changes in healthcare today, our software solutions allow users to create custom plans for clients that benefit both the employer and employee. Not only have we created a single platform for all systems with myRSC.com, with the integration of our mySourceCard Debit Card at Wal-Mart and other retailers, our clients are able to offer a hassle-free solution with 100% compliance.” ®

HSA/HRA/FSA TECHNOLOGY: ADMINISTRATION & MANAGEMENT

At Flex, we believe in making health FLEXIBLE BENEFIT SERVICE benefits more affordable for everyone.

CORPORATION (FLEX) For 25 years, we have enabled thousands of clients to make their health care 10275 W. Higgins Road, Suite 500 dollars go further with our consumer Rosemont, IL 60018 driven plans and benefits administration +1-888-353-9178 services, including: fpsales@flexiblebenefit.com Q Flexible Spending Accounts (FSAs) www.flexiblebenefit.com Q Health Reimbursement Arrangements (HRAs) Q Health Savings Accounts (HSAs) Q Transit/Parking Reimbursement Accounts (TRAs) Q COBRA Administration Q And more!

Flex continues to evolve and enhance our product portfolio with the addition of our scalable private insurance exchange, InsureXSolutions™. This latest innovation promotes a defined contribution funding model that allows employers to provide health and retiree benefits at a fixed cost, while offering employees with access to coverage options through our online insurance marketplace All Flex clients receive our personalized customer service and a wealth of resources that make our plans easy to use. Each plan we administer comes with online account access, simple transaction tools like debit cards, custom educational resources and unrivaled plan design expertise to keep you in compliance every step of the way. www.TheIHCC.com I HealthCare Consumerism Solutions™ I January/February 2013

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6ROXWLRQV WR KHOS \RXU LQQRYDWLYH KHDOWK DQG EHQH¿ W SURJUDPV FSA/HRA/HSA/TRANSIT/COBRA: ADMINISTRATION & MANAGEMENT

HEALTH DECISION SUPPORT TOOLS

eflexgroup (eflex) is a nationwide eflexgroup administrator of pre-tax benefits 2740 Ski Lane and COBRA. Committed to providing Madison, WI 53713 fast answers, fast claims, and web 877.933.3539 ext 300 self-service, we set the industry www.eflexgroup.com standards for service. With a efgsales@eflexgroup.com customer focus and Lean Six Sigma methodology, we don’t talk about service, we prove it. See our metrics at eflexgroup.com.

Castlight Health enables employers, their CASTLIGHT HEALTH 85 Market Street, Suite 300 employees, and health plans to take San Francisco, CA 94105 control of health care costs and improve care. Named #1 on The Wall Street 415.829.1400 Journal’s list of “The Top 50 Venturewww.castlighthealth.com Backed Companies” for 2011 and one of Dow Jones’ 50 Most Investment-Worthy Technology Start-Ups, Castlight Health helps the country’s self-insured employers and health plans empower consumers to shop for health care. Castlight Health is headquartered in San Francisco and backed by prominent investors including Allen & Company, Cleveland Clinic, Maverick Capital, Morgan Stanley Investment Management, Oak Investment Partners, Redmile Group, T. Rowe Price, U.S. Venture Partners, Venrock, Wellcome Trust and two unnamed mutual funds.

“eflexgroup’s customer service department should be a model for ALL customer service departments. The courtesy, professionalism and knowledge surpass ANY customer service department I’ve encountered! I feel the outstanding, exemplary customer service of eflexgroup is simply the best!”

— Kimberly Adams, Southeast Energy Assistance [testimonial] PROFESSIONAL DEVELOPMENT

Health Insurance 101: An Orientation is a new, flexible online course offered by AHIP. It is designed to teach health insurance basics to those new to health care or individuals who wish to review the fundamentals.

The course is formatted in short modules; you learn at your own pace and on your own time, moving through the materials as you choose. Plus, AHIP will customize the course to fit your organization’s specific learning requirements.

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AMERICA’S HEALTH INSURANCE PLANS 601 Pennsylvania Ave., NW South Building, Suite 500 Washington, D.C. 20004 Lindsey Miranda Canaley Tel: 800.509.4422 Fax: 202.861.6354 lmirandacanaley@ahip.org www.ahip.org/courses

January/February 2013 I HealthCare Consumerism Solutions™ I www.TheIHCC.com

Giovanni Colella, M.D. CEO and Co-Founder, Castlight Health HEALTHCARE DATA ANALYTICS

Med-Vision delivers health-plan risk MED-VISION LLC management and wellness strategies to Connie Gee, Vice President help employer groups achieve optimal connie.gee@med-vision.com employee health. Med-Vision’s healthcare data analysis tool, Med-View, guides 813-205-1577 www.med-vision.com employers in mitigating health risks. With www.med-view.net Med-Vision’s help, self-funded employers, healthcare facilities, municipalities, and school districts have reversed trends and decreased healthcare costs while enhancing care.

“You can’t change what you can’t measure. That’s why Med-Vision leverages Med-View’s analytics tool to investigate employee-health data and determine actionable solutions for employers. Med-Vision uses the data to implement innovative and customized plans for strategic wellness and disease management.

Results include healthier employees, greater productivity, and drastically lower healthcare costs.”

— Connie Gee, Vice President, Wellness Strategist & Health Data Analyst

WWW.THEIHCC.COM

WHO’S WHO PROFILES

$FFHVV WKHVH SUR¿OHV RQOLQH DW ZZZ 7KH,+&& FRP HEALTH INCENTIVES

MedEncentive offers a patented, web-based incentive system that’s been independently validated

MEDENCENTIVE

Cecily Hall Executive Vice President medencentive.com chall@medencentive.com

to control healthcare costs. Doctors and patients earn financial rewards for declaring adherence to best practices and healthy behaviors, provided they agree to be accountable to the other party for doing so. Easy to implement and

ExperienceLab has created a breakthrough, CDHCENTRIC patented communication program that saves 507 S. 8th Ave. Bozeman, employers money by increasing adoption and Montana 59715 usage of consumer directed health (CDH) 617.224.6223 insurance plans among their employees. www.experiencelab.com CDHCentric, sold on a subscription basis, rtravis@experiencelab.com delivers regular, multi-media communications that are tailored based on seven unique attitudinal segments developed from proprietary research.

Traditional health plans protect employees from having to learn the basic skills for making cost-effective healthcare decisions. Our segmentation research, which is based on 20 years of behavioral marketing, found 7 unique personality types, and each makes healthcare decisions differently. The result is that, when employee messages are correctly tailored to their personalities, employees become health care consumers!

— Roger Travis, President

embraced by users.

SUPPLEMENTAL HEALTH

Transitions Optical, Inc. is the maker of Transitions® lenses, the #1-eyecare professional recommended photochromic lenses worldwide.

EMPLOYEE COMMUNICATION AND EDUCATION

TRANSITIONS OPTICAL 9251 Belcher Road Pinellas Park, FL 33782

800.533.2081 ext. 2262 www.healthysightworkingforyou.org

Transitions Healthy Sight Working for You® is an education initiative that helps HR professionals and benefits professionals communicate the value of the vision benefit to employees. More information and complimentary education tools are available at HealthySightWorkingForYou.org.

“Don’t overlook your employees’ healthy sight when thinking about your business goals. A vision benefit that includes an eye exam and sight-optimizing eyewear helps ensure that employees see their best, so they can do their best work, directly affecting your business.”

HEALTH ACCESS ALTERNATIVES

WeCare TLC is a medical risk management company that leverages onsite primary care clinics to provide solutions to rising healthcare costs while improving patient health and wellness.

WE CARE TLC

120 Crown Oak Centre Dr Longwood, FL 32750 800.941.0644 www.wecaretlc.com raegan.garber@wecaretlc.com

Our holistic approach to care empowers the clinic staff to act as patient advocates, which increases compliance and decreases unnecessary expensive services.

“Healthcare is now a right and employers are faced with the challenge of truly managing their healthcare costs. We have created a unique medical home clinic model that properly addresses quality of care and cost. This requires constant, aggressive, creative, and directed attention to accomplish but it can be done.”

— Lynn Jennings, CEO, WeCare TLC

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6ROXWLRQV WR KHOS \RXU LQQRYDWLYH KHDOWK DQG EHQH¿W SURJUDPV HSA/HRA/FSA TECHNOLOGY: ADMINISTRATION & MANAGEMENT

MasterCard (NYSE: MA), is a global payments and technology company.

MASTERCARD WORLDWIDE 2000 Purchase St. Purchase, NY 10577-2509

It operates the world’s fastest payments processing network, connecting consumers, financial institutions, merchants, governments and businesses in more than 210 countries and territories. MasterCard’s products and solutions make everyday commerce activities—such as shopping, traveling, running a business and managing finances—easier, more secure and more efficient for everyone.

HEALTH ACCESS ALTERNATIVES

Carena provides 24/7, on-demand access to CARENA, INC. health care by phone, webcam, and house 1525 4th Avenue, Suite 300 call. Seattle-based Carena is committed to Seattle, WA 98101 delivering the best health care experience 800.572.2103 possible. Its technology-enabled care delivery www.CarenaMD.com model provides on-demand access to health James.Taylor@CarenaMD.com care 24/7, via phone, secure video, and house call. Carena provides health care solutions to patients through employers, health systems and through its consumer service, CareSimple.

“People are paying more out of pocket for care than ever—through higher co-pays and deductibles, reduced benefits, and in the rising costs of goods and services. Taken together, health care has become more expensive and less accessible. Our goal is to make health care more affordable by providing the right care at the right time for the right cost; to help people live healthier lives by removing the barriers to people taking control of their health care.”

— Ralph C. Derrickson, President & CEO, Carena

TOTAL POPULATION HEALTH MANAGEMENT

Orriant helps businesses produce a better, more profitable product by creating a workforce that is healthier, more productive, and less expensive to insure.

ORRIANT

9980 South 300 West Ste. 100 Sandy, Utah 84070 801.574.2603 www.orriant.com suzanne.viehweg@orriant.com

Orriant’s proven strategy is to hold people accountable for improving their health as an integral part of your benefit strategy in a way that is fair and compassionate to all.

“Employers can fight back to control rising health care costs.

Orriant’s strategies have helped major employers from almost every industry cut the cost of health care, improve the health and productivity of their workforce, and push hundreds of thousands of dollars to their bottom lines.”

— Darrell Moon, Orriant CEO

HSA/HRA/FSA TECHNOLOGY: ADMINISTRATION & MANAGEMENT/PRIVATE EXCHANGE

Workable Solutions is based in WORKABLE SOLUTIONS, LLC Orlando, FL and provides a full array of 7120 Lake Ellenor Dr. employee benefit solutions including Orlando, FL 32809 HSA, HRA, FSA and commuter accounts, COBRA administration, and benefits 800.946.6342 administration outsourcing. They offer Fax: 407.540.1749 a comprehensive benefit exchange www.workablesolutions.com application, Workable Choice, which provides plan selection assistance, comparison-shopping technology, eligibility management, enrollment, consolidated billing, and more. Workable also offers a myriad of defined contribution options, which allow employers to control their employee health care costs while giving their employees greater choice and flexibility.

“As a small business, we understand first-hand what challenges a small business faces. At Workable Solutions, we can help you control the cost of employee benefits. Workable Choice is a private exchange solution that makes offering defined contribution and a multitude of consumer-driven products easy and affordable.”

— Terry McCorvie, President/CEO, Workabe Solutions, Inc.

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$FFHVV WKHVH SUR¿OHV RQOLQH DW ZZZ 7KH,+&& FRP HEALTH DECISION SUPPORT TOOLS

FSAstore.com is the only one-stop-shop FSASTORE.COM exclusively stocked with FSA eligible 244 5th Avenue, Suite J-257 products and services. At FSAstore.com, New York, NY 10001 consumers have access to more than 4,000 888.FSA.1450 (372-1450) FSA eligible products, a national database of FSA eligible services, and much-needed information through the FSA Learning Center. FSAstore accepts all FSA and major credit cards, offers 24/7 customer service, one-to-two-day turnaround for all orders, and free shipping on orders over $50.

“Each year consumers lose hundreds of millions of dollars simply because they do not deplete all of the pre-tax funds available to them in their FSA. But this year, more consumers than ever are realizing that they can use that money to buy many of the daily health products they need, and without a prescription. FSAstore.com strives to make it easy for participants to use and understand their FSAs.” — Jeremy Miller, Founder and President, FSAstore.com

BENEFIT ADMINISTRATION/PRIVATE EXCHANGES

Since 1988, CieloStar (formerly OutsourceOne) CIELOSTAR has helped brokers, employers and employees 530 U.S. Trust Building navigate the ever-changing world of benefits.

730 Second Avenue South Now, with the dawn of “Defined Contribution Minneapolis, MN 55402 Health Care” we are again on the leading edge.

With a team of industry thought leaders, CieloStar 612.436.2706 makes navigating healthand benefits choices john.reynolds@cielostar.com easy for employers and employees by offering comprehensive benefits administration solutions with a high-touch, high technology model—most recently launching a proprietary private health insurance exchange.

“Fueled by the far-reaching impact and complexities of health care reform taking effect in 2013 and 2014, employers and employees increasingly find themselves in a ‘farmer’s market’ of benefits choices. Cielostar is uniquely positioned with enabling technology that helps purchasers and consumers make the best possible decisions and create a best-in-class benefits administration process. Our unique comprehensive approach to benefits offers everything from back room technology for enrollment, data, billing and call centers to complete solutions for COBRA, CDHP and health insurance exchanges.”

— John Reynolds, CEO, Cielostar

TOTAL POPULATION HEALTH MANAGEMENT

Dr. tools Steven Level1Diagnostics uses new to M. Helschien LEVEL1DIAGNOSTICS Founderhealth and CC&BW evaluate employees’ cardiovascular 11722 Lightfall Court Heart disease is the number one killer Columbia, MD 21044 www.level1diagnostics.com in the U.S. and costs millions of dollars 410-707-5667 ◆ doc@level1diagnostics.com Dr. Steven Helschien, Founder in medical care and time lost from Sales: Penny Aleo, Executive VP work. Detection and prevention is the 443.878.3087 key to heart health. Level1Diagnostics pbaleo@gmail.com is an innovative program that, unlike conventional cardiology tests, provides new advanced technology testing and methods to detect and prevent the earliest signs of cardiovascular disease and encourage optimal health.

“The biggest problem with traditional cardiology is that it is not preventive—there isn’t a testing program to evaluate people who don’t have any symptoms of heart disease, but may be at significant risk. Drugs and surgery are offered to patients instead of lifestyle change programs and supplements.”

HEALTH DECISION SUPPORT TOOLS

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

TRUVEN HEALTH ANALYTICS 6200 S Syracuse Way, Suite 300 Greenwood Village, CO 80111 734.913.3000

Hospitals, government agencies, employers, health plans, clinicians, and life sciences companies have relied on us for more than 30 years. We combine deep clinical, financial, and health care management expertise with innovative technology platforms and information assets to make health care better by collaborating with our customers to uncover and realize opportunities for improving quality, efficiency, and outcomes.

—Dr. Steven Helschien, Founder, Level1Diagnostics

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6ROXWLRQV WR KHOS \RXU LQQRYDWLYH KHDOWK DQG EHQH¿ W SURJUDPV HEALTH DECISION SUPPORT AND COST-SAVING TOOLS

EMPLOYEE ENGAGEMENT TOOLS

Under the CIVA (CodeBaby Intelligent Virtual CODEBABY CIVA Assistant) brands of benefits and health 111 S. Tejon St. Suite 107 advisor, CodeBaby improves the healthcare Colorado Springs, CO 80903 consumer experience and optimizes online 877.334.3465 self-service on any web-based platform codebaby.com/online-solutions or device with absolutely no IT disruption. solutions@codebaby.com Benefits advisor offers guidance and selfservice options that help consumers and organizations alike to make better decisions about benefits selection. Health advisor engages new patient visitors on hospital or office websites or existing patients on wellness, prevention & disease management platforms.

“With the rapid changes in health care, our solutions provide organizations innovative ways to optimize their current platform while meeting the demand for an enhanced online experience.

CIVA benefits and health advisor solutions are industryleading models that help consumers and organizations more efficiently navigate complex health benefit exchanges and patient portals. “

WiserTogether Inc., helps patients choose the right care at the time. It

202.276.3074

selection & shared decision support

www.wisertogether.com praveen.mooganur@wisertogether.com

platform that helps patients make evidence-based, cost effective

treatment decisions across musculoskeletal, cardiovascular, mental health, diabetes, pregnancy and respiratory illnesses saving payers money. Currently 1.5 million members have access to the platform through employers and health plans in the country.

WiserTogether was founded in 2008 and is based in Washington, DC.

R E S O U R C E

— Praveen Mooganur, COO

G U I D E

ADVERTISING INDEX AHIP ........................................................ 46

IHC Membership .........................................10

Allstate ........................................................5

Level1Diagnostics ......................................49

Best Buy Reward Zone ........Inside Back Cover

LifeSynch ...................................................45

Carena .......................................................48

MasterCard ................................................48

Castlight Health .........................................46

MedEncentive ............................................47

CieloStar ....................................................49

MedVision ..................................................46

CDHCentric ............................................... 47

Orriant .......................................................48

CodeBaby ................................................. 50

Transitions ......................................... 38, 47

DataPath .................................................. 45

Truven Health Analytics....................... 12, 49

eflexgroup ................................................ 46

TSYS Healthcare ................................... 9, 44

Evolution1 ..................................................44

UnitedHealthCare ......................... Back Cover

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Flexible Benefit Service Corporation ...........45

WageWorks................................................44

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WeCare TLC ............................................. 47

healthPERX............................................... 45

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HealthStat ........................ Inside Front Cover

Workable Solutions ....................................48

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WISER TOGETHER

January/February 2013 I HealthCare Consumerism Solutions™ I www.TheIHCC.com

THEY JUST MIGHT WHISTLE WHILE THEY WORK Positivity is contagious. So create some good vibes with Reward Zone® Incentive Points, which allows you to easily motivate, thank and reward your employees. There’s an online tool that allows you to manage and track your account as you award Best Buy® Reward Zone points in amounts of your choosing. It’s easy for you to use and easy for them to love.

Learn more at RewardZoneIncentivePoints.com/CDHC.

© 2012 BBY Solutions, Inc.

INCENTIVE POINTS

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.

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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.

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